Cancer health disparities are adverse differences between certain groups in cancer measures, such as:

• Incidence (new cases)
• Prevalence (all existing cases)
• Morbidity (cancer-related health complications)
• Mortality (deaths)
• Survivorship and quality of life after cancer treatment
• Burden of cancer or related health conditions
• Screening rates
• Stage at diagnosis

Cancer health disparities are often considered in the context of race and ethnicity; however, other population groups may experience disparities. People who are from low socioeconomic backgrounds often bear a greater burden of disease than the general U.S. population. Other population groups that experience cancer health disparities may be defined by age, disability, gender and sexual identity, education, or other characteristics.

What Contributes to Cancer Health Disparities?

Complex and interrelated factors contribute to the observed disparities in cancer incidence and death among racial, ethnic, and underserved groups. The most obvious factors are associated with a lack of health care coverage and low socioeconomic status (SES).

SES is most often based on a person's income, education level, occupation, and other factors, such as social status in the community and where he or she lives. Studies have found that SES, more than race or ethnicity, predicts the likelihood of an individual's or a group's access to education, certain occupations, health insurance, and living conditions—including conditions where exposure to environmental toxins is most common—all of which are associated with the risk of developing cancer and the likelihood of survival. SES, in particular, appears to play a major role in influencing the prevalence of behavioral risk factors for cancer, such as tobacco use, physical inactivity, obesity, excessive alcohol intake, and health status). SES also affects individuals' decisions to follow cancer screening recommendations.

Research also shows that individuals from medically underserved populations are more likely to be diagnosed with late-stage diseases that might have been treated more effectively or cured if diagnosed earlier. Financial, physical, and cultural beliefs are also barriers that prevent individuals or groups from obtaining adequate health care.

Biological differences also appear to play a role in some cancer health disparities. For example, there may be biological differences between the triple-negative breast, colorectal, and prostate cancers in African Americans and people of other racial/ethnic groups. Advances in genomics and other molecular technologies are improving our understanding of how biological differences among population groups contribute to health disparities and how biological factors interact with other potentially relevant factors, such as diet and the environment.

Cancer affects all population groups in the United States, but due to social, environmental, and economic disadvantages, certain groups bear a disproportionate burden of cancer compared with other groups.

Cancer disparities (sometimes called cancer health disparities) are differences in cancer measures such as:

• incidence (new cases)
• prevalence (all existing cases)
• mortality (deaths)
• survival (how long people survive after diagnosis)
• morbidity (cancer-related health complications)
• survivorship (including quality of life after cancer treatment)
• financial burden of cancer or related health conditions
• screening rates
• stage at diagnosis

Cancer disparities can also be seen when outcomes are improving overall but the improvements are not seen in some groups relative to other groups.

Population groups that may experience cancer disparities include groups defined by race/ethnicity, disability, gender identity, geographic location, income, education, age, sexual orientation, national origin, and/or other characteristics.

Although cancer incidence and mortality overall are declining in all population groups in the United States, certain groups continue to be at increased risk of developing or dying from particular cancers.

Statistics from NCI’s Surveillance, Epidemiology, and End Results Program include information specific to racial and ethnic populations as well as populations defined by age, gender, and geography. Some key cancer incidence and mortality disparities in the United States include:

• Black/African American people have higher death rates than all other racial/ethnic groups for many, although not all, cancer types.

• Despite having similar rates of breast cancer, Black/African American women are more likely than White women to die of the disease.

• The incidence rates of colorectal, lung, and cervical cancers are much higher in rural Appalachia than in urban areas in the region.

• Although deaths from prostate cancer have dropped substantially in recent decades among all men, Black/African American men are twice as likely as White men to die of prostate cancer and continue to have the highest prostate cancer mortality among all US population groups.

• People with more education are less likely to die prematurely (before the age of 65) from colorectal cancer than those with less education, regardless of race or ethnicity.

• Hispanic/Latino and Black/African American women have higher rates of cervical cancer than women of other racial/ethnic groups, with Black/African American women having the highest rates of death from the disease.

• American Indians/Alaska Natives have higher death rates from kidney cancer than any other racial/ethnic group.

• The rates of smoking and alcohol drinking, which increase cancer risk, are higher among lesbian, gay, and bisexual youths than among heterosexual youths.

• American Indians/Alaska Natives have the highest rates of liver and intrahepatic bile duct cancer, followed by Hispanics/Latinos and Asians/Pacific Islanders.

Cancer disparities reflect the interplay among many factors, including social determinants of health, behavior, biology, and genetics—all of which can have profound effects on health, including cancer risk and outcomes.

Certain groups in the United States experience cancer disparities because they are more likely to encounter obstacles in getting health care.

For example, people with low incomes, low health literacy, long travel distances to screening sites, or who lack health insurance, transportation to a medical facility, or paid medical leave are less likely to have recommended cancer screening tests and to be treated according to guidelines than those who don’t encounter these obstacles.

Social Determinants of Health

The Department of Health and Human Services defines social determinants of health as the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect health, functioning, and quality of life.

People who do not have reliable access to health care are also more likely to be diagnosed with late-stage cancer that might have been treated more effectively if diagnosed at an earlier stage.

Some groups are disproportionately affected by cancer due to environmental conditions. People who live in communities that lack clean water or air may be exposed to cancer-causing substances.

The built environment can also influence behaviors that raise one’s risk of cancer. For example, people who live in neighborhoods that lack affordable healthy foods or safe areas for exercise are more likely to have poor diets, be physically inactive, and obese, all of which are risk factors for cancer.

