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Mülder DT, O'Mahony JF, Doubeni CA, Lansdorp-Vogelaar I, Schermer MHN. The Ethics of Cancer Screening Based on Race and Ethnicity. Ann Intern Med 2024. [PMID: 39102717 DOI: 10.7326/m24-0377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/07/2024] Open
Abstract
Racial and ethnic disparities in incidence and mortality are well documented for many types of cancer. As a result, there is understandable policy and clinical interest in race- and ethnicity-based clinical screening guidelines to address cancer health disparities. Despite the theoretical benefits, such proposals do not typically address associated ethical considerations. Using the examples of gastric cancer and esophageal adenocarcinoma, which have demonstrated disparities according to race and ethnicity, this article examines relevant ethical arguments in considering screening based on race and ethnicity. Race- and ethnicity-based clinical preventive care services have the potential to improve the balance of harms and benefits of screening. As a result, programs focused on high-risk racial or ethnic groups could offer a practical alternative to screening the general population, in which the screening yield may be too low to demonstrate sufficient effectiveness. However, designing screening according to socially based categorizations such as race or ethnicity is controversial and has the potential for intersectional stigma related to social identity or other structurally mediated environmental factors. Other ethical considerations include miscategorization, unintended negative effects on health disparities, disregard for underlying risk factors, and the psychological costs of being assigned higher risk. Given the ethical considerations, the practical application of race and ethnicity in cancer screening is most relevant in multicultural countries if and only if alternative proxies are not available. Even in those instances, policymakers and clinicians should carefully address the ethical considerations within the historical and cultural context of the intended population. Further research on alternative proxies, such as social determinants of health and culturally based characteristics, could provide more adequate factors for risk stratification.
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Affiliation(s)
- Duco T Mülder
- Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (D.T.M., I.L.)
| | - James F O'Mahony
- Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands, and School of Economics, University College Dublin, Dublin, Ireland (J.F.O.)
| | - Chyke A Doubeni
- The Ohio State University Wexner Medical Center, Columbus, Ohio (C.A.D.)
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (D.T.M., I.L.)
| | - Maartje H N Schermer
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus Medical Center, Rotterdam, the Netherlands (M.H.N.S.)
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Kohli K, Kohli M, Jain B, Swami N, Ranganathan S, Chino F, Iyengar P, Yerramilli D, Dee EC. Characterizing disparities in receipt of palliative care for Asian Americans, Native Hawaiians, and Pacific Islanders with metastatic cancer in the United States. Support Care Cancer 2024; 32:494. [PMID: 38977496 DOI: 10.1007/s00520-024-08633-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 06/05/2024] [Indexed: 07/10/2024]
Abstract
PURPOSE Palliative care plays essential roles in cancer care. However, differences in receipt among individuals identifying as Asian American, Native Hawaiian, and Other Pacific Islanders (AA&NHPI) with cancer are not well-characterized, especially when these diverse groups are disaggregated. We characterized disparities in receipt of palliative care among AA&NHPI patients with AJCC Stage IV prostate, breast, or lung cancer. METHODS We performed multivariable logistic regressions were performed in this retrospective cohort analysis, using deidentified data from the National Cancer Database (NCDB) of patients diagnosed with AJCC analytic group stage IV breast, lung, or prostate cancer (2004-2018) who were White or of Asian Indian/Pakistani, Chinese, Filipino, Hawaiian, Hmong, Japanese, Kampuchean, Korean, Laotian, Other Pacific Islander, Thai, or Vietnamese descent. We conducted multivariable logistic regression analyses in a retrospective cohort study using deidentified data from the National Cancer Database (NCDB). The study included patients diagnosed with AJCC analytic group Stage IV breast, lung, or prostate cancer between 2004 and 2018, who were White or identified as Asian Indian/Pakistani, Chinese, Filipino, Hawaiian, Hmong, Japanese, Kampuchean, Korean, Laotian, Other Pacific Islander, Thai, or Vietnamese descent. Adjusted odds ratios and 95% confidence intervals of receiving palliative care were measured when comparing White vs. AA&NHPI patients as one cohort and White vs. disaggregated AA&NHPI patients, adjusting for clinical, socioeconomic, and demographic covariates. RESULTS Among 775,289 individuals diagnosed with cancer (median age: 68 years), no significant differences in palliative care receipt were observed between White patients and aggregated AA&NHPI patients among patients with prostate, breast, or lung cancer. However, disaggregated analyses revealed reduced palliative care receipt for breast cancer patients of Asian Indian/Pakistani descent (AOR 0.75, 95% CI, 0.60-0.94, P = 0.011) and for lung cancer patients of Chinese, Vietnamese, Thai, and Asian Indian/Pakistani descent compared to White patients (Chinese AOR 0.88, [0.81-0.94], P = 0.001; Vietnamese AOR 0.89, [0.80 to 0.99], P = 0.032; Thai AOR 0.64, [0.44-0.92], P = 0.016; Asian Indian/Pakistani AOR 0.83, [0.74-0.93], P = 0.001). Palliative care was greater for patients of Japanese and Hawaiian descent with prostate cancer (Japanese AOR 1.92, [1.32-2.75], P = 0.001; Hawaiian AOR 2.09, [1.20-3.66], P = 0.009), breast cancer (Japanese AOR 1.72, [1.21-2.43], P = 0.001; Hawaiian AOR 1.70, [1.08-2.67], P = 0.021), and lung cancer (Japanese AOR 1.92, [1.70-2.17], P < 0.001; Hawaiian AOR 2.95, [2.5-3.5], P < 0.001), as well as patients of Other Pacific Islander descent with lung cancer (AOR 1.62, [1.34-1.96], P < 0.001). CONCLUSIONS AND RELEVANCE Our findings demonstrate disparities in receipt of palliative care upon disaggregation of diverse AA&NHPI groups, the need for disaggregated research and targeted interventions that address the unique cultural, socioeconomic, and healthcare system barriers to palliative care receipt.
