(The Hill) — About 2 million people in the United States will be diagnosed with cancer this year, and 600,000 will die from the disease, the National Cancer Institute (NCI) estimates.
But cancer is not equal opportunity.
A wide range of factors plays a role in determining whether a person will get and potentially die from the disease, including their genetics and where they live.
Cancer death rates have decreased over the last 25 years across the United States, according to the American Cancer Society. The sharpest decrease has occurred among Black people, Native Americans and Alaskan natives, according to a February 2022 report from KFF.
This is in part due to improvements in cancer screening, treatments, early diagnosis and changes in behavior like reduced cigarette smoking, according to Latoya Hill, senior policy analyst at KFF’s Racial and Health Policy Program.
But even though white Americans have higher rates of new cancer diagnoses, some people of color, especially Black people, are still more likely to die from the disease, NCI data show.
Between 2016 and 2020, there were 469.9 cancer diagnoses per 100,000 non-Hispanic white people, 451.8 diagnoses per 100,000 Black people, 417.9 diagnoses for every 100,000 Native Americans and Alaska Natives, 348.1 diagnoses per 100,000 Hispanics and 302 diagnoses per 100,000 people of Asian and Pacific Islander descent.
Meanwhile, during that same time there were 174.7 cancer deaths per 100,000 Black people, 158 cancer deaths per 100,000 Native Americans and Alaska Natives, 154.4 cancer deaths per 100,000 white people, 108.2 cancer deaths per 100,000 Hispanics and 94.5 cancer deaths per 100,000 Asian people and Pacific Islanders.
Income is also important in determining who gets and dies from cancer. Research shows poorer communities have higher rates of cancer than affluent areas. And people living in persistent poverty are more likely to die from cancer.
In addition, while rural communities tend to have lower rates of cancer than their urban and suburban counterparts, they have higher death rates.
Cancer genetics
Genetics plays a role in the types of cancer that are more common among certain racial and ethnic groups.
For instance, about 10 percent of all breast cancer cases are due to genetic predisposition, according to Otis Brawley, an oncologist and epidemiologist at Johns Hopkins University.
Ashkenazi Jewish women, who have family roots in Eastern Europe, have a higher risk of getting breast cancer and ovarian cancer at an early age compared to other groups of women because of a known gene mutation.
Breast cancer rates are about equal between white women and Black women, according to Jasmine McDonald, assistant professor of epidemiology at Columbia University. But Black women are more likely to die from the disease.
This is partly because they are more likely to be diagnosed later than white women, which makes treating the disease more difficult, according to the Centers for Disease Control and Prevention (CDC).
Compared to women of other racial and ethnic backgrounds, Black women are also specifically more likely to get triple-negative breast cancer, a more aggressive type with a faster growth rate.
“That isn’t necessarily a function of access to earlier screening or, or necessarily environment but it’s something truly at the biological level that we are still striving to understand,” said Susan Vadaparamipil, associate center director for community outreach, engagement and equity at the Moffitt Cancer Center in Florida.
Cancer and where you live
But while genetics plays a role, cancer death disparities are really the result of broader socioeconomic inequities that are rooted in ongoing racism and discrimination.
“When considering cancer disparities, we need to stop using language about predisposition and making generalizations that it is only a DNA conversation,” said Robert Winn, director of the VCU Massey Cancer Center.
It is critical to consider what is happening in the world outside of the cell, he said.
“Where you live, your place and space matters,” Winn added in an email to The Hill. “Your ZNA, zip code and neighborhood of association, may have structures in place that ultimately cause additional stress.”
Cancer experts agree that location plays a far more significant role in cancer incidence and death disparities than genetics does.
Unequal access to cancer screenings
Many communities with cancer clusters or elevated rates of cancer diagnoses are low-income communities that are burdened with limited access to health care or lower-quality care and cancer screenings.
And communities of color, particularly Black communities, are more likely to live in high-poverty communities due to economic inequity and racist housing laws like due to racist housing laws like redlining. A little over 14 percent of people of color lived in a high-poverty neighborhood in 2020, compared to about 4 percent of white people, according to the National Equity Atlas.
