Which Cancers Are Still More Deadly in Black vs White Patients?

The cancer mortality gap between Black and White individuals in the US has narrowed, but disparities in breast, uterine corpus, and prostate cancer specifically have remained wide or gotten worse, according to a new analysis.

The excess cancer mortality rate among Black patients fell by 98.4 deaths per 100,000 in men and 21.7 deaths per 100,000 in women, when comparing the 1991-1995 period with the 2019-2023 period.

A closer look at the data, however, reveals stubborn or even widening disparities in several cancer types. For instance, even though improvements in prostate cancer mortality accounted for a quarter of the reduction among men, Black men remain twice as likely as White men to die from prostate cancer. Meanwhile, mortality disparities persisted or widened between Black and White women with breast or uterine corpus cancer.

“The findings that deserve the most attention are where progress has stalled or reversed because these cancers now account for the largest excess mortality remaining,” lead author Chenxi Jiang, MPH, told Medscape Medical News. “Closing these gaps will require more targeted approaches addressing the drivers specific to each cancer type.”

The study by Jiang, an associate scientist in the Surveillance, Prevention, & Health Services Research program at the American Cancer Society (ACS) in Atlanta, and colleagues was published online this month in JAMA Oncology.

Familiar Gap, Fresh Perspective

For years, annual updates provided by initiatives such as the Surveillance, Epidemiology, and End Results Program from the National Cancer Institute have highlighted the narrowing mortality gap between Black and White patients with cancer.

But comprehensive analyses have been limited, Jiang said, noting that the former flagship Black-White disparity study included only 10 cancer types and was published almost 20 years ago.

“Our study extends this evidence through 2023 and covers 30 cancer types, which to our knowledge is the most comprehensive evaluation to date,” she said.

The present analysis is also notable because it compared the most recent 5 years of available data with those during the period when the Black-White cancer mortality gap was at its widest.

“This approach allows us to answer a question that previous studies could not: Measured against the worst period of Black-White cancer mortality disparity, which cancer types account for the largest share of the reduction achieved since then, and where does the gap remain?” Jiang said.

A Clearer Picture of Gaps and Gains

The overall narrowing of the Black-White cancer mortality gap could be traced to a handful of cancer types.

Among men, lung cancer accounted for 31.1% of the drop in the excess mortality rate, followed by prostate at 25.8% and esophageal cancer at 12.1%. Among women, colorectal cancer accounted for 18.8%, cervical cancer for 16.9%, and lung cancer for 15.1%.

These improvements “deserve attention because they demonstrate that population-wide efforts such as tobacco control and screening can meaningfully reduce racial disparities,” Jiang said.

Three disparities bucked this trend.

Breast cancer mortality fell among both Black and White women, but the gap barely changed, from about 7.0 to 7.2 excess deaths per 100,000, making it the largest single source of excess cancer mortality among Black women. Similarly, deaths due to uterine corpus cancer fell overall, but the gap grew from 3.2 to 4.9 excess deaths per 100,000.

Among men, prostate cancer deaths fell dramatically overall, accounting for one quarter of the narrowing gap between Black and White men. Still, the largest gap between men of the two races continues to be in prostate cancer, with 18.5 excess cancer deaths per 100,000 occurring in Black men.

Experts in cancer disparities research not involved in the study shared their perspectives on these new findings, including key drivers of inequity, and suggested steps to address them.

Uterine Corpus Cancer: An Accelerating Gap

Kemi M. Doll, MD, was not surprised to see uterine corpus cancer emerge as the disparity moving fastest in the wrong direction. As a gynecologic oncologist at the University of Washington in Seattle and founder of the Endometrial Cancer Action Network for African-Americans, Doll has watched the trend building for two decades.

Still, this new study is important because it is “the synthesis of all of it in one place” and spotlights areas of growing concern, such as uterine corpus cancer, she told Medscape Medical News. The small absolute number of annual cases has kept the issue largely under the radar, she said, but as incidence climbs, the disparity is becoming “more and more of a siren.”

