Faina Linkov, PhD Univerisity of Pittsburgh Cancer Institute

1. Faina Linkov, PhDUniverisity 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 • 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 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.*

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

14. Physical Activity and risk of common cancers 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 andstomach 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, 2002.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, 2002.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