Bridging the Gap Between Populations—The Challenge of Reducing Cancer Disparities Among African-Americans and Other Ethnic Minority Populations

US Oncological Review, 2008;4(1):72-5 DOI:
Citation US Oncological Review, 2008;4(1):72-5 DOI:

For most cancers, African-Americans have the highest mortality rates and shortest survival times of any racial or ethnic group in the US. Furthermore, compared with other racial/ethnic groups, African-Americans experience the highest rates of late-stage cancers and consequently the poorest cancer outcomes.1 In addition to later-stage cancer diagnoses, African-American cancer patients in the US frequently receive a different standard of care, even if diagnosed at the same stage of disease.1–5 Evidence further shows that when multiple treatment regimens are available, African-Americans are more likely to receive a less efficacious form of treatment, do not consistently receive information regarding all available treatment options, and are less likely to be referred to a specialist and/or to a chemoprevention clinical trial.2–6 Even though tremendous advances in cancer detection and treatment have benefited all populations, and despite targeted efforts aimed at addressing gaps in cancer outcomes in racial/ethnic minorities, African-Americans continue to suffer disproportionately from every major form of cancer (see Table 1).1
The widespread racial disparity in the early detection of cancer and in cancer morbidity, mortality, treatment, and survival are well-documented and reflect a national phenomenon. These persistent racial/ethnic disparities, which are often magnified in the major cancers such as cancers of the lung, colon and rectum, breast, and prostate, have prompted federal agencies to develop national cancer control initiatives and programs to assist states in eliminating cancer disparities in communities of color.7–8 Recommendations and initiatives targeting racial/ethnic minority populations in general and African-Americans specifically have been outlined in numerous reports such as ‘Healthy People 2010’ (HP 2010),8 ‘The Unequal Burden of Cancer,’9 and the landmark document ‘Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare.’2 These documents, along with a host of data from research studies and clinical trial reports, have repeatedly confirmed that the disparity between racial/ethnic minority populations and Caucasians in the US persists.
However, those who are committed to reducing (and eventually eliminating) healthcare disparities in general and cancer disparities specifically concede that the time has come to move beyond merely documenting racial/ethnic disparities and to begin to focus our efforts and resources on strategies to address the seemingly intractable racial/ethnic disparities among social groups. We know that addressing the cancer disparity in African-Americans and other racial/ethnic minority groups requires targeted, multidisciplinary efforts that span the cancer continuum. Indeed, a number of national initiatives and community-based programs and interventions specifically targeting African-Americans and other racial/ethnic minority populations are under way.10–13 However, to date reducing the racial/ethnic disparity among social groups has proved to be an elusive goal.
It is the complex meaning of race/ethnicity and the manner in which it is used to assign value and life opportunities in society that poses the greatest challenge to reducing racial/ethnic disparities. Furthermore, the intricate manner in which race/ethnicity and social status are interwoven and the resultant health implications on minority populations in the US present an additional set of unique challenges. We believe that the distinct set of challenges embedded in issues of race/ethnicity and social status and their impact on cancer prevention and risk, early detection and screening, and diagnosis and treatment ultimately delay progress toward the goal of reducing cancer health disparities in African-Americans and other racial/ethnic minority populations. This brief report will highlight specific conceptual challenges that impede progress toward the goal of reducing the racial/ethnic gap in cancer health disparities and present recommendations for future research and intervention.
  1. American Cancer Society, Cancer Facts and Figures for African Americans 2007–2008, American Cancer Society, 2007.
  2. Institute of Medicine, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, Washington, DC: National Academy Press, 2002.
  3. Shavers V, Brown M, Racial and ethnic disparities in receipt of cancer treatment, JNCI J Nat Cancer Institute, 2002;94:334–57.
  4. Bach PB, Schrag D, Brawley OW, et al., Survival of blacks and whites after a cancer diagnosis, JAMA, 2002;287(16):2106–13.
  5. Underwood W, DeMonner S, Ubel P, et al., Racial/ethnic disparities in the treatment of localized/regional prostate cancer, J Urology, 2004;171:1504–7.
  6. Morris AM, Billingsley KG, Hayanga AJ, et al., Residual treatment disparities after oncology referral for rectal cancer, JNCI J Nat Cancer Institute, 2008;100(10):738–44.
  7. National Cancer Institute (US), The National Cancer Institute strategic plan to reduce health disparities, Bethesda, MD: National Cancer Institute, 2002.
