NBCI National Clinical Trials Strategic Plan (NCTSP) employs an interdisciplinary approach. We assist by providing critical education, data collection on all cancers, and help persuade our members to participate in necessary clinical trials to advance the science and improve health outcomes for the patient population.

Oncology is a medical specialty focused on the diagnosis, treatment, and prevention of cancer, a disease characterized by the uncontrolled growth of cells. It involves a comprehensive approach to understanding cancer's causes, genetic makeup, and progression to develop targeted therapies like immunotherapy, chemotherapy, and radiation. Oncologists utilize advanced diagnostic tools and personalized treatment plans, recognizing that each cancer has a unique genetic profile influencing its development and response to therapy.

African Americans and Cancers

African Americans face significant disparities in cancer, experiencing higher death rates and worse outcomes for many types of cancer compared to other racial and ethnic groups. While a wide range of factors are involved, these inequities largely stem from structural racism and resulting inequalities in the social determinants of health, such as income, access to care, and environmental conditions.

Overall disparities

Higher mortality: African Americans have the highest death rate and the shortest survival time of any racial or ethnic group for most cancers.

Worse outcomes: This is often the result of being diagnosed at a more advanced stage, when the cancer is harder and more costly to treat. Factors contributing to worse outcomes include delays in treatment and less access to high-quality care.

Narrowing gap: While the overall disparity in cancer mortality between Black and White people has narrowed over time, the gap for many common cancers remains wide. This progress is largely due to historical reductions in smoking and advances in treatment.

Disparities by cancer type

Prostate cancer: African American men have the highest incidence of prostate cancer and are more than twice as likely to die from it than other men.

Breast cancer: Although White women have a similar or higher incidence of breast cancer, African American women are about 40% more likely to die from the disease. This is linked to later-stage diagnoses, aggressive tumor biology (such as triple-negative breast cancer), and differences in treatment access.

Colorectal cancer: African Americans have the second-highest incidence of colorectal cancer in the U.S. and significantly higher death rates compared to White people.

Lung cancer: While the disparity in lung cancer is not as stark as for some other cancers, when looking at sex separately, African American men have higher death rates than White men.

Other cancers: African Americans also face higher death rates from several other cancers, including stomach, uterine, cervical, liver, and multiple myeloma.

Contributing factors to cancer disparities

Socioeconomic status (SES): Lower SES, often tied to a history of structural racism, is associated with a higher prevalence of cancer risk factors, less access to high-quality care, and inadequate health insurance.

Structural and institutional racism: Policies and practices embedded in major institutions like healthcare and housing can block access to resources and opportunities for marginalized groups. For example, some areas with a high African American population lack nearby cancer treatment facilities, affecting access.

Mistrust in the medical system: A history of racial bias and discrimination has led to a greater mistrust of the healthcare system among African Americans, which can influence participation in screenings and follow-up care.

Biological factors: Some evidence suggests differences in tumor biology, such as the genetics and immune environment of tumors, that may lead to more aggressive cancers in African Americans.

Environmental factors: Research suggests that exposure to pollution may play a role in the development of more aggressive cancers in some African Americans.

Lifestyle factors: Differences in risk factors like obesity, smoking rates, and diet can also contribute to disparities, though these are often tied to social and environmental conditions.

Underrepresentation in clinical trials: The lack of diversity in clinical trials is a major obstacle to understanding how certain therapies affect specific populations. African Americans are often underrepresented due to mistrust and other barriers.

Addressing the disparities

The National Black Health Agenda

What does oncology mean?

Oncology is the study of cancer. The word comes from the Greek word onkos, meaning tumor or mass. It is the branch of medicine that focuses on the diagnosis, treatment, and care of people with cancer.

Specialists trained in oncology provide care for people who are at risk for cancer, being treated for cancer, and living with cancer after treatment. Together, these specialists – along with other care providers like nurses, pharmacists, and social workers – make up your cancer care team.

What is an oncologist and what do they do?

African Americans have a disproportionately high cancer burden, with higher mortality rates and worse survival outcomes than other racial groups due to structural racism and social determinants of health, including limited access to care, systemic medical mistrust, and underrepresentation in clinical trials. While mortality rates have been declining, disparities persist in cancers such as breast, prostate, and lung cancer. Efforts to address this include increasing diversity in clinical trials, enhancing provider education, improving access to care, and promoting culturally competent health communication to reduce stigma and misinformation.

Cancer Disparities and Outcomes

Higher Mortality:

African Americans experience the highest cancer death rates and shortest survival of any racial or ethnic group in the U.S. for most cancers.

Specific Cancers:

Disparities are particularly pronounced in prostate cancer, where Black men have more than double the death rate compared to other groups, and in breast cancer, where Black women are 40% more likely to die. Black women also face higher risks of certain types of breast cancer, including triple-negative and inflammatory breast cancer.

