|
1
|
Thaploo A, Kohli K, Wang S, Ho FDV, Feliciano EJG, Wang K, Ong EP, Jain B, Kohli M, Chou C, Liu S, Iyengar R, Alberto IRI, Patel TA, Dee EC, Chino F. Disparities in Stage at Presentation for Disaggregated Asian American, Native Hawaiian, and Pacific Islander Patients with Breast Cancer. Ann Surg Oncol 2025; 32:3317-3330. [PMID: 40025362 DOI: 10.1245/s10434-025-16974-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Accepted: 01/21/2025] [Indexed: 03/04/2025]
Abstract
INTRODUCTION Cancer is the leading cause of death among Asian American, Native Hawaiian, and Pacific Islander (AA&NHPI) populations, who are among the most diverse and rapidly growing racial/ethnic groups in the United States. Despite this population's diverse socioeconomic, cultural, and immigration backgrounds, little is known about the within-group disparities in breast cancer stages at diagnosis. This study aims to identify AA&NHPI subgroups at heightened risk for advanced breast cancer by analyzing detailed incidence rates and diagnostic stages across these diverse subgroups. METHODS Patient data spanning from 2004 to 2020 were extracted from the National Cancer Database, focusing on individuals newly diagnosed with breast cancer. Individuals were disaggregated into specific AA&NHPI subgroups by self-reported country of origin. Ordinal logistic regression, adjusting for clinical and sociodemographic factors, was used to calculate adjusted odds ratios (AORs). Higher adjusted odds ratios signify more advanced stage diagnoses. RESULTS Of 3,001,173 patients with breast cancer, 99,128 (3.30%) identified as AA&NHPI. Compared with NHW patients, AA&NHPI patients were younger (median age, NHW: 62 years versus AA&NHPI: 57 years, p < 0.001) and more likely to be uninsured (NHW: 1.50% vs. AA&NHPI: 2.60%, p < 0.001). The largest AA&NHPI subgroups were Filipino (n = 21,666, 21.9% of AA&NHPI), Chinese (n = 21,303, 21.5%), Indian/Pakistani (n = 20,295, 20.5%), Vietnamese (n = 6680, 6.74%), and Korean (n = 7776, 7.84%). In aggregate, AA&NHPI patients were less likely to present with advanced stage at diagnosis relative to NHW patients (AOR 0.89, 95% confidence interval [CI] 0.88-0.90, p < 0.001). However, AA&NHPI disaggregation demonstrated that Hawaiian (AOR 1.15, 95% CI 1.09-1.22, p < 0.001), Hmong (AOR 1.70, 95% CI 1.28-2.27, p < 0.001), Laotian (AOR 1.37, 95% CI 1.17-1.61, p < 0.001), and Pacific Islander patients (AOR 1.24, 95% CI 1.17-1.32, p < 0.001) were more likely to present at a more advanced stage relative to NHW patients. Relative to Chinese Americans (the reference AA&NHPI group), all AA&NHPI ethnic groups had higher odds of advanced-stage diagnosis with the highest odds in Hmong (AOR 2.41, 95% CI 1.81-3.20, p < 0.001), Laotian (AOR 1.89, 95% CI 1.61-2.20, p < 0.001), Pacific Islander (AOR 1.71, 95% CI 1.60-1.82, p < 0.001), and Hawaiian (AOR 1.57, 95% CI 1.48-1.67, p < 0.001) patients. CONCLUSIONS Our study characterizes disparities in the stage of breast cancer at presentation across disaggregated AA&NHPI groups, with notably advanced diagnoses in patients of Hmong, Laotian, Pacific Islander, Hawaiian, and Kampuchean descent. These findings underscore the need for disaggregated research exploring both risk factors and barriers to early diagnosis, as well as culturally tailored interventions that involve community leaders and leverage cultural norms to improve cancer screening and diagnosis.
