Background

There is a difference in cancer survival rates between Caucasians and minorities. African Americans have the highest death rate from all cancers. From data provided by the SEER program shown in Figure 1, for all cancers there is a divergence in death rates between African American patients and Caucasian patients from 1975 to the early 1990s. This gap has since lessened, however it remains larger than it was

All cancers (Male)

All cancers (Female)

White

African American = American Indian/Alaskan Native Asian or Pacific Islander Hispanic

1975 1980 1985 1990 1995 2000 1975 1980 1985 1990 1995 2000

Colorectal cancer (Female)

1975 1980 1985 1990 1995 2000 1975 1980 1985 1990 1995 2000

Colorectal cancer (Female)

1975 1980 1985 1990 1995 2000 1975 1980 1985 1990 1995 2000

Prostate Cancer

Female Breast Cancer

1975 1980 1985 1990 1995 2000 1975 1980 1985 1990 1995 2000

100 90 80 70 60 50 40 30 20 10

Prostate Cancer

Female Breast Cancer

1975 1980 1985 1990 1995 2000 1975 1980 1985 1990 1995 2000

Year of Death

Figure 1. Trends in Mortality for All Combined Cancer, Prostate, Female Breast and Colorectal, by Race and Ethnicity, 1975-2000. (Reprinted with permission from Ward et al.2)

in 1975. A similar trend is seen with death rates from all cancers in relation to race and socioeconomic status.5 6

The IOM report showed that there were obvious disparities in health care for minorities in many disciplines of medicine and this disparity extends to cancer. African Americans and other minorities were diagnosed at later stages, had a higher likelihood of having a delay in diagnosis and, even with equivalent treatment, had worse survival rates.7,8 These disparities are disheartening and closing the gap is an important goal. This goal has already been embraced by the American Cancer Society as one of its challenge goals by the year 2015.

There is an abundance of literature suggesting possible causes for these disparities. These include socioeconomic status,3,6,9,10 race/ethnicity,2,7 tumor biology,11,12 and comorbidities.13,14 All of these factors contribute to the disparity seen in the mortality from cancer. The impact of these factors on cancer survivors is not well known; only recently have studies on cancer survivors been done. In 1992, a National Health Interview survey was done to examine cancer prevalence and survivorship issues. At that time approximately 6.1% of the adult population or 11 million people reported that they had ever had cancer.15 Chirikos et al. found that breast cancer survivors were more likely than controls to have functional impairments such as lymphedema resulting in decreased work ability, which may affect employment opportunities.16 Whether differences in these indices of quality of life differ among different racial or ethnic groups ;as not reported however, there is a significant burden of illness among cancer survivors and there is every reason to assume that disparity in access, quality of care, and outcomes contributes to this. While mortality data are available by gender, race, and ethnicity, research is needed to identify the role of these factors among cancer survivors who experience poorer long-term health, and increased loss of productivity.17

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