Cancer Health Disparities in Hispanics/Latinos
Despite notable progress in the overall health of Americans in general, continuing disparities continue to exist in the burden of illness and death experienced by Hispanics/Latinos, as well as among other special ethnic groups compared to the U.S. population as a whole. Disparities are generally measured by three health statistics: incidence, mortality, and survival rates. It has long been observed by scientists that Hispanics/Latinos, African Americans, Native Americans, Asian Americans and other special population groups do not enjoy the same health status as other groups. Yet research studies consistently show that when patients from different ethnic and racial groups receive the same quality of care, their outcomes are very similar. This means that equal care for cancer results in equal outcomes and equal survival rates, regardless of race or ethnic background.
By 2012, the Hispanic/Latino population in the U.S. is expected to surpass 52 million, and are projected to possibly rank as the 2nd largest Hispanic population in the world, ranking only behind Mexico. Hispanics/Latinos have become the largest minority group in the nation. (1) And with a growth rate of 3.6 percent, the Hispanic population is predicted to reach 60 million by 2020, 73 million by 2030 and 88 million by 2040. (1) As in other U.S. populations, cancer is a leading cause of morbidity and premature death in this burgeoning minority group. The cancer profile of the Latino population is difficult to characterize because of the diversity of Latino subgroups whose risk behaviors, practices, and access to care vary widely.
Hispanics/Latinos are also affected by many economic and cultural disparities in health care, including disproportionate participation in federally funded cancer research. In addition, lack of involvement in health research has hindered the development of prevention and treatment efforts for this special population group. Among Hispanics, inadequate screening and preventive care often leads to late diagnosis, later or inadequate treatment and, with some cancers, higher mortality.
Lower Screening Participation Rates Among Hispanic Women
Poverty, lack of insurance, low education, limited access to health care, lack of awareness about breast cancer risks and screening methods, lack of physician referrals, acculturation levels and barriers related to language, culture, and negative provider attitudes play an important role in the lower rates of screening services utilized by Hispanic women. (2, 3-6)
Low screening participation rates make Hispanic women more likely to be diagnosed at a more advanced stage of cancer when fewer treatment options are available, resulting in poorer outcomes and higher mortality. (2, 3-6)
- While Hispanics/Latinos represent about 15% of the population, they make up 30.4% of the nation's uninsured, making them the largest portion of uninsured persons in the country. (7)
- Since Hispanics are almost 3 times less likely to have a consistent source of medical care, they rely more heavily on emergency room treatment. Latinos are 1.5 times more likely to use the hospital ER as their primary source of care than the general population. (8)
- Among children, 30% of Hispanics are uninsured, compared with nearly 20% of Blacks and 13% of Whites. (8)
- Latino children are more likely to be living in poverty than non-Hispanic White children. Hispanic children represented 15.7% of all children in the United States but constituted over one-fourth (28.5%) of all children in poverty. Based on 1998 data, 34.4% of Hispanic children under 18 years of age were living in poverty, compared with only 10.6% of non-Hispanic White children. (9)
- Uninsured Hispanics are 2 to 3 times more likely to have cancer diagnosed at a later stage, making it less treatable. (8)
- Uninsured Latinas with breast cancer are 2.3 times more likely to be diagnosed at a later stage. And uninsured Hispanic men with prostate cancer are 3.75 times more likely to be diagnosed at a later stage. (8)
- Health risks experienced by the uninsured Latino population include a reduced access to care and poorer medical outcomes. The uninsured are less likely to have a regular source of medical care, less likely to have had a recent physician visit, more likely to delay seeking medical care, more likely to report they have not received needed care, and less likely to use preventive services. (8)
- Among Hispanics overall, lower socioeconomic and education levels negatively impact health status (e.g., economic status directly relates to availability of health insurance and access to care). (10)
Cancer Sites, Incidence and Mortality Rates