Collapse
Affiliation(s)
| | | | | | - Frances Dominique V Ho
- University of the Philippines, Manila, Philippines
- Philippine Institute for Development Studies, Manila, Philippines
| | | | | | - Erika P Ong
- University of Pittsburgh, Pittsburgh, PA, USA
| | - Bhav Jain
- Stanford University School of Medicine, Palo Alto, CA, USA
| | - Mahi Kohli
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cody Chou
- Harvard University, Cambridge, MA, USA
| | - Samuel Liu
- University of Southern California, Los Angeles, CA, USA
| | - Ranvir Iyengar
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Tej A Patel
- The University of Pennsylvania, Philadelphia, PA, USA
| | | | | |
Collapse
|
|
2
|
Shen H, Vos RO, Liu L. Relationships Between Living in Ethnic Enclaves and Cancer Outcomes: A Systematic Review of Literature. J Racial Ethn Health Disparities 2025:10.1007/s40615-025-02439-0. [PMID: 40259186 DOI: 10.1007/s40615-025-02439-0] [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: 11/25/2024] [Revised: 02/11/2025] [Accepted: 04/07/2025] [Indexed: 04/23/2025]
Abstract
BACKGROUND Ethnic enclaves (EEs) are culturally distinct neighborhoods, and complex relationships may exist between living in EEs and cancer outcomes. Given the increasing demographic diversity, expansion of EEs, and ongoing burden of cancer in the U.S., a growing body of literature focuses on the enclave-cancer relationships. This review aims to describe the scope, assess methods, synthesize existing evidence, and identify research gaps on this topic. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we found 34 empirical studies, published between January 2000 and May 2023, that examined how living in EEs may relate to various cancer outcomes, including incidence, diagnosis, treatment, and survival. RESULTS Most studies examined the relationships between residing in Hispanic or Asian enclaves and cancer incidence or survival in California. Studies used divergent methods to identify EEs, and results were mixed among null, protective, and risk findings. Studies explored several cancer types, with breast and colon cancers being the most studied, and findings also varied by patients' race and ethnicity, sex, and neighborhood socioeconomic status (SES). The small number of studies limits the power to draw statistical conclusions from the existing literature. CONCLUSIONS More research is needed to adequately explore enclave-cancer relationships among diverse populations across different U.S. regions, and to comprehensively investigate potential moderators and mediators connecting EEs and cancer outcomes. Future studies may benefit from conceptualizing and operationalizing EEs based on demographic, geographic, economic, and cultural characteristics, and recognizing varying SES, immigrant concentrations, and racial/ethnic subgroup compositions across EEs.
Collapse
Affiliation(s)
- Han Shen
- Spatial Sciences Institute, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, CA, USA.
| | - Robert O Vos
- Spatial Sciences Institute, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, CA, USA
| | - Lihua Liu
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Los Angeles Cancer Surveillance Program, Los Angeles, CA, USA
| |
Collapse
|
|
3
|
Holder EX, Barnard ME, Xu NN, Barber LE, Palmer JR. Neighborhood Disadvantage, Individual Experiences of Racism, and Breast Cancer Survival. JAMA Netw Open 2025; 8:e253807. [PMID: 40193073 PMCID: PMC11976487 DOI: 10.1001/jamanetworkopen.2025.3807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2024] [Accepted: 02/04/2025] [Indexed: 04/10/2025] Open
Abstract
Importance Due to the legacy of structural racism in the United States, Black US residents are more likely to live in disadvantaged neighborhoods regardless of individual socioeconomic status. Black women are also more likely to die from their breast cancer. Objective To investigate whether neighborhood disadvantage and individual experiences of racism are associated with breast cancer mortality among Black US women. Design, Setting, and Participants Prospective follow-up study conducted within the Black Women's Health Study (BWHS), a nationwide cohort study of 59 000 self-identified Black females enrolled in 1995 and followed up by biennial questionnaires. BWHS participants diagnosed with breast cancer at stages I to III and who survived 12 months after initial diagnosis were included (n = 2290). Deaths and cause of death were identified through linkage with the National Death Index. Exposures Geocoded participant addresses were linked with US Census Bureau and American Community Survey data to create neighborhood-level indices reflecting relative disadvantage. Data on experiences of racism were obtained from questionnaires. Main Outcomes and Measures Breast cancer-specific and all-cause mortality. Hazard ratios (HRs) and 95% CIs were estimated from multivariable Cox proportional hazards regression models. Results There were 305 breast cancer-specific deaths among 2290 women with invasive breast cancer (mean [SD] age at diagnosis, 56.7 [10.9] years) who were followed up for a median (IQR) of 10.5 (5.6-16.1) years. The mortality rate was 14.26 (95% CI, 11.01-17.51) per 1000 person-years for those living in the most disadvantaged neighborhoods and 8.82 (95% CI, 6.55-11.09) per 1000 person-years for those living in the least disadvantaged neighborhoods (HR, 1.47; 95% CI, 1.02-2.12). HRs for women living in areas of extreme economic deprivation (vs privilege) and for women who reported experiences of racism in at least 2 institutional spheres (vs none) were also greater than 1, but not statistically significant (extreme economic deprivation vs privilege: HR, 1.19; 95% CI, 0.88-1.61; racism in 2 spheres vs none: HR, 1.28; 95% CI, 0.96-1.73). Conclusions and Relevance In this cohort of Black women, living in disadvantaged neighborhoods was associated with a higher mortality from breast cancer, even after accounting for stage at diagnosis, treatments, and individual-level lifestyle factors. Community-level interventions to reduce environmental stressors and improve conditions in disadvantaged neighborhoods, including access to high-quality cancer care, may be critical to reducing racial disparities in breast cancer survival.
