Racial/Ethnic Disparities in Cancer Incidence, Survival and Treatment Linda C. Harlan, PhD, MPH National Cancer Institute Division of Cancer Control and Population Sciences

Disparities in Cancer Age Age Gender Gender Marital Status Marital Status Income Income Education Education Insurance Insurance Health System Characteristics Health System Characteristics Geographic Geographic Race/Ethnicity Race/Ethnicity

Age-Adjusted US Mortality Rates for the Most Common Cancers by Race/Ethnicity for Source: US population NCHS

Racial/Ethnic Disparities Along the Cancer Continuum Incidence Incidence Screening Screening Stage at Diagnosis Stage at Diagnosis Therapy Therapy Survival Survival

Age-Adjusted Incidence Rates for the Most Common Cancers by Race/Ethnicity for Source: SEER

Percentage of Women Age 40 and Older Reporting Having Mammography in the Past Two Years Source: NCHS

Documented Time Elapsed Since Last Mammogram for Women Age 40 and Older by Racial/Ethnic Group* Source: Smith-Bindman, 2006 *Adjusted for age and registry

SEER Data Population-Based Registries Population-Based Registries Register all cancer cases within a geographic areas Register all cancer cases within a geographic areas 26% of the US population 26% of the US population Detailed data on Detailed data on Demographics Demographics Tumor characteristic Tumor characteristic Treatment Treatment Active follow-up of cases Active follow-up of cases Public use files, available to researchers Public use files, available to researchers Analysis program associated with data Analysis program associated with data

Stage at Diagnosis of In Situ and Invasive Breast Cancer by Race/Ethnicity for Cases Diagnosed in Source: SEER

5-year Cancer-Specific Survival by Race/Ethnicity and Stage for Invasive Breast Cancer Patients Diagnosed Between Source: SEER

Percentage of Women Receiving Radiation Following Breast Conserving Surgery by Racial/Ethnicity and Year of Diagnosis Tumor < 5cm Source: SEER

Percent of Breast Cancer Cases Receiving Radiation Following BCS by Race/Ethnicity and County Family Poverty Rate Source: SEER Families at or Below Poverty Level

Use of Adjuvant Chemo/Hormonal Therapy for Early Stage, Node Negative Breast Cancer by Race/Ethnicity, and ER status 2000 ER negativeER positive Source: Harlan unpublished

Adjusted* Percentage of Patients Diagnosed 1995 through 1999 Receiving Guideline Therapy by Insurance Status and Race/Ethnicity *Charlson score, stage, number of positive lymph nodes, residency training program, hospital bed size, age, marital status, % high school diploma, gender, geographic region Source: Harlan, 2005

Summary Racial/ethnic disparities occur across the cancer continuum Racial/ethnic disparities occur across the cancer continuum Screening Screening Stage at diagnosis Stage at diagnosis Treatment Treatment Survival Survival

Data Sources Surveillance, Epidemiology and End-Results Data Surveillance, Epidemiology and End-Results Data Demographic, tumor characteristic, surgery and radiation Demographic, tumor characteristic, surgery and radiation Active follow-up for vital status Active follow-up for vital status SEER-Medicare linked file SEER-Medicare linked file Cancer cases age 65+ and a 5% sample of non-cancer patients Cancer cases age 65+ and a 5% sample of non-cancer patients SEER data + SEER data + Treatment data, long-term medical follow-up, procedures Treatment data, long-term medical follow-up, procedures Breast Cancer Surveillance Consortium Breast Cancer Surveillance Consortium Mammography registries Mammography registries