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Affiliation(s)
| | - Mahi Kohli
- Olathe North High School, Olathe, KS, USA
| | - Bhav Jain
- Stanford University School of Medicine, Stanford, CA, USA
| | - Nishwant Swami
- Division of Internal Medicine, University of Pennsylvania Health System, Pennsylvania, PA, USA
| | | | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Puneeth Iyengar
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Divya Yerramilli
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
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Kazzi B, Mankuzhy NP, Swami N, Jain B, Patel TA, Chan JSK, Lam MB, Tian S, Dee EC. Surgical Resection Delays among Patients with Stage 1 Lung Cancer: A Study with Disaggregated Ethnic Groups. Ann Surg Oncol 2024; 31:2818-2823. [PMID: 38282026 DOI: 10.1245/s10434-024-14952-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 01/09/2024] [Indexed: 01/30/2024]
Affiliation(s)
- Bahaa Kazzi
- Hope Clinic of the Emory Vaccine Center, Emory University School of Medicine Decatur, Atlanta, GA, USA
| | - Nikhil P Mankuzhy
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nishwant Swami
- Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Bhav Jain
- Department of Health Policy, Stanford University School of Medicine, Stanford, CA, USA
| | - Tej A Patel
- Department of Healthcare Management and Policy, University of Pennsylvania, Philadelphia, PA, USA
| | - Jeffrey Shi Kai Chan
- Cardio-Oncology Research Unit, Cardiovascular Analytics Group, UK-China Collaboration, Hong Kong, China
| | - Miranda B Lam
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Sibo Tian
- Department of Radiation Oncology, Winship Cancer Institute, Atlanta, GA, USA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Llanos AAM, Fong AJ, Ghosh N, Devine KA, O'Malley D, Paddock LE, Bandera EV, Hudson SV, Evens AM, Manne SL. COVID-19 perceptions, impacts, and experiences: a cross-sectional analysis among New Jersey cancer survivors. J Cancer Surviv 2024; 18:439-449. [PMID: 35904727 PMCID: PMC9336177 DOI: 10.1007/s11764-022-01236-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/11/2022] [Indexed: 10/27/2022]
Abstract
BACKGROUND Cancer survivors are particularly vulnerable to adverse COVID-19-related outcomes, but limited data exist on perceptions about the pandemic and related experiences in this group. METHODS In a cross-sectional analysis of 494 survivors of genitourinary, breast, gynecologic, colorectal, lung, melanoma, or thyroid cancer, from a larger study of cancer survivors in New Jersey, we assessed perceptions about COVID-19 threat, impacts, and experiences using three validated instruments. Responses were coded on a 7-point Likert scale, and subscales were averaged across included items, with higher scores indicating greater perceptions of COVID-19 threat and greater impacts and experiences because of the pandemic. Multivariable linear regression models were used to determine factors associated with higher scores, with Bonferroni correction for multiple comparisons. RESULTS In general, cancer survivors reported moderate perceived COVID-19 threat (3 items, mean score = 3.71 ± 1.97), minimal COVID-19-related impacts (6 items, mean score = 2.23 ± 1.34), and COVID-19-related experiences (7 items, mean score = 2.17 ± 1.00). COVID-19 impact subscale scores varied little (mean subscale score range = 2.09 to 2.29), while COVID-19 experiences subscale scores were quite variable (mean subscale score range = 1.52 to 3.39). Asian American/Pacific Islander race, Black race, female sex, and having more cardiovascular and metabolic and other comorbidities were associated with higher scores on the perceived coronavirus threat questionnaire. Having completed the COVID-19 questionnaires earlier in the pandemic, younger age, American/Pacific Islander race, Hispanic ethnicity, and having more comorbidities were associated with higher scores on the COVID-19 impact questionnaire. Younger age, racial minority status, and having more cardiovascular and metabolic comorbidities were associated with higher scores on the COVID-19 experience questionnaire. CONCLUSION Among cancer survivors in New Jersey-a state that experienced high rates of COVID-19 infection-sociodemographic and health-related factors (e.g., race and ethnicity, sex, and multimorbidity) correlate with greater perceptions of COVID-19 threat, impacts, and experiences. IMPLICATIONS FOR CANCER SURVIVORS Studies are needed to examine the influence of vaccination status on COVID-19 perceptions and identify inequities in clinical outcomes due to pandemic-related disruptions to cancer care.
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Affiliation(s)
- Adana A M Llanos
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA.
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA.
| | - Angela J Fong
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Nabarun Ghosh
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Katie A Devine
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Denalee O'Malley
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Lisa E Paddock
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- New Jersey Department of Health, New Jersey State Cancer Registry, Trenton, NJ, USA
| | - Elisa V Bandera
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Shawna V Hudson
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Andrew M Evens
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Sharon L Manne
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
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Dee EC, Swami N, Kazzi B, Lapen K, Franco I, Jain B, Patel TA, Mahal BA, Rimner A, Wu A, Iyengar P, Li B, Florez N, Gomez DR. Disparities in Stage at Presentation Among Hispanic and Latinx Patients With Non-Small-Cell Lung Cancer in the United States. JCO Oncol Pract 2024; 20:525-537. [PMID: 38252900 DOI: 10.1200/op.23.00474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 10/12/2023] [Accepted: 11/02/2023] [Indexed: 01/24/2024] Open
Abstract
PURPOSE Hispanic and Latinx people in the United States are the fastest-growing ethnic group. However, previous studies in non-small-cell lung cancer (NSCLC) often analyze these diverse communities in aggregate. We aimed to identify differences in NSCLC stage at diagnosis in the US population, focusing on disaggregated Hispanic/Latinx individuals. METHODS Data from the National Cancer Database from 2004 to 2018 identified patients with primary NSCLC. Individuals were disaggregated by racial and ethnic subgroup and Hispanic country of origin. Ordinal logistic regression adjusting for age, facility type, income, educational attainment, comorbidity index, insurance, and year of diagnosis was used to create adjusted odds ratios (aORs), with higher odds representing diagnosis at later-stage NSCLC. RESULTS Of 1,565,159 patients with NSCLC, 46,616 were Hispanic/Latinx (3.0%). When analyzed in the setting of race and ethnicity, Hispanic patients were more likely to be diagnosed with metastatic disease compared with non-Hispanic White (NHW) patients: 47.0% for Hispanic Black, 46.0% Hispanic White, and 44.3% of Hispanic other patients versus 39.1% of non-Hispanic White patients (P < .001 for all). By country of origin, 51.4% of Mexican, 41.7% of Puerto Rican, 44.6% of Cuban, 50.8% of South or Central American, 48.4% of Dominican, and 45.6% of other Hispanic patients were diagnosed with metastatic disease, compared with 39.1% of NHWs. Conversely, 20.2% of Mexican, 26.9% of Puerto Rican, 24.2% of Cuban, 22.5% of South or Central American, 23.7% of Dominican, and 24.5% of other Hispanic patients were diagnosed with stage I disease, compared with 30.0% of NHWs. All Hispanic groups were more likely to present with later-stage NSCLC than NHW patients (greatest odds for Mexican patients, aOR, 1.44; P < .001). CONCLUSION Hispanic/Latinx patients with non-small-cell lung cancer were more likely to be diagnosed with advanced disease compared with NHWs. Disparities persisted upon disaggregation by both race and country of origin, with over half of Mexican patients with metastatic disease at diagnosis. Disparities among Hispanic/Latinx groups by race and by country of origin highlight the shortcomings of treating these groups as a monolith and underscore the need for disaggregated research and targeted interventions.
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Affiliation(s)
| | - Nishwant Swami
- University of Massachusetts Chan Medical School, Worcester, MA
- Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Bahaa Kazzi
- The Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, Emory University, Decatur, GA
| | - Kaitlyn Lapen
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Idalid Franco
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Bhav Jain
- Stanford School of Medicine, Palo Alto, CA
| | - Tej A Patel
- University of Pennsylvania, Philadelphia, PA
| | - Brandon A Mahal
- Department of Radiation Oncology, University of Miami/Sylvester Cancer Center, Miami, FL
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Abraham Wu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Puneeth Iyengar
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Radiation Oncology, Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Bob Li
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Narjust Florez
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniel R Gomez
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Radiation Oncology, Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York, NY
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Kim DY, Dee EC, Cheng I, Hartman RI. Advanced melanoma presentation and disease-specific survival disparities among disaggregated Asian American, Native Hawaiian, and Pacific Islander populations. J Am Acad Dermatol 2024; 90:623-626. [PMID: 37923219 DOI: 10.1016/j.jaad.2023.10.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 09/21/2023] [Accepted: 10/22/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Daniel Y Kim
- Harvard-MIT Health Sciences and Technology Program, Harvard Medical School, Boston, Massachusetts
| | - Edward C Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Iona Cheng
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Rebecca I Hartman
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Dermatology Section, VA Integrated Service Network 1 (VISN-1), Jamaica Plain, Massachusetts.
