1 / 31

Cervical cancer among Asian subgroups in California, 1990-2004

This study examines the patterns of cervical cancer incidence, mortality, and survival among six major Asian subgroups in California. Variations between subgroups highlight the need for targeted public health programs for cervical cancer screening and prevention.

phyllisd
Download Presentation

Cervical cancer among Asian subgroups in California, 1990-2004

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Cervical cancer among Asian subgroups in California, 1990-2004 Janet Bates, MD MPH California Cancer Registry NAACCR Annual Meeting Denver, Colorado June 10, 2008

  2. Background • National cancer statistics show lower overall cancer rates among Asians in the US • Asians have wide variability in countries of origin, immigration history, culture, language, education and SES that influence cancer risk • Aggregated cancer statistics for Asians mask important differences among subgroups • Limited national cancer data available on Asian subgroups

  3. Asians in California • California has largest Asian population of any state • 3.7 million Asians = 12% of state population • 90% of California Asian population comprised of 6 subgroups: Chinese, Filipino, Japanese, Korean, South Asian, and Vietnamese

  4. Study purpose To describe patterns of cervical cancer incidence, mortality, and survival among 6 major Asian subgroups in California

  5. Methods • Cervical cancer cases diagnosed among California residents 1990-2004 • Included all 6 Asian subgroups and non-Hispanic whites (NHW) • Variables: • Age (<40, 40-64, 65+ years) • SES quintile (composite census-based measure*) • Stage (local, regional, distant, unknown) • Surgery (none, local, hysterectomy, other) • Radiation (none, any) • Chemotherapy (none, any) • *Yost K et al, Cancer Causes & Control, 2001

  6. Methods • Cervical cancer incidence rates and trends calculated using SEERstat • Cervical cancer survival probabilities (5 and 10 year) calculated using Kaplan-Meier method • Multivariate evaluation of survival calculated using Cox proportional hazards modeling, adjusted for stage, age, SES, and treatment factors

  7. Results

  8. Demographic characteristics: age and SES * P for comparison with NHW is significant at < 0.05

  9. Clinical characteristics: stage distribution * P for comparison with NHW is significant at < 0.05

  10. Clinical characteristics: stage distribution Lowest proportion of cases diagnosed at local stage were found among South Asian, Filipino, and Korean women; stage distribution among South Asian women not significantly different from NHW * P for comparison with NHW is significant at < 0.05

  11. Cervical cancer incidence trends: 1990-2004

  12. Cervical cancer incidence trends: 1990-2004 Vietnamese had highest incidence throughout period, as well as most dramatic decline

  13. Cervical cancer incidence trends: 1990-2004 …followed by Korean, then Filipino women

  14. Cervical cancer incidence trends: 1990-2004 Chinese women and NHW had comparable rates in 1990-1992…

  15. Cervical cancer incidence trends: 1990-2004 …but by 2002-2004 incidence rates were lower among Chinese women NHW Chinese

  16. Cervical cancer incidence trends: 1990-2004 Rates among Japanese and South Asian women also declined, but trend not statistically significant Japanese South Asian

  17. Unadjusted cause-specific 5- and 10-year cervical cancer survival

  18. Unadjusted cause-specific cervical cancer survival

  19. Clinical characteristics: stage distribution Lowest proportion of cases diagnosed at local stage were found among South Asian, Filipino, and Korean women; stage distribution among South Asian women not significantly different from NHW * P for comparison with NHW is significant at < 0.05

  20. Risk of death due to cervical cancer among Asian subgroups Referent group is Non-Hispanic Whites

  21. Risk of death due to cervical cancer among Asian subgroups Referent group is non-Hispanic whites

  22. Risk of death due to cervical cancer among Asian subgroups Referent group is non-Hispanic whites

  23. Risk of death due to cervical cancer among Asian subgroups Referent group is non-Hispanic whites

  24. Discussion • Higher incidence among Vietnamese, Korean, Filipino women mirror international patterns • South Asian rates relatively low despite high rates in countries of origin

  25. Discussion • Variability in cervical cancer incidence is largely attributed to screening • Expect populations with low screening to have higher incidence • Examined cervical cancer screening survey data from the California Health Interview Survey (CHIS)

  26. Percent pap test in past 3 years by Asian subgroup, California Source: California Health Interview Survey 2003

  27. Percent pap test in past 3 years and cervical cancer incidence by Asian subgroup, California Source: California Health Interview Survey 2003

  28. Limitations • Limited number of cases in some subgroups • Misclassification of race is possible • Risk factor data (HPV subtypes, smoking, diet, co-morbidities, immigration data, etc.) not available

  29. Summary • Distinct variations among subgroups in patterns of cervical cancer incidence and survival • Practice of aggregating statistics for Asians masks these differences • Public health programs targeting cervical cancer screening and prevention must take these differences into account

  30. Summary • Lower risk of cervical cancer death among Vietnamese, Korean, Filipino, and South Asian women • Few studies on this • Further evaluation of reasons for this apparent survival advantage is needed

  31. Acknowledgements • Co-authors: Brenda Hofer, Arti Parikh-Patel • CDC Cancer supplement coordinators: Meg Watson, Mona Saraiya • CCR research and surveillance program staff: Mark Allen, Allyn Fernandez Ami, Sandy Kwong

More Related