Can Ethnicity and Race Impact Cancer Survival?

A cancer diagnosis is scary for everyone. For many of us, it’s our worst fear. Clearly, we worry about the prognosis and the potentially hard treatments that lay ahead. What we shouldn’t have to worry about is how our race or ethnicity could impact our chance of having a positive outcome. But it looks fairly certain that it does. And not always in a positive way. How and why does ethnicity and race impact cancer survival rates?

Racism in cancer healthcare.

Racism contributes to cancer health disparities by limiting the ability of people of racial and ethnic minority groups to prevent cancer, find cancer early, and get treatment.

The Centers for Disease Control and Prevention (CDC) outlines several ways racism impacts cancer care and outcomes. Firstly, structural racism makes it harder for minorities to access, navigate, and pay for healthcare.

Additionally, institutional racism may block minority groups from access to testing and treatment resources and opportunities, which can impact the quality of care received. And interpersonal racism, or implicit bias, can lead medical providers to discriminatory practices that block a minority’s access to healthcare resources or opportunities.

Does ethnicity and race impact cancer survival?

To determine the impact of ethnicity and race, researchers analyzed the diagnoses, treatments and outcomes of 950,377 Asian, Black, White, and Hispanic patients. Each patient had received a diagnosis of prostate, ovarian, breast, stomach, pancreatic, lung, liver, esophageal, or colorectal cancer between January 2004 and December 2010. The team analyzed at least 5 years’ worth of data for each patient.

The results, as seen below, indicate it’s likely that ethnicity and race impact cancer survival.

* Metastatic cancer – the spread of cancer cells from the place where they first formed to another part of the body.

** Definitive treatment – the plan chosen as the best one for a patient after all other choices have been considered.

What are the specific findings of this study?

This study is unique in that it analyzed the cancer stage at diagnosis, treatment, and survival for each patient. The study identified many areas in which ethnicity and race impact cancer survival rates. Among the study’s findings:

• White patients were more likely than Asian patients to develop metastasis in stomach, lung, liver and colorectal cancers.
• Black patients were more likely to have metastatic prostate, ovarian, breast, and colorectal cancers than Asian patients.
• Asian patients with gastric cancer have better survival rates than patients from other racial/ethnic groups.
• White patients with lung cancer had worse survival rates than Asian patients.
• White patients were more likely to develop metastatic liver cancer, less likely to receive active treatment, and more likely to have worse outcomes than Asian patients.
• The Asian patients with colorectal cancer had the best survival outcomes compared with other groups.
• White patients with prostate cancer had higher rates mortality than Asian patients.
• Compared with Asian patients, white patients received more treatments for ovarian cancer and had the best prognoses for breast cancer. In contrast, Black patients received treatment less often and had worse outcomes.

What do other studies show?

Many studies show disparities on treatment and outcomes among people of color, particularly for Black people. Unfortunately, Blacks face great obstacles to cancer prevention, detection, treatment, and survival. And Black people having higher incidence rates of cancer and worse outcomes than white people.

In fact, Black people have the highest death rate and shortest survival of any racial or ethnic group for most cancers in the US. For instance, Blacks are more likely to have an aggressive form of colorectal cancer, which leads to lower survival rates for Black patients with colorectal cancers than for those in other racial or ethnic groups.

Other minority groups face challenges as well. For instance, American Indian and Alaska Native people are more likely to get colorectal cancer than white people. One reason may be that many Native people live far away from clinics that provide colonoscopies.

Here are a few additional findings:

• A study of over 39,000 Medicare beneficiaries found that Black patients with prostate cancer were less likely than white patients to receive a prostate MRI. The analysis found that geographic differences, socioeconomic status, and racialized residential segregation were associated with most of the disparity between Black and white patients.
• Another study evaluated the use of proton beam therapy (PBT) for newly diagnosed cancer patients. Researchers found that Black patients were less likely to receive PBT, as compared to white patients. Sadly, this was especially true for cancers for which PBT is recommended over photon-based radiation therapy.
• Researchers found that the death rate from breast cancer for Black women is 50% higher than for white women. The authors believe racial and economic inequities in screening and treatment options contribute to this difference in survival rates.
• Another study found that among those undergoing curative surgery for gastrointestinal (GI) tract cancers, Black patients were less likely to receive standard of care treatment.
• Another study evaluated the records of over 600,000 brain tumor patients from the past 50 years. The researchers found that doctors were significantly less likely to recommend surgical removal of 4 common brain tumors for Black patients, as compared to white patients.
• One study of breast cancer patients in North Carolina between 2004 and 2017 found that Black patients were more likely than non-Black patients to wait more than 60 days from their diagnosis to their first treatment. Interestingly, the gap in treatment delay ranged from 0 to 9.4%, varying from region to region.

