In 2020, there were 46.9 million Americans who identified as Black or African American, accounting for 14.2% of the total US population.1, 2 The Black population is the third-largest racial/ethnic group following White and Hispanic people and primarily resides in the South . The population includes ancestors of individuals brought to the US as slaves who largely identify as African American, as well as nearly 10% who are recent immigrants, mostly of African or Caribbean descent. The Black immigrant population has increased 5-fold over the past four decades, from 816,000 in 1980 to more than 4.3 million in 2019.3. Although racial classification is a social construct based on appearance, it remains useful for describing health patterns in the US because long-standing structural racism has contributed to inequalities in the social determinants of health. Although some cancer-associated genetic mutations are inherited, most health differences between population groups do not stem from biology, but from variations in socioeconomic status and access to medical care. Collectively, Black people have the highest death rates and shortest survival rates of any racial/ethnic group in the US for most cancers, largely driven by social mechanisms that are further explained on page 3. Notably, Black immigrants have lower cancer mortality than US-born Black people, highlighting the importance of where a person lives over race or biology.