- The leading cancer sites for Hispanic men and women are the same as those for Whites: prostate, breast, lung, and colon and rectum. (10,11)
- Incidence rates among Hispanics for each of these cancers are at least 30% lower than rates for Whites, although patients are generally diagnosed at a later stage of the disease due to lack of access to care and low participation in pre-screening prevention programs. (10, 11)
- The 5 most frequently diagnosed cancers among Hispanic men are prostate, lung and bronchus, colon and rectum, urinary bladder, and stomach. (12)
- The 5 most frequently diagnosed cancers among Hispanic women are breast, colon and rectum, lung and bronchus, cervix uteri, and corpus uteri. (12)
- The 5 most common types of cancer deaths among Hispanic men are lung and bronchus, prostate, colon and rectum, stomach, and pancreas. (12)
- The 5 most common types of cancer deaths among Hispanic women are breast, lung and bronchus, colon and rectum, pancreas, and ovary. (12)
- Lung cancer is the leading cause of cancer deaths among Hispanics. Smoking is responsible for 87% of U.S. lung cancer deaths. (13, 14)
- Lung cancer deaths are about 3 times higher for Hispanic men (23.1 per 100,000) than for Hispanic women (7.7 per 100,000). The rate of lung cancer deaths per 100,000 is higher among Cuban American men (33.7) than among Puerto Rican (28.3) and Mexican American (21.9) men. (13, 14)
- The Centers for Disease Control and Prevention's 1999 Youth Risk Behavior Surveillance System (YRBSS) found that about one-third of Hispanic high school students in grades 9 through 12 were current smokers. Smoking prevalence among Hispanic students increased by one-third from 1991 (25.3%) to 1997 (34.0%). Recent YRBSS data shows that current smoking trends among Hispanic students remain high, but appeared to have plateaued with no statistically significant difference between 1997 and 1999 -- 34.0% and 32.7%, respectively. (14, 15)
- Tobacco products are advertised and promoted disproportionately to racial/ethnic minority communities. Examples of target promotions include the introduction of a cigarette product with the brand name "Rio" and an earlier cigarette product named "Dorado," which was advertised and marketed to the Hispanic American community. (13, 14)
- To increase its credibility in the Hispanic community, the tobacco industry has contributed to programs that aim to enhance the primary and secondary education of children, has funded universities and colleges, and has supported scholarship programs targeting Hispanics. Tobacco companies have also placed advertising in many Hispanic publications. The industry also contributes to cultural Hispanic events and provides significant support to the Hispanic art community. (13, 14)
- In general, smoking rates among Mexican American adults increase as they learn and adopt the values, beliefs, and norms of American culture. (16)
- Although Hispanics have lower breast cancer rates (69.8 per 100,000) than do non-Hispanic White or Black women (111.8 and 95.4, respectively), this is the leading cause of cancer death among Hispanic women. (17, 18)
- Only 38% of Hispanic women age 40 and older have regular screening mammograms, a simple procedure that can detect breast cancer at its earliest stage, before clinical symptoms develop. (11, 17, 19)
- Age, income, education, health insurance coverage, language proficiency, physician referrals, system barriers, are some of the factors that influence the participation of Hispanic women in the utilization of screening services. Other factors include cultural beliefs about modesty and sexual behavior, fatalism, acculturation factors unrelated to language use, family-centered values, and existing social support networks. The degree to which each Hispanic population group in each locale holds onto beliefs about cancer may play an important role in levels of participation. (2-6)
- Hispanic women have lower breast cancer screening rates than non-Hispanic White women and tend to seek and attain health care services less than other ethnic groups. (3-4, 20)
- The five-year survival rate for non-Hispanic White women with breast cancer is 85%, while for Hispanic women it is 76%. (21)
- Hispanics experienced the highest invasive cervical cancer incidence rates (16.2 per 100,000) of any group other than Vietnamese, and twice the incidence rates of non-Hispanic White women (7.9 per 100,000). (2, 11, 18, 23)
- Factors related to higher cervical cancer mortality among Latinas are most certainly due to the underutilization of Pap smear screening in this population. (2, 24)
