Cancer Rates
Improving Among African Americans
Fewer African Americans
are dying from cancer than 10 years ago, according to new statistics from
the American Cancer Society, but African Americans still suffer more from
the disease than other racial groups.
“The good news is that death rates are decreasing,” says Michael
Thun, MD, vice president of epidemiology and surveillance research for
the American Cancer Society. “The bad news, and the issue that still
needs enormous work, is that death rates from cancer remain almost 30%
higher in African Americans than in non-Hispanic whites, and that the
survival for African Americans who develop cancer is lower than in whites.”
The Society published its latest findings in Cancer Facts & Figures
for African Americans, 2003-2004.
The report estimates about 132,700 new cancer cases will be diagnosed
in the African American community in 2003, and about 63,100 African Americans
will die from cancer this year.
Those figures represent a decline in both incidence and death since 1992.
Despite that decrease, African- American men still have a 20% higher incidence
rate and a 40% higher death rate from cancer than white men.
African Americans are also more likely to be diagnosed with later stage
disease than whites, meaning their treatment is less likely to be successful
because the cancer is more advanced and harder to control. About 28% of
African Americans will be diagnosed with advanced cancer, compared to
22% of whites.
Regardless of when their cancer is diagnosed, though, African Americans
have a lower likelihood of surviving five years beyond diagnosis, the
report finds.
Socio-economic Factors Important
The higher poverty rate among African Americans, and the reduced access
to health care that goes along with poverty, are key reasons for these
disparities, the report says.
“Access to high-quality treatment might be less available, it might
be that treatment is delayed, or is sub-optimal, or not completed,”
Thun says.
These differences persist even though screening rates for colorectal,
cervical, breast, and prostate cancer among African Americans are comparable
to those among whites.
Thun says even though the percentage of people screened is about the same,
screening may be occurring less frequently in the African American community,
or there may be a longer interval between screening and actual diagnosis
and treatment of a problem.
Socio-economic factors may also be at work here, Thun says. A woman without
health insurance may be able to get a mammogram through a public screening
program, but may not be able to get immediate care from a doctor if a
problem is detected.
The new statistics emphasize the “continuing importance” of
eliminating these social disparities through public policy and education
efforts, Thun says.
Individual Strategies
But there are also things all people can do on an individual level to
lower their risk of getting cancer and dying from it.
Quitting smoking, and keeping kids from starting, is tops on the list,
Thun says, “because smoking kills half of the people who continue
to do it long term.”
Indeed, lung cancer kills more African Americans than any other cancer,
according to the new statistics; some 15,800 African Americans are expected
die from it this year. Yet more than 26% of African American men and nearly
21% of African American women were still lighting up in the year 2000.
Another important step African Americans can take is maintaining a healthy
body weight and level of physical activity, Thun says, not only for cancer
prevention, but also for prevention of heart disease, stroke, and diabetes.
The latest figures show that 77% of African American women and 59% of
African American men are overweight, putting them at increased risk for
breast cancer, colon cancer, kidney cancer and other cancers. About one-third
of African American adults report getting no leisure time physical activity.
Thun says the American Cancer Society is working on policy approaches
that make it easier for people to have a healthy lifestyle – improving
neighborhood safety so physical activity isn’t dangerous, restricting
tobacco – in addition to raising awareness about cancer in minority
communities.
“For all Americans,” he says, “there are great opportunities
in reducing cancer by applying the knowledge we already have with respect
to prevention, avoidance of tobacco, healthy body weight, regular physical
activity, diet, detection, and improvements in treatment.”
Power of Positive
Thinking Extends, It Seems, to Aging
Do happy people live longer? A growing body of evidence suggests they
may. Recent studies have correlated long life with optimism, with positive
thinking, and with a lack of hostility, anxiety and depression.
One thing that remains unclear, however, is whether happiness can actually
cause longevity. Perhaps happy people live longer because they practice
healthy behaviors, or for some other unknown reason.
"It is definitely the case that certain people who are psychologically
healthier live longer," said Dr. Howard S. Friedman of the University
of California at Riverside, a psychologist who has studied personality
traits that correlate with longevity. "But the explanations are usually
complicated."
The second open question is: What, if anything, can unhappy people do
about it?
The most recent study of personality and longevity was conducted among
a group of 660 people over 50 in Oxford, Ohio, who, in 1975, had answered
questions having to do with, among other things, their attitudes about
aging. They had been asked whether they agreed or disagreed with statements
like "Things keep getting worse as I get older," "I have
as much pep as I did last year," and "I am as happy now as I
was when I was younger."
Researchers checked to see which participants were still alive in 1998,
and they noted when the others had died. It turned out that those who
viewed aging as a positive experience lived, on average, 7.5 years longer
than those who took a darker view.
That is an advantage far greater, the researchers point out, than what
can be gained from lowering blood pressure or reducing cholesterol, each
of which has been found to lengthen life about four years. It also beats
exercise, not smoking and maintaining a healthy weight, strategies that
add one to three years.
The researchers who conducted the study have been careful not to suggest
that views of aging are more important for one's health than exercise,
nutrition and not smoking. "I think they are all important in predicting
survival," said Dr. Becca Levy, a social psychologist at Yale. But,
Dr. Levy said, it is surprising to find that a psychological characteristic
could also be such a strong predictor of life span.
In analyzing the data, Dr. Levy and her colleagues took into account race,
sex, socioeconomic status, self-reported health, overall morale and loneliness
— all factors that might have clouded the picture. But even after
statistically controlling for such characteristics, views of aging were
highly correlated with long life.
Optimism was linked to longevity in a study reported two years ago by
researchers at the Mayo Clinic in Rochester, Minn. Dr. Toshihiko Maruta,
a psychiatrist, reviewed psychological tests that had been given to more
than 800 people in the early 1960's, and based on the people's responses,
he classified 197 of them as pessimistic. He then checked to see how long
they lived.
Dr. Maruta found that the pessimists had a risk of death for any given
year that was 19 percent greater than average.
Other studies have drawn connections between longevity and the degree
of control people feel over their lives and between longevity and mindfulness,
defined as an awareness of one's environment and one's reactions to it.
Some research has shown that people who are relatively more depressed,
hostile or anxious are unlikely to live as long as others.
Dr. Carolyn Aldwin, a professor of human and community development at
the University of California at Davis, has reviewed many such studies
and examined another group of people who took psychological tests in the
1960's. She found that those who seemed to be relatively stable emotionally
had lived longer.
"You're better off if you are less likely to go to extremes emotionally,"
Dr. Aldwin said, "if you keep on an even keel and don't let yourself
get too upset."
How do happy, upbeat, calm people keep themselves alive?
Dr. Levy suspected that the answer might be linked to the positive thinkers'
will to live. Previous studies showing, for example, that people of all
cultures are more likely to die in the days and weeks after holidays than
they are in the days leading up to them, had suggested that will to live
could affect survival.
So Dr. Levy and her colleagues checked back to see how the respondents
had answered other questions in the original survey. In these, they had
been asked to choose from three pairs of adjectives — empty-full,
hopeless-hopeful and worthless-worthy — the ones that best described
their lives. Those who answered full, hopeful and worthy were deemed to
have the greater will to live
"Will to live
appeared to be a partial mediator," Dr. Levy said, "but it didn't
completely explain why the people with positive views lived longer. So
there must be other things involved. One likely candidate is how people
respond to stress. Older people with a negative view of aging."
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