The contribution of cancer incidence, stage at diagnosis and survival to racial differences in years of life expectancy.
BACKGROUND
African Americans have higher cancer mortality rates than whites. Understanding the relative contribution of cancer incidence, stage at diagnosis and survival after diagnosis to the racial gap in life expectancy has important implications for directing future health disparity interventions toward cancer prevention, screening and treatment.


OBJECTIVE
We estimated the degree to which higher cancer mortality among African Americans is due to higher incidence rates, later stage at diagnosis or worse survival after diagnosis.


METHODS
Stochastic model of cancer incidence and survival after diagnosis.


METHODS
Surveillance and Epidemiology End Result cancer registry and National Health Interview Survey data.


METHODS
Life expectancy if African Americans had the same cancer incidence, stage and survival after diagnosis as white adults.


RESULTS
African-American men and women live 1.47 and 0.91 fewer years, respectively, than whites as the result of all cancers combined. Among men, racial differences in cancer incidence, stage at diagnosis and survival after diagnosis account for 1.12 (95% CI: 0.52 to 1.36), 0.17 (95% CI: -0.03 to 0.33) and 0.21 (95% CI: 0.05 to 0.34) years of the racial gap in life expectancy, respectively. Among women, incidence, stage and survival after diagnosis account for 0.41 (95% CI: -0.29 to 0.60), 0.26 (95% CI: -0.06 to 0.40) and 0.31 (95% CI: 0.05 to 0.40) years, respectively. Differences in stage had a smaller impact on the life expectancy gap compared with the impact of incidence. Differences in cancer survival after diagnosis had a significant impact for only two cancers-breast (0.14 years; 95% CI: 0.05 to 0.16) and prostate (0.05 years; 95% CI 0.01 to 0.09).


CONCLUSIONS
In addition to breast and colorectal cancer screening, national efforts to reduce disparities in life expectancy should also target cancer prevention, perhaps through smoking cessation, and differences in survival after diagnosis among persons with breast and prostate cancer.
Wong
Mitchell D
MD
Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, Los Angeles, CA 90024, USA. mitchellwong@mednet.ucla.edu
Ettner
Susan L
SL
Boscardin
W John
WJ
Shapiro
Martin F
MF
D001741:Black or African American; D001943:Breast Neoplasms / Q000401:mortality; D005260:Female; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008962:Models, Theoretical; D009367:Neoplasm Staging; D009369:Neoplasms / Q000175:diagnosis* / Q000401:mortality* / Q000517:prevention & control; D011471:Prostatic Neoplasms / Q000401:mortality; D015996:Survival Rate; D044465:White People