Even people of higher socioeconomic status and those with health insurance may experience cancer disparities. The disparities these individuals experience may reflect the health impact of institutional racism and the chronic stress it causes, conscious or unconscious bias from health providers, mistrust of the health care system, and/or fatalistic attitudes about cancer.

In some cases, inherited factors or tumor biological factors may, either directly or by interacting with factors such as diet, chronic stress, or tobacco exposure, lead to cancer disparities.

Health Equity

According to the Centers for Disease Control and Prevention, health equity is achieved when every person has the opportunity to attain his or her full health potential and no one is disadvantaged from achieving this potential because of social position or other socially determined circumstances.

For example, some evidence suggests that there are differences in the genetics, tumor biology, and immune environment of triple-negative breast, colorectal, and prostate cancers that arise in African Americans compared with those that arise in people of other racial/ethnic groups. These differences may contribute to disparities in incidence, aggressiveness, and response to treatment of these cancers.

Cancer disparities may also be exacerbated by the lack of diversity in clinical research participation. Because of this lack of diversity, research results may not be applicable to all populations.

Because many different factors can influence cancer disparities, addressing them is not always simple or straightforward. Reducing or eliminating some cancer disparities in the pursuit of health equity will require policy changes to overcome systemic social, racial, and/or institutional inequalities.

NCI-funded researchers are working to identify other ways to improve outcomes for groups disproportionately affected by cancer. Their research efforts range in scope from designing and implementing culturally appropriate health interventions, to improving access to care and clinical trials, to examining genetic factors that may explain differences in rates of aggressive cancers.

Racism is a system that assigns value and gives opportunity to people based on the way they look or the color of their skin. CDC brought issues of social justice and health equity to the forefront of the national discussion in April 2021, when CDC’s director declared racism a serious public health threat. Racism is a serious threat to the public’s health because it makes it harder to address other social determinants of health.

Racism works as a system on several connected levels and includes structural, institutional, interpersonal, and internalized racism. It contributes to cancer health disparities by limiting the ability of people of racial and ethnic minority groups to prevent cancer, find cancer early, and get treatment. For example—

• Structural racism is the way key areas of society (education, employment, health care, housing, and law enforcement) are structured to benefit the group in power and hinder racial and ethnic minority groups. Because of structural racism, health care can be difficult to access, navigate, and pay for, especially for historically marginalized groups.

  For example, American Indian and Alaska Native people are more likely to get colorectal cancer than White people. One reason may be that many Native people live far away from clinics that provide colonoscopies.

• Institutional racism is the way practices and policies of institutions block racial and ethnic minority groups from access to resources and opportunities.

  For example, Black women are less likely to live 5 years after being diagnosed with cervical cancer than White women. This disparity may be partly explained by a lack of proper clinical follow-up practices after screening.

• Interpersonal racism can be seen during individual interactions, when a person’s conscious or unconscious racial prejudice results in discriminatory behavior or actions that block another person’s access to resources or opportunities.

  For example, a scheduler who only gives the most convenient follow-up appointments to patients who look like them, regardless of the patients’ health status, is showing interpersonal racism.

• Intrapersonal or internalized racism is when people of racial and ethnic minority groups accept stereotypes about themselves and those who share their identity and believe that members of other racial and ethnic groups are superior.

From 1999 to 2019, rates of cancer deaths declined steadily among Black people in the United States. Nevertheless, in 2019, Black people still had considerably higher rates of cancer death than people in other racial and ethnic groups, a large epidemiologic study has found. The study was led by researchers at the National Cancer Institute, part of the National Institutes of Health, and the findings appeared May 19 in JAMA Oncology.

“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,” said Wayne R. Lawrence, Dr.P.H., of the Metabolic Epidemiology Branch in NCI’s Division of Cancer Epidemiology and Genetics, who led the study.

Dr. Lawrence and his colleagues used death certificate data from the National Center for Health Statistics to analyze age-adjusted cancer death rates by age, sex, and cancer site among non-Hispanic Black people ages 20 and older in the United States. They then compared cancer death rates in 2019 among Black men and women with those in other racial and ethnic groups.  

Between 1999 and 2019, more than 1 million Black men and women ages 20 and older died of cancer. During that period, cancer death rates among this group decreased by 2% per year, with a more rapid decrease among men (2.6% per year) than women (1.5% per year).

Death rates declined for most cancer types; the most rapid decreases were in lung cancer among men (3.8% per year) and stomach cancer among women (3.4% per year). However, over the same 20-year period, deaths from liver cancer increased among older Black men and women and deaths from uterine cancer increased among Black women.

Dr. Lawrence noted that the overall declines in cancer death rates in Black people could be due to some combination of improved access to screening, earlier detection, advances in treatment, and behavioral changes, such as declines in cigarette smoking.

In their comparison of cancer death rates among racial and ethnic groups in 2019, the researchers found that Black men and women had higher rates of cancer death, both overall and for most cancer types, than White, Asian or Pacific Islander, American Indian/Alaska Native, and Hispanic/Latino men and women.

For example, the prostate cancer death rate among Black men was nearly five times higher than among Asian or Pacific Islander men. The breast cancer death rate among Black women was nearly 2.5 times higher than among Asian or Pacific Islander women.

Dr. Lawrence noted that 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, he explained, “Black individuals continue to have a delay in care or receive poorer care than their White counterparts.”