Late-Stage Diagnosis:

African Americans are often diagnosed with cancer at more advanced stages, which is linked to lower survival rates.

Contributing Factors

Structural Racism and Social Determinants of Health:

These systemic inequalities, rooted in historical injustices, play a fundamental role in cancer disparities.

Access to Care:

Many African Americans face barriers to accessing quality healthcare services, often due to being uninsured or underinsured.

Medical Mistrust:

Systemic issues have created a significant mistrust of the medical community among some African Americans, leading to reluctance in seeking care and participating in research.

Underrepresentation in Clinical Trials:

Black Americans are significantly underrepresented in clinical trials, leading to a lack of data on how drugs and treatments affect this population.

Economic Factors:

The financial burden of cancer is higher for the Black community, with many reporting problems paying medical bills, delaying care, and experiencing food insecurity.

Addressing the Disparities

Increase Diversity in Clinical Trials:

Efforts are underway to increase the proportion of Black Americans in clinical trials to ensure cancer drugs are effective for all patients.

Enhance Cultural Competence:

Improving provider education and implementing culturally sensitive approaches can help build trust and improve the patient-physician relationship.

Promote Health Equity:

Strategies focus on addressing social determinants of health and making equitable, quality care accessible to all.

Public Education and Stigma Reduction:

Open communication about cancer can help destigmatize the condition and combat misinformation within the African American community.

Leadership and Role Models:

The legacy of leaders like Dr. LaSalle D. Leffall, Jr. and the presence of Black oncologists like Dr. Edith P. Mitchell highlight the importance of diversity and advocacy in oncology.

An oncologist is a physician (medical doctor) who specializes in cancer. An oncologist leads a cancer care team in the care of people with cancer. Oncologists may:

• Diagnose cancer
• Make treatment recommendations and create treatment plans
• Carry out or oversee treatment
• Evaluate how the cancer responds to treatment
• Coordinate a patient’s care with other members of the cancer care team
• Provide follow-up care after treatment is completed
• Conduct research through clinical trials

Oncology issues for African Americans include disproportionately high rates of certain cancers like multiple myeloma, lung, and oral cancer, stemming from systemic factors such as structural racism, targeted marketing of products like menthol cigarettes, and limited access to care. Communication barriers, implicit racial bias, and mistrust in healthcare also contribute to disparities in treatment and poorer outcomes, though structural changes and community-focused initiatives can help improve the situation.

Systemic and Environmental Factors

Targeted Marketing: Menthol cigarette advertising, which specifically targets the African American community, is linked to a higher risk of lung and oral cancers due to the presence of multiple carcinogens.

Structural Racism: Generational and ongoing systemic racism in the healthcare system contributes to disparities in cancer incidence and outcomes for African Americans.

Limited Access to Care: Financial barriers, geographic limitations, and a lack of healthcare facilities in some communities create significant obstacles to timely diagnosis and treatment.

Healthcare System and Provider-Patient Interactions

Communication Gaps: Physicians often spend less time on treatment planning, health education, and informal conversation with African American patients compared to White patients, leading to poorer communication and understanding.

Implicit Bias and Mistrust: Oncologists can exhibit implicit racial biases, while African American patients may have higher levels of mistrust in physicians due to historical discrimination, affecting their engagement in care.

Unequal Participation: African American patients may participate less actively in their appointments by asking fewer questions or bringing fewer companions, which can impact information exchange and treatment planning.

Clinical Trial and Treatment Disparities

Clinical Trial Bias: African Americans are underrepresented in clinical trials, leading to selection bias and results that are not generalizable to the entire population.

Missed Treatment Opportunities: The low enrollment of Black men in trials for prostate cancer has led to a missed opportunity to demonstrate potential benefits of treatments, such as abiraterone, for this specific population.

Outcomes and Specific Cancers

Higher Incidence: African Americans have a higher incidence of certain cancers, including multiple myeloma, with rates of about 19 cases per 100,000 men between 1995 and 2021.

Increased Myeloma Deaths: Tragically, over 2,500 Black Americans die from myeloma each year.

Melanoma Survival Rates: The five-year survival rate for Black patients with melanoma is 70% compared to 94% for white patients.

Solutions and Recommendations

Promote Open Dialogue: Encouraging open conversations and providing culturally tailored messages can destigmatize cancer and empower patients.

Increase Diversity in Care Teams: Having a diverse team of nurses, pharmacists, and medical assistants can improve the patient experience.

Empower Patients: Patients should bring a companion to appointments and feel empowered to seek a second opinion to improve outcomes.

Utilize Community Resources: Partnering with trusted community outreach organizations and patient advocacy groups can enhance access to culturally sensitive support.

Oncology specialties

While oncology is considered a “specialty” of medical care, there are specialized areas of oncology care, too.

