Editor’s note: This post was originally published on May 2, 2022, and has been updated on May 31, 2023, for accuracy and comprehensiveness.
Cancer is a complex disease with many forms. It affects people worldwide, regardless of age, gender, economic background, or race. Genetic and environmental factors can increase your risk of developing cancer. Research shows that race and ethnicity play a role, which was often overlooked until recently.
Not everyone faces the same level of cancer risk or shares similar outcomes. As a result, researchers are trying to understand the reasons behind the differences in how cancer occurs and its effects among different populations.
Studies show that in the US, people from minority or non-White racial/European ethnic backgrounds face a considerably higher level of disparity when it comes to cancer screening, detection, and treatment. This discrepancy affects their prognosis and the final outcome of their cancer battle.
This article explores racial and ethnic disparities in factors impacting cancer incidence, screening, treatment, and outcome.
Your non-genetic risk factors are the aspects of your life, surroundings, and environment that you may or may not be able to control. They include your social, cultural, environmental, lifestyle, or financial situations.
Independently or together, these factors often play a role in determining your chance of getting cancer and how likely you are to survive.
Race, ethnicity, and financial status are closely linked and can significantly impact your health, including your chance of getting cancer.
In the US, various racial and ethnic minority communities, such as Black/African American, Hispanic/Latino, and American Indian/Alaska Native (AI/AN), often face higher poverty rates and financial difficulties. These inequalities are due to historical and ongoing discrimination, which affects a community’s overall well-being and access to proper cancer screening and treatment.¹
Your socioeconomic situation may also affect your level of education, which in turn impacts your life choices. Smoking, alcohol consumption, and unhealthy eating habits increase your risk of cancer. For example, it is reported that regardless of race or ethnicity, those with the lowest educational attainment have a higher risk of many cancers, particularly those related to smoking.²
Many racial and ethnic minority communities also experience higher exposure to pollution, workplace hazards, and unhealthy living conditions. These factors, as well as the stress of living in poverty and facing discrimination, can lead to a higher risk of cancer.
People from lower socioeconomic backgrounds face challenges in accessing cancer screening and treatment. Not being able to access good healthcare, inadequate insurance coverage, and discrimination from healthcare providers all lead to delays in getting screened and worse treatment outcomes.
Unhealthy lifestyle habits, such as smoking, excessive alcohol consumption, and poor diet, can significantly increase your risk of developing various cancers.³
While you might think your lifestyle habits are fully within your control, this isn’t always the case. Your race, ethnicity, and where you were born may, unfortunately, determine your socioeconomic status, impacting your childhood circumstances, educational experiences, work, and access to healthcare. These factors can influence your ability to adopt or maintain healthy lifestyle habits.⁴
Research has consistently shown that people living at or near the poverty line face a higher risk of poor nutrition.⁵ Poverty creates a vicious cycle of inadequate access to healthy food, insufficient time or energy for exercise, and high stress levels. All these things contribute to declining overall health and an increased chance of developing chronic medical issues and cancers.⁶
Racial and ethnic groups living in areas with higher pollution levels, radiation, or hazardous waste may be at a higher risk of developing cancer. This is due to increased exposure to carcinogenic substances.
For instance, research has shown that Hispanic and Latino/a farmworkers in the US may have an elevated risk of cancer due to long-term exposure to agricultural pesticides.⁷ Moreover, minority and low-income communities tend to live in areas with high levels of air pollution, which disproportionately increases their risk of developing lung cancer and other respiratory illnesses.
A study examined the differences in cancer risks due to air pollution in Cancer Alley, Louisiana, based on income and race.⁸ This 100-mile area is named due to its abundance of petrochemical plants and their toxic byproducts.
The study’s findings show that people living in low-income areas, many of whom are Black, have a 12% higher cancer risk than those in high-income areas. Meanwhile, people living in predominantly Black areas have a 16% higher risk than those in mainly White areas. The study reports that as the percentage of Black residents increases, so does cancer risk.
The study also reveals that higher pollution levels lead to larger differences in cancer risk, especially in poorer and predominantly Black neighborhoods.
A review discussed how polluting industries are more likely to be situated near low-income communities of color in the US.⁹ Pollutants like toxic metals and harmful chemicals linger in the soil and water long after they are banned or discontinued. These harmful substances continue to affect new generations living near polluted areas. They face cumulative health hazards as a result, including an increased risk of developing various cancers and other health conditions.
As mentioned, access to healthcare is closely linked to socioeconomic status. Obtaining medical services can be highly challenging in countries like the US that have private healthcare systems.
Underprivileged individuals, particularly low-income minorities, often struggle to afford medical treatment for severe or chronic conditions. And, when they receive treatment, the quality of care may not be as high as what the White population receives. These communities experience a disproportionately higher mortality rate as a result.
