Worse Breast Cancer Outcomes for Southern Nevadans, Filipina and Black Women

Survival of Filipino women with breast cancer in the United States

BACKGROUND

The survival of women with early-stage breast cancer varies by racial group. Filipino women with breast cancer are an understudied group and are often combined with other Asian groups. We compared clinical presentations and survival rates for Filipino and White women with breast cancer diagnosed in the United States.

METHODS

We conducted a retrospective cohort study of women with breast cancer diagnosed between 2004 and 2015 in the SEER18 registries database. We compared crude survival between Filipino and White women. We then calculated adjusted hazard ratios (HR) in a propensity-matched design using the Cox proportional hazards model.

RESULTS

There were 10,834 Filipino (2.5%) and 414,618 White women (97.5%) with Stage I-IV breast cancer in the SEER database. The mean age at diagnosis was 57.5 years for Filipino women and 60.8 years for White women (p < 0.0001). Filipino women had more high-grade and larger tumors than White women and were more likely to have node-positive disease. Among women with Stage I-IIIC breast cancer, the crude 10-year breast cancer-specific survival rate was 91.0% for Filipino and 88.9% for White women (HR 0.81, 95% CI 0.74-0.88, p < 0.01). In a propensity-matched analysis, the HR was 0.73 (95% CI 0.66-0.81). The survival advantage for Filipino women was present in subgroups defined by age of diagnosis, nodal status, estrogen receptor status, and HER2 receptor status.

CONCLUSION

In the United States, Filipino women often present with more advanced breast cancers than White women, but experience better breast cancer-specific survival.

Elevated breast cancer mortality among highly educated Asian American women

Background

Postmenopausal breast cancer (PMBC) is the most commonly diagnosed and the second leading cause of cancer death among women in the US. Research examining the association between PMBC and education level has been inconsistent; no study in the US has examined how educational level impacts PMBC mortality in Asian American women, a largely immigrant population with above-average educational attainment.

Methods

California Vital Statistics data from 2012–2017 were analyzed to derive age-adjusted mortality rate ratios (MRRs) by education level (associates degree or above referred to as “higher education”, high school, less than high school) and race [Non-Hispanic White (NHW), Asian/Pacific Islander (Asian), and its two largest subpopulations: Chinese and Filipino] from negative binomial regression models.

Results

PMBC mortality for both NHWs and Asians was greater among women with higher education compared to those who did not complete high school: NHWs had 22% higher PMBC mortality (MRR 1.22; 95% CI: 1.14–1.31) and Asians had 2.6 times greater PMBC mortality (MRR 2.64; 95% CI: 2.32–3.00) than their counterparts who did not complete high school. Asians in the lowest education level had 70% lower mortality than NHWs (MRR 0.30; 95% CI: 0.27–0.34). This mortality advantage among Asians was greatly reduced to only 27% lower among the highest educated (MRR 0.73; 95% CI: 0.68–0.78). For higher educated Filipina women, no mortality advantage was evident compared to NHWs (MRR 0.96; 95% CI: 0.88–1.05).

Conclusion

PMBC mortality for higher educated Asian women is elevated in comparison to their counterparts with less education. Given that PMBC survival is greater among those with higher education, our findings strongly suggest an excess in the incidence of PMBC (more than double) among higher educated Asian women; this warrants more research into potentially modifiable causes of PMBC in this burgeoning population.

Assessment of Oral Human Papillomavirus Prevalence in Pediatric and Adult Patients within a Multi-Ethnic Clinic Population

Introduction: Human papillomavirus (HPV) encompasses a large family of oncogenic viruses responsible for increasing rates of both cervical and oral cancer, particularly among minority and low-income populations. Although this represents an increasingly significant public health risk, few studies have screened for oral HPV within Nevada. Based upon this information, the primary objective of this study was to provide a temporal analysis of oral HPV screening among a primarily low-income, minority patient population. Methods: This retrospective analysis was reviewed and approved by the Institutional Review Board (IRB). In brief, unstimulated saliva samples were previously obtained from clinical patient volunteers who provided informed consent and pediatric assent (if applicable). DNA was isolated and screened using spectrophotometry for quality (A260:A280 ratio > 1.70) and quantity (concentration > 100 ng). Validated qPCR primers were used to screen repository samples for high-risk HPV strains HPV16 and HPV18. Results: A total of N = 930 samples were identified for this study, which involved n = 555 samples from adults and n = 375 from pediatric patients treated between 2011 and 2019. A demographic analysis revealed nearly equal distribution between males and females with most derived from non-White (minority) patients. A qPCR screening revealed an overall increase in high-risk HPV of 3.17-fold from 5.7% in 2011 to 18.1% in 2019 and a coefficient of determination or R2 = 0.764, suggesting a strong, positive correlation between more recent sample years and HPV-positive results, which was observed among both pediatric (R2 = 0.671) and adult (R2 = 0.971) patients. In addition, although the average age among adult patients increased over time, a significant decrease was observed among pediatric patients from an average of 16.0 years to 14.81 years. Conclusions: These data suggest temporal changes and positive increases in the prevalence of oral HPV among both the pediatric and adult patient samples taken from this clinic population. These data are important as considerations are made regarding which HPV vaccination education and awareness programs are introduced and the specific populations most likely to benefit from these interventions.

