There is significant disparity of cancer outcome (incidence, survival, and mortality) for black Americans when compared with white Americans. The extent of disease is inversely associated with survival and directly associated with mortality rates. Blacks, who tend to be diagnosed at later stages of cancer than their white counterparts, may have a poorer outcome even when diagnosed within the same stage. Socioeconomic status and class have been shown to be significant predictors of poor outcome, and blacks are disproportionately represented among the poor and disadvantaged. Some studies continue to show significant "race" effects after controlling for income, a result likely due to unmeasured related variables. Possible solutions are discussed that deal primarily with promotion of cultural and class- sensitive educational interventions and efforts aimed at overcoming barriers to early and effective prevention and treatment. A more comprehensive plan based on providing opportunities for upward mobility is likely to be the ultimate solution, but this will require national governmental commitment, which is not presently evident.