Cancer Health Disparities

1. How does the National Cancer Institute (NCI) define "cancer health disparities"?The National Cancer Institute (NCI) defines "cancer health disparities" as adverse differences in cancer incidence (new cases), cancer prevalence (all existing cases), cancer death (mortality), cancer survivorship, and burden of cancer or related health conditions that exist among specific population groups in the United States. These population groups may be characterized by age, disability, education, ethnicity, gender, geographic location, income, or race. People who are poor, lack health insurance, and are medically underserved (have limited or no access to effective health care)—regardless of ethnic and racial background—often bear a greater burden of disease than the general population.
2. A close look at cancer incidence and death statistics reveals that certain groups in this country suffer disproportionately from cancer and its associated effects, including premature death. For example, African Americans/Blacks, Asian Americans, Hispanic/Latinos, American Indians, Alaska Natives, and underserved Whites are more likely than the general population to have higher incidence and death statistics for certain types of cancer. 
3. What factors contribute 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 and surviving cancer. SES, in particular, appears to play a major role in influencing the prevalence of behavioral risk factors for cancer (for example, tobacco smoking, physical inactivity, obesity, and excessive alcohol intake, and health status), as well as in following 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 effective health care.
4. How does NCI gather data on cancer incidence and death for various population groups in the United States?
   The Surveillance, Epidemiology, and End Results (SEER) Program is NCI's authoritative source for information about cancer incidence and survival. SEER collects cancer incidence and survival data from cancer registries that cover approximately 26 percent of the U.S. population. Over several decades, SEER has worked diligently to better represent racial, ethnic, and socioeconomic diversity and currently covers 23 percent of African Americans/Blacks, 40 percent of Hispanic/Latinos, 42 percent of American Indians and Alaska Natives, 53 percent of Asian Americans, and 70 percent of Hawaiian/Pacific Islanders living in the United States. In addition, SEER statistics reflect the U.S. population in regard to poverty and education, with both urban and rural groups represented. The Methods for Measuring Cancer Disparities: A Review Using Data Relevant to Healthy People 2010 Cancer-Related Objectives report (http://seer.cancer.gov/publications/disparities/) describes how data are collected to measure cancer health disparities.
   The incidence and death statistics presented in this fact sheet are from Tables I-23 through I-28 of the SEER Cancer Statistics Review, 1975-2004 (http://seer.cancer.gov/csr/1975_2004). These statistics are most often reported as the numbers of new cases of invasive cancer and cancer deaths per year per 100,000 persons in the U.S. population. When the statistics focus on cancer incidence and death in a single gender—for example, on female breast cancer or male prostate cancer—the numbers are per 100,000 persons of that gender. In addition, the SEER statistics are age-adjusted to the 2000 U.S. standard population. Age-adjustment is done because different population groups may not be comparable with respect to age. Age-adjustment allows cancer incidence and death statistics (expressed below as cancer incidence and death “rates”) for these population groups to be compared.