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International Health
Disparities in Cancer Diagnosis, Treatment, and Survival Between
African-American and Other Population Groups
Melissa Sileo, MSW, LCSW,
1
Lee Boerner, Ms ED, CRC,
1
Haley Justice, MPH, CHES,
1
Devon McGoldrick, MPH
1
and Claire Neal, MPH, CHES
2
1. Project Manager; 2. Director, Education and Program Development, Lance Armstrong Foundation
Abstract
There are currently more than 800,000 African-American cancer survivors in the US. While cancer affects all segments of the population, there
are wide disparities in cancer survival rates and quality of life according to race, ethnicity, and geography. According to the American Cancer
Society Cancer Facts and Figures for African-Americans, 2008, African-Americans have the highest death rate and the shortest survival of any
racial and ethnic group in the US for most cancers. Social barriers to high-quality cancer prevention, early detection, and treatment services
and the impact of discrimination have a direct impact on these high death rates. African-Americans consistently see disparities across the
cancer control continuum. This article provides an in-depth analysis of the disparities in the African-American cancer community, as well as
strategies that are recommended to address these inequities.
Keywords
Cancer, survivorship, cancer survivor, national action plan, African-Americans, disparities, Lance Armstrong Foundation, minorities, minority
populations, social barriers, cancer prevention, discrimination, inequities, survival rates, quality of life
Disclosure: The authors have no conflicts of interest to declare.
Received: July 3, 2008 Accepted: May 6, 2009
Correspondence: Melissa Sileo, MSW, LCSW, Project Manager, Patient Navigation, Lance Armstrong Foundation, 1210 East 6th Street Austin, TX 78702. E:
melissa.sileo@livestrong.org
Health disparities are defined as the “differences in the incidence, detection options. Socioeconomic issues are the primary factors that
prevalence, mortality, and burden of cancer and related adverse health influence the entire spectrum of cancer, from prevention and early
conditions that exist among specific population groups in the United detection to treatment, quality of life, and survival. Compared with 10% of
States. These population groups may be characterized by gender, age, Caucasians, 24% of African-Americans live below the poverty line.
2
In
ethnicity, education, income, social class, disability, geographic location, or addition, 20% of African-Americans are uninsured compared with only 11%
sexual orientation.”
1
There are currently more than 800,000 African- of Caucasians.
2
Socioeconomic factors can also affect cancer prevention
American cancer survivors in the US.
2
While cancer affects all segments and early detection, including behaviors such as avoidance of tobacco,
of the population, there are wide disparities in cancer survival rates and participation in physical exercise, and maintenance of a healthy
quality of life issues according to race, ethnicity, and geography. According bodyweight, as well as regular access to high-quality screening tests with
to the American Cancer Society Cancer Facts and Figures for African- timely and appropriate follow-up. For certain cancer types, African-
Americans, 2008, African-Americans have the highest death rate and the Americans experience higher incidence rates than Caucasians. African-
shortest survival of any racial and ethnic group in the US for most cancers. Americans are also more likely to be diagnosed at a later stage of cancer
“Social barriers to high-quality cancer prevention, early detection, and than Caucasians, possibly due to factors such as less awareness about
treatment services and the impact of discrimination”
2
have a direct impact cancer symptoms and reduced access to cancer screening services.
on these high death rates. African-Americans consistently see disparities Cancers among African-Americans are more frequently diagnosed after
across the cancer control continuum, including: the cancer has metastasized and spread to regional or distant sites.
3
Other
factors linked to the healthcare-related behaviors and adjustment of
• disparities in prevention, screening, and early detection; African-American cancer patients include limited knowledge and
• disparities in treatment services; and misinformation about cancer, mistrust of the medical community,
• disparities in survival. concerns about privacy, lack of insurance, religious beliefs, and fear and
stigma associated with seeking emotional support.
4
Disparities in Prevention, Screening,
and Early Detection Disparities in Treatment Services
Among the African-American population, a number of factors affect African-Americans can also experience disparities in treatment
prevention behaviors, access to screening, and understanding of early services. As previously stated, African-Americans are more likely to
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