American Cancer Society's report on the status of cancer disparities in the United States, 2021

In this report, the authors provide comprehensive and up‐to‐date US data on disparities in cancer occurrence, major risk factors, and access to and utilization of preventive measures and screening by sociodemographic characteristics. They also review programs and resources that have reduced cancer disparities and provide policy recommendations to further mitigate these inequalities. The overall cancer death rate is 19% higher among Black males than among White males. Black females also have a 12% higher overall cancer death rate than their White counterparts despite having an 8% lower incidence rate. There are also substantial variations in death rates for specific cancer types and in stage at diagnosis, survival, exposure to risk factors, and receipt of preventive measures and screening by race/ethnicity, socioeconomic status, and geographic location. For example, kidney cancer death rates by sex among American Indian/Alaska Native people are ≥64% higher than the corresponding rates in each of the other racial/ethnic groups, and the 5‐year relative survival for all cancers combined is 14% lower among residents of poorer counties than among residents of more affluent counties. Broad and equitable implementation of evidence‐based interventions, such as increasing health insurance coverage through Medicaid expansion or other initiatives, could substantially reduce cancer disparities. However, progress will require not only equitable local, state, and federal policies but also broad interdisciplinary engagement to elevate and address fundamental social inequities and longstanding systemic racism.

[1]  O. Brawley,et al.  Minimizing the burden of cancer in the United States: Goals for a high‐performing health care system , 2019, CA: a cancer journal for clinicians.

[2]  Apoorva Mylavarapu,et al.  Diversity Within the Most Competitive Internal Medicine Fellowships: Examining Trends from 2008 to 2018 , 2020, Journal of General Internal Medicine.

[3]  J. Onnela,et al.  Assessment of Racial Disparities in Primary Care Physician Specialty Referrals , 2021, JAMA network open.

[4]  L. Collin,et al.  Neighborhood-Level Redlining and Lending Bias Are Associated with Breast Cancer Mortality in a Large and Diverse Metropolitan Area , 2020, Cancer Epidemiology, Biomarkers & Prevention.

[5]  A. Jemal,et al.  Shared decision making and prostate-specific antigen based prostate cancer screening following the 2018 update of USPSTF screening guideline , 2020, Prostate Cancer and Prostatic Diseases.

[6]  S. Sutton,et al.  Cancer and lesbian, gay, bisexual, transgender/transsexual, and queer/questioning (LGBTQ) populations , 2015, CA: a cancer journal for clinicians.

[7]  C. N. Coleman,et al.  Cancer Care Access and Outcomes for American Indian Populations in the United States: Challenges and Models for Progress. , 2017, Seminars in radiation oncology.

[8]  T. Hyslop,et al.  The Effect of Hospital Volume on Breast Cancer Mortality , 2018, Annals of surgery.

[9]  A. Jemal,et al.  County-Level Variations in Receipt of Surgery for Early-Stage Non-small Cell Lung Cancer in the United States. , 2019, Chest.

[10]  A. Jemal,et al.  Temporal trends in liver cancer mortality by educational attainment in the United States, 2000‐2015 , 2019, Cancer.

[11]  Tilicia L. Mayo-Gamble,et al.  A pilot study of a culturally-appropriate, educational intervention to increase participation in cancer clinical trials among African Americans and Latinos , 2021, Cancer Causes & Control.

[12]  R. Carlson,et al.  The State of Cancer Care in America: Impact of State Policy on Access to High-Quality Cancer Care. , 2020, Journal of the National Comprehensive Cancer Network : JNCCN.

[13]  Tracey A. Dechert,et al.  The Impact of Racial Residential Segregation on Colorectal Cancer Outcomes and Treatment , 2020, Annals of surgery.

[14]  J. Schorge,et al.  Disparities in receipt of care for high-grade endometrial cancer: A National Cancer Data Base analysis. , 2017, Gynecologic oncology.

[15]  R. Elk,et al.  Social Inequalities in Palliative Care for Cancer Patients in the United States: A Structured Review. , 2018, Seminars in oncology nursing.