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Seelam B, Sandhu R, Alam M, Kethireddy A, Zapata I. Rates of Compliance in South Indian American Communities of Southern California Regarding Cancer Screening. Clin Pract 2024; 14:337-343. [PMID: 38391412 PMCID: PMC10888186 DOI: 10.3390/clinpract14010026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/31/2024] [Accepted: 02/06/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Studies have shown lower rates of cancer screening and high mortality rates among all Asian Americans than among non-Hispanic White populations. However, most of these studies often confound diverse Asian American subgroups with limited data on cancer screening for Indian Americans, with this group being particularly interesting because of their counterintuitive socioeconomic status. For this reason, the objective of this study is to evaluate knowledge of the United States Preventive Services Task Force (USPSTF) cancer screening guidelines and compliance among South Indian Americans residing in Southern California. METHODS This was a cross-sectional study gathering community responses through an electronic survey. The survey reports knowledge of USPSTF screening guidelines and participant compliance rates. Rates were further compared to non-Hispanic White populations from official sources. RESULTS South Indian Americans residing in California had lower rates of compliance for colorectal, lung, and breast cancer screening when compared to that of non-Hispanic White populations in the same region, with the exception of cervical cancer screening rates. CONCLUSION Understanding the cultural characteristics of special populations, such as Indian Americans, can help communities adhere to more effective screening practices that can improve outcomes.
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Affiliation(s)
- Bhavana Seelam
- Rocky Vista University College of Osteopathic Medicine, Ivins, UT 84738, USA
| | - Ria Sandhu
- Rocky Vista University College of Osteopathic Medicine, Ivins, UT 84738, USA
| | - Mariam Alam
- Rocky Vista University College of Osteopathic Medicine, Englewood, CO 80112, USA
| | | | - Isain Zapata
- Department of Biomedical Sciences, Rocky Vista University College of Osteopathic Medicine, Englewood, CO 80112, USA
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Wang CP, McKinley M, Vu A, Yang JY, Gupta S, Gomez SL, Kim MK, Itzkowitz SH, Shah SC. Demographic Comparison of the Burden of Endoscopically Screenable Cancers in the United States. GASTRO HEP ADVANCES 2024; 3:482-490. [PMID: 39131721 PMCID: PMC11308758 DOI: 10.1016/j.gastha.2024.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 01/08/2024] [Indexed: 08/13/2024]
Abstract
Background and Aims Gastrointestinal cancer incidence varies by race and ethnicity. In the United States (US), there are screening guidelines for esophageal cancer (EC) and colorectal cancer (CRC), but not gastric cancer (GC). We compared GC, CRC, and EC incidence among the most populous racial and ethnic groups to inform US interception strategies. Methods We used SEER∗Stat to compare GC, CRC, and EC incidence rates across non-Hispanic White (NHW), non-Hispanic Black, Hispanic, and the 8 largest Asian American populations using the Surveillance, Epidemiology, and End Results 9 registries (2010-2014). Results Noncardia GC incidence was highest among Korean (18.7 cases per 100,000) and lowest among NHW (1.4 cases per 100,000) Americans. CRC incidence was highest among non-Hispanic Black, Southeast Asian, and Japanese (35.9, 34.2, and 33.8 per 100,000, respectively) Americans and lowest among South Asian Americans (18.9 per 100,000). EC incidence was greatest in NHW (4.7 per 100,000) and lowest in Filipino (1.2 per 100,000) Americans. The incidence of noncardia GC slightly exceeded colon cancer in Korean American men (25.5 vs 22.4 per 100,000). GC surpassed EC incidence in all non-White racial and ethnic groups. Conclusion The burden of GC, CRC, and EC differs based on race and ethnicity. Non-White racial and ethnic groups experience a disproportionate burden of GC for which systematic programs for cancer interception, similar to CRC and EC, are needed.
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Affiliation(s)
- Christina P. Wang
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Meg McKinley
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
- Greater Bay Area Cancer Registry, University of California San Francisco, San Francisco, California
| | - Annie Vu
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
- Greater Bay Area Cancer Registry, University of California San Francisco, San Francisco, California
| | - Jeong Yun Yang
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samir Gupta
- GI Section, VA San Diego Healthcare System, San Diego, California
- Division of Gastroenterology, University of California San Diego, San Diego, California
| | - Scarlett L. Gomez
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
- Greater Bay Area Cancer Registry, University of California San Francisco, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Michelle Kang Kim
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Steven H. Itzkowitz
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Shailja C. Shah
- GI Section, VA San Diego Healthcare System, San Diego, California
- Division of Gastroenterology, University of California San Diego, San Diego, California
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Leung TH, El Helali A, Wang X, Ho JC, Pang H. Trends and age, sex, and race disparities in time to second primary cancer from 1990 to 2019. Cancer Med 2023; 12:22316-22324. [PMID: 38063337 PMCID: PMC10757087 DOI: 10.1002/cam4.6785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 10/09/2023] [Accepted: 11/23/2023] [Indexed: 12/31/2023] Open
Abstract
BACKGROUND Despite the growth in primary cancer (PC) survivors, the trends and disparities in this population have yet to be comprehensively examined using competing risk analysis. The objective is to examine trends in time to second primary cancer (SPC) and to characterize age, sex, and racial disparities in time-to-SPC. METHODS A retrospective analysis was conducted based on Surveillance, Epidemiology, and End Results (SEER). Two datasets for this study are (1) the discovery dataset with patients from SEER-8 (1990-2019) and (2) the validation dataset with patients from SEER-17 (2000-2019), excluding those in the discovery dataset. Patients were survivors of lung, colorectal, breast (female only), and prostate PCs. RESULTS The 5-year SPC cumulative incidences of lung PC increased from 1990 to 2019, with the cumulative incidence ratio being 1.73 (95% confidence intervals [CI], 1.64-1.82; p < 0.001). Age disparities among all PCs remained from 2010 to 2019, and the adjusted HRs (aHRs) of all PCs were above 1.43 when those below 65 were compared with those 65 and above. Sex disparity exists among colorectal and lung PC survivors. Racial disparities existed among non-Hispanic (NH) Black breast PC survivors (aHR: 1.11; 95% CI: 1.07-1.17; p < 0.001). The types of SPC vary according to PC and sex. CONCLUSIONS Over the past three decades, there has been a noticeably shortened time-to-SPC among lung PC survivors. This is likely attributed to the reduced number of lung cancer deaths due to advancements in effective treatments. However, disparities in age, sex, and race still exist, indicating that further effort is needed to close the gap.
