die from the disease (see Table 1, p. 16). Men have a higher incidence of many cancer types, including bladder, colon, and brain cancer compared to women and ongoing research is evaluating the role of a range of biological factors including genetics, epigenetics, metabolism, and immunity in mediating these differences. Unfortunately, many population groups in the United States experience a disproportionately high rate of cancer incidence and death attributable largely to socioeconomic disadvantages. It should also be noted that current estimates of cancer burden do not reflect the adverse impact of COVID-19, which caused serious declines in screening, early detection, and new cancer diagnoses, and which continues to take a toll on cancer care especially among the medically underserved populations (911). Ongoing monitoring of cancer-related population-based data is warranted to assess the long-term consequences of COVID-19 on cancer burden in the United States. Inequities in the Burden of Cancer in the United States While we are making unprecedented advances against cancer, the grim reality is that these advances have not benefited everyone equally. Because of a long history of structural inequities and systemic injustices in the United States, certain segments of the population continue to shoulder a disproportionate burden of adverse health conditions, including cancer. Cancer disparities are one of the most pressing public health challenges in the United States. The National Cancer Institute (NCI) defines cancer disparities as adverse differences in cancer, such as number of new cases, number of deaths, cancer-related health complications, survivorship and quality of life after cancer treatment, screening rates, and stage at diagnosis that exist among certain population groups (see Sidebar 2, p. 17). As outlined in the AACR Cancer Disparities Progress Report 2022 (13), racial and ethnic minorities and other medically underserved U.S. populations shoulder a disproportionately higher burden of cancer (see Sidebar 3, p. 18). Individuals who are Black have the highest death rates and lowest survival rates of any racial or ethnic group in the U.S. for most cancers, largely driven by structural and systemic inequities (14). While the disparity in the overall cancer death rate between Black and White populations has narrowed by half over the last two decades, Black individuals still had a 12 percent higher overall cancer death rate compared to White individuals, and the highest death rate from cancer among all U.S. racial or ethnic groups in 2020 (5). American Indian and Alaska Native (AIAN) individuals are a culturally and geographically diverse U.S. population group who experience a disproportionally high prevalence of several chronic illnesses, including many cancers, largely because of 5-YEAR RELATIVE SURVIVAL RATE (All cancers combined) Source: (2). 20122018 mid1970s 86% 68% 85% 58% Children (Ages 0-14) Adolescents (Ages 15-19) Source: (12). AVERAGE NUMBER OF NEW CANCER DIAGNOSES DURING THE COVID-19 PANDEMIC (For eight cancer types combined) PRE-COVID January 2019 - February 2020 COVID RECOVERY June 2020 - March 2021 RECOVERY CONTINUED April 2021 - March 2022 PEAK COVID March 2020 - May 2020 30% 15% 11% Cancer in 2023 AACR Cancer Progress Report 2023 15
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