AACR report: Despite progress, disparities in cancer incidence, mortality persist
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Key takeaways:
- The overall gap in cancer mortality between Black and white individuals has declined.
- Disparities for specific cancers or certain racial or ethnic minority groups still persist.
The gap in cancer mortality between Black and white individuals shrunk dramatically during the past 3 decades, according to a new report.
However, racial and ethnic disparities remain a significant issue, the AACR Cancer Disparities Progress Report 2024 showed.
The biennial update revealed several positive trends.
For example, in 1990, Black individuals had a 33% higher risk for death from cancer than white individuals. That elevated risk declined to 11.3% by 2020.
However, report authors identified several disparities that persist, including how mortality risk from multiple specific cancer types remains twice as high among Black populations.
“There has been such great advancement in the way we treat cancer and the way we diagnose cancer,” Camille Ragin, PhD, MPH, associate director of diversity, equity and inclusion at Fox Chase Cancer Center, told Healio. “The technology has gotten to that point where we’re really doing great things. ...
“Our cancer survivor pool is increasing in the United States,” Ragin added. “However, when we look at certain population groups, we don’t see that. The fact that these disparities exist tells us that certain population groups are not experiencing the same benefits or the advancements that we’ve had in the U.S.”
’A lot more work’ to do
Black individuals continue to have the highest cancer incidence and mortality rates among all racial and ethnic groups, the report showed.
Between 2016 and 2020, Black individuals had at least twice the risk for dying of multiple myeloma, stomach cancer or prostate cancer as white individuals.
Additionally, Black women had more than twice the risk for developing triple-negative breast cancer and a 30% higher mortality risk compared with white women. Black women also had a 40% higher risk for death from any breast cancer.
Some numbers are improving, though.
The disparity in mortality rates between Black and white individuals with colorectal cancer declined from 40% in 2000 to 30% in 2020.
Mortality rate disparities also have improved for lung cancer — from a difference of 72.1 vs. 58.2 deaths per 100,000 in 1990, to a difference of 32.3 vs. 32.6 in 2020. Gaps also narrowed for prostate cancer and cervical cancer, as well.
Death from liver cancer dropped more than seven times faster for Black individuals than white individuals from 2016 to 2020.
“I’m not going to say that we haven't made progress. We’ve made progress, but I still think a lot more work needs to be done,” Ragin said.
Additional disparities
The report detailed several other disparities within specific cancer types. Among them:
- Hispanic individuals had an 85% higher risk for developing stomach cancer than white individuals between 2016 and 2020, and they also exhibited more than double the mortality risk.
- Hispanic individuals exhibited twice the risk for developing liver cancer, along with a 56% increased mortality rate from this malignancy.
- Hispanic women had a 43% higher risk for cervical cancer than white women.
- Hispanic individuals had a higher increase in early-onset colorectal cancer than all other racial or ethnic minority groups between 2015 and 2019.
- Asian and Pacific Islander individuals, as well as American Indian or Alaska Native individuals, had greater than twice the mortality risk from stomach cancer than white individuals, as well as higher incidence of and death due to liver cancer.
- Lung cancer incidence increased for Asian women who have never smoked.
The report revealed some favorable trends:
- Gas in cervical cancer death between Hispanic and white women narrowed, with rates decreasing eight times faster among Hispanic women from 2011 to 2020).
- The disparity in stomach cancer mortality between Asian and Pacific Islander individuals and white individuals declined.
- Stomach cancer incidence declined at more than twice the rate among Asian and Pacific Islanders as white individuals.
- Prostate cancer deaths decreased five times faster among American Indian or Alaska Native individuals than white individuals from 2016 to 2020.
Sexual minority women exhibited higher risks for breast cancer incidence than heterosexual women, the report showed.
Transgender individuals had a 76% greater risk than cisgender individuals of getting diagnosed with advanced lung cancer, and transgender women had almost twice the risk for prostate cancer death than men.
“We have to recognize that there are special conditions or considerations that have to be made for these populations,” Ragin said.
Individuals who live in either nonmetropolitan or rural areas had a 38% higher incidence of and mortality risk from lung cancer than those who live in metropolitan and urban areas.
‘The whole patient’
The AACR report highlighted several factors that contribute to disparities — notably social determinants of health, which include education, income, housing and access to insurance.
“When a patient with cancer has to think about putting food on their table and really trying to stay alive, they may not necessarily be able to prioritize that cancer,” Ragin said. ”That results in later-stage diagnosis, or perhaps delays in treatment, and that ultimately impacts mortality.”
AACR also pointed to ancestry-related factors, as well as underrepresentation in clinical trials and Science, Technology, Engineering, Mathematics and Medicine (STEMM) education.
Increased attention has helped in some areas. For example, outreach has led to an 11% increase in clinical trial enrollment among Black men with prostate cancer.
More can be done, though. It begins with awareness, Ragin said.
“Clinicians really need to pay attention to the whole patient,” Ragin said. “It is about the cancer, but it’s about the whole patient. They have to think about those social determinants of health because if they want to be able to successfully treat that cancer for that patient, they’re going to have to make sure that there’s nothing that gets in the way of that. ...
“Accessibility through insurance, poverty [and] food insecurity all play a part in a patient’s space and how well they are going to be able to receive and be compliant to the cancer treatment.”
Cultural sensitivity is a vital piece, too.
“We have to know how to effectively communicate so that you have a real, positive patient-provider relationship,” she said. “It’s critical not just for the clinician to inform the patient, but it’s also critical for the patient to understand what is happening with their care, and how they can make decisions that would be the right decisions for their care.”
AACR highlighted other ways disparities can be narrowed, such as increased investment from governments and implementation of policies to guarantee equal care.
Ragin emphasized the importance of research funding.
“There are still a lot of unanswered questions for us to address to be able to really narrow those disparities,” she said. “We have to come up with those interventions that are going to help to prevent or alleviate poor outcomes from cancer.”
She also would like to see the federal government institute a national patient navigation program.
“That would be a really phenomenal thing,” Ragin said. “It would allow patients to be able to easily access care in a way that is palatable. ... We’ve shown in research that patient navigation really does the trick, especially for underserved population groups.”
Steps can be taken to significantly reduce disparities by the time AACR issues its next report, Ragin said.
“It may be aspirational, but I’d love to be able to see a report that says there are no more disparities,” she said. “At the end of the day, we want all patients to be able to benefit from all of the great things that we’ve accomplished as it relates to cancer treatment.”
References:
- American Association for Cancer Research. AACR Cancer Disparities Progress Report 2024. Available at: https://cancerprogressreport.aacr.org/disparities/. Published May 15, 2024. Accessed May 15, 2024.
- AACR releases Cancer Disparities Progress Report 2024 (press release). Available at: https://www.aacr.org/about-the-aacr/newsroom/news-releases/aacr-releases-cancer-disparities-progress-report-2024/. Published May 15, 2024. Accessed May 15, 2024.
For more information:
Camille Ragin, PhD, MPH, can be reached at camille.ragin@fccc.edu.
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American Association for Cancer Research. AACR Cancer Disparities Progress Report 2024. Available at: https://cancerprogressreport.aacr.org/disparities/. Published May 15, 2024. Accessed May 15, 2024.
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