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Affiliation(s)
- Tiffany H. Leung
- Department of Medicine, Li Ka Shing Faculty of MedicineThe University of Hong KongHong KongChina
- School of Public Health, Li Ka Shing Faculty of MedicineThe University of Hong KongHong KongChina
| | - Aya El Helali
- Department of Clinical Oncology, School of Clinical Medicine, Li Ka Shing Faculty of MedicineThe University of Hong KongHong KongChina
| | - Xiaofei Wang
- Department of Biostatistics and Bioinformatics, School of MedicineDuke UniversityDurhamNorth CarolinaUSA
| | - James C. Ho
- Department of Medicine, Li Ka Shing Faculty of MedicineThe University of Hong KongHong KongChina
| | - Herbert Pang
- School of Public Health, Li Ka Shing Faculty of MedicineThe University of Hong KongHong KongChina
- Department of Biostatistics and Bioinformatics, School of MedicineDuke UniversityDurhamNorth CarolinaUSA
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Jain B, Bajaj SS, Patel TA, Vapiwala N, Lam MB, Mahal BA, Muralidhar V, Amen TB, Nguyen PL, Sanford NN, Dee EC. Colon Cancer Disparities in Stage at Presentation and Time to Surgery for Asian Americans, Native Hawaiians, and Pacific Islanders: A Study with Disaggregated Ethnic Groups. Ann Surg Oncol 2023; 30:5495-5505. [PMID: 37017832 PMCID: PMC10075171 DOI: 10.1245/s10434-023-13339-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 02/19/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND Vast differences in barriers to care exist among Asian American, Native Hawaiian, and Pacific Islander (AANHPI) groups and may manifest as disparities in stage at presentation and access to treatment. Thus, we characterized AANHPI patients with stage 0-IV colon cancer and examined differences in (1) stage at presentation and (2) time to surgery relative to white patients. PATIENTS AND METHODS We assessed all patients in the National Cancer Database (NCDB) with stage 0-IV colon cancer from 2004 to 2016 who identified as white, Chinese, Japanese, Filipino, Native Hawaiian, Korean, Vietnamese, Laotian, Hmong, Kampuchean, Thai, Asian Indian or Pakistani, and Pacific Islander. Multivariable ordinal logistic regression defined adjusted odds ratios (AORs), with 95% confidence intervals (CI), of (1) patients presenting with advanced stage colon cancer and (2) patients with stage 0-III colon cancer receiving surgery at ≥ 60 days versus 30-59 days versus < 30 days postdiagnosis, adjusting for sociodemographic/clinical factors. RESULTS Among 694,876 patients, Japanese [AOR 1.08 (95% CI 1.01-1.15), p < 0.05], Filipino [AOR 1.17 (95% CI 1.09-1.25), p < 0.001], Korean [AOR 1.09 (95% CI 1.01-1.18), p < 0.05], Laotian [AOR 1.51 (95% CI 1.17-1.95), p < 0.01], Kampuchean [AOR 1.33 (95% CI 1.04-1.70), p < 0.01], Thai [AOR 1.60 (95% CI 1.22-2.10), p = 0.001], and Pacific Islander [AOR 1.41 (95% CI 1.20-1.67), p < 0.001] patients were more likely to present with more advanced colon cancer compared with white patients. Chinese [AOR 1.27 (95% CI 1.17-1.38), p < 0.001], Japanese [AOR 1.23 (95% CI 1.10-1.37], p < 0.001], Filipino [AOR 1.36 (95% CI 1.22-1.52), p < 0.001], Korean [AOR 1.16 (95% CI 1.02-1.32), p < 0.05], and Vietnamese [AOR 1.55 (95% CI 1.36-1.77), p < 0.001] patients were more likely to experience greater time to surgery than white patients. Disparities persisted when comparing among AANHPI subgroups. CONCLUSIONS Our findings reveal key disparities in stage at presentation and time to surgery by race/ethnicity among AANHPI subgroups. Heterogeneity upon disaggregation underscores the importance of examining and addressing access barriers and clinical disparities.
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Affiliation(s)
- Bhav Jain
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | - Tej A Patel
- University of Pennsylvania, Philadelphia, PA, USA
| | - Neha Vapiwala
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Miranda B Lam
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Brandon A Mahal
- Department of Radiation Oncology, University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Vinayak Muralidhar
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
- Kaiser Permanente Northwest, Portland, OR, USA
| | - Troy B Amen
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Paul L Nguyen
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Nina N Sanford
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX, USA.
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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11
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Patel TA, Jain B, Dee EC, Gomez SL, Vapiwala N, Chino F, Fayanju OM. Delays in Time to Surgery Among Asian and Pacific Islander Women with Breast Cancer. Ann Surg Oncol 2023; 30:5337-5340. [PMID: 37365415 PMCID: PMC10869161 DOI: 10.1245/s10434-023-13806-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/12/2023] [Indexed: 06/28/2023]
Affiliation(s)
- Tej A Patel
- University of Pennsylvania, Philadelphia, PA, USA
| | - Bhav Jain
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Scarlett Lin Gomez
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Neha Vapiwala
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Oluwadamilola M Fayanju
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Rena Rowan Breast Center, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA.
- Penn Center for Cancer Care Innovation (PC3I), Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA.
- Leonard Davis Institute of Health Economics (LDI), University of Pennsylvania, Philadelphia, PA, USA.
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12
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Jain B, Bajaj SS, Patel TA, Vapiwala N, Lam MB, Mahal BA, Muralidhar V, Amen TB, Nguyen PL, Sanford NN, Dee EC. ASO Author Reflections: Colon Cancer Disparities in Stage at Presentation and Time to Surgery for Asian Americans, Native Hawaiians, and Pacific Islanders. Ann Surg Oncol 2023; 30:5506-5508. [PMID: 37120487 DOI: 10.1245/s10434-023-13560-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 05/01/2023]
Affiliation(s)
- Bhav Jain
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | - Tej A Patel
- University of Pennsylvania, Philadelphia, PA, USA
| | - Neha Vapiwala
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Miranda B Lam
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Brandon A Mahal
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Vinayak Muralidhar
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
- Kaiser Permanente Northwest, Portland, OR, USA
| | - Troy B Amen
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Paul L Nguyen
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Nina N Sanford
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX, USA.
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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13
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Hong JH, Swami N, Dee EC, Gomez SL, Lam MB. Non-small cell lung cancer disparities in stage at presentation and treatment for Asian American, Native Hawaiian, and Pacific Islander women. J Surg Oncol 2023; 127:882-890. [PMID: 36719164 DOI: 10.1002/jso.27204] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/06/2023] [Accepted: 01/17/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND OBJECTIVES Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPI) represent the fastest-growing group in the United States. While described in aggregate, great variations exist within the community. We aimed to determine whether there were differences in stage at presentation and treatment status among AANHPI women with non-small cell lung cancer (NSCLC). METHODS Between 2004 and 2016, we identified 522 361 female patients with newly diagnosed NSCLC from the National Cancer Database. Multivariable logistic regression models were used to define adjusted odds ratios (aORs) of presenting with stage IV disease and not receiving treatment. RESULTS AANHPI women were more likely to present with stage IV disease compared to White (54.32% vs. 40.28%, p < 0.001). Aside from Hawaiian, Pakistani, and Hmong women, all other ethnic groups had greater odds of presenting with stage IV disease than White women. AANHPI women <65 years were more likely to present with stage IV disease (p = 0.030). Only Vietnamese women showed a significant difference (aOR = 1.30 [1.06-1.58], p = 0.010) for likelihood of receiving treatment compared to White. CONCLUSIONS Differences in stage at presentation and treatment status in women with NSCLC were observed among AANHPI ethnic groups when populations were disaggregated.