Collapse
Affiliation(s)
- Etienne X. Holder
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
| | - Mollie E. Barnard
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Nuo N. Xu
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
| | - Lauren E. Barber
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Julie R. Palmer
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| |
Collapse
|
|
4
|
Rosowicz A, Hewitt DB. Disparities in Cancer Screening Among the Foreign-Born Population in the United States: A Narrative Review. Cancers (Basel) 2025; 17:576. [PMID: 40002170 PMCID: PMC11852454 DOI: 10.3390/cancers17040576] [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: 12/31/2024] [Revised: 01/29/2025] [Accepted: 02/04/2025] [Indexed: 02/27/2025] Open
Abstract
Background: The foreign-born population in the United States has reached a record high over the last three years. Significant disparities in cancer screening rates exist among this population, resulting in later-stage diagnoses and worse outcomes. This narrative review explores the sociodemographic factors, barriers, and interventions influencing cancer screening rates among foreign-born individuals in the U.S. Methods: A comprehensive review of studies was conducted to assess colorectal, cervical, and breast cancer screening disparities among immigrants. Factors examined include length of residence, race and ethnicity, income, education, citizenship, insurance, usual source of care, language, medical literacy, and cultural barriers. Furthermore, the effectiveness of educational interventions, patient navigators, and at-home testing in addressing these screening disparities was evaluated. Results: Immigrants have lower screening rates for colorectal, cervical, and breast cancer compared to U.S.-born individuals, with the largest disparities observed in colorectal cancer. Factors influencing these gaps include shorter duration of residence, Asian ethnicity, and lower income and education levels. Lack of health insurance and of a usual source of care are currently the most significant barriers to screening. Interventions such as education, patient navigation, and at-home testing have shown moderate success in improving screening rates, though data on their effectiveness remain limited. Conclusions: Addressing cancer screening disparities within the U.S. foreign-born population is essential, especially as the immigrant population continues to reach record numbers. Targeted interventions are needed to improve screening among immigrant groups with the lowest completion rates. Future research on these interventions should prioritize larger sample sizes, longitudinal studies, and the utility of new technologies such as artificial intelligence.
Collapse
Affiliation(s)
| | - Daniel Brock Hewitt
- Department of Surgery, NYU Grossman School of Medicine, New York, NY 10016, USA;
| |
Collapse
|
|
5
|
Harvey-Sullivan A, Ali S, Dhesi P, Hart J, Painter H, Walter FM, Funston G, Zenner D. Comparing cancer stage at diagnosis between migrants and non-migrants: a meta-analysis. Br J Cancer 2025; 132:158-167. [PMID: 39533108 PMCID: PMC11756392 DOI: 10.1038/s41416-024-02896-0] [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: 05/13/2024] [Revised: 10/18/2024] [Accepted: 10/24/2024] [Indexed: 11/16/2024] Open
Abstract
BACKGROUND Migrants face barriers accessing healthcare, risking delays in cancer diagnosis. Diagnostic delays result in later stage diagnosis which is associated with poorer cancer survival. This review aims to compare the differences in cancer stage at diagnosis between migrants and non-migrants. METHODS We conducted a systematic review and meta-analysis of three databases from 2000 to 2023 for studies conducted in OECD countries that compared stage at diagnosis between migrants and non-migrants. Meta-analysis compared odds ratios (OR) for early (stage I and II) stage at diagnosis. The Risk of Bias in Non-randomised Studies of Exposure tool was used to assess study quality. RESULTS 41 of the 11,549 studies identified were included; 34 studies had suitable data for meta-analysis. Overall, migrants were significantly less likely to be diagnosed with early stage cancer compared with non-migrants (OR 0.84; 95% CI 0.78-0.91). This difference was maintained across cancer types, although only statistically significant for breast (OR 0.78; 95% CI 0.70-0.87) and prostate cancer (OR 0.92; 95% CI 0.85-0.99). DISCUSSION Published studies indicate that migrants are less likely to be diagnosed with early stage cancer. Variation by cancer type, study location and region of origin highlights the need for further research to understand these differences.
