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Research Question

  1. What findings and data gaps can be identified from analysis of available data regarding cancer-related outcomes among District of Columbia residents?

This report synthesizes and analyzes available data regarding cancer-related outcomes among District of Columbia residents, highlighting key findings and data gaps across the continuum of cancer prevention, treatment, and outcomes and noting variability across subgroups of District residents. Data sources used in this report include the Behavioral Risk Factor Surveillance System, the National Cancer Database, the Centers for Disease Control and Prevention and National Cancer Institute Wide-Ranging Online Data for Epidemiologic Research database, and the American Community Survey.

The findings reveal disparities in cancer-related outcomes between black and white District residents across the continuum. First, black District residents are more likely than white residents to be uninsured. Lack of insurance is associated with lower rates of routine cancer screening among asymptomatic patients and may delay care for patients experiencing early symptoms of cancer. In addition, the rate of smoking is significantly higher, and the rate of exercise is significantly lower, among black District residents than among white residents, placing black residents at higher risk of the most common cancers. Limitations in general access to health care, in primary and secondary prevention, and in access to cancer-related treatment all likely contribute to dramatically higher cancer incidence and mortality among black residents of the District than among white residents.

Key Findings

General Access to Care

  • In 2010, 6.5 percent of adult District residents reported that they lacked health insurance coverage, compared with 15.1 percent of adults nationally.
  • 13.6 percent of District adults reported not having a personal health care provider, 19.9 percent reported not having a routine checkup in the past year, and 8.9 percent reported missing care in the last 12 months because of cost.

Primary Prevention

  • Compared with adults nationally, District adults are less likely to report smoking, binge drinking, or heavy drinking and slightly more likely to report exercising.
  • The rate of smoking is significantly higher, and the rate of exercise significantly lower, among black District residents than among white residents.

Secondary Prevention

  • Overall, self-reported rates of cancer screening among District residents are higher than those among adults nationwide.
  • Black residents are less likely to report being screened for colorectal cancer than white residents.

Cancer Incidence and Mortality

  • Cancer incidence and mortality among black residents of the District are dramatically higher than for white residents of the District.
  • Cancer incidence and mortality among white District residents are lower than they are among whites nationally. Cancer incidence among black District residents is comparable with that for blacks nationally, while cancer mortality among black District residents is higher than it is for blacks nationally.

Cancer Treatment

  • Black patients, and those who are uninsured or covered by Medicaid, are more likely to present for first course of treatment with Stage IV cancers than white patients and those who are privately insured.


  • More needs to be known about cancer treatment patterns and quality in the District.
  • Regular, continued monitoring and timely reporting of cancer-related outcomes among District residents are essential, as is assuring validity and comprehensiveness of cancer registry data in the District.
  • Supplementary data would provide a more robust understanding of potential barriers to cancer screening.
  • Opportunities exist to learn more about patient experiences across the continuum.
  • More information is needed on awareness and knowledge of cancer prevention and control among District residents.
  • More attention needs to be given to understanding the regional burden of disease, patient flows across geographic borders, and regional capacity for cancer care.

Table of Contents

  • Chapter One


  • Chapter Two

    Setting the Context: Sociodemographics and Health Care Access in the District

  • Chapter Three

    Primary and Secondary Cancer Prevention

  • Chapter Four

    Cancer Incidence and Mortality

  • Chapter Five

    Use of Cancer Treatment Services in the District

  • Chapter Six

    Capacity for Delivering Cancer Care in the District

  • Chapter Seven

    Summary and Conclusion

  • Appendix A

    Additional Figure and Tables

  • Appendix B

    List of Stakeholders Interviewed

  • Appendix C

    Semistructured Guide for Stakeholder Interviews

The research described in this report was sponsored by the DC Cancer Consortium and was conducted within RAND Health, a unit of the RAND Corporation.

This report is part of the RAND Corporation Technical report series. RAND technical reports may include research findings on a specific topic that is limited in scope or intended for a narrow audience; present discussions of the methodology employed in research; provide literature reviews, survey instruments, modeling exercises, guidelines for practitioners and research professionals, and supporting documentation; or deliver preliminary findings. All RAND reports undergo rigorous peer review to ensure that they meet high standards for research quality and objectivity.

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