Cancer and Minorities

Norma Kanarek, MPH, PhD

Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health

Department of Oncology, Johns Hopkins School of Medicine

Cancer Health Disparities

Differences by among disadvantaged groups defined by– Race– Ethnicity– Sexuality– Wealth/income– Gender– Disability status

Ways to think about differences among population groups

• Poverty/policies the root cause of disparities??

• Differences by cancer site

• Differences by person, place and time

• Key determinants of health disparities

• Data issues and sources

Poor Breast Cancer Survival in Blacks May Not Be Due to Race

Many factors, including access to health care, could affect outcome, analysis finds

WEDNESDAY, June 23 (HealthDay News) -- Underinsured black breast cancer patients have worse survival outcomes than underinsured white patients, a new U.S. study has found.

Researchers analyzed the records of 574 breast cancer patients treated at Wishard Memorial Hospital in Indianapolis between Jan. 1, 1997 and Feb. 28, 2006, and found that 84 percent of these patients were underinsured.

The study authors noted that black patients had more advanced breast cancer at diagnosis and poorer cancer-specific survival outcomes than whites. But after adjusting for age, cancer stage and other factors, they found that race was no longer significantly associated with breast cancer-related death.

In addition, contrary to previous study findings, black women were as likely as white women to opt for breast-conserving procedures and "adjuvant" therapy, which is therapy given after the completion of the initial treatment -- such as chemotherapy, radiation or hormone therapy -- to lower the risk of cancer recurrence.

"Despite the similar surgical care and adjuvant therapy, African American women in this study had lower overall and breast cancer-specific survival compared with non-Hispanic white women. After adjustment for competing causes of death, the survival disparity between African American and non-Hispanic white women appears to be attributable in part to differences in clinical and socio-demographic factors between the groups," Dr. Ian K. Komenaka Socio-demographic factors include variables such as income, education level and access to health care, they explained.

Mammography Use by Race

Percent of American Women Over 40 Who Have Had a Mammogram Within Past 2 Years

WhiteBlack, Non-HispanicHispanicAmerican Indian/Alaska NativeAsian American

70.4%70.4%66.1%68.6%58.8%69.3%

Source: American Cancer Society, 2005. Based on 2003 data.

Risk of surviving cancer lessens with advanced stage, SEER 1975-2007

Female Breast Cancer

Stage5-year Relative Survival Rate

0 100%

I 100%

IIA 92%

IIB 81%

IIIA 67%

IIIB 54%

IV 20%

Differences by Cancer site

2003-07 Major Cancer SitesSource: SEER Cancer Statistics Review, 1975-2007

Incidence*– Prostate 69.9 ↓– Breast 66.5 ↓– Lung & bronchus 62.5 ↓– Colon & rectum 47.9 ↓– Urinary Bladder 21.1 ↓– Melanoma of the skin 20.1 ↑– Non-Hodgkin Lymphoma

19.6 →

Mortality*– Lung & bronchus 52.5 ↓– Colon and rectum 17.6 ↓– Breast 13.5 ↓– Pancreas 10.7 ↑– Prostate 9.5 ↓– Leukemia 7.1 ↓– Non-Hodgkin Lymphoma 6.9 ↓– Liver & IBD 5.2 ↑– Ovary 4.8 ↓– Esophagus 4.4 →

*rate per 100,000 people, age adjusted to year 2000 standard

Top 5 Cancer Mortality Sites by Race

White: Lung & bronchus, colon &rectum, breast, pancreas, prostate

Black: Lung & bronchus, colon &rectum, prostate, breast, pancreas

Asian/Pacific Islander: Lung & bronchus, colon &rectum, liver & IBD, pancreas, stomach

American Indian/Alaska Native: Lung & bronchus, colon &rectum, breast, pancreas, liver & IBD

Hispanic: Lung & bronchus, colon &rectum, breast, pancreas, liver &IBD

2003-07 Major Cancer Mortality by SiteSource: SEER Cancer Statistics Review, 1975-2007