  8. Healthy People 2010, 2008. Available at:
  9. Institute of Medicine, The Unequal Burden of Cancer: An Assessment of NIH Research and Program for Ethnic Minorities and the Medically Underserved, Washington, DC: National Academy Press, 1999.
  10. Lisovicz N, Johnson RE, Higginbotham J, et al., The Deep South Network for cancer control. Building a community infrastructure to reduce cancer health disparities, Cancer, 2006;107(Suppl. 8): 1971–9.
  11. Jandorf L, Fatone A, Borker PV, et al., Creating alliances to improve cancer prevention and detection among urban medically underserved minority groups. The East Harlem Partnership for Cancer Awareness, Cancer, 2006;107(Suppl. 8): 2043–51.
  12. Adams EK, Breen N, Joski PJ, Impact of the National Breast and Cervical Cancer Early Detection Program on mammography and Pap test utilization among white, Hispanic, and African American women: 1996–2000, Cancer, 2007;109(Suppl. 2): 348–58.
  13. Freeman HP, Patient navigation: a community based strategy to reduce cancer disparities, J Urban Health, 2006;83(2):139–41.
  14. US Department of Health and Human Services, Tobacco Use Among US Racial and Ethnic Minority Groups—Africans, American-Indians, and Alaska Natives, Asian-Americans and Pacific Islanders, and Hispanics: A Report of the Surgeon General. Atlanta, US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1998.
  15. Fagan P, Moolchan ET, Lawrence D, et al., Identifying health disparities across the tobacco continuum, Addiction, 2007;102 (Suppl. 2):5–29.
  16. Gullate M, The influence of spirituality and religiosity on breast cancer screening delay in African-American women: application of the Theory of Reasoned Action and Planned Behavior, ABNF J, 2006;17(2):89–94.
  17. Lantz PM, Mujahid M, Schwartz K, et al., The influence of race, ethnicity, and individual socioeconomic factors on breast cancer stage at diagnosis, Am J Public Health, 2006;96(12):2173–8.
  18. Haas JS, Earle CC, Orav JE, et al., Racial segregation and disparities in cancer stage for seniors, J Gen Intern Med, 2008;23(5):699–705.
  19. Lee CT, Dunn RL, Williams C, Underwood W 3rd, Racial disparity in bladder cancer: trends in tumor presentation at diagnosis, J Urology, 2006;176(3):927–33.
  20. Gadgeel SM, Severson RK, Kau Y, et al., Impact of race in lung cancer: analysis of temporal trends from a surveillance, epidemiology, and end results database, Chest, 2001;120(1): 55–63.
  21. Braveman PA, Cubbin C, Egerter S, et al., Socioeconomic status in health research. One size does not fit all, JAMA, 2005;294(22):2879–88.
  22. LaVeist TA, Disentangling race and socioeconomic status: a key to understanding health inequalities, J Urban Health, 2005;82(Suppl. 3):iii26–34.
  23. Fiscella K, Williams DR, Health inequalities based on socioeconomic inequities: Implications for urban healthcare, Academic Medicine, 2004;79:1139–47.
  24. Singh GK, Miller BA, Hankey BF, Edwards BK, Area socioeconomic variations in US cancer incidence, mortality, stage, treatment, and survival, 1975–1999. NCI Cancer Surveillance, National Cancer Institute, 2003;03–5417.
  25. Evans GW, Kantrowitz E, Socioeconomic status and health: The potential role of environmental risk exposure, Ann Review of Pub Health, 2002;23:303–31.
  26. Byers TE, Wolf HJ, Bauer KR, et al., for the Patterns of Care Study Group, The impact of socioeconomic status on survival after cancer in the US: findings from the National Program of Cancer Registries Patterns of Care Study, Cancer, 2008;113(3):582–91.
  27. Pearcy JN, Keppel KG, A summary measure of health disparity, Public Health Reports, 2002;117(3):273–80.
  28. Harper S, Lynch J, Meersman SC, et al., An overview of methods for monitoring social disparities in cancer with an example using trends in lung cancer incidence by area-socioeconomic position and race-ethnicity, 1992–2004, Am J Epidemiol, 2008;167(8):889–99.
  29. Cook ED, Moody-Thomas S, Anderson KB, et al., Minority recruitment to the Selenium and Vitamin E Cancer Prevention Trial (SELECT), Clinical Trials, 2005;2(5):436–42.
  30. Williams RA, Eliminating Healthcare Disparities in America: Beyond the IOM Report, 2007;378.