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Figure 1.  Trends in Age-Standardized Death Rates Among Black Men by Cancer Site From 1999 to 2019
Trends in Age-Standardized Death Rates Among Black Men by Cancer Site From 1999 to 2019

Death rates are calculated from the entire US population. Trends were estimated using joinpoint regression. Filled circles represent observed age-adjusted rates; dotted lines, modeled age-adjusted rates.

Figure 2.  Trends in Age-Standardized Death Rates Among Black Women by Cancer Site From 1999 to 2019
Trends in Age-Standardized Death Rates Among Black Women by Cancer Site From 1999 to 2019

Death rates are calculated from the entire US population. Trends were estimated using joinpoint regression. Filled circles represent observed age-adjusted rates; dotted lines, modeled age-adjusted rates. NOS indicates not otherwise specified.

Table.  Age-Standardized Death Rates for the Most Common Causes of Death From Cancer by Sex and Racial and Ethnic Group in the US in 2019
Age-Standardized Death Rates for the Most Common Causes of Death From Cancer by Sex and Racial and Ethnic Group in the US in 2019
1.
Henley  SJ, Ward  EM, Scott  S,  et al.  Annual report to the nation on the status of cancer, part I: national cancer statistics.   Cancer. 2020;126(10):2225-2249. doi:10.1002/cncr.32802PubMedGoogle ScholarCrossref
2.
Islami  F, Guerra  CE, Minihan  A,  et al.  American Cancer Society’s report on the status of cancer disparities in the United States, 2021.   CA Cancer J Clin. 2022;72(2):112-143. Published online December 8, 2021. doi:10.3322/caac.21703PubMedGoogle ScholarCrossref
3.
Schabath  MB, Cote  ML.  Cancer progress and priorities: lung cancer.   Cancer Epidemiol Biomarkers Prev. 2019;28(10):1563-1579. doi:10.1158/1055-9965.EPI-19-0221PubMedGoogle ScholarCrossref
4.
Warren  GW, Cummings  KM.  Tobacco and lung cancer: risks, trends, and outcomes in patients with cancer.   Am Soc Clin Oncol Educ Book. 2013;(33):359-364. doi:10.14694/EdBook_AM.2013.33.359PubMedGoogle ScholarCrossref
5.
American Lung Association. National Center for Health Statistics. National Health Interview Survey 1965-2018. 2020. November 10, 2021. https://www.lung.org/research/trends-in-lung-disease/tobacco-trends-brief/data-tables/ad-cig-smoke-rate-sex-race-age
6.
Islami  F, Goding Sauer  A, Miller  KD,  et al.  Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States.   CA Cancer J Clin. 2018;68(1):31-54. doi:10.3322/caac.21440PubMedGoogle ScholarCrossref
7.
DeSantis  CE, Miller  KD, Goding Sauer  A, Jemal  A, Siegel  RL.  Cancer statistics for African Americans, 2019.   CA Cancer J Clin. 2019;69(3):211-233. doi:10.3322/caac.21555PubMedGoogle ScholarCrossref
8.
Daly  B, Olopade  OI.  A perfect storm: how tumor biology, genomics, and health care delivery patterns collide to create a racial survival disparity in breast cancer and proposed interventions for change.   CA Cancer J Clin. 2015;65(3):221-238. doi:10.3322/caac.21271PubMedGoogle ScholarCrossref
9.
Negoita  S, Feuer  EJ, Mariotto  A,  et al.  Annual report to the nation on the status of cancer, part II: recent changes in prostate cancer trends and disease characteristics.   Cancer. 2018;124(13):2801-2814. doi:10.1002/cncr.31549PubMedGoogle ScholarCrossref
