A long-term population study – which will track 100 000 women for three decades – has been started by the American Cancer Society (ACS), focusing on the high rates of cancer and cancer-related deaths among black women, who have the highest death rates and lowest survival rates for many cancers of any racial or ethnic group.
Called VOICES of Black Women, it will enrol 100 000 black women without cancer, aged 25 to 55, who will be surveyed twice annually about their behaviours, environmental exposures and life experiences, and followed for 30 years; any cancers they may develop will be tracked.
The New York Times reports that similar studies by ACS in the past yielded critical lessons about what causes cancer, for example, identifying cigarette smoking as a cause of lung cancer and linking red- and processed-meat consumption to increased risk of colon cancer.
While some earlier studies have included large numbers of black women, the research wasn’t able to “hone in on the specific drivers of cancer in that population”, said Dr Alpa Patel, senior vice president of population science at the society and co-principal investigator of the VOICES study, along with Dr Lauren McCullough.
“In general population studies, you tend to ask questions that will be applicable to the majority of the population,” she said. “So, going deeply into the lived experiences of discrimination, bias, systematic issues, environmental influences and cultural aspects of health-related behaviours, and how the narratives around them are shaped in different populations … those types of unique aspects of understanding what contributes to cancer in a population weren’t being asked about.”
Women will be surveyed on their use of personal care products, for example, including chemical hair straighteners, which have been implicated in some cancers. The researchers will track stressors related to the physical environment, and factors like neighbourhood walkability, crime, air pollution, access to healthy food, and proximity to liquor stores and establishments that sell cigarettes.
Black women have the highest death rates and lowest survival rates for many cancers of any racial or ethnic group. Black men and women have higher rates of colorectal cancer than white Americans, for example.
Black women die of uterine cancer at twice the rate of white women, are twice as likely to be diagnosed with stomach cancer and more than twice as likely to die of it. They are also 40% more likely to die of breast cancer.
Persistently high deaths rates among black breast cancer patients were one reason the US Preventive Services Task Force cited recently for lowering the age for starting mammography screening to 40 again from 50.
The racial disparities in breast cancer survival are relatively new. Until the 1970s, there was no racial disparity in breast cancer outcomes between black and white women, Patel said.
“We know now there are more aggressive tumours, especially at younger ages in black women compared with white women, and we don’t fully understand why.”
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