The Black Lives Matter movement has drawn attention to the unique needs of African Americans. For many years oncologists have been focusing attention on disparities in outcomes among African American patients with cancer.
Recently, the American Cancer Society has reviewed the most up-to-date evidence of cure rates and prevalence of cancer in the black community. These data provide an opportunity to get tips on preventing and treating cancer so that people can improve low cure rates in African Americans. An easily readable summary is also available from the American Cancer Society.
What do these data show us? The risk of cancer is higher in blacks. Between 2008 and 2012, the rate in black individuals was 12% higher than in non-Hispanic Caucasian individuals. This amounts to an expected 190,000 African Americans developing cancer in 2016. Most commonly, these cancers are prostate, lung and colon cancers in men, and breast, lung and colon cancers in women. 1 in every 2 men, and 1 in every 3 women will get cancer during their life. 1 of every 6 black men will get prostate cancer, compared to only 1 of every 8 white men. Digging deeper, certain other cancers are also much more likely to occur in black people, including stomach cancer, multiple myeloma, and Kaposi's sarcoma.
But here is a strange and encouraging difference. Among men, the African American risk of having a cancer is 12% higher than in Caucasians. But among women, the risk of having a cancer in African Americans is 6% lower! Unfortunately, this encouraging statistic in black women does not translate into lower death rates.
Sadly, the death rate from cancer is 17% higher in African Americans than in Caucasians. 1 in every 4 men and 1 in every 5 women will die from cancer. About 69,000 black individuals will die of cancer in 2016. Between 2008 and 2012, mortality rates were 27% higher in black men compared to white men. And in black women, the mortality rate from cancer is 14% higher compared to white women, despite a 6% lower incidence of cancer in black women. Clearly, there needs to be improvement in the care of African American women by diagnosing cancer earlier and treating cancer better.
But among these grim statistics is a favorable finding: the rate of cancer occurrence, and the death rate has been decreasing in all Americans since 1995 by about 2 to 2.5% per year, and the decrease is slightly higher in black people compared to white people. The gap of higher incidence and mortality rates in African Americans versus Caucasians is narrowing. This probably represents greater health awareness in everyone, improved health habits, better access to health care (thanks to the Affordable Care Act), and greater attention to early diagnosis and compliance with standard proven treatments in all people, but especially in African Americans.
Although getting better, the cancer picture for African Americans reveals some explanations for the higher risks. More African Americans are obese, lack exercise, and have not had PSA testing in men for prostate cancer (despite their higher risk). Even though the rates in black and white individuals are about equal, still the rate of completed HPV vaccination (to prevent cancers of the cervix, penis, and mouth) is only 39% in girls and 20% in boys; breast mammogram rates are only 66%; colon cancer screening was performed in only 59% of people; and smoking rates were still 22% in men and 14% in women. Worrisome is the 8.5 fold higher risk of HIV in black people (which also predisposes to sarcoma, lymphoma, liver, anal, mouth, lung, colon, and skin cancer risks), and a higher risk of H. pylori stomach infections (which causes stomach cancer).
So here are my tips for protecting you (especially if you are African American, because of your higher risk, but also appropriate if you are not black).
• Always have health insurance. It is only through your healthcare team (you, your primary doctor and specialists, and your healthcare facilities for testing) that you can get up-to-date prevention and early detection.
• Be sure you have chosen a primary care physician who is really interested in you and can give you the time you need to answer all of your questions. If your doctor uses a nurse practitioner (NP) to see patients most of the time, be sure that the NP can give you enough time for your visit to be able to talk with you about all your problems and not just rush you out the door. If you are not getting attention or can't understand what the doctor is saying (some don't say much, or use techno-speak, or just have too thick an accent), try another medical practice.
• Don't just use your doctor for treating minor illnesses. Talk to your doctor and emphasize that you want to reduce your risk of cancer and detect cancer early when it is more curable. If your doctor does not pay enough attention to this, it's time for a second opinion or specialist consultation! For more advice on how to discuss prevention issues, see my website or book Surviving American Medicine.
• Pay attention to making your life safer through better health habits. Make sure you and your family, friends and physicians focus on smoking cessation, make sure you achieve a normal weight, and check that you are getting enough exercise (these all reduce heart disease risk as well) and having safe sex. Avoid excessive alcohol use (more than 1 drink daily for women or 2 drinks daily for men). Be sure your vaccinations are complete for hepatitis B (it causes liver cancer) and HPV (if you are under 25; also be sure you vaccinate your children as well). Treat hepatitis C if you are positive and treat H. pylori if you have evidence of infection.
• Take steps with your physician to get all the health screenings steps to diagnose cancer early, when it is more curable. This includes mammograms in women over the age of 40 to 45 (discuss a starting time with your doctor), pap testing with HPV testing in women, PSA testing starting at age 40 or 50 after discussion with your physician about benefits and risks, low dose CAT scan of the chest if you have been a smoker, colonoscopy or stool blood checks to detect polyps (removal can prevent a colon cancer) or early stage cancer, discussion of vaginal ultrasound (with a blood test for CA125) in women to detect early ovarian and uterine cancers, skin check for suspicious moles (they could be melanoma or Kaposi's sarcoma), blood tests for hepatitis B and C and HIV, mouth examination (for oral cancers), and a urine check for blood (to detect early kidney or bladder cancers). If your doctor has not ordered these tests or discussed them with you, get a second opinion or a consultation with a specialist.
• Know the history of cancer in your family. Make certain you and your doctor discuss if your family history shows a higher risk of certain cancers, and if you need a saliva or blood check to see if you have inherited a genetic risk of cancer. If your doctor is uncertain about your risk, get a second opinion from an oncologist or genetics counselor to be sure. Your life and your family's lives could depend on this.
• If you are at risk for breast cancer, discuss with your doctor whether prevention with the oral medications tamoxifen, raloxifene or aromatase inhibitors can reduce your chance of having breast cancer. If you are at risk of colon cancer, discuss prevention with aspirin. And if you are at risk of prostate cancer, discuss prevention with finasteride or dutasteride. Sometimes these discussions require a consultation with an oncologist to individualize the medications you need.
• If you have developed cancer, make sure you are getting the most comprehensive care. The higher risk of death in black cancer patients emphasizes how important this can be. To be certain your care complies with all the recent recommendations, always ask your cancer doctors is your care is according to national guidelines (like the NCCN published guidelines, which you yourself can access, or the National Cancer Institute website). After asking for your physician's advice, if you have any questions be sure to get a second opinion from another physician.
The American Cancer Society deserves our admiration for continuing to emphasize risks of cancer in all Americans, but especially now in African Americans. Identifying the higher risks of cancer diagnosis and mortality in black people have will certainly improve the choices all people can make to reduce risks. These data will also re-emphasize to physicians how attentive they must be to black patients to protect their lives. Black lives matter, especially in cancer prevention and care.
The opinions expressed are those of Dr. Cary Presant and do not represent opinions of City of Hope or other organizations.