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In 2021, the American Cancer Society published its first biennial report on the status of cancer disparities in the United States. In this second report, the authors provide updated data on racial, ethnic, socioeconomic (educational attainment as a marker), and geographic (metropolitan status) disparities in cancer occurrence and outcomes and contributing factors to these disparities in the country. The authors also review programs that have reduced cancer disparities and provide policy recommendations to further mitigate these inequalities. There are substantial variations in risk factors, stage at diagnosis, receipt of care, survival, and mortality for many cancers by race/ethnicity, educational attainment, and metropolitan status. During 2016 through 2020, Black and American Indian/Alaska Native people continued to bear a disproportionately higher burden of cancer deaths, both overall and from major cancers. By educational attainment, overall cancer mortality rates were about 1.6-2.8 times higher in individuals with ≤12 years of education than in those with ≥16 years of education among Black and White men and women. These disparities by educational attainment within each race were considerably larger than the Black-White disparities in overall cancer mortality within each educational attainment, ranging from 1.03 to 1.5 times higher among Black people, suggesting a major role for socioeconomic status disparities in racial disparities in cancer mortality given the disproportionally larger representation of Black people in lower socioeconomic status groups. Of note, the largest Black-White disparities in overall cancer mortality were among those who had ≥16 years of education. By area of residence, mortality from all cancer and from leading causes of cancer death were substantially higher in nonmetropolitan areas than in large metropolitan areas. For colorectal cancer, for example, mortality rates in nonmetropolitan areas versus large metropolitan areas were 23% higher among males and 21% higher among females. By age group, the racial and geographic disparities in cancer mortality were greater among individuals younger than 65 years than among those aged 65 years and older. Many of the observed racial, socioeconomic, and geographic disparities in cancer mortality align with disparities in exposure to risk factors and access to cancer prevention, early detection, and treatment, which are largely rooted in fundamental inequities in social determinants of health. Equitable policies at all levels of government, broad interdisciplinary engagement to address these inequities, and equitable implementation of evidence-based interventions, such as increasing health insurance coverage, are needed to reduce cancer disparities. [ABSTRACT FROM AUTHOR]

The article discusses the prevalence of youth and adult smoking in the U.S. Based on the result of separate surveys, 20% of high school students and 20.5% of adults are smoking. It notes that the increased prevalence of youth smoking is attributed to the tobacco industry's promotional efforts while trends in adult smoking is strongly associated to socioeconomic status. Meanwhile, tobacco control initiatives in the U.S. which include increases in excise taxes and cessation programs are explored.

The article discusses the relationship of health insurance with the utilization of cancer care in the United States. According to the author, the lack of health insurance in some part of the US is related to the fact that not all population benefited the progress in cancer prevention, and treatment. Data about the relationship of health insurance to the cancer utilization is presented. The author suggests that the all Americans could be part of the progress if health insurance is addressed.

The article reports on tobacco control in the United States. An improvement in controlling tobacco use results from policies that increase tobacco excise taxes, smoke free laws and counteradvertising. Tobacco dependence was also reduced though enhanced smoking cessation programs. These approaches were found to be effective ways to reduce the use of tobacco thus preventing diseases caused by smoking which includes cancer.