Collapse
Affiliation(s)
- Adam Harvey-Sullivan
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
| | - Sana Ali
- Primary Care & Population Health Department, University College London, London, UK
| | - Parveen Dhesi
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Joseph Hart
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Helena Painter
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Fiona M Walter
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Garth Funston
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Dominik Zenner
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| |
Collapse
|
|
6
|
Tan NQP, Ma GX, Maxwell AE, Brown RL, Zhou K, Loh A, Young L, Volk RJ, Lu Q, Wang JH. The impact of a small-group mammography video discussion on promoting screening uptake among nonadherent Chinese American immigrant women: A randomized controlled trial. Cancer 2025; 131:e35524. [PMID: 39257218 PMCID: PMC11694167 DOI: 10.1002/cncr.35524] [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: 01/16/2024] [Revised: 06/25/2024] [Accepted: 07/10/2024] [Indexed: 09/12/2024]
Abstract
BACKGROUND The objective of this study was to evaluate the efficacy of an in-person, small-group mammography video discussion (SMVD) intervention on mammography uptake among nonadherent Chinese American immigrant women. METHODS Women (N = 956) were randomized into either an SMVD group, where Chinese-speaking community health workers (CHWs) used an effective, culturally appropriate video to discuss mammography, or a video-only group, which viewed the cultural video sent by mail. Outcomes were mammography uptake at 6 months and 21 months postintervention. RESULTS Women in both groups increased mammography uptake, and an outcome analysis revealed no group differences (adjusted odds ratio [AOR], 1.18; 95% confidence interval [CI], .68-2.06). Overall, 61.2% of the SMVD group and 55.3% of the video-only group had at least one mammogram during the 21-month follow-up period. When considering attendance to the SMVD, SMVD attendees had higher mammography uptake than the video-only group (AOR, 1.51; 95% CI, 1.19-1.92), and SMVD nonattendees had lower mammography uptake than the video-only group (AOR, .33; 95% CI, .22-.50). CONCLUSIONS Both intervention strategies were associated with increased mammography uptake. The authors observed that the increase in use was greater among women who participated in the SMVD session compared with those who viewed the cultural video only. Future research may explore a virtual SMVD intervention for higher session attendance and increased mammography uptake (ClinicalTrials.gov identifier NCT01292200).
Collapse
Affiliation(s)
- Naomi Q. P. Tan
- Rutgers Cancer InstituteRutgers UniversityNew BrunswickNew JerseyUSA
- Division of Medical OncologyRobert Wood Johnson Medical SchoolRutgers UniversityNew BrunswickNew JerseyUSA
| | - Grace X. Ma
- Center for Asian HealthLewis Katz School of MedicineTemple UniversityPhiladelphiaPennsylvaniaUSA
| | - Annette E. Maxwell
- Center for Cancer Prevention and Control ResearchUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | - Roger L. Brown
- Schools of Nursing Medicine and Public HealthUniversity of WisconsinMadisonWisconsinUSA
| | - Kathy Zhou
- Center for Asian HealthLewis Katz School of MedicineTemple UniversityPhiladelphiaPennsylvaniaUSA
| | - Alice Loh
- Herald Cancer AssociationSan GabrielCaliforniaUSA
| | - Lucy Young
- Herald Cancer AssociationSan GabrielCaliforniaUSA
| | - Robert J. Volk
- Department of Health Services ResearchThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Qian Lu
- Department of Health Disparities ResearchThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Judy Huei‐Yu Wang
- Department of Oncology, Cancer Prevention and Control Program of Lombardi Comprehensive Cancer CenterGeorgetown University Medical CenterWashingtonDistrict of ColumbiaUSA
| |
Collapse
|
|
7
|
Wilsnack C, Cubbin C. The relationship of race/ethnicity and age with medical financial hardship for cancer survivors in the United States. J Cancer Surviv 2024:10.1007/s11764-024-01707-y. [PMID: 39612085 DOI: 10.1007/s11764-024-01707-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 11/01/2024] [Indexed: 11/30/2024]
Abstract
PURPOSE The present study examined the association between race/ethnicity and medical financial hardship between cancer survivors aged 18-64 years who were diagnosed when they were adolescents or young adults (AYAs, aged 15-39 years old) and non-AYAs (aged 40-64 years old). METHODS We used data from the 2013-2018 National Health Interview Survey (NHIS) to identify AYA cancer survivors who were defined as receiving a cancer diagnosis between 15 and 39 years old and non-AYA cancer survivors who were defined as receiving a cancer diagnosis between 40 and 64 years old. Medical financial hardship was defined by 3 hardship domains: material (e.g., difficulty paying off medical bills), psychological (e.g., worry about medical costs), and behavioral (e.g., not receiving/postponing care because of cost). RESULTS There were 2162 AYA cancer survivors (mean age = 32 years) and 3393 non-AYA cancer survivors (mean age = 51 years). AYA cancer survivors were more likely than non-AYA cancer survivors to experience all 3 hardship domains (30% vs. 20%, P < 0.01). Hispanic AYA and non-AYA cancer survivors had increased odds for experiencing any psychological hardship compared to White counterparts (P < 0.05). Black non-AYA cancer survivors had increased odds for experiencing any material hardship (P < 0.05). CONCLUSION Race/ethnicity was associated with some domains of medical financial hardship for Black and Hispanic cancer survivors. AYA cancer survivors also experienced more domains of medical financial hardship compared to non-AYA cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS Direct practice and policy-level interventions are needed to address financial disparities among cancer survivors. Future research should examine disaggregated racial data.
