Cancer Deadlier for Poor, Minorities

New data underscore racial, ethnic and economic disparities

THURSDAY, March 11, 2004 (HealthDayNews) -- Minorities and people living in poverty are still at greater risk of getting cancer and dying from it than whites and more affluent individuals, a new American Cancer Society study finds.

Blacks have the highest death rate from all cancers combined, with an annual death rate from cancer that is 40 percent higher for black men and 20 percent higher for black women than their white counterparts, the study found.

Being poor also boosts cancer death rates, regardless of race or ethnicity, researchers found. Men who live in poverty-stricken counties have a 13 percent higher death rate from all cancers combined, vs. men in richer counties. Cancer deaths are 3 percent higher for women in poor counties than for their more affluent counterparts.

The report appears in the March/April issue of CA: A Cancer Journal for Clinicians, a peer-reviewed journal of the American Cancer Society.

"The issue of how we can actually eliminate these disparities represents a very large and unresolved problem," says Dr. Michael Thun, head of epidemiology research at the American Cancer Society and a co-author of the paper.

Using data from the National Cancer Institute, researchers documented and provided examples of disparities across the entire spectrum of cancer intervention, from primary prevention to end-of-life care.

To begin with, the prevalence of certain cancers appears to vary among racial and ethnic groups. Asian-Americans and Hispanic/Latinos, for example, suffer from higher rates of stomach cancer.

Access to recommended screenings also varies. Mammography use was lowest among American Indian/Alaskan Native women. Only 52 percent had a mammogram within two years, while just 36.6 percent had one in the last year.

Gaps also persist in the availability of quality treatment and the adequacy of pain relief for those who are dying of cancer.

Poverty, lack of health insurance, and racism all contribute to the chasm in cancer care, the authors explain. It will take the combined effort of many different groups to narrow the gap, they add.

"Communities can do a lot by exposing the efforts of tobacco companies to prey on more vulnerable and less educated segments of the population," Thun says.

Recognizing the challenge, Aetna Inc. last year became the only national health insurer to begin collecting racial and ethnic data from its members. The company says that is part of a larger initiative it has developed to understand differences in disparities in care and develop strategies to reduce the gaps.

Already, the Hartford, Conn.-based health insurer has rolled out a program to educate and support black women who are at increased risk of preterm labor.

Aetna defends its data collection effort, which critics say raises concerns about patient privacy.

"Without data, you're kind of shooting yourself in the dark," says Dr. Melissa Welch, medical director for health-care delivery in Aetna's West region. "The good news is we've at least taken a step."

Aetna also has developed a cultural competency module that its physicians and nurse employees are required to take. The goal now is to find a way to expand that training to all network providers, she says.

For its part, the cancer society has set a goal of reducing cancer death rates and incidence by the year 2015. Part of the challenge is to reduce disparities in cancer care.

"There is a downturn in death rates from all cancers combined across all racial and ethnic subgroups, so there is progress being made in improving early detection, and there's certainly been progress in treating certain cancers," Thun notes. "It's that the progress is not being shared equally among socioeconomic groups."

More information

The American Cancer Society and the National Cancer Institute have more information on confronting racial and ethnic disparities and efforts to reduce them.

SOURCES: Michael Thun, M.D., M.S., vice president, department of epidemiology and surveillance research, American Cancer Society, Atlanta; Melissa Welch, M.D., M.P.H., medical director, health care delivery, Aetna West Region, San Ramon, Calif.; March/April 2004 CA: A Cancer Journal for Clinicians
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