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Despite advances in cancer treatment and early detection, significant disparities in cancer care persist across racial and ethnic lines in the US. At ACCC, we recognize that achieving health equity in oncology requires sustained and systemic efforts.
Despite advances in cancer treatment and early detection, significant disparities in cancer care persist across racial and ethnic lines in the United States. These disparities are multifaceted and deeply rooted in systemic inequities, disproportionately impacting Black, Hispanic, American Indian/Alaska Native, and other communities of color. From screening and diagnosis to treatment and survivorship, people from racial and ethnic minority groups continue to experience worse cancer-related outcomes compared with their White counterparts.
At the Association of Cancer Care Centers (ACCC), we recognize that achieving health equity in oncology requires intentional, sustained, and systemic efforts. ACCC’s work spans national education programs, community collaborations, and policy advocacy. It is grounded in elevating voices from historically marginalized communities, dismantling barriers to care, and advancing models that ensure all patients benefit from high-quality, personalized oncology care.
People from marginalized groups often experience lower rates of cancer screening, contributing to later-stage diagnoses for cancers such as breast, cervical, and colorectal. Even when screening rates are comparable, outcomes may still diverge due to systemic barriers, including delayed follow-up of abnormal results and disparities in diagnostic quality. For instance, standard screening guidelines may not account for the earlier onset of certain cancers in Black or Hispanic individuals, which can lead to missed opportunities for early intervention.
When it comes to treatment, the barriers become even more pronounced. Patients from minority backgrounds are more likely to be uninsured or underinsured, live in areas with limited access to specialty care, and face transportation and financial challenges. Health literacy and mistrust in the medical system, rooted in a long history of discrimination, further complicate the path to timely, effective treatment.
Figure 1: Disparities in Cancer Treatment
These factors often result in delayed diagnoses, advanced disease at presentation, and higher rates of treatment resistance. Surgical disparities are especially concerning, as Black and Hispanic patients are less likely to be offered or undergo curative cancer surgeries and are more frequently treated in resource-constrained settings lacking specialized oncology services.
The consequences of these disparities are stark. Black/African American individuals have higher cancer death rates than all other racial and ethnic groups for many types of cancer. Breast cancer is one of the clearest examples: although Black women have slightly lower incidence rates than White women, they are 40% more likely to die from the disease. This disparity is particularly pronounced in aggressive subtypes, such as triple-negative breast cancer (TNBC), which disproportionately affects Black women and is often diagnosed at younger ages with poorer prognoses.
Black men are also more than twice as likely to die from prostate cancer compared to White men. For cervical cancer, incidence and mortality rates remain highest among Black and American Indian/Alaska Native women. At their core, these gaps reveal the broader social injustices impacting patient care.
At the heart of these disparities are deeply embedded structural factors. Systemic racism in health care, limited insurance coverage, lower socioeconomic status, and environmental exposures intersect to drive unequal outcomes. In many cases, there are biological considerations, such as the higher prevalence of BRCA mutations among certain populations or the aggressive nature of cancers like TNBC, but these biological risks are often compounded by poor access to precision diagnostics and tailored therapies.
Compounding the problem is underrepresentation. Minority populations remain grossly underrepresented in oncology clinical trials, in the development of national screening guidelines, and in leadership roles within cancer research and delivery systems. This lack of inclusion perpetuates a cycle of invisibility, where the unique needs of communities of color are not adequately addressed.
ACCC is actively working to close these gaps through targeted education, community engagement, and systems-level change. In partnership with our member programs, we are amplifying innovative strategies to reduce disparities, particularly in populations most affected by cancer inequities.
In our efforts to address the stark disparities in TNBC, ACCC has launched several initiatives focused on improving access to timely, high-quality care for Black women. These include educational programs that equip providers with tools to improve shared decision-making and culturally appropriate communication, and quality improvement projects aimed at streamlining biomarker testing and timely referrals to genetic counseling.
One of our most promising efforts is our current collaboration with Harvard University under a National Cancer Institute R01 grant, which focuses on increasing engagement with electronic patient-reported outcomes (ePROs) among Black women with breast cancer. ePROs are an increasingly vital tool for monitoring symptoms, adverse effects, and psychosocial needs during treatment. However, engagement with these digital tools has been inconsistent due to technological barriers, low digital literacy, and lack of culturally tailored support.
Through this grant, ACCC and Harvard are working together to codesign strategies with Black patients to increase the adoption and sustained use of ePROs. By involving patients directly in the development and implementation process, our goal is to ensure that digital health tools reflect their lived experiences and preferences, ultimately improving communication, symptom management, and overall quality of care.
There is evidence that when people from different racial and ethnic groups receive the same high-quality care as their White peers, disparities in outcomes can be eliminated. Studies within the Veterans Affairs health system and integrated care models like Kaiser Permanente have shown that equal access to timely, guideline-concordant cancer care results in no significant survival differences across racial lines. This reinforces a central truth that disparities are not inevitable. Rather, they are the result of inequitable systems, and systems can be changed.
Achieving health equity involves embedding antiracist practices across cancer care delivery, redesigning care pathways to address social determinants of health, ensuring diverse representation in research and clinical leadership, and fostering accountability at every level.
Eliminating cancer disparities will not be addressed by any single organization or initiative. It requires a collective commitment from health care systems, community-based organizations, researchers, funders, and policymakers. We must listen to patients, earn their trust through authentic partnerships, and confront the structural factors that perpetuate inequity. As we look to the future, ACCC will continue to invest in programs that promote culturally responsive care, elevate community voices, and dismantle barriers to innovation and access.
