cancer disparities

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Cancer, lung, smoking, disparities, minorities

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  • 1.Cancer disparitiesFaina Linkov, PhD University of Pittsburgh Cancer Institute

2. 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." 3. True of false? Disparities exist only because of poverty 4. True of false? Most disparities have genetic basis 5. True of false? Minority groups in most countries have poorer health outcomes 6. True of false? Minority groups in various countries around the world countries have poorer health outcomes 7. Burden of NCI Priorities Seven Strategic Cancer in U.S. Reducing Cancer Health Disparities Integrated Clinical Trials System Advanced TechnologiesPrevention, Early Detection andMolecular Epidemiology Integrative Cancer BiologyStrategic Development of Cancer Interventions 8. 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 9. What is the cause of cancer disparities? 10. 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 11. Table 1. Overall Cancer Incidence and Death Rates All Sites Racial/Ethnic GroupIncidenceDeathAll470.1192.7African 504.1 American/Black238.8Asian/Pacific Islander314.9115.5Hispanic/Latino356.0129.1American Indian/Alaska Native297.6160.4White477.5190.7 12. Obesity and Common Cancers Women Endometrial, ovarian, colon, breast (postmenopausal), 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 13. Dietary components and risk of common cancers CancerIncrease RiskDecrease RiskBreastAlcohol, excess energy intake, weight gainVegetables, monounsaturated fatsColonRed meatFruit/vegetable fiber, AlcoholLungVegetables, especially green/yellowProstateMeatLycopene (tomatoes)GIAlcohol, SodiumFruit/vegetables 14. Physical Activity and risk of common cancers CancerCancer riskBreastinconsistent associationtime period may be criticalColon30-40% decreased risk among active men & women (Rectalno association)Prostatefindings inconclusivePossible mechanisms: 1. Decreased GI transit time which decreases carcinogen exposure) 2. Enhanced immune function with moderate PA 3. Lowered levels of reproductive hormones 15. 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 16. African Americans Highest 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 17. Asian Americans/Pacific Islanders Highestincidence 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 18. 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 19. Burden of Cancer in U.S. Overall Cancer Disparities CANCER INCIDENCE Hispanics/Latinos352.4 512.3 335.6 233.6African Americans Asian Americans/Pacific IslandersAmerican Indians/Alaska Natives479.7WhitesSource: Surveillance, Epidemiology and End-Results Users Program, 2002. Numbers per 100,000 persons 20. Burden of Cancer in U.S. Overall Cancer Disparities CANCER MORTALITY Hispanics/Latinos135.2 248.1 132.4African Americans Asian Americans/Pacific IslandersAmerican Indians/Alaska Natives119.9 195.3WhitesSource: Surveillance, Epidemiology and End-Results Users Program, 2002. Numbers per 100,000 persons 21. What makes these population groups different Different levels of infection with h. pylori and hpv Differential access to care Genetics Insurance coverage SES 22. Review Questions (Developed by the Supercourse team) What is the cause of cancer disparities? How does NCI define disparities? Give examples of differential mortality for Caucasians, African American, Latin American, and Native American groups Why do you think African Americans have some of the highest mortality rates in the US?

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