10.
Grossman  DC, Curry  SJ, Owens  DK,  et al; US Preventive Services Task Force.  Screening for prostate cancer: US Preventive Services Task Force recommendation statement.   JAMA. 2018;319(18):1901-1913. doi:10.1001/jama.2018.3710PubMedGoogle ScholarCrossref
11.
Shiels  MS, Engels  EA, Yanik  EL, McGlynn  KA, Pfeiffer  RM, O’Brien  TR. Incidence of hepatocellular carcinoma among older Americans attributable to hepatitis C and hepatitis B: 2001 through 2013. Cancer. Published online April 12, 2019. doi:10.1002/cncr.32129
12.
Islami  F, Miller  KD, Siegel  RL, Fedewa  SA, Ward  EM, Jemal  A.  Disparities in liver cancer occurrence in the United States by race/ethnicity and state.   CA Cancer J Clin. 2017;67(4):273-289. doi:10.3322/caac.21402PubMedGoogle ScholarCrossref
13.
Palmer Kelly  E, McGee  J, Obeng-Gyasi  S,  et al.  Marginalized patient identities and the patient-physician relationship in the cancer care context: a systematic scoping review.   Support Care Cancer. 2021;29(12):7195-7207. Published online July 1, 2021. doi:10.1007/s00520-021-06382-8PubMedGoogle ScholarCrossref
14.
Bickell  NA, LePar  F, Wang  JJ, Leventhal  H.  Lost opportunities: physicians’ reasons and disparities in breast cancer treatment.   J Clin Oncol. 2007;25(18):2516-2521. doi:10.1200/JCO.2006.09.5539PubMedGoogle ScholarCrossref
15.
Amram  O, Robison  J, Amiri  S, Pflugeisen  B, Roll  J, Monsivais  P.  Socioeconomic and racial inequities in breast cancer screening during the COVID-19 pandemic in Washington state.   JAMA Netw Open. 2021;4(5):e2110946. doi:10.1001/jamanetworkopen.2021.10946PubMedGoogle ScholarCrossref
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    3 Comments for this article
    EXPAND ALL
    Other Variable of Note
    H Silverstein, MD | Unoversity of Connecticut School of Medicine
    It would be well to mention, include, and compare known risk factors such as education, diabetes, BMI progressively, alcohol, likely most important of all higher fat-high calorie-higher salt diet, as well as patient agreement, involvement, adherence, and appointment keeping. Including these factors is essential, fair, balanced, and even handed when also discussing social inequities.
    CONFLICT OF INTEREST: None Reported
    Income
    Harry Wetzler, MD, MSPH | Independent Analyst
    Income should be added to Dr Silverstein's list.
    CONFLICT OF INTEREST: None Reported
    Use of broadly defined racial and ethnic groups
    Kristin Primm, PhD, MPH | The University of Texas MD Anderson Cancer Center
    We commend the authors of “Trends in Cancer Mortality Among Black Individuals in the US From 1999 to 2019”in their assessment highlighting the burden of cancer mortality experienced by Black adults. As the authors note, detailed understanding of cancer mortality trends among Black individuals is essential to assess recent progress and inform interventions aimed at addressing disparities. Mortality rates in 2019 among Black individuals are compared with those for four other broadly defined groups, specifically, Hispanic/Latino and non-Hispanic American Indian or Alaska Native, White, and Asian or Pacific Islander.

