A new analysis has found that Hispanic lung cancer patients seem to live longer than white or black patients. Published early online in Cancer, a peer-reviewed journal of the American Cancer Society, the study suggests that, as with several other types of cancer, certain yet-to-be-defined genetic and/or environmental factors put Hispanic patients at a survival advantage.
Most studies that look at ethnic and racial disparities in lung cancer compare black patients with whites. To see how Hispanics compare with other ethnicities with regards to survival after a lung cancer diagnosis, Ali Saeed, an MD/PhD candidate, and Brian Lally, MD, of the University of Miami Miller School of Medicine, led a team that analyzed patient information from the Survival, Epidemiology, and End Results (SEER) Database, which compiles incidence and survival data from population-based cancer registries in the United States.
The investigators identified 172,398 adult patients who were diagnosed with any stage of non-small cell lung cancer (the most common form of lung cancer) between 1988 and 2007.
Compared with white patients, Hispanic patients had a 15 percent lower risk of dying during the years of the study, whether they were born in the United States or not.
“This is important because it shows that our findings are indicative of the Hispanic population in general and not specific to specific groups of Hispanics,” said Saeed. Black patients were slightly more likely to die than whites. Also, Hispanics were more likely to develop a lung cancer type called bronchioalveolar carcinoma that is not as serious or life-threatening as other types.
“Our findings will motivate researchers and physicians to understand why Hispanics have more favorable outcomes and may shed light on potential environmental factors and/or genetic factors that can explain our observations,” said Saeed. “For instance, the fact that Hispanics developed higher frequencies of bronchioalveolar carcinoma could be due to genetic predispositions and/or their lower smoking rates.” (Smokers are at increased risk for developing tumor types associated with a poor prognosis.)
- The five most common types of cancers by incidence in
Hispanic/Latino men are prostate, colon and rectum, lung
and bronchus, urinary bladder, and non-Hodgkin lymphoma.
The five most common cancers causing death in Hispanic/
Latino men are lung and bronchus, prostate, colon and
rectum, liver and intrahepatic bile duct, and pancreas.
- The five most common types of cancers by incidence in
Hispanic/Latino women are breast, colon and rectum, lung
and bronchus, corpus and uterus, and non-Hodgkin
lymphoma. The five most common cancers causing death in
Hispanic/Latino women are breast, lung and bronchus, colon
and rectum, pancreas, and ovarian.
- The incidence rate of gastric cancer in Hispanic/Latino men
(17.8 per 100,000) and women (10 per 100,000) when
compared with non-Hispanic/Latino white men (10.8) and
women (5.0) is higher.
- The incidence rate of liver and bile duct cancer in
Hispanic/Latino men (13.5 per 100,000) and women (5.8 per
100,000) is higher than that of non-Hispanic/Latino white
men (7.2 per 100,000) and women (2.9 per 100,000).
- The mortality rate for cervical cancer among Hispanic/Latino
women is 3.3 per 100,000 compared to 2.6 per 100,000 for
women of all races.
Saeed noted that the results fit into a phenomenon known as the “Hispanic paradox,” in which Hispanics tend to have more favorable outcomes after being diagnosed with certain diseases despite having socioeconomic factors (such as decreased access to health care and higher poverty rates) that would predict otherwise. This paradox is seen for breast cancer, prostate cancer, cardiovascular disease, and now non-small cell lung cancer.
Racial/Ethnic Disparities and Geographic Differences in Lung Cancer Incidence - 38 States and the District of Columbia, 1998-2006
Lung cancer is the second most commonly diagnosed cancer in both males and females and the leading cause of cancer-related death in the United States. Lung cancer affects some races more than others; blacks have higher incidence and mortality rates than do whites. This report presents the first analysis of lung cancer incidence among racial/ethnic groups by U.S. census region. CDC analyzed data collected by CDC’s National Program of Cancer Registries (NPCR) and the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program for the period 1998-2006. These combined data reflect new lung cancer cases representing approximately 80% of the U.S. population. During this study period, annual incidence per 100,000 population was highest among blacks (76.1), followed by whites (69.7), American Indians/Alaska Natives (AI/ANs) (48.4), and Asian/Pacific Islanders (A/PIs) (38.4). Hispanics had lower lung cancer incidence (37.3) than non-Hispanics (71.9). Incidence varied greatly with age, peaking among persons aged 70-79 years (426.7). The region with the highest incidence was the South (76.0); the lowest was the West (58.8). Among whites, the highest lung cancer incidence was in the South (76.3); the highest incidence among blacks (88.9), AI/ANs (64.2), and Hispanics (40.6) were in the Midwest, and the highest incidence among A/PIs was in the West (42.5). These findings identify the racial/ethnic populations and geographic regions that would most benefit from enhanced efforts in primary prevention, specifically by reducing tobacco use and exposure to environmental carcinogens.
Data available from population-based cancer registries affiliated with NPCR, the SEER Program, or both were used in this analysis; new cases of cancer were those reported in NPCR as of January 31, 2009, and in SEER as of November 1, 2008. Data were evaluated according to United States Cancer Statistics (USCS) eligibility criteria.* Thirty-eight states and the District of Columbia met these criteria, representing 79.5% of the U.S. population for the years 1998-2006. Because of the 79.5% population coverage, cancer rates derived from these data are considered to approximate national incidence. Only cancer cases with the primary site of lung or bronchus, according to the World Health Organization’s International Classification of Diseases for Oncology, Third Edition, were included in this analysis. Incidence is presented as average annual number of new cases per 100,000 persons. All findings are statistically significant unless otherwise noted. With the exception of age-specific rates, rates are age-adjusted to the 2000 U.S. standard population with 19 age groups.† Adjustments to population data were made by the U.S. Census Bureau to account for the Gulf Coast population in Alabama, Mississippi, Louisiana, and Texas displaced by Hurricanes Katrina and Rita in 2005.
TL Fairley, PhD, E Tai, MD, JS Townsend, MS, SL Stewart, PhD, CB Steele, DO, Div of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion; SP Davis, PhD, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion; JM Underwood, PhD, EIS Officer, CDC.