Reducing the burden of cancer borne by African Americans: if not now, when?

Introduction Cancer incidence, mortality, and survival rates differ among racial/ethnic populations in the United States. African Americans have the highest overall cancer mortality rates and the lowest survival rates. Published reports have highlighted challenges faced by African Americans with regard to cancer prevention, early detection, and disparities in treatment outcomes. Past initiatives have been inadequate to substantially reduce the burden of cancer borne by African Americans. To achieve this national goal, efforts must be undertaken to garner the necessary political will, resources, and support. The United States Department of Commerce report entitled “Race and Ethnic Standards for Federal Statistics and Administrative Reporting” classifies citizens who trace their ancestry of origin to Sub-Saharan Africa as African American (1). According to the 2000 United States Census, African Americans comprise the second largest racial group in the United States (2). Most are descendants of African men, women, and children who were forcibly transported from SubSaharan Africa to the United States and the Caribbean in the 17th to 19th centuries and sold into slavery. Others are their descendants who voluntarily came to the United States from the Caribbean Islands, Sub-Saharan Africa, or other parts of the world. There are approximately 35.5 million African Americans, 93% of whom were born in the United States. Among those over age 16 years, approximately 43% have at least a high school education, 92% are employed, and 88% reside in metropolitan areas. Cancer is the second leading cause of death among African Americans. Data from the National Cancer Institute, American Cancer Society, and Centers for Disease Control and Prevention indicate that incidence and mortality rates for all cancers combined have decreased over the last decade (3–5). Advances in early detection, screening, and treatment have reduced cancer incidence and mortality, improved life expectancy, and enhanced quality of life for many cancer patients. However, when cancer incidence and mortality rates of African Americans are compared with other ethnic groups, African Americans are significantly more likely to develop cancer and, subsequently, die from their disease. In 1992–1999, overall age-adjusted cancer incidence rates for all cancers combined (per 1,000,000 in the population) were 527 for African Americans, 480 for whites, 330 for Hispanics, 341 for Asian/Pacific Islanders, and 245 for American Indians/ Alaska Natives (Table 1; Ref. 5). Corresponding cancer mortality rates were 267 (per annum) for African Americans, 205 for whites, 129 for Hispanics, 121 for Asian/Pacific Islanders, and 129 for American Indians/Alaska Natives (Table 2). Also, overall 5-year relative cancer survival rates were 53% among African Americans, as compared with 64% among whites and 62% in the total United States population (Table 3). Prostate cancer is the most common form of cancer among African-American men, followed by cancers of the lung and bronchus, cancers of the colon and rectum, non-Hodgkin’s lymphoma, and cancers of the oral cavity (Table 1; Refs. 3 and 5). When compared with other racial/ethnic groups in the United States, African-American men have the highest ageadjusted incidence and mortality rates for at least nine forms of cancer, including cancers of the lung and bronchus, colon and rectum, oral cavity and pharynx, stomach, urinary bladder, pancreas, kidney, and renal pelvis and non-Hodgkin’s lymphoma. Among African-American women, the most common cancers are cancers of the lung and bronchus, colon and rectum, uterus, ovary, and pancreas (3, 5); African-American women have the highest age-adjusted incidence and mortality rates for cancers of the esophagus, larynx, oral cavity, and pancreas and multiple myeloma. In addition, African Americans have the highest age-adjusted mortality rates for cancers of the breast, stomach, urinary bladder, uterine cervix, and uterine corpus and Hodgkin’s disease. When compared with whites, African Americans of both sexes have poorer 5-year survival rates for many cancers.