    However, recognition is growing that variation within broadly defined racial
    and ethnic groupings can mask disparities that are unaddressed or insufficiently addressed. For example, Asian Americans are typically reported as one aggregated racial category, and often grouped with Pacific Islanders. Yet, we and others have reported substantial variation in cancer outcomes for Asian and Pacific Islander subgroups (3,4). Similarly, Hispanic individuals are frequently treated as a single ethnic group despite being an extremely heterogenous population. Studies have demonstrated that disaggregating Hispanic ethnicity by race (Hispanic White, Hispanic Black, etc.) can reveal important differences by cancer stage, treatment, and survival not observable when Hispanic individuals are aggregated into a single group (5). Thus, we encourage the authors to reconsider the cancer mortality trends after disaggregating the broad groups, particularly the Hispanic groups by race, as the National Center for Health Statistics data contain information on both Hispanic origin and race; doing so would reveal whether the finding of higher cancer mortality rates among Black individuals is also observed for Hispanic Black individuals.

    As our nation becomes increasingly diverse, advancing health equity requires understanding how health outcomes and disparities are experienced across diverse populations. Missing the chance to disaggregate broadly defined racial and ethnic groups will prohibit opportunities for identifying and helping groups with unrecognized burden. When data are available, Asian, Hispanic, and Pacific Islander populations should be disaggregated for investigating and describing cancer or any health disparities. Moreover, improving the types of information collected (e.g., nativity, immigrant status, and acculturation), analyses performed, and report of disaggregated data are needed for a more precise picture of cancer disparities that clearly depicts subgroups with greater burden. Only then can we progress towards health equity.


    Coauthors: Zhabian Gonzalez, Shine Chang, PhD

    References

    1. Lawrence WR, McGee-Avila JK, Vo JB, et al. Trends in Cancer Mortality Among Black Individuals in the US From 1999 to 2019. JAMA Oncol. Published online May 19, 2022. doi:10.1001/jamaoncol.2022.1472
    2. Islami F, Guerra CE, Minihan A, et al. American Cancer Society's report on the status of cancer disparities in the United States, 2021. CA Cancer J Clin. 2022;72(2):112-143.
    3. Primm KM, Zhao H, Hernandez DC, Chang S. A Contemporary Analysis of Racial and Ethnic Disparities in Diagnosis of Early-Stage Breast Cancer and Stage-Specific Survival by Molecular Subtype. Cancer Epidemiol Biomarkers Prev 1 June 2022; 31 (6): 1185–1194. https://doi.org/10.1158/1055-9965.EPI-22-0020
    4. Ooi SL, Martinez ME, Li CI. Disparities in breast cancer characteristics and outcomes
    CONFLICT OF INTEREST: None Reported
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    Brief Report
    May 19, 2022

    Trends in Cancer Mortality Among Black Individuals in the US From 1999 to 2019

    Author Affiliations
    • 1Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
    JAMA Oncol. Published online May 19, 2022. doi:10.1001/jamaoncol.2022.1472
    Key Points

    Questions  How did cancer mortality among Black individuals change in the US from 1999 to 2019 by age, sex, and cancer site, and how did 2019 cancer mortality rates among Black individuals compare with rates in other racial and ethnic groups?

    Findings  In this cross-sectional study of 1 361 663 deaths from cancer among Black individuals, although cancer mortality decreased considerably among Black individuals from 1999 to 2019, the cancer mortality rate was higher among Black men and women than in other racial and ethnic groups in 2019.

    Meaning  The findings suggest that resources should be allocated toward eliminating social inequalities and barriers throughout the cancer control continuum that contribute to substantially higher cancer mortality rates among Black men and women.

    Abstract

    Importance  Cancer is the second leading cause of mortality in the US. Despite national decreases in cancer mortality, Black individuals continue to have the highest cancer death rates.

    Objective  To examine national trends in cancer mortality from 1999 to 2019 among Black individuals by demographic characteristics and to compare cancer death rates in 2019 among Black individuals with rates in other racial and ethnic groups.

    Design, Setting, and Participants  This serial cross-sectional study used US national death certificate data obtained from the National Center for Health Statistics and included all cancer deaths among individuals aged 20 years or older from January 1999 to December 2019. Data were analyzed from June 2021 to January 2022.

    Exposures  Age, sex, and race and ethnicity.

    Main Outcomes and Measures  Trends in age-standardized mortality rates and average annual percent change (AAPC) in rates were estimated by cancer type, age, sex, and race and ethnicity.

