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1 President of the American Cancer Society, is Director of Surgery at Harlem Hospital, and Professor of Clinical Surgery at Columbia University College of Physicians and Surgeons, in New York, New York.
About one million Americans develop cancer and about 500,000 Americans die of cancer each year. A disproportionate number of people who develop cancer and die of the disease are among the socioeconomically disadvantaged of all races. There are 39 million poor Americans. Two thirds of the poor are white, and nearly one third are black. A total of 37 million Americans have no health insurance. Combining the two overlapping segments of the population who are poor and uninsured, approximately 55 million Americans experience significant difficulties in gaining access to early diagnosis and treatment of cancer. Poor Americans regardless of race have a five-year cancer survival rate that is 10 to 15 percent lower, as well as a higher rate of cancer incidence, compared with other Americans. The recurrent cycle of poverty is a key component in the problem of cancer control. Black Americans have a five-year survival rate 12 percent lower than that of whites. Racial disparities in cancer results are due primarily to differences in economic status. The relatively poor cancer results in black Americans are an indication of the health consequences that befall a group that represents one third of the poor and one fourth of the unemployed, but only one tenth of the population. There is no known genetic basis for racial differences in cancer incidence and outcome. Race, on the other hand, is a significant proxy for culture, tradition, belief system, and lifestyle. Accordingly, race (culture) becomes a prism through which the effects of poverty are reflected. In 1983, the war against cancer took on a new approach when the National Cancer Institute set a goal to diminish the mortality from cancer by 50 percent by the year 2000. The achievement of such a goal requires, among other things, the dramatic narrowing or elimination of the gap in cancer survival between the socioeconomically disadvantaged and other Americans. To substantially reduce this disparity by the year 2000, energetic application of culturally targeted public education to the disadvantaged is needed, along with strong advocacy for legislative changes both locally and nationally so that all Americans will be provided with adequate information and appropriate access to cancer screening. diagnosis, and treatment. In the words of the great civil rights leader, the Reverend Martin Luther King, Jr.: "Of all the forms of inequality, injustice in health is the most shocking and inhumane."
Cancer in the Socioeconomically Disadvantaged
Harold P. Freeman MD1
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