How cancer affects disadvantaged groups in the US

The risk of dying from cancer in the US has fallen over the last three decades, but race, ethnicity, socioeconomic background and location continue to have an impact on occurrence and outcomes.

Statistics from the American Cancer Society paint a bleak picture. Cancer survival rates are lower for Black people than for White people in the US, for virtually all forms of the disease.

Black women have a 41% higher death rate from breast cancer than White women do, despite their incidence rate being 4% lower.

Over a quarter of US men without a high school education smoked cigarettes in 2019, compared to just 6% of men with a college degree. Smoking continues to be by far the biggest cause of lung cancer.

American Indians and Alaska Natives have a particularly high liver cancer incidence - more than double that seen in White people.

Many of these differences can be attributed to persistent inequalities which make accessing high-quality healthcare difficult for some people. The American Cancer Society calls out “historical and persistent structural racism in the US experienced by all people of colour” as being the cause of many of these disparities.

Black people have the highest cancer death rate and shortest survival of any racial or ethnic group in the US for most cancers. Black men also have the highest cancer incidence rate.

Social, economic and cultural differences are the driving factors in these disparities, rather than any biological differences. There continues to be unequal access in the US to opportunities and resources such as work, wealth, healthy food, education and housing - and these all affect health outcomes.

For example, Hispanic men and women are the least likely to have health insurance of any major racial or ethnic group in the US.

Cultural factors such as language, values and traditions also influence behaviours, beliefs and approaches to illness. It has been suggested that improving health professionals’ understanding of these factors could help reduce health disparities.

Correlated with this is the disproportionately high burden of other diseases affecting minority groups, which has a significant impact on cancer survival rates.

Historically, death rates for Black people have been higher than for White people for heart disease, stroke, influenza, pneumonia, diabetes, hypertension, HIV/AIDS, kidney disease and homicide. This means the difference in life expectancy between Black and White people is greater than 4.5 years for men, and three years for women.

It is still unclear what impact the pandemic has had on cancer rates, but there is plenty of research suggesting that COVID-19 has disproportionately affected already disadvantaged groups. For example, data from the Centers for Disease Control and Prevention suggests the Hispanic population experienced a three year decline in life expectancy between 2019 and 2020.

Cancer is the second largest cause of death in the US, with over 1,900,000 new cases and 609,000 deaths projected in 2022. The leading cause of cancer death, lung cancer, is expected to kill 350 people a day in the country.

There has, however, been progress on lung cancer, with a sharp decline in the number of people with advanced stages of the disease. More people are being diagnosed with the disease at an earlier stage and therefore living longer. Diagnosis and drug improvements have also helped.

Progress on some other cancer types has stalled, though, with improvements in diagnosis and treatment of both breast and prostate cancer slowing.

According to research by the American Cancer Society, many of the projected new cancers are potentially avoidable. This includes the cancers caused by smoking, and other types where obesity, lack of exercise, alcohol and poor diet play a role.

Harnessing new technologies to better treat, diagnose and prevent disease is a major challenge in the coming years.

The Centre for the Fourth Industrial Revolution in India has recently published a strategy for tackling cancer in the country, taking advantage of digital technology. It has identified four critical gaps holding back further progress. These are: early diagnosis and continuation of care; knowledge and skills development; financing solutions; and interoperable, standardized data.

Data is a major challenge, not least because there is limited uptake of technology outside key urban areas, and the medical profession in India has yet to embrace digital health records. The Centre recommends the creation of an Oncology Master Record to capture data from patients at every stage.

It also suggests that other solutions to India’s cancer burden could include greater uptake of telemedicine, skilling of field workers, and the use of AI in insurance to help customers access suitable coverage more affordably.