    Results  From 1999 to 2019, 1 361 663 million deaths from cancer occurred among Black individuals. The overall cancer death rate significantly decreased among Black men (AAPC, −2.6%; 95% CI, −2.6% to −2.6%) and women (AAPC, −1.5%; 95% CI, −1.7% to −1.3%). Death rates decreased for most cancer types, with the greatest decreases observed for lung cancer among men (AAPC, −3.8%; 95% CI, −4.0% to −3.6%) and stomach cancer among women (AAPC, −3.4%; 95% CI, −3.6% to −3.2%). Lung cancer mortality also had the largest absolute decreases among men (−78.5 per 100 000 population) and women (−19.5 per 100 000 population). We observed a significant increase in deaths from liver cancer among men (AAPC, 3.8%; 95% CI, 3.0%-4.6%) and women (AAPC, 1.8%; 95% CI, 1.2%-2.3%) aged 65 to 79 years. There was also an increasing trend in uterus cancer mortality among women aged 35 to 49 years (2.9%; 95% CI, 2.3% to 2.6%), 50 to 64 years (2.3%; 95% CI, 2.0% to 2.6%), and 65 to 79 years (1.6%; 95% CI, 1.2% to 2.0%). In 2019, Black men and women had the highest cancer mortality rates compared with non-Hispanic American Indian/Alaska Native, Asian or Pacific Islander, and White individuals and Hispanic/Latino individuals.

    Conclusions and Relevance  In this cross-sectional study, there were substantial decreases in cancer death rates among Black individuals from 1999 to 2019, but higher cancer death rates among Black men and women compared with other racial and ethnic groups persisted in 2019. Targeted interventions appear to be needed to eliminate social inequalities that contribute to Black individuals having higher cancer mortality.

    Introduction

    Cancer is the second leading cause of mortality in the US.1 Despite annual decreases in cancer mortality, death rates among Black individuals remain higher than in other racial and ethnic groups.2 Detailed understanding of cancer mortality trends among Black individuals is essential to assess recent progress and to inform interventions aimed at addressing disparities. Therefore, we assessed trends in cancer mortality rates from 1999 to 2019 among Black adults by cancer site, age, and sex and compared cancer mortality rates in 2019 among Black men and women with rates in other racial and ethnic groups.

    Methods

    For this cross-sectional study, demographic characteristics and causes of death were ascertained from national death certificate data from the National Center for Health Statistics from January 1999 to December 2019 (eTable 1 in the Supplement). Data were analyzed from June 2021 to January 2022. The National Institutes of Health institutional review board waived approval and informed consent because the study used publicly available deidentified data. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.

    Our main analysis focused on age-adjusted cancer death rates by age group, sex, and cancer site among non-Hispanic Black individuals aged 20 years or older. All rates were age-standardized in 5-year age groups to the 2000 US population. Joinpoint regression was used to estimate average annual percent changes (AAPCs) in mortality rates and APCs to identify calendar years during which significant changes in trajectories occurred and to assess the trend in each segment. Age-standardized cancer death rates in 2019 were used to compare cancer death rates between Black individuals and Hispanic/Latino and non-Hispanic American Indian/Alaska Native, Asian or Pacific Islander, and White individuals. American Indian/Alaska Native death rates were restricted to Indian Health Service Purchased/Referred Care Delivery Areas to increase ascertainment of this group on death certificates. SEER*Stat software, version 8.3.9 was used to estimate age-adjusted mortality rates.

    Results

    From 1999 to 2019, 1 361 663 million cancer deaths occurred among Black individuals aged 20 years or older. The age-adjusted death rate was 377.3 per 100 000 population among Black men and 239.4 per 100 000 population among Black women (eTable 2 in the Supplement).

    Cancer mortality rates among Black individuals decreased 2.0% per year from 1999 to 2019 (change, −120.1 per 100 000 population), with a larger reduction among men (change, −200.1 per 100 000 population; AAPC, −2.6% [95% CI, −2.6% to −2.6%]) than among women (−74.8 per 100 000 population; AAPC −1.5% [95% CI, −1.7% to −1.3%]) (eTable 3 in the Supplement). There were decreases in rates for most cancer sites among men except the liver, for which the rate increased from 1999 to 2013 (APC, 3.0%; 95% CI, 2.7%-3.3%) and later decreased (APC, −1.3%; 95% CI, −2.1% to −0.4%) (Figure 1). Similarly, among women, there were decreases in rates for most cancer sites except the liver (AAPC, 1.1%; 95% CI, 0.0%-2.3%) and uterus (AAPC, 1.3%; 95% CI, 0.5%-2.2%) (Figure 2). The greatest decreases were observed for lung cancer among men (AAPC, −3.8%; 95% CI, −4.0% to −3.6%) and stomach cancer among women (AAPC, −3.4%; 95% CI, −3.6% to −3.2%). Lung cancer mortality had the largest absolute decreases among men (−78.5 per 100 000 population) and women (−19.5 per 100 000 population).