[16]  T. Akinyemiju,et al.  Race, Socioeconomic Status, and Health-Care Access Disparities in Ovarian Cancer Treatment and Mortality: Systematic Review and Meta-Analysis , 2019, JNCI cancer spectrum.

[17]  Mariana C. Arcaya,et al.  Cancer Stage at Diagnosis, Historical Redlining, and Current Neighborhood Characteristics: Breast, Cervical, Lung, and Colorectal Cancers, Massachusetts, 2001–2015 , 2020, American journal of epidemiology.

[18]  Amy Y. Chen,et al.  Association of insurance status and ethnicity with cancer stage at diagnosis for 12 cancer sites: a retrospective analysis. , 2008, The Lancet. Oncology.

[19]  K. Stoltzfus,et al.  Promoting colorectal cancer screening: A scoping review of screening interventions and resources. , 2021, Preventive medicine.

[20]  A. Neugut,et al.  Impact of hospital volume on racial disparities and outcomes for endometrial cancer. , 2018, Gynecologic oncology.

[21]  Jonathan Mermin,et al.  Estimating Prevalence of Hepatitis C Virus Infection in the United States, 2013‐2016 , 2018, Hepatology.

[22]  N. Powe,et al.  Race, gender, and partnership in the patient-physician relationship. , 1999, JAMA.

[23]  R. Schilsky,et al.  American Society of Clinical Oncology 2013 top five list in oncology. , 2013, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[24]  Jeffrey R. Harris,et al.  Program, policy, and price interventions for tobacco control: quantifying the return on investment of a state tobacco control program. , 2012, American journal of public health.

[25]  L. Shulman Estimated Effects of the National Breast and Cervical Cancer Early Detection Program on Breast Cancer Mortality , 2011 .

[26]  G. Giovino,et al.  Differential trends in cigarette smoking in the USA: is menthol slowing progress? , 2013, Tobacco Control.

[27]  Makram Talih,et al.  Measurement of Health Disparities, Health Inequities, and Social Determinants of Health to Support the Advancement of Health Equity. , 2016, Journal of public health management and practice : JPHMP.

[28]  O. Solar,et al.  A conceptual framework for action on the social determinants of health. , 2007 .

[29]  A. Guddati,et al.  Age and race distribution in patients in phase III oncology clinical trials. , 2020, American journal of translational research.

[30]  A. Jemal,et al.  Comparison of Insurance Status and Diagnosis Stage Among Patients With Newly Diagnosed Cancer Before vs After Implementation of the Patient Protection and Affordable Care Act , 2018, JAMA oncology.

[31]  Erin Fitzgerald,et al.  Palliative Care for American Indians and Alaska Natives: A Review of the Literature. , 2016, Journal of palliative medicine.

[32]  A. Jemal,et al.  Temporal Trends in Mortality from Major Cancers by Education in the United States, 2001-2016 , 2019, JNCI Cancer Spectrum.

[33]  A. Olshan,et al.  Race and delays in breast cancer treatment across the care continuum in the Carolina Breast Cancer Study , 2019, Cancer.

[34]  J. Kestle Clinical Trials , 2014, World Journal of Surgery.

[35]  Ahmedin Jemal,et al.  Cancer Disparities by Race/Ethnicity and Socioeconomic Status , 2004, CA: a cancer journal for clinicians.

[36]  S. Devesa,et al.  Hysterectomy-Corrected Uterine Corpus Cancer Incidence Trends and Differences in Relative Survival Reveal Racial Disparities and Rising Rates of Nonendometrioid Cancers , 2019, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[37]  A. Parekh,et al.  Impact of race, ethnicity, and socioeconomic factors on receipt of radiation after breast conservation surgery: analysis of the national cancer database , 2017, Breast Cancer Research and Treatment.

[38]  D. Woodfield Hepatocellular carcinoma. , 1986, The New Zealand medical journal.

[39]  D. Levy,et al.  Cigarette taxes, prices, and disparities in current smoking in the United States , 2020, SSM - population health.

[40]  Ruth E Malone,et al.  Racialized Geography, Corporate Activity, and Health Disparities: Tobacco Industry Targeting of Inner Cities , 2007, Journal of health care for the poor and underserved.

