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#387 - Cancer Injustice -- Part 2, 27-Apr-1994

As we saw last week (RHWN #386), for 11 kinds of cancer, the U.S.
incidence rate is higher among African-Americans (blacks) than among
European-Americans (whites). The incidence rate is the number of new
cancers diagnosed among 100,000 individuals of a particular race during
a year's time. For all cancers combined, the incidence rate among
blacks is about 6% higher than it is among whites; in other words, the
chances of a black person getting ANY cancer are about 6% higher than a
white person's chances.

However that is only part of the story. As we also saw last week, for
14 cancers, the U.S. death rate (deaths per 100,000 individuals of a
particular race during a year's time) is much higher among blacks than
it is among whites. When all cancers are considered together, a black
is 1.3 times as likely as a white to die of one cancer or another;
i.e., there's a 30% greater chance that any black person will die of
cancer, compared to any white person.

In sum, whites have a slightly lower chance of getting cancer and a
much higher chance of surviving it. (At a later date, we will examine
detailed reasons for this, but it is clear that the root causes are
racial and class bias in the health care system.)[1]

Now we will continue examining the details of each cancer, site by
site. Our information is taken from Barry A. Miller and others,
editors, CANCER STATISTICS REVIEW 1973-1989 [National Institutes of
Health Publication No. 92-2789] (Bethesda, Md.: National Cancer
Institute, 1992); page numbers inside square brackets refer to this
study. This study uses the term "blacks" to refer to African-Americans
and we have retained that terminology.

ESOPHAGUS: In 1992, there were an estimated 7900 new male cases and
3200 new female cases (estimated). This is a particularly lethal
cancer. Both incidence and mortality rates are about three times as
high among black men as among white men. [pg. VIII.[1]]

KIDNEY CANCER: 26,500 new cases estimated for 1992; 10,700 deaths in
1992 estimated. Between 1973 and 1989, incidence of kidney and renal
cancer among all races increased about 2% per year. However, among
blacks (both males and females) 65 and older, incidence increased twice
as fast (4% per year). The largest overall increase was among black
males over 64; between 1973 and 1989, the kidney cancer increase was
113.2% among this group. [pg. XI.[1]]

Overall, deaths from this cancer increased at 1% per year, 1973-1989.
Among blacks 65 and older, deaths from this cancer increased at 4% per
year.

CANCER OF THE LARYNX: 12,500 new cases in 1992, estimated; 3650 deaths
in 1992, estimated. [pg. XII.[1]]

This is a tobacco-related cancer. The death rate is dropping among
white males but rising among white females and among black males and
females. Incidence of this cancer is 1.5 times as high among blacks as
among whites, and the death rate among blacks is 2.3 times the death
rate among whites.

LIVER CANCER: An estimated 15,400 new cases in 1992 and an estimated
12,300 deaths. [pg. XIV.[1]]

Cancer of the liver occurs more frequently in the old, particularly in
black males over 65. For the period 1985-89, black males over 65 had an
incidence rate of 39.3 per 100,000; among whites of the same age, the
rate was about half as great (20.3 per 100,000). Among black females 65
and over the rate was 11.4 per 100,000 and among white females of the
same age, the rate was 8.2 per 100,000. [pg. XIV.[4]]

In 1989 black males over 65 has a death rate of 33.7 per 100,000; the
death rate among same-aged whites was 22.6 per 100,000. The rate among
black females 65 and older was 15.0 per 100,000; among same-aged white
females the rate was 10.8 per 100,000. [pg. XIV.[5]]

LUNG CANCER: 168,000 new cancers in 1992 (estimated) and 146,000 deaths
(estimated). [pg. XV.[1]]

The incidence rate in the period 1985-89 was 63.7 per 100,000 for white
males and 102.9 per 100,000 among black males. The disparity among
women was less: 31.8 among white females and 35.3 among black females.
[pg. XV.[4]]

During 1985-89, the death rate among white males was 56.0 per 100,000
and among black males was 83.1 per 100,000. Among white women the rate
was 23.1 and among black women it was 23.2. [pg. XV-5.]

