Cancer and African-Americans Toolkit

Cancer is a group of diseases characterized by uncontrolled growth and spread of abnormal cells. The cancer cells form tumors that destroy normal tissue. If cancer cells break away from a tumor, they can travel through the blood stream or the lymph system to other areas of the body, where they might form new tumors (also known as Metastases). If this growth is not controlled, cancer might be fatal.

Not all irregular growths of abnormal cells lead to cancer. A tumor can be either benign (non-cancerous) or malignant (cancerous). Benign tumors do not metastasize and, with very rare exceptions, are not life threatening. Benign tumors usually grow slowly, remain localized, and do not destroy surrounding normal tissue.

All cancers develop because of damage or mutation of the genes that control cell growth and division. These genetic changes can be caused by exposure to external factors (for example, tobacco, poor diet, alcohol, chemicals, sunlight, radiation, and infectious organisms) or internal factors (for example, inherited mutations, hormones, immune conditions, and mutations that occur from metabolism). Approximately five to 10 percent of cancers are caused by various inherited gene mutations that predispose people to developing certain cancers.

External and internal factors often act together in sequence to initiate or promote cancer development. Many years often pass between exposures or mutations and detectable cancer. Because of this, it is often difficult to directly identify causes of specific cancer cases.

African-Americans have the highest death rate and shortest survival of any racial and ethnic group in the United States for most cancers.1 The causes of these inequalities are complex and are thought to reflect social and economic disparities more than biologic differences associated with race. These include inequities in work, wealth, income, education, housing and overall standard of living, as well as barriers to high-quality cancer prevention, early detection, and treatment services. In Indiana, while the overall racial disparities in cancer incidence and mortality rates have been gradually decreasing, during  2007-2011, African-Americans had a 4.3 percent greater incidence of cancer than whites, and more than a 20 percent higher mortality rate.2

What Types of Cancer Impact the African-American Community the Most?

In Indiana, during 2011, lung and bronchus cancer was the most common cause of cancer-related death among all African-Americans.2 The second leading cause of cancer death among men was prostate cancer, and breast cancer was the second leading cause of cancer death among women. Colorectal cancer was the third leading cause of cancer deaths among both sexes.2

While African-Americans, compared to whites, continue to be unequally burdened by cancer in Indiana, the disparities between the two groups have been gradually decreasing. For example, when comparing 2002-2006 to 2007-2011, the disparity in incidence rates was cut almost in half from 7.3 percent to 4.2 percent, and the disparity in mortality rates was cut almost a third from 28.3 percent to 20.3 percent.2 Despite these gains, continued work needs to be done to address the differences among the races, especially the difference in cancer mortality rates. In Indiana, during 2007-2011, the impact of specific cancer types among African-Americans includes2:

  • Colon and Rectum. In comparison to whites, African-Americans had a 22 percent higher incidence rate (54.9 versus 45.0 cases per 100,000 people) and a 36 percent higher mortality rate for colon and rectum cancer (22.3 versus 16.4 deaths per 100,000 people). African-American males, in particular, were at higher risk, as their age-adjusted incidence rate was 24 percent higher than white males (63.7 versus 51.4 cases per 100,000 males) and their mortality rate was 40 percent higher (28.1 versus 20.1 deaths per 100,000 males). African-American females had a 24 percent higher incidence rate than white females (49.4 to 39.7 cases per 100,000 females) and a 38 percent higher mortality rate (18.9 vs. 13.7 per 100,000 females).
  • Lung Cancer. In comparison to whites, African-Americans had a nine percent higher incidence rate (81.8 versus 75.0 cases per 100,000 people) and a 13 percent higher mortality rate (65.4 versus 57.9 deaths per 100,000 persons). Additionally, the age-adjusted death rate for lung cancer was nearly two times higher for African-American males compared to African-American females (90.5 versus 48.1 deaths per 100,000 persons).
  • Prostate Cancer. The age-adjusted incidence rate for prostate cancer was 47 percent higher among African-American males compared to white males (159.4 versus 108.3 cases per 100,000 males). Moreover, the death rate for prostate cancer was more than two times higher (44.0 vs. 21.1 per 100,000 males).
  • Breast Cancer. African-American females were as likely as white females to be diagnosed with breast cancer (120.7 versus 117.8 cases per 100,000 females, respectively). However, African-American female deaths from breast cancer were 36 percent higher than white females (30.3 versus 22.2 deaths per 100,000 females).

Prevention

Many cancers can be prevented by modifying external risk factors and making lifestyle changes, such as eliminating tobacco use, improving dietary habits, increasing physical activity, losing weight and avoiding excessive sun and infectious disease exposure. For example:

  • Avoid tobacco use and secondhand smoke.
    • During 2012, African-American men had the highest prevalence of current smokers (29.2 percent) among adults in Indiana.3
  • Limit alcohol consumption.
  • Maintain a healthy weight.
    • During 2012, in Indiana, just over 40 percent of African-American adults were considered obese.3
    • Consume a healthy diet that emphasizes plant sources, includes five or more servings of a variety of vegetables and fruit each day, includes whole grains in preference to processed or refined grains, and has minimal processed and red meats.
      • During 2012, almost 80 percent of African-American adults failed to eat the daily recommended servings of fruits and vegetables.3
    • Adopt a physically active lifestyle.
      • During 2012, 56 percent of African-American adults did not get the recommended 150 minutes of exercise per week.3
    • Protect yourself from too much sun exposure.
    • Talk to your primary health provider about:
      • Any potential signs and symptoms of cancer, including unexplained weight loss, fever, fatigue, pain and skin changes.
      • Cancer screening options for breast, cervical, colorectal and prostate cancers.
      • Vaccines that can reduce your risk for developing cancer, like hepatitis B and human papillomavirus (HPV).

