Racial Disparities in Late-Stage Cancer Diagnosis for Adolescents and Young Adults

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While cancer affects all demographics, there is a noticeable difference in burden within underrepresented populations. According to the National Cancer Institute, there are a number of cancer health disparities including survival, morbidity, and prevalence. A more specific example is Black/African American people having higher death rates than all other racial/ethnic groups for many cancer types.¹

A recent study published in JAMA Network Open identified some other examples of racial disparities in cancer for adolescents and young adults (AYA). The authors used data from 291,899 cancer patients aged 15 to 39 years. Findings were categorized by the 5 federally defined races in the US: American Indian or Alaska Native, Asian, Black, Native Hawaiian or Other Pacific Islander, and non-Hispanic White (White).²

“This is likely the most inclusive and comprehensive study to evaluate cancer disparities in stage at diagnosis and survival among AYA patients across all 5 federally defined racial categories,” the study authors wrote. “Adolescent and young adult patients with cancer vary in survival and stage at diagnosis by race, with some of the largest gaps seen in melanoma, colorectal cancer, and sarcoma.”

According to the results, risk of late-stage diagnosis was higher for Asian (AOR, 1.20; 95% CI, 1.14-1.26), Black (AOR, 1.40; 95% CI, 1.36-1.43), and Native Hawaiian or Other Pacific Islander (AOR, 1.34; 95% CI, 1.16-1.55) patients compared with White patients. Additionally, the findings showed a difference in overall survival (OS) by race in all cancers besides central nervous system and ovary. Risk of death was higher for all of the populations except Asian patients compared with White patients.

“This analysis of AYA patients with cancer in the US revealed significant racial disparities in late-stage diagnosis and OS,” the authors said of the results. “Black patients had higher odds of late-stage diagnosis compared with White patients and a significantly higher risk of death for most cancers. Native Hawaiian or Other Pacific Islander and American Indian or Alaska Native patients had the greatest deficits in 10-year OS rates among the greatest number of cancers, despite not having a corresponding increased risk of late stage at diagnosis. Asian patients generally had a significantly lower risk of death compared with White patients, despite having a higher risk of late stage at diagnosis overall.”

While research in this area is lacking across all of the populations, the authors specifically called out Indigenous American Indian, Alaska Native, Native Hawaiian, and Other Pacific Islander populations as ones that are excluded even more. In this study, these populations showed some of the worst survival rates compared with White patients overall.

“It is important to include these Indigenous groups disaggregated as federally defined so they can be assessed, mitigating the erasure of significant health disparities faced by these populations,” the authors wrote.

According to the authors, the study’s large sample size and evaluation of the 10 deadliest cancers diagnosed in AYA patient are major strengths. The authors also believe this is the first study to evaluate these cancers in the American Indian or Alaska Native and Native Hawaiian or Other Pacific Islander populations.

“American Indian or Alaska Native, Black, and Native Hawaiian or Other Pacific Islander AYA patients are disproportionately affected by multiple cancers, with significantly inferior OS,” the authors concluded. “Indigenous data inclusion has uncovered racial disparities previously masked by data omission and aggregation, emphasizing the need for consistent inclusion of these federally defined racial categories.”

References

1. Cancer Disparities. National Cancer Institute. March 21, 2024. Accessed September 25, 2024. https://www.cancer.gov/about-cancer/understanding/disparities

2. Taparra K, Kekumano K, Benavente R, et al. Racial Disparities in Cancer Stage at Diagnosis and Survival for Adolescents and Young Adults. JAMA Netw Open. 2024;7(8):e2430975. doi:10.1001/jamanetworkopen.2024.30975