Cancer death rates in the U.S. have dropped dramatically in the past 35 years, falling by 35%, according to a report from the American Association for Cancer Research published Wednesday. The decline, which translates to nearly 5 million fewer cancer deaths since 1991, has been driven in large part by increased screening and advances in cancer treatments.

But the progress has not been seen equally across the country.

“African American communities and American Indian and Alaska Native populations have the highest overall cancer death rates of any U.S. racial or ethnic group, and this means higher incidence and mortality for multiple cancers,” said the chair of the report, Mariana Stern, a professor of clinical population and public health sciences and urology at the Keck School of Medicine of the University of Southern California.

Black people in the U.S. have long had higher cancer death rates than white people, though the gap has narrowed in recent years. Still, Black people are about twice as likely to die from multiple myeloma and cancers of the stomach, prostate and gallbladder than white people. For breast cancer, mortality rates are 35% higher among Black women than among white women.

Colorectal cancer — which is rising in people under 50 — also has higher mortality rates among Black and American Indian/Alaska Native populations, compared with white people.

Increased screening has contributed to 79% of the colorectal cancer deaths averted, according to the AACR report. During a colonoscopy, doctors remove precancerous polyps before they have the chance to turn into cancer. People at average risk are advised to begin screening at age 45.

But screening rates are lower among non-white populations, the report found.

In 2023, only 53% of Hispanic people and 57% of Asian and American Indian/Alaska Native people were up to date on colonoscopies, compared with 67% of white people. The Hispanic population has had the largest increase in early-onset colorectal cancer, with annual rises of 4.7% among women and 3.7% among men.

Alex Valdez, 40, was diagnosed with colorectal cancer when he was 38. He had gone in for a colonoscopy to monitor his ulcerative colitis and Crohn’s disease.

“When the pathology came back, they said that I had a 7-centimeter tumor on the other side of my colon and said that I had cancer for probably 1½ to two years without even knowing,” Valdez said. “A lot of people are under the misconception that they don’t need to get a colonoscopy until their mid 40s, but it happened to me at 38.”

Experts say screenings are crucial when it comes to reducing the overall burden of cancer, because they can catch the disease earlier, when it’s easier to treat. But disparities in access remain.

Cervical cancer screening rates were consistently lower among Asian and Hispanic women, compared with white women, according to the report. Women from poor counties are also less likely to be regularly screened for the cancer.

“Cervical cancer still remains a problem,” said Dr. Sarah Kim, a gynecologic surgeon at Memorial Sloan Kettering Cancer Center in New York City. “Especially for patients who don’t have access to care for a multitude of reasons, one of them is really people who are socially disadvantaged or maybe working multiple jobs or don’t have good healthcare and therefore aren’t able to see their gynecologist once a year.”

The report found that rates of cervical cancer were 32% higher among women living in poor counties, compared with higher-income counties. Death rates from that cancer are 49% higher in poor counties.

The findings are particularly striking given that cervical cancer is preventable with the HPV vaccine.

“This is one of those vaccines where we know there are no side effects, there is really only benefit, and it prevents women from getting cervical cancer,” Kim said. “You don’t need a prescription, you don’t need an appointment with a doctor, you can just walk into your CVS or Walgreens or Duane Reid, request an HPV vaccine, and the pharmacist will give it to you.”

The disparities in cancer diagnoses and death rates stem from a variety of factors that can be difficult to disentwine, including the enduring effects of systemic racism and the social, economic and physical conditions people live in that influence their health and quality of life. Those factors affect not only screening and diagnosis but also treatment.

Patients from racial and ethnic minority groups and low-income and other medically underserved populations are less likely to have the caliber of care that is recommended for their cancer, despite major advancements in cancer treatment, according to the report.

Finding the time and resources for sufficient care is also a challenge. Many Americans say they cannot afford healthcare, and enrollment in Medicaid and the Affordable Care Act has fallen by more than 5 million over the past year, according to a report from the advocacy group Protect Our Care.

Stern said there are resources available at many hospitals to help meet patients where they are and guide them through their cancer treatment, which have been shown to be widely successful.

“One example that has been used in multiple studies and has shown to be very effective… is the use of patient navigators,” Stern said.

Patient navigators work with people to overcome barriers to care and guide them through the healthcare system. Kim said she worked closely with patient navigators during her medical residency.

“We would call [patients] and make sure they came in, because that’s really the most important thing when it comes to cervical cancer, is not missing your surveillance appointments.”

Future funding for such programs is uncertain, however.

“The current administration has proposed cutting the NIH budget and eliminating the National Institute of Minority and Health Disparities, [which] suggests that there could be some threats to our progress in eliminating cancer disparities,” Stern said.