Studies find slight improvements in racial disparities.

A 2020 report by AACR (American Association for Cancer Research) cites a reduction in the racial disparities for cancer death rates. In 1990, the cancer death rate for Blacks was 33% higher than the rate for whites. But in 2016, the difference declined to 14%. Even better news, the disparity in the overall cancer death rate between Blacks and whites is close to zero for men under the age of 50 and for women 70 and older.

How does ethnicity and race impact cancer care and survival?

Experts believe the differences in survival rates among different races and ethnicities are likely caused by many factors, including tobacco or alcohol use, diet (too much fat and red meat), obesity and/or a genetic susceptibility to cancer. But, it’s not just those factors.

Importantly, patients of color, particularly Black patients, tend to have more barriers to care access, and less timely follow-ups after an abnormal finding. Additionally, patients of color are more likely to receive diagnoses at later stages of cancer.

Barriers to care include difficulty accessing high-quality health care, with shortages of doctors and medical centers in Black and Hispanic communities.

Additionally, Black, Hispanic, and American Indian/Alaska Native (AIAN) populations are less likely to have health insurance, which makes it harder to access healthcare.

Importantly, research shows that Blacks’ socioeconomic status, health insurance coverage, and access to medical care tends to be lower than that among members of other racial and ethnic groups in the US.

Unsurprisingly, delays in diagnoses, and/or lack of access to cutting edge treatments, can lead to worse survival rates for any cancer patient.

Medical research lacks minority participation.

Cancer-related clinical trials generally test medications for safety and effectiveness using human volunteers. Although it’s important to know how diverse populations fare in these trials, people from racial and ethnic minority groups are often underrepresented in clinical trials.

Why does this matter? If there is no data on the safety and effectiveness of treatments for patients of color, it’s harder for doctors to determine which medications and dosages to recommend.

Concerns related to studies on screening for cancer.

In addition to a lack of diverse patients in medication trials, there aren’t enough minorities in research on parameters for screening. For instance, although about 13% of the US population is Black, Black people made up just 4.4% of participants in the National Lung Screening Trial. This important trial evaluated if screening with low-dose CT scans could reduce mortality from lung cancer.

Clearly the lack of diverse representation in trials, for both screenings and treatments, can lead to delayed diagnoses and higher mortality rates for minorities.

What can you do about the impact of ethnicity and race on cancer survival?

Fortunately, you can take actions to help yourself get the best healthcare and outcome possible. Of course, you can’t erase years of systemic racism, but these suggestions are a step in the right direction.

Early detection is key.

The chances of surviving cancer increase with early detection.

First, stay on top of your healthcare and screenings. Use the cancer screening guidelines published by the US Centers for Disease Control and Prevention to learn about the recommended frequency of tests, along with a description of each test.

However, realize recommendations can change as scientific research evolves. You can also find helpful information on cancer screening on the National Cancer Institute site.

It’s also important to talk to you primary care doctor about your risk factors for cancer. Ask if your race, ethnicity, gender, age, work, eating, drinking, smoking, drug use, or other habits put you at increased risk for cancer.

Certainly, being honest about your lifestyle with your doctor, and yourself, is important. Ask what steps you can take to reduce your risk of cancer. And of course, ask your doctor about cancer screenings.

Choose your cancer doctor and hospital carefully.

Unsurprisingly, extensive research shows that hospital choice significantly impacts cancer survival rates. Receiving complex cancer treatment from a hospital where doctors don’t have adequate training and experience can increase the risk of death from surgical complications by 4x.

Conversely, teaching hospitals with high volumes, along with high volume surgeons, have superior long-term cancer survival rates.