Collapse
Affiliation(s)
- Catherine Wilsnack
- Steve Hicks School of Social Work, University of Texas at Austin, 405 W 25th St, Austin, TX, 78705, USA.
| | - Catherine Cubbin
- Steve Hicks School of Social Work, University of Texas at Austin, 405 W 25th St, Austin, TX, 78705, USA
| |
Collapse
|
|
8
|
Sasaki T, Liyanage A, Bansil S, Silva A, Pagano I, Hidalgo EY, Jones C, Ueno NT, Takahashi Y, Fukui J. Differences in Breast Cancer Subtypes among Racial/Ethnic Groups. Cancers (Basel) 2024; 16:3462. [PMID: 39456556 PMCID: PMC11506832 DOI: 10.3390/cancers16203462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2024] [Revised: 10/02/2024] [Accepted: 10/10/2024] [Indexed: 10/28/2024] Open
Abstract
BACKGROUND Differences in the incidence of breast cancer subtypes among racial/ethnic groups have been evaluated as a contributing factor in disparities seen in breast cancer prognosis. We evaluated new breast cancer cases in Hawai'i to determine if there were subtype differences according to race/ethnicity that may contribute to known disparities. METHODS We reviewed 4591 cases of women diagnosed with breast cancer from two large tumor registries between 2015 and 2022. We evaluated breast cancer cases according to age at diagnosis, self-reported race, breast cancer subtype (ER, PR, and HER2 receptor status), histology, county, and year. RESULTS We found both premenopausal and postmenopausal Native Hawaiian women were less likely to be diagnosed with triple-negative breast cancer (OR = 0.26, 95% CI 0.12-0.58 p = 0.001; OR = 0.54, 95% CI 0.36, 0.80 p = 0.002, respectively). CONCLUSIONS The results of our study support that there are racial/ethnic differences in breast cancer subtypes among our population, which may contribute to differences in outcomes. Further evaluation of clinical and pathological features in each breast cancer subtype may help improve the understanding of outcome disparities seen among different racial/ethnic groups.
Collapse
Affiliation(s)
- Tamlyn Sasaki
- John A. Burns School of Medicine, University of Hawai’i, Honolulu, HI 96813, USA; (T.S.); (N.T.U.)
| | - Akash Liyanage
- John A. Burns School of Medicine, University of Hawai’i, Honolulu, HI 96813, USA; (T.S.); (N.T.U.)
| | - Surbhi Bansil
- John A. Burns School of Medicine, University of Hawai’i, Honolulu, HI 96813, USA; (T.S.); (N.T.U.)
| | - Anthony Silva
- John A. Burns School of Medicine, University of Hawai’i, Honolulu, HI 96813, USA; (T.S.); (N.T.U.)
| | - Ian Pagano
- Translational and Clinical Research Program, University of Hawai’i Cancer Center, Honolulu, HI 96813, USA; (I.P.); (Y.T.)
| | - Elena Y. Hidalgo
- Queen’s Medical Center Oncology Data Registry, Honolulu, HI 96813, USA
| | - Corinne Jones
- Kapi’olani Medical Center for Women and Children, Honolulu, HI 96822, USA;
| | - Naoto T. Ueno
- John A. Burns School of Medicine, University of Hawai’i, Honolulu, HI 96813, USA; (T.S.); (N.T.U.)
- Translational and Clinical Research Program, University of Hawai’i Cancer Center, Honolulu, HI 96813, USA; (I.P.); (Y.T.)
- Kapi’olani Medical Center for Women and Children, Honolulu, HI 96822, USA;
- The Queen’s Health Systems, Honolulu, HI 96813, USA
| | - Yoko Takahashi
- Translational and Clinical Research Program, University of Hawai’i Cancer Center, Honolulu, HI 96813, USA; (I.P.); (Y.T.)
| | - Jami Fukui
- John A. Burns School of Medicine, University of Hawai’i, Honolulu, HI 96813, USA; (T.S.); (N.T.U.)
- Translational and Clinical Research Program, University of Hawai’i Cancer Center, Honolulu, HI 96813, USA; (I.P.); (Y.T.)
