be noted that patients with intersectional identities often experience multilevel barriers to cancer care that adversely impact screening, diagnosis, treatment, and survivorship. As one example, recent data have shown that Black and AIAN populations living in rural areas experience greater poverty and lack of access to quality care, which expose them to greater risk of experiencing poor cancer outcomes (22). Root causes of cancer disparities are multidimensional and multifactorial. Researchers have developed many models to understand and address health inequities. A key component of these models is the framework of social determinants of health (SDOH). According to NCI, SDOH are the social, economic, and physical conditions in the places where people are born and where they live, learn, work, play, and grow older that can affect their health, well-being, and quality of life (see Figure 2, p. 19). It is increasingly evident that structural racism and systemic injustices are key adverse social factors, creating conditions that perpetuate health inequities, including cancer disparities, for racial or ethnic minorities and other medically underserved populations (23-26). Considering that a significant proportion of the U.S. population is affected by cancer disparities, it is important Cancer Inequities in the United States Certain U.S. population groups (see Sidebar 2, p. 17) shoulder a disproportionate burden of cancer. Recent examples of disparate cancer incidence and outcomes are provided here. Disparities in other aspects of cancer care are highlighted in relevant sections throughout the report. A more in-depth discussion of cancer disparities and recent progress in addressing these inequities, as well as a call to action, is detailed in AACR Cancer Disparities Progress Report 2022 (13). HIGHER cancer death rates From 2018 to 2020: • Black women had 1.4 times and two times higher death rates for breast and uterine cancer, respectively, compared to White women, despite having similar incidence rates; Black men had two times higher death rates for prostate cancer, compared to White men (17). • American Indian and Alaska Native men had 1.8-, 2.1-, and 2.7-times higher death rates due to cancers of the kidney, liver, and stomach, respectively, compared to White men (17). • Native Hawaiian or other Pacific Islander (NHOPI) 20- to 49-year-olds had the highest cancer death rates, compared to all other racial or ethnic groups of similar age range (17). • Hispanic men and women had twofold higher death rates for stomach cancer, compared to White men and women (17). 2-FOLD or higher Compared to cisgender patients, transgender patients have twofold or higher increased risk of death from non-Hodgkin lymphoma, prostate cancer, and bladder cancer (18). 5-FOLD or higher Among childhood cancer survivors, those living in neighborhoods with the highest socioeconomic deprivation are at a five-fold or higher increased risk of all-cause deaths compared to those living in the least socioeconomically disadvantaged neighborhoods (19). LEAST progress Congressional districts in the U.S. Midwest and Appalachia made the least progress, while those along the southern East Coast and the southern border made the greatest progress in reducing overall cancer death rates between 1996–2003 and 2012–2020 (20). 78% higher Among older adults with newly diagnosed cancer, rural residents have a 78 percent higher one-year mortality compared to urban residents (21). SIDEBAR 3 AACR Cancer Progress Report 2023 Cancer in 2023 18
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