and Brown, 2002). The consequences of these treatment disparities include more frequent recurrence, shorter disease-free survival, and higher mortality rates. The unequal burden of cancer has been widely recognized and efforts are underway to reduce the gaps in access to care that often contribute to the resultant excess cancer morbidity and mortality (ACS, 2004a). These efforts include interventions to reduce cancer risk factors, improve screening, and improve access to state-of-the-art medical care, including diagnosis and cancer treatment.
This section of the chapter summarizes information on survival for certain racial and ethnic groups provided by the American Cancer Society (Ward et al., 2004; ACS, 2004a).5 Compared to whites and other racial ethnic groups, African-American men and women have the highest mortality rates for all cancer sites combined (Figure 2-10). African Americans have the highest overall incidence rates among men but, among women, whites have the highest incidence rates.
As a group, African Americans are underrepresented in the cancer survivor population—they made up approximately 13 percent of the U.S. population in 2000 (Grieco and Cassidy, 2001; Ingram et al., 2003), but only 8 percent of the survivor population. Furthermore, among cancer survivors in 2000, African Americans are less likely than whites to be long-term survivors (29 percent versus 38 percent had survived 10 years or more).
Cancer registries do not routinely collect information on an individual’s educational attainment, income, and other socioeconomic characteristics, so it is not possible to use registry data to analyze cancer statistics by individual socioeconomic status. However, the relationship between cancer survival and the areawide poverty level of an individual’s residence has been examined (Singh et al., 2003). Across all racial and ethnic groups, the 5-year survival rate is more than 10 percent higher for persons who live in affluent census tracts (tracts with less than 10 percent of the population below the poverty line) than for persons who live in poorer census tracts (tracts with more than 20 percent of the population below the poverty line) (Figures 2-11 and 2-12). Racial and ethnic differences persist, however, when county poverty level is accounted for, especially for African Americans.