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RACHEL’S HAZARDOUS WASTE NEWS #386
—April 21, 1994—
News and resources for environmental justice.
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CANCER INJUSTICE–PART 1
In this series, we examine the distribution of cancers among the
U.S. population.
About 2 million people die of all causes in the U.S. each year;
of these, about 25% die of cancer. In 1992, an estimated
1,130,000 new cases of cancer were diagnosed, and an estimated
520,000 cancer deaths occurred (in a population of about 250
million people). [1]
Cancers are not distributed evenly among the U.S. population.
African-Americans, who make up about 12.6% of the population,
have more than their fair share of cancer problems, whether we
measure incidence rates (occurrence of new cancer cases per
100,000 population) or mortality rates (deaths per 100,000
population) or 5-year survival rates (the proportion of a
population that survives for 5 years after diagnosis).
Furthermore, as time passes, the cancer situation for
African-Americans is deteriorating, relative to whites.
Unless otherwise noted, all our cancer data are taken from the
National Cancer Institute’s (NCI’s) 1992 summary of cancer
statistics for the period 1973 to 1989. [1] The numbers have all
been adjusted (by NCI) for the size, racial makeup, and
age-distribution of the U.S. population. NCI uses the term blacks
to refer to African-Americans and we have retained that
terminology.
MORTALITY: In its 1992 review of cancer statistics, the NCI said,
“The extent to which blacks experience higher cancer mortality
than whites is striking…. Not only do blacks have higher
mortality rates than whites, but the mortality rates are
increasing faster…. Further, mortality rates which are
decreasing for whites are either still increasing for blacks or
are not decreasing as quickly. For five cancers –larynx, oral
cavity, pancreas, colorectal and leukemia –the mortality rates
for whites have been decreasing while for blacks they have been
increasing.” [2]
INCIDENCE: NCI goes on: “The age-adjusted incidence rate for all
cancer sites combined and both sexes has increased in both blacks
and whites by 17% between 1973 and 1989. However, the magnitude
of the overall cancer incidence rate among blacks is about 6%
higher than among whites in 1989.” [3]
SURVIVAL RATES: Here the story is the same. There are 9 cancers
for which whites enjoy a better than 10% advantage over blacks in
5-year survival rate (colon/rectum; oral cavity; larynx;
melanoma; female breast; cervix; uterus; prostate; and urinary
bladder); whites also have a better than 10% advantage over
blacks in 5-year survival rate for all cancer sites combined.
Blacks have a more favorable survival rate than whites for
cancers of the brain, and for multiple myeloma.
Here we present an analysis, cancer site by cancer site.
BREAST CANCER: In 1992, an estimated 181,000 breast cancers were
diagnosed, and an estimated 46,300 deaths occurred. [4] (Three
hundred of the deaths and 1000 of the cancers occurred among
males.) The death rate for breast cancer in 1989 among whites
was 27.5 per 100,000 whereas the death rate for blacks was 30.4
(10.5% worse than for whites).
The NCI says that the overall increase of 2.7% for female breast
cancer, among all races combined, during the period 1973-1989,
appears primarily due to a nearly 18% increase among black women.
Among women under age 65, breast cancer mortality has been
decreasing among whites, but increasing among blacks. Among women
65 and older, mortality has been increasing among both whites and
blacks.
Despite the rapidly-increasing incidence rate among younger black
women, the incidence rate among white women is still 20% higher
than among blacks; however, the five-year relative survival rate
for black women diagnosed during 1983-1988 is 17% less than for
whites, resulting in a higher breast cancer death rate among
black women. [5]
CERVIX: Total new cases (all races) in 1992: 13,500 estimated,
with 4400 deaths estimated. The incidence rate among blacks has
been consistently about twice that for whites, 14.8 vs. 7.8 per
100,000 during 1985-1989. This disparity is especially evident
in woman aged 65 and over with blacks experiencing nearly three
times the incidence of whites during 1985-1989, 48.5 vs. 15.9 per
100,000. Black mortality (7.1 per 100,000) is nearly three times
that for whites (2.6 per 100,000), again due largely to women
aged 65 and older.
Cancer tends to spread. First is it localized (in one place);
then it is “regional” (invading nearby areas); and finally it is
“distant” (invading areas of the body far from the original
site). Cervical cancer is generally detected earlier in whites
than in blacks. Only about one third of cervical cancers among
blacks are detected while the disease is localized, as compared
to half for whites. Five-year survival rates are 89% for women
diagnosed with localized disease and only 13% for women with
distant disease. Thus early diagnosis is important for
survival. For the past two decades, five-year relative survival
rates have been 68% for whites and 60% for blacks. However, in
the period 1983-1988, the rate for blacks declined to 55%. [6]
COLON & RECTUM: In 1992, there were an estimated 111,000
diagnoses of colon cancer and 45,000 rectal cancers. During the
same year there were an estimated 51,000 deaths from colon cancer
and 7300 deaths from rectal cancer. [7]
Between 1973 and 1989, the incidence of colorectal cancers
increased 5.6% among white males, 36.1% among black males and
16.1% among black females. Among white females, the incidence
rate dropped 3.8% during this period.
During the five-year period, 1985-1989, there were significant
declines among white males (6.7%) and white females (9.9%).
During the same period, the incidence rate decreased 3.3% among
black females, but increased 0.1% among black males. [8]
In the period 1973-1989, the death rate from colorectal cancers
declined 8.5% among white males and 20.0% among white females of
all ages. [9] During the same period, the death rate increased
2.6% among black females and 22.5% among black males. During the
past 5 years, the death rate for colorectal cancers reversed
itself among black females of all ages and declined 4.4%, but
during the same period the death rate increased 1.6% among black
males of all ages. [10]
The five-year survival rate among white males improved from 49.1
per 100,000 to 58.8 per 100,000 between the periods 1974-76 and
1983-87. During the same periods, the survival rate for black men
increased from 41.0 per 100,000 to 45.9 per 100,000. Thus,
despite improvements, black males in 1983-87 did not achieve the
survival rate that whites had achieved 10 years earlier. [11] The
rate of improvement among whites is faster than the rate of
improvement among blacks, so as time passes the disparity between
the two groups is growing.
CANCER OF THE UTERUS: An estimated 32,000 new cases were
diagnosed in 1992, with 5600 deaths estimated in 1992.
Incidence rates are higher among whites (22.3 per 100,000 in
1985-89) than among blacks (14.8 per 100,000 in 1985-89).
Uterine cancer is detected while localized in 75% of cases among
whites vs. only 52% of cases among blacks. This may explain why
mortality among blacks was about twice as high (6.0 per 100,000
in 1985-89) as among whites during the same period (3.4 per
100,000). The overall relative survival rate is 30% lower among
blacks than among whites. [12]
[To be continued next week.]
                