 Early Detection

Early detection tests can lead to prevention of cancer through the identification and removal of precancerous lesions, particularly for cancer of the cervix and colon and rectum.

  • Screening can detect cancer at an earlier stage, when treatment is most effective.
  • In general, race did not play a role in cancer screening rates among Indiana adults during 2012.3
  • During 2012, in Indiana, early detection rates for African-Americans included:3
    • 76.6 percent of women ages 18 and older had a Pap test within the past three years (cervical cancer).
    • 68 percent of women ages 40 and older had a mammogram within the past two years (breast cancer).
    • 85.1 percent of men ages 40 and older had ever had a prostate-specific antigen (PSA) test (prostate cancer).
    • 62.1 percent of people ages 50 and older had ever had a colonoscopy or sigmoidoscopy (colorectal cancer). 

How is Cancer Staged?

A cancer’s stage is based on the primary tumor’s size and location in the body, and whether it has spread to other areas of the body. There are two main staging systems used to classify tumors.

  • TNM staging system — This system assesses tumors in three ways: extent of the primary tumor (T), absence or presence of regional lymph node involvement (N), and absence or presence of distant metastases (M). Once the T, N and M are determined, a stage of I, II, III or IV is assigned, with stage I being early stage and IV being advanced.
  • Summary staging — This is useful for descriptive and statistical analyses of cancer data. An in situ tumor is at the earliest stage when it has not invaded surrounding tissue; it can only be diagnosed by microscopic examination. A localized tumor has not spread beyond the primary organ. A regional or distant tumor has spread to other parts of the body, either through the blood or lymph systems. With an unstaged/unknown tumor, there is insufficient information available to determine the stage of the disease.

Staging is essential in determining treatment and assessing prognosis. It is a strong predictor of survival; generally, the earlier the stage, the better the prognosis. Locally and nationally, about half of newly diagnosed cases are either in situ or localized.

How is Cancer treated?

Treatment depends on the cancer type and stage, specific diagnosis, and overall health of the individual. Cancer is treated by one or more of the following therapies:

  • Surgery removes the tumor by cutting out the cancerous mass; it is mostly used for localized tumors.
  • Chemotherapy uses either intravenous or oral drugs to destroy cancer cells. It is used with the intention of curing or inducing remission in cancers in early stages.
  • Hormone therapy might be given to block the body’s natural hormone and to slow or stop the growth of certain cancers.
  • Immunotherapy (or biologic therapy) is used to stimulate and strengthen a person’s own immune system to destroy the cancer cells.
  • Radiation or radiotherapy uses high-energy rays to destroy or slow the growth of cancer cells. It can be done with the intention of curing some cancers that have not spread too far from their site of origin or to relieve symptoms.

Can Cancer be cured?

Many cancers can be cured if detected and promptly treated. For most types of cancer, if a person’s cancer has been in remission (which means that all signs and symptoms of the disease are absent) for five years, the cancer is considered cured. However, the length of remission at which a person is considered cured differs by cancer type. Certain skin cancers, such as a basal cell carcinoma, are considered cured as soon as the lesion is removed. For other cancers (for example, pancreatic cancer), eight to 10 years must pass before the person is considered cured.

Resources

  • Cancer Among African-Americans Fact Sheet — Use this fact sheet to educate your partners and communities. The fact sheet provides information and statistics on the cancer burden for African-Americans in Indiana.
  • 2012 Indiana Facts and Figures — Provides current statistics and information on cancer in Indiana in convenient PDF form. This can be linked to documents, websites, presentations, or through social media.
  • Indiana Cancer Control Plan 2010-2014 — Provides a roadmap for cancer control in Indiana. The ICCP includes six focus areas: primary prevention, early detection, treatment, quality of life, data, and advocacy. This can be linked to documents, websites, presentations, or through social media.

Breast Cancer Resources:

Colorectal Cancer Resources:

Lung Cancer Resources:

Prostate Cancer Resources:

Additional and online resources:

 

References

  1. American Cancer Society; Cancer Facts and Figures for African Americans 2013-2014. Atlanta. American Cancer Society, 2013. Accessed online on August 22, 2013 at http://www.cancer.org/Research/CancerFactsStatistics/2013-2014-cancer-facts-figures-african-americans.pdf.
  2. Indiana Cancer Consortium, Indiana State Department of Health and the American Cancer Society Great Lakes Division; Indiana Cancer Facts and Figures 2012. March, 2012. Available at http://indianacancer.org/resources-for-indiana-cancer-consortium-members/indianacancerfactsandfigures2012/. Updated cancer statistics are available online from the Indiana State Cancer Registry Statistics Report Generator at http://www.in.gov/isdh/24360.htm.
  3. Indiana Behavioral Risk Factor Surveillance Systems, Data Analysis Team, Indiana State Department of Health.