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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.