It is reported that African American individuals are most likely to live for the shortest time after receiving a cancer diagnosis. Their likelihood of dying from most cancers is also higher than any other racial/ethnic group.¹⁰ This could be partially attributed to lower levels of adequate health insurance and access to high-quality care, which is crucial to early cancer detection and treatment.
Race and ethnicity even play a role in disparities in cancer screening. A study suggests that the current lung cancer screening criteria may need to be reviewed for African Americans who smoke.¹¹ ¹² Even when African American and White smokers have similar smoking habits, two-thirds of African American men with lung cancer wouldn’t meet the criteria for early screening.
Disparities in screening could cause an individual to receive a late diagnosis and a worse prognosis. The research shows that screening criteria need to be adjusted to account for these disparities, ensuring timely diagnoses and better healthcare outcomes within this group.
In a 2021 review on disparities in the screening, diagnosis, and treatment of liver cancer, researchers found that liver cancer rates are higher among Hispanics, Black people, and Asian Pacific Islanders (APIs) compared to non-Hispanic White people.¹³ This disparity may be due to the prevalence of conditions such as hepatitis C virus (HCV), nonalcoholic fatty liver disease (NAFLD), alcoholic liver disease, metabolic disorders, and certain genetic predispositions within these populations.
However, race and ethnicity have still been found to impact how people receive medical care for liver cancer. According to a 2018 study, a similar proportion of hepatocellular carcinoma (HCC) is detected through regular check-ups in both White and non-White people.¹⁴ However, White patients tend to get more specialized care for liver issues in the year before they are diagnosed.
Black and Hispanic patients are also less likely to be diagnosed during the early stages of liver cancer than White patients. For Black patients, this difference can be explained by lower screening rates resulting from a lack of access to healthcare. Limitations in access to care also impact the type of cancer treatment both Hispanic and Black patients receive.
Other factors, such as location (rural versus urban living), mobility and transportation, and doctor availability, can also impact healthcare access. Limited access to timely and affordable healthcare services makes underprivileged populations even more vulnerable.
Discrimination remains prevalent in hospitals and medical facilities across the Western world. This is despite advances in the last few decades and continued efforts to improve healthcare professionals’ awareness of the issues various racial and ethnic populations face in healthcare.
A significant body of research reveals that people of color often receive lower-quality care than their White peers.¹⁵ Unfortunately, to this day, many aspects of the medical system are affected by long-standing biases that result in individual and systemic discrimination.
Additionally, the medical education healthcare professionals receive is sometimes influenced by racial bias and a lack of diversity. Many healthcare professionals are not adequately prepared to equitably evaluate, diagnose, and treat people of different races or ethnic backgrounds.
Sometimes, healthcare providers may unintentionally provide substandard care to patients of color due to hidden biases.¹⁶ These biases can affect how they diagnose and treat patients. For example, a small number of White healthcare providers may wrongly believe their non-White patients are less likely to follow treatment plans or more likely to engage in risky health behaviors. They might overlook symptoms or make incorrect assumptions about a patient’s pain tolerance, among other things.
Although open discrimination has decreased, subtle discrimination and institutional bias still impact treatment decisions and provider actions. Despite this, it’s crucial to recognize that most healthcare professionals from various backgrounds strive to offer fair care to all patients.
Unsurprisingly, though, people of color are more reluctant than their White peers to seek the help they need because they fear they may not be treated fairly. This can ultimately contribute to less cancer screening and late-stage diagnosis.
Various factors contribute to the differences in cancer rates among different racial and ethnic groups. While we can’t ignore the role that lifestyle, access to healthcare, and even racism might play in these disparities, it’s essential to acknowledge that genetic factors can also make a difference.
A family history of cancer can heighten your risk of developing the same type of cancer. Some types of hereditary cancer appear to be more common in specific racial and ethnic groups, leading to increased cancer risks within these groups.¹⁷
Examples of such hereditary diseases include Lynch syndrome and Li-Fraumeni syndrome. These syndromes involve inherited gene mutations that significantly increase the risk of developing various types of cancer. Therefore, identifying those affected and providing appropriate monitoring and preventive measures is crucial.
Other examples include hereditary breast cancer and ovarian cancer. Inherited gene mutations, such as BRCA1 and BRCA2, can substantially increase your risk of developing these and other cancers.
