Three years ago, the American Cancer Society (ACS) broke some exciting news: for the first time in decades, U.S. cancer deaths fell. The trend continued the following year. But new research today shows that the milestone has been a mixed bag for one segment of the population, African-Americans. They’re also dying less of cancer—in some cases, their gains are coming at a faster pace than for whites—but the disease still kills them more often.
About 150,000 cancers will be diagnosed in blacks this year, and more than 63,000 African Americans will die of the disease, says a new report from the ACS. Some more numbers: In 1990, 399 per 100,000 African-American men died of cancer; that number fell to 297 per 100,000 by 2005. But white men started off dying less often of cancer than black men did, and also showed an improvement: 272 per 100,000 in 1990, and 223 per 100,000 in 2005.
Among women in 1990, the cancer death rate was 205 per 100,000 for African Americans, a number that fell to 180 by 2005. That compares to 1990 figures of 173 per 100,000 for white women and 2005 figures of 155 per 100,000. (It takes awhile to crunch the numbers, so the big news we heard in 2006 and 2007 about cancer deaths declining reflected trends in 2003 and 2004, respectively. Accordingly, today’s report reflects numbers from 2005.)
In other words, the gap between African-Americans and Caucasians is narrowing, but not as much for women as for men, by the percentages.
As would be expected, differences in smoking patterns may be responsible for the figures. Some of the reason black men are catching up to white men is a decrease in lung cancer deaths as African-American men have stopped smoking in greater proportions than white men, says Ahmedin Jemal, strategic director for cancer occurrence at the ACS. Similarly, lung cancer death rates are increasing among black women, the report notes, which could explain why black women aren’t seeing the gains that white women are. (Women picked up cigarettes about 20 years later than men, so any decrease in women's lung cancer deaths will lag behind men's, Jemal says.) A potential bright spot for the future: black children today have lower smoking rates than any other racial or ethnic group, suggesting that they may be better protected against cancer in years to come, says Harold Freeman, president and founder of the Ralph Lauren Center for Cancer Care and Prevention in New York City.
Another potential explanation for the figures: Breast and colon cancers are still deadlier for black women than they are for white women.
Blacks also have a worse five-year survival rate than whites for all cancers—57 percent compared to 66 percent, according to the report. A number of factors may be responsible: African Americans are more likely to be diagnosed at later stage of the disease, when treatment is less effective, says Jemal. They are less likely to get recommended treatments, such as surgery for lung cancer, he says. In some cases, such as breast cancer, biological differences in the tumor may play a role, according to the report.
Other contributors may involve lifestyle, including diets high in salt and fat, says Freeman. The rest involve money and insurance coverage: African Americans are disproportionately poor, uninsured or on Medicaid, and people on Medicaid don’t do any better against cancer than people without insurance, Freeman says.
But survival rates reflect the time since a person is diagnosed with cancer; they don’t necessarily mean his lifespan is any longer overall. So would a narrowing of the five-year survival between blacks and whites really matter?
It would, Freeman says. Over the last half century, life expectancy has increased for blacks and whites, but has remained lower for African Americans. Right now, he says, white women's life expectancy is 80 years, compared to 73 years for black women. Among men, whites can expect to live 73 years, versus 67 years for their black counterparts.
Given that heart disease and cancer — the top two causes of death in the U.S.—share common origins in cigarette smoking, and that the death rate in blacks due to both cancer and cardiovascular disease is higher than it is in whites, "if the disproportionate cancer burden in blacks were eliminated, some of the racial survival difference would be eliminated," Freeman says. "Measures which diminish heart disease and cancer for all races would likely have an appreciable effect in increasing longevity—an increase which would be disproportional for blacks."
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