[41]  A. Jemal,et al.  Cancer statistics for African Americans, 2019 , 2019, CA: a cancer journal for clinicians.

[42]  Craig M. Hales,et al.  Trends in Obesity Prevalence by Race and Hispanic Origin-1999-2000 to 2017-2018. , 2020, JAMA.

[43]  Rebecca M. Jungbauer,et al.  Effectiveness of Patient Navigation to Increase Cancer Screening in Populations Adversely Affected by Health Disparities: a Meta-analysis , 2020, Journal of General Internal Medicine.

[44]  C. Boring,et al.  Cancer statistics for african americans , 1992, CA: a cancer journal for clinicians.

[45]  Megan E O'Brien,et al.  Alleviating the access abyss in palliative care and pain relief—an imperative of universal health coverage: the Lancet Commission report , 2017, The Lancet.

[46]  Vinay Prasad,et al.  Five Years of Cancer Drug Approvals: Innovation, Efficacy, and Costs. , 2015, JAMA oncology.

[47]  T. Thompson,et al.  Cancer Screening Test Receipt — United States, 2018 , 2021, MMWR. Morbidity and mortality weekly report.

[48]  The State of Cancer Care in America, 2017: A Report by the American Society of Clinical Oncology. , 2017, Journal of oncology practice.

[49]  A. Cardona,et al.  Lung Cancer Disparities in Hispanics: Molecular Diagnosis and Use of Immunotherapy , 2020, JCO global oncology.

[50]  N. Powe,et al.  Race and Genetic Ancestry in Medicine - A Time for Reckoning with Racism. , 2021, The New England journal of medicine.

[51]  J. Birkmeyer,et al.  Black patients more likely than whites to undergo surgery at low-quality hospitals in segregated regions. , 2013, Health affairs.

[52]  M. Parker,et al.  Inclusion of diverse populations in genomic research and health services: Genomix workshop report , 2017, Journal of Community Genetics.

[53]  I. Tannock,et al.  Limits to Personalized Cancer Medicine. , 2016, The New England journal of medicine.

[54]  Michael Halpern,et al.  Association of Insurance with Cancer Care Utilization and Outcomes , 2008, CA: a cancer journal for clinicians.

[55]  Kristin N. Ray,et al.  System-Level Factors Associated With Use of Outpatient Specialty Palliative Care Among Patients With Advanced Cancer. , 2019, Journal of oncology practice.

[56]  A. Jemal,et al.  Changes in Breast and Colorectal Cancer Screening After Medicaid Expansion Under the Affordable Care Act. , 2019, American journal of preventive medicine.

[57]  Brian A. King,et al.  Tobacco Product Use Among Adults - United States, 2013-2014. , 2016, MMWR. Morbidity and mortality weekly report.

[58]  A. Jemal,et al.  The Affordable Care Act and access to care across the cancer control continuum: A review at 10 years , 2020, CA: a cancer journal for clinicians.

[59]  G. Rosner,et al.  Racial disparities in the rate of cardiotoxicity of HER2‐targeted therapies among women with early breast cancer , 2018, Cancer.

[60]  E. Paskett,et al.  Eliminating racial disparities in colorectal cancer in the real world: it took a village. , 2013, Delaware medical journal.

[61]  Eli Hustad,et al.  Bridging Digital Divides: a Literature Review and Research Agenda for Information Systems Research , 2021, Information Systems Frontiers.

[62]  I. Agaku,et al.  Disparities in current cigarette smoking among US adults, 2002–2016 , 2019, Tobacco Control.

[63]  M. Giuliani,et al.  Homelessness, Cancer and Health Literacy: A Scoping Review , 2020, Journal of health care for the poor and underserved.

[64]  S. Kansagra,et al.  Making it harder to smoke and easier to quit: the effect of 10 years of tobacco control in New York City. , 2014, American journal of public health.

[65]  F. Laurie,et al.  Race Disparities in Proton Radiotherapy Use for Cancer Treatment in Patients Enrolled in Children's Oncology Group Trials. , 2020, JAMA oncology.

