Faina Linkov, PhD Univerisity of Pittsburgh Cancer Institute Cancer disparities Faina Linkov, PhD Research Assistant Professor of Medicine and Epidemiology University of Pittsburgh Cancer Institute E-mail (preferred mode of communications): fyL1 (at) pitt.edu Faina Linkov, PhD Univerisity of Pittsburgh Cancer Institute

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." Cancer disparities exist not only in the US, but around the world.

True of false? Disparities exist only because of poverty False. Many different factors were implicated in cancer disparities, including genetics, access to care, and many other factors discussed later

True of false? Most disparities have genetic basis False.

True of false? Minority groups in most countries have poorer health outcomes True. This is true for minority populations in the US, as well as around the world

True of false? Minority groups in various countries around the world countries have poorer health outcomes True. This is true for minority populations in the US, as well as around the world

Seven Strategic NCI Priorities 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 Reducing cancer disparities is one of the key strategic priorities at NCI.

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

What is the cause of cancer disparities? The exact cause of cancer disparities is a very complex issue, that is why it is important to talk about cancer disparities.

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…

Table 1. Overall Cancer Incidence and Death Rates   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 From http://www.cancer.gov/cancertopics/factsheet/cancer-health-disparities#1 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.*

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

Dietary components and risk of common cancers 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

Physical Activity and risk of common cancers 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

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

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

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

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

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

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

What makes these population groups different Different levels of infection with h. pylori and hpv Differential access to care Genetics Insurance coverage SES All these factors must be investigated to get to the core of cancer disparities.