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Cancer Incidence and Mortality of African Americans in Texas

Cancer is a large classification of diseases characterized by uncontrolled growth and spread of abnormal cells. Undetected and uncontrolled, it can ultimately result in death. Causes of cancer can be categorized into three factors: external (chemicals, tobacco smoke, radiation, viruses), internal (hormones, immune conditions, genetics) and lifestyle (tobacco and alcohol use, unprotected sun exposure, poor nutrition, physical inactivity). Many cancers can be cured if detected and treated promptly, and many others prevented by lifestyle changes.

In 2004, it was estimated that more than 1. illion people in the United States would be diagnosed with cancer. In Texas alone, it was estimated that approximately 85,000 individuals will be diagnosed with cancer in 2004, and another 37,000 will die from the disease (Table 1). Four cancer sites account for more than half of the cancer that affect Texans, lining up with the national incidences and mortality sites. These include lung and bronchus, colorectal, breast (female), and prostate cancer. Together these four sites account for approximately 41,900 new cases of cancer diagnosed and 16,900 cancer deaths in Texans.

Cancer is the second leading cause of death in the United States and is expected to become the leading cause of death within the next decade. Cancer also is the second leading cause of death in Texas. While cancer affects all people, studies have shown that this disease does not subscribe to “equal opportunity” mandates; varied distributions appear when cases are tallied by gender, age, race and economic groups, usually to the disadvantage of the minority in each instance. In Texas, African American men are diagnosed with cancer in higher numbers in comparison to their Non-Hispanic White and Hispanic counterparts.

The mortality rates are 1. 5 times greater than Non-Hispanic Whites and 2. 0 times more than Hispanic males in Texas for the top five sites (larynx, prostate, stomach, myeloma and oral cavity. ) There are many factors that contribute to the increased cancer risk that African American men and women sustain. Three to be discussed further will be economic, social, and cultural. All three on their own are significant enough to separate the African American population by percentages, but combined the gap widens even more for individual and community health. Poverty is a critical factor affecting one’s health.

With the poverty line defined at having an annual income of $18,392 for a family of four, African Americans make up 13% of the impoverish population of Texas, where Hispanics take 60% of that poverty pie (and only make up 33% of the state’s population. ) Early detection is not common among those in poverty, a key factor in cancer survival. Furthermore, Texas leads the nation in the percentage of working people who have no health insurance. African Americans are second to Hispanics in the percentage of working age adults without health insurance coverage.

Overall, this creates financial limits to cancer screening tests, tests that may seem routine to many of us. Without insurance coverage doctors visits are more of a luxury not indulged. Historical social inequalities suffered by African Americans, such as racial discrimination, still have an influence on the quality of health care received by this segment of our population. Interactions between physicians and patients guided by racial discrimination can determine an African American’s informed state, timely diagnosis being shared or not, optimal treatment not offered and poor or less than average follow up.

There are patient interviews documenting African American patients that did not receive the same waiting room discretion as other patients by embarrassing personal questions through the reception windows, thus discouraging follow-up visits. Another contributing social aspect is the under-representation of ethnic minorities in the health car professions. When care is provided by a person in one’s ethnic group, a trusting relationship is more easily fostered between patient and care giver and naturally facilitates personal health information exchanges.

The African American culture historically has put them at risk for incidence of cancer. While supporting data is scarce, African Americans have traditionally eaten high-fat foods when compared to whites. Southern food or soul food generally came from the use of cheaper cuts of meats and use of animal fats for cooking. According to Gwendolyn Pla, PhD, from Howard University, obesity seems to be more accepted among African Americans and being 440% or more overweight puts one at an increased risk for breast and prostate cancer (also for colon, gallbladder and ovarian cancers).

Dr. Pla has treated individuals for eating disorders and has noted that her white patients were more concerned with thinness, where her black patients were more eating and binging to feel better. While health organizations are focusing their campaigns on the convenience and importance of cancer screening procedures, the African American population is still disproportionately suffering from cancer incidence and mortality. Not until early detection is common place will the numbers change, especially with the African American elderly population expected to increase by 160% over the next quarter of a century.

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