    Cancer death rates decreased in all age groups from 1999 to 2019 for most cancer sites among Black men and women (eFigures 1-3 in the Supplement). For men, the greatest decreases were for lung cancer among those aged 35 to 49 years, 50 to 64 years, and 65 to 79 years. Liver cancer mortality rates increased among men aged 65 to 79 years (AAPC, 3.8%; 95% CI, 3.0%-4.6%). For women, uterus cancer mortality increased among those aged 35 to 49 years (AAPC, 2.9%; 95% CI, 2.3%-3.6%), 50 to 64 years (AAPC, 2.3%; 95% CI, 2.0%-2.6%), and 65 to 79 years (AAPC, 1.6%; 95% CI, 1.2%-2.0%) and liver cancer mortality increased among those aged 65 to 79 years (AAPC, 1.8; 95% CI, 1.2%-2.3%).

    In 2019, compared with other racial and ethnic groups, Black men and women had a higher cancer mortality rate overall and for most cancer sites (Table). Among men, the most pronounced difference was observed for deaths from prostate cancer; for example, rates among Black men were approximately 5-times higher than those among Asian or Pacific Islander men (51.3 per 100 000 population [95% CI, 49.8-52.8 per 100 000 population] vs 11.0 per 100 000 population [95% CI, 10.2-11.9 per 100 000 population]). Breast cancer mortality rates were nearly 2.5-times higher among Black women than among Asian or Pacific Islander women (39.0 per 100 000 population [95% CI, 38.0-39.9 per 100 000 population] vs 16.1% per 100 000 population [95% CI, 15.3-17.0 per 100 000 population]). Moreover, myeloma mortality rates were substantially higher among Black individuals than among Asian or Pacific Islander and American Indian/Alaska Native individuals.

    Discussion

    From 1999 to 2019, there were substantial decreases in cancer mortality rates among Black men and women in the US in all age groups studied. Decreases were observed for most cancer sites except the liver and uterus among older adults, and the greatest decreases were observed for lung cancer among men and stomach cancer among women. Despite decreases in cancer mortality among Black individuals, cancer mortality rates in 2019 were higher in this group than in other racial and ethnic groups included in the analysis.

    Decreases in cigarette smoking and improvements in early detection and targeted cancer treatment plans have been shown to be associated with decreases in cancer mortality among Black men and women.3 In the US, smoking prevalence among Black individuals decreased from 24.3% in 1999 to 14.9% in 2019, contributing to decreases in deaths from lung, bladder, kidney, and pancreatic cancer.1,4-6 Decreases in breast cancer mortality among Black women may be associated with increased accessibility to screening, earlier detection, and advances in treatment.7,8 In addition, decreases in colorectal cancer mortality, particularly among Black individuals aged 50 years or older, may be associated with increased access to both invasive and noninvasive screening.7 Decreasing rates of death from prostate cancer may be associated with improved treatment and hormonal therapy for advanced disease.9 However, the slowing trend in prostate cancer mortality rates among older men might be attributable to the increasing incidence of distant stage disease, which may be associated with the 2012 US Preventive Task Force recommendation against prostate-specific antigen screening.10

    Trends in liver cancer mortality rates among Black individuals differed by sex and age group. Increasing mortality rates in older age groups may be associated with these groups having the highest national prevalence of chronic hepatitis C virus infection and a higher prevalence of obesity, alcohol use, and metabolic disorders.6,11,12 The reduction in liver cancer mortality in recent years in some age groups may be associated with improvements in screening for hepatitis C virus infection and treatment for hepatitis B and C virus infection as well as with liver dysfunction in individuals with liver cancer.12 After accounting for hysterectomy, increasing uterine cancer death rates among Black women have been shown to be associated with longer duration of excess adiposity, largely owing to greater exposure to stressors and neighborhood-level factors.6,7

