Who you are, where you live helps determine your chances of beating cancer

Who you are, where you live helps determine your chances of beating cancer

About 2 million people in the United States will be diagnosed with cancer this year and 600,000 will die from the disease, according to estimates from the National Cancer Institute (NCI).

But cancer is not equal opportunity.

A wide range of factors play a role in determining whether a person will get and potentially die from the disease, including their genetics and where they live.

Death rates from cancer have decreased over the past 25 years in the United States, according to the American Cancer Society. The sharpest declines occurred among Blacks, Native Americans and Alaska Natives, according to a February 2022 report by KFF.

This is in part due to improvements in cancer screening, treatments, early detection and changes in behavior such as reducing cigarette smoking, according to Latoya Hill, a senior policy analyst at KFF’s race and health policy program.

But even though white Americans have higher rates of new cancer diagnoses, some black people, especially blacks, are still more likely to die from the disease, NCI data shows.

Between 2016 and 2020, there were 469.9 cancer diagnoses per 100,000 non-Hispanic whites, 451.8 diagnoses per 100,000 blacks, 417.9 diagnoses per 100,000 Native Americans and Alaska Natives, 348.1 diagnoses per 100,000 Hispanics and 302 diagnosed per 100,000 people of Asian and Pacific Islander ancestry.

Meanwhile, during the same period there were 174.7 cancer deaths per 100,000 blacks, 158 cancer deaths per 100,000 Native Americans and Alaska Natives, 154.4 cancer deaths per 100,000 whites, 108.2 cancer deaths per 100,000 Hispanics and 94.5 cancer deaths per 100,000 Asians and Pacific Islanders.

Income is also important in determining who gets and dies from cancer. Research shows that poorer communities have higher cancer rates than affluent areas. And people living in persistent poverty are more likely to die of cancer.

Additionally, while rural communities tend to have lower cancer rates than their urban and suburban counterparts, they have higher mortality rates.

Cancer and genetics

Genetics play a role in the types of cancers that are more common among certain racial and ethnic groups.

For example, about 10 percent of all breast cancer cases are due to genetic predisposition, according to Otis Brawley, an oncologist and epidemiologist at Johns Hopkins University.

Ashkenazi Jewish women, who have family roots in Eastern Europe, have a higher risk of getting breast and ovarian cancer at an early age than other groups of women due to a known genetic mutation.

Breast cancer rates are nearly equal between white and black women, according to Jasmine McDonald, an assistant professor of epidemiology at Columbia University. But black women are more likely to die from the disease.

That’s in part because they’re more likely to be diagnosed later than white women, which makes treating the disease more difficult, according to the Centers for Disease Control and Prevention (CDC).

Compared to women of other racial and ethnic backgrounds, women of color are also more likely to get triple-negative breast cancer, a more aggressive type with a faster growing rate.

“This isn’t necessarily a function of previous screening access or, or necessarily the environment, but it’s something really at a biological level that we’re still trying to figure out,” said Susan Vadaparampil, director of the Associated Center for Community Outreach. , engagement and equity at the Moffitt Cancer Center in Florida.

Cancer and where do you live

But while genetics play a role, the disparities in cancer mortality are actually the result of broader socioeconomic inequalities that are rooted in ongoing racism and discrimination.

“When considering cancer disparities, we need to stop using language about susceptibility and making generalizations that this is just a conversation about DNA,” said Robert Winn, director of VCU Massey Cancer Center.

It’s crucial to consider what’s happening in the world outside the cell, he said.

“Where you live, your place and your space matter,” Winn added in an email to The Hill. “Your ZNA, zip code, and association neighborhood may have structures in place that ultimately cause additional stress.”

Cancer experts agree that location plays a far more significant role in cancer incidence and death disparities than genetics.

Unequal access to cancer screenings

Many communities with cancer clusters or high rates of cancer diagnoses are low-income communities burdened with limited access to health care or lower quality care and cancer screenings.

And communities of color, especially black communities, are just as likely to live in high-poverty communities because of economic inequity and racist housing laws as because of racist housing laws like redlining. Just over 14% of black people lived in a high-poverty neighborhood in 2020, compared to about 4% of whites, according to the National Equity Atlas.

