Several studies have documented that African American men are far more likely than non-Hispanic white men to die of prostate cancer. Other studies have shown that Hispanic women are more likely to be diagnosed with cervical cancer than non-Hispanic white women. Do disparities like these reflect differences in health insurance status, diet, genetics, or a combination of those factors? In many cases, the explanation is unclear.
Cancer research has produced notable achievements over the past several decades, including a vaccine that prevents the viral infection that causes the majority of cervical cancers and a host of treatments that target the molecular changes that drive several cancers. But, by and large, cancer-related health disparities in the United States have been an intractable problem.
Numerous studies have documented cancer health disparities (as well as disparities in other health conditions that may be linked to an increased cancer risk, such as obesity and diabetes). Researchers believe the time is now ripe for actively developing and testing ways to reduce—or better yet, eliminate—these disparities.
“We’ve accomplished a lot, and I’m pleased to see where things are going,” said Sanya Springfield, Ph.D., director of NCI’s Center to Reduce Cancer Health Disparities (CRCHD). “However, there’s still much work to be done.”
The increased attention on disparities is important and a big step forward, Dr. Springfield continued, as is “the growing recognition that the solutions to disparities frequently lie within communities themselves.”
A Multi-Factorial Problem
Although discussions of health disparities are often framed around race, much of the published evidence indicates that the problem is more complex.
For example, when researchers from Johns Hopkins University looked at the health of people who live in a racially integrated, low-income neighborhood in Baltimore, they found that white residents had higher rates of medical conditions like diabetes and hypertension than the national average for whites. And their rates of these conditions, in most cases, were essentially the same as those among African American residents in the neighborhood—which were similar to the national average for African Americans. The health status of both racial groups in that Baltimore neighborhood was, in effect, the same.
The results seem to support what American Cancer Society Chief Medical Officer Otis Brawley, M.D., believes is one of the chief contributors to health care disparities in general and cancer disparities specifically: access to health care.
Access, Dr. Brawley said, is influenced by several factors, including health insurance status and a person’s proximity to physicians and health care facilities.
Two studies conducted in the metropolitan Atlanta area offer good examples. In a 2008 study of women diagnosed with early-stage breast cancer, African American women were four- to five-times more likely than white women to have a delay in treatment of 60 days or longer. A more recent study, meanwhile, found that women who lived in predominantly African American neighborhoods had far longer travel times to reach radiation therapy facilities than women who lived in predominantly white neighborhoods.
Updated July 31, 2020