[66]  R. Blendon,et al.  Insurance Churning Rates For Low-Income Adults Under Health Reform: Lower Than Expected But Still Harmful For Many. , 2016, Health affairs.

[67]  C. Scanlon Turning a Vision into Reality. , 2015, Health progress.

[68]  G. Colditz,et al.  Realizing the Potential of Cancer Prevention — The Role of Implementation Science , 2017, The New England journal of medicine.

[69]  W. Mathews,et al.  Physician Attitudes Toward Homosexuality and HIV: The PATHH-III Survey , 2018, LGBT health.

[70]  Edith D Balbach,et al.  R.J. Reynolds' targeting of African Americans: 1988-2000. , 2003, American journal of public health.

[71]  Ketra L. Rice,et al.  Assessing the implementation of a patient navigation intervention for colonoscopy screening , 2019, BMC Health Services Research.

[72]  Laura A. Levit,et al.  Closing the Rural Cancer Care Gap: Three Institutional Approaches. , 2020, JCO oncology practice.

[73]  P. Polanco,et al.  Underutilization of Palliative Care in Metastatic Foregut Cancer Patients Is Associated with Socioeconomic Disparities , 2020, Journal of Gastrointestinal Surgery.

[74]  K. Fiscella,et al.  Disparities in Pancreatic Cancer Treatment and Outcomes , 2019, Health equity.

[75]  Cynthia K Sanders,et al.  The Digital Divide Is a Human Rights Issue: Advancing Social Inclusion Through Social Work Advocacy , 2021, Journal of Human Rights and Social Work.

[76]  A. Jemal,et al.  The changing landscape of cancer in the USA — opportunities for advancing prevention and treatment , 2020, Nature Reviews Clinical Oncology.

[77]  Mindy M. Ma,et al.  The Impact of Patient-Provider Race/Ethnicity Concordance on Provider Visits: Updated Evidence from the Medical Expenditure Panel Survey , 2019, Journal of Racial and Ethnic Health Disparities.

[78]  A. Jemal,et al.  Financial Hardship Associated With Cancer in the United States: Findings From a Population-Based Sample of Adult Cancer Survivors. , 2016, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[79]  F. Meric-Bernstam,et al.  Patient-Reported Out-of-Pocket Costs and Financial Toxicity During Early-Phase Oncology Clinical Trials. , 2021, The oncologist.

[80]  S. Glied,et al.  Associations Between a New York City Paid Sick Leave Mandate and Health Care Utilization Among Medicaid Beneficiaries in New York City and New York State , 2021, JAMA health forum.

[81]  A. Jemal,et al.  Association of Medicaid Expansion with Cancer Stage and Disparities in Newly Diagnosed Young Adults. , 2021, Journal of the National Cancer Institute.

[82]  H. Freeman Cancer in the socioeconomically disadvantaged , 1989, CA: a cancer journal for clinicians.

[83]  Allison N. Kurti,et al.  A growing geographic disparity: Rural and urban cigarette smoking trends in the United States. , 2017, Preventive medicine.

[84]  J. Shults,et al.  Association of Racial/Ethnic and Gender Concordance Between Patients and Physicians With Patient Experience Ratings , 2020, JAMA network open.

[85]  Moon S. Chen,et al.  Twenty years post‐NIH Revitalization Act: Enhancing minority participation in clinical trials (EMPaCT): Laying the groundwork for improving minority clinical trial accrual , 2014, Cancer.

[86]  S. Koroukian,et al.  The effect of Medicaid expansion among adults from low-income communities on stage at diagnosis in those with screening-amenable cancers. , 2020, Cancer.

[87]  M. Jerrett,et al.  Understanding the cumulative impacts of inequalities in environmental health: implications for policy. , 2011, Health affairs.

[88]  C. Kong,et al.  Cost and Utilization of Lung Cancer End-of-Life Care Among Racial-Ethnic Minority Groups in the United States. , 2019, The oncologist.

[89]  Elias Mossialos,et al.  Racial and ethnic differences in end-of-life care in the United States: Evidence from the Health and Retirement Study (HRS) , 2018, SSM - population health.

