White–Black Differences in Cancer Incidence, Stage at Diagnosis, and Survival among Adults Aged 85 Years and Older in the United States

Abstract

Background Increased life expectancy, growth of minority populations, and advances in cancer screening and treatment have resulted in an increasing number of older, racially diverse cancer survivors. Potential black/white disparities in cancer incidence, stage, and survival among the oldest old (≥85 years) were examined using data from the SEER Program of the National Cancer Institute. Methods Differences in cancer incidence and stage at diagnosis were examined for cases diagnosed within the most recent 5-year period, and changes in these differences over time were examined for white and black cases aged ≥85 years. Five-year relative cancer survival rate was also examined by race. Results Among those aged ≥85 years, black men had higher colorectal, lung and bronchus, and prostate cancer incidence rates than white men, respectively. From 1973 to 2012, lung and bronchus and female breast cancer incidence increased, while colorectal and prostate cancer incidence decreased among this population. Blacks had higher rates of unstaged cancer compared with whites. The 5-year relative survival rate for all invasive cancers combined was higher for whites than blacks. Notably, whites had more than three times the relative survival rate of lung and bronchus cancer when diagnosed at localized (35.1% vs. 11.6%) and regional (12.2% vs. 3.2%) stages than blacks, respectively. Conclusions White and black differences in cancer incidence, stage, and survival exist in the ≥85 population. Impact Continued efforts are needed to reduce white and black differences in cancer prevention and treatment among the ≥85 population.

Cancer statistics for adults aged 85 years and older, 2019

“…Black men have a 5% higher cancer mortality rate than white men despite their lower incidence rate (Fig. ), reflecting the persistence of racial/ethnic disparities in stage at diagnosis and survival . Although racial differences in stage at diagnosis for the oldest old are generally smaller than those observed in the general population, survival differences are still striking.…”

“…Although racial differences in stage at diagnosis for the oldest old are generally smaller than those observed in the general population, survival differences are still striking. For example, 5‐year relative survival rates for patients aged 85 years and older with either local‐stage or regional‐stage lung cancer are about 3 times higher in whites compared with blacks . This disparity may reflect inequalities in access to and receipt of quality medical care and differences in the burden of comorbidities and other age‐associated conditions .…”

“…2), reflecting the persistence of racial/ethnic disparities in stage at diagnosis and survival. 38,39 Although racial differences in stage at diagnosis for the oldest old are generally smaller than those observed in the general population, survival differences are still striking. For example, 5-year relative survival rates for patients aged 85 years and older with either local-stage or regional-stage lung cancer are about 3 times higher in whites compared with blacks.…”

“…For example, 5-year relative survival rates for patients aged 85 years and older with either local-stage or regional-stage lung cancer are about 3 times higher in whites compared with blacks. 39 This disparity may reflect inequalities in access to and receipt of quality medical care and differences in the burden of comorbidities and other age-associated conditions. [40][41][42] Despite relatively universal access to basic health insurance through Medicare, some costs of cancer care are not fully covered by Medicare and can be burdensome for older patients with limited, fixed incomes.…”

The 22Rv1 prostate cancer cell line carries mixed genetic ancestry: Implications for prostate cancer health disparities research using pre‐clinical models

“…African American (AA) men and other men of African ancestry have the highest incidence and mortality rates of prostate cancer (PCa) in the world, resulting in the highest reported cancer health disparity . We use the term “African American” recognizing that while race is a social construct, racial classification remains extremely useful for describing general patterns of national health and health disparities, as most US health data are reported by self‐identified race .…”