Cancer affects people of all racial and ethnic groups. An estimated 556,500 Americans are expected to die of the disease in 2003.

However, a close look at cancer rates for racial and ethnic groups reveals some significant differences. Such differences have been described as health disparities. A National Institutes of Health working group defined health disparities as differences in the incidence, prevalence, mortality, and burden of cancer and related adverse health conditions that exist among specific population groups in the United States. These population groups may be characterized by gender, age, ethnicity, education, income, social class, disability, geographic location, sexual orientation.

One important example of a health disparity is African-Americans higher overall cancer incidence and mortality (death) rates compared to other groups. Additionally, certain racial/ethnic groups experience higher rates for specific cancers than other groups.

Many of the differences in cancer incidence and mortality rates among racial and ethnic groups may be due to factors associated with social class rather than ethnicity. Socioeconomic status (SES) in particular appears to play a major role in the differences in cancer incidence and mortality rates, risk factors, and screening prevalence among racial and ethnic minorities. Moreover, studies have found that SES, more than race, predicts the likelihood of a groups access to education, certain occupations, and health insurance, as well as income level and living conditions, all of which are associated with a persons chance of developing and surviving cancer.

One purpose of this fact sheet is to give a brief overview of the currently available data on cancer health disparities among racial and ethnic groups. The rates are based on statistics from the National Cancer Institute (NCI) and the National Center for Health Statistics.* It should be noted that these agencies are concerned that the small size of some non-white population groups and the methods used to collect data have the potential to yield counts that are unrepresentative of the group as a whole. Work to overcome these problems is ongoing (see under Selected NCI Research Activities, SEER Program Expansion).

The fact sheet also summarizes some NCI research projects and initiatives designed to understand and eventually eliminate these disparities.

CANCER RATES

OVERALL INCIDENCE AND MORTALITY RATES.   The following U.S. incidence and death rates are for all cancers combined.

•  Cancer Incidence Rates (Number of new cases each year).

Statistics are for 1996-2000, are adjusted to the 2000 U.S. standard million population, and represent the number of new cases of invasive cancer per year per 100,000 of both sexes, males, and females, respectively.

•  Cancer Death Rates (Number of deaths each year).

Statistics are for 1996-2000, are adjusted to the 2000 U.S. standard million population, and represent the number of deaths per year per 100,000 of both sexes, males, and females, respectively.

AFRICAN-AMERICANS

African-Americans have the highest incidence and death rates overall, as well as the highest rates for certain cancers.

•  African-American Females: Highest incidence rates for certain cancers.

Among females, African-Americans have the highest incidence rates of certain cancers, such as colon and rectal cancer and lung and bronchus cancer. Rates are also available for whites, Asian/Pacific Islanders, Hispanics/Latinas, and American Indian/Alaska Natives for these and other cancer sites. Statistics are for 1996-2000, are adjusted to the 2000 U.S. standard million population, and represent the number of new cases of invasive cancer per year per 100,000 females.

•  African-American Females: Highest death rates for breast cancer.

African-American females experience higher death rates from breast cancer than any other racial or ethnic group, even though whites experience higher incidence rates. Statistics are for 1996-2000, are adjusted to the 2000 U.S. standard million population, and represent the number of deaths or new cases of invasive cancer, respectively, per year per 100,000 females.

•  African-American Males: Highest incidence rates for certain cancers.

Statistics are for 1996-2000, are adjusted to the 2000 U.S. standard million population, and represent the number of new cases of invasive cancer per year per 100,000 males.

•  African-American Males: Highest death rates for certain cancers.

Statistics are for 1996-2000, are adjusted to the 2000 U.S. standard million population, and represent the number of deaths per year per 100,000 males.

HISPANICS/LATINOS

While Hispanics/Latinos have lower incidence and death rates overall compared with those of African-Americans and whites, they do experience higher rates for certain cancers.

•  Hispanic/Latina Females: Highest incidence rates for cervical cancer.

