The gap in cancer mortality between Black and White individuals has narrowed substantially since its peak in the early 1990s, with lung and prostate cancer accounting for more than half of the improvement among men, according to a study published in JAMA Oncology by researchers at the American Cancer Society.
They drew on cancer mortality data compiled by the National Center for Health Statistics for non-Hispanic Black and non-Hispanic White individuals who died of cancer between 1991 and 2023.
Using SEER software, the authors compared excess mortality rates between a peak period and a contemporary period, calculating them as five-year moving averages across 30 individual cancer types.
Mortality rates were age-standardized to improve estimate stability, particularly for less common cancers.
The American Cancer Society researchers found that the all-cancer excess mortality rate fell from 124.0 to 25.6 per 100,000 among Black males and from 34.2 to 12.5 per 100,000 among Black females, declines of 98.4 and 21.7 per 100,000, respectively.
Among men, lung cancer accounted for the largest share of that improvement, followed by prostate cancer and esophageal cancer.
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For women, colorectal cancer contributed the most, followed by cervical cancer and lung cancer.
The mortality rate ratio between Black and White individuals also narrowed, from 1.47 to 1.14 among men and from 1.20 to 1.10 among women.
Despite the overall progress, prostate, lung, and stomach cancer remained among the top five cancer types with the largest excess mortality among Black men.
Among women, breast cancer continued to account for the greatest excess mortality, followed by uterine corpus cancer, whose disparity widened over the study period.
Relative disparities for breast cancer widened from 22% to 37% and for uterine corpus cancer from 82% to 102% between the two periods.
These disparities are indicative of the continuing effects of disparities rooted in broader social determinants of health.
In practice, this means that Black individuals are more likely to face barriers in accessing healthcare, including preventive screenings and follow-up care, which can exacerbate existing disparities.
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Black individuals were 53% less likely than White individuals to receive lung cancer screening between 2017 and 2020.
Racial differences in prostate-specific antigen (PSA) screening prevalence also widened after the US Preventive Services Task Force recommended against routine PSA screening in 2012.
Recent research suggests that implementing screening guidelines tailored to Black males, including earlier and annual screening, could help address these disparities.
Ultimately, the study’s findings highlight the need for more targeted and efficient cancer prevention and control strategies to further accelerate progress in reducing cancer disparities.
Persistent or worsening disparities in breast cancer and uterine corpus cancer and substantial residual disparities in prostate cancer highlight priorities for equitable interventions.
It is necessary to address these disparities to improve healthcare outcomes for Black individuals.
