The Cancer Answer

Jan. 17-23, 2005 Listen to the message

African Americans and Cancer

This week we celebrate Martin Luther King, Jr. Day, a holiday that honors the life and contributions of our country’s greatest champion of racial equality, who helped us make great strides in leveling the playing field for all Americans.

But African Americans still face disparities in some areas, including quality of health. And cancer is one health issue in particular that affects blacks disproportionally.

For several reasons, lifestyle and healthcare patterns included, African Americans develop and die from cancer at greatly inflated rates.

It doesn’t have to be this way.

Everyone can reduce their cancer risk by exercising, maintaining a healthy diet and, most of all, not smoking.

Add routine screening tests to find cancer early, to this healthy lifestyle combination, and cancer will be prevented 75% of the time.

Act today. It could save your life.

Cancer affects people in all ethnic and racial groups, but there are differences among specific groups of people. African Americans have a larger percentage of cancer diagnoses and deaths than the general population. Most of the higher rates appear to be related to socioeconomic status. There are a number of research studies that have linked higher income, better living conditions, higher levels of education, and access to good health insurance with earlier diagnosis of cancer and longer life after diagnosis, regardless of race or ethnicity. For example, African Americans who have high levels of education, income, and good health insurance have cancer death rates that are closer to the general population, and lower cancer death rates than impoverished African Americans.

Also related to socioeconomic status is diet. Poor people, regardless of race or ethnicity, have less access to healthy foods and are more likely to be overweight. There is increasing evidence that being overweight increases the risk for developing and dying from cancer. (See last week’s message about diet and cancer to learn more.) African American women have a greater incidence of being overweight than other races and ethnicities, which puts them at greater risk of developing cancer.

There are some differences that can’t be explained by socioeconomic factors. For example, African American men develop prostate cancer at much higher rates than white men, regardless of income, level of education, and access to health insurance. Currently, the reason for this is unknown, but there are research studies exploring this question.

The American Cancer Society and the National Cancer Institute are very concerned about differences in cancer diagnosis and cure rates among racial and ethnic groups (described by both organizations as “cancer health disparities”). Both organizations have detailed information on their web sites about the current problems, ongoing research, and programs that are being developed to address the disparities. To find a list of their publications on this topic go to each web site below and enter “cancer disparities” or “African Americans and cancer” in the search boxes. The American Cancer Society also publishes the booklet “Cancer Facts and Figures for African Americans, 2003-2004” that can be downloaded from their site, or a free copy can be requested from your local American Cancer Society office.

www.cancer.gov (National Cancer Institute)

www.cancer.org (American Cancer Society)

African Americans should follow the same guidelines for cancer prevention and early detection as the general population: quit smoking, eat lots of fruits and vegetables and a generally healthy diet, lose weight if overweight, and follow the American Cancer Society Guidelines for cancer screening listed below.

Screening Guidelines For the Early Detection of Cancer in Asymptomatic People

Breast

Women 40 and older should have an annual mammogram, an annual clinical breast examination (CBE) by a health care professional, and should perform monthly breast self-examinations (BSE). Ideally the CBE should occur before the scheduled mammogram. Women ages 20-39 should have a CBE by a health care professional every three years and should perform a BSE monthly.

Colon & rectum

Beginning at age 50, men and women should follow one of the examination schedules below:

• A fecal occult blood test (FOBT) every year
• A flexible sigmoidoscopy (FSIG) every five years
• Annual fecal occult blood test and flexible sigmoidoscopy every five years*
• A double-contrast barium enema every five years
• A colonoscopy every 10 years

* Combined testing is preferred over either annual FOBT, or FSIG every 5 years, alone. People who are at moderate or high risk for colorectal cancer should talk with a doctor about a different testing schedule.

Prostate

The PSA test and the digital rectal examination should be offered annually, beginning at age 50,to men who have a life expectancy of at least 10 years. Men at high risk (African American men and men with a strong family history of one or more first-degree relatives diagnosed with prostate cancer at an early age) should begin testing at age 45. For both men at average risk and high risk, information should be provided about what is known and what is uncertain about the benefits and limitations of early detection and treatment of prostate cancer so that they can make an informed decision about testing.

Uterus

Cervix: Screening should begin approximately three years after a woman begins having vaginal intercourse, but no later than 21 years of age. Screening should be done every year with regular Pap tests or every two years using liquid-based tests. At or after age 30,women who have had three normal test results in a row may get screened every 2-3 years. However, doctors may suggest a woman get screened more often if she has certain risk factors, such as HIV infection or a weak immune system. Women 70 years and older who have had three or more consecutive normal Pap tests in the last 10 years may choose to stop cervical cancer screening. Screening after total hysterectomy (with removal of the cervix) is not necessary unless the surgery was done as a treatment for cervical cancer.

Endometrium: The American Cancer Society recommends that all women should be informed about the risks and symptoms of endometrial cancer, and strongly encouraged to report any unexpected bleeding or spotting to their physicians. Annual screening for endometrial cancer with endometrial biopsy beginning at age 35 should be offered to women with or at risk for hereditary nonpolyposis colon cancer (HNPCC).

Cancer-related checkup

For individuals undergoing periodic health examinations, a cancer-related checkup should include health counseling, and depending on a person’s age, might include examinations for cancers of the thyroid, oral cavity, skin, lymph nodes, testes, and ovaries, as well as for some nonmalignant diseases.