MULTIPLE MYELOMA: 12,500 new cases in 1992 (estimated) and 9200 deaths
(estimated). [pg. XVII.[1]]

Multiple myeloma is a cancer of the old, especially of older blacks. In
1985-89, black males 65 and older had an incidence rate of 64.3 per
100,000, twice the rate for whites of the same age group (32.4 per
100,000). The same is true for black females of the same age group
whose rate of 42.7 per 100,000 is twice that of white females (21.3 per
100,000).

The pattern appears again in the death rate. In 1985-89 black males 65
and older had a death rate of 47.7 per 100,000, twice the rate seen in
white males of the same age group (23.6 per 100,000). The death rate
among females over 65 was similarly skewed: 31.1 per 100,000 among
blacks vs. 15.4 per 100,000 among whites.

Between 1973 and 1989, mortality rates for multiple myeloma increased
by almost 2% each year among whites over age 65, but 3% to 4% per year
among same-aged blacks.

NON-HODGKIN'S LYMPHOMA: 41,000 new cases in 1992 (estimated); 20,000
deaths in 1992 (estimated). Whites get this disease 2 to 3 times as
often as blacks, but even here there is bad news for blacks: Between
the periods 1974-76 and 1983-88 the survival rates improved
significantly for whites but not for blacks. [pg. XVIII.[1]]

CANCER OF THE ORAL CAVITY AND PHARYNX: 30,300 new cases in 1992
(estimated); 8000 deaths in 1992 (estimated). [pg. XIX.[1]]

In people less than 65 years old, the incidence rate among blacks is
nearly twice what it is among whites. Furthermore, in general, among
males, incidence rates are declining for whites (1973-1989) but are
increasing for blacks.

Over the age of 65, incidence rates are increasing among both black and
white women. Among females under the age of 65, incidence rates are
falling for whites but rising for blacks.

Survival rates are higher for whites than for blacks. Black males
diagnosed in 1983-87 have a five-year survival rate that is half that
for whites (26.2 vs. 52.4 percent).

Mortality rates have significantly declined for white males of all ages
and for white females under 65 years of age. In recent years (1985-
1989) there is a downward trend in mortality among white females of all
ages. Among blacks, on the other hand, during the same period there
were increases in mortality for both males and females of all ages, for
males less than age 65, and for males and females 65 and over.

CANCER OF THE PANCREAS: 28,300 new cases in 1992 estimated; 25,000
deaths in 1992 estimated. [pg. I.[21]]

During 1973-89, incidence declined among white males (-14.8%) and
females (-3.7%) and black males (-13.9%), but increased among black
females (+7.2%). During the same period, the death rate declined 11.1%
among white males, but increased 3.2% among white females while the
death rate among black males rose 10.6% and among black females rose
25.5%. [pg. XXI.[3]]

PROSTATE: 132,000 new cases estimated for 1992; 34,000 deaths estimated
for 1992. [pg. XXII.[1]]

Incidence rates are higher among blacks (139.7 per 100,000) than among
whites (98.8 per 100,000) in the period 1985-89.

Between 1973 and 1989, mortality increased at 1.7% per year among
blacks vs. 0.8% per year among whites. Black men in the U.S. have the
highest reported death rate for prostate cancer in the world.

No one has a good explanation for the high prostate cancer rate in the
U.S. The NCI [National Cancer Institute] says that studies of migrants
"suggest that environmental exposures play a more important role than
genetic [inherited] factors."

STOMACH CANCER: 24,400 new cases estimated for 1992; 13,300 deaths
estimated for 1992. [pg. XXIII.[1]]

In general, rates of incidence and death are declining, but rates among
black males and females remain about twice as high as rates among
whites.

