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Faina Linkov, PhD University of Pittsburgh Cancer Institute. Cancer disparities. Cancer Disparities: Definition.

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Faina linkov phd university of pittsburgh cancer institute l.jpg

Faina Linkov, PhDUniversity 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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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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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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Physical Activity and risk of common cancers

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 andstomach 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

352.4

Hispanics/Latinos

512.3

African Americans

335.6

Asian Americans/Pacific Islanders

233.6

American Indians/Alaska Natives

479.7

Whites

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

132.4

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


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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


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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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