- Cervical cancer risk is high among Latinas, with incidence rates that are double those of Whites. This risk differential has not appreciably improved over the last decades. Cervical cancer mortality is also markedly higher among Latinas. (24)
- Low screening rates among Hispanic women increase the likelihood of cervical cancer diagnosis at a more advanced stage of the disease when fewer treatment options are available, resulting in poorer outcomes and higher mortality. (2-3, 21)
- Colorectal cancer is the third most common cancer in Hispanic men and the second most common cancer in Hispanic women in the United States. Hispanic men have a colorectal cancer incidence rate of 35.5 per 100,000 and Hispanic women have an incidence rate of 24.3 per 100,000. (25, 26)
- According to the 1992 National Health Interview Survey Results, Hispanics are less likely than non-Hispanics to report having had a screening test for colorectal cancer. Low screening rates among Hispanics indicate a great need for providing education to Hispanics about the importance of early screening for, and detection of, colorectal cancer and an equally great need for increasing Hispanic's access to these critical health services. (26)
Prostate, Stomach, Liver and Gallbladder Cancers
- Prostate cancer is among the five most frequently diagnosed cancers among Hispanic men, and it is the second most common type of cancer death among Hispanic men. (12)
- Uninsured Hispanic men with prostate cancer are 3.75 times more likely to be diagnosed at a later stage. (8)
- While rates of stomach cancer have decreased dramatically over the decades among all race and ethnic groups, Latinos still have higher risks than Whites. (24)
- Although stomach cancer has long been known to be related to socioeconomic status, little is known about the exact causes of the high risk among Latinos. Among males, stomach cancer rates are 30 percent to 90 percent higher than Whites in the same geographic area. Incidence rates are 50 percent to twofold higher among Latina than among non-Latina populations. (24)
- For both males and females, incidence of primary liver cancer is about twice as high as for non-Latinos in the same area. Rates of primary liver cancer appear to be particularly high among Mexican Americans in Texas, even when compared to Latinos in California or other regions. (24)
- Primary liver cancer has several known risk factors -- these are Hepatitis B and C viruses, exposure to aflatoxins, cirrhosis, and alcohol use. (27) Which of these risk factors explains the excessive risks observed in Latinos is as yet unknown. Another risk factor suggested but not directly proven is exposure to chemicals or organic solvents via agricultural occupations. (24, 27)
- Incidence rates for gallbladder cancer are excessive in Latino populations compared to non-Latinos. Although relatively rare, rates are about 1 per 100,000 in Latino males and about 3-4 per 100,000 in Latinas. (24)
- US Census Bureau. Population Projections Program. Population Division. (NP-D1-A) Projections of the resident population by age, sex, race, and Hispanic origin: 1999-2100. Washington DC; 2000. Available from: URL: http://www.census.gov/population/projections/nationa/deail/d1999_00.pdf
- Ramirez AG, Suarez L, McAlister A, Villarreal R, Trapido E, Talavera GA, P?rez-Stable E, Marti J. Cervical cancer screening in regional Hispanic populations. Am J Health Behav 2000; 24(3): 181-92.
- Ramirez AG, Talavera GA, Villarreal R, Suarez L, McAlister A, Trapido E, P?rez-Stable E, Marti J. Breast cancer screening in regional Hispanic populations. Health Educ Res 2000; 15(5): 559-68.
- Ramirez AG, McAlister A, Gallion K, Villarreal R. Targeting Hispanic populations: future research and prevention strategies. Environ Health Perspect 1995; 103(8 Suppl):287-90.
- Ramirez AG, Suarez L, Laufman L, Barroso C, Chalela P. Hispanic women's breast and cervical cancer knowledge, attitudes and screening behaviors. Am J Health Promot 2000; 14(5):292-300.
- US Department of Health and Human Services. Racial and ethnic disparities in health. February 21, 1998. Available from: URL: http://raceand-health.hhs.gov/3rdpgBlue/Cancer/3pgGoalsCancer.htm
- National Center for Health Statistics. Health, United States, 2002 With Chartbook on Trends in the Health of Americans. Hyattsville, Maryland: National Center for Health Statistics; 2002.
- American College of Physicians - American Society of Internal Medicine. No health insurance? It's enough to make you sick. Latino community at great risk. Philadelphia: College of Physicians - American Society of Internal Medicine; White Paper; 2000. (Available from American College of Physicians - American Society of Internal Medicine, 190 N. Independence Mall West, Philadelphia, PA 19106).