Breast cancer screenings offer one example of how lower-incoming neighborhoods are subjected to poorer quality cancer health care.
Doctors recommend that women start getting an annual mammogram once they turn 40 to look for signs of breast cancer. Such screenings can aid with early detection of the disease and increase the odds of surviving it.
But low-income women sometimes get inferior mammograms compared to those received by middle-class or wealthy women, often because the medical equipment they have access to is inferior or the availability of resources to complete thorough testing are limited.
Take, for instance, mammography vans, which are frequently deployed in low-income neighborhoods.
Brawley, of Johns Hopkins University, explained that during a “high quality” mammogram, a physician will compare current and past images to look for signs of change.
“Well, if you get your mammogram on a breast mobile, they don’t have access to last year’s mammogram,” Brawley said. “So, you have all these women who go to these mammogram vans in these poor neighborhoods and they are very proud of the fact that they got a mammogram… but nobody tells them that they actually got lower quality than what the middle class and upper-middle-class women who go to brick-and-mortar facilities get.”
A lack of health insurance and a shortage of primary care physicians and oncologists also contributes to cancer disparities in rural communities, according to the NCI.
Environmental and lifestyle factors
In addition to limited health screening access, low-income and rural communities are often subject to environmental and lifestyle factors that, combined with less access to health care, can lead to higher case or death rates of cancer.
In rural communities, residents “tend to be older, engage in risky health behaviors, and have lower adherence to preventative care” than their suburban and urban counterparts, according to the NCI, leading to their higher death rates.
Research shows that rural and low-income communities have higher rates of smoking, which directly impacts a person’s likelihood of developing lung cancer.
And while lung cancer diagnoses and deaths have decreased, mainly due to lower levels of smoking across the country, there are still disparities in who dies from the disease.
Rates of new lung cancer diagnoses run very close along racial and ethnic lines, but people of color are still less likely to survive the disease than white people.
In 2019, there were 57.1 new cases of lung cancer per 100,000 white people, according to the most recent CDC data. That same year, there were 54.9 lung cancer diagnoses per 100,000 Black people, 49.9 incidents per 100,000 Native American and Alaska Natives, 33.2 per 100,000 Asian and Pacific Islanders and 27.5 per 100,000 Hispanic people.
People of Asian or Pacific Islander descent have the highest lung cancer survival rate, followed by Latinos, with 26 percent and 23 percent, surviving five years after their diagnoses, respectively, according to the American Lung Association.
White people have the next highest five-year survival rate at 22 percent, while Black people and Indigenous people have lung cancer survival rates of 21 and 19 percent.
Lower-income communities also suffer from higher rates of obesity than higher-income neighborhoods, in part due to limited access to fresh food. Research suggests there is a link between high body fat and increased risk for several types of cancer, including endometrial, esophageal and liver cancer, though there is more work to be done to fully understand the connection.
Additionally, some low-income neighborhoods, and especially low-income communities of color, are exposed to higher rates of toxic chemicals that can lead to cancer in the homes they live in, the water they drink and the air they breathe.
Lead poisoning, which has been linked to higher risks of some types of cancers, disproportionately affects low-income communities, particularly low-income Black communities in the United States.
This is in part because low-income communities with homes that were built before the 1970s are more likely to still have lead-based paint.
Another factor that can contribute to this disparity is the fact that low-income communities, especially low-income communities of color, are more likely to be near industrial facilities that work with lead than their more affluent counterparts, according to the CDC.
Proximity to industrial sites that emit toxic pollutants also plays into disparities in cancer rates and can result in cancer “hotspots.”
Some of these hotspots are so large that they are more akin to “cancer corridors,” like the 85-mile section of the Mississippi River in Louisiana located between New Orleans and Baton Rouge that is known as Cancer Alley.
This particular stretch of land is home to oil refineries and chemical plants that emit a huge amount of air pollution laced with known carcinogens like ethylene oxide and acetaldehyde, according to a ProPublica analysis.
On average, about 30 out of a million people in the U.S. run the risk of developing cancer due to exposure to carcinogens in air pollution. But a significantly higher share face that risk in Cancer Alley: 46 out of a million, one study found in 2012.