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

White 70.4%
Black, Non-Hispanic 70.4%
Hispanic 66.1%
American 68.6%
Indian/Alaska Native 58.8%
Asian American 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
5-year Relative
Stage
Survival Rate
0 100%
I 100%
IIA 92%
IIB 81%
IIIA 67%
IIIB 54%
IV 20%
Differences by Cancer site
 2003-07 Major Cancer Sites
Source: 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 Site
Source: SEER Cancer Statistics Review, 1975-2007

Males* Female*
– Lung & bronchus 68.8 ↓ – Lung & bronchus 40.6 →
– Prostate 24.7 ↓ – Breast 24.0 ↓
– Colon & rectum 21.2 ↓ – Colon and rectum 14.9 ↓
– Pancreas 12.3 → – Pancreas 9.4 ↑
– Leukemia 9.7 ↓ – Ovary 8.6 ↓
– Non-Hodgkin Lymphoma – Non-Hodgkin Lymphoma
8.7 ↓ 5.5 ↓
– Esophagus 7.8 → – 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 BROWNSTEIN
ABC 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   1 out of 1,760
   By age 30   1 out of 229
   By age 40   1 out of 69
   By age 50   1 out of 42
   By age 60   1 out of 29
   By age 70   1 out of 27
   Lifetime   1 out of 8
Person: Race, Ethnicity, Gender
Breast Cancer Death Rates by Race

Race/Ethnicity Female
  All Races   25.5 per 100,000 women
  White   25.0 per 100,000 women
  Black   33.8 per 100,000 women
  Asian/Pacific Islander   12.6 per 100,000 women
  American Indian/Alaska Native   16.1 per 100,000 women
  Hispanic   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   68.2 21.5
Native
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 Disparities
Prostate Cancer and African Americans

B>W
B>W
Cancer B=W
Incidence B=W
TX Outcomes
B>W
Data issues and sources PSA use
B>W
B>W
GSTP1
Obesity
RARß2 Diet
SPARC
TIMP3
NKX2-5 B>W

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

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

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