Black people are also more likely to live in neighborhoods with poor access to specialists, to see physicians with limited clinical resources, and to live in communities with greater exposure to environmental carcinogens such as air pollution, the researchers said.

One limitation of the study is the broad groupings used for race and ethnicity, which could make it harder to tease out differences among people who are racially categorized as Black, Dr. Lawrence said. Another limitation is the potential misclassification of race and ethnicity and of underlying cause of death recorded on death certificates.

One cause for concern, he noted, is the disproportionate effect of COVID-19 on access to cancer-related medical care in Black communities in the United States, such as a larger decline in breast cancer screening among Black women compared with White women.

“These factors could cause the decline in cancer death rates among Black individuals to slow in coming years,” Dr. Lawrence said.

Melanie Nix is a triple-negative breast cancer survivor.

Credit: National Cancer Institute

Health-related differences in disease incidence and outcomes among distinct racial and ethnic groups, known as health disparities, are thought to reflect the interplay of socioeconomic factors, culture, diet, stress, the environment, and biology. The least understood of these factors is the role of biology. With the advent of advanced genomics and other molecular technologies and the growing sophistication of computational tools, an understanding of how biology contributes to health disparities and how biological factors interact with other relevant factors, such as diet and the environment, may finally be within our reach.

Some examples of early findings in this area of research are summarized below. These examples are from studies of men and women of African and European descent. Until fairly recently, the lack of large samples of germline DNA from individuals across a wide range of racial and ethnic groups for comparative purposes was a barrier to expanding this research.

Future Directions

Understanding the role that biology plays in cancer health disparities and the interplay of biological factors with other factors that contribute to differences in the cancer burden experienced by different populations must remain a research priority. As that understanding grows, new opportunities for prevention, early detection, and intervention will undoubtedly be revealed.

We must also continue to explore and find innovative ways to mitigate the effects of other factors apart from biology that contribute to cancer health disparities, such as limited access to and utilization of health care services, including cancer screening programs, and the ability to pay for care. The state of Delaware’s experiment to reduce racial disparities in colorectal cancer is a real-world example of what is possible.

From health statistics data, we have known for some time that African American women have a higher death rate from breast cancer than women of other racial and ethnic groups. Research reported within the past few years has revealed a higher prevalence of a poor prognosis molecular subtype of breast cancer, called the basal-like or triple-negative subtype (estrogen-receptor negative, progesterone-receptor negative, and HER2-protein negative), among African American women than among women of other racial and ethnic groups, especially among premenopausal women. However, the higher frequency of this poor prognosis subtype alone does not fully explain the poorer breast cancer survival rates among African American women. In a study reported in 2006, the 5-year relative survival of premenopausal women with advanced (stage III or IV) triple-negative breast cancer was 14 percent for African American women, compared with 37 percent for non-Hispanic white women and 38 percent for Hispanic women.

Some evidence suggests there could be biological differences between the triple-negative breast cancers that arise in African American women compared with those that arise in women of other racial and ethnic groups. Nearly 70 percent of the breast cancers that occur in BRCA1 gene mutation carriers are triple-negative. Several studies, however, have shown that the incidence of germline BRCA1mutations is much lower among African American women diagnosed with triple-negative disease than among similar women of other races or ethnicities. In one study, 50 percent of white non-Ashkenazi Jewish women diagnosed with triple-negative breast cancer had a germline mutation in BRCA1, whereas fewer than 20 percent of African American women diagnosed with triple-negative disease did. These observations suggest another genetic mechanism or mechanisms could be at play in promoting triple-negative breast cancers in African American women.

Colorectal cancer incidence and mortality are higher among African American men and women than among men and women of other racial and ethnic groups. To explore the possibility that tumor genetics might contribute to this disparity, an NCI-supported team of researchers sequenced paired germline and tumor DNA from more than 100 patients diagnosed with either late-stage or early-stage colorectal cancer. They identified 20 new genes that are significantly mutated in colorectal cancer. Fifteen of these genes appear to be preferentially associated with colorectal tumors that arise in African Americans, accounting for 41 percent of colorectal cancers in African Americans versus 15 percent of colorectal cancers in whites.

Mutations in three of the 15 genes, namely EPHA6, FLCN, and HTR1F, were found exclusively in colorectal cancers arising in African Americans. EPHA6 and FLCN are of particular interest because they belong to known oncogenic pathways. EPHA6encodes a cell-surface receptor tyrosine kinase called ephrin type-A receptor 6, which is involved in cell signaling. The function of the protein encoded by FLCN, folliculin, is not yet known, but researchers believe it may act as a tumor suppressor. Based on their findings and other data, the researchers have proposed EPHA6 and FLCN as candidate colorectal cancer driver genes in African Americans.

Because the patient population in this study was drawn exclusively from northeastern Ohio, it will be necessary to confirm these findings in African American patients from other regions of the country. However, the results suggest that the tyrosine kinase activity of the EPHA6 protein may be a target for potential therapeutic drug development.

The incidence of prostate cancer among African American men is approximately 60 percent higher than among American men of European ancestry, and their mortality rate is two to three times higher. At the time of prostate cancer diagnosis, African American men typically present with more advanced disease than white men. Some evidence indicates that prostate cancer growth is faster and/or there is an earlier transition from latent to aggressive disease in African American men, which may explain, in part, the observation of more advanced disease at diagnosis. These features suggest that the biology of prostate cancer in African American men and white men may differ in important ways.

