Coming to America: Cancer Trends among Filipinos in Manila and Los Angeles Andrea Sipin-Baliwas Los Angeles Cancer Surveillance Program University of Southern California NAACCR/IACR Meeting June 13, 2019 Vancouver, Canada

BACKGROUND First large group of immigrants arrived in California in 1923  2,426 admitted Earlier immigration to Hawaii High demand for agricultural labor on the West Coast (California, Oregon, and Washington) Referred to as “manongs” Education Exchange Act passed in 1948 Enabled foreign nurses to study and gain experience in the U.S.

DISTRIBUTION OF FILIPINO RESIDENCY Table 1. Top concentrations by Metropolitan Area for Filipinos, 2012-2016 Figure 1. Top States of Residence for Filipinos in the United States, 2012-2016 https://www.migrationpolicy.org

FILIPINOS IN LOS ANGELES COUNTY Filipino-Americans (FA) are the 2nd largest group making up the Asian demographic in LAC (2015) Relatively large population in Southern California allows for robust studies focus on health issues prominent in this community Since 1973, the overall cancer incidence rates for Filipinos have risen in LAC for both males and females, while rates have declined in Manila

METHODS Most currently available population-based data from Los Angeles County, Manila (Cancer Incidence in Five Continents database), and SEER we will calculate the following trends while examining screenable cancers: Site-specific incidence Mortality Survival (Relative)

SCREENABLE CANCERS Prostate Cervix Breast Colorectal Lung

INCIDENCE (Male) USA, California, Los Angeles: Filipino (1983-2012) Male, age [0-85+] Cancer Cases Crude rate ASR (World) All cancers excluding non-melanoma skin (C00-96/C44) 10698 296.4 239.7 Prostate (C61) 3252 90.1 72.6 Lung (incl. trachea) (C33-34) 1795 49.7 39.7 Colon (C18) 772 21.4 17.1 Non-Hodgkin lymphoma (C82-86,C96) 560 15.5 12.6 Rectum and anus (C19-21) 546 15.1 12.3 Philippines, Manila (1983-2012) Male, age [0-85+] Cancer Cases Crude rate ASR (World) All cancers excluding non-melanoma skin (C00-96/C44) 79862 104.6 202.9 Lung (incl. trachea) (C33-34) 17703 23.2 48.9 Prostate (C61) 6965 9.1 24.3 Liver and intrahepatic bile ducts (C22) 8836 11.6 21.2 Colon (C18) 5294 6.9 14.4 Lip oral cavity and pharynx (C00-14) 5871 7.7 13.1 USA, SEER (9 registries): White (1983-2012) Male, age [0-85+] Cancer Cases Crude rate ASR (World) All cancers excluding non-melanoma skin (C00-96/C44) 1488056 501.6 360.2 Prostate (C61) 425432 143.4 101.6 Lung (incl. trachea) (C33-34) 217605 73.4 51.2 Colon (C18) 106761 36 24.3 Bladder (C67) 102257 34.5 23.2 Melanoma of skin (C43) 69443 23.4 17.6

INCIDENCE (Male) Prostate, lung, and colon cancer are among the top 5 cancer sites across SEER White, Filipinos-Manila, and Filipinos-LA Despite screening efforts, prostate cancer is the most common for Filipinos in LA and SEER White No population screening in the Philippines (PSA) Lung cancer is the most common for Filipinos in Manila

MORTALITY (Male) *SEER 9 White and LAF rates were calculated using incidence-based (IB) mortality while Manila rates were calculated using death certificate (DC)-based mortality; IB mortality is slightly lower than DC mortality.

MORTALITY (Male) *SEER 9 White and LAF rates were calculated using incidence-based (IB) mortality while Manila rates were calculated using death certificate (DC)-based mortality; IB mortality is slightly lower than DC mortality.

MORTALITY (Male) *SEER 9 White and LAF rates were calculated using incidence-based (IB) mortality while Manila rates were calculated using death certificate (DC)-based mortality; IB mortality is slightly lower than DC mortality.

