American Cancer Society’s report on the status of cancer disparities in the United States, 2023

Abstract

In 2021, the American Cancer Society published its first biennial report on the status of cancer disparities in the United States. In this second report, the authors provide updated data on racial, ethnic, socioeconomic (educational attainment as a marker), and geographic (metropolitan status) disparities in cancer occurrence and outcomes and contributing factors to these disparities in the country. The authors also review programs that have reduced cancer disparities and provide policy recommendations to further mitigate these inequalities. There are substantial variations in risk factors, stage at diagnosis, receipt of care, survival, and mortality for many cancers by race/ethnicity, educational attainment, and metropolitan status. During 2016 through 2020, Black and American Indian/Alaska Native people continued to bear a disproportionately higher burden of cancer deaths, both overall and from major cancers. By educational attainment, overall cancer mortality rates were about 1.6–2.8 times higher in individuals with ≤12 years of education than in those with ≥16 years of education among Black and White men and women. These disparities by educational attainment within each race were considerably larger than the Black–White disparities in overall cancer mortality within each educational attainment, ranging from 1.03 to 1.5 times higher among Black people, suggesting a major role for socioeconomic status disparities in racial disparities in cancer mortality given the disproportionally larger representation of Black people in lower socioeconomic status groups. Of note, the largest Black–White disparities in overall cancer mortality were among those who had ≥16 years of education. By area of residence, mortality from all cancer and from leading causes of cancer death were substantially higher in nonmetropolitan areas than in large metropolitan areas. For colorectal cancer, for example, mortality rates in nonmetropolitan areas versus large metropolitan areas were 23% higher among males and 21% higher among females. By age group, the racial and geographic disparities in cancer mortality were greater among individuals younger than 65 years than among those aged 65 years and older. Many of the observed racial, socioeconomic, and geographic disparities in cancer mortality align with disparities in exposure to risk factors and access to cancer prevention, early detection, and treatment, which are largely rooted in fundamental inequities in social determinants of health. Equitable policies at all levels of government, broad interdisciplinary engagement to address these inequities, and equitable implementation of evidence‐based interventions, such as increasing health insurance coverage, are needed to reduce cancer disparities.

Spectrum of somatic mutational features of colorectal tumors in ancestrally diverse populations

“…For decades, disparities in treatment response and cancer-related mortality have been reported across populations by factors such as socioeconomics, geography and racial and ethnic identities (3)(4)(5). Structural inequities and social injustices clearly impact prognosis and contribute to these persistent disparities (6,7).…”

Factors contributing to differences in cervical cancer screening in rural and urban community health centers

“…7 Similar to many other cancer types, cervical cancer mortality rates in the United States have generally been higher in rural and nonmetropolitan areas than urban and metropolitan areas. [12][13][14] For example, cervical cancer mortality in 2016-2020 was 27% higher in nonmetropolitan areas compared with metropolitan areas. 13 These disparities in rural-urban cancer mortality may reflect limited access to cancer preventive care, early detection, and treatment in rural populations because of socioeconomic barriers, low health insurance coverage, and limited transportation, internet access, or health literacy.…”

“…[12][13][14] For example, cervical cancer mortality in 2016-2020 was 27% higher in nonmetropolitan areas compared with metropolitan areas. 13 These disparities in rural-urban cancer mortality may reflect limited access to cancer preventive care, early detection, and treatment in rural populations because of socioeconomic barriers, low health insurance coverage, and limited transportation, internet access, or health literacy. 15,16 In particular, although early detection through cancer screening can reduce mortality from screenable cancers and also potentially prevent cervical cancers by identifying precancerous lesions, 17 the prevalence of cervical cancer screening has been lower in rural areas compared with urban areas.…”

“…15,16 In particular, although early detection through cancer screening can reduce mortality from screenable cancers and also potentially prevent cervical cancers by identifying precancerous lesions, 17 the prevalence of cervical cancer screening has been lower in rural areas compared with urban areas. 13,[18][19][20] For example, individuals living in rural areas in Minnesota, Iowa, and Wisconsin had lower odds of being up to date with cervical cancer screening than their counterparts living in urban areas in 2016-2017. 19 Although rural-urban disparities in cervical cancer screening in the general population have been well documented in prior studies, 13,[18][19][20] little information is available on differences in cervical cancer screening between rural and urban CHCs over time, including before and during the COVID-19 pandemic.…”

“…13,[18][19][20] For example, individuals living in rural areas in Minnesota, Iowa, and Wisconsin had lower odds of being up to date with cervical cancer screening than their counterparts living in urban areas in 2016-2017. 19 Although rural-urban disparities in cervical cancer screening in the general population have been well documented in prior studies, 13,[18][19][20] little information is available on differences in cervical cancer screening between rural and urban CHCs over time, including before and during the COVID-19 pandemic. Previous studies found an overall decline in the receipt of cancer screening among CHC patients in the first year of the pandemic but did not report the trends for rural and urban CHCs.…”