In support of this notion, genetic analyses conducted by NCI-funded researchers have identified multiple regions on the long arm of chromosome 8 (at 8q24) that are associated with susceptibility to prostate cancer. The researchers have proposed that genetic variation in these regions may explain up to 50 percent of the higher risk of prostate cancer observed among men of African descent.

Some of the same researchers have identified a second chromosomal region—this one on the long arm of chromosome 17 (at 17q21)—that is associated with increased prostate cancer risk among African American men compared with men of other populations. Approximately 5 percent of African American men carry a rare genetic variant in this region that appears to be associated with higher prostate cancer risk. This genetic variant has been found in less than 1 percent of men of other populations.

Ongoing research is aimed at understanding the functional consequences of these and other genetic variants that influence prostate cancer risk—not only among African American men but in all men. Only then will we have insights that have the potential to be translated into clinical benefit, including effective strategies for early detection and disease prevention.

Additional studies have identified epigenetic differences and differences in gene expression patterns and other molecular characteristics between the prostate tumors of African American men and white men. In one study, researchers found higher levels of a protein called Kaiso, a regulator of gene expression, in the nuclei of prostate cancer cells from African American men than in the nuclei of prostate cancer cells from white men. In the study, higher nuclear levels of Kaiso were associated with aggressive prostate cancer, and the protein was shown to decrease expression of E-cadherin, a tumor suppressor protein that functions as a cell–cell adhesion receptor. Loss of E-cadherin-mediated cell–cell adhesion has been implicated in the transition from noninvasive lesions to invasive, metastatic cancers.

When talking about cancer, equity is when everyone has an equal opportunity to prevent cancer, find it early, and get proper treatment and follow-up care. Different groups of people have different rates of getting and dying from certain kinds of cancer. Some groups find it harder to make healthy choices that help prevent cancer, or to get medical care.

Compared to members of other races, Black and African American people have higher rates of getting and dying from many kinds of cancer.

• Black people have the highest death rate for cancer overall.
• Black people have a lower overall 5-year cancer survival rate than White people.
• Black people are more likely than White people to be diagnosed with female breast, lung, and colorectal cancers at a late stage. Cancer is harder to treat after it spreads from the place where it started to other parts of the body.

Many cancers can be prevented. Staying away from tobacco smoke, keeping a healthy weight, drinking little or no alcohol, and getting human papillomavirus (HPV) vaccinations on time can lower the risk of getting cancer. Screening tests can prevent some cancers or find them early, when treatment works best. Some of these risk factors vary by race and ethnicity.

• More Black men than White men say they smoke cigarettes now.
• Non-Hispanic Black Americans are more likely than other groups to be exposed to smoke from other people’s cigarettes, called secondhand smoke.
• Obesity is most prevalent among non-Hispanic Black adults.
• Non-Hispanic White adults are more likely than non-Hispanic Black adults to engage in heavy drinking.
• Overall, non-Hispanic White adults are more likely than non-Hispanic Black adults to be vaccinated against HPV. HPV vaccines help prevent several kinds of cancer.
• Black people are more likely than White people to be up to date on screening tests for colorectal, breast, and cervical cancer.

Note: In the statistics above, some comparisons are only between race categories, while others are between race and ethnicity categories (non-Hispanic or Hispanic).

How to Lower Your Risk

If you are a Black or African American person, you can take steps to lower your risk of getting cancer.
Note: Some comparisons are only between race categories, while others are between race and ethnicity categories (non-Hispanic or Hispanic).

Prostate Cancer

Black men are more likely to get prostate cancer than men who are members of other racial or ethnic groups. They are more than twice as likely to die from prostate cancer than other men. Learn about the possible benefits and harms of prostate cancer screening. Then talk to your doctor about your own risk and decide if screening is right for you.

Breast Cancer

Overall, White women are more likely to get breast cancer than Black women, but Black women are more likely die from the disease. Breast cancer is often diagnosed at later stages and is more aggressive in African American women than in White women. Know how your breasts normally look and feel. Talk to your doctor if you notice changes.

Lung Cancer

Black men have the highest rates of developing and dying from lung cancer. If you smoke, try to quit, and stay away from other people’s cigarette smoke. If you’re 50 to 80 years old and smoke now or quit in the last 15 years, lung cancer screening may be right for you.

Cervical Cancer

Black women are more likely to die from cervical cancer than other women in the United States. If you’re 26 years old or younger, make sure you’re vaccinated against HPV. HPV causes almost all cervical cancers. If you’re 21 to 65 years old, get screened for cervical cancer regularly.

Non-Hispanic American Indian and Alaska Native people have higher rates of getting certain kinds of cancer than non-Hispanic White people. They have been the subject of centuries of systemic racism, which have often resulted in less access to health care, healthy food, and educational and employment opportunities.

These types of inequities have contributed to many health disparities, including higher cancer rates, across American Indian and Alaska Native tribes and between American Indian and Alaska Native people and people of other races and ethnicities. Eliminating these inequities can improve health outcomes for these populations.

Cancer Rates

Tribal groups have unique cancer patterns. The rates of getting and dying from certain kinds of cancer can vary widely among American Indian and Alaska Native people in different areas of the United States. For example—

• Lung cancer is the most common cancer among non-Hispanic American Indian and Alaska Native populations in five of the six Indian Health Service (IHS) regions in the United States. But in the Southwest region, lung cancer is the fourth most common cancer, after colorectal, kidney, and liver cancer.
• Stomach cancer is the fourth most common cancer among non-Hispanic American Indian and Alaska Native people in Alaska but the sixth most common cancer among this population in the Southwest region. Stomach cancer is not among the top 10 most common cancers in other regions.
• The overall rate of getting cancer is more than twice as high among non-Hispanic American Indian and Alaska Native people in the Southern Plains region (612 per 100,000 people) compared to the Southwest region (294 per 100,000 people).