Many oncologists focus on specialty areas based on how cancer is treated:

• Surgical oncologists treat cancer using surgery, including removing part or all of a solid tumor and nearby tissue. They can also perform certain types of biopsies to help diagnose cancer.
• Medical oncologists treat cancer using medication, including chemotherapy, immunotherapy, and targeted therapy.
• Radiation oncologists treat cancer with radiation therapy, which uses high-energy particles or waves to destroy cancer cells.

Some oncologists specialize in caring for specific groups of people or treating certain types of cancer. For example:

• Breast oncologists treat breast cancers in men and women.
• Geriatric oncologists work with people with cancer who are age 65 and older to provide the best care for older adults.
• Gynecologic oncologists treat cancers in the female reproductive organs, including the cervix, fallopian tubes, ovaries, uterus, vagina, and vulva.
• Hematologist oncologists treat blood cancers, such as leukemia, lymphoma, and myeloma.
• Neuro-oncologists treat cancers of the brain, spine, and nervous system.
• Pediatric oncologists treat cancer in children and teens. They may also treat adults with cancers that are more common in children.
• Thoracic oncologists treat cancers inside the chest area, including the lungs and esophagus.
• Urologic oncologists treat cancers in the genitourinary system, such as the bladder, kidneys, penis, prostate gland, and testicles.

When do I need an oncologist?

If you have been diagnosed with cancer. When a person is diagnosed with cancer, they will likely be referred to a medical oncologist. Depending on the specifics of your cancer and possible treatment plans, they may refer you to a surgeon or radiation oncologist, as well.

If cancer is suspected. In some cases, a surgical oncologist might be the first specialist a patient sees to diagnosis and stage a cancer. Sometimes when cancer is suspected but not diagnosed, a medical oncologist might also be involved. Some people with blood disorders that may or may not be cancerous might be referred to a hematologist oncologist.

After you have completed cancer treatment. Many people will continue seeing their oncologist for follow-up appointments to check for signs of cancer coming back and to manage any side effects from treatment. Over time, these visits are usually needed less often. You might also go back to only seeing your primary care doctor or other health care provider.

Other oncology professionals

In addition to oncologists, specially trained oncology nurses may give chemotherapy or other treatments, help manage symptoms and side effects, and provide patient education and support. Other health care professionals also provide specialized care and support for people with cancer, including:

• Advanced practice providers (nurse practitioners and physician assistant/associates)
• Patient navigators
• Oncology social workers
• Genetic counselors
• Clinical pharmacists
• Registered dietitians
• Radiologists
• Pathologists
• Mental health professionals

Learn more in Who Is the Cancer Care Team. Each member plays a vital role in your care and will work with you and your caregivers throughout your cancer journey.

Who Is the Cancer Care Team?

It's common to have different medical specialists or health care professionals as part of your cancer care team. Understanding how your team works together – and how to talk with them – can help you and your loved ones know who to go to with specific questions or concerns.

Who is on my cancer care team?

Your cancer care team is the team of professionals who work together to provide care before, during, and after cancer treatment. Many of these professionals have had extra training that focuses on:

• A certain type of cancer or cancer treatment
• A specific area, system, or part of the body
• Health problems related to cancer
• Managing (coordinating) the patient with cancer’s care

Each member of the cancer care team completes education and training specific to their role. Many also have licenses or certifications to show they meet professional standards. They include medical doctors, nurses, and other health care professionals.

Medical doctors

Medical doctors (physicians) diagnose and treat health conditions. They may focus on certain types of cancer, perform specific procedures, prescribe treatments, or treat side effects and other health problems. Doctors may have an MD (Doctor of Medicine) or a DO (Doctor of Osteopathic Medicine) degree. Both must pass a licensing exam to treat patients. You may also see other letters after a doctor’s name, which show their special training, certifications, or credentials.

Communicating with your cancer care team

It’s essential to feel at ease with your cancer care team. You rely on them for clear, helpful information to guide you through decisions. They rely on you to be open, honest, and trustworthy. Together, you’re a team working to ensure you receive the best care possible.

Talking with your cancer care team can sometimes feel overwhelming or intimidating. You might get a lot of information at once or feel confused by medical terms. You might even worry that asking too many questions seems disrespectful. But your cancer care team wants you to feel comfortable, ask questions, and understand your care and treatment.

Taking an active role

Being involved in your cancer treatment can help you get the best care possible. When you take an active role, it shows your care team that you’re open to talking with them and willing to consider their advice. Each team member brings different skills that can help in making decisions. They’re there to answer your questions, support you and your family, and help you feel confident and informed about the choices you make.

It’s also important to talk about how cancer will affect your life. Be honest about your concerns and habits, even the ones that are hard to talk about, like smoking, drinking, or drug use. The more your care team knows, the better they can support you.