- Kapi’olani Medical Center for Women and Children, Honolulu, HI 96822, USA;
- The Queen’s Health Systems, Honolulu, HI 96813, USA
| |
Collapse
|
|
9
|
Lu Q, Lun D, Dawkins-Moultin L, Li Y, Chen M, Giordano SH, Pennebaker JW, Young L, Wang C. Study protocol for writing to heal: A culturally based brief expressive writing intervention for Chinese immigrant breast cancer survivors. PLoS One 2024; 19:e0309138. [PMID: 39325778 PMCID: PMC11426517 DOI: 10.1371/journal.pone.0309138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Accepted: 08/07/2024] [Indexed: 09/28/2024] Open
Abstract
BACKGROUND This study uses a randomized controlled trial (RCT) to test the health benefits of expressive writing that is culturally adapted for Chinese immigrant breast cancer survivors (BCSs) and to characterize how acculturation moderates the effects of expressive writing interventions. METHODS We will recruit Chinese immigrant BCSs (N = 240) diagnosed with stage 0-III breast cancer and within 5 years of completion of primary treatment. Recruitment will occur primarily through community-based organizations and cancer registries. Participants will be randomly assigned either to a control condition to write about neutral topics or to one of two intervention conditions, self-regulation or self-cultivation, both of which aim to promote adaptive cognitive processes but differ in how they achieve this goal. The self-regulation intervention culturally adapts a Western expressive writing paradigm and incorporates emotional disclosure, whereas the self-cultivation intervention originates from Asian cultural values without disclosing emotions. Participants in all three conditions will be asked to write in their preferred language for three 30-minute sessions. The primary outcome will be quality of life (QOL) at the 6- and 12-month follow-ups, and the secondary outcomes will be perceived stress, stress biomarkers, and medical appointments for cancer-related morbidities. DISCUSSION This project will be the first large RCT to test culturally based brief interventions to improve QOL and reduce stress among Chinese immigrant BCSs. This project is expected to address two important needs of Chinese immigrant BCSs: their unmet psychological needs and the lack of culturally competent mental health care for Chinese immigrant BCSs. The immediate product of this line of research will be empirically evaluated, culturally responsive interventions ready for dissemination to Chinese immigrant BCSs across the United States. CLINICALTRIALS.GOV IDENTIFIER NCT04754412.
Collapse
Affiliation(s)
- Qian Lu
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Di Lun
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Lenna Dawkins-Moultin
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Yisheng Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Minxing Chen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Sharon Hermes Giordano
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - James W. Pennebaker
- Department of Psychology, The University of Texas at Austin, Austin, Texas, United States of America
| | - Lucy Young
- Herald Cancer Association, San Gabriel, California, United States of America
| | - Carol Wang
- Herald Cancer Association, San Gabriel, California, United States of America
| |
Collapse
|
|
10
|
Sharma N, Mehta TS, Wahab RA, Patel MM. Facilitating Culturally Competent Breast Imaging Care in South Asian Patients. JOURNAL OF BREAST IMAGING 2024; 6:529-538. [PMID: 38787594 DOI: 10.1093/jbi/wbae026] [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: 09/29/2023] [Indexed: 05/25/2024]
Abstract
South Asians are a rapidly growing subset of the Asian population in the United States. They comprise people from multiple countries with diverse beliefs, languages, and cultural identities and values. The incidence of breast cancer is rising in South Asian women in the United States, with earlier onset and predilection for HER2-enriched tumors. Despite the rising incidence of breast cancer, participation in screening remains lower than other populations. Health care inequities in South Asian women are multifactorial and may be due to traditional health beliefs and practices, language barriers, cultural differences, and lack of overall awareness. Developing a culturally sensitive environment in breast imaging clinic practice can lead to improved patient care and adherence. Given the scarcity of data specific to the South Asian population in United States, there is a need for health service researchers and practice leaders to obtain more high-quality data to understand the needs of South Asian patient populations.
Collapse
Affiliation(s)
- Nidhi Sharma
- Department of Radiology, Texas A&M University, Dallas, TX, USA
| | - Tejas S Mehta
- Department of Radiology, UMass Memorial Medical Center/UMass Chan Medical School, Worcester, MA, USA
| | - Rifat A Wahab
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Miral M Patel
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
|
11
|
Chu JN, Tsoh JY, Shariff-Marco S, Allen L, Oh D, Kuo MC, Wong C, Bui H, Chen J, Truong A, Wang K, Hwang A, Li FM, Ma C, Gomez SL, Nguyen TT. Patient COUNTS: A pilot navigation program for Asian American cancer patients. ASIAN AMERICAN JOURNAL OF PSYCHOLOGY 2024; 15:205-212. [PMID: 39387093 PMCID: PMC11460540 DOI: 10.1037/aap0000319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/12/2024]
Abstract
Many Asian American cancer patients face barriers to cancer care but little is known about their navigational needs. We designed and implemented a pilot study to provide culturally- and linguistically-appropriate navigation for Asian American cancer patients. We recruited Asian American adults age 21+ years, who spoke English, Cantonese, Mandarin, or Vietnamese, with newly diagnosed, stage I-III colorectal, liver, or lung cancer in the Northern California Bay Area. Participants were assigned a language-concordant patient navigator, who provided support and resources over 6 months. Surveys were administered at baseline, 3-, and 6-months to assess sociodemographic characteristics, healthcare access, quality of life (FACT-G), and cancer care needs. Participants' mean age was 65 years (range 38-81); 62% were men, 67% spoke Chinese, and 75% reported limited English proficiency. Forty-two percent of participants had lung, 38% colorectal, and 21% liver cancer. Of 24 participants who enrolled, 67% completed the program and 75% completed standard of care cancer treatment. The average total FACT-G score was 72.6 (SD 17) at baseline, 68.0 (SD 20) at 3 months, and 69.9 (SD 22) at 6 months. All participants reported that the program was culturally appropriate and would recommend it. Asian American cancer patients in a patient navigation program reported lower quality of life compared to the general adult cancer population. Even with navigation, 75% of participants reported completing standard of care treatment. While participants were satisfied with the program, more research is needed to address the quality of cancer care Asian American cancer patients receive.