[90]  Jeffrey A. Bacha,et al.  Report of National Brain Tumor Society roundtable workshop on innovating brain tumor clinical trials: building on lessons learned from COVID-19 experience , 2021, Neuro-oncology.

[91]  A. Jemal,et al.  Updated Review of Major Cancer Risk Factors and Screening Test Use in the United States in 2018 and 2019, with a Focus on Smoking Cessation , 2021, Cancer Epidemiology, Biomarkers & Prevention.

[92]  J. Teno,et al.  Asian American Medicare Beneficiaries Disproportionately Receive Invasive Mechanical Ventilation When Hospitalized at the End-of-Life , 2021, Journal of General Internal Medicine.

[93]  A. Joshua Living the Social Determinants of Health: , 2021, Indigenous Australian Youth Futures.

[94]  R. Osarogiagbon,et al.  Immune-Based Cancer Treatment: Addressing Disparities in Access and Outcomes. , 2021, American Society of Clinical Oncology educational book. American Society of Clinical Oncology. Annual Meeting.

[95]  J. Drope,et al.  Who's still smoking? Disparities in adult cigarette smoking prevalence in the United States , 2018, CA: a cancer journal for clinicians.

[96]  David R. Williams,et al.  Evaluating Strategies For Reducing Health Disparities By Addressing The Social Determinants Of Health. , 2016, Health affairs.

[97]  Yalda Jabbarpour,et al.  Diversity in the Family Medicine Workforce. , 2021, Family medicine.

[98]  Yuling Hong,et al.  Potentially Excess Deaths from the Five Leading Causes of Death in Metropolitan and Nonmetropolitan Counties - United States, 2010-2017. , 2019, Morbidity and mortality weekly report. Surveillance summaries.

[99]  A. Jemal,et al.  Current Prevalence of Major Cancer Risk Factors and Screening Test Use in the United States: Disparities by Education and Race/Ethnicity , 2019, Cancer Epidemiology, Biomarkers & Prevention.

[100]  K. Flegal,et al.  Comparisons of Self‐Reported and Measured Height and Weight, BMI, and Obesity Prevalence from National Surveys: 1999‐2016 , 2019, Obesity.

[101]  Melissa J. Krauss,et al.  Trends in Adult Alcohol Use and Binge Drinking in the Early 21st‐Century United States: A Meta‐Analysis of 6 National Survey Series , 2018, Alcoholism, clinical and experimental research.

[102]  R. Jagsi,et al.  Racial disparities in guideline-concordant cancer care and mortality in the United States , 2018, Advances in radiation oncology.

[103]  WenderRichard,et al.  The American Cancer Society's Approach to Addressing the Cancer Burden in the LGBT Community. , 2015 .

[104]  Recinda L. Sherman,et al.  Annual Report to the Nation on the Status of Cancer, 1975–2014, Featuring Survival , 2017, Journal of the National Cancer Institute.

[105]  Ahmedin Jemal,et al.  Cancer Statistics for Hispanics/Latinos, 2018 , 2018, CA: a cancer journal for clinicians.

[106]  T. Hu,et al.  Reducing cigarette consumption in California: tobacco taxes vs an anti-smoking media campaign. , 1995, American journal of public health.

[107]  Ahmedin Jemal,et al.  Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States , 2018, CA: a cancer journal for clinicians.

[108]  M. Cadogan,et al.  We Don’t Talk about It: Cancer Pain and American Indian Survivors , 2020, Cancers.

[109]  D. Schrag,et al.  Race, Poverty, and Initial Implementation of Precision Medicine for Lung Cancer. , 2018, Journal of the National Cancer Institute.

[110]  Criminal records and college admissions: A modified experimental audit , 2019, Criminology.

[111]  S. Glantz,et al.  Effect of the Arizona tobacco control program on cigarette consumption and healthcare expenditures. , 2011, Social science & medicine.

[112]  G. Connolly,et al.  The First Decade of the Massachusetts Tobacco Control Program , 2005, Public health reports.

[113]  J. Griggs Disparities in Palliative Care in Patients With Cancer. , 2020, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[114]  A. Jemal,et al.  Racial/Ethnic Disparities in Lost Earnings From Cancer Deaths in the United States , 2020, JNCI cancer spectrum.

