Faina Linkov, PhD Univerisity of Pittsburgh Cancer Institute

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Faina Linkov, PhDUniverisity of Pittsburgh
Cancer Institute

• Cancer disparities

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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."

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True of false?

• Disparities exist only because of poverty

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True of false?

• Most disparities have genetic basis

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True of false?

• Minority groups in most countries have poorer
  health outcomes

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True of false?

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

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Burden of Cancer in U.S.
Seven Strategic NCI Priorities

• Reducing Cancer Health Disparities
• Integrated Clinical Trials System
  
  
• Advanced Technologies
• Molecular Epidemiology
• Integrative Cancer Biology
• Strategic Development of Cancer Interventions
• Prevention, Early Detection and Prediction

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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

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What is the cause of cancer disparities?
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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

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Table 1. Overall Cancer Incidence and Death
Rates
  All Sites All Sites
Racial/Ethnic Group Incidence Death
All 470.1 192.7
African 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.
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Obesity and Common Cancers

• Women
• 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

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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
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Physical Activity and risk of common cancers
Cancer Cancer risk
Breast inconsistent associationtime period may be critical
Colon 30-40 decreased risk among active men women (Rectalno 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
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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

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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

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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

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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

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Overall Cancer Disparities
Burden of Cancer in U.S.

CANCER INCIDENCE
Hispanics/Latinos
352.4
512.3
African Americans
335.6
Asian Americans/Pacific Islanders
233.6
American Indians/Alaska Natives
Whites
479.7
Source Surveillance, Epidemiology and
End-Results Users Program, 2002. Numbers per
100,000 persons
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Overall Cancer Disparities
Burden of Cancer in U.S.

CANCER MORTALITY
Hispanics/Latinos
135.2
248.1
African Americans
Asian Americans/Pacific Islanders
132.4
American Indians/Alaska Natives
119.9
195.3
Whites
Source Surveillance, Epidemiology and
End-Results Users Program, 2002. Numbers per
100,000 persons
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What makes these population groups different

• Different levels of infection with h. pylori and
  hpv
• Differential access to care
• Genetics
• Insurance coverage
• SES