Statistics are for 1996-2000, are adjusted to the 2000 U.S. standard million population, and represent the number of new cases of invasive cancer per year per 100,000 females.

•  Hispanic/Latina Females: Cervical cancer death rates.

Despite high incidence rates, Hispanic/Latina females have the second highest death rate for cervical cancer; African-American females have the highest. Statistics are for 1996-2000, are adjusted to the 2000 U.S. standard million population, and represent the number of deaths per year per 100,000 females.

•  Hispanic/Latino Males: Incidence rates for prostate cancer.

Hispanic/Latino males have the third highest incidence rate for prostate cancer after African-Americans and whites. Statistics are for 1996-2000, are adjusted to the 2000 U.S. standard million population, and represent the number of new cases of invasive cancer per year per 100,000 males.

•  Hispanic/Latino Males: Death rates for prostate cancer.

Death rates for Hispanic/Latino males reveal that they have the third highest death rates from prostate and colon and rectal cancer, after African-Americans and whites. Statistics are for 1996-2000, are adjusted to the 2000 U.S. standard million population, and represent the number of deaths per year per 100,000 males.

ASIAN/PACIFIC ISLANDERS

While Asian/Pacific Islanders experience lower rates overall compared with other minority groups, they do experience higher death and incidence rates for certain cancers.

Asian/Pacific Islanders are not a homogenous population and contain subgroups that have different cancer rates.

•  Highest incidence rates of liver and stomach cancer for both sexes.

This group experiences the highest incidence rates of liver cancer and stomach cancer. The liver cancer incidence rate for American Indian/Alaska Natives is much lower. Statistics are for 1996-2000, are adjusted to the 2000 U.S. standard million population, and represent the number of new cases of invasive cancer per year per 100,000 population.

•  Asian/Pacific Islander females: Third highest breast cancer incidence rate.

Statistics are for 1996-2000, are adjusted to the 2000 U.S. standard million population, and represent the number of new cases of invasive cancer per year per 100,000 females.

•  Asian/Pacific Islander females: Third highest incidence for lung and bronchus and colon and rectum cancers.

Statistics are for 1996-2000, are adjusted to the 2000 U.S. standard million population, and represent the number of new cases of invasive cancer per year per 100,000 females.

•  Asian/Pacific Islander females: Lower death rates for some cancers.

Among females, Asian/Pacific Islanders experience the lowest breast cancer and are colon and rectal cancer death rates. Statistics are for 1996-2000, are adjusted to the 2000 U.S. standard million population, and represent the number of deaths per year per 100,000 females.

•  Asian/Pacific Islander males: Third in incidence rates for certain cancers.

Asian/Pacific Islander males have the third highest rate for lung and bronchus cancer and colon and rectal cancer. Statistics are for 1996-2000, are adjusted to the 2000 U.S. standard million population and represent the number of new cases of invasive cancer per year per 100,000 males.

•  Asian/Pacific Islander males: High death rates for some cancers.

Asian/Pacific Islander males experience high death rates for liver cancer and stomach cancer. Statistics are for 1996-2000, are adjusted to the 2000 U.S. standard million population and represent the number of new cases of invasive cancer per year per 100,000 males.

•  Asian/Pacific Islanders: Low death rates overall.

Statistics are for 1996-2000, are adjusted to the 2000 U.S. standard million population, and represent the number of deaths per year per 100,000 population.

AMERICAN INDIAN/ALASKA NATIVES

While American Indian/Alaska Natives experience some of the lowest rates among all groups, they do experience higher death and incidence rates for certain cancers.

The Indian Health Service reports a large variability in cancer rates among this population, especially in areas such as the Northern plains and Alaska.

•  American Indian/Alaska Native males: Lowest prostate cancer incidence rates.

American Indian/Alaska Native males have the lowest prostate cancer incidence rates. Statistics are for 1996-2000, are adjusted to the 2000 U.S. standard million population, and represent the number of new cases of invasive cancer or deaths, respectively, per year per 100,000 males.