[115]  Steffie Woolhandler,et al.  Inequality and the health-care system in the USA , 2017, The Lancet.

[116]  N. Esnaola,et al.  Racial differences and disparities in cancer care and outcomes: where's the rub? , 2012, Surgical oncology clinics of North America.

[117]  Fernando A Wilson,et al.  Paid Sick Leave and Healthcare Utilization in Adults: A Systematic Review and Meta-analysis. , 2021, American journal of preventive medicine.

[118]  Kevin H. Nguyen,et al.  Lesbian, Gay, And Bisexual Adults Report Continued Problems Affording Care Despite Coverage Gains. , 2018, Health affairs.

[119]  S. Winawer,et al.  New York Citywide Colon Cancer Control Coalition: A public health effort to increase colon cancer screening and address health disparities , 2016, Cancer.

[120]  A. Jemal,et al.  Changes in Black-White Difference in Lung Cancer Incidence among Young Adults , 2020, JNCI cancer spectrum.

[121]  A. Jemal,et al.  Educational Disparities in Mortality Between Adults Aged 50-64 and 66-79 Years, U.S. , 2017, American journal of preventive medicine.

[122]  C. Yeo,et al.  Racial Disparities in Rates of Surgery for Esophageal Cancer: a Study from the National Cancer Database , 2020, Journal of Gastrointestinal Surgery.

[123]  M. Avigan,et al.  Finding, evaluating, and managing drug‐related risks: approaches taken by the US Food and Drug Administration (FDA) , 2009, Dermatologic therapy.

[124]  E. Kohn,et al.  Hysterectomy-corrected rates of endometrial cancer among women younger than age 50 in the United States , 2018, Cancer Causes & Control.

[125]  E. Bruera,et al.  Redefining Palliative Care—A New Consensus-Based Definition , 2020, Journal of pain and symptom management.

[126]  Ahmedin Jemal,et al.  Breast cancer statistics, 2019 , 2019, CA: a cancer journal for clinicians.

[127]  F. Chaloupka,et al.  Tobacco taxes as a tobacco control strategy , 2012, Tobacco Control.

[128]  Eric P. Winer,et al.  Breast Cancer Treatment: A Review , 2019, JAMA.

[129]  R. Winn,et al.  Association of Insurance Status and Racial Disparities With the Detection of Early-Stage Breast Cancer. , 2020, JAMA oncology.

[130]  Maria E Fernandez,et al.  Patient Navigation in a Colorectal Cancer Screening Program. , 2015, Journal of public health management and practice : JPHMP.

[131]  M. Cole,et al.  Racial/Ethnic And Income-Based Disparities In Health Savings Account Participation Among Privately Insured Adults. , 2020, Health affairs.

[132]  J. Ruterbusch,et al.  Trends and racial disparities in aggressive end‐of‐life care for a national sample of women with ovarian cancer , 2021, Cancer.

[133]  H. G. van der Poel,et al.  A Systematic Review of the Impact of Surgeon and Hospital Caseload Volume on Oncological and Nononcological Outcomes After Radical Prostatectomy for Nonmetastatic Prostate Cancer. , 2021, European urology.

[134]  J. Nonnemaker,et al.  Estimating the return on investment of the Bureau of Tobacco Free Florida tobacco control programme from 1999 to 2015 , 2021, BMJ Open.

[135]  B. Sommers,et al.  Changes in Mortality After Massachusetts Health Care Reform , 2014, Annals of Internal Medicine.

[136]  Kearney T. W. Gunsalus,et al.  The new face of US science , 2017, Nature.

[137]  N. Krieger,et al.  Structural racism and health inequities in the USA: evidence and interventions , 2017, The Lancet.

[138]  B. Sommers,et al.  Comparison of Income Eligibility for Medicaid vs Marketplace Coverage for Insurance Enrollment Among Low-Income US Adults , 2021, JAMA health forum.

[139]  M. Cabana,et al.  Screening for Hepatitis C Virus Infection in Adolescents and Adults: US Preventive Services Task Force Recommendation Statement. , 2020, JAMA.