Compared to non-Hispanic White people, non-Hispanic American Indian and Alaska Native people have different rates of getting some kinds of cancer. For example—

• Non-Hispanic American Indian and Alaska Native women have higher rates of getting cervical cancer than non-Hispanic White women in all regions except the East region.
• Non-Hispanic American Indian and Alaska Native males and females have higher rates of getting colorectal, kidney, and stomach cancers than non-Hispanic White males and females in almost all regions.
• Non-Hispanic American Indian and Alaska Native people in the East and Southwest regions have lower rates of getting lung cancer than non-Hispanic White people. Lung cancer rates are higher among non-Hispanic American Indian and Alaska Native people compared to non-Hispanic White people in the other four regions.
• In all regions, non-Hispanic American Indian and Alaska Native people have higher rates of getting liver cancer than non-Hispanic White people.
• Non-Hispanic American Indian and Alaska Native women have higher rates of getting cervical cancer than non-Hispanic White women in all regions except the East region.
• Non-Hispanic American Indian and Alaska Native men have lower rates of getting prostate cancer than non-Hispanic White men in all regions except the Northern Plains and the Southern Plains.

Data source: United States Cancer Statistics: Data Visualizations. Data are restricted to non-Hispanic American Indian and Alaska Native people living in IHS purchased/referred care delivery area counties.

Risk Factors

Many cancers can be prevented. Staying away from commercial tobacco smoke, keeping a healthy weight, drinking little or no alcohol, and getting human papillomavirus (HPV) vaccinations on time can lower a person’s risk of getting cancer. Screening tests can prevent some cancers or find them early, when treatment works best.

A risk factor is something that may increase a person’s chances of getting cancer. American Indian and Alaska Native people in the United States have a higher prevalence of some risk factors compared to White people. For example—

• Obesity is more prevalent among non-Hispanic American Indian and Alaska Native adults than non-Hispanic White adults.
• On average, American Indian and Alaska Native people are more likely to smoke cigarettes than members of other racial or ethnic groups in the United States.
• American Indian and Alaska Native people have the highest rate of getting chronic hepatitis C, which can lead to liver cancer.
• The prevalence of Helicobacter pylori (H. pylori)—a type of bacteria that can lead to stomach cancer—is particularly high among Alaska Native people.
• Non-Hispanic American Indian and Alaska Native people are less likely than non-Hispanic White people to be up to date on cancer screening tests, according to the IHS’s 2021 Government Performance and Results Act (GPRA) report.
• About 66% of non-Hispanic American Indian and Alaska Native teens from 13 to 17 are up to date with HPV vaccination, compared to 55% of non-Hispanic White teens.

Note: In the statistics above, some comparisons are only between race categories, while others are between race and ethnicity categories (non-Hispanic or Hispanic).

Barriers to Health Care

Compared to non-Hispanic White people in the United States, American Indian and Alaska Native people generally find it harder to get medical care. They often face the following barriers—

• Lack of health insurance. A higher percentage of non-Hispanic American Indian and Alaska Native people are uninsured [PDF-498KB] than members of other races.
• Lower household incomes. In 2019, the median household income for American Indian and Alaska Native people was $49,906, compared to $71,664 for non-Hispanic White households.
• Lower educational attainment. In 2019, about 84% of American Indian and Alaska Native people had at least a high school diploma, compared to about 93% of non-Hispanic White people.
• Remote locations. American Indian and Alaska Native people who live on reservations and in rural areas often find it hard to get health care. They may live far from a screening facility and have little or no access to public transportation.

Cancer is the leading cause of death for Hispanic or Latino people in the United States. Compared to members of other races and ethnicities, Hispanic and Latino people have higher rates of getting and dying from some kinds of cancer.

• Hispanic women have the highest rate of getting cervical cancer. Hispanic women have the second highest rate of dying from cervical cancer, after non-Hispanic Black women.
• Hispanic people have the highest rate of dying from liver cancer.
• Hispanic people and non-Hispanic Black people have the highest rates of getting and dying from stomach cancer.

However, Hispanic people have the lowest rates of getting and dying from lung cancer.

Data source: United States Cancer Statistics: Data Visualizations.

Barriers to Health Care

Compared to non-Hispanic White people in the United States, Hispanic or Latino people generally find it harder to get medical care. They often face the following barriers—

• Language barriers. A recent study found that Hispanic adults who have limited comfort speaking English were less likely to use health care services than Hispanic adults who were comfortable speaking English.
• Lack of paid sick leave. A survey by the Agency for Healthcare Research and Quality found that 56.6% of Hispanic or Latino workers had paid sick leave—the lowest percentage of all US racial and ethnic groups. Workers who have paid sick leave are much more likely to go to a doctor or get a routine cancer screening test compared with workers without paid sick leave.
• Lack of health insurance. Hispanic people are more than twice as likely to be uninsured as non-Hispanic White people (20% and 8%, respectively, in 2019). Hispanic people who have health insurance are more likely to get a mammogram, Pap test, or colorectal cancer screening test than those with no insurance.
• Educational disparities. Cancer screening is associated with higher education levels. Hispanic people with higher education are more likely to be screened. Only 67% of Hispanic people had a high school education in 2015, compared to 93% of non-Hispanic White people, 89% of Asian people, and 87% of Black people, according to the US Census Bureau.