Collapse
Affiliation(s)
- Janet N. Chu
- Department of Medicine, University of California San Francisco
- Asian American Research Center on Health
| | - Janice Y. Tsoh
- Asian American Research Center on Health
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco
| | - Salma Shariff-Marco
- Department of Epidemiology and Biostatistics, University of California San Francisco
| | - Laura Allen
- Department of Epidemiology and Biostatistics, University of California San Francisco
| | - Debora Oh
- Department of Epidemiology and Biostatistics, University of California San Francisco
| | - Mei-Chin Kuo
- Department of Epidemiology and Biostatistics, University of California San Francisco
| | - Ching Wong
- Department of Medicine, University of California San Francisco
- Asian American Research Center on Health
| | - Hoan Bui
- Department of Medicine, University of California San Francisco
- Asian American Research Center on Health
| | - Junlin Chen
- Department of Medicine, University of California San Francisco
| | | | - Katarina Wang
- Asian American Research Center on Health
- Department of Epidemiology and Biostatistics, University of California San Francisco
| | | | | | - Carmen Ma
- Asian American Research Center on Health
| | - Scarlett L. Gomez
- Department of Epidemiology and Biostatistics, University of California San Francisco
| | - Tung. T Nguyen
- Department of Medicine, University of California San Francisco
- Asian American Research Center on Health
| |
Collapse
|
|
12
|
Cannavale KL, Xu L, Nau CL, Armenian SH, Bhatia S, Wong FL, Huang PYS, Cooper R, Chao CR. Neighborhood factors associated with late effects among survivors of adolescent and young adult cancer. J Cancer Surviv 2024:10.1007/s11764-024-01596-1. [PMID: 38839694 DOI: 10.1007/s11764-024-01596-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/05/2024] [Indexed: 06/07/2024]
Abstract
PURPOSE The purpose of this study is to evaluate the associations between neighborhood income, education, and neighborhood racial composition (measured as a low percentage of white residents) and risk of developing cardiovascular diseases (CVD), diabetes (DM), and severe depression among survivors of AYA cancer and matched non-cancer peers. METHODS Two-year survivors of AYA cancers diagnosed at age 15-39 yrs at Kaiser Permanente Southern California (diagnosed 2000-2012) and individually matched (1:13) non-cancer subjects were included. The development of CVD, DM, and severe depression was ascertained via electronic health records. Neighborhood characteristics were obtained from census-based geocoded data. Cox regression evaluated associations between neighborhood characteristics and the health outcomes of interest among both the cancer survivors and the non-cancer comparison cohort and effect modification by cancer survivor status on these relationships. RESULTS Among cancer survivors (n = 6774), living in mostly non-white neighborhoods, was associated with risk of CVD (hazard ratio (HR) = 1.54 (95% CI 1.00-2.36)), while lower education level (HR = 1.41 (95% CI 1.02-1.94)) was associated with risk of severe depression. None of the neighborhood characteristics were associated with risk of DM. Effect modification was found for neighborhood education and risk of DM and severe depression. CONCLUSION When jointly considered, cancer survivors who resided in the most disadvantaged neighborhoods were at the highest risk of developing these health outcomes compared to other subgroups. IMPLICATIONS FOR CANCER SURVIVORS Our findings may inform screening strategy and addressing social determinants of health among AYA cancer survivors.
Collapse
Affiliation(s)
- Kimberly L Cannavale
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Lanfang Xu
- MedHealth Analytics Inc., Sugar Land, TX, USA
| | - Claudia L Nau
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Saro H Armenian
- Department of Population Sciences, City of Hope, Duarte, CA, USA
- Department of Pediatrics, City of Hope, Duarte, CA, USA
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - F Lennie Wong
- Department of Population Sciences, City of Hope, Duarte, CA, USA
| | - Po-Yin Samuel Huang
- Department of Family Medicine, Los Angeles Medical Center, Kaiser Permanente Southern California, Los Angeles, CA, USA
| | - Robert Cooper
- Department of Pediatric Oncology, Los Angeles Medical Center, Kaiser Permanente Southern California, Los Angeles, CA, USA
| | - Chun R Chao
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
- Department of Health Systems Science, Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA, USA.
