Cancer health disparities and equity

In the US, Black patients have the highest death rate for most cancers (e.g. ~40% higher breast cancer mortality than White women despite similar incidence, 2× prostate cancer mortality, worse outcomes in multiple myeloma and colorectal cancer); rural patients, uninsured patients and American Indian/Alaska Native populations face large gaps; Hispanic and Asian populations have distinct patterns (higher liver, stomach, cervical cancer). Drivers: screening access, time to treatment, guideline-concordant care, trial under-representation (Black patients ~4-6% of pivotal trial enrolment), social determinants, environmental exposures, medical mistrust, and biology shaped by these (e.g. TNBC incidence). Medicaid expansion narrowed disparities in stage at diagnosis and survival; navigation, community health workers, mobile screening and diverse trial recruitment (FDA diversity action plans, 2024) are evidence-based responses. Globally, disparity is between countries as much as within (see global oncology).