Cancer disparities

Faina Linkov, PhD
University of Pittsburgh Cancer
Institute
Cancer Disparities: Definition
The NCI defines "cancer health disparities"
as "differences in the incidence,
prevalence, m...
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 NCI Priorities
Seven Strategic Cancer in U.S.
 Reducing Cancer Health Disparities
 Integrated Clinical Trials ...
The anatomy of disparity
 Death from Preventable cancers
 Death from late-stage cancers otherwise
detectable
 Sub-stand...
What is the cause of cancer
disparities?
Some of the reasons
 Genetic? Big question
 Nutrition & Physical Activity
 Tobacco use
 Viruses (Hepatitis B, HPV)
 L...
Table 1. Overall Cancer Incidence and Death Rates
All Sites
Racial/Ethnic
Group

Incidence

Death

All

470.1

192.7

Afri...
Obesity and Common Cancers
 Women
 Endometrial, ovarian, colon, breast (postmenopausal), renal cell

 Men
 Colon, pros...
Dietary components and risk of
common cancers
Cancer

Increase Risk

Decrease Risk

Breast

Alcohol, excess energy
intake,...
Physical Activity and risk of
common cancers
Cancer

Cancer risk

Breast

inconsistent association—time period may be crit...
Hispanics
… Highest cervical cancer
incidence rates:
 Highest cervical cancer
rates
 15.8 per 100,000
Hispanic females
...
African Americans
Highest prostate
cancer mortality
rates:
 68.1 deaths per
100,000 black men
 More than twice the
rate ...
Asian Americans/Pacific
Islanders
… Highest

incidence rates of
liver and stomach
cancers for both genders
 14.0 per 100,...
American Indians/Alaska
Natives
 Third highest lung
and bronchus death
rates among women
– 27.1 deaths per
100,000 female...
Burden of Cancer in U.S.
Overall Cancer Disparities
CANCER INCIDENCE
Hispanics/Latinos

352.4
512.3
335.6
233.6

African A...
Burden of Cancer in U.S.
Overall Cancer Disparities
CANCER MORTALITY
Hispanics/Latinos

135.2
248.1
132.4

African America...
What makes these population
groups different
• Different levels of infection with h. pylori
and hpv
• Differential access ...
Review Questions (Developed by
the Supercourse team)
• What is the cause of cancer disparities?
• How does NCI define disp...
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Cancer Disparities

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Cancer, lung, smoking, disparities, minorities