•  American Indian/Alaska Native females: Lowest breast cancer incidence rates.

American Indian/Alaska Native females have the lowest breast cancer incidence rates. Statistics are for 1996-2000 and are adjusted to the 2000 U.S. standard million population and represent the number of new cases of invasive cancer or deaths, respectively, per year per 100,000 females.

•  American Indian/Alaska Native females: Third highest lung and bronchus death rates.

However, among females, American Indian/Alaska Natives have the third highest rate of death from lung and bronchus cancer, after whites and African-Americans. Statistics are for 1996-2000, are adjusted to the 2000 U.S. standard million population, and represent the number of deaths per year per 100,000 females.

SELECTED NCI RESEARCH ACTIVITIES

Reducing cancer health disparities is designated as one of NCIs key challenge areas (http://plan.cancer.gov/infra/reducing.htm). Following are some examples of current research programs and projects in this area.

RESEARCH PROGRAMS:

Surveillance, Epidemiology, and End Results (SEER) Program Expansion

The Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute is the most authoritative source of information on cancer incidence and survival in the United States. NCIs SEER cancer registry program has been recently expanded to cover more of the racial, ethnic, and socioeconomic diversity of the United States, allowing for better description and tracking of trends in health disparities. Methodological studies are seeking better ways to measure socioeconomic factors and determine their relationship to cancer incidence, survival, and mortality. Additionally, NCI supports a growing body of research to examine the environmental, sociocultural, behavioral, and genetic causes of cancer in different populations and apply these discoveries through interventions in clinical and community settings. These interventions cover topics such as tobacco control, dietary modification, and adherence to screening practices. Recognizing the broad relevance of this research to other disease outcomes, NCI collaborates with other Federal agencies in supporting important research initiatives, including co-funded research with the Agency for Healthcare Research and Quality (AHRQ) under its initiative, Understanding and Eliminating Minority Health Disparities. For more information: http://www.seer.cancer.gov.

NCI has established the Center to Reduce Cancer Health Disparities (CRCHD) to direct the implementation of the Institutes Strategic Plan to Reduce Health Disparities and to provide an organizational locus for critical tasks in translating discovery into delivery. The Center also houses NCIs Office of Special Populations Research (OSPR). The OSPR coordinates research that addresses cancer-related concerns for medically underserved and other vulnerable populations.

Special Population Networks

NCI-sponsored Special Populations Networks for Cancer Awareness Research and Training (SPNs) were established at 18 research institutions in 2000. The SPNs build relationships with community-based programs to foster cancer awareness activities, increase minority enrollment in clinical trials, and develop minority junior biomedical researchers through cancer control, prevention, research, and training programs in minority and underserved communities. For more information: http://crchd.nci.nih.gov/spn.

Cervical Cancer Mortality in Geographically High-Risk Populations

Research is needed to determine why, despite a three-fold reduction in cervical mortality nationwide in the past 50 years, counties stretching from Maine southwest through Appalachia to the Texas/Mexico border, in many Southeastern states, and in the Central Valley of California have experienced persistently higher cervical cancer mortality rates. To address this disparity NCI and its partners are working to (1) synthesize research knowledge, (2) identify core findings, (3) articulate program and policy options, and (4) disseminate this information to Federal, state, and local policy makers. NCIs CRCHD has assembled a Think Tank to begin planning the accomplishment of these tasks.

Centers for Population Health and Health Disparities

With this initiative, NCI will support four to five centers in collaboration with other institutes at the National Institutes of Health, beginning in 2003. The centers will support inter-disciplinary research leading to an understanding and reduction of health disparities across several different diseases. Each center will support a minimum of three research projects with a common theme focusing on social and environmental determinants of health, population health and significant disparate health outcomes.

Comprehensive Minority Biomedical Program

The Comprehensive Minority Biomedical Program (CMBP) aims to increase the number of minority scientists in biomedical research and enhance the careers of those already in the field. CMBP programs include a host of training opportunities targeting high school students through established researchers. Increasing the representation of ethnic and minority individuals in research and clinical care is crucial to ensure that important research questions about disparities are investigated and that discoveries are translated into community practice.

