Cancer statistics, 1999: challenges in minority populations
Authors: C. J. McDonald
Journal: CA A Cancer Journal for Clinicians (1999)

Each year for more than two decades, the American Cancer Society's Department of Epidemiology and Surveillance Research has provided an up-to-date perspective on the occurrence of cancer in the United States through publication of a series of articles in CA titled “Cancer Statistics.” The tradition continues in this issue.1 In 1999, Landis et al estimate that about 1,221,800 new cases of invasive cancer will be diagnosed in the US.1 Although this seems like a large number, there is an apparent overall downward trend in cancer incidence rates. The incidence rates of breast cancer in young women and lung cancer in men are down, as are those of colon and rectal cancer in both men and women. It is important to note that this 1.2 million estimate does not include more than 1 million cases of basal and squamous cell cancer of the skin (the most prevalent of all human cancers) or carcinoma in situ of sites other than the urinary bladder. Although these underreported cancers are not often fatal in humans, medical management is associated with considerable morbidity and adds tremendously to the ever-increasing cost of medical care. In 1999 an estimated 563,100 US citizens are expected to die of cancer.1 US cancer death rates are declining in all major sites. At first glance, these new figures on incidence and mortality are comforting and speak well for our increasing efforts in cancer control. A closer look reveals these successes have taken place mainly in the majority community. Among major ethnic groups, African Americans continue to have higher incidence rates of cancer, with 445.8 cancers per 100,000 population.1 They are also at greater risk of dying of cancer than is any other racial or ethnic group, with a mortality rate of 224.8 per 100,000. On a more poignant note, we need only look at the record in two major cancer sites. Although African-American women are less likely to develop breast cancer than are white women, the rate of African-American women dying of breast cancer is greater. Also, African-American men are 1.5 times more likely to develop prostate cancer than are white men and twice as likely to die of the disease. Rather than being encouraging, these new figures from “Cancer Statistics, 1999” are quite disconcerting. Cancer incidence and mortality of the magnitude experienced by African Americans and other underserved populations pose a major threat to the Society's achieving its goal of a 50% reduction in cancer mortality rates and a 25% reduction in cancer incidence rates by the year 2015. The Society has long speculated on reasons for, and solutions to, the disparity in cancer incidence and mortality and to the other negative aspects of health care too often experienced by disadvantaged populations and ethnic minorities. We have yet to achieve success in developing meaningful programs and plans to address these disparities effectively. Not addressed in “Cancer Statistics, 1999” but highlighted in another ACS publication, “Cancer Risk Report, 1998,”2 is another significant threat to the Society's achieving its 2015 goals. This is the alarming increase in the prevalence of cigarette smoking among high school students during the years 1991 to 1997 and the leveling off of smoking prevalence among the adult population of the US. Among the high school population overall, cigarette smoking increased 32% in the 7-year period 1991 to 1997. It has increased 80% among African-American and 34% among Hispanic students. Certainly, cancer attributable to smoking in this population will not be an unpalatable statistic by the year 2015, but what about adult prevalence and its impact now and in the future? More and better programs in prevention, early detection, and treatment are needed now. These programs must be designed and effected with full participation, from start to finish, by those most at risk: African Americans, the poor, the disadvantaged, and our youth. Only through their full participation in the process will they acquire a sense of ownership and a desire to achieve the goals the Society has established. As I view the scene, the tasks before the Society are immense. We must now ask ourselves whether we are up to the challenge. Do we have the wherewithal to mobilize and motivate our staff and our volunteers, and the population at large, to join with us and work diligently as we marshal our forces in the fight to eliminate cancer as a major scourge of society?