Faina Linkov, PhD University of Pittsburgh Cancer Institute Cancer disparities.
Faina Linkov, PhD Univerisity of Pittsburgh Cancer Institute
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Transcript of 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 DisparitiesReducing Cancer Health Disparities Integrated Clinical Trials System Integrated Clinical Trials System
Advanced TechnologiesAdvanced Technologies Molecular Epidemiology Molecular Epidemiology Integrative Cancer BiologyIntegrative Cancer Biology Strategic Development of Cancer Strategic Development of Cancer InterventionsInterventions Prevention, Early Detection and Prevention, Early Detection and PredictionPrediction
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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 SitesRacial/Ethnic Group
Incidence Death
All 470.1 192.7African 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 CancersWomen
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 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
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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 AmericansHighest 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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Burden of Cancer in U.S.Overall Cancer Disparities
African Americans
Hispanics/Latinos
Asian Americans/Pacific Islanders
American Indians/Alaska Natives
Source: Surveillance, Epidemiology and End-Results Users Program, 2002. Numbers per 100,000 persons
Whites
CANCER INCIDENCE
352.4
512.3
335.6
233.6
479.7
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Burden of Cancer in U.S.Overall Cancer Disparities
African Americans
Hispanics/Latinos
Asian Americans/Pacific Islanders
American Indians/Alaska Natives
Source: Surveillance, Epidemiology and End-Results Users Program, 2002. Numbers per 100,000 persons
Whites
CANCER MORTALITY
248.1
135.2
132.4
119.9
195.3
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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