Cancer Is Killing Fewer Americans, But a Racial Gap Endures

A close-up look of cervical cancer. Photo: American Cancer Society/Getty Images
A close-up look of cervical cancer. Photo: American Cancer Society/Getty Images

Here’s some good news, courtesy of the American Cancer Society’s annual Facts & Figures report: Fewer Americans are getting and dying from cancer, at least as of 2015, continuing a long decline seen since the early 1990s. But the report also highlights continuing racial and wealth disparities in who gets properly screened for cancer and which patients survive.


The report, published in CA: A Cancer Journal for Clinicians, provides a regular temperature check of our progress against cancer. It complies the most recent data from several national cancer databases to come up with an estimate of new cancer cases and deaths for the upcoming year, while also charting the historical trend of cancer incidence, survival, and mortality rates using the most up-to-date figures collected by the government.

In 2015, for instance, there were 595,930 deaths from cancer—a relative 1.5 percent drop in the death rate from 2014, the report found. Since 1991, when the rate was at its peak, there’s been a 26 percent drop overall. That amounts to nearly 2.4 million fewer deaths than there would have been if the rate had stayed the same. As for 2018, the report estimates the country will see 1,735,350 new cancer cases and 609,640 cancer deaths (the number of cancer deaths typically rises each year, but, accounting for population growth, the overall death rate has and is expected to decline).

“The decline in cancer mortality over the past two decades is primarily the result of steady reductions in smoking and advances in early detection and treatment,” the report found. These decreases were especially apparent in the four most common forms: lung, breast, prostate, and colorectal cancer.

These gains haven’t been equal among all Americans, though. Men are still more likely to get and die from cancer than women (though men have seen an ongoing drop in new cases in recent years, while women haven’t). Black people are still more likely to get and die from cancer than their white counterparts, while white people are worse off than Asians, Native Americans, and Hispanics. In 2015 alone, the overall cancer death rate was 15 percent higher among black people than whites.

Some of the reasons behind these differences are largely unchangeable—being on average taller, for example, is partly why men get cancer more often. But the racial and ethnic differences, the report concludes, are “largely because of inequalities in wealth that lead to differences in risk factor exposures and barriers to high-quality cancer prevention, early detection, and treatment.”

Even though the rate of being diagnosed with cancer was lower among black women than white women from 2010 to 2014, the overall cancer death rate was still higher for black women. And the five-year relative survival rate of all cancers for white people is 68 percent, compared to 61 percent for black people.


This racial gap has definitely gotten smaller since the 1990s, but that’s not as encouraging as it looks. In some states where the gap is gone, like Kentucky and West Virginia, it’s likely that white people and black people are just getting the same relatively poor cancer care, since those states have some of the worst cancer death rates in the country.

For fans of “Medicare for All,” there are some encouraging tidbits. The racial gap was much smaller among people older than 65, “probably in part due to universal health care access for seniors through Medicare.” And some states, including Massachusetts, seem to have closed the gap—so much that blacks are now less likely to die of cancer than whites there—in part because of their early comprehensive health reforms that led to near-universal insurance coverage (there’s some very early evidence that Obamacare may eventually have a similar beneficial effect on cancer rates).


The report also offers some forward-looking suggestions.

“Advancing the fight against cancer for all citizens requires broader application of existing cancer control knowledge, including smoking cessation and the increased uptake of cancer-preventing cervical and colorectal cancer screening and HPV vaccination, across all segments of the population, with an emphasis on disadvantaged groups,” it concluded.


[CA: A Cancer Journal for Clinicians]

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The study suggests that “white people are worse off than Asians, Native Americans, and Hispanics.” I wonder whether this is true when you adjust for incomes. Also, it seems odd to include Asians with Native Americans and Hispanics (though this may just be an artifact of how the data is summarized). However, it suggests that there may be some interesting differences still to be teased out here, and also suggests that the health outcomes of the average white person is not necessarily the standard that should be used for every measurement.