Risks of Second Primary Gynecologic Cancers following Ovarian Cancer Treatment in Asian Ethnic Subgroups in the United States, 2000-2016

BACKGROUND

The differential occurrence of second primary cancers by race following ovarian cancer is poorly understood. Our objective was to determine the incidence of second primary gynecologic cancers (SPGC) following definitive therapy for ovarian cancer. Specifically, we aimed to determine differences in SPGC incidence by Asian ethnic subgroups.

METHODS

We identified 27,602 women ages 20 years and older and diagnosed with first primary epithelial ovarian cancer between 2000 and 2016 who received surgery and chemotherapy in 18 population-based Surveillance, Epidemiology and End Results Program registries. We compared the incidence of SPGC with expected incidence rates in the general population of women using estimated standardized incidence ratios (SIR) and 95% confidence intervals (CI).

RESULTS

The incidence of SPGC was lower among White women (SIR = 0.73; 95% CI, 0.59-0.89), and higher among Black (SIR = 1.80; 95% CI, 0.96-3.08) and Asian/Pacific Islander (API) women (SIR = 1.83; 95% CI, 1.07-2.93). Increased risk of vaginal cancers was observed among all women, although risk estimates were highest among API women (SIR = 26.76; 95% CI, 5.52-78.2) and were also significant for risk of uterine cancers (SIR = 2.53; 95% CI, 1.35-4.33). Among API women, only Filipinas had significantly increased incidence of SPGC overall including both uterine and vaginal cancers.

CONCLUSIONS

Risk of SPGC following treatment of ovarian cancer differs by race and ethnicity, with Filipina women having the highest rates of second gynecologic cancers among Asian women.

IMPACT

Ensuring access and adherence to surveillance may mitigate ethnic differences in the early detection and incidence of second gynecologic cancers.

Low colorectal cancer survival in the Mountain West state of Nevada: A population-based analysis

Colorectal cancer (CRC) is the third greatest cancer burden in the United States. The remarkably diverse Mountain West state of Nevada has uncharacteristically high CRC mortality compared to other Western states. We aimed to study the determinants of the CRC excess burden by using data from the Nevada Central Cancer Registry from 2003-2013. Five-year cause-specific age-adjusted survival from colorectal cancer was calculated and stratified by sex, race/ethnicity and region of Nevada. Cox Proportional Hazards regression modelling was used to study the impact of demographic, social, and clinical factors on CRC survival in Nevada, assessing follow-up as accurately as possible. The extent to which differences in survival can be explained by receipt of stage-appropriate treatment was also assessed. 12,413 CRC cases from 2003-2013 in Nevada were analyzed. Five-year CRC survival was low: 56.0% (95% CI: 54.6-57.5) among males and 59.5% (95% CI: 58.0-61.1) among females; significantly lower than national 5-year survival of 65.1% and 66.5%, respectively. Low survival was driven by populous Southern Nevada; after adjustment for all covariates, Southern Nevadans were at 17% higher risk of death than their counterparts in Northwestern Nevada (HR:1.17; 95% CI:1.08-1.27). Many patients did not receive stage-appropriate treatment, although this only partly explained the poor survival, uniformly low for every race/ethnicity in Nevada. The observed disparity for this one state within a single nation merits public health attention; regardless of the state or region of residence, all Americans deserve equal opportunity for optimum health outcomes in the face of a cancer diagnosis. The current study provides baseline information critical to clinicians, public health professionals, and all relevant stakeholders as they attempt to discern why Nevada's outcomes are vastly divergent from its neighboring Western states and make plans for remediation.

A Health Needs Assessment of the Filipino American Community in the Greater Las Vegas Area

Purpose: The number of Filipino Americans in Las Vegas, Nevada, is growing considerably, but no research to date has assessed the specific health needs of this burgeoning population. Thus, this study aims to assess health behaviors, perceived community health problems, and self-reported diseases/conditions among Filipino Americans in the Greater Las Vegas area and evaluate any difference by gender.

Methods: A cross-sectional survey was conducted among 200 Filipino American adults residing in the Greater Las Vegas area using a prevalidated instrument.

Results: The self-reported prevalence of hypertension, high cholesterol, and diabetes was 48%, 46%, and 25%, respectively. Adverse health behaviors, in terms of insufficient exercise and diets lacking in fruits and vegetables, were noted among our participants. Approximately 67% of participants reported exercising less than the recommended 150 min of physical activity per week and <3% of the study population ate the recommended five servings of fruits and vegetables a day. On the contrary, consumption of sweet snacks and salty condiments was high. More than two-thirds of respondents indicated that the Filipino American community should address the identified health conditions.

Conclusions: The high self-reported prevalence of hypertension, high cholesterol, and diabetes demonstrates a pressing public health problem among Filipino Americans in Las Vegas. Given that our study population comprised predominantly college-educated, middle-income, and insured individuals, the findings may be underestimated and thus the actual disease prevalence may be even higher. Results of this survey will be used to develop future interventions for the Filipino American community in Las Vegas using the principles of community-based participatory research.