Cancer and minorities

Statistics shed light on the causes, risk factors, and forces that influence cancer's prevalence, survival, and mortality. Data help chart the course and are the basis for determining that, although all population groups have benefitted from the progress against cancer, there are distinct disparities among these groups, disparities that challenge both public health and basic research. This presentation examined cancer patterns by race and ethnicity as an essential element of understanding differences, identifying disparities, and moving forward to meet special needs through research, prevention, and improved public and private health services. Cancer is the second leading cause of death, accounting for about one-fourth of all deaths in the United States in 1995. Just recently, there has been real progress in reducing cancer mortality, with declines in breast, prostate, and colorectal cancer. The data show that black men have higher incidence, higher mortality, and lower survival from all cancers combined than white men. Cancer incidence among black women, however, is lower than among white women. Despite the lower incidence, black women have higher mortality and therefore lower survival than white women. These differences in cancer experience represent opportunities to better understand cancer and thereby to make progress against this disease for everyone, regardless of their a priori risk. The distribution of stage at diagnosis for whites, blacks, and Hispanics shows that, for whites, cancers are found at an earlier stage, but earlier stage is not the whole explanation. There are still other factors, including diet, that play a role in cancer. Being overweight has also been identified as a risk factor. Another risk factor is smoking, and the prevalence of smoking varies greatly by race and ethnicity. Four major conclusions emerge: First, progress against cancer is clear. There are not only great gains in fundamental knowledge of cancer and its risk factors and improvement in detection and screening technology, but also progress in reducing the cancer death rate, the primary measure of burden. Second, to know best how to intervene both in general and for specific population groups, cancer prevention and control research must be carried out to complement basic and clinical research. Third, data on the cancer experience is crucial to working with specific populations. Studying the variation in cancer rates among populations-the epidemiology of cancer-provides clues to cancer's causes. Finally, to be able to produce the important data that we need for policy, research, prevention, and control, we need even more coordination than we have today-coordination between national, state, local, and especially private data resources. As our health care system changes, private sources of data will be even more important, and standardization of data across all components of the health care system will foster linkage and data comparability. Population-based information is crucial to understanding cancer. With it and with further research, we will be closer to seeing significant progress in narrowing the disparities in cancer experience and lowering the burden of the disease for all of us.