1. Faina Linkov, PhD University of Pittsburgh Cancer Institute Cancer disparities

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."

3. True of false? Disparities exist only because of poverty

4. True of false? Most disparities have genetic basis

5. True of false? Minority groups in most countries have poorer health outcomes

6. True of false? Minority groups in various countries around the world countries have poorer health outcomes

7. Burden of Cancer in U.S. Seven Strategic NCI Priorities  Reducing Cancer Health Disparities Integrated Clinical Trials System  Integrated Clinical Trials System  Advanced Technologies  Molecular Epidemiology  Integrative Cancer Biology  Strategic Development of Cancer Interventions  Prevention, Early Detection and Prediction

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?

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 IncidenceDeath All470.1192.7 African American/Black 504.1238.8 Asian/Pacific Islander 314.9115.5 Hispanic/Latino356.0129.1 American Indian/Alaska Native 297.6160.4 White477.5190.7

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 CancerIncrease RiskDecrease Risk Breast Alcohol, excess energy intake, weight gain Vegetables, monounsaturated fats Colon Red meatFruit/vegetable fiber, Alcohol Lung Vegetables, especially green/yellow Prostate MeatLycopene (tomatoes) GI Alcohol, SodiumFruit/vegetables

14. Physical Activity and risk of common cancers CancerCancer 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. 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

20. 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

21. What makes these population groups different Different levels of infection with h. pylori and hpv Differential access to care Genetics Insurance coverage SES

22. Review Questions (Developed by the Supercourse team) What is the cause of cancer disparities? How does NCI define disparities? Give examples of differential mortality for Caucasians, African American, Latin American, and Native American groups Why do you think African Americans have some of the highest mortality rates in the US?