Breast cancer screenings offer an example of how low-income neighborhoods are subject to lower quality cancer healthcare.

Doctors recommend that women begin having annual mammograms once they turn 40 to look for signs of breast cancer. Such screenings can help with early diagnosis of the disease and increase your chances of survival.

But low-income women sometimes get fewer mammograms than middle-class or affluent women get, often because they have less medical equipment or limited resources to complete extensive testing.

Take, for example, mammography vans, which are often employed in low-income neighborhoods.

Brawley, of Johns Hopkins University, explained that during a “high-quality” mammogram, a doctor will compare current and past images to look for signs of change.

“Well, if you get your mammogram on a mobile breast, they don’t have access to last year’s mammogram,” BRawley said. “So, there are all these women who go to these mammogram vans in these slums and are very proud that they got a mammogram…but no one tells them that they actually got a lower quality than class middle and upper-middle class women who go to physical facilities get.”

Lack of health insurance and shortages of primary care physicians and oncologists also contribute to cancer disparities in rural communities, according to the NCI.

Environmental and lifestyle factors

In addition to limited access to health screening, low-income and rural communities are often subject to environmental and lifestyle factors which, combined with lower access to health care, can lead to higher case or death rates for cancer.

In rural communities, according to the NCI, residents “tend to be older, engage in health risk behaviors, and have lower adherence to preventive care” than their suburban and urban counterparts, leading to rates of higher mortality.

Research shows that rural and low-income communities have higher rates of smoking, which has a direct impact on a person’s likelihood of developing lung cancer.

And while lung cancer diagnoses and deaths have declined, mainly due to lower smoking levels across the country, there are still disparities in who dies from the disease.

Rates of new lung cancer diagnoses run very close across racial and ethnic lines, but people of color are still less likely to survive the disease than whites.

In 2019, there were 57.1 new cases of lung cancer for every 100,000 whites, according to the most recent data from the CDC. In the same year, there were 54.9 lung cancer diagnoses per 100,000 Black people, 49.9 incidents per 100,000 Native Americans and Alaska Natives, 33.2 per 100,000 Asians and Pacific Islanders, and 27.5 per 100,000 Hispanics.

People of Asian or Pacific Islander descent have the highest lung cancer survival rate, followed by Latinos, with 26 percent and 23 percent, respectively, surviving five years after diagnosis, according to the American Lung Association .

Whites have the next highest five-year survival rate at 22%., while Black and Indigenous people have lung cancer survival rates of 21 and 19 percent.

Low-income communities also suffer from higher obesity rates than higher-income neighborhoods, partly due to limited access to fresh food. Research suggests there is a link between high body fat and increased risk of several types of cancer, including cancer of the endometrium, esophagus and liver, although much work needs to be done to fully understand the connection.

Additionally, some low-income neighborhoods, and especially low-income communities of color, are exposed to higher rates of toxic chemicals that can lead to cancer in the homes they live in, in the water they drink and in the air they they breathe.

Lead poisoning, which has been linked to higher risks of some cancers, disproportionately affects low-income communities, especially low-income black communities in the United States.

This is in part because low-income communities with homes built before the 1970s are more likely to still have lead-based paint.

Another factor that may contribute to this disparity is the fact that low-income communities, especially low-income communities of color, are more likely to be located near industrial facilities that work with lead than their more affluent counterparts, according to the CDC.

Proximity to industrial sites that emit toxic pollutants also plays into disparities in cancer rates and can result in cancer “hot spots”.

Some of these hotspots are so large that they’re more like “cancer corridors.”,such as the 85-mile section of the Mississippi River in Louisiana located between New Orleans and Baton Rouge known as Cancer Alley.

This particular tract of land is home to oil refineries and chemical plants that emit a huge amount of air pollution laced with known carcinogens like ethylene oxide and acetaldehyde, according to an analysis by ProPublica.

On average, about 30 in a million people in the United States are at risk of developing cancer from exposure to carcinogens in air pollution. But a significantly higher proportion face this risk in Cancer Alley: 46 in a million, a study found in 2012.

Updated at 9:17

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