Sep 17, 2020 - Health

Cancer death rates drop but Black Americans still face highest risk

Adapted from the National Cancer Institute; Chart: Naema Ahmed/Axios 
Adapted from the National Cancer Institute; Chart: Naema Ahmed/Axios 

There's some good news in 2020: Cancer death rates have been falling overall, and the gap between racial and ethnic groups has been narrowing.

Yes, but: Decades of systemic racism and the structures developed under it continue to limit the ability of Americans to benefit equally from cancer advances, some medical experts tell Axios, as seen by Black Americans who've had the highest death rate from cancer for 40 years. And the pandemic is expected to exacerbate the problem further.

"When we talk about even the folks who are caring for those underserved groups — the numbers of researchers and of doctors — there are disparities there. When we talk about funding, most of our underserved patients get their care at under-resourced places. It's a continuum, and it's all because there were structures [based on systemic racism] set up long ago."
— Loretta Erhunmwunsee, a City of Hope thoracic surgeon, tells Axios

Driving the news: The American Association for Cancer Research on Wednesday issued its first annual cancer disparities progress report intended to be a "baseline" for watching trends, says John Carpten, chair of the report's steering committee and of the AACR Minorities in Cancer Research Council.

  • "Socioeconomic issues, financial toxicities and health care inequities in general are definitely the foundation of many of the disparities that we know exist," Carpten tells Axios.
  • "And, without dealing with and addressing and mitigating those issues, no matter what we do to improve our understanding of cancer, all of that will be moot."

The good news: Overall cancer death rates dropped for all groups from 2000 to 2017...

  • 30% for African Americans.
  • 20% for white people, Hispanics and Asians/Pacific Islanders.
  • 11% for American Indians/Alaska Natives.

The bad news: The report says cancer burden disparities are evident in many areas, like...

  • African American men and women face a greater risk of dying from prostate cancer (111%) and breast cancer (39%), respectively, compared to their white counterparts.
  • Hispanic youths are more likely to develop leukemia than white youths, with a 20% higher risk for Hispanic children and a 38% higher risk for Hispanic adolescents.
  • Asian/Pacific Islander adults are twice as likely to die from stomach cancer than white adults.
  • Poor men have a 35% higher death rate for colorectal cancer than wealthy men.
  • Bisexual women are 70% more likely to be diagnosed with cancer than heterosexual woman.

Lack of diversity in both the health care workforce and in clinical trials is also a problem.

  • "Less than 11% of researchers in the U.S. are members of underrepresented groups," says Antoni Ribas, president of AACR, who spoke Wednesday at a congressional briefing on the report.
  • "AACR is also extremely concerned that racial and ethnic minorities continue to be underrepresented in cancer research and clinical trials, especially because the different ages, races and ethnicities may respond differently to cancer treatments," Ribas says.

Between the lines: Further research is needed to better understand the importance of any biological or genetic differences, says Namandjé Bumpus, professor and chair of the pharmacology department at Johns Hopkins University School of Medicine.

  • "There's this promise of precision medicine, but we don't even have the data or information to be able to leverage precision medicine for a lot of people," Bumpus tells Axios.
  • "Cancer really is a prime space for precision medicine. Both in the context of figuring out what works best for certain tumors and tumor types and people because of the genetics of their cancer, but also because of the flip side, the genetics of their drug response," she says.
  • Carpten, who is also professor and a department chair at USC Keck School of Medicine, agrees and says research has started to grow as technology advances and interest has been sparked.
  • "We're starting to see molecular differences in the characteristics of cancers from individuals of different degrees of genetic ancestry ... and these differences have been observed in diseases like prostate cancer, breast cancer, multiple myeloma, and colon and colorectal cancers," he adds.
  • Some initiatives on this include the AACR's Project GENIE and the NCI-funded AMBER Consortium, which studies breast cancer in African American women.

What's next: Ribas says AACR has formed a task force to call on policymakers and stakeholders to work on concrete actions to alleviate cancer disparities.

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