    Despite national progress in reducing cancer mortality, Black individuals had considerably higher cancer mortality rates in 2019 compared with other racial and ethnic groups. The factors associated with racial disparities in cancer death rates are primarily systemic and preventable. Black patients are more likely to experience poor patient-physician interactions, longer referral times, delays in treatment, greater medical mistrust, underuse of treatment, and health care system failure—all mutable factors.8,13,14 In addition, Black individuals are more likely to reside in neighborhoods with poor accessibility to specialists, see physicians with fewer clinical resources, and live in communities with greater exposure to environmental toxins.8 Therefore, examining individual-level behavioral and biological factors is insufficient, and greater emphasis should be aimed at understanding the contribution of social inequities to higher cancer mortality rates among Black individuals. Addressing inequalities that contribute to racial disparities in cancer mortality requires policies that seek to resolve adverse socioenvironmental conditions and determinants that contribute to inequities throughout the entire continuum of care.

    Limitations

    The main limitations of this study include potential misclassification of cause of death and race and ethnicity on death certificates and the use of broad groupings of race and ethnicity that can mask differences within groups. Moreover, decreases in cancer death rates may slow in future years in association with the COVID-19 pandemic, which has disproportionately affected Black communities in the US.15

    Conclusions

    In this cross-sectional study, there were substantial decreases in cancer death rates among Black individuals from 1999 to 2019. This decrease may have been associated with advances in cancer prevention, detection, and treatment as well as with population changes in exposure to cancer risk factors. However, in 2019, Black individuals continued to have the highest cancer mortality rates compared with other racial and ethnic groups, suggesting a need to address the pervasiveness of longstanding racial and ethnic inequities. Eliminating racial and ethnic disparities in cancer mortality will require equitable access to cancer prevention, early diagnosis, and timely and guideline-adherent high-quality care.

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    Article Information

    Accepted for Publication: February 22, 2022.

    Published Online: May 19, 2022. doi:10.1001/jamaoncol.2022.1472

    Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Lawrence WR et al. JAMA Oncology.

    Corresponding Author: Wayne R. Lawrence, DrPH, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr, Bethesda, MD 20850 (wayne.lawrence@nih.gov).

    Author Contributions: Dr Lawrence had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    Concept and design: Lawrence, Berrington de Gonzalez, Freedman, Shiels.

    Acquisition, analysis, or interpretation of data: All authors.

    Drafting of the manuscript: Lawrence, McGee-Avila.

    Critical revision of the manuscript for important intellectual content: All authors.

    Statistical analysis: Lawrence, McGee-Avila, Berrington de Gonzalez, Shiels.

    Obtained funding: Lawrence.

    Administrative, technical, or material support: Freedman.

    Supervision: Shiels.

    Conflict of Interest Disclosures: None reported.

    Funding/Support: This work was supported by the National Institutes of Health Intramural Research Program of the National Cancer Institute.

    Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study, collection, management, analysis, and interpretation of the data, and decision to submit the manuscript for publication. However, the funder did have final approval of the manuscript prior to submission.

    Disclaimer: The information presented by the authors is their own, and this material should not be interpreted as representing the official viewpoint of the US Department of Health and Human Services, the National Institutes of Health, or the National Cancer Institute.

