ABSTRACT
Racial and ethnic minority groups including recent immigrants suffer greater morbidity and mortality from common forms of cancer due to health-related organizational framework factors including lack of access to affordable healthcare, behavioral risk factors including poor quality dietary intake, and some biological differences related to unique cancer genomics. Limited access to quality nutrition is a key and underappreciated contributor to minority health disparities. Poor and medically underserved minorities are more likely to live in food deserts, exercise less, and have more obesity. They are less likely to have recommended cancer screening tests than the general population and are more likely to be diagnosed with later-stage cancers that might have been treated more effectively if diagnosed earlier. The higher cancer burden in medically underserved and poor minority individuals also reflects increased rates of behavioral risk factors for cancer, including increased rates of tobacco smoking, and excessive alcohol intake. In addition, individuals who live in impoverished communities may experience higher rates of exposure to cancer-causing substances in the environment including air pollution and poor quality food and water. Even among minority individuals in a higher socioeconomic bracket, there remain cancer disparities which can reflect cultural differences and historical mistreatment such as mistrust of the western allopathic health care system, attitudes about cancer, or embarrassment about having certain kinds of cancer screening procedures. Furthermore, racial/ethnic minorities may be beset by disproportionately high exposure to adverse factors in the organizational framework of healthcare, the many social and economic factors that influence cancer incidence, and postdiagnosis survival for patients. Lastly, advances in cancer genomics have led to an increased understanding of how biological differences among population groups can contribute to health disparities. These biological factors can also interact with diet and the environment such as triple-negative breast cancers in African Americans. This chapter will review these inequities in the organizational framework of cancer diagnosis, care, and survival and advocate for modification of risk factors including diet and exercise through community intervention and education which may improve cancer-related incidence and survival in minorities.