INCIDENCE (Female) Philippines, Manila (1983-2012) Female, age [0-85+] Cancer Cases Crude rate ASR (World) All cancers excluding non-melanoma skin (C00-96/C44) 106793 133.6 198.7 Breast (C50) 30127 37.7 55.2 Cervix Uteri (C53) 11290 14.1 19.6 Lung (incl. trachea) (C33-34) 6862 8.6 14.8 Ovary (C56) 6728 8.4 11.7 Colon (C18) 5237 6.5 11.1 USA, California, Los Angeles: Filipinas (1983-2012) Female, age [0-85+] Cancer Cases Crude rate ASR (World) All cancers excluding non-melanoma skin (C00-96/C44) 13094 310.6 220.4 Breast (C50) 4921 116.7 84.6 Thyroid (C73) 944 22.4 16.9 Corpus uteri (C54) 961 22.8 16.6 Lung (incl. trachea) (C33-34) 936 22.2 14.4 Colon (C18) 784 18.6 12.1 USA, SEER (9 registries): White (1983-2012) Female, age [0-85+] Cancer Cases Crude rate ASR (World) All cancers excluding non-melanoma skin (C00-96/C44) 1378777 454.6 287 Breast (C50) 409960 135.2 90.5 Lung (incl. trachea) (C33-34) 170646 56.3 33 Corpus uteri (C54) 86871 28.6 19.1 Colon (C18) 114840 37.9 19 Melanoma of skin (C43) 55958 18.4 13.7

INCIDENCE (Female) Breast, lung, and colon cancer are among the top 5 cancer sites across SEER White, Filipinas-Manila, and Filipinas-LA Despite screening efforts, breast cancer is the most common for all three groups According to a randomized trial in the Philippines, breast cancer cases generally present at advanced stages Too expensive to have a nationwide program that requires screening every 2 years for women between 50 and 69 Main reasons to refuse follow up in the Philippines: Cost Lack of trust in health system Fear of having the disease

INCIDENCE (Female) Among Filipinas in Manila, cervical cancer is the 2nd most common (Not a top 5 site for LAF or SEER White) Low uptake of pap smear screening Human Papillomavirus (HPV) types 16 and 18 are most common HPV vaccination recently introduced Screening programs such as pap smears, visual inspection w/ acetic acid and cryotherapy, and colposcopy are available  low uptake Pap smear first introduced in the Philippines in the 1990’s (women ages 35-55, once in a lifetime)

MORTALITY (Female) *SEER 9 White and LAF rates were calculated using incidence-based (IB) mortality while Manila rates were calculated using death certificate (DC)-based mortality; IB mortality is slightly lower than DC mortality.

MORTALITY (Female) *SEER 9 White and LAF rates were calculated using incidence-based (IB) mortality while Manila rates were calculated using death certificate (DC)-based mortality; IB mortality is slightly lower than DC mortality.

MORTALITY (Female) *SEER 9 White and LAF rates were calculated using incidence-based (IB) mortality while Manila rates were calculated using death certificate (DC)-based mortality; IB mortality is slightly lower than DC mortality.

MORTALITY (Female) *SEER 9 White and LAF rates were calculated using incidence-based (IB) mortality while Manila rates were calculated using death certificate (DC)-based mortality; IB mortality is slightly lower than DC mortality.

Survival Laudico, A., & Mapua, C. (2011). Cancer survival in Manila, Philippines, 1994-1995. Cancer survival in Africa, Asia, the Caribbean and Central America. IARC Scientific Publications, 162, 147-54.

Survival Laudico, A., & Mapua, C. (2011). Cancer survival in Manila, Philippines, 1994-1995. Cancer survival in Africa, Asia, the Caribbean and Central America. IARC Scientific Publications, 162, 147-54.

Survival Laudico, A., & Mapua, C. (2011). Cancer survival in Manila, Philippines, 1994-1995. Cancer survival in Africa, Asia, the Caribbean and Central America. IARC Scientific Publications, 162, 147-54.

CONCLUSION Males and females across all three groups share some of the same most common cancer sites Filipino males in Los Angeles have similar mortality rates to SEER Whites for prostate, lung, and colon cancer Filipino females in Los Angeles have very similar mortality rates to SEER Whites for breast cancer only Filipinos in Manila have poorer survival across three of the most common cancer sites (M/F colon, F cervical and breast) Need to improve efforts to decrease mortality rates in screenable cancer sites Incidence and mortality rates are higher in SEER White and LAF Further analyses needed

THANK YOU Co-Authors: Dennis Deapen, DrPH Amie Hwang, PhD Lihua Liu, PhD Ziwei Song Acknowledgements: Juanjuan Zhang Joshua Hack James Huynh The collection of cancer incidence data used in this study was supported by the California Department of Public Health pursuant to California Health and Safety Code Section 103885; Centers for Disease Control and Prevention’s (CDC) National Program of Cancer Registries, under cooperative agreement 5NU58DP006344; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract HHSN261201800032I awarded to the University of California, San Francisco, contract HHSN261201800015I awarded to the University of Southern California, and contract HHSN261201800009I awarded to the Public Health Institute.  The ideas and opinions expressed herein are those of the author(s) and do not necessarily reflect the opinions of the State of California, Department of Public Health, the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors.

Watsonville, CA 1956