Significant Racial Differences
The report showed that African Americans are less likely than whites to receive standard-cancer therapies for lung, breast, colorectal, and prostate cancers, even among Medicare-insured patients.
The authors reported that this is due to the disproportionately high burden of poverty in the African American community.
The report showed that higher cancer mortality rates among African Americans are partly due to a later stage of disease at diagnosis. It stated that later stage diagnosis is particularly striking for cancers of the uterine corpus, oral cavity, female breast, and cervix.
The authors of the report noted that African American women have lower breast cancer incidence rates compared to their white counterparts but they have higher breast cancer death rates.
African American men have the highest overall cancer incidence and death rates, according to the report. The death rates are about double those of Asian Pacific Islander men, who have the lowest death rates.
This was true for all major tumor types except kidney cancer. The death rates for stomach and prostate cancers are about 2.5 times greater in African American men compared to their white counterparts.
“Often times, minority patients are seen later because they don’t undergo adequate screening. So, they are detected later and that affects the cure rate,” said Dr Vose.
The report showed there are significant regional variations in cancer rates and these are being fueled by risk factors such as smoking and obesity. Poverty and access to health care also play a significant role.
The largest geographic variation in cancer occurrence by far is for lung cancer. Kentucky historically has the highest smoking prevalence and subsequently has a 3.5 times higher lung cancer incidence rate than Utah, which has the lowest smoking prevalence.
There are also significant differences in prostate cancer incidence, with a 2-fold difference for incidence rates, which range from 89.8 (per 100 000 population) in Arizona to 184.1 in the District of Columbia. This appears to be due to prostate specific antigen testing prevalence and population demographics.
Christine Walko, PharmD, who is an applied research scientist and member of the Health Outcomes & Behavior Program at Moffitt Cancer Center in Tampa, FL, said this year’s report is rather remarkable. While it highlights dramatic successes, it also shows there are significant barriers yet to be overcome.
“There are numerous access issues to patients getting the optimal treatment, including not just the rising costs of cancer care but also the ability to identify the unique aspects driving the growth of each patient’s cancer,” Walko told Cancer Therapy Advisor.
She said precision medicine will increasingly have a significant impact on cancer-related morbidity and mortality. It has the ability to help identify patients most likely to respond to a particular treatment while not exposing them to unnecessary therapies. Walko said this is a very important point because precision medicine can spare many patients from undergoing toxic therapies that may be of little or no benefit.
“This includes physical toxicities such as diarrhea, fatigue, rash, and others as well as the financial toxicity of paying for a drug that will likely yield little value,” Walko said.
- Siegel RL, Miller, KD, Jemal A. Cancer statistics, 2016 [published online ahead of print January 7, 2016]. CA: A Cancer Journal for Physicians. doi: 10.3322/caac.21332.