| |
Collapse
|
|
13
|
Barber LE, Maliniak ML, Moubadder L, Johnson DA, Miller-Kleinhenz JM, Switchenko JM, Ward KC, McCullough LE. Neighborhood Deprivation and Breast Cancer Mortality Among Black and White Women. JAMA Netw Open 2024; 7:e2416499. [PMID: 38865125 PMCID: PMC11170302 DOI: 10.1001/jamanetworkopen.2024.16499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/12/2024] [Indexed: 06/13/2024] Open
Abstract
Importance Neighborhood deprivation has been associated with increased breast cancer mortality among White women, but findings are inconsistent among Black women, who experience different neighborhood contexts. Accounting for interactions among neighborhood deprivation, race, and other neighborhood characteristics may enhance understanding of the association. Objective To investigate whether neighborhood deprivation is associated with breast cancer mortality among Black and White women and whether interactions with rurality, residential mobility, and racial composition, which are markers of access, social cohesion, and segregation, respectively, modify the association. Design, Setting, and Participants This population-based cohort study used Georgia Cancer Registry (GCR) data on women with breast cancer diagnosed in 2010 to 2017 and followed-up until December 31, 2022. Data were analyzed between January 2023 and October 2023. The study included non-Hispanic Black and White women with invasive early-stage (I-IIIA) breast cancer diagnosed between 2010 and 2017 and identified through the GCR. Exposures The Neighborhood Deprivation Index (NDI), assessed in quintiles, was derived through principal component analysis of 2011 to 2015 block group-level American Community Survey (ACS) data. Rurality, neighborhood residential mobility, and racial composition were measured using Georgia Public Health Department or ACS data. Main Outcomes and Measures The primary outcome was breast cancer-specific mortality identified by the GCR through linkage to the Georgia vital statistics registry and National Death Index. Cox proportional hazards regression was used to estimate age-adjusted and multivariable-adjusted hazard ratios (HRs) and 95% CIs for the association between neighborhood deprivation and breast cancer mortality. Results Among the 36 795 patients with breast cancer (mean [SD] age at diagnosis, 60.3 [13.1] years), 11 044 (30.0%) were non-Hispanic Black, and 25 751 (70.0%) were non-Hispanic White. During follow-up, 2942 breast cancer deaths occurred (1214 [41.3%] non-Hispanic Black women; 1728 [58.7%] non-Hispanic White women). NDI was associated with an increase in breast cancer mortality (quintile 5 vs 1, HR, 1.36; 95% CI, 1.19-1.55) in Cox proportional hazards models. The association was present only among non-Hispanic White women (quintile 5 vs 1, HR, 1.47; 95% CI, 1.21-1.79). Similar race-specific patterns were observed in jointly stratified analyses, such that NDI was associated with increased breast cancer mortality among non-Hispanic White women, but not non-Hispanic Black women, irrespective of the additional neighborhood characteristics considered. Conclusions and Relevance In this cohort study, neighborhood deprivation was associated with increased breast cancer mortality among non-Hispanic White women. Neighborhood racial composition, residential mobility, and rurality did not explain the lack of association among non-Hispanic Black women, suggesting that factors beyond those explored here may contribute to breast cancer mortality in this racial group.
Collapse
Affiliation(s)
- Lauren E. Barber
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Maret L. Maliniak
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Leah Moubadder
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Dayna A. Johnson
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | | | - Jeffrey M. Switchenko
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Kevin C. Ward
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Lauren E. McCullough
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| |
Collapse
|
|
14
|
Desjardins MR, Kanarek NF, Nelson WG, Bachman J, Curriero FC. Disparities in Cancer Stage Outcomes by Catchment Areas for a Comprehensive Cancer Center. JAMA Netw Open 2024; 7:e249474. [PMID: 38696166 PMCID: PMC11066700 DOI: 10.1001/jamanetworkopen.2024.9474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/04/2024] [Indexed: 05/05/2024] Open
Abstract
Importance The National Cancer Institute comprehensive cancer centers (CCCs) lack spatial and temporal evaluation of their self-designated catchment areas. Objective To identify disparities in cancer stage at diagnosis within and outside a CCC's catchment area across a 10-year period using spatial and statistical analyses. Design, Setting, and Participants This cross-sectional, population-based study conducted between 2010 and 2019 utilized cancer registry data for the Johns Hopkins Sidney Kimmel CCC (SKCCC). Eligible participants included patients with cancer in the contiguous US who received treatment for cancer, a diagnosis of cancer, or both at SKCCC. Patients were geocoded to zip code tabulation areas (ZCTAs). Individual-level variables included sociodemographic characteristics, smoking and alcohol use, treatment type, cancer site, and insurance type. Data analysis was performed between March and July 2023. Exposures Distance between SKCCC and ZCTAs were computed to generate a catchment area of the closest 75% of patients and outer zones in 5% increments for comparison