Males*– Lung & bronchus 68.8 ↓– Prostate 24.7 ↓– Colon & rectum 21.2 ↓– Pancreas 12.3 →– Leukemia 9.7 ↓– Non-Hodgkin Lymphoma

8.7 ↓– Esophagus 7.8 →

Female*– Lung & bronchus 40.6 → – Breast 24.0 ↓– Colon and rectum 14.9 ↓– Pancreas 9.4 ↑ – Ovary 8.6 ↓– Non-Hodgkin Lymphoma

5.5 ↓– Uterine 4.1 →

*rate per 100,000 people, age adjusted to year 2000 standard

Cancer by Person, Place and Time

Person, Place, Time

Cancer death rates per 100,000 population, Europe & US

#1   Netherlands:433

# 2   Italy:418

# 3   Hungary:411

# 4   Luxembourg:409.7

# 5   Slovakia:405.3

# 6   Ireland:357.6

# 7   Czech Republic:335.4

# 8   New Zealand:327.3

# 9   United States:321.9

# 10   Australia:298.9

http://www.nationmaster.com/graph/hea_dea_fro_can-health-death-from-cancer , OECD 2004

Hispanic Cancer Rates Change After U.S. Immigration After Arrival, Habit Changes Affect Cancer Risks

By JOSEPH BROWNSTEINABC News Medical Unit

Aug. 6, 2009

Risk of developing cancer increases with age

Probability of Developing Breast Cancer Within the Next 10 years

   By age 20   By age 30   By age 40   By age 50   By age 60   By age 70   Lifetime

  1 out of 1,760  1 out of 229  1 out of 69  1 out of 42  1 out of 29  1 out of 27  1 out of 8

Person: Race, Ethnicity, Gender

Breast Cancer Death Rates by Race

Race/Ethnicity Female

  All Races  White  Black  Asian/Pacific Islander  American Indian/Alaska Native  Hispanic

  25.5 per 100,000 women  25.0 per 100,000 women  33.8 per 100,000 women  12.6 per 100,000 women  16.1 per 100,000 women  16.1 per 100,000 women

Key Determinants of Disparities

Key Determinants of Disparities

James, SA Epidemiologic Reviews 31(1):1-6

Prostate Cancer Incidence and Death Rates

Racial/Ethnic Group Incidence Death

All 168.0 27.9

African American/Black 255.5 62.3

Asian/Pacific Islander   96.5 11.3

Hispanic/Latino 140.8 21.2

American Indian/Alaska Native

  68.2 21.5

White 161.4 25.6

Statistics are for 2000-2004, age-adjusted to the 2000 U.S. standard million population, and represent the number of new cases of invasive cancer and deaths per year per 100,000 men.*

http://www.cancer.gov/cancertopics/factsheet/disparities/cancer-health-disparities

Key Determinants of DisparitiesProstate Cancer and African Americans

James, SA Epidemiologic Reviews 31(1):1-6

B>W ObesityDiet

B>W

B>WPSA use

B>W Cancer Incidence

B>W

GSTP1RARß2SPARCTIMP3NKX2-5 B>W

B=WB=WTX Outcomes

Red: worse, orange: same as, and green: better.

Data issues and sources

Cancer Mortality in the US by Education Level and Race, Albano JD, et al. JNCI 99(18):1384.

Data Issues and Sources

Cancer graphics/tables will have:

• Caveats about the statistics• Source of data• Data availability issues• How and when it was created

For example, due to data availability issues, the time period used in the calculation of the joinpoint regression model may differ for selected racial groups or counties.

Surveillance epidemiology and End Results (NCI) Racial/Ethnic Patterns of Cancer in the United States, 1988-1992 http://seer.cancer.gov/publications/ethnicity/

Cancer Control P.L.A.N.E.T.– State Cancer Profiles– Research seminars– Partners in Cancer Control– General information by cancer topic