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Affiliation(s)
- Ji Hyun Hong
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Nishwant Swami
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Scarlett Lin Gomez
- Department of Epidemiology & Biostatistics and Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California, USA
| | - Miranda B Lam
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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14
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Eden CM, Johnson J, Syrnioti G, Malik M, Ju T. The Landmark Series: The Breast Cancer Burden of the Asian American Population and the Need for Disaggregated Data. Ann Surg Oncol 2023; 30:2121-2127. [PMID: 36652024 PMCID: PMC9848042 DOI: 10.1245/s10434-023-13103-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/02/2023] [Indexed: 01/19/2023]
Abstract
The Asian American Pacific Islander (AAPI) population is a heterogeneous group of people from geographically and ethnically distinct regions of the world. Traditionally, these patients have been reported as one large aggregate in the breast cancer literature under the race category of "Asian." A detailed examination of this group shows compelling evidence that breast cancer manifests differently among Asian ethnic subgroups, resulting in overlooked health disparities when these races are grouped together. The AAPI community is the fastest growing ethnic group in the United States, and their incidence of breast cancer is increasing at rates greater than among their non-Asian counterparts. When these patients are disaggregated by race, they show wide variations in breast cancer screening, presentation, treatment, and outcomes. This population often faces additional unique challenges in the health care system due to cultural, social, health literacy, and language barriers, which can contribute to further disparity. Our landmark series aims to showcase the breadth of the breast cancer burden in the AAPI population and highlight the need for disaggregated ethnic data.
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Affiliation(s)
- Claire M Eden
- Department of Surgery New York Presbyterian Queens, Weill Cornell Medicine, Flushing, NY, USA
| | - Josh Johnson
- Department of Surgery New York Presbyterian, Weill Cornell Medicine, New York, NY, USA
| | - Georgia Syrnioti
- Department of Surgery New York Presbyterian, Weill Cornell Medicine, New York, NY, USA
| | - Manmeet Malik
- Department of Surgery New York Presbyterian Queens, Weill Cornell Medicine, Flushing, NY, USA
| | - Tammy Ju
- Department of Surgery New York Presbyterian Queens, Weill Cornell Medicine, Flushing, NY, USA.
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15
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Kohli K, Jain B, Dee EC. Crossing Borders: Improving Mental Health Outcomes in Asian American Immigrants With Cancer. JCO Oncol Pract 2023; 19:234-237. [PMID: 36821806 DOI: 10.1200/op.22.00740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Affiliation(s)
| | - Bhav Jain
- Massachusetts Institute of Technology, Cambridge, MA
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16
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Baluran DA. Life expectancy, life disparity, and differential racialization among Chinese, Asian Indians, and Filipinos in the United States. SSM Popul Health 2022; 21:101306. [PMID: 36567799 PMCID: PMC9772563 DOI: 10.1016/j.ssmph.2022.101306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/28/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022] Open
Abstract
This article advances differential racialization as a lens to frame health disparity trends within the Asian racial category. Using formal demographic methods, I analyzed data from the Multiple Cause of Death File and the American Community Survey to examine the trends in life expectancy and life disparity among Chinese, Asian Indians, and Filipinos in the United States between 2005 and 2019. While Chinese, Asian Indian, and Filipino life expectancy oscillated between each period under study, those oscillations contributed to an overall widening advantage for Chinese over their Asian Indian and Filipino counterparts. I posit that widening inequalities between the three groups are suggestive of their increasingly disparate racial statuses. These findings underscore the importance of contextualizing disaggregated health data within the social conditions that produce inequalities, namely race/racialization/racism.
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17
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Swami N, Nguyen T, Dee EC, Franco I, Baez YA, Lapen K, Wang L, Goel N, Mahal BA, Fayanju OM, Duma N, Chino F. Disparities in Primary Breast Cancer Stage at Presentation Among Hispanic Subgroups. Ann Surg Oncol 2022; 29:7977-7987. [PMID: 35953743 DOI: 10.1245/s10434-022-12302-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/02/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although the United States (US) Hispanic population consists of diverse communities, prior breast cancer studies often analyze this group in aggregate. Our aim was to identify differences in breast cancer stage at presentation in the US population, with a particular focus on Hispanic subgroups. METHODS Data from the National Cancer Database (NCDB) from 2004 to 2017 were used to select women with primary breast cancer; individuals were disaggregated by racial and ethnic subgroup and Hispanic country of origin. Ordinal logistic regression was used to create adjusted odds ratios (aORs) with 95% confidence intervals (CIs), with higher odds representing presentation at later-stage breast cancer. Subgroup analysis was conducted based on tumor receptor status. RESULTS Overall, among 2,282,691 women (5.2% Hispanic), Hispanic women were more likely to live in low-income and low-educational attainment neighborhoods, and were also more likely to be uninsured. Hispanic women were also more likely to present at later-stage primary breast cancer when compared with non-Hispanic White women (aOR 1.19, 95% CI 1.18-1.21; p < 0.01). Stage disparities were demonstrated when populations were disaggregated by country of origin, particularly for Mexican women (aOR 1.55, 95% CI 1.51-1.60; p < 0.01). Disparities worsened among both racial and country of origin subgroups in women with triple-negative disease. CONCLUSION Later breast cancer stage at presentation was observed among Hispanic populations when disaggregated by racial subgroup and country of origin. Socioeconomic disparities, as well as uncaptured disparities in access and/or differential care, may drive these observed differences. Future studies with disaggregated data are needed to characterize outcomes in Hispanic communities and develop targeted interventions.
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Affiliation(s)
- Nishwant Swami
- University of Massachusetts Chan Medical School, Worcester, MA, USA.,Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Tiffany Nguyen
- University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Idalid Franco
- Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA, USA
| | - Yefri A Baez
- Department of Urology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Kaitlyn Lapen
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lora Wang
- Department of Radiation Oncology, University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Neha Goel
- Department of Surgical Oncology, University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Brandon A Mahal
- Department of Radiation Oncology, University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Oluwadamilola M Fayanju
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA.,Rena Rowan Breast Center, Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA.,Penn Center for Cancer Care Innovation, The University of Pennsylvania, Philadelphia, PA, USA
| | - Narjust Duma
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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18
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Paguio JA, Ojikutu BO, Alfonso PG, Yao JS, Amen TB, Dee EC, Escota GV. Association of culturally competent care with influenza vaccination coverage in the United States. Vaccine 2022; 40:6607-6615. [PMID: 36208977 DOI: 10.1016/j.vaccine.2022.08.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 08/24/2022] [Accepted: 08/28/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Cultural minority groups in the United States have lower vaccination rates or worse influenza-related outcomes. Culturally competent care, which aims to engage the social, cultural, and linguistic needs of all patients, may address some of these disparities. OBJECTIVE We investigate how self-reported measures of culturally competent care is associated with influenza vaccination rates in the United States. METHODS The National Health Interview Survey (NHIS) 2017 was queried for respondents asked a set of questions which assessed respondents' access to culturally competent care in the past year. The outcome of interest was self-reported receipt of the annual influenza vaccine. Sample-weighted multivariable logistic regressions estimated the adjusted odds ratios and 95 % confidence intervals (95 %CI) of influenza vaccination with response to the cultural competency survey questions as the dependent variable of interest. Subsequent marginal modeling predicted the adjusted vaccination rates among cultural minorities (racial/ethnic minorities, LGBTQ + adults, foreign-born individuals, and non-English speakers) and respondents with high-risk comorbidities for worse influenza outcomes. Models were adjusted for other known determinants of vaccination coverage. RESULTS 20,303 sample adults were included in the analyses. There were significantly higher odds of influenza vaccination among respondents who were "always" or "most of the time" treated with respect by their providers (aOR 1.53, 95 %CI [1.23-1.90], P < 0.001), given easy-to-understand information (aOR 1.37, 95 %CI [1.19-1.58], P < 0.001), asked about their opinions or beliefs about their care (aOR 1.29, 95 %CI [1.19-1.39], P < 0.001), and seen by providers who shared or understood their culture (aOR 1.15 95 %CI [1.01-1.30], P = 0.03), compared to their counterparts who responded with "some" or "none of the time" to the same survey questions. Higher adjusted influenza vaccination rates were seen among multiple racial/ethnic groups, LGBTQ + adults, foreign-born individuals, non-English speakers, and individuals with high-risk comorbidities who reported positive responses to the cultural competency survey questions. CONCLUSIONS We demonstrate a positive association between self-reported frequency of access to culturally competent care and receipt of the annual influenza vaccine. These findings support future efforts to evaluate vaccination outcomes among patients who receive components of culturally competent care, such as linguistically appropriate services, race-concordant healthcare workforce, and community engagement.
