Black Iowans die from cancer at higher rate due to ‘structural racism,’ report shows

IOWA CITY - Black Iowans are getting and dying from cancer at higher rates than any other racial or ethnic group in the state, according to a new 2021 Cancer in Iowa Report that found 'structural racism” is largely to blame for the disparities.

'There is no gene or cancer type common only to Black people or white people, or any other ethnic group, that increases or decreases their risk overall of getting cancer or dying from cancer,” George Weiner, director of the University of Iowa Holden Comprehensive Cancer Center, said Wednesday during a presentation following the report's release.

'The disparities - including undue burdens of cancer borne by Iowa's communities of color - result from differences in social determinants of health,” he said.

Such factors include less access to quality health care and experienced providers, support systems, cancer screening and healthy food.

Socioeconomic inequalities - like income, education and occupation - can put Black Iowans at greater risk by keeping them in neighborhoods with more exposure to environmental toxins; increasing stress; and supporting dangerous behavior like smoking and drinking.

Health insurance is among the key factors in determining access to quality care, and the report notes those who lack it are at higher risk of poor cancer outcomes.

'And racial and ethnic minorities have lower rates of health insurance compared to the white population,” it said.

Because researchers wanted to compare cancer rate differences between racial groups among people of similar ages, and the Black population in Iowa has a younger age distribution, they had to adjust the data for age - revealing stark disparities.

Black Iowans had the highest cancer rates of all racial or ethnic groups in the 50-79 age range, while white Iowans had the highest incidence rates over age 80.

Beyond cancer, data revealed Black Iowans have the highest mortality rates in most other causes of death - possibly contributing to the age gap in cancer rates.

'This could mean that many Black people die of some other cause before they ever develop cancer or are unable to access cancer services to diagnose their cancer before they die of another cause,” the report found.

Report co-author Mary Charlton, a UI College of Public Health epidemiology professor, said circumstances created by structural racism are tied to all the disparities - not just cancer.

'Black people have less access to health care, lower representation in clinical trials, more mistrust in the health care system and may have historically received lower quality health care, resulting in increased mortality from diseases including cancer, heart disease and diabetes,” she said.

The report's findings show the problem - which has been widely discussed nationally - is just as relevant to Iowa, according to Weiner.

'Some Iowans may have had the perception that these disparities are found mostly in other states, other than Iowa, that have larger urban areas,” Weiner said. 'The data in the report … should open all of our eyes to the fact that health care disparities are in our own backyard in our own communities, and are causing undue pain and suffering for our fellow Iowans.”

‘It's Frustrating'

ShanQuiesha Robinson's grandmother died of breast cancer at a relatively young age. Her younger sister - at age 21 - had been diagnosed with breast cancer, too.

So with some health care education and experience under her belt, and plans to pursue a nursing degree, Robinson at age 25 in 2007 got a mammogram. 'Unfortunately, being so young, the tumor was missed on the mammogram,” she told reporters Wednesday while discussing this year's cancer report.

Because of her family history, Robinson regularly did self-breast exams and - like her sister - discovered a lump herself. But because she was just 25 and two weeks from graduating from the University of Northern Iowa, she said she wanted to deny it.

With pressure from her mom, though, Robinson had it checked out and learned it was cancerous. Thanks to her background and education, Robinson said she knew the course of treatment she wanted and got support from doctors.

Where she didn't find the support she needed was in peers experiencing the same thing.

'ShanQuiesha said when she was going through her treatment that she wanted to start a support group because the support groups that she attended, they didn't reflect who she was,” her mother, Cathy Ketton, said. 'There were no African Americans, or people of color.”

So they partnered to launch Splash of Color, a breast cancer support group for women of color that also helps the women financially and advocates for them in the health care system.

Researchers project 18,900 Iowans will be diagnosed with cancer this year - breast cancer being the most common among women and prostate cancer the most common among men. This year's estimate is slightly more than the 18,700 projected for 2020.

About 6,400 Iowans are expected to die from cancer in 20201 - making it one of the leading causes of death in the state.

Because cancer incidence numbers run a couple years behind, Weiner and Charlton said they're watching closely for potential COVID-19 impacts.

'Our cancer therapy continued throughout the pandemic, but our screenings did drop and we have concerns about what that's going to lead to,” Weiner said.

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