Despite these challenges, a recent CDC study found that Hispanic people are equally as likely to receive a colorectal cancer screening test, and more likely to receive a mammogram or Pap test, as non-Hispanic White people (after statistical adjustment).

Note: The comparisons above may be between race categories only or between race and ethnicity (non-Hispanic or Hispanic) categories.

What Can Be Done to Reduce Health Disparities?

To help reduce health disparities, the public health community can work to improve health literacy, address barriers to care, and provide language assistance to people who need it. These steps can help Hispanic or Latino people use preventive health services, including cancer screenings. Health literacy is the ability to find, understand, and use information and services to inform health-related decisions and actions. Two-thirds of Hispanic people in the United States have limited health literacy.

Health care organizations can also help by developing culturally relevant health messages that encourage Hispanic or Latino people to get cancer screenings. Community health workers can help people in minority communities get the health care they need. Trained interpreters and bilingual health care providers can improve the quality of care for people who speak Spanish.

Researchers use certain measurements to describe how much a group of people is affected by cancer. Some common measurements that can show cancer health disparities include—

• Incidence rate: the number of new cancer cases per 100,000 people in a year. For example, in 2019 in Kentucky, 505 out of every 100,000 people got cancer, while 367 out of every 100,000 people in New Mexico got cancer.
• Mortality (death) rate: the number of people who died of cancer per 100,000 people in a year. For example, in 2019 in the United States, 171 out of every 100,000 non-Hispanic Black people died of cancer, compared to 151 out of every 100,000 non-Hispanic White people.
• 5-year survival: the percentage of cancer patients who have not died from their cancer within a certain time frame, such as 5 years after diagnosis. For example, in 2019, about 66% of non-Hispanic White people with cancer in the United States were alive 5 years after their cancer diagnosis, compared to about 63% of non-Hispanic Black people with cancer.
• Screening prevalence: the percentage of people who have been screened for a certain kind of cancer. For example, in the United States in 2018, about 77% of women with health insurance were up to date with breast cancer screening, compared to about 40% of women without health insurance.

Cancer Registry Data Lay the Groundwork for Measuring Disparities

Researchers, clinicians, policy makers, health advocates, and public health professionals can use these data to—

• Learn which groups of people are most affected by cancer.
• Find out how well cancer prevention programs work.
• See which communities need more help with cancer prevention and control.
• Work with community leaders and partners to build and improve cancer prevention programs.
• Develop resources to reach communities with higher cancer rates.

Cancer Registry Data Lead to Action

South Carolina Uses Data to Focus Its Screening Efforts

South Carolina has a high rate of cancer deaths, especially from breast and cervical cancer. Cancer death rates are also higher among Black women than White women in the state. To help reduce this disparity, state officials used cancer registry data to develop the Can Screen Initiative to reach more Black people to make sure they get the treatment they need.

Kentucky Data Inspire Pediatric Cancer Research

Kentucky Cancer Registry data showed that the rate of common childhood cancers is higher in Kentucky than in the overall United States. The data also showed that childhood cancer rates are even higher in Kentucky’s Appalachian region. In response, the state legislature established the Kentucky Pediatric Cancer Research Trust Fund in 2015 to find out why children in Kentucky have high cancer rates.

Delaware Is Closing the Gap in Prostate Cancer Deaths Among Black Men

Since 2011, cancer programs in Delaware have worked to educate men, especially Black men, about the risk of getting prostate cancer. The Delaware Cancer Registry provides detailed information about new cases of, and deaths from, prostate cancer. Although the rate of getting prostate cancer is high in Delaware, the 5-year average death rate has dropped by nearly one-third in the past 10 years. Much of this decrease is because fewer Black men are dying from the disease.

Some population groups continue to experience cancer health disparities and a diminished quality of life. These groups include the poor, racially and ethnically diverse groups, and those with limited or no access to healthcare. Cancer is a terrifying disease for whomever it touches. Unfortunately, it also generates some myths and false ideas out of fear and having inaccurate information.

To better understand cancer and cancer health disparities, some common misconceptions are addressed below.

Myth 1: Everyone experiences the same burden of cancer, regardless of racial/ethnic background and socioeconomic factors.

Truth: It is true that cancer affects people of all races and ethnicities in the U.S.; however, some population groups experience a greater burden than others. People from low socioeconomic households, who lack or have inadequate health insurance, and members of select racially and ethnically diverse communities frequently have a higher incidence and/or mortality rate for specific types of cancers. There are many examples of cancer health disparities.

Myth 2: Cancer is a death sentence.

Truth: In the United States, the likelihood of dying from cancer has dropped steadily since the 1990s. More than 12 million cancer survivors are living in the United States. Thanks to improved treatments and earlier diagnosis of some cancers, more cancer patients are alive five years after diagnosis. Five-year survival rates for some cancers, such as breast, prostate, thyroid cancers, and leukemia, now exceed 90 percent.

Myth 3: I don’t have control of my own cancer risk.

Truth: Cancer is unpredictable, but there is growing research that shows that adopting certain behaviors can lower your cancer risk. The NCI lists some preventative measures you can take – regardless of age or family history. These include not smoking, eating healthy, staying active, getting screened regularly and vaccinated for certain types of cancer, and using sun protection to name a few. Learn more about cancer causes and risk factors.

