Thesocietalburdenofcancerisoneofthemajorpublichealthchallengesofour
time. Yetthatburdenisnotequallysharedbyall.
Troublingdisparitieshave been documented not only by racial/ethnic
group but also by social class,
insurancestatus,geography,andahostofotherdimensions. Furthermore,
suchdisparitiesrepresenttheendresultofaconstellationofforcesstemming
frominsideandoutsidethehealthcaresystem.
Manycancerdisparitiesshould bepreventable.
Fewhaveattemptedtocapturethebreadthanddepthofthedimensionsof
cancerdisparitiesfrombothclinicalaswellaspublichealthperspectives.
To addressthisneed,wepresentthisvolumeto: broaden concepts of
disparities beyond traditional discussions of race/
ethnicitytoexplorehow,where,andwhytheyoccur;
focusoncancerdisparitiesintheUS,whilecitingsomemajorexamplesfrom
abroad;
analyzecertainmajorcancerswithrespecttodisparities,withemphasison
socioeconomicposition;
examinethesourcesofdisparitiesfrombothinsideandoutsidethehealth
caresystem;
identifyinitialinterventionsthatattempttoreduceandeliminatethesed-
parities;and
identifyissuesthatdeserveattentionwithrespecttofutureresearch.
Ourmonographaddressescancerdisparitiesacrossthecontinuum(fromp-
vention to mortality and by the domains of social inequality). We
begin by
exploringbroaddimensionsuchasdefinitionsofdisparities,datasystems,the
roleofgenesandenvironment,andtheroleofworkandoccupationincancer
disparities.
Thenwemoveintospecificchallengesincancerdisparitiessuchas
tobaccouseandlungcancer,breastcancer,colorectalcancer,prostatecancer,
cervicalcancer,melanoma,andhepatocellularcarcinoma.
Wethenconcludewith
someavenuestoaddresscancerdisparities,includingpolicyandadvocacy,health
v vi Preface communication, overcoming barriers to cancer care, and
community-based approaches.
Oureffortsarefarfromexhaustive,buttheyrepresentoneofthe
firstattemptstoaddresscancerdisparitiesfromsuchacomprehensiveperspective.
Thisvolumereflectstheworkofanumberofnationalexpertsincancer
disparities. Many are members of the Executive Committee of the
Cancer Disparities Program-in-Development of the
Dana-Farber/Harvard Cancer Center. Still others are also
investigators in the National Cancer Institute Community Network
Program MassCONECT (Massachusetts Community
NetworkstoEliminateCancerDisparitiesthroughEducation,Researchand
Training). Also,thisvolumeupdatesandexpandsaearlier2005monographon
thetopicpublishedinthejournalCancerCausesandControl. Allauthorsare
dedicatedtothegoalofeliminatingcancerdisparitiesandIamindebtedto
them.
IamparticularlygratefultoRachelWarren,TerraZipoyrnSnider,andDr.
ClaudiaArriggfortheirunendingencouragementandsupport. Itismyhope
thatthismonographrepresentsanothercontributiontowardhelpingallpeople
enjoytheirhighestattainablestandardofhealth. Boston,MA HowardK.
Koh,MD,MPH Contents PartI DimensionsofCancerDisparities 1
Defining,Investigating,andAddressingCancerInequities:
CriticalIssues...3 NancyKrieger,KarenM. Emmons,andDavidWilliams 2
CancerDisparities:DataSystems,Sources,andInterpretation...29
BarbaraD. Powe,AhmedinJemal,DexterCooper, andLokieHarmond 3
Genes,Environment,andCancerDisparities...49 AlexandraE.
Shields,StephanieM. Fullerton,andKennethOlden 4
WorkandOccupation:ImportantIndicatorsofSocioeconomic
PositionandLifeExperiencesInfluencingCancerDisparities...83
GlorianSorensen,GraceSembajwe,AmyHarley, andLisaQuintiliani PartII
SpecificChallengesinCancerDisparities 5
DisparitiesinTobaccoUseandLungCancer...109 HowardK.
Koh,LorisElqura,andSarahMassinShort 6
SocioeconomicStatusandBreastCancerDisparities...137
SherrieFlyntWallington,OtisW. Brawley, andMichelleD. Holmes 7
DisparitiesandColorectalCancer...161 EricC. Schneider 8
DisparitiesinProstateCancer...179 OtisW.
BrawleyandSherrieFlyntWallington vii viii Contents 9
DisparitiesandCervicalCancer...203
MarceladelCarmenandTeresaDiaz-Montez 10
MelanomaandPrimaryHepatocellularCarcinoma...227 ChristopherA.
Aoki,AlanGeller,andMoonS. Chen PartIII
SomeAvenuestoAddressCancerDisparities 11
Interventions,Policy,andAdvocacy...259
DeborahKleinWalkerandChristineM. Judge 12
HealthCommunicationandCommunicationInequalities
inAddressingCancerDisparities...277 K. ViswanathandKarenM. Emmons
13 OvercomingBarrierstoCancerCare:PatientandPublic
Perspectives...299 KarenDonelan 14
Community-BasedApproachestoCancerDisparities...317 BarbaraGottlieb
Index...359 Contributors ChristopherA. Aoki
DivisionofGastroenterologyandHepatology,
DepartmentofInternalMedicine,SchoolofMedicine,Universityof
California,Davis,CA OtisW. Brawley
AmericanCancerSocietyandEmoryUniversity,Atlanta,GA MarceladelCarmen
DivisionofGynecologicOncology,Massachusetts
GeneralHospital,HarvardMedicalSchool,Boston,MA MoonS.
General
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