- US Census Bureau. The Hispanic population in the United States: 1999. Current Population Reports, Series P20-527. Washington, DC; 2000. Available from: URL: http://www.census.gov/prod/2000pubs/p20-527.pdf
- Ramirez AG, Suarez L. (2000a). Hispanic cultures, Latinos, Central Americans. 2000 in press.
- American Cancer Society. Cancer facts and figures 1997. Available from: URL: http://www.cancer.org/statistics/97cff/97racial.html
- Miller BA, Kolonel LN, Bernstein L, Young Jr JL, Swanson GM, West D, Key CR, Liff JM, Glover S, Alexander GA, et al, editors. Racial/ethnic patterns of cancer in the United States 1988-1992. Bethesda, MD: National Cancer Institute; 1996. NIH Pub. No. 96-4104. Available from: URL: http://www-seer.ims.nci.nih.gov/Publications/REPoC/
- Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion. Tobacco information and prevention source (Tips) - Hispanics and tobacco. 2000. Available from: URL: http://www.cdc.gov/tobacco/sgr/sgr__1998/sgr-min-fs-hsp.htm
- US Department of Health and Human Services. Tobacco use among US racial/ethnic minority groups -- African Americans, American Indians and Alaska Natives, Asian Americans and Pacific Islanders, and Hispanics: a report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 1998.
- Centers for Disease Control and Prevention. Youth risk behavior surveillance-United States, 1999. MMWR Morb Mortal Wkly Rep 2000; 49, No. SS-5.
- Action on Smoking and Health. Surgeon General's report AT-A-GLANCE: tobacco use among US racial/ethnic minority groups. 1998. Available from: URL: http://no-smoking.org/april98/04-27-98-7.html
- National Cancer Institute. Cancer facts: breast cancer and mammography facts, 1998. Available from: URL: http://cis.nci.nih.gov/fact/6_29.htm
- Ries LAG, Kosary CL, Hankey BF, Miller BA, Edwards BK, editors. SEER cancer statistics review, 1973-1995. Bethesda, MD: National Cancer Institute; 2000. Available from: URL: http://www-seer.ims.nci.nih.gov/Publications/CSR7395/
- Susan G. Komen Foundation. Breast health. Hispanic women and breast cancer. 1998. Available from: URL: http://www.breastcancerinfo.com/bhealth/html/hispanic.html
- The National Cancer Institute Cancer Screening Consortium for Underserved Women. Breast and cervical cancer screening among underserved women. Baseline survey results from six studies. Arch Fam Med 1995; 4(7):617-24.
- Gilliland FD, Hunt WC, Key CR. Trends in the survival of American Indian, Hispanic, and Non-Hispanic White cancer patients in New Mexico and Arizona, 1969-1994. Cancer 1998; 82(9): 1769-83.
- Miller AR, Ramirez AG, Aparacio-Ting F, San Miguel de Majors S, Pollock BH (2003). Breast cancer fear factor deadly to Hispanics. American College of Surgeons 2003 Clinical Congress. Philadelphia, PA; Oct. 2003.
- Parker SL, Davis KJ, Wingo PA, Ries LAG, Heath CW. Cancer statistics by race and ethnicity. CA Cancer J Clin 1998; 48(1):31-48.
- Ramirez AG, Suarez L. The impact of cancer in Latino population. In: Aguirre-Molina M, Molina C, Zambrana R, editors. Latino health book; 2000 in press.
- American Cancer Society. Cancer facts and figures 1999. Atlanta, GA: American Cancer Society; 1999, p18-21. Available from: URL: http://www3.cancer.org/cancerinfo/sitecenter.as;?ct=1&ctid=8&scp=220.127.116.11002&scs=2&scss=2&scdoc=42046
- The National Alliance for Hispanic Health. The National Hispanic Colorectal Cancer Outreach and Education Program (NHCCOP). 2000. Available from: URL: http://www.hispanichealth.org/cancer.html
- London TW, McGlynn KA. Liver Cancer. In: Schottenfeld and Fraumeni, Editors. Cancer epidemiology and prevention. New York: Oxford Press; 1996.
Source: Intercultural Cancer Council: Cancer Fact Sheets. Additional facts and information on Hispanics/Latinos, as well as for other underserved population groups can be found at: URL: http://iccnetwork.org/cancerfacts