Wingo P A, Bolden S, Tong T, Parker S L, Martin L M, Heath C W
Department of Epidemiology and Surveillance, American Cancer Society, Atlanta, Georgia, USA.
CA Cancer J Clin. 1996 Mar-Apr;46(2):113-25. doi: 10.3322/canjclin.46.2.113.
Although cancer remains a major public health burden for African Americans, progress is being achieved. For both genders, stomach cancer mortality and mortality related to Hodgkin's disease showed large decreases over the past 30 years. Among African-American females, large decreases in cancer mortality occurred for nonmelanoma skin cancers, rectal cancers, and cervical and other uterine cancers. Tobacco use continues to decline among African Americans and, at present, is significantly lower among African-American youths than among their white counterparts. Despite these successes, additional work remains. Increased patient education regarding self-examinations and improved access to cancer screening are necessary to reduce the high percentage of cancers diagnosed at late stages among African Americans. Improved screening ultimately would increase survival and decrease cancer mortality. Some research has suggested that the increased morbidity and mortality in African Americans are related to poverty, lower education, and inadequate access to care as opposed to inherent racial characteristics. A recent study of black-white differences according to stage at diagnosis of breast cancer confirms some of these factors but also suggests that multiple factors may explain these differences, including mammograms, having a breast examination by a physician, and a history of patient delay. Such observations point to the importance of enacting broad social policies and establishing support mechanisms to diminish the impact of cancer in the African-American community.
尽管癌症仍然是美国非裔人群的一项重大公共卫生负担,但目前已取得了一些进展。在过去30年里,无论男性还是女性,胃癌死亡率以及与霍奇金淋巴瘤相关的死亡率都大幅下降。在非裔美国女性中,非黑色素瘤皮肤癌、直肠癌以及宫颈癌和其他子宫癌的癌症死亡率也大幅下降。非裔美国人的吸烟率持续下降,目前,非裔美国青少年的吸烟率显著低于白人青少年。尽管取得了这些成功,但仍有更多工作要做。有必要加强对患者的自我检查教育,并改善癌症筛查的可及性,以降低非裔美国人中晚期癌症诊断的高比例。改善筛查最终将提高生存率并降低癌症死亡率。一些研究表明,非裔美国人发病率和死亡率的增加与贫困、教育程度较低以及获得医疗服务不足有关,而非与种族固有特征有关。最近一项关于乳腺癌诊断分期的黑白差异研究证实了其中一些因素,但也表明多种因素可能解释这些差异,包括乳房X光检查、由医生进行乳房检查以及患者延误就医的病史。这些观察结果表明,制定广泛的社会政策并建立支持机制以减少癌症对非裔美国人社区的影响非常重要。