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Racial inequalities remain in cancer survival in the US

Wide racial disparities in cancer survival still exist in the United States, according to new research published in a special supplement of the journal Cancer.

The research, which used data from the second cycle of the CONCORD programme, was led by the London School of Hygiene & Tropical Medicine, in partnership with the Centers for Disease Control and Prevention. It focused on survival for patients diagnosed with one of 10 common cancers in 37 US states between 2001 and 2009.

In the analysis of women with ovarian cancer, more than half (172,849) were diagnosed at an advanced stage of disease. Five-year net survival for ovarian cancer for all races combined was 39.6% in 2001-2003 and 41.0% in 2004-2009. During 2004-2009, five-year survival was 86.4% for localised disease, 60.9% for regional stage, and 27.4% for advanced disease. Survival for black women was consistently 10% lower than for white women (29.6% vs. 40.1% in 2001-2003 and 31.1% vs. 41.7% in 2004-2009), despite similar distributions of stage at diagnosis. Survival for black women was 6% to 15% lower than for white women at each stage of disease.

Among more than 800,000 patients diagnosed with colon cancer, five-year net survival increased slightly from 63.7% during 2001-2003 to 64.6% during 2004-2009. Survival improved for both black and white women, but it was 10% lower for black women than for white women throughout the decade. Survival among black women diagnosed during 2004-2009 (56.6%) was still lower than survival among white women diagnosed during 1990-1994, some 15-20 years earlier. Black women were diagnosed with advanced disease more often than white women, both during 2001-2003 (21.5% vs. 17.2%) and during 2004-2009 (23.3% vs. 18.8%).

Of more than 1.3 million women diagnosed with breast cancer, five-year net survival for all races combined was very high (88.2% for 2001-2003 and 88.6% for 2004-2009). However, survival for black women was more than 10% lower than for white women: 76.9% vs. 89.1% during 2001-2003 and 78.4% vs. 89.6% during 2004-2009.

CONCORD is an award-winning programme for the global surveillance of cancer survival. It is coordinated by the London School of Hygiene & Tropical Medicine’s Cancer Survival Group. It brings together almost 600 collaborators in over 320 cancer registries across 71 countries and territories worldwide.

Dr Claudia Allemani, Associate Professor in Cancer Epidemiology at the School and co-principal investigator of the CONCORD programme, said:

“Racial disparities in population-based cancer survival in the United States have been reported for decades. Our research shows that even though cancer survival in the US is among the highest in the world, disparities in survival between white and blacks women were still evident for most cancers in 2009; even for patients diagnosed at the same stage of disease.

“The research published in the Cancer supplement provides a valuable contribution to cancer control in the United States. It benchmarks population-based cancer survival in more than 80% of the US population immediately before implementation of the Patient Protection and Affordable Care Act (Obamacare) in 2010.

“The public health challenge is now to ensure that every patient diagnosed with cancer in the United States benefits equally from future advances in diagnosis and treatment, regardless of race and socio-economic status.”

Publication

Hannah K. Weir PhD, Sherri L. Stewart PhD, Cheryll C. Thomas MSPH, Arica White PhD, MPH, Michel P. Coleman BA, BM, BCh, MSc, FFPH, Claudia Allemani MSc, PhD, FHEA, HonMFPH (Editors). Population-based cancer survival in the United States (2001-2009): Findings from the CONCORD-2 study. Cancer. 2017; 123:4954-5189.