Myth 4: No one in my family has cancer, so I don’t have to worry about getting screened.

Truth: Only about 5 to 10 percent of cancers are caused by inherited gene mutations. The remaining 90 to 95 percent of cancers are caused by mutations as a result of aging and other factors, such as lifestyle, behavioral, and environmental factors. Learn more about cancer prevention, genetics, and causes. Cancer screenings can identify some types of cancers before symptoms appear and research shows that early screening for these cancers does reduce cancer deaths. Learn more about cancer screening and screening tests.

Myth 5: There is nothing I can do to help reduce cancer health disparities.

Truth: Everyone can help reduce cancer health disparities. If you’re a member of a racial or ethnic group with a greater burden of cancer, you can encourage your family and friends to get regular health check-ups and ask their doctor about questions they have about cancer. You can participate in community health fairs and surveys that help assess the health needs of your community and you can pass on healthy lifestyle and screening practices to your children. You can consider participating in clinical trials to help further our understanding of cancer health disparities, and help advance the field of precision medicine.

You can also help deconstruct some common cancer myths by sharing this blog article with your loved ones, friends, and colleagues in the cancer research community and help educate others about cancer health disparities.

Health equity is when everyone has an equal opportunity to be as healthy as possible.

When talking about cancer, equity is when everyone has an equal opportunity to prevent cancer, find it early, and get proper treatment and follow-up after treatment is completed. Everyone deserves to be treated equally, and CDC works to eliminate cancer disparities to improve the health of all Americans.

Unfortunately, many Americans can’t make healthy choices because of factors like where they live, their race or ethnicity, their education, their physical or mental abilities, or their income. As a result, they have more health problems than others. These differences in health among groups of people that are linked to social, economic, geographic, or environmental disadvantage are known as health disparities.

For example, it’s hard to eat healthy food if there are no grocery stores or fresh food markets near where you live or work. If you live in an unsafe neighborhood or there are no sidewalks in your community, it’s hard to be physically active.

Social Determinants of Health

CDC’s National Center for Chronic Disease Prevention and Health Promotion is funding a community health pilot project to learn how coalitions are advancing health equity by addressing social determinants of health.

The places where people live, learn, work, and play can affect their chances of getting and dying from cancer. These conditions are called social determinants of health. Examples of social determinants of health include a person’s ability to access—

• A good education.
• Healthy food.
• A safe home to live in.
• Reliable transportation.
• Health care.
• Clean water and air.

Social determinants of health can affect how likely a person is to get or die from cancer. For example—

• Cigarette smoking can cause cancer almost anywhere in the body. Smoking rates are higher among people with a lower education level. For example, nearly 20% of all US adults with a high school education smoke, but only about 7% of people with a 4-year college degree smoke. CDC’s Office on Smoking and Health is at the forefront of the nation’s efforts to reduce deaths and prevent chronic diseases that result from smoking, including cancer.
• Having overweight or obesity is linked with a higher risk of getting at least 13 kinds of cancer. Adults living in rural counties are more likely to have obesity than adults in urban counties. “People who live in poor and rural communities may have less access to quality grocery stores that sell healthy and affordable [food] options,” explained CDC’s Dr. Latetia Moore in the video, The Obesity Epidemic. CDC’s Division of Nutrition, Physical Activity, and Obesity develops and shares evidence-based approaches that help make healthy living easier for everyone, which can help people reduce their risk of cancer.
• Not getting screened for cancer as recommended can result in cancer being found at a late stage, when it’s harder to treat. For some people, it can be hard to get screened as recommended. For example, they may not be able to afford cancer screening tests and don’t have health insurance. People whose jobs don’t provide sick leave, people who live in rural or remote areas, and people without reliable transportation may not be able to go to a doctor’s office. CDC has several programs and initiatives to reduce barriers to screening.

CDC’s Division of Cancer Prevention and Control (DCPC) strives for a world where all people are free of cancer. DCPC is working to advance health equity through research, programs, and partnerships. Activities to support this effort include—

• Identifying the level of awareness of cancer risk among groups that have higher cancer rates.
• Providing access to screening for people who are medically underserved and have low incomes.
• Studying the cost of preventive care and cancer treatment.
• Studying the reasons people may not be able to prevent cancer, find it early, and get treatment.

Social Determinants of Health

Differences in social determinants of health contribute to chronic disease disparities in the United States among racial, ethnic, and socioeconomic groups. CDC’s National Center for Chronic Disease Prevention and Health Promotion has developed a framework to make progress toward health equity.

Educating People About Cancer Prevention and Risk

People need to know their risk of getting cancer so they can take steps to lower this risk. Many things can make a person more likely to get cancer, such as—

• Being exposed to tobacco smoke or drinking alcohol.
• Eating unhealthy food or not being physically active.
• Having a family history of cancer.
• Getting older.

DCPC’s three public health campaigns educate people—including those at higher risk of cancer—about cancer symptoms and how to lower their risk. The campaigns use survivor stories, interactive simulations, public service announcements, print materials, and other resources.

The Screen for Life: National Colorectal Cancer Action Campaign informs men and women who are 45 years or older about the importance of getting screened for colorectal cancer regularly.

The Inside Knowledge About Gynecologic Cancer campaign raises awareness of the five main types of cancers that only affect women (cervical, ovarian, uterine, vaginal, and vulvar).