[140]  S. Fedewa,et al.  Cancer screening in the United States, 2019: A review of current American Cancer Society guidelines and current issues in cancer screening , 2019, CA: a cancer journal for clinicians.

[141]  S. Glantz,et al.  Tobacco Industry Promotional Strategies Targeting American Indians/Alaska Natives and Exploiting Tribal Sovereignty. , 2019, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[142]  Shawna V. Hudson,et al.  Understanding primary care-oncology relationships within a changing healthcare environment , 2019, BMC Family Practice.

[143]  Deborah Klein Walker,et al.  Persons with disabilities as an unrecognized health disparity population. , 2015, American journal of public health.

[144]  S. Reisner,et al.  Sexual orientation-related disparities in employment, health insurance, healthcare access and health-related quality of life: a cohort study of US male and female adolescents and young adults , 2018, BMJ Open.

[145]  S. Gomez,et al.  Disaggregating Hispanic American Cancer Mortality Burden by Detailed Ethnicity , 2019, Cancer Epidemiology, Biomarkers & Prevention.

[146]  S. Dube,et al.  A comprehensive examination of the influence of state tobacco control programs and policies on youth smoking. , 2013, American journal of public health.

[147]  Kassandra I. Alcaraz,et al.  Understanding and addressing social determinants to advance cancer health equity in the United States: A blueprint for practice, research, and policy , 2019, CA: a cancer journal for clinicians.

[148]  Zhiyuan Zheng,et al.  For Working-Age Cancer Survivors, Medical Debt And Bankruptcy Create Financial Hardships. , 2016, Health affairs.

[149]  F. Meric-Bernstam,et al.  Patient-Reported Out-of-Pocket Costs and Financial Toxicity During Early-Phase Oncology Clinical Trials. , 2020, The oncologist.

[150]  A. Jemal,et al.  State Variation in Low-Dose Computed Tomography Scanning for Lung Cancer Screening in the United States , 2020, Journal of the National Cancer Institute.

[151]  J. Carethers Diversification in the medical sciences fuels growth of physician-scientists. , 2019, The Journal of clinical investigation.

[152]  Ahmed Jamal,et al.  Tobacco Product Use Among Adults — United States, 2019 , 2020, MMWR. Morbidity and mortality weekly report.

[153]  P. Stoddard-Dare,et al.  Paid sick leave and preventive health care service use among U.S. working adults. , 2017, Preventive medicine.

[154]  H. Weir,et al.  Incidence and Trends of the Leading Cancers with Elevated Incidence Among American Indian and Alaska Native Populations, 2012–2016 , 2020, American journal of epidemiology.

[155]  A. Jemal,et al.  Cancer Statistics, 2021 , 2021, CA: a cancer journal for clinicians.

[156]  C. Kerr,et al.  Substance Abuse and Mental Health Services Administration , 2020, Definitions.

[157]  A. Milbourne Cervical Cancer Screening and Management Practices Among Providers in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) , 2007 .

[158]  Building Bridges to Address Health Disparities in Puerto Rico: the "Salud para Piñones" Project. , 2017, Puerto Rico health sciences journal.

[159]  Gerhard Jentzsch,et al.  Working group on , 1991 .

[160]  A. Jemal,et al.  Annual Report to the Nation on the Status of Cancer, Part 1: National Cancer Statistics , 2021, Journal of the National Cancer Institute.

[161]  David R Williams,et al.  Moving upstream: how interventions that address the social determinants of health can improve health and reduce disparities. , 2008, Journal of public health management and practice : JPHMP.

[162]  Therese A. Stukel,et al.  Hospital Volume and Late Survival After Cancer Surgery , 2007, Annals of surgery.

[163]  G. Rubin,et al.  Utilization of Lung Cancer Screening in the Medicare Fee-for-Service Population. , 2020, Chest.

[164]  James Tsai,et al.  Exposure to Secondhand Smoke Among Nonsmokers — United States, 1988–2014 , 2018, MMWR. Morbidity and mortality weekly report.

[165]  N. Chiu,et al.  EPA Assessment of Risks from Radon in Homes , 2003 .