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  • Faina Linkov, PhD
    Research Assistant Professor of Medicine and Epidemiology
    University of Pittsburgh Cancer Institute
    E-mail (preferred mode of communications): fyL1 (at) pitt.edu
    Original Power Point file of this lecture
  • Cancer disparities exist not only in the US, but around the world.
  • I’ll start this lecture by asking you several true or false questions that will help to check your basic beliefs about disparities.
    Correct answer is False.
    Many different factors were implicated in cancer disparities, including genetics, access to care, and several other factors discussed later
  • Correct answer is False.
    Disparities are caused by multiple factors, not limited to genetics.
  • Correct answer is True.
    This is true for minority populations in the US, as well as around the world
    Some of the examples of inequalities in the US include:
    -Minorities are more likely to be diagnosed with late-stage breast cancer and colorectal cancer compared with whites.
    -Patients of lower socioeconomic position are less likely to receive recommended diabetic services and more likely to be hospitalized for diabetes and its complications.
    -When hospitalized for acute myocardial infarction, Hispanics are less likely to receive optimal care.
    -Many racial and ethnic minorities and persons of lower socioeconomic position are more likely to die from HIV. --Minorities also account for a disproportionate share of new AIDS cases.
    -The use of physical restraints in nursing homes is higher among Hispanics and Asian/Pacific Islanders compared with non-Hispanic whites.
    -Blacks and poorer patients have higher rates of avoidable hospital admissions (i.e., hospitalizations for health conditions that, in the presence of comprehensive primary care, rarely require hospitalization).
    (from http://www.ahrq.gov/qual/nhdr03/nhdrsum03.htm)
  • True. This is true for minority populations in the US, as well as around the world
  • Reducing cancer disparities is one of the key strategic priorities at NCI. Prevention is especially important, as it can provide cost effective approaches to solving the issue of disparities.
  • Avoiding death from preventable cancers is very important, as many lives can be saved by easy to implement programs, such as smoking cessation.
    While you may argue that implementation of smoking cessation is not easy, it is still easier than trying to find cure for Stage 4 lung cancer.
  • The exact cause of cancer disparities is a very complex issue, that is why it is important to talk about cancer disparities.
  • In this slide, it is important to emphasize that smoking cessation and preventive care could be at the core of closing the disparity gap.
  • From
    http://www.cancer.gov/cancertopics/factsheet/cancer-health-disparities#1
    Please note that African American/Black minorities in the US have a heavy burden of both, cancer incidence and cancer mortality. More research is needed as to why this is happening.
    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.
  • If obesity is a contributing factor for many cancers, programs that target obesity prevention are needed to address this issue. Bariatric surgery may provide alternative last option solution for people who cannot lose weight through traditional means.
  • While there are many different publications out there about the link between diet and cancer, it is important to point out that the exact dietary intake is very difficult to measure. The field of nutritional epidemiology is moving towards objective tests of dietary consumption (such as urine test), which can potentially give more information than traditional dietary surveys or diaries.
  • Physical activity for cancer prevention receives quite a bit of attention, however more research is needed to explore the exact link.
  • Cervical cancer can be easily prevented. The number of deaths from cervical cancer has decreased since widespread screening with the Pap test(Pap smear) began.
  • There are many controversies that exist in the treatment of prostate cancer. Prostate cancer treatment options, including surgery, radiation, chemotherapy, and watchful waiting need to be carefully evaluated with this population of high risk.
  • The majority of both, primary liver and stomach cancers are caused by infectious agents, thus they can potentially be prevented.
  • As can be seen from this figure, cancer incidence disproportionally effects minorities in the US. More research is needed in this important area.
  • All these factors must be investigated to get to the core of cancer disparities.
  • We would appreciate your help with evaluating the content of this course. Please send completed Evaluation Form to super1@pitt.edu  with the subject "chronic disease supercourse evaluation"
      
    If you have any comments or questions, please send a message to super1@pitt.edu 
  • Cancer Disparities

    1. 1. Cancer disparities Faina Linkov, PhD University of Pittsburgh Cancer Institute
    2. 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. 3. True of false? Disparities exist only because of poverty
    4. 4. True of false? Most disparities have genetic basis
    5. 5. True of false? Minority groups in most countries have poorer health outcomes
    6. 6. True of false? Minority groups in various countries around the world countries have poorer health outcomes
    7. 7. Burden of NCI Priorities Seven Strategic Cancer in U.S.  Reducing Cancer Health Disparities  Integrated Clinical Trials System     Advanced Technologies  Prevention, Early Detection and Molecular Epidemiology Integrative Cancer Biology Strategic Development of Cancer Interventions
    8. 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. 9. What is the cause of cancer disparities?
    10. 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. 11. Table 1. Overall Cancer Incidence and Death Rates All Sites Racial/Ethnic Group Incidence Death All 470.1 192.7 African 504.1 American/Black 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
    12. 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. 13. 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
    14. 14. 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
    15. 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. 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. 17. 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
    18. 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. 19. Burden of Cancer in U.S. Overall Cancer Disparities CANCER INCIDENCE Hispanics/Latinos 352.4 512.3 335.6 233.6 African Americans Asian Americans/Pacific Islanders American Indians/Alaska Natives 479.7 Whites Source: Surveillance, Epidemiology and End-Results Users Program, 2002. Numbers per 100,000 persons
    20. 20. Burden of Cancer in U.S. Overall Cancer Disparities CANCER MORTALITY Hispanics/Latinos 135.2 248.1 132.4 African Americans Asian Americans/Pacific Islanders American Indians/Alaska Natives 119.9 195.3 Whites Source: Surveillance, Epidemiology and End-Results Users Program, 2002. Numbers per 100,000 persons
    21. 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. 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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