Use the tips in How to Choose a Hospital for Cancer Treatment. to find the “right” hospital for you and your type of cancer. Then call them and ask for an appointment with an oncologist who specializes in your type of cancer.

Engage in the process.

Importantly, being an engaged member of your medical team can help you get the best care and outcome possible.

• Advocate for yourself – don’t let doctors intimidate you.
• If something seems wrong, speak up! Don’t be afraid to be the polite, squeaky wheel.
• Prepare for appointments. Write down all your questions ahead of time, and make sure you mention your top 2-3 concerns at the beginning of every appointment.
• Get a 2nd, or even a 3rd, opinion. Try to get an opinion at a teaching hospital. For more information, read Why are Second Opinions Important?
• If needed, ask for a language interpreter.
• If you think your doctor is discriminating against you, try to find another doctor. For more information, read How Do You Find a New Doctor You Can Trust?
• Use a notebook at home to keep track of questions and symptoms. And use it to take detailed notes at every appointment. Read Why Take Detailed Notes at Doctor Appointments?
• Keep all your medical documents organized and together. Bring them to every medical appointment.

For more information, read What Should You Do When You Get a Cancer Diagnosis? and Does Where You Live Impact Cancer Outcome? Sadly, Yes.

Is money keeping you from cancer screenings and treatment?

If you have private insurance offered through your employer, your coverage probably includes free cancer screenings with no co-pay or deductible. Your insurance should also cover cancer treatments, although deductibles and/or co-pays will apply. However, it’s always a good idea to call your insurance company to learn about costs before scheduling an appointment.

Medicare coverage for cancer screenings.

Medicare provides free screening for many cancers, but coverage varies. To learn about coverage requirements for screenings, including for breast, cervical, lung, prostate and colorectal cancers, visit the Medicare.gov site.

Importantly, realize your doctor may recommend screenings more often than the Medicare payment schedule allows. Or, your doctor may recommend services that Medicare doesn’t cover. In these situations, you may have to pay some or all of the costs. So before scheduling any screening test, ask your doctor:

• Why he/she is recommending each test.
• If Medicare will pay for each test, given your circumstances.
• How much you can expect to pay.

According to the Medicare website, the amount you’ll owe can depend on several things, including:

• Other insurance you may have.
• How much your doctor charges.
• Whether your doctor accepts the assignment. (Assignment means that your doctor, provider, or supplier agrees to, or is required by law, to accept the Medicare-approved amount as full payment for covered services.)
• Where you get your test, item, or service.

Medicare coverage for cancer treatments.

Coverage for treatments and hospitalizations varies according to your plan. It can be confusing, so check out your coverage in their online Medicare Coverage of
Cancer Treatment Services booklet.

No insurance coverage at all?

If you don’t have health insurance, you might be able to get low-cost or free cancer screenings. Call the National Cancer Institute (1-800-422-6237) or the American Cancer Society (1-800-227-2345) for help.

Additionally, the government requires nonprofit hospitals to have Charity Care programs that can cover some or all of your hospital bill if you qualify. Additionally, for-profit hospitals have programs for low-income patients as well. Note that doctors and other medical providers generally do not provide charity care.

Find information on your hospital’s charity care program by searching online with the hospital name and the phrase “patient financial assistance”. Or call the hospital and ask to speak with someone in the billing department.

To take advantage of these programs, you must complete a potentially difficult and confusing application process. Additionally, you may have to persist to get an application since some hospitals deter applicants. And don’t assume a hospital will know about your financial concerns – you have to ask for help.

Get financial help through nonprofit support organizations.

Fortunately, there are nonprofit organizations dedicated to helping patients and families with financial issues.

The Cancer Financial Assistance Coalition (CAFC) is a coalition of organizations that help cancer patients manage their financial challenges. Search their database by your location and the type of help you require.

CancerHawk has a website with links to hundreds of organizations that provide financial assistance to cancer patients. You can find help for a variety of expenses, including medical, travel, rent, groceries, college tuition and more.

Patient Access Network (PAN) Foundation helps underinsured patients with out-of-pocket expenses for medications and treatments. They help patients with federal and commercial insurance who have life-threatening, chronic and rare diseases.