    References
    1.
    Henley  SJ, Ward  EM, Scott  S,  et al.  Annual report to the nation on the status of cancer, part I: national cancer statistics.   Cancer. 2020;126(10):2225-2249. doi:10.1002/cncr.32802PubMedGoogle ScholarCrossref
    2.
    Islami  F, Guerra  CE, Minihan  A,  et al.  American Cancer Society’s report on the status of cancer disparities in the United States, 2021.   CA Cancer J Clin. 2022;72(2):112-143. Published online December 8, 2021. doi:10.3322/caac.21703PubMedGoogle ScholarCrossref
    3.
    Schabath  MB, Cote  ML.  Cancer progress and priorities: lung cancer.   Cancer Epidemiol Biomarkers Prev. 2019;28(10):1563-1579. doi:10.1158/1055-9965.EPI-19-0221PubMedGoogle ScholarCrossref
    4.
    Warren  GW, Cummings  KM.  Tobacco and lung cancer: risks, trends, and outcomes in patients with cancer.   Am Soc Clin Oncol Educ Book. 2013;(33):359-364. doi:10.14694/EdBook_AM.2013.33.359PubMedGoogle ScholarCrossref
    5.
    American Lung Association. National Center for Health Statistics. National Health Interview Survey 1965-2018. 2020. November 10, 2021. https://www.lung.org/research/trends-in-lung-disease/tobacco-trends-brief/data-tables/ad-cig-smoke-rate-sex-race-age
    6.
    Islami  F, Goding Sauer  A, Miller  KD,  et al.  Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States.   CA Cancer J Clin. 2018;68(1):31-54. doi:10.3322/caac.21440PubMedGoogle ScholarCrossref
    7.
    DeSantis  CE, Miller  KD, Goding Sauer  A, Jemal  A, Siegel  RL.  Cancer statistics for African Americans, 2019.   CA Cancer J Clin. 2019;69(3):211-233. doi:10.3322/caac.21555PubMedGoogle ScholarCrossref
    8.
    Daly  B, Olopade  OI.  A perfect storm: how tumor biology, genomics, and health care delivery patterns collide to create a racial survival disparity in breast cancer and proposed interventions for change.   CA Cancer J Clin. 2015;65(3):221-238. doi:10.3322/caac.21271PubMedGoogle ScholarCrossref
    9.
    Negoita  S, Feuer  EJ, Mariotto  A,  et al.  Annual report to the nation on the status of cancer, part II: recent changes in prostate cancer trends and disease characteristics.   Cancer. 2018;124(13):2801-2814. doi:10.1002/cncr.31549PubMedGoogle ScholarCrossref
    10.
    Grossman  DC, Curry  SJ, Owens  DK,  et al; US Preventive Services Task Force.  Screening for prostate cancer: US Preventive Services Task Force recommendation statement.   JAMA. 2018;319(18):1901-1913. doi:10.1001/jama.2018.3710PubMedGoogle ScholarCrossref
    11.
    Shiels  MS, Engels  EA, Yanik  EL, McGlynn  KA, Pfeiffer  RM, O’Brien  TR. Incidence of hepatocellular carcinoma among older Americans attributable to hepatitis C and hepatitis B: 2001 through 2013. Cancer. Published online April 12, 2019. doi:10.1002/cncr.32129
    12.
    Islami  F, Miller  KD, Siegel  RL, Fedewa  SA, Ward  EM, Jemal  A.  Disparities in liver cancer occurrence in the United States by race/ethnicity and state.   CA Cancer J Clin. 2017;67(4):273-289. doi:10.3322/caac.21402PubMedGoogle ScholarCrossref
    13.
    Palmer Kelly  E, McGee  J, Obeng-Gyasi  S,  et al.  Marginalized patient identities and the patient-physician relationship in the cancer care context: a systematic scoping review.   Support Care Cancer. 2021;29(12):7195-7207. Published online July 1, 2021. doi:10.1007/s00520-021-06382-8PubMedGoogle ScholarCrossref
    14.
    Bickell  NA, LePar  F, Wang  JJ, Leventhal  H.  Lost opportunities: physicians’ reasons and disparities in breast cancer treatment.   J Clin Oncol. 2007;25(18):2516-2521. doi:10.1200/JCO.2006.09.5539PubMedGoogle ScholarCrossref
    15.
    Amram  O, Robison  J, Amiri  S, Pflugeisen  B, Roll  J, Monsivais  P.  Socioeconomic and racial inequities in breast cancer screening during the COVID-19 pandemic in Washington state.   JAMA Netw Open. 2021;4(5):e2110946. doi:10.1001/jamanetworkopen.2021.10946PubMedGoogle ScholarCrossref
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