VCU Massey Cancer Center, Richmond, VA, United States.
Meharry-Vanderbilt Alliance, Nashville, TN, United States.
J Natl Med Assoc. 2023 May;115(2S):S2-S7. doi: 10.1016/j.jnma.2023.02.001. Epub 2023 Mar 30.
Cancer incidence and outcomes vary considerably between racial and ethnic groups. Non-Hispanic (NH) Blacks are disproportionately burdened with the most common cancer types, having the highest death rate of any group. Racial health disparities are complex and have been identified at each step of the cancer care continuum, encompassing patient and provider factors and health care system processes. The higher cancer mortality among NH Blacks may reflect underuse of prevention strategies such as vaccination and screening, resulting in later stage of disease at diagnosis and underuse of cancer-directed therapy. Inequalities in the quality of care, including access to health care and receipt of recommended diagnostic and therapeutic interventions as well as supportive care also contribute to the excess burden of cancer-related deaths among NH Blacks. Non-clinical factors such as structural racism and lower socioeconomic status are associated with unequal access to resources such as housing, healthy foods, employment, and education, which have been demonstrated to drive racial disparities in cancer. Concerted efforts to understand and target the causes of the observed differences in access, screening, and treatment utilization will be critical for achieving more equitable treatment delivery and outcomes for all patients with cancer. Moreover, ongoing efforts to enhance diversity in clinical trials enrollment and access to novel precision medicine initiatives are processes warranted to reduce healthcare inequalities.
癌症的发病率和结局在不同种族和族裔群体之间存在显著差异。非西班牙裔黑人（NH 黑人）不成比例地承受着最常见癌症类型的负担，其死亡率是所有群体中最高的。种族健康差异是复杂的，在癌症护理连续体的每一个步骤中都有发现，包括患者和提供者因素以及医疗保健系统流程。NH 黑人的癌症死亡率较高可能反映了预防策略（如疫苗接种和筛查）的使用不足，导致诊断时疾病处于晚期，以及癌症定向治疗的使用不足。护理质量的不平等，包括获得医疗保健以及接受推荐的诊断和治疗干预措施以及支持性护理，也导致 NH 黑人癌症相关死亡人数过多。非临床因素，如结构性种族主义和较低的社会经济地位，与获得资源（如住房、健康食品、就业和教育）的不平等有关，这些因素已被证明会导致癌症方面的种族差异。为了实现所有癌症患者更公平的治疗提供和结局，需要齐心协力地了解和针对观察到的在获得、筛查和治疗利用方面的差异的原因。此外，不断努力增加临床试验参与和获得新的精准医学倡议的多样性是减少医疗保健不平等的过程。
