How Race and Income Affect Cancer Survival: They Don’t

I would like to go back to my previous post about Lance Armstrong and analyze what he said about cancer survival rates being related to race and income. Armstrong said that if someone in Harlem came down with cancer, because of “the color of their skin, where they live and the choice they’ve made” in life, their chances of survival are much lower. He went on to say that is a “moral and ethical failure of the United States.”

Inasmuch as we move away from religious morals, our country does fail in many respects. But the US is one of the most moral and ethical countries on the planet. Transparency International rates the US as one of the least corrupt countries in the world.

But what about race and income affecting cancer survival rates. I wondered if I could find any data to back this claim, particularly the implication that poor black people are more likely to get inferior health care and thus more likely to die than their rich white counterparts. What I found was that there do appear to be differences in cancer survival rate based on race and income level, but it would be a stretch to say that this is due to the failures of a morally and ethically corrupt country.

According to the National Cancer Institute, Blacks are more likely than Whites to get cancer and Blacks are more likely than Whites to die of cancer. Black males have a cancer incident rate about 20% higher than White males, while Black and White women’s cancer incident rates are roughly equal. Black of either gender are about 10% more likely to die of cancer than their White counterparts. Why Blacks have a lower survival rate is inconclusive, but why Blacks have a higher likelihood of contracting cancer appears to be genetic (or you could say God is a racist, which is an accusation that probably wouldn’t be past some people).

Medical News Today confirms that race, as a genetic factor, does appear to greatly influence cancer contraction and treatment. They report that, “Japanese American men respond better to hormonal treatment for prostate cancer and have a much higher survival rate than white American men, according to research published in the latest issue of the UK-based urology journal BJU International.”

As you can see, from 1988 to 1997, cancer survival rates improved for all six racial groups. The National Cancer Institute says that, “differences in access to and utilization of effective cancer screening and treatment services by race or ethnicity might explain some of our findings” but this research did not study such factors, so it would be inappropriate to make that conclusion. The study did find, though, that there was a direct correlation between breast cancer survival and having a mammogram screening every two years. And the 2-year mammography screening rate for different ethnic group directly paralleled the cancer survival rates. Meaning, White women are more likely than Black women to get mammograms and Black women are more likely than Native Americans to get mammograms. White women are in turn, more likely than Black women to survive cancer and Black women are more likely than Native Americans to survive. And seeing how all communities offer free cancer screenings, these survival rates then become more of a factor of individual choice or, perhaps, education.

Notice the group with the highest improvement in cancer survival are Black males. And overall, Blacks have a higher cancer survival rate than Native Americans and Asian Americans.

The statistics above discuss how race or ethnicity affect cancer detection, treatment and survival, but income level is not factored. The American Society for Clinical Oncology in their Journal of Clinical Oncology in 1999 published a study, though, that does discuss how income affects cancer detection and treatment. This study found that higher income brackets in both the United States and Canada (where they have socialized medicine) had higher cancer survival rate. Again, the evidence shows that this is caused, not by a prejudice nation withholding the best treatment from poor people, but a factor of education, screening and racial genetics.

The really interesting thing about this study, though, is that is shows how socialized medicine lowers the quality of health care, rather than raising it. If you notice in the graph below, in Canada survival rates cluster toward the bottom, with only the very rich having a significantly higher cancer survival rate. Whereas in the United States, survival rates cluster toward the top, with only the very poor having a significantly lower cancer survival rate.

In the chart above, the solid line represents the richest fifth and the broadest dashed line represents the poorest fifth of people.

So while Blacks do have a cancer survival rate lower than Whites, Blacks survival rate higher than many other racial groups in the US. And while the survival rates are different by racial groups, genetics and education are much more of a factor than race alone. The only way one can come to the conclusion that Blacks have a lower cancer survival rate due to moral and ethical failures of our country is to 1) ignore the facts above, and 2) have an underlying belief that America is a morally and ethically corrupt country. I choose not to ignore the facts above and I have an underlying belief that America is a morally and ethically good country. I wish Lance Armstrong would do the same.