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Affiliation(s)
- Joseph Alexander Paguio
- Department of Internal Medicine, Albert Einstein Medical Center, Philadelphia, PA, United States.
| | - Bisola O Ojikutu
- Harvard Medical School, Boston, MA, United States; Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | | | - Jasper Seth Yao
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Troy B Amen
- Harvard Medical School, Boston, MA, United States; Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, United States
| | - Edward Christopher Dee
- Harvard Medical School, Boston, MA, United States; Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Gerome V Escota
- Division of Infectious Diseases, Washington University School of Medicine, Saint Louis, MO, United States
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19
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Escobedo LA, Morey BN, Sabado-Liwag MD, Ponce NA. Lost on the frontline, and lost in the data: COVID-19 deaths among Filipinx healthcare workers in the United States. Front Public Health 2022; 10:958530. [PMID: 36091528 PMCID: PMC9452815 DOI: 10.3389/fpubh.2022.958530] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/08/2022] [Indexed: 01/24/2023] Open
Abstract
Background Filipinx Americans working in healthcare are at risk for COVID-19 death but lack consistent mortality data on healthcare worker deaths. The lack of disaggregated data for Asian subgroups proliferates anti-Asian structural racism as the needs of high-risk groups are systematically undetected to merit a proper public health response. We work around this aggregated data problem by examining how the overrepresentation of Filipinxs in healthcare contributes to COVID-19 mortality among Asian American populations. Methods To overcome the lack of COVID-19 mortality data among Filipinx American healthcare workers, we merged data from several sources: Kanlungan website (the only known public-facing source of systematically reported mortality data on Filipinx healthcare workers nationally and globally), National Center for Health Statistics, and 2014-2018 American Community Survey. We examined county-level associations using t-tests, scatterplots, and linear regression. Findings A higher percentage of Filipinxs among Asian Americans was correlated with a higher percentage of COVID-19 decedents who are Asian Americans (r = 0.24, p = 0.01). The percentage of Filipinx in healthcare remained a strong predictor of COVID-19 deaths among Asian Americans even after adjusting for age, poverty, and population density (coef = 1.0, p < 0.001). For every 1% increase in Filipinx among the healthcare workforce, the percentage of Asian American COVID-19 decedents increased by 1%. Interpretation Our study shows that the overrepresentation of Filipinxs in healthcare contributes to COVID-19 mortality disparities among Asian Americans. Our findings advocate for systems change by practicing anti-racist data agendas that collect and report on Asian subgroups for effective real-time targeted approaches against health inequities.
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Affiliation(s)
- Loraine A. Escobedo
- Cancer Research Center for Health Equity, Cedars-Sinai Cancer, West Hollywood, CA, United States,*Correspondence: Loraine A. Escobedo
| | - Brittany N. Morey
- Department of Health, Society, and Behavior, University of California, Irvine, Irvine, CA, United States
| | - Melanie D. Sabado-Liwag
- Filipinx/a/o Community Health Association, Los Angeles, CA, United States,Department of Public Health, California State University, Los Angeles, CA, United States
| | - Ninez A. Ponce
- Filipinx/a/o Community Health Association, Los Angeles, CA, United States,UCLA Center for Health Policy Research, Los Angeles, CA, United States,Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
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20
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Taparra K, Dee EC, Dao D, Patel R, Santos P, Chino F. Disaggregation of Asian American and Pacific Islander Women With Stage 0-II Breast Cancer Unmasks Disparities in Survival and Surgery-to-Radiation Intervals: A National Cancer Database Analysis From 2004 to 2017. JCO Oncol Pract 2022; 18:e1255-e1264. [PMID: 35594493 PMCID: PMC9377694 DOI: 10.1200/op.22.00001] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 03/28/2022] [Accepted: 04/21/2022] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Aggregation of Asian Americans (AAs) with Native Hawaiians and Other Pacific Islanders (NHPIs) masks significant health disparities. We evaluated overall survival (OS) and surgery-to-radiation intervals (STRIs) among AA and NHPI women with early-stage breast cancer. METHODS This National Cancer Database study included women with stage 0-II breast cancer diagnosed between 2004 and 2017. STRI was defined as days from surgery to radiation. Patients were stratified by adjuvant treatment. AAs were disaggregated into geographically relevant subpopulations: East, South, and Southeast Asians. Kaplan-Meier estimates and log-rank tests assessed survival. Cox proportional hazard and linear regression were adjusted for clinical and sociodemographic factors. RESULTS In total, 578,927 women were included (median age 61 years, median follow-up 65 months, and 10-year OS 83%). AA and NHPI 10-year OS was 91% overall; subpopulation 10-year OS was 92% for East Asian, 90% for South Asian, 90% for Southeast Asian, and 83% for NHPI. On multivariable analysis, compared with non-Hispanic White, NHPI women had worse survival (adjusted hazard ratio [aHR] = 1.38; 95% CI, 1.09 to 1.77); all AA subpopulations had improved survival: East Asian (aHR = 0.57; 95% CI, 0.48 to 0.69), South Asian (aHR = 0.66; 95% CI, 0.51 to 0.84), and Southeast Asian (aHR = 0.78; 95% CI, 0.65 to 0.94). The AA and NHPI median STRI for was 73 days overall; the disaggregated median STRI was 68 days for East Asian, 80 days for South Asian, 77 days for Southeast Asians, and 81 days for NHPI. On adjusted analysis, compared with non-Hispanic White, Southeast Asians and NHPI had longer STRI by 6.6 (95% CI, 4.3 to 8.9) and 10.0 (95% CI, 5.8 to 14) days, respectively. CONCLUSION Breast cancer disparities exist among disaggregated AA and NHPI subpopulations. Data disaggregation insights may lead to interventions to overcome these disparities, such as optimizing time-to-treatment for select populations.