Researchers have found that these mutations are more common in some racial and ethnic groups. For instance, Ashkenazi Jews have a higher prevalence of BRCA1 and BRCA2 mutations, making them more susceptible to developing breast and ovarian cancer.¹⁸
Understanding the differences in how cancer affects various racial groups involves diving into the world of genetics, specifically looking at something called genetic polymorphism. Polymorphism is when two or more trait variations are found in a single gene, revealing that the DNA is quite diverse.¹⁹
The concept of polymorphism might sound a little foreign. Even the experts are still trying to fully grasp its medical significance and implications.
One interesting example to help illustrate this concept is the TP53 P72R polymorphism. This particular genetic variation is more commonly found in African Americans with colon cancer and Asians with gastric cancer.²⁰ Researchers believe this may be due to a faster accumulation of mutations and a larger pool of cells that could potentially initiate cancer. Essentially, people with this polymorphism might be more genetically predisposed to developing these types of cancer.
Scientists are currently studying many other polymorphisms to better understand the differences in cancer risk among racial groups. Although we don’t yet have all the answers, genome sequencing could play a key role in helping us unravel this complex area of human science.²¹
Cancer-driving gene mutations, or “driver” mutations, are changes in DNA that promote cancer development. They do so by altering the function of genes involved in cell growth, division, and repair.
Some racial and ethnic groups may have a higher prevalence of specific cancer-driving gene mutations, which can contribute to disparities in cancer risk. For example, the EGFR gene mutation, which drives the development of non-small cell lung cancer, is more prevalent in Asian populations than in other racial groups.²²
Other gene mutations could also make some groups more likely to experience obesity, chronic inflammation, and inappropriate immune responses, which can impact an individual’s overall health.
Obesity is a well-established risk factor for various types of cancer, including breast, colorectal, and endometrial cancer.
Research has shown that certain racial and ethnic groups, such as African Americans and Hispanic people in the US, have higher obesity rates than others.²³ This may partly explain the higher cancer rates observed in these groups.
Obesity has been shown to affect cancer risk through various mechanisms, such as increased levels of inflammation, altered hormone production, and changes in the microenvironment surrounding cells. These mechanisms can promote cancer development and progression.²⁴
Disparities in obesity rates can be attributed to some non-genetic factors such as exposure to public health and nutrition education, access to healthcare, cultural influences, and lifestyle habits. However, biological and genetic factors can also influence a person’s risk of obesity and cancer.
Certain genetic variants may make a person more prone to obesity or impact their ability to maintain a healthy weight. These genetic factors can vary between individuals and populations, which can result in different obesity rates and cancer risks among various racial and ethnic groups.
For example, some African American and Hispanic populations may have a higher prevalence of genetic variants that predispose them to obesity, raising their cancer risk.²⁵
Additionally, the SEMA4D protein has been linked to a significantly higher risk of obesity.²⁶ While both West Africans and African Americans share high expression of the gene that encodes this protein, research shows that African people born in other countries are less likely to become obese than African Americans. This indicates that obesity-related genes are not independent risk factors — the environment also plays a role.
Obesity can significantly increase both the incidence and mortality of various cancers.²⁷ Implementing targeted interventions to address obesity, such as culturally tailored nutrition and physical activity programs, can help reduce cancer risk in these populations.
Chronic inflammation, which can be caused by numerous health conditions, has been linked to an increased risk of several types of cancer, including colorectal, liver, and pancreatic cancer. Certain racial and ethnic groups may experience higher levels of chronic inflammation due to genetic factors, dietary patterns, or exposure to environmental factors.
This heightened inflammation can contribute to disparities in cancer risk among different populations. For instance, a higher prevalence of Helicobacter pylori infection, which causes chronic inflammation in the stomach, is associated with increased gastric cancer rates in Black and Hispanic populations.²⁸ According to some studies, genetic polymorphisms in East Asian individuals with Helicobacter pylori infection may induce gastric precancerous conditions that increase the risk of stomach cancer in this population.²⁹
Research shows that Black and Hispanic people generally have higher levels of inflammatory proteins in their blood compared to other groups. This is true even when considering factors like body mass index (BMI).
A study examined genetic variations of C-reactive protein (CRP) in about 7,000 people.³⁰ This protein reflects the level of inflammation in the body. It found that specific gene variations were linked to higher CRP levels in Black and Mexican American groups. Other gene variations were tied to lower CRP levels in these same groups. These genetic differences in CRP might help explain why cancer rates vary among different groups.
Your immune system plays a crucial role in detecting and eliminating cancer cells, and variations in immune function may impact your susceptibility to cancer. Researchers are currently exploring how immune responses might vary between different racial groups.
Genetic variations are often found within your immune system. Over time, the genes in your immune system evolve in response to various factors, such as environmental conditions and historic population migration.
People with African ancestry appear to have unique differences in their immune systems, possibly resulting from evolutionary pressures relating to specific regional diseases.³¹
Differences in immune responses among racial and ethnic groups can contribute to disparities in cancer risk and outcomes.
