Cancer Deaths Decline in Black Americans, but Disparities Persist

The cancer death rate among Black Americans has declined over the past two decades, but remains elevated compared to all other racial and ethnic groups, a cross-sectional study indicated.

From 1999 to 2019, a large decrease in the annual cancer death rate was observed among Black individuals, on the magnitude of 200 per 100,000 Black men and 75 per 100,000 Black women, reported Wayne R. Lawrence, DrPH, of the National Cancer Institute in Bethesda, Maryland, and colleagues.

These decreases translated into average annual reductions in cancer deaths of 2.6% for men and 1.5% for women, according to their findings in JAMA Oncology.

Drops in lung cancer deaths represented the largest absolute decreases for Black men and women alike: 78.5 and 19.5 fewer deaths per 100,000, respectively, by the final year of the study. And death rates steadily fell for most cancer types, with the greatest observed declines seen with lung cancer in men (-3.8% annual change) and gastric cancer in women (-3.4% annual change).

“Even though there has been a decline in cancer mortality nationally among Black people, they continued to bear a higher cancer burden overall than all other racial and ethnic groups studied,” Lawrence said in a statement.

“The disparity in deaths likely reflects systemic and preventable barriers to getting quality care. Whether it’s screening for cancer, timely diagnosis, or the receipt of proven treatments,” Lawrence explained. “Black individuals continue to have a delay in care or receive poorer care than their white counterparts.”

By 2019, age-standardized cancer mortality rates were 294.1 per 100,000 Black men and 205.1 per 100,000 Black women, both higher than all other groups:

• White: 249 and 181.8 per 100,000, respectively
• American Indian/Alaska Native: 255.2 and 188.5 per 100,000
• Hispanic: 176.7 and 127.9 per 100,000
• Asian/Pacific Islanders: 149.5 and 113.2 per 100,000

This extended to multiple types of cancers, with the most pronounced being prostate cancer, where the mortality rate in Black men was five times higher than that seen in Asian or Pacific Islander men (51.3 vs 11.0 per 100,000). For breast cancer, deaths among Black women were more than twice as high compared with Asian or Pacific Islander women (39.0 vs 16.1 per 100,000).

Overall, 1,361,663 million cancer deaths occurred among Black adults (age 20 and up) from 1999 to 2019, with age-adjusted rates of 377.3 per 100,000 men and 239.4 per 100,000 women for the full study period.

While most types of cancers declined, there were increases in liver cancer deaths in Black individuals ages 65 to 79, with annual increases of 3.8% in men and 1.8% in women. Annual increases were also seen with uterine cancer in Black women across multiple age groups: 35 to 49 years (2.9% per year), 50 to 64 years (2.3%), and 65 to 79 years (1.6%).

“Eliminating racial and ethnic disparities in cancer mortality will require equitable access to cancer prevention, early diagnosis, and timely and guideline-adherent high-quality care,” concluded Lawrence and colleagues.