Minority-Based Community Clinical Oncology Programs

The Community Clinical Oncology Program (CCOP) provides support for expanding clinical research efforts in the community setting. Of the sixty CCOPs, ten are minority-based. Initiated in 1990, the Minority-Based CCOPs provide minority cancer patients with access to state-of-the-art cancer treatment, and prevention and control technology in their own communities. The current program involves more than 40 hospitals and more than 100 minority investigators. For more information: http://www3.cancer.gov/prevention/ccop

Minority Institution/Cancer Center Partnership Program

This program reaches out to the five major minority institutions with medical schools, as well as to more than 300 smaller institutions dedicated to educating African Americans, Hispanics, Native Americans, and other groups underrepresented in biomedical research. Research-intensive NCI Cancer Centers, together with culturally sensitive minority-serving institutions (MSIs), offer an entirely new set of opportunities for training more minority scientists, expanding the cancer research capability of MSIs, and focusing more research and community outreach programs of Cancer Centers on minority health disparities.

RESEARCH PROJECTS:

NCI funds hundreds of studies related to minority health and health disparities. What follows is a small sample of these projects. More information can be found through CRISP, a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other research institutions. Visit CRISP at http://crisp.cit.nih.gov/

Improving Cancer Treatment for American Indians and Hispanic Latinos

Two large grants will investigate methods of improving cancer treatment for American Indians and Hispanic Latinos. The five-year, multi-million dollar grantswere awarded to Rapid City Regional Hospital in Rapid City, SD, which serves a predominantly American Indian population and to Murphy Hospital in Laredo, NM, which serves a predominantly Hispanic/Latino population. The researchers will study barriers to cancer treatment as well as state-of-the art radiologic approaches for common malignancies.

Southern Community Cohort Study

NCI recently awarded a multi-million dollar grant to fund this study that will help determine why African Americans are more likely to develop cancer and die from the disease. The study will enroll and follow 105,000 people, two-thirds of them African-American in six southeastern states. The initiative is a collaborative effort of the Vanderbilt Ingram Cancer Center (Nashville, Tenn.), Meharry Medical College (Nashville, Tenn.), and the International Epidemiology Institute (Rockville, Md.).

SELECT

The Selenium and Vitamin E Cancer Prevention Trial (SELECT) is a large prostate cancer prevention study launched by NCI and a network of researchers known as the Southwest Oncology Group (SWOG). The study will determine if two dietary supplements, selenium and vitamin E, can protect against prostate cancer. Researchers are making a special effort to ensure a high rate of participation among African-Americans. For more information: http://cancer.gov/SELECT.

Cancer Survivorship in Minority and Underserved Populations

Investigators at NCI-supported Comprehensive Cancer Centers are using supplemental funding to examine:

1. The physical and psychosocial needs of medically underserved cancer survivors and/or their families and how these needs compare with those found in cancer survivors and/or their families from majority populations.

2. Sociocultural variables that affect cancer survivorship, particularly those that affect quality of life.

3. The nature and effectiveness of existing post-treatment medical and support services designed for cancer patients from underserved communities.

4. The effectiveness and feasibility of behavioral measures and interventions aimed at assessing and reducing secondary physical and psychological consequences in minority or underserved cancer survivors and their families.

Follow-Up Study for Causes of Illness in Black Women

This study will examine multiple risk factors for cancer, cardiovascular disease, and other major illnesses in African-American women. Possible risk factors to be examined include obesity, cigarette smoking, physical activity, alcohol use, diet, estrogen use, and reproductive factors.

The Association of Diet and Other Factors with Gastric Cancer

This five-year, population-based case control trial will assess the various risk factors that may be involved in the development of gastric cancer. Ethnic groups receiving special emphasis include Caucasian, Chinese, Filipino, Hawaiian/part-Hawaiian, and Japanese.

