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      Cancer health disparities in racial/ethnic minorities in the United States

      review-article
      1 , 2 , 3 , 4 , 5 , 5 , 6 , 7 , 8 , 9 , 10 , 1 , 11 , 2 , 12 , 13 , 14 , 7 , 15 , 1 , 16 , 17 , 18 , 19 , 1 , 20 , 18 , 21 , 22 , 23 , 24 , 14 , 25 , 26 , 27 , 1 , 1 ,
      British Journal of Cancer
      Nature Publishing Group UK
      Cancer epidemiology, Cancer epidemiology

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          Abstract

          There are well-established disparities in cancer incidence and outcomes by race/ethnicity that result from the interplay between structural, socioeconomic, socio-environmental, behavioural and biological factors. However, large research studies designed to investigate factors contributing to cancer aetiology and progression have mainly focused on populations of European origin. The limitations in clinicopathological and genetic data, as well as the reduced availability of biospecimens from diverse populations, contribute to the knowledge gap and have the potential to widen cancer health disparities. In this review, we summarise reported disparities and associated factors in the United States of America (USA) for the most common cancers (breast, prostate, lung and colon), and for a subset of other cancers that highlight the complexity of disparities (gastric, liver, pancreas and leukaemia). We focus on populations commonly identified and referred to as racial/ethnic minorities in the USA—African Americans/Blacks, American Indians and Alaska Natives, Asians, Native Hawaiians/other Pacific Islanders and Hispanics/Latinos. We conclude that even though substantial progress has been made in understanding the factors underlying cancer health disparities, marked inequities persist. Additional efforts are needed to include participants from diverse populations in the research of cancer aetiology, biology and treatment. Furthermore, to eliminate cancer health disparities, it will be necessary to facilitate access to, and utilisation of, health services to all individuals, and to address structural inequities, including racism, that disproportionally affect racial/ethnic minorities in the USA.

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          Cancer statistics, 2020

          Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States and compiles the most recent data on population-based cancer occurrence. Incidence data (through 2016) were collected by the Surveillance, Epidemiology, and End Results Program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data (through 2017) were collected by the National Center for Health Statistics. In 2020, 1,806,590 new cancer cases and 606,520 cancer deaths are projected to occur in the United States. The cancer death rate rose until 1991, then fell continuously through 2017, resulting in an overall decline of 29% that translates into an estimated 2.9 million fewer cancer deaths than would have occurred if peak rates had persisted. This progress is driven by long-term declines in death rates for the 4 leading cancers (lung, colorectal, breast, prostate); however, over the past decade (2008-2017), reductions slowed for female breast and colorectal cancers, and halted for prostate cancer. In contrast, declines accelerated for lung cancer, from 3% annually during 2008 through 2013 to 5% during 2013 through 2017 in men and from 2% to almost 4% in women, spurring the largest ever single-year drop in overall cancer mortality of 2.2% from 2016 to 2017. Yet lung cancer still caused more deaths in 2017 than breast, prostate, colorectal, and brain cancers combined. Recent mortality declines were also dramatic for melanoma of the skin in the wake of US Food and Drug Administration approval of new therapies for metastatic disease, escalating to 7% annually during 2013 through 2017 from 1% during 2006 through 2010 in men and women aged 50 to 64 years and from 2% to 3% in those aged 20 to 49 years; annual declines of 5% to 6% in individuals aged 65 years and older are particularly striking because rates in this age group were increasing prior to 2013. It is also notable that long-term rapid increases in liver cancer mortality have attenuated in women and stabilized in men. In summary, slowing momentum for some cancers amenable to early detection is juxtaposed with notable gains for other common cancers.
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            Cancer statistics, 2019

            Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States and compiles the most recent data on cancer incidence, mortality, and survival. Incidence data, available through 2015, were collected by the Surveillance, Epidemiology, and End Results Program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data, available through 2016, were collected by the National Center for Health Statistics. In 2019, 1,762,450 new cancer cases and 606,880 cancer deaths are projected to occur in the United States. Over the past decade of data, the cancer incidence rate (2006-2015) was stable in women and declined by approximately 2% per year in men, whereas the cancer death rate (2007-2016) declined annually by 1.4% and 1.8%, respectively. The overall cancer death rate dropped continuously from 1991 to 2016 by a total of 27%, translating into approximately 2,629,200 fewer cancer deaths than would have been expected if death rates had remained at their peak. Although the racial gap in cancer mortality is slowly narrowing, socioeconomic inequalities are widening, with the most notable gaps for the most preventable cancers. For example, compared with the most affluent counties, mortality rates in the poorest counties were 2-fold higher for cervical cancer and 40% higher for male lung and liver cancers during 2012-2016. Some states are home to both the wealthiest and the poorest counties, suggesting the opportunity for more equitable dissemination of effective cancer prevention, early detection, and treatment strategies. A broader application of existing cancer control knowledge with an emphasis on disadvantaged groups would undoubtedly accelerate progress against cancer.
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              The mutational constraint spectrum quantified from variation in 141,456 humans

              Genetic variants that inactivate protein-coding genes are a powerful source of information about the phenotypic consequences of gene disruption: genes that are crucial for the function of an organism will be depleted of such variants in natural populations, whereas non-essential genes will tolerate their accumulation. However, predicted loss-of-function variants are enriched for annotation errors, and tend to be found at extremely low frequencies, so their analysis requires careful variant annotation and very large sample sizes 1 . Here we describe the aggregation of 125,748 exomes and 15,708 genomes from human sequencing studies into the Genome Aggregation Database (gnomAD). We identify 443,769 high-confidence predicted loss-of-function variants in this cohort after filtering for artefacts caused by sequencing and annotation errors. Using an improved model of human mutation rates, we classify human protein-coding genes along a spectrum that represents tolerance to inactivation, validate this classification using data from model organisms and engineered human cells, and show that it can be used to improve the power of gene discovery for both common and rare diseases.
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                Author and article information