                
                
                
    
–Peter Montague, Ph.D.
=================================================================
Figure 1
U.S. Cancer Incidence and
Mortality Rates, 1985-89 (All Ages)
Ratio of Black Rate to White Rate
-----------Incidence-------------|----------Mortality---------------3.4 Esophagus 3.0 *********************************|********************************** 1.9 Cervix 2.7 *******************|*************************** 1.5 Larynx 2.3 ***************|*********************** 1.4 Prostate 2.2 **************|********************** 2.1 Multiple myeloma 2.2 *********************|********************** 1.8 Stomach 2.0 ******************|******************** 1.3 Oral, pharynx 1.9 *************|******************* 0.7 Uterus 1.8 #######|****************** 2.0 Liver 1.7 ********************|***************** 1.6 Pancreas 1.5 ****************|*************** 1.6 Lung (male) 1.4 ****************|************** 0.5 Thyroid 1.3 #####|************* 1.1 All sites combined 1.3 ***********|************* 1.0 Colon/Rectum 1.2 **********|************ 0.8 Breast, female 1.1 ########|*********** 1.1 Lung (female) 1.0 ***********|********** 0.5 Bladder 1.0 #####|********** 0.6 Hodgkin's 1.0 ######|********** 1.1 Kidney/Renal 0.9 ***********|######### 0.9 Leukemia 0.9 #########|######### 0.7 Ovary 0.8 #######|######## 0.6 Non-Hodgkin's 0.7 ######|####### 0.1 Testis 0.7 #|####### 0.6 Brain 0.6 ######|###### 0.1 Melanoma (skin) 0.2 #|##
Figure 1 shows cancer rates (both incidence and death) for blacks
compared to the same rates among whites during the period
1985-1989. (What is shown is the ratio of black rates to white
rates; in other words, it shows black rates divided by white
rates.) The bars on the left show the ratio of incidence rates
and the bars on the right show the ratio of death rates (labeled
“mortality”).
Example: The first cancer listed, esophagus, shows that blacks
have an incidence rate 3.4 times as great as the incidence rate
among whites and a death rate 3.0 times as great as the death
rate among whites.
When the ratio shown is 1.0 (for example, the incidence for
cancers of the colon and rectum), it means that the rates are
identical among blacks and whites.
A number smaller than 1.0 indicates that the rate is higher
among whites than among blacks. For example, see ovarian
cancer.
Numbers smaller than 1.0, are graphed with a # symbol; numbers
1.0 and larger are graphed with a * symbol.
Source: Reproduced from Barry A. Miller and others, editors.
CANCER STATISTICS REVIEW 1973-1989 [National Institutes of
Health Publication No. 92-2789] (Bethesda, Md.: National Cancer
Institute, 1992), Figure I-10, pg. I.51.
=================================================================
[1] Barry A. Miller and others, editors. CANCER STATISTICS REVIEW
1973-1989 [National Institutes of Health Publication No. 92-2789]
(Bethesda, Md.: National Cancer Institute, 1992), Table I-1, pg.
I.21.
[2] NCI, cited above in note 1, pg. I.10.
[3] NCI, cited above in note 1, pg. I.11.
[4] NCI, cited above in note 1, pg. IV.1.
[5] NCI, cited above in note 1, pg. IV.2.
[6] NCI, cited above in note 1, pg. V.1.
[7] NCI, cited above in note 1, Table I-1, pg. I.21.
[8] NCI, cited above in note 1, pgs VI.1 and VI.3.
[9] NCI, cited above in note 1, Table VI-6, pg. VI.8.
[10] NCI, cited above in note 1, pg. VI.3.
[11] NCI, cited above in note 1, pg. VI.9.
[12] NCI, cited above in note 1, pg. VII.1.
Descriptor terms: cancer; morbidity statistics; mortality
statistics; race; african-americans; blacks; whites; caucasians;
nci; national cancer institute; breast cancer; colorectal
cancer; rectum; colon; cervix; uterus;