February 1, 2014 | by Nicole White
This year, Black History Month converges with the 50th anniversary of the Civil Rights Movement, and the nation's notable gains in equality give us much to celebrate. But equality in health and access to care continue to be areas of serious concern.
“Across most illnesses including cancer, African-Americans have the worst outcomes,” said Kimlin Tam Ashing, Ph.D., director of City of Hope’s Center of Community Alliance for Research & Education. “African-Americans get cancer at younger ages, have more aggressive cancers, have more treatment-resistant cancers and lower five-year survival than the general population.”
Half of African-American men and a third of African-American women will be diagnosed with cancer in their lifetimes. The causes of cancer health disparities are complex, stemming from such factors as genetic susceptibility, stress and immune function, and family history.
In her research, Ashing has pinpointed several health care system factors that feed into the disparity, including limited access and use of preventive care, limited access to high-quality care, and delays in diagnosing and treating disease. Other studies point to a higher incidence of chronic conditions and illnesses among African-Americans with cancer. Lifestyle factors including smoking, diet and sedentary routines also play a role.
When cancers are examined individually, the disparities become even clearer. Black men are 60 percent more likely than white men to be diagnosed with prostate cancer, and the death rate for prostate cancer is 2.4 times higher in African-American men than in white men. Black women have a greater-than-average risk of premenopausal-onset, triple-negative and inflammatory breast cancers that are more difficult to treat.
African-Americans have the highest rate of colorectal cancer and mortality of all racial groups in the U.S. The incidence rate of cervical cancer is 34 percent higher for black women than white women, and they are twice as likely to die from the disease.
“Health care systems must gain the trust and confidence of the African-American community to engage in lifesaving early detection and screening to catch tumors when they are small, localized, contained and highly treatable, and even curable,” Ashing said.
Given the higher cancer burden on African-Americans, Ashing said, they must be especially aware of the early detection tests for the five most common cancers: mammograms for breast cancer, Pap tests for cervical cancer, PSA tests for prostate cancer, colonoscopy for colon cancer, and – under a new U.S. Preventive Services Task Force recommendation – low-dose CT scanning for those at highest risk of lung cancer.
“Health care systems must be more accountable to their most vulnerable patients by ensuring timely and quality care delivery, and integrated care that attends to other serious chronic health conditions,” she said. “Personal cancer prevention and control practices involve talking and doing.”
"Talking" means discussing cancer with family members in a way that reveals familial risk. "Doing” includes eating more fruits and vegetables while reducing meat consumption. Increased activity – such as through dance or walking – can reduce cancer risk and promote greater well-being after cancer treatment.
“The most important behavior is to avoid tobacco products,” Ashing said. “If you smoke, quit; and if you drink alcohol, reduce alcohol consumption to less than one drink per day for women and two drinks per day for men.”
Ashing said that the African-American community has many strengths upon which to draw when it comes to promoting greater health and reducing cancer risk.
“The African-American community has for generations found joy, comfort and strength in its creative cultural expression of music, dance, writing and poetry, and spirituality,” she said. “These can be protective for cancer survivors, especially as they strive for a new normal post-cancer diagnosis and treatments.”
Peer-based support groups have been an effective part of supportive and emotional care for many African-American breast cancer survivors. Also, individual and family counseling can help mitigate the depression and anxiety common among cancer patients – issues that are less likely to be addressed among African-Americans.
To reduce cancer health disparities and achieve cancer equality, cancer care for the whole person must be the standard of care for African-Americans.