Cancer Type–Specific Contributions to the Reduction in Cancer Mortality Gap Between Black Individuals and White Individuals

Importance: Mortality disparity in cancer between Black individuals and White individuals in the US has been declining since its peak in the early 1990s, but a comprehensive analysis of cancer type-specific contributions to this reduction is lacking. Objective: To examine cancer type-specific contributions to the reduction in the all-cancer excess mortality rate among Black individuals compared with White individuals between the peak period (1991-1995) and a contemporary period (2019-2023) in the US. Design, Setting, and Participants: A cross-sectional temporal analysis was conducted between March 2025 and October 2025. Non-Hispanic Black individuals and White individuals who died of cancer between 1991 and 2023 were included in the analysis. The data were compiled by the National Center for Health Statistics. Exposure: Race as recorded on death certificates. Main Outcomes and Measures: All-cancer and cancer type-specific excess mortality rates per 100 000 for Black individuals compared with White individuals were calculated by sex. Changes in excess mortality rates were estimated by subtracting the current excess mortality rate for 2019 to 2023 from the peak excess mortality rate for 1991 to 1995. Cancer type-specific contributions to all-cancer excess mortality rate reduction were expressed as percentages. Results: The analysis included 2 461 715 cancer deaths in 1991 to 1995 (11.8% non-Hispanic Black individuals; 47.4% were female) and 2 674 385 cancer deaths in 2019 to 2023 (13.2% non-Hispanic Black individuals; 47.2% were female). Between 1991 to 1995 and 2019 to 2023, the all-cancer excess mortality rate decreased by 98.4 (95% CI, 96.1-100.7) per 100 000 in Black males and by 21.7 (95% CI, 20.3-23.1) per 100 000 in Black females. Among males, lung (31.1% [95% CI, 29.9%-32.4%]), prostate (25.8% [95% CI, 24.7%-27.0%]), and esophageal (12.1% [95% CI, 11.7%-12.5%]) cancer accounted for the largest share of reductions in the all-cancer excess mortality rate. Among females, colorectal (18.8% [95% CI, 16.6%-20.9%]), cervical (16.9% [95% CI, 15.8%-18.0%]), and lung (15.1% [95% CI, 12.3%-17.9%]) cancer accounted for the largest share of reductions in the all-cancer excess mortality rate. Despite these gains in excess mortality rate reduction, prostate, lung, and stomach cancer remained among the top 5 cancer types with the largest contemporary excess mortality rate among males, whereas colorectal cancer increased in rank (from fifth to second) as well as liver cancer (from tenth to fifth), reflecting comparatively smaller or stalled progress. Breast cancer and uterine corpus cancer ranked highest during the contemporary period in excess mortality rate among Black females compared with White females (7.2 per 100 000 and 4.9 per 100 000, respectively), followed by myeloma, colorectal, and pancreatic cancer. Conclusions and Relevance: In this cross-sectional temporal analysis, the marked reductions in excess mortality indicate meaningful progress achieved for several major cancer types through population-wide cancer control efforts. Persistent or worsening disparities in breast cancer and uterine corpus cancer and substantial residual disparities in prostate cancer highlight priorities for equitable interventions. These findings may guide more targeted and efficient cancer prevention and control strategies to further accelerate progress.