This year, Black History Month converges with the 50th anniversary of the Civil Rights Movement, and the nation’s notable gains in equality give us much to celebrate. But equality in health and access to care continue to be areas of serious concern.

“Across most illnesses including cancer, African Americans have the worst outcomes,” said Kimlin Tam Ashing, PhD, director of City of Hope’s Center of Community Alliance for Research and Education in Duarte, California. “African Americans get cancer at younger ages, have more aggressive cancers, have more treatment-resistant cancers, and lower 5-year survival than the general population.”

Half of African-American men and a third of African-American women will receive a diagnosis of cancer in their lifetimes. The causes of cancer health disparities are complex, stemming from such factors as genetic susceptibility, stress and immune function, and family history.

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In her research, Ashing has pinpointed several health care system factors that feed into the disparity, including limited access and use of preventive care, limited access to high-quality care, and delays in diagnosing and treating disease. Other studies point to a higher incidence of chronic conditions and illnesses among African Americans with cancer. Lifestyle factors including smoking, diet, and sedentary routines also play a role.

When cancers are examined individually, the disparities become even clearer. Black men are 60% more likely than white men to develop prostate cancer, and the death rate for prostate cancer is 2.4 times higher in African American men than in white men. Black women have a greater-than-average risk of premenopausal-onset, triple-negative, and inflammatory breast cancers that are more difficult to treat.

African Americans have the highest rate of colorectal cancer and mortality of all racial groups in the United States. The incidence rate of cervical cancer is 34% higher for black women than white women, and they are twice as likely to die from the disease.

“Health care systems must gain the trust and confidence of the African-American community to engage in lifesaving early detection and screening to catch tumors when they are small, localized/contained, and highly treatable and even curable,” Ashing said.

Given the higher cancer burden on African Americans, Ashing explained, they must be especially aware of the early detection tests for the five most-common cancers: mammography for breast cancer, Papanicolaou tests for cervical cancer, prostate-specific antigen (PSA) tests for prostate cancer, colonoscopy for colon cancer, and—under a new US Preventive Services Task Force recommendation—low-dose computed tomography scanning for those at highest risk of lung cancer.

“Health care systems must be more accountable to their most vulnerable patients by ensuring timely and quality care delivery, and integrated care that attends to other serious chronic health conditions,” she said. “Personal cancer prevention and control practices involve talking and doing.”

“Talking” means discussing cancer with family members in a way that reveals familial risk. “Doing” includes eating more fruits and vegetables, reducing meat consumption, and increasing activity.