Although cancer death rates among Black people have steadily declined over the past two decades, they are still "considerably higher" than the rates seen in other racial and ethnic groups, according to a new study published in JAMA Oncology.

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Study details and key findings

In the cross-sectional study, researchers analyzed national death certificate data from the National Center for Health Statistics for all cancer deaths from individuals ages 20 and older between January 1999 and December 2019.

Overall, the researchers found that 1,361,663 cancer deaths occurred among Black individuals between 1999 and 2019. During that period, cancer death rates among Black people fell 2% every year, going from 329 cancer deaths per 100,000 to 239 deaths per 100,000.

In particular, lung cancer saw the largest decline per 100,000, which experts attributed to fewer people smoking. The cancers that saw the greatest decreases in total deaths were lung cancer for men and stomach cancer for women.

However, not all cancers saw their death rates decrease. Among older Black men and women, liver cancer deaths increased, and among women ages 35 to 70, uterine cancer deaths increased.

In addition, cancer deaths rates among Black people remained "considerably higher" than the rates observed in other groups at the end of the study period, the researchers wrote. In 2019, Black men had the highest cancer death rates of all racial and ethnic groups at 294 deaths per 100,000 people. In comparison, white men had a cancer death rate of 249 deaths per 100,000, and Hispanic men had 177 deaths per 100,000.

Commentary

Wayne Lawrence, a researcher from the National Cancer Institute who led the study, said the gradual reduction in cancer deaths among Black people was encouraging, but noted that the enduring disparity between Black people and other racial and ethnic groups is "troubling."

According to the researchers, social and economic disparities, including poverty, reduced access to care, and a mistrust of doctors, as well as an overall "health care system failure," have likely contributed to the elevated cancer death rates among Black people in the United States.

"The health care system is failing because we don't focus on prevention and risk reduction," said Otis Brawley, a Bloomberg distinguished professor of oncology and epidemiology at Johns Hopkins University. "When we do focus on screening and treatment, it is given disproportionately to people of upper incomes and people who are white."

Vivian Bea, a breast surgical oncologist at Weill Cornell Medicine, expressed a similar sentiment, saying that not all groups have "benefited equally" from advancements in treatments, prevention, and screening. Black people "are still dying at alarming rates when you compare us to other populations," she said.

Bea also noted that a lack of Black participants in trials for cancer treatments has led to some treatments being less effective in Black people than they are in white people.

"We have to address racism head-on," she said. "It has an impact on our mortality and morbidity." (AP/Modern Healthcare, 5/19; Hassanein, USA Today, 5/19; Lawrence et al., JAMA Oncology, 5/19)