TOPIC: Cancer Health Disparities

WHAT'S THE PROBLEM?

Cancer affects people of all racial and ethnic groups. One in four deaths in the United States is due to cancer, and one in three Americans will eventually develop some form of cancer. Each day 3,400 people in the United States are diagnosed with cancer, and another 1,500 die from the disease. But the burden of cancer is too often greater for the poor, ethnic minorities and the uninsured, than for the general population.

Many ethnic minorities develop cancer more frequently than the majority of the U.S. white population. African-American males, for example, develop cancer 15 percent more frequently than white males. Some specific forms of cancer affect other ethnic minority communities at rates up to several times higher than national averages. Many ethnic minorities also experience poorer cancer survival rates than whites. American Indians, for example, experience the lowest cancer survival rates of any U.S. ethnic group.

WHO IS AT RISK?

While overall cancer incidence and deaths have dropped, there are wide variations in survival associated with race and ethnicity. In every racial and ethnic population, with the exception of Asian/Pacific Islander (API) women, the risk of cancer death from all cancer sites combined was higher than the risk of death for non-Hispanic white patients.

One important example of a health disparity is African-Americans’ higher overall cancer incidence and mortality (death) rates compared to other groups.

Racial and ethnic minorities tend to receive lower-quality health care than whites even when insurance status, income, age and severity of conditions are comparable. Many of the differences in cancer incidence and mortality rates among racial and ethnic groups may be due to factors associated with social class rather than ethnicity. Socioeconomic status, in particular, appears to play a major role in differences in cancer incidence and mortality rates, risk factors and screening prevalence among racial and ethnic minorities.

CAN IT BE PREVENTED?

While great strides in developing and testing the most beneficial cancer care interventions have been made, not all segments of the population are being reached with these screening and treatment advances.

Furthermore, studies consistently show that when patients from different ethnic and racial groups do receive the same quality of care, their outcomes are very similar. This means that equal care for cancer results in equal outcomes and equal survival rates, regardless of race or ethnic background. Conversely, unequal outcomes strongly suggest unequal care.

The National Cancer Institute has recognized the problem of health disparities and has established the Center to Reduce Cancer Health Disparities to focus on this issue. In addressing the matter of health disparities, it is necessary to consider the following factors:

• Financial barriers
• Physical barriers
• Barriers related to information or education
• Barriers related to cultural differences and biases on cancer care

Whether it will be possible to entirely eliminate disparities between racial/ethnic or even geographic groups remains unclear as genetics may play an important role in the development of cancer in many populations. However, reducing risk factors for the disease as well as providing equal access to health care, particularly screening procedures, may help to lessen disparities.

THE BOTTOM LINE

• Significant progress in prevention, early detection and treatment has been made, but not all parts of the U.S. population are benefiting from these advances.
• A close look at cancer rates for racial and ethnic groups reveals significant differences, or health disparities.
• Health disparities result from unfair treatment when one group of Americans receives better care than another. To remedy this situation, we must work to remove the barriers to care and make sure that no one with cancer is goes under- or untreated.

CASE EXAMPLES

Lakota has been smoking for many years. Recently, he has developed a cough that won’t go away, as well as shortness of breath and a recurring chest pain. When he begins coughing up blood, his son urges him to see a doctor. However, the nearest Indian Health Service facility on the reservation is 300 miles away. Lakota is wheezing every day and becomes weaker. He is unable to undertake the long journey to visit the clinic and grows progressively worse. It is only when a neighbor offers to drive him to the clinic that he finally receives care.

Alan is a 45-year-old African American chemical engineer. He has recently begun to wake up several times in the middle of the night with an urgent need to urinate often accompanied by a painful and burning sensation. Knowing African Americans have the highest incidence rate of prostate cancer, Alan decides that undergoing screening for the disease is important. This test, along with a biopsy, shows that Alan does in fact have early stage prostate cancer. But because it was caught early, it is highly treatable.

Jung, a 62-year-old Korean woman, learns that she has stomach cancer. Having immigrated to the United States only ten years ago, Jung is wary of and unfamiliar with the U.S. health care system and the steps necessary to seek appropriate and effective treatment. Her local physician refers her to the Patient Navigator program at her hospital, a program established by the National Cancer Institute to help guide patients from underserved populations through the complex journey of seeking treatment and overcoming language, financial and cultural barriers that often undermine their care. Through her participation in the program, Jung’s fear and skepticism are allayed, and she receives timely and effective treatment.

FOR MORE INFORMATION:

Cancer Information Service
1-800-4-CANCER
www.cancer.gov

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