Disparities in Cancer Care: Do You Know the Facts?
5/23/2023
It’s no secret that people of color in the United States tend to have worse health outcomes compared to white Americans. This is due to factors called the social determinants of health, including categories such as economic stability, education, and healthcare quality and access, according to the Office of Disease Prevention and Health Promotion. Unfortunately, this can also include the quality of cancer care, from screening to treatment and survival rates.
In fact, mortality rates for certain cancers can be significantly higher in people of color. “Black and American Indian/Alaska Native [AIAN] men have the highest cancer mortality rate for all cancers combined — 18 percent higher than white men,” says William Dahut, MD, chief scientific officer for the American Cancer Society (ACS) who is based in Bethesda, Maryland.
What makes this especially disconcerting is that people of color have higher death rates for cancers that can be screened for and treated successfully when caught early. But according to Kaiser Family Foundation, the overall rate of cancer screening is lower among Black, Hispanic, Asian, and AIAN people compared to whites. “Black women are 40 percent more likely to die from breast cancer than white women, and Black men are over twice as likely to die from prostate cancer than white men,” says Dr. Dahut. People of color also typically have higher mortality rates for cancers associated with infectious agents, such as stomach and liver cancers, he adds.
Why Healthcare Disparities Exist in Cancer Care
Part of the issue is that people of color are more likely to be underinsured or uninsured than white Americans. “In the U.S., healthcare is largely tied to employment, and studies have found that Black Americans are less likely to have jobs that offer health insurance,” says Dahut. “Additionally, Black Americans disproportionately live in states that have not expanded Medicaid, like Texas, Mississippi, Alabama, and Georgia, further limiting access to care.” They may also face personal barriers to treatment such as a lack of reliable transportation and a lack of support for childcare and work duties, and they may be treated at lower-quality healthcare centers than white Americans, he adds.
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In addition, people of color are not recruited as often for clinical trials of cancer care. They may face obstacles to participation, like not being able to take time off from work, or they may not be asked to participate in the first place. “Many people of color are not recruited for participation in clinical trials due to medical provider bias, lack of emphasis on a diverse study population recruitment, and stringent criteria for comorbidities,” Dahut says. That means if a person of color has another health condition besides cancer, they may not be asked to participate — and they may be at greater risk for other health conditions, just based on the social determinants of health.
Cancer Awareness and Screening
As with any other aspect of your health, the key to better cancer care is to be proactive. This starts with awareness and screening.
According to the National Cancer Institute (NCI), the five most common types of cancer are:
In 2020, prostate, lung, and colorectal cancers made up 43 percent of cancers diagnosed in men. In the same year, breast, lung, and colorectal cancers made up 50 percent of cancers diagnosed in women, the NCI says. The cancer mortality rate is highest among African American men, at 227.3 per 100,000.
To prevent lung cancer, the best course of action is not to smoke cigarettes, or to quit if you do smoke, according to the Centers for Disease Control and Prevention (CDC). If you’re a current or former smoker, talk to your doctor about lung cancer screening recommendations.
Even if you never sunburn as a person of color, the best way to prevent skin cancer is by wearing sunscreen with a sun protection factor (SPF) of 30 or greater, and to wear clothes that protect you from the sun. The American Academy of Dermatology also suggests doing a monthly skin self-exam to look for darker spots on your skin that grow, bleed, or change, or sores that have a hard time healing.
When it comes to colorectal, breast, and prostate cancers, screenings are critical to prevention and early detection. The CDC recommends starting colorectal cancer screening at age 45, or earlier if you have a family history of it. The ACS says African American men should be screened starting at age 45 for prostate cancer, or at 50 for other races. Women should start annual breast cancer screening at age 45, or sooner if they want to or have family history, says the ACS.
Getting the Best Cancer Care
For anyone currently on their cancer treatment journey, there’s plenty you can do to receive quality care. Here are Dahut’s suggestions for working with healthcare providers.
- Watch out for implicit bias. Your provider may be well-meaning, but they may treat you differently if you are a person of color. “For instance, people of color, Black people in particular, are less likely to be prescribed pain medication for cancer care compared to white people, potentially due to harmful stereotypes held by the provider, such as that they are drug-seeking, or experience pain differently,” says Dahut.
- Seek providers you feel comfortable with and who are culturally competent. “Even well-meaning providers may run into language and communication barriers if they do not offer interpreters or are not familiar with the cultures and values of the individual they are treating,” Dahut says.
- Talk to your doctor about your family cancer history. Have conversations with your doctor about your family cancer history and what screening tests or treatment options are available.
- Join support groups specific to your identity or cancer type. The American Cancer Society has a 24/7 helpline at 1-800-227-2345 that can connect you or a caregiver to reliable information regarding your diagnosis, treatment, and ACS programs and services.
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