[166]  A. Tsai,et al.  Economic influences on population health in the United States: Toward policymaking driven by data and evidence , 2020, PLoS medicine.

[167]  David K. Espey,et al.  Methods for improving cancer surveillance data in American Indian and Alaska Native populations , 2008, Cancer.

[168]  F. Faraji,et al.  The prevalence of human papillomavirus in oropharyngeal cancer is increasing regardless of sex or race, and the influence of sex and race on survival is modified by human papillomavirus tumor status , 2018, Cancer.

[169]  D. Ekwueme,et al.  Estimating the impact of increasing cervical cancer screening in the National Breast and Cervical Cancer Early Detection Program among low-income women in the USA , 2020, Cancer Causes & Control.

[170]  K. A. Cullen,et al.  Tobacco Product Use and Cessation Indicators Among Adults — United States, 2018 , 2019, MMWR. Morbidity and mortality weekly report.

[171]  H. Freeman Cancer in the economically disadvantaged , 1989, Cancer.

[172]  James G. Corrigan,et al.  Changes in the National Cancer Institute's R01 workforce: growth, aging, retention, and policy implications. , 2021, The Journal of clinical investigation.

[173]  Kimberly M. Kelly,et al.  Receipt of Guideline-Concordant Care Among Older Women With Stage I-III Breast Cancer: A Population-Based Study. , 2018, Journal of the National Comprehensive Cancer Network : JNCCN.

[174]  A. Jemal,et al.  Factors That Contribute to Differences in Survival of Black vs White Patients With Colorectal Cancer. , 2017, Gastroenterology.

[175]  A. Jemal,et al.  Association between disparities in intergenerational economic mobility and cause-specific mortality among Black and White persons in the United States. , 2021, Cancer epidemiology.

[176]  S. French,et al.  Nutrition quality of food purchases varies by household income: the SHoPPER study , 2019, BMC Public Health.

[177]  H. Holzer,et al.  Declining employment among young black less-educated men: The role of incarceration and child support , 2005 .

[178]  Melissa A. Greiner,et al.  Rapid rise in the cost of targeted cancer therapies for Medicare solid tumor patients from 2006 to 2015. , 2020, Journal of geriatric oncology.

[179]  A. Jemal,et al.  Elimination of cost‐sharing and receipt of screening for colorectal and breast cancer , 2015, Cancer.

[180]  Melissa B. Davis,et al.  Cancer health disparities in racial/ethnic minorities in the United States , 2020, British Journal of Cancer.

[181]  E. Feuer,et al.  Bias Associated With Self-Report of Prior Screening Mammography , 2009, Cancer Epidemiology Biomarkers & Prevention.

[182]  P. Lund,et al.  Examining trends in the diversity of the U.S. National Institutes of Health participating and funded workforce , 2018, FASEB journal : official publication of the Federation of American Societies for Experimental Biology.

[183]  A. Olshan,et al.  Academic Affiliation and Surgical Volume Predict Survival in Head and Neck Cancer Patients Receiving Surgery , 2020, The Laryngoscope.

[184]  D. Ekwueme,et al.  Estimated effects of the National Breast and Cervical Cancer Early Detection Program on breast cancer mortality. , 2011, American journal of preventive medicine.

[185]  D. Takeuchi,et al.  Residential Segregation and Racial/Ethnic Disparities in Ambient Air Pollution , 2018, Race and social problems.

[186]  O. Owoyemi,et al.  Underrepresentation in Oncology: Identifying and Addressing Structural Barriers. , 2021, The oncologist.

[187]  F. Laurie,et al.  Race Disparities in Proton Radiotherapy Use for Cancer Treatment in Patients Enrolled in Children's Oncology Group Trials. , 2020, JAMA oncology.

[188]  M. Bassett,et al.  How Structural Racism Works - Racist Policies as a Root Cause of U.S. Racial Health Inequities. , 2020, The New England journal of medicine.

[189]  S. Gomez,et al.  Disparities in Hepatocellular Carcinoma Incidence in California: An Update , 2019, Cancer Epidemiology, Biomarkers & Prevention.