1. 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
(preferred mode of communications): fyL1 (at) pitt.edu
Faina Linkov, PhD Univerisity of Pittsburgh Cancer Institute

2. 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.

3. 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

4. True of false?
Most disparities have genetic basis
False.

5. 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

6. 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

7. 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.

8. 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

9. 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.

10. 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…

11. 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
Statistics are for , 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.*

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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, Numbers per 100,000 persons

20. 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, Numbers per 100,000 persons

21. 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.