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Affiliation(s)
- Kekoa Taparra
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | | | - Dyda Dao
- Department of Surgery, Oregon Health and Science University, Portland, OR
| | - Rohan Patel
- Department of Internal Medicine, SUNY Downstate Medical Center, Brooklyn, NY
| | - Patricia Santos
- Department of Radiation Oncology, Memorial Sloan Kettering, New York, NY
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering, New York, NY
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21
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Dee EC, Gomez SL. Cancer among Immigrants: Diverse Histories, Diverse Disparities, Diverse Opportunities to Promote Equity. Cancer Epidemiol Biomarkers Prev 2022; 31:1251-1253. [PMID: 35775230 DOI: 10.1158/1055-9965.epi-22-0337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 11/16/2022] Open
Abstract
Immigrants-people who live in a country different from their country of birth-constitute approximately 250 million people globally. Migrants are diverse in their reasons for immigration, ranging from those who are forced to flee their home country for survival, to those seeking a better life. Migrants face diverse barriers in access to care. Therefore, it is critical in the context of cancer health to improve our understanding of the epidemiology of cancer amongst migrants to inform policy, screening, and management. In this issue of Cancer Epidemiology, Biomarkers & Prevention, Yu and colleagues evaluate patterns in the incidence of infection-associated cancers-cancers of the stomach, liver, and cervix-amongst migrants in Australia. They demonstrate that the incidence of infection-related cancers is heterogeneous amongst immigrant populations, underscoring the value of studies that disaggregate groups in ways that reflect the diversity amongst these groups. In this editorial, we contextualize the work of Yu and colleagues in the setting of studies exploring cancer health amongst migrants in various parts of the world. We call attention to disparities in risk factors, prevention, screening, and access to care. Finally, we call on the research and medical communities to work to elucidate their diverse stories, understand their diverse disparities, and act upon diverse opportunities to promote equity. See related article by Yu et al., p. 1394.
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Affiliation(s)
- Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Scarlett Lin Gomez
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California.,Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
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22
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Liu CZ, Wang E, Nguyen D, Sun MD, Jumreornvong O. The Model Minority Myth, Data Aggregation, and the Role of Medical Schools in Combating Anti-Asian Sentiment. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:797-803. [PMID: 35703909 DOI: 10.1097/acm.0000000000004639] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The COVID-19 pandemic has resulted in an alarming increase in hate incidents directed toward Asian Americans and Pacific Islanders (AAPIs), including verbal harassment and physical assault, spurring the nationwide #StopAsianHate movement. This rise in anti-Asian sentiment is occurring at a critical time of racial reckoning across the United States, galvanized by the Black Lives Matter movement, and of medical student calls for the implementation of antiracist medical curricula. AAPIs are stereotyped by the model minority myth, which posits that AAPIs are educated, hardworking, and therefore able to achieve high levels of success. This myth acts as a racial wedge between minorities and perpetuates harm that is pervasive throughout the field of medicine. Critically, the frequent aggregation of all AAPI subgroups as one monolithic community obfuscates socioeconomic and cultural differences across the AAPI diaspora while reinforcing the model minority myth. Here, the authors illustrate how the model minority myth and data aggregation have negatively affected the recruitment and advancement of diverse AAPI medical students, physicians, and faculty. Additionally, the authors discuss how data aggregation obscures health disparities across the AAPI diaspora and how the model minority myth influences the illness experiences of AAPI patients. Importantly, the authors outline specific actionable policies and reforms that medical schools can implement to combat anti-Asian sentiment and support the AAPI community.
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Affiliation(s)
- Clifford Z Liu
- C.Z. Liu is an MD-PhD candidate, Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, New York; ORCID: https://orcid.org/0000-0003-1783-299X
| | - Eileen Wang
- E. Wang is a first-year resident, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Don Nguyen
- D. Nguyen is an MD-PhD candidate, Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mary D Sun
- M.D. Sun is an MD-MSCR candidate, Icahn School of Medicine at Mount Sinai, New York, New York, and an MA candidate, Harvard University, Cambridge, Massachusetts
| | - Oranicha Jumreornvong
- O. Jumreornvong is a fourth-year medical student, Icahn School of Medicine at Mount Sinai, New York, New York
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23
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Wang TS, Kim ES, Duh QY, Gosain A, Kao LS, Kothari AN, Tsai S, Tseng JF, Tsung A, Wang KS, Wexner SD. Proceedings From the Advances in Surgery Channel Diversity, Equity, and Inclusion Series: Lessons Learned From Asian Academic Surgeons. J Surg Res 2022; 278:14-30. [PMID: 35588571 DOI: 10.1016/j.jss.2022.04.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/11/2022] [Indexed: 11/15/2022]
Abstract
In this series of talks and the accompanying panel session, leaders from the Society of Asian Academic Surgeons discuss issues faced by Asian Americans and the importance of the role of mentors and allyship in professional development in the advancement of Asian Americans in leadership roles. Barriers, including the model minority myth, are addressed. The heterogeneity of the Asian American population and disparities in healthcare and in research, specifically as relates to Asian Americans, also are examined.
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Affiliation(s)
- Tracy S Wang
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Eugene S Kim
- Department of Surgery, Children's Hospital of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Quan-Yang Duh
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Ankush Gosain
- Department of Surgery, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Lillian S Kao
- Department of Surgery, McGovern Medical School at University of Texas Health Science Center at Houston, Houston, Texas
| | - Anai N Kothari
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Susan Tsai
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jennifer F Tseng
- Department of Surgery, Boston Medical Center and Boston University, Boston, Massachusetts
| | - Allan Tsung
- Department of Surgery, The Ohio State University Medical Center, Columbus, Ohio
| | - Kasper S Wang
- Department of Surgery, Children's Hospital of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Steven D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida
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24
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Kamran SC, Winkfield KM, Reede JY, Vapiwala N. Intersectional Analysis of U.S. Medical Faculty Diversity over Four Decades. N Engl J Med 2022; 386:1363-1371. [PMID: 35388674 DOI: 10.1056/nejmsr2114909] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The 2020 U.S. Census data show a rapidly diversifying U.S. population. We sought to evaluate whether clinical faculty and leadership representation at academic medical schools reflects the diversifying population over time. Using data from the Association of American Medical Colleges for the period of 1977 through 2019, we found notable progress in female representation among clinical faculty, with smaller gains among department chairs and medical school deans. Racial and ethnic groups that are underrepresented in medicine are designated as such because their presence within the medical profession is disproportionate to the U.S. Census data. Even with accounting for this underrepresentation, clinical faculty and leadership positions show even starker disparities. Thoughtful policy implementation could help address this persistent underrepresentation among medical school faculty and leadership positions.
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Affiliation(s)
- Sophia C Kamran
- From the Department of Radiation Oncology (S.C.K.), Massachusetts General Hospital (J.Y.R.), the Office for Diversity Inclusion and Community Partnership (J.Y.R.), Harvard Medical School (S.C.K.), and the Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health (J.Y.R.) - all in Boston; Meharry-Vanderbilt Alliance, Vanderbilt University Medical Center, Nashville (K.M.W.); and the Department of Radiation Oncology, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia (N.V.)
| | - Karen M Winkfield
- From the Department of Radiation Oncology (S.C.K.), Massachusetts General Hospital (J.Y.R.), the Office for Diversity Inclusion and Community Partnership (J.Y.R.), Harvard Medical School (S.C.K.), and the Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health (J.Y.R.) - all in Boston; Meharry-Vanderbilt Alliance, Vanderbilt University Medical Center, Nashville (K.M.W.); and the Department of Radiation Oncology, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia (N.V.)
| | - Joan Y Reede
- From the Department of Radiation Oncology (S.C.K.), Massachusetts General Hospital (J.Y.R.), the Office for Diversity Inclusion and Community Partnership (J.Y.R.), Harvard Medical School (S.C.K.), and the Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health (J.Y.R.) - all in Boston; Meharry-Vanderbilt Alliance, Vanderbilt University Medical Center, Nashville (K.M.W.); and the Department of Radiation Oncology, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia (N.V.)
| | - Neha Vapiwala
- From the Department of Radiation Oncology (S.C.K.), Massachusetts General Hospital (J.Y.R.), the Office for Diversity Inclusion and Community Partnership (J.Y.R.), Harvard Medical School (S.C.K.), and the Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health (J.Y.R.) - all in Boston; Meharry-Vanderbilt Alliance, Vanderbilt University Medical Center, Nashville (K.M.W.); and the Department of Radiation Oncology, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia (N.V.)
