Cancer, lung, smoking, disparities, minorities

1. Cancer disparities
Faina 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 Technologies

Prevention, Early Detection and
Molecular Epidemiology
Integrative Cancer Biology
Strategic 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
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. 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
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. 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. 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
… 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. 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/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. 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. 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?