According to Doll, who cited a natural history model published in the Journal of the National Cancer Institute, the disparity is partly biological because Black women are more likely to develop aggressive non-endometrioid tumors.

But biology is only a partial explanation, she said, because Black women are also less likely to receive guideline-concordant care, underscoring the need for social and environmental research, along with targeted interventions.

For example, Doll called for increased education of nongynecologic health care practitioners, citing her own research published in the Journal of Women’s Health, which has shown that many older women presenting with postmenopausal bleeding do not receive an appropriate workup.

“A physician would never dismiss a woman who said…‘I notice I have a lump in my breast,’” Doll said. “We need the same kind of awareness in uterine cancer symptoms. So when a 63-year-old woman says, ‘I’ve noticed I’ve had some spotting’…that isn’t a generic referral to gynecology…you need an endometrial biopsy.”

The American College of Obstetricians and Gynecologists recently updated their guidelines to recommend both ultrasound and biopsy for women with such symptoms, Doll said, adding that ultrasound alone often fails to detect uterine corpus cancer in Black women.

“This is a cancer that’s only going to grow in incidence over the next several decades,” Doll said. “We have a collective responsibility to respond to a woman who’s reporting symptoms.”

Breast Cancer: The Largest Gap Among Women

For Lisa A. Newman, MD, MPH, chief of the Section of Breast Surgery at Weill Cornell Medicine and NewYork-Presbyterian in New York City, the breast cancer gap represents biology stacked on top of inequity. “This study provides an important reminder that the causes are multifactorial and differ by tumor type,” Newman told Medscape Medical News. “At least some of this variation [in breast tumor biology] is related to genetic African ancestry and its impact on the immune landscape of the breast.”

Black women are about twice as likely to develop triple-negative breast cancer, which is more aggressive than other subtypes and has seen the least therapeutic progress, Newman said. She predicted that immunotherapy could improve this picture, but such agents are too new to shift the reported findings. The rest of the disparity between Black and White women is likely driven by “systemic inequities in our public healthcare system,” including inferior screening and delayed care, she said. More research is needed to identify modifiable risk factors, Newman added, noting how smoking cessation has reduced lung cancer in Black communities, but similar interventions have not been realized in breast cancer.

Prostate Cancer: Progress Without Parity

B. Lee Green, PhD, a senior member of the Department of Health Outcomes and Behavior at Moffitt Cancer Center in Tampa, Florida, blamed overgeneralization for the overall reduction in prostate cancer mortality without a commensurate reduction in the Black-White disparity.

“I think that this gap persists because we’ve treated prostate cancer as a one-size-fits-all disease when it really is not that simple,” Green told Medscape Medical News. “Screening guidelines were essentially built and applied the same, without accounting for the fact that this cancer shows up earlier and behaves more aggressively in Black men.”

Green, who studies cancer health disparities and leads the Black Men’s Health Study, called for refined prostate cancer screening guidelines to account for these differences.

“There is a growing case for starting to screen earlier in Black men and screening more frequently,” he said.

But better screening will not be enough, he predicted. “We know Black patients face longer gaps between diagnosis and treatment, so health systems need to be looking at their own referral and treatment pipelines, not just their screening recommendations,” Green said.

Beyond the need for disease-specific interventions, Green described broader lessons from the collective findings. “This study is a good reminder that cancer control efforts, tobacco policy, screening expansion, and treatment access have moved the needle before,” he said. “The question is whether we apply them with the same intensity to the cancers where progress has stalled.”

Prostate cancer is among them, Green said, and it deserves further attention; however, this should not come at the expense of emerging disparities, such as uterine corpus cancer.

“We need to be watching for where the next gap is opening, not just managing the ones we’ve already identified,” Green said.

The study was supported by the intramural research department of the ACS. Jiang and colleagues reported having no relevant financial relationships. Newman reported having no relevant financial relationships. Doll reported receiving research grant funding from Merck within the past 24 months; she is also the author of a book on uterine cancer in Black women. Green reported receiving funds for the Black Men’s Health Study from Genentech.

A version of this article first appeared on Medscape.com.