Certain aggressive cancer subtypes have been found to affect specific racial and ethnic groups disproportionately, even after accounting for other risk factors.
For example, triple-negative breast cancer, an aggressive form of the disease that is more difficult to treat, is more common among African American women.³²
To address cancer disparities among different racial and ethnic groups, researchers and healthcare professionals are working to improve early detection, access to care, development of targeted therapies, and community-based campaigns to raise awareness about the importance of cancer prevention and screening.
However, efforts to close the gap in cancer outcomes between racial groups have yet to yield significant changes.³³ Recently, more targeted efforts to improve inclusion and healthcare access to various populations have been launched on governmental and federal levels.
Two new acts, the Diverse and Equitable Participation in Clinical Trials (DEPICT) Act and the Diversifying Investigations Via Equitable Research Studies For Everyone (DIVERSE) Trials Act, are part of new US legislation in 2023.³⁴ ³⁵ These acts aim to achieve increased diversity in clinical trials to ensure new treatments are effective across different populations.
The DEPICT Act makes it mandatory for researchers to be more transparent about demographic enrollment targets for clinical trials. They will need to provide a Diversity Action Plan for achieving their targets, which might include diversity training for those working on the trial and outreach activities in certain demographic groups.³⁶
Participation of Black Americans in cancer clinical trials is extremely low. Research shows that while Black Americans make up roughly 22% of yearly multiple myeloma cancer cases, enrollment in clinical trials is just 4.5%.³⁷
From 2009 to 2019, the US Food and Drug Administration (FDA) granted approval for 81 oral chemotherapy drugs referencing data from 142 clinical trials. Only 52% of these trials reported on participants’ race and ethnicity.³⁸ So, the recent move to mandate the inclusion of diverse populations in clinical trials is a major milestone.
Increasing access to quality healthcare in underrepresented communities is crucial in addressing disparities in cancer outcomes.
Providing culturally competent care and ensuring that healthcare providers are knowledgeable about the unique challenges faced by different racial and ethnic groups can also contribute to better cancer prevention, diagnosis, and treatment.
More culturally appropriate education and outreach programs are needed to bridge knowledge gaps and encourage participation in cancer prevention and screening activities. Race-adapted cancer screening programs can improve early detection rates and inform patients about how race-specific genetics impacts their health.
Most importantly, open communication between medical professionals and vulnerable communities is essential for fostering trust and encouraging participation in research and healthcare initiatives.
There’s a long way to go in closing the gap between cancer incidence and mortality rates among different racial groups. However, there’s hope for improved genetic research and a better understanding of race’s role in cancer susceptibility.
Race and ethnicity play a significant role in a person’s risk of developing cancer, with various genetic, environmental, and socioeconomic factors contributing to these disparities. It also affects their chance of receiving a diagnosis and treatment.
Understanding the complex relationship between race, ethnicity, and cancer risk is crucial for developing effective prevention and treatment strategies to help close the cancer outcomes gap between different populations.
Breaking the cycle of poverty, inadequate healthcare, and poor health can be challenging. This makes it difficult for medical professionals, scientists, and data analysts to pinpoint specific solutions.
Continued research into the genetic, environmental, and socioeconomic factors that contribute to cancer disparities will enable the development of targeted interventions and personalized treatments. By increasing awareness, supporting research, and implementing targeted interventions, a future where everyone has equal access to cancer prevention, early detection, and effective treatments will emerge, ultimately reducing the global burden of this devastating disease.
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Cancer Disparities | NIH: National Cancer Institute
Preventing Cancer | The Nutrition Source — Harvard T.H. Chan School of Public Health
Hunger & Health — The Impact of Poverty, Food Insecurity, and Poor Nutrition on Health and Well-Being | Food Research & Action Center
Polymorphism | National Human Genome Research Institute
Obesity and Cancer | Centers for Disease Control and Prevention
Obesity and Cancer Fact Sheet | NIH: National Cancer Institute
H.R.6584 - 117th Congress (2021-2022): DEPICT Act | Library of Congress
S.2706 - 117th Congress (2021-2022): DIVERSE Trials Act | Library of Congress
What is the DEPICT Act | Society for Clinical Research Sites
A SNAPSHOT OF U.S. CANCER HEALTH DISPARITIES | American Association for Cancer Research
Toketemu Ohwovoriole is a healthcare writer who has spent the last six years creating content for companies and publications around the globe. She has been featured in The Huffington Post, Insider, Verywell, and other major publications. Her previous work delves into the mental and physical health effects of birth control, overall wellness, and sensitive women's healthcare issues.
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