Figure 1 shows which cancer death rates have increased and which have
diminished, 1973-1989, among blacks and whites. Examination of Figure 1
reveals that death rates among whites are improving, relative to death
rates among blacks, for 18 out of 24 cancers: for these 18, either the
death rate has increased among blacks faster than it has among whites,
or the death rate has decreased more slowly among blacks than it has
among whites. The trend is clear: as time passes, cancer inequities
between blacks and whites in the U.S. are continuing to worsen.

--Peter Montague, Ph.D.

=====

[1] See, for example, John Z. Ayanian, "Race, Class and the Quality of
Medical Care," JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Vol. 271,
No. 15 (April 20, 1994), pgs. 1207-1208. See also pgs. 1169-1174 and
1175-1180.

=====
. FIGURE 1 . Trends in U.S. Cancer Death Rates, 1973-89, by Cancer
Type . . Whites and Blacks All Ages . Percent Change, 1973-89 . -80
-40 0 40 80 120 Lung (female) . . |wwwwwwwwwwwwwwwwwwwwwwww (120%) . .
. |bbbbbbbbbbbbbbbbbbbbbbb. (116%) Non-Hodgkin's . . |wwwwww . . .
(28%) . . . |bbbbbbb. . . (32%) Multiple Myeloma . . |wwwww . . .
(26%) . . . |bbbbbbb. . . (35%) Lung (Males) . . |www . . . (17%) .
|bbbbbbbb . . (39%) . . Esophagus . . |www . . . (17%) . . . |b . . .
(7%) Prostate . . |www . . . (15%) . . . |bbbbbb . . . (29%) Brain &
Nerves . . |www . . . (13%) . . . |bbb . . . (14%) . . | . . Liver .
. |www . . . (13%) . . . |bb . . . (8%) . . | . . Kidney . . |ww . .
. (11%) . . . |bbbbbbbbb . . (46%) . All sites . . |w . . . (6%) . .
. |bbb . . . (16%) . . | . . Breast (females) . . |w . . . (2%) . .
|bbbb . . . (18%) Pancreas . . w| . . . (-5%) . . . |bbb . . . (17%)
Leukemia . . w| . . . (-7%) . . . |b . . . (5%) Ovary . . w| . . .
(-7%) . . . bb| . . . (- 8%) . . | . . Larynx . . ww| . . . (-11%) .
. . |bbb . . . (16%) Colon/Rectum . . www| . . . (-14%) . . . |bb . .
. (11%) . . | . . Oral Cavity . . wwww| . . . (-22%) . . . |bb . . .
(10%) Bladder . . wwwww| . . . (-23%) . . . bbbb| . . . (-19%)
Thyroid . . wwwww| . . . (-24%) . . . bbbbb| . . . (-25%) Uterus . .
wwwww| . . . (-24%) . . . bbbb| . . . (- 19%) . . | . . Stomach .
.wwwwwww| . . . (-33%) . . . bbbbb| . . . (-24%) Cervix .
wwwwwwwww| . . . (-42%) . . bbbbbbbbb| . . . (-44%) Hodgkin's .
wwwwwwwwwww| . . . (-55%) . . bbbbbbbb| . . . (-37%) Testicles .
wwwwwwwwwwwww| . . . (-63%) . . bbbbbbb| . . . (-33%) . . . -80
-40 0 40 80 120 . . PERCENT CHANGE, 1973-89 . w=WHITES b=BLACKS .
=====
Source: Reproduced from Barry A. Miller and others, editors. CANCER
STATISTICS REVIEW 1973-1989 [National Institutes of Health Publication
No. 92-2789] (Bethesda, Md.: National Cancer Institute, 1992), Figure
I-9, pg. I-50.
=====

Descriptor terms: cancer; race; caucasians; african-americans;
european-americans; morbidity statistics; mortality; esophagus; kidney
cancer; larynx cancer; liver cancer; lung cancer; multiple myeloma;
non-hodgkin's lymphoma; oral cavity cancer; pharynx cancer; pancreatic
cancer; prostate cancer; stomach cancer;