                Contributors
                laura.fejerman@ucsf.edu
                Journal
                Br J Cancer
                Br J Cancer
                British Journal of Cancer
                Nature Publishing Group UK (London )
                0007-0920
                1532-1827
                9 September 2020
                9 September 2020
                19 January 2021
                : 124
                : 2
                : 315-332
                Affiliations
                [1 ]GRID grid.266102.1, ISNI 0000 0001 2297 6811, Division of General Internal Medicine, Department of Medicine, , University of California, San Francisco, ; San Francisco, CA USA
                [2 ]GRID grid.266102.1, ISNI 0000 0001 2297 6811, Department of Epidemiology and Biostatistics, , University of California, San Francisco, ; San Francisco, CA USA
                [3 ]GRID grid.214458.e, ISNI 0000000086837370, Departments of Internal Medicine and Human Genetics, and Rogel Cancer Center, , University of Michigan, ; Ann Arbor, MI USA
                [4 ]GRID grid.27860.3b, ISNI 0000 0004 1936 9684, University of California Davis Comprehensive Cancer Center and Department of Biochemistry and Molecular Medicine, School of Medicine, , University of California Davis, ; Sacramento, CA USA
                [5 ]GRID grid.27860.3b, ISNI 0000 0004 1936 9684, Genome Center, , University of California Davis, ; Davis, CA USA
                [6 ]GRID grid.267033.3, ISNI 0000 0004 0462 1680, Department of Cancer Biology, , University of Puerto Rico Comprehensive Cancer Center, ; San Juan, Puerto Rico
                [7 ]GRID grid.413734.6, ISNI 0000 0000 8499 1112, Division of Breast Surgery, Department of Surgery, , NewYork-Presbyterian/Weill Cornell Medical Center, ; New York, NY USA
                [8 ]GRID grid.42505.36, ISNI 0000 0001 2156 6853, Center for Genetic Epidemiology, , University of Southern California Keck School of Medicine, ; Los Angeles, CA USA
                [9 ]GRID grid.262009.f, Cancer Biology Division, Ponce Research Institute, , Ponce Health Sciences University, ; Ponce, Puerto Rico
                [10 ]GRID grid.50956.3f, ISNI 0000 0001 2152 9905, Samuel Oschin Comprehensive Cancer Institute, , Cedars-Sinai Medical Center, ; Los Angeles, CA USA
                [11 ]GRID grid.213910.8, ISNI 0000 0001 1955 1644, Department of Oncology, Lombardi Comprehensive Cancer Center, , Georgetown University, ; Washington, DC USA
                [12 ]GRID grid.266102.1, ISNI 0000 0001 2297 6811, Helen Diller Family Comprehensive Cancer Center, , University of California San Francisco, ; San Francisco, CA USA
                [13 ]GRID grid.423606.5, ISNI 0000 0001 1945 2152, Laboratorio de Terapia Molecular y Celular, IIBBA, , Fundación Instituto Leloir, CONICET, ; Buenos Aires, Argentina
                [14 ]GRID grid.410425.6, ISNI 0000 0004 0421 8357, Department of Population Sciences, , Beckman Research Institute of City of Hope, ; Duarte, CA USA
                [15 ]GRID grid.413734.6, ISNI 0000 0000 8499 1112, Interdisciplinary Breast Program, , New York-Presbyterian/Weill Cornell Medical Center, ; New York, NY USA
                [16 ]GRID grid.189504.1, ISNI 0000 0004 1936 7558, Slone Epidemiology Center at Boston University, ; Boston, MA USA
                [17 ]GRID grid.266102.1, ISNI 0000 0001 2297 6811, Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, , University of California, San Francisco, ; San Francisco, CA USA
                [18 ]GRID grid.94365.3d, ISNI 0000 0001 2297 5165, Division of Intramural Research, National Heart, Lung and Blood Institute, , National Institutes of Health, ; Bethesda, MD USA
                [19 ]GRID grid.94365.3d, ISNI 0000 0001 2297 5165, Office of the Director, National Institute on Minority Health and Health Disparities, , National Institutes of Health, ; Bethesda, MD USA
                [20 ]GRID grid.266102.1, ISNI 0000 0001 2297 6811, Division of Hematology/Oncology, Department of Medicine, , University of California San Francisco, ; San Francisco, CA USA
                [21 ]Subdirección de Investigaciones - Instituto Nacional de Cancerología de Colombia, Bogotá, Colombia
                [22 ]GRID grid.468198.a, ISNI 0000 0000 9891 5233, Department of Cancer Epidemiology, , H. Lee Moffitt Cancer Center and Research Institute, ; Tampa, FL USA
                [23 ]GRID grid.419169.2, ISNI 0000 0004 0621 5619, Grupo de investigación en biología del cáncer, , Instituto Nacional de Cancerología, ; Bogotá, Colombia
                [24 ]GRID grid.42505.36, ISNI 0000 0001 2156 6853, Departments of Preventive Medicine and Urology, Keck School of Medicine of USC, Norris Comprehensive Cancer Center, , University of Southern California, ; Los Angeles, CA USA
                [25 ]GRID grid.410425.6, ISNI 0000 0004 0421 8357, Department of Medical Oncology and Therapeutics Research, , City of Hope Comprehensive Cancer Center, ; Duarte, CA USA
                [26 ]GRID grid.240871.8, ISNI 0000 0001 0224 711X, Department of Pharmaceutical Sciences, Department of Oncology, , St. Jude Children’s Research Hospital, ; Memphis, TN USA
                [27 ]GRID grid.279863.1, ISNI 0000 0000 8954 1233, Department of Pediatrics and Stanley S. Scott Cancer Center LSUHSC, ; New Orleans, LA USA
                Author information
                http://orcid.org/0000-0001-7129-2918
                http://orcid.org/0000-0002-0770-9659
                http://orcid.org/0000-0003-3179-1151
                Article
                1038
                10.1038/s41416-020-01038-6
                7852513
                32901135
                6118fa4e-fd46-45a2-a4fc-c776419d0671
                © The Author(s) 2020

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 14 November 2019
                : 16 July 2020
                : 3 August 2020
                Funding
                Funded by: FundRef https://doi.org/10.13039/100011541, U.S. Department of Health & Human Services | NIH | NCI | Division of Cancer Epidemiology and Genetics, National Cancer Institute (National Cancer Institute Division of Cancer Epidemiology and Genetics);
                Award ID: R01CA204797
                Award Recipient :
                Categories
                Review Article
                Custom metadata
                © Cancer Research UK 2021

                Oncology & Radiotherapy
                cancer epidemiology
                Oncology & Radiotherapy
                cancer epidemiology

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