Black Americans in rural areas more likely to die of cancer

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Black Americans living in rural settings are more vulnerable to dying of lung, prostate, breast, and colorectal cancer than their non-Black peers, even when sociodemographics and tumor characteristics are taken into account, according to a study published May 19 in JAMA Network Open.

The findings highlight an ongoing healthcare inequity that must be addressed, wrote a team led by Marquita Lewis-Thames, PhD, of Northwestern University in Chicago.

"Policy changes, research, and financial supports are urgently needed to further investigate and close the [decades-long] gap that persists in urban and rural probabilities of cancer survival," the group noted.

Rural populations tend to experience higher cancer incidence and mortality rates compared with urban residents, and this tendency may be compounded by sociodemographic factors such as poverty, limited healthcare access, and racial discrimination -- factors which can be "overrepresented in rural communities," the team wrote.

The authors sought to explore national rural and urban trends in five-year cancer-specific survival for lung, prostate, breast, and colorectal cancer across a range of racial and ethnic groups. They used Surveillance, Epidemiology, and End Results (SEER) data from 1975 to 2016 (ending their analysis at 2011 to account for the last five-year survival period) and categorized the 3.6 million patients with cancer included in the study by type of region.

Of the total patient cohort, most were white (77.2%), while 10.8% were Black and 6.5% were Latinx (the remaining percentage were other races/ethnicities).

As to types of cancer, the team found the following:

  • 24.3% of patients had lung cancer.
  • 20.5% had colorectal cancer.
  • 27% had breast cancer.
  • 28% had prostate cancer.

Although cancer survival rates among Black individuals did improve between 1975 and 2016, they remained the shortest compared to their peers across all cancer types, the team found.

5-year cancer survival rate by type of disease and race/ethnicity
Group 1975 2011
Breast cancer
Urban Black women 74.2% 86.7%
Rural Black women 72% 86.5%
Urban Latinx women 81.5% 91.1%
Rural Latinx women 76.7% 90.4%
Urban white women 82.9% 92.4%
Rural white women 80.9% 91.5%
Colorectal cancer
Urban Black 65.6% 77.5%
Rural Black 71.3% 75.6%
Urban Latinx 70% 79.3%
Rural Latinx 74.5% 77.3%
Urban white 72.2% 79.7%
Rural white 69.9% 79.9%
Lung cancer
Urban Black 56.4% 57.8%
Rural Black 55.1% 57.7%
Urban Latinx 57.2% 59%
Rural Latinx Not significant Not significant
Urban white 57.7% 58.3%
Rural white 56.6% 58.6%
Prostate cancer
Urban Black men 80.9% 96%
Rural Black men 73.8% 95.4%
Urban Latinx men 82.3% 96.2%
Rural Latinx men 78.4% 96.1%
Urban white men 83.7% 96.9%
Rural white men 81.1% 96.5%

Also on May 19, a report published in JAMA Oncology outlined similar results as the Lewis-Thames study, finding that although cancer death rates decreased among Black Americans between 1999 and 2019, "higher cancer death rates among Black men and women compared with other racial and ethnic groups persisted in 2019."

"There were substantial decreases in cancer death rates among Black individuals from 1999 to 2019," wrote a team led by Wayne Lawrence, DrPH, of the U.S. National Institutes of Health (NIH) in Rockville, MD. "However, in 2019, Black individuals continued to have the highest cancer mortality rates compared with other racial and ethnic groups, suggesting a need to address the pervasiveness of longstanding racial and ethnic inequities."

One takeaway from the Lewis-Thames research is that geography is important, but it doesn't paint the whole picture, wrote Dr. Zachary Frosch of Fox Chase Cancer Center in Philadelphia in an accompanying commentary. There is a link between geography and sociodemographic factors, but some rural cancer patients may have more economic resources than others. That's why further research is important.

"Future studies should seek to untangle these complex associations," he urged. "Such data will help inform programs that aim to improve access to cancer care for rural patients and facilitate future progress in closing the rural-urban outcomes gap."

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