Some longstanding cancer disparities in the US are narrowing, but many Americans are still being left behind when it comes to cancer prevention, screening, and treatment.

That’s according to the latest Cancer Disparities Progress Report from the American Association for Cancer Research (AACR) — a biennial look at the unequal burden of cancer in the US. As in prior years, the update contains a mix of good and bad news.

Among the highlights: The cancer mortality gap between Black and White Americans has narrowed substantially, from a one third higher rate among Black individuals in the 1990s to a 9% higher rate as of 2024. Much of that progress can be traced to specifically to lung cancer, where the racial divide in mortality has been erased.

At the same time, many gaps in cancer incidence and mortality persist, based not only on race/ethnicity but also on income, sexual orientation, and geography.

Speaking at congressional briefing last week, AACR CEO Margaret Foti, PhD, MD, characterized the report as a “call to action.”

Over the past several decades, Foti noted, cancer treatment advances have “transformed care for countless patients.” But it’s clear that the burden of cancer is not shared equally, she said.

Some key takeaways from the report include: 

• Despite positive trends, Black Americans, together with Native Americans and Alaskan Natives, still have the highest overall cancer mortality rates of all racial and ethnic groups — at roughly 163 and 155 cancer deaths per 100,000, respectively, vs 149 per 100,000 among White Americans.
• Americans in rural counties bear a 17% higher risk for colorectal cancer relative to urban residents, coupled with a 27% greater mortality risk.
• Lesbian women are twice as likely to develop thyroid cancer and/or non-Hodgkin lymphoma compared with heterosexual women.
• The once-substantial gap in cervical cancer mortality between White and Hispanic women has largely disappeared, thanks to a steep decline among Hispanic women in the past decade. However, other disparities remain: Cervical cancer incidence is 32% higher in US counties with high poverty rates relative to those with low poverty rates, together with a nearly 50% higher mortality rate.
• Breast cancer mortality is 26% higher among Pacific Islander and Native Hawaiian women than among White women — possibly due in part to inadequate access to specialists and delays in surgical treatment.
• More than 70% of US counties have no ongoing cancer clinical trials.

The reasons for these trends are complex and interconnected. Modifiable risk factors, such as smoking, poor diet, alcohol use, and lack of exercise, play a role. But those things — often framed as individual choices — are actually “strongly shaped” by structural conditions and social injustices, the report stresses.

Disparities in cancer screening abound, as well. Compared with their White counterparts, Americans of other races/ethnicities are often less likely to be up to date with routine cancer screenings. The same is true of people living in rural parts of the country vs those in urban and suburban areas. All of these screening gaps have various underlying reasons, including lack of insurance, a primary care home, and/or reliable transportation.

In addition to statistics, this year’s AACR report features stories from cancer survivors, several of whom were on hand at the briefing.

Janaylon Wright, a 33-year-old Philadelphia resident, was diagnosed with stage III colon cancer at the age of 29 — but only after a frustrating odyssey to find a cause for her persistent abdominal pain and constipation.

Wright, who is Black, spoke of misdiagnoses she received at multiple emergency room and urgent care settings, where she said her symptoms and distress were “dismissed and passed off as a ‘woman problem.’”

Wright’s case is part of a broader trend highlighted in the report: While early-onset colorectal cancer is rising across racial and ethnic groups in the US, young Black adults are more likely than their White peers to present with advanced disease and have a 34%-59% greater risk for death.

Still, the strides made in closing certain disparities show the way forward, said Mariana C. Stern, PhD, chair in the report steering committee.

The improvement in cancer mortality among Black Americans is a prime example. It includes a 50% drop in cancer deaths among Black men between 1991 and 2024, the largest such decline for any racial or ethnic group. That trend, according to the report, has been spurred by a decline in smoking and earlier detection of certain cancers, along with treatment advances.

“Progress is possible,” Stern said. “We know how to do it.”

Solutions, the AACR said, must include government investment. Medicaid expansion under the Affordable Care Act has been linked to earlier cancer diagnosis and improved survival — including greater access to surgical resection and better survival outcomes for patients with pancreatic cancer. The report calls on policymakers to protect Medicaid coverage for cancer screenings and follow-up care — and to restore “robust funding” for cancer research, prevention, and surveillance.

Community efforts are key, as well. The report points to examples of effective programs, including an initiative developed with input from members of Black churches that improved awareness of lung cancer screening using culturally tailored messaging and trained lay health advisors.

Boosting the pool of trained patient navigators could also be an effective way of ensuring more Americans access recommended care.

The report cites an analysis of 42 randomized clinical trials finding that patient navigation increased breast cancer screening by 50% and cervical cancer screening by 62% — with the strongest effects among medically underserved groups.

The experts cited in this article had no relevant disclosures.