Faina Linkov, PhDUniverisity of Pittsburgh Cancer

Institute

Cancer disparities

Cancer Disparities: Definition

The NCI defines "cancer health disparities" as "differences in the incidence, prevalence, mortality, and burden of cancer and related adverse health conditions that exist among specific populations groups in the United States."

True of false?

Disparities exist only because of poverty

True of false?

Most disparities have genetic basis

True of false?

Minority groups in most countries have poorer health outcomes

True of false?

Minority groups in various countries around the world countries have poorer health outcomes

Burden of Cancer in U.S.Seven Strategic NCI Priorities Reducing Cancer Health DisparitiesReducing Cancer Health Disparities Integrated Clinical Trials System Integrated Clinical Trials System

Advanced TechnologiesAdvanced Technologies Molecular Epidemiology Molecular Epidemiology Integrative Cancer BiologyIntegrative Cancer Biology Strategic Development of Cancer Strategic Development of Cancer InterventionsInterventions Prevention, Early Detection and Prevention, Early Detection and PredictionPrediction

The anatomy of disparity

Death from Preventable cancers Death from late-stage cancers otherwise

detectable Sub-standard treatment and care for

minority groups Death from curable cancers Absence of pain control, other palliative

care for cancers that do not have cure

What is the cause of cancer disparities?

Some of the reasons

Genetic? Big question

Nutrition & Physical Activity

Tobacco use

Viruses (Hepatitis B, HPV)

Lack of early-detection

Lack of timely and aggressive treatment

Access to care

Many, many others…

Table 1. Overall Cancer Incidence and Death Rates

  All SitesRacial/Ethnic Group

Incidence Death

All 470.1 192.7African American/Black

504.1 238.8

Asian/Pacific Islander

314.9 115.5

Hispanic/Latino

356.0 129.1

American Indian/Alaska Native

297.6 160.4

White 477.5 190.7

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 and women.

Obesity and Common CancersWomen

Endometrial, ovarian, colon, breast (post-menopausal), renal cell

Men Colon, prostate

Possible Mechanisms: Hyperinsulinemia (especially central adiposity)

associated with cell growth & proliferation Adipose tissue is primary source of estrogens,

which has been linked to carcinogenesis

Dietary components and risk of common cancers

Cancer Increase Risk Decrease Risk

Breast Alcohol, excess energy intake, weight gain

Vegetables, monounsaturated fats

Colon Red meat Fruit/vegetable fiber, Alcohol

Lung Vegetables, especially green/yellow

Prostate Meat Lycopene (tomatoes)

GI Alcohol, Sodium Fruit/vegetables

Physical Activity and risk of common cancers

Cancer Cancer risk

Breast inconsistent association—time period may be critical

Colon 30-40% decreased risk among active men & women (Rectal—no association)

Prostate findings inconclusive

Possible mechanisms: 1. Decreased GI transit time which decreases carcinogen exposure) 2. Enhanced immune function with moderate PA 3. Lowered levels of reproductive hormones

Hispanics… Highest cervical cancer

incidence rates: Highest cervical cancer

rates 15.8 per 100,000

Hispanic females Almost twice the

incidence rate of white females

African AmericansHighest prostate

cancer mortality rates: 68.1 deaths per

100,000 black men More than twice the

rate of whites and nearly three times the rate of Hispanics

Asian Americans/Pacific Islanders

… Highest incidence rates of liver and stomach cancers for both genders 14.0 per 100,000 for

liver and bile duct cancer– more than twice as high as any other population group

15.9 per 100,000 for stomach cancer, which is twice the incidence rate for whites

American Indians/Alaska Natives

Third highest lung and bronchus death rates among women– 27.1 deaths per

100,000 females, nearly twice the rate of Hispanic/Latinas

Burden of Cancer in U.S.Overall Cancer Disparities

African Americans

Hispanics/Latinos

Asian Americans/Pacific Islanders

American Indians/Alaska Natives

Source: Surveillance, Epidemiology and End-Results Users Program, 2002. Numbers per 100,000 persons

Whites

CANCER INCIDENCE

352.4

512.3

335.6

233.6

479.7

Burden of Cancer in U.S.Overall Cancer Disparities

African Americans

Hispanics/Latinos

Asian Americans/Pacific Islanders

American Indians/Alaska Natives

Source: Surveillance, Epidemiology and End-Results Users Program, 2002. Numbers per 100,000 persons

Whites

CANCER MORTALITY

248.1

135.2

132.4

119.9

195.3

What makes these population groups different

• Different levels of infection with h. pylori and hpv

• Differential access to care• Genetics• Insurance coverage • SES