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25
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Jain B, Ng K, Santos PMG, Taparra K, Muralidhar V, Mahal BA, Vapiwala N, Trinh QD, Nguyen PL, Dee EC. Prostate Cancer Disparities in Risk Group at Presentation and Access to Treatment for Asian Americans, Native Hawaiians, and Pacific Islanders: A Study With Disaggregated Ethnic Groups. JCO Oncol Pract 2022; 18:e204-e218. [PMID: 34709962 PMCID: PMC8758129 DOI: 10.1200/op.21.00412] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/16/2021] [Accepted: 09/15/2021] [Indexed: 01/03/2023] Open
Abstract
PURPOSE We identified (1) differences in localized prostate cancer (PCa) risk group at presentation and (2) disparities in access to initial treatment for Asian American, Native Hawaiian, and Pacific Islander (AANHPI) men with PCa after controlling for sociodemographic factors. METHODS We assessed all patients in the National Cancer Database with localized PCa with low-, intermediate-, and high-risk disease who identified as Thai, White, Asian Indian, Chinese, Vietnamese, Korean, Japanese, Filipino, Hawaiian, Pacific Islander, Laotian, Pakistani, Kampuchean, and Hmong. Multivariable logistic regression defined adjusted odds ratios (AORs) with 95% CI of (1) presenting at progressively higher risk group and (2) receiving treatment or active surveillance with intermediate- or high-risk disease, adjusting for sociodemographic and clinical factors. RESULTS Among 980,889 men (median age 66 years), all AANHPI subgroups with the exception of Thai (AOR = 0.84 [95% CI, 0.58 to 1.21], P > .05), Asian Indian (AOR = 1.12 [95% CI, 1.00 to 1.25], P > .05), and Pakistani (AOR = 1.34 [95% CI, 0.98 to 1.83], P > .05) men had greater odds of presenting at a progressively higher PCa risk group compared with White patients (Chinese AOR = 1.18 [95% CI, 1.11 to 1.25], P < .001; Japanese AOR = 1.36 [95% CI, 1.26 to 1.47], P < .001; Filipino AOR = 1.37 [95% CI, 1.29 to 1.46], P < .001; Korean AOR = 1.32 [95% CI, 1.18 to 1.48], P < .001; Vietnamese AOR = 1.20 [95% CI, 1.07 to 1.35], P = .002; Laotian AOR = 1.60 [95% CI, 1.08 to 2.36], P = .018; Hmong AOR = 4.07 [95% CI, 1.54 to 10.81], P = .005; Kampuchean AOR = 1.55 [95% CI, 1.03 to 2.34], P = .036; Asian Indian or Pakistani AOR = 1.15 [95% CI, 1.07 to 1.24], P < .001; Native Hawaiians AOR = 1.58 [95% CI, 1.38 to 1.80], P < .001; and Pacific Islanders AOR = 1.58 [95% CI, 1.37 to 1.82], P < .001). Additionally, Japanese Americans (AOR = 1.46 [95% CI, 1.09 to 1.97], P = .013) were more likely to receive treatment compared with White patients. CONCLUSION Our findings suggest that there are differences in PCa risk group at presentation by race or ethnicity among Asian American, Native Hawaiian, and Pacific Islander subgroups and that there exist disparities in treatment patterns. Although AANHPI are often studied as a homogenous group, heterogeneity upon subgroup disaggregation underscores the importance of further study to assess and address barriers to PCa care.
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Affiliation(s)
- Bhav Jain
- Massachusetts Institute of Technology, Cambridge, MA
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA
| | - Kenrick Ng
- Department of Medical Oncology, Barts Health NHS Trust, London, United Kingdom
- UCL Cancer Institute, University College London, London, United Kingdom
| | | | - Kekoa Taparra
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - Vinayak Muralidhar
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA
| | - Brandon A. Mahal
- University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL
| | - Neha Vapiwala
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Quoc-Dien Trinh
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA
| | - Paul L. Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
- Harvard Medical School, Boston, MA
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Aldrighetti CM, Niemierko A, Van Allen E, Willers H, Kamran SC. Racial and Ethnic Disparities Among Participants in Precision Oncology Clinical Studies. JAMA Netw Open 2021; 4:e2133205. [PMID: 34748007 PMCID: PMC8576580 DOI: 10.1001/jamanetworkopen.2021.33205] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
IMPORTANCE Precision oncology is revolutionizing cancer care, allowing for personalized treatments to improve outcomes. Cancer research has benefitted from well-designed studies incorporating precision medicine objectives, but it is unclear if these studies are representative of the diverse cancer population. OBJECTIVE To evaluate racial and ethnic representation in breast, prostate, lung, and colorectal cancer studies incorporating precision oncology objectives in the Clinicaltrials.gov registry and compare with the incidence of these cancer types in racial and ethnic minority groups in the US population. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study identified US-based breast, prostate, lung, and colorectal cancer studies incorporating precision oncology objectives for reporting of race and ethnicity. The Surveillance, Epidemiology, and End Results and US Census databases were used to determine cancer incidence by race and ethnicity, linked with cancer type and median year of enrollment for each trial. Data were collected and analyzed between December 2020 and April 2021. MAIN OUTCOMES AND MEASURES The expected number of participants per study by each racial and ethnic group was calculated based on the corresponding US-based proportion. Under- and overrepresentation was defined as the ratio of the actual number of enrolled cases to the expected number of cases for each trial by cancer type. Ratios above 1 indicated overrepresentation while a ratio below 1 indicated underrepresentation. Random-effects meta-analysis of representation ratios of individual trials was performed to weigh each individual study. RESULTS Of 93 studies encompassing 5867 enrollees with race and ethnicity data; 4826 participants (82.3%) were non-Hispanic White, 587 (10.0%) were Black, and 238 (4.1%) were Asian. Per observed-to-expected ratios, White participants were overrepresented in all studies, with a ratio of 1.35 (95% CI, 1.30-1.37), as well as Asian participants, with a ratio of 1.46 (95% CI, 1.28-1.66), while Black participants (ratio, 0.49; 95% CI, 0.45-0.54), Hispanic participants (ratio, 0.24; 95% CI, 0.20-0.28), and American Indian and Alaskan Native participants (ratio, 0.43; 95% CI, 0.24-0.78) were underrepresented. By individual cancer site, White participants were consistently overrepresented in all studies, while Black and Hispanic participants were underrepresented. CONCLUSIONS AND RELEVANCE This analysis found that precision oncology studies for breast, lung, prostate, and colorectal cancers vastly underrepresent racial and ethnic minority populations relative to their cancer incidence in the US population. It is imperative to increase diversity among enrollees so that all individuals may benefit from cancer research breakthroughs and personalized treatments.
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Affiliation(s)
| | - Andrzej Niemierko
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Eliezer Van Allen
- Dana-Farber Cancer Institute, Boston, Massachusetts
- Broad Institute of Harvard and MIT, Cambridge, Massachusetts
- Center for Cancer Precision Medicine, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Henning Willers
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Sophia C. Kamran
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston
- Broad Institute of Harvard and MIT, Cambridge, Massachusetts
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