Racial/Ethnic Disparities in Cancer Incidence, Survival and Treatment

1
Racial/Ethnic Disparities in Cancer Incidence,
Survival and Treatment

• Linda C. Harlan, PhD, MPH
• National Cancer Institute
• Division of Cancer Control and Population Sciences

2
Disparities in Cancer

• Age
• Gender
• Marital Status
• Income
• Education
• Insurance
• Health System Characteristics
• Geographic
• Race/Ethnicity

3
Age-Adjusted US Mortality Rates for the Most
Common Cancers by Race/Ethnicity for 2000-2003
Source US population NCHS
4
Racial/Ethnic Disparities Along the Cancer
Continuum

• Incidence
• Screening
• Stage at Diagnosis
• Therapy
• Survival

5
Age-Adjusted Incidence Rates for the Most Common
Cancers by Race/Ethnicity for 2000-2003
Source SEER
6
Percentage of Women Age 40 and Older Reporting
Having Mammography in the Past Two Years
Source NCHS
7
Documented Time Elapsed Since Last Mammogram for
Women Age 40 and Older by Racial/Ethnic Group
Adjusted for age and registry
Source Smith-Bindman, 2006
8
SEER Data

• Population-Based Registries
• Register all cancer cases within a geographic
  areas
• 26 of the US population
• Detailed data on
• Demographics
• Tumor characteristic
• Treatment
• Active follow-up of cases
• Public use files, available to researchers
• Analysis program associated with data

9
Stage at Diagnosis of In Situ and Invasive Breast
Cancer by Race/Ethnicity for Cases Diagnosed in
2000-2003
Source SEER
10
5-year Cancer-Specific Survival by Race/Ethnicity
and Stage for Invasive Breast Cancer Patients
Diagnosed Between 1990 -2002
Source SEER
11
Percentage of Women Receiving Radiation Following
Breast Conserving Surgery by Racial/Ethnicity and
Year of Diagnosis
Tumor lt 5cm Source SEER
12
Percent of Breast Cancer Cases Receiving
Radiation Following BCS by Race/Ethnicity and
County Family Poverty Rate 2000-2003
Source SEER
Families at or Below Poverty Level
13
Use of Adjuvant Chemo/Hormonal Therapy for Early
Stage, Node Negative Breast Cancer by
Race/Ethnicity, and ER status 2000
Source Harlan unpublished
ER negative
ER positive
14
Adjusted Percentage of Patients Diagnosed 1995
through 1999 Receiving Guideline Therapy by
Insurance Status and Race/Ethnicity
Charlson score, stage, number of positive lymph
nodes, residency training program, hospital bed
size, age, marital status, high school diploma,
gender, geographic region
Source Harlan, 2005
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Summary

• Racial/ethnic disparities occur across the cancer
  continuum
• Screening
• Stage at diagnosis
• Treatment
• Survival

16
Data Sources

• Surveillance, Epidemiology and End-Results Data
• http//seer.cancer.gov/seerstat/
• Demographic, tumor characteristic, surgery and
  radiation
• Active follow-up for vital status
• SEER-Medicare linked file
• http//healthservices.cancer.gov/seermedicare/obta
  in/
• Cancer cases age 65 and a 5 sample of
  non-cancer patients
• SEER data
• Treatment data, long-term medical follow-up,
  procedures
• Breast Cancer Surveillance Consortium
• Mammography registries
• http//breastscreening.cancer.gov/work/proposal_da
  ta.html