Gap in Cancer Death Rates Narrows Between Blacks, Whites

Pam Harrison

February 14, 2019

Death rates from cancer among African Americans continue to decline such that the disparity between blacks and whites is narrowing for the most common cancers and in some age groups, the mortality gap has been almost eliminated, new statistics show.

"In the United States, African American/black individuals bear a disproportionate share of the cancer burden, having the highest death rate and the lowest survival rate of any racial or ethnic group for most cancers," Carol DeSantis, MPH, American Cancer Society, and colleagues write.

"[But] twenty-five years of continuous declines in the cancer death rate among black individuals translates to more than 462,000 fewer cancer deaths," they add.

"And the decline in the black-white cancer mortality disparity is even more striking in some age groups," researchers observe.

The research was published online February 14 in CA: A Cancer Journal for Clinicians.

The tri-annual report by researchers from the American Cancer Society (ACS) relies on cancer incidence data from the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute. Long-term incidence trends were based on data from SEER 9 registries.

"We projected the numbers of new cancer cases and deaths for blacks in the United States in 2019 to provide an estimate of the contemporary cancer burden," DeSantis and colleagues explain.

Rates of cancer deaths overall are basically all trending in the right direction for the black population, as the analysis shows.

In 1990, for example, death from cancer was 47% higher in black men than it was in white men, but in 2016, the cancer mortality rate was only 19% higher in black men.

The disparity in cancer death rates between black and white females dropped less dramatically during the same interlude, from 19% in 1990 to 13% in 2016, they add.

However, among men ages 40 to 49 years, the disparity in the black/white cancer death rate dropped from 102% in 1990-1991 to only 17% in 2015-2016.

"Likewise, among women ages 40 to 49 years, the overall disparity narrowed from 44% in 1990-1991 to 30% in 2015-2016," researchers add.

And in black women between 80 and 89 years of age, the mortality rate from cancer in 2015 to 2016 was actually 3% lower for black women than it was for white women, they note.

Unfortunately, the 5-year survival rate is still lower in blacks than it is for whites for every stage of diagnosis and for most cancers.

This survival gap likely reflects socioeconomic barriers to timely, high-quality medical care among disadvantaged blacks, as researchers suggest.

"Nevertheless, the overall 5-year relative survival rate among blacks has improved from 27% during 1960-1963 to 63% during 2008–2014 compared with an increase in whites from 39% to 70%," the ACS team report.

Selected Cancers

Breast cancer is the most common cancer affecting black women and death rates from breast cancer are still 41% higher in black women than they are among white women.

Five-year survival rates from breast cancer (all stages) are also somewhat lower among black women (81% in the period 2008 to 2014) compared with 91% for white women during the same period.

Among black men, prostate cancer is the most commonly diagnosed cancer and is the second-leading cause of death in this racial group.

Black men are also most likely to die from prostate cancer than any other racial or ethnic group in the US, as the authors point out.

Encouragingly, the death rate from prostate cancer among black men has dropped precipitously, falling more than 50% from its peak in 1993 (81.9 deaths per 100,000 men) to just 39.8 deaths per 100,000 men in the years 2012­–2016, they note.

Indeed, between 2006 and 2015, mortality from prostate cancer actually decreased faster among black men than among white men, again narrowing the disparity between the two ethnic groups in survival outcomes.

Blacks also have the highest rates of colorectal cancer (CRC) of any racial or ethnic group in the US, a fact that has been true for many decades.

However, between 2006 and 2015, "incidence rates [of CRC] decreased by 2.7% per year among black men and by 2.8% per year among black women, similar to declines in white [men and women]," researchers note. 

And while racial disparities in mortality from CRC between the two groups are still large, "from 2007 to 2016, CRC death rates declined faster in blacks than in whites, resulting in a narrowing of the racial disparity among both men and women," the authors observe.

Lung cancer, in turn, is the second most common cancer in both black men and black women, and is leading cause of cancer death in blacks as well.

However, having peaked in the mid-1980s, the incidence of lung cancer in black men has been steadily declining over time. From 2006 to 2015, lung cancer incidence rates decreased faster in black men and in black women compared with their white counterparts, researchers observe.

"As a result, the racial disparity in lung cancer death rates among men of all ages has been substantially reduced, from an excess of 40% in 1990–1992 to 18% during 2012–2016," they authors state — and this disparity has now been eliminated in people under the age of 40 years, they add.

For female-only cancers, cervical cancer rates are still 30% higher in black women than they are in white women.

But here again, there has been a faster decline in the incidence of cervical cancer among black women than white women.

The steeper decline in cervical cancer incidence rates among black women has again closed the racial mortality gap overall — the gap has now been eliminated in women under the age of 50, researchers note.

Lastly, death by uterine cancer bucked the overall trend in cancer mortality rates, increasing 2.2% in black women between 2007–2016 and 1.7% in white women.

And despite similar incidence rates of uterine cancer among black and white women, death rates are still nearly double in black women compared with white women, while 5-year survival rates are substantially lower in black women (62%) compared with white women (83%).

"Seeing the substantial progress made over the past several decades in reducing black-white disparities in cancer mortality is incredibly gratifying," Len Lichtenfeld, MD, interim chief medical officer, American Cancer Society, said in a statement.

"To continue this progress, we need to expand access to high-quality cancer prevention, early detection, and treatment for all Americans," he added.

The ACS researchers have disclosed no relevant financial relationships.

CA: A Cancer Journal for Clinicians. Published online February 14, 2019. Abstract

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