Black Men and Cancer: Closing the Disparity Gap

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Black Men and Cancer Closing the Disparity Gap

• Shanita Williams-Brown, PhD, MPH, APRN-BC
• Assistant Professor, Department of Community
  Health and Preventive Medicine
• Research Scholar, National Center for Primary
  Care
• Morehouse School of Medicine
• Atlanta, GA
• Swilliams-brown_at_msm.edu

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Objectives

• To describe the cancer disparity problem in
  Black/African American men
• Risk
• Incidence (new cases)
• Mortality (deaths)
• Survival
• Trends over time
• Patterns of disparities
• Present strategies to close the cancer
  disparities gap in Black men

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• Black versus African American

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Ethnic Diversity within the Black race US-born
and Foreign-born Blacks

• Foreign-born Blacks (heterogeneous group 2
  million, 2000 Census)
• Caribbean nations (1,250,611)
• African nations (512,628)
• Central and South America (249,909)
• Distinct cultural identities Do not identify
  w/African-American
• Self-select out of health messages targeting
  African-Americans
• Risk profiles (1st, 2nd, 3rd generation
  immigrants vs. U.S.-born)

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Black Men and the Cancer Disparity Gap
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Hypothesis

• Cancer disparities are a physical consequence of
  a lifetime of social, political, and economic
  inequities

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What counts as a disparity?

• Two core concepts
• Differences between social groups
• Social Justice/Injustice (unfair)

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The Breast Cancer ExampleCancer Disparity?

• US breast cancer incidence rates (2007)
• Total cases expected 180,510
• 2,030 cases US males (
• 178,480 US females (99.0)
• NOT health disparity
• Rate inequality, NOT inequity

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Source 9 SEER registries (San-Francisco-Oakland
, Connecticut, Detriot-Metropolitan, Hawaii,
Iowa, New Mexico, Seattle-Puget Sound, Utah, and
Atlanta-Metropolitan).
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Data Source 9 SEER registries (San-Francisco-Oakl
and, Connecticut, Detriot-Metropolitan, Hawaii,
Iowa, New Mexico, Seattle-Puget Sound, Utah, and
Atlanta-Metropolitan).
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The Cancer Disparity Problem in Black Men

• Life expectancy in US Black men is 69.8 versus
  75.7 years in US white men
• US Black Men (2007)
• 83,250 new cancer cases expected
• 31,760 deaths are expected
• Death rate for all cancers combined 38 higher in
  African American/Black men than in white men

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Black Men and Cancer Disparities

• Black men are more likely to develop and die from
  cancer than any other racial/ethnic group in the
  world
• Incidence (new cases) and mortality (deaths) are
  higher for all major cancer sites in Black men as
  compared to white men in the U.S.

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Cross-sectional Incidence Data (2007)

• Black Males
• Prostate cancer (30,870 or 37 of all new cancer
  cases in Black males)
• Lung cancer (12,490 or 15 of new cases)
• Colorectal cancers (7,860 or 9)

Three cancers Prostate, Lung, and Colorectal
will account for almost 2/3 (61) of all the
(new) incident cases of cancer in 2007 in Black
men.
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Cross-sectional Mortality Data2007

• Black Males
• Lung cancer (9,970 or 1/3 of all cancer deaths in
  Black males)
• Prostate cancer (4,240 or 13)
• Colorectal cancers (3,420 or 11)

Three cancers Lung, Prostate, and Colorectal,
will account for approximately (55) of all
deaths from cancer in 2007
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Survival
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Cross-sectional Survival Data

• Survival has steadily increased over time
• 5-year survival all-cancers (43.8) in 1973 to
  68.0 in 2003
• Screening/earlier detection methods
• Disparities with the poorest survival noted
  among
• Racial/ethnic minorities (6-15 lower rates than
  Whites)
• Poor (10-15 lower rates than middle/upper class)
• Uninsured/disenfranchised (10-15 lower rates
  than insured)

Singh GK, Miller BA, Hankey BF, Edwards BK. Area
socioeconomic variations in US cancer incidence
mortality, stage, treatment, and survival,
1975-1999. NCI Cancer Surveillance Monograph
Series, No. 4. Bethesda, MD National Cancer
Institute 2003. NIH Publ. No. 03-5417.
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• Closing the Disparity Gap

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Our Goal

• Eliminate disparity NOT create equality

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Goals?

• Do we really want everyone to have the same level
  of health?
• Do we want improvement in health of the most
  disadvantaged social group to approach the health
  of the more advantaged social group?
• Example of income redistribution
• Realityhealth goals will be a moving target

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Closing the Disparity Gap

• Not achieving equality with the best social
  group
• Means optimal goals become a moving target

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Factors Implicated in Black Mens Cancer
Disparities

• Overweight, obesity, physical inactivity
• Tobacco use
• Underutilization of screening tests
• Socioeconomic status (not a risk factor but a
  risk marker)

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What Works Now

• Healthy Lifestyle Behaviors (cancer prevention)
• Good nutrition
• Regular physical activity
• Tobacco avoidance/not smoking
• Reduced alcohol consumption
• Safe sexual practices
• Early Detection
• Screening (prostate cancer, colorectal cancer,
  skin cancer, lung cancer)

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Black Men and cancer survival
Source Surveillance, Epidemiology, and End
Results (SEER) Program, 17 SEER
Registries 1973-2003, Division of Cancer Control
and Population Sciences, National Cancer
Institute, 2006
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How Do We Get Black Men to participate in

• Healthy lifestyles behaviors
• Early detection through cancer screening

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Possible Strategies with Black Men

• Step One
• Frame cancer as
• physical illness that may have social roots
• targets one specific individual but impacts the
  entire family and community surrounding that
  individual
• Cancer survivorshipcancer survivors are defined
  as those who have been diagnosed with cancer as
  well as people in their lives who are affected by
  the diagnosis, including family members, friends,
  and caregivers

Source A National Action Plan for Cancer
Survivorship African American Priorities, CDC,
Lance Armstrong Foundation, 2006
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Possible Strategies with Black Men

• Step Two
• Target interventions to address mens social role
  functions within their families and communities
  (provide meaning for their lives)
• Familial roles
• Father, Husband/Provider, Partner, Son, Brother
• Community-based roles
• Career, Provider, Mentor/Role-Model (i.e. breast
  cancer advertisements)
• Significant Other roles
• Best friend, fraternity brother, Deacon

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Possible Strategies with Black Men

• Step Three
• Hold Black men accountable for their actions and
  follow-through
• Policy-level interventions (social justice,
  health insurance, quality health care)

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