Genetic Susceptibility to Cancer in Multiethnic Cohorts

This study explores the role of environmental risk factors and genes in determining the risk of sporadic cancers of the colorectum, prostate, and breast. The study comprises African-Americans, Hispanics/Latinos, Japanese-Americans, and whites.

Cervical Cancer ScreeningThe ASCUS/LSIL Triage Study (ALTS)

This six-year clinical trial was designed to determine the optimal treatment of women with abnormal Pap smears. Nearly 40 percent of the women accrued were African-American or Hispanic/Latino. For more information: http://cancer.gov/prevention/alts/index.html

Prostate Cancer Risk in U.S. Blacks and Whites

This project is a large, case-control study of prostate cancer among U.S. African Americans and whites in selected areas of Georgia, Michigan, and New Jersey. The study will attempt to identify risk factors for the disease and to explain the black/white differential in prostate cancer rates.

Breast Cancer Risk Among Alaska Native Women

In this study, researchers will investigate the possible role of organochlorines in breast cancer risk. Organochlorines are found in the polar ice cap and are concentrated in the marine mammals heavily consumed by Native Alaskans. The study is a collaborative effort with the Centers for Disease Control and Prevention (CDC) and the Indian Health Service (IHS).

Cancer Risk in Migrant Farm workers

In this series of studies, researchers will examine the exposure to pesticides experienced by mostly Hispanic/Latino migrant and seasonal farm workers.

Hawaii Family Registry of Colon Cancer

Researchers will examine environmental and genetic factors and attitudes toward genetic testing for colorectal cancer among Hawaiian families.

Network for Cancer Control Research Among American Indian/Alaska Native Populations

The Network foster exchanges of information on cancer control research; improves community links to the NCI and the American Cancer society; and is intended to increase the number of AI/AN researchers, scientists, and medical students involved in cancer control activities in AI/AN communities.

INTERNET SITES FOR MORE INFORMATION

NCIs SEER home page: http://www.seer.cancer.gov (This Web site is the source for all statistics used in this document. The site also contains data points for graphs in the manuscript, as well as supplementary data and charts.

NCI Plans and Priorities: Reducing Cancer Related Health Disparities: http://plan.cancer.gov/infra/reducing.htm

CRISP (Computer Retrieval of Information on Scientific Projects): http://crisp.cit.nih.gov

American Cancer Society: http://www.cancer.org

CDCs Division of Cancer Prevention and Control: http://www.cdc.gov/cancer

CDCs National Center for Health Statistics mortality page:

http://www.cdc.gov/nchs/about/major/dvs/mortdata.htm

North American Association of Central Cancer Registries (NAACCR): http://www.naaccr.org

* Cancer incidence data comes from the Surveillance, Epidemiology, and End Results Program (SEER) covering 14 percent of the U.S. population. The areas chosen include San Francisco, Connecticut, Detroit, Hawaii, Iowa, New Mexico, Seattle, Utah, Atlanta, San Jose-Monterey, and Los Angeles. Rates for American Indians/Alaska Natives (Amer Ind/Alaska Nat) also include cases on residents living in Alaska. Cancer mortality data comes from the National Center for Health Statistics (NCHS) and covers the entire U.S. population. Hispanic cancer incidence rates exclude data from Hawaii and Detroit; death rates for Hispanics exclude Connecticut, Oklahoma, New York and New Hampshire. Cancer incidence and death rates for some racial and ethnic populations may be limited by problems in ascertaining race and by the misreporting of race and ethnicity on forms used to collect information on cancer incidence, deaths, and the populations at risk. For instance, while reporting race for African-American and white populations is generally considered reliable, biases are more serious for smaller populations, particularly American Indian/Alaskan Natives, as well as for groups living in smaller geographical areas. Additionally, it is important to note that Hispanics can be of any race and are not mutually exclusive from white, African Americans, Asian/Pacific Islanders, and American Indian/Alaskan Natives. These biases can affect trends and comparisons among groups.

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