from cancer. The incidence of most cancers increases with age, making elderly individuals the group most burdened by cancer. The majority (58 percent) of new cases of cancer occur among those age 65 and older (Ries et al., 2002). For women the risk of dying from cancer is increasing, mainly because of the increasing incidence of lung cancer among women.

Cancer is the leading cause of death among women ages 35 to 64 (National Center for Health Statistics, 2001). Like age and sex, family history is another risk factor that cannot be modified but that is an important indicator of increased susceptibility.

Cancer incidence is correlated with adverse socioeconomic conditions, which affect the lives of many Americans. In the United States, people are more likely to die from cancer if they are poor, have limited education, or both. For example, the probability that a 65-year-old man will die from lung cancer is 547.9/100,000 if his annual family income is less than $10,000, but the risk decreases to 273.6/100,000 if his annual family income exceeds $25,000 (National Center for Health Statistics, 1998). Certain racial and ethnic groups in the United States, African Americans in particular, are at substantially higher risk for cancer (Table 1.3).

There are many differences in host susceptibility, lifestyle, the environment, and health modifiers that are independently associated with each of these demographic factors, and the complex interrelationships among these factors have not been fully described to account for the racial and ethnic disparities in cancer risk (Berkman and Kawachi, 2000).

African Americans are more likely than the rest of the population to suffer morbidity and die from cancer (Table 1.3). The rate of mortality from cancer among African Americans is 33 percent greater than that among whites (218.2/100,000 and 164.5/100,000, respectively) (ACS, 2002a). The fact that health outcomes are worse in certain populations also has multifaceted explanations, some of which include documented disparities in access to and the quality of health care (Berkman and Kawachi, 2000; Smith, 1998). For certain populations cancers are more advanced at diagnosis, partly because the individuals in those populations have less exposure to screening services, as documented later in this report. African Americans are less likely than whites to be diagnosed with cancer at a localized stage and, for each stage of diagnosis for almost every cancer, African Americans have lower 5-year survival rates than whites (Table 1.4) (Greenlee et al., 2001; Ries et al., 2000a). The failings of the health care system are only part of the explanation for these disparities. Personal health behaviors, biological factors, adherence to treatment, and a complex sociological and environmental milieu are interwoven factors contributing to morbidity and death from cancer.

Cancer is characterized by abnormal cell growth; but it is really more than 100 different diseases, each with a unique profile in terms of the



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