The Bring Your Brave campaign provides information about breast cancer to women younger than 45 years, with a focus on young breast cancer survivors.

Increasing the Number of People Who Are Screened for Cancer as Recommended

Screening means checking your body for cancer before you have symptoms. Screening tests can find cervical, colorectal (colon), breast, and lung cancers early, when treatment works best. DCPC’s programs work to increase screening among groups of people who are more likely to get or die from cancer.

The National Breast and Cervical Cancer Early Detection Program has provided more than 15 million breast and cervical cancer screening tests to more than 6 million women with low incomes who are uninsured or underinsured. The program has diagnosed more than 71,000 breast cancers and 4,800 cervical cancers.

The Colorectal Cancer Control Program works with health systems, including clinics, hospitals, and other health care organizations, to use and strengthen strategies that have been shown to work to increase quality colorectal cancer screening, especially among groups that are most at risk.

The National Comprehensive Cancer Control Program promotes equitable access to high-quality and affordable cancer screening, treatment, and care options.

Future Directions

Health equity is a focus of DCPC’s scientific research and programmatic work. As a part of CDC’s CORE Health Equity Science and Intervention Strategy, DCPC has two plans—

• By September 30, 2026, DCPC will work with three award recipients who will engage with local and community-based organizations to find ways to reduce differences in rates of getting and dying from cancer among different racial and ethnic groups.
• By 2026, DCPC’s National Breast and Cervical Cancer Early Detection Program will increase the percentage of women the program serves who are overdue for cervical cancer screening tests from 20% to 35%. These efforts will help more women who are members of racial and ethnic minority groups, which have higher rates of cervical cancer.

CDC awarded funds to three research organizations to help us understand what works to advance health equity in cancer.

These projects allow CDC researchers to partner with researchers at the funded organizations to study new ways to achieve equity in cancer prevention and control.

CDC awarded funds to three research organizations to help us understand what works to advance health equity in cancer. These CDC-funded projects are some of the first that address systemic racism as a key driver of health inequities within communities of color.

The projects support these cancer prevention and control priorities—

• Reduce preventable cancers.
• Make sure all people get the right screening at the right time.
• Support cancer survivors in a way that allows them to live longer, healthier lives.

These projects allow CDC researchers to partner with researchers at the funded organizations to study new ways to achieve equity in cancer prevention and control. The research team will see how well specific, community-based strategies work, for whom, and why. The lessons learned can be applied to reduce cancer disparities in other communities.

Working with Black Communities in Mississippi to Help People Quit Using Tobacco

Many Black people in Jackson, Mississippi smoke cigarettes—often as a way to cope with systemic racism, poverty, and stress. But tobacco use can cause cancer and other illnesses. To reduce tobacco use in this population, the nonprofit organization Cicatelli Associates, Inc. will examine Project BAT (Black people Against Tobacco).

Project BAT aims to help Black people quit using tobacco by—

• Referring people who use tobacco to smoking cessation.
• Creating resources to help people stop smoking.
• Engaging with the community to educate people about the risks and harms of tobacco use.
• Explaining how other communities have restricted tobacco use in public places.
• Informing decision makers about policies that can help reduce tobacco use.

Cicatelli Associates has partnered with New York University (NYU) Grossman School of Medicine and Fahrenheit Creative Group, a Mississippi-based firm, on this project.

Making Cancer Screening Accessible to New York City Communities

Screening means checking your body for cancer before you have symptoms. Screening tests can find some cancers early, when treatment is likely to work best.

NYC CONNECT (New York City Cancer Outreach Network in Neighborhoods for Equity and Community Translation) aims to work to make cancer screening accessible. NYC CONNECT builds on a program at NYU that uses patient navigators. Patient navigators are health workers who are trained to help people overcome problems that stop them from getting health care.

NYC CONNECT aims to help people get cancer screening by—

• Working to reduce systemic racism in the places where we live, work, and play; in food access; and in health care among groups that have been marginalized, including Black, Asian, and Hispanic people.
• Leading a research project to learn how well patient navigator programs work to increase screening for breast, cervical, and colorectal cancers.
• Studying the effect of reduced systemic racism on community-clinical cancer screening interventions in New York City.
• Sharing strategies that work, so they can be used in other communities.

The NYU School of Medicine will work with NYU Cancer Prevention and Control Research Network collaborating center, the Albert Einstein Cancer Center, the Laura and Isaac Perlmutter Cancer Center at NYU, the Food Bank for New York City, and the NYU School of Medicine’s network of partners on this project.

Improving Cancer Survivors’ Health and Well-Being Through Patient Navigation in Washington, DC

Cancer survivors may have questions about how to be healthy after their cancer treatment is finished. This project focuses on Black breast and prostate cancer survivors in Washington, DC. Its goal is to find ways to improve care coordination, meet cancer survivors’ needs, reduce cancer health disparities, and increase awareness of systemic racism in the medical field and its effect on communities of color.

The project aims to—

• Create one screening and referral process across three cancer centers in metropolitan Washington, DC to coordinate care.
• Ensure doctors and patients have the information they need to provide high-quality care for all community members.
• Learn how community health workers can identify and help Black breast and prostate cancer survivors who may need support and connection to other resources in their communities.
• Provide training for doctors and medical staff to help them recognize and avoid racism and be anti-racist.

The MedStar Health Research Institute will work with researchers from George Washington University, Howard University, and Georgetown University on this project. The partners will see how well their strategies work. Plans that work well can be used in other communities.