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National Cancer Institute

Keynote Address: Increasing Survivorship in Communities with an Excess Burden of Cancer

Harold Freeman, M.D.
Senior Advisor to the Director

  • Cancer and poverty make a lethal combination. The poor in the United States have a 10- to 15-percent lower rate of survival from cancer, independent of race. Poverty, low socioeconomic status, social injustice, and cultural differences drive disparities in prevention, early detection, diagnosis and incidence, treatment, post-treatment quality of life, and survival and mortality, all of which negatively impact the cancer experience of the poor.
  • African-American men in the United States have the lowest life expectancies; the life expectancies of white men and African-American women are nearly equal, while white women in the United States have the highest life expectancies. African Americans also have the highest poverty rate in the United States (25%), followed by Hispanics (approximately 22%) and whites (8%). One-third of Hispanics and 20 percent of African Americans are uninsured, compared with 11 percent of whites.
  • Poverty in the United States generally means substandard housing; inadequate access to information and knowledge; a higher rate of risk-promoting lifestyles, attitudes, and behaviors; and diminished access to health care. The interactions between poverty and culture can lead to decreased survival from cancer.
  • The discovery-delivery disconnect represents a critical factor contributing to health disparities and affects the cancer continuum from prevention and early detection to treatment and survival. Many cancer disparities could be eliminated by providing universal access to health care, regardless of ability to pay. At a minimum, populations at highest risk (i.e., geographically and culturally defined areas of extreme excess mortality) should be identified and designated "chronic disaster areas," similar to natural disaster areas. These populations should be targeted with culturally relevant education and access to care, and individuals should be encouraged to share responsibility for their health. Treatment should be monitored, and the role of patient navigators—who help patients negotiate the cancer medical care environment-should be augmented. The Harlem Hospital Breast Cancer Screening Program increased 5-year survival rates from 39 percent to 70 percent by providing patient navigators.

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