Cancer and Minorities (Norma Kanarek, PhD, MPH)

8/7/2019 Cancer and Minorities (Norma Kanarek, PhD, MPH)

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Cancer and MinoritiesNorma Kanarek, MPH, PhD

Department of Environmental Health Sciences, JohnsHopkins Bloomberg School of Public Health

Department of Oncology, Johns Hopkins School ofMedicine


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Cancer Health Disparities

Differences by among disadvantaged

groups defined by

Race Ethnicity

Sexuality

Wealth/income

Gender

Disability status


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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


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Poor Breast Cancer Survival in Blacks

May Not Be Due to RaceMany factors, including access to health care, could affectoutcome, analysis finds

WEDNESDAY, June 23 (HealthDay News) -- Underinsured black breast cancer patients haveworse 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 84percent of these patients were underinsured.

The study authors noted that black patients had more advanced breast cancer atdiagnosis 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 withbreast cancer-related death.

In addition, contrary to previous study findings, black women were as likely as whitewomen to opt for breast-conserving procedures and "adjuvant" therapy, which is therapy givenafter 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 thisstudy had lower overall and breast cancer-specific survival compared with non-Hispanic whitewomen. After adjustment for competing causes of death, the survival disparity between AfricanAmerican and non-Hispanic white women appears to be attributable in part to differencesin 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.


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Mammography Use by Race

Percent of American Women Over 40 Who Have Had a

Mammogram Within Past 2 Years

White

Black, Non-HispanicHispanic

American

Indian/Alaska Native

Asian American

70.4%

70.4%66.1%

68.6%

58.8%

69.3%Source: American Cancer Society, 2005. Based on 2003 data.


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Risk of surviving cancer lessens with

advanced stage, SEER 1975-2007Female Breast Cancer

Stage5-year Relative

Survival Rate

0 100%

I 100%

IIA 92%

IIB 81%IIIA 67%

IIIB 54%

IV 20%


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Differences by Cancer site


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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*


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


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Top 5 Cancer Mortality Sites by Race

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

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

breast, pancreasAsian/Pacific Islander: Lung & bronchus, colon

&rectum, liver & IBD, pancreas, stomach

American Indian/Alaska Native: Lung & bronchus,

colon &rectum, breast, pancreas, liver & IBDHispanic: Lung & bronchus, colon &rectum, breast,

pancreas, liver &IBD


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

Males*


Prostate 24.7

Colon & rectum 21.2

Pancreas 12.3

Leukemia 9.7


8.7

Esophagus 7.8

Female*


Breast 24.0

Colon and rectum 14.9

Pancreas 9.4

Ovary 8.6


5.5

Uterine 4.1

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


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Cancer by Person, Place and

Time


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Person, Place, Time


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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


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Risk of developing cancer

increases with ageProbability of Developing Breast Cancer

Within the Next 10 years

By age 20

By age 30By age 40

By age 50

By age 60

By age 70

Lifetime

1 out of 1,760

1 out of 2291 out of 69

1 out of 42

1 out of 29

1 out of 27

1 out of 8


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Person: Race, Ethnicity, Gender

Breast Cancer Death Rates by Race

Race/Ethnicity Female

All Races

WhiteBlack

Asian/Pacific Islander

American Indian/Alaska Native

Hispanic

25.5 per 100,000 women

25.0 per 100,000 women33.8 per 100,000 women

12.6 per 100,000 women

16.1 per 100,000 women

16.1 per 100,000 women


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Key Determinants of

Disparities


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Key Determinants of Disparities

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


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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


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Key Determinants of Disparities

Prostate Cancer and African Americans

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

B>W

Obesity

Diet

B>W

B>WPSA use

B>W

Cancer

Incidence

B>W

GSTP1

RAR2

SPARCTIMP3

NKX2-5 B>W

B=W

B=WTX Outcomes

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

Data issues and sources


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Data Issues and Sources


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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 ofthe joinpoint regression model may differfor selected racial groups or counties.


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Surveillance epidemiology and End Results(NCI) Racial/Ethnic Patterns of Cancer in

the United States, 1988-1992

http://seer.cancer.gov/publications/ethnicity/


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Cancer Control P.L.A.N.E.T.

State Cancer Profiles

Research seminars Partners in Cancer Control

General information by cancer topic

Documents

Cancer and Minorities (Norma Kanarek, PhD, MPH)