American Indian and Alaska Native populations currently face the highest cancer mortality rates and the least favorable survival trends in the United States, driven largely by high lung cancer incidence linked to smoking rates significantly above the national average. However, Rebecca Siegel, MPH, cancer epidemiologist and senior scientific director of surveillance research at the American Cancer Society, emphasizes these outcomes result from predatory corporate strategies and systemic neglect rather than individual choice alone.
Tobacco companies have historically employed aggressive, highly calculated marketing tactics to target marginalized groups, including people of color, low-income communities, and those living on tribal reservations. Combined with disproportionate poverty levels and significant geographic barriers to healthcare, this creates a cycle of addiction and late-stage diagnosis.
The Indian Health Service, the federal agency responsible for providing healthcare to American Indian and Alaska Native populations, is chronically and severely underfunded. Many clinics cannot offer even basic preventative services such as routine breast cancer screenings or modern diagnostic imaging, leading to cancers being detected only in advanced, less treatable stages.
Significant disparities also persist within the Black population, which experiences the second-highest burden of cancer mortality. Black men face death rates from prostate cancer that are 2 to 4 times higher than those of any other racial or ethnic group. While biological reasons for higher incidence of aggressive prostate cancer in Black men are not fully understood, the disparity in death rates is largely attributed to unequal access to high-quality care. When adjusted for equivalent access to treatment and early screening, these survival gaps often narrow, suggesting the survival gap reflects structural inequities in the healthcare delivery system.
See: “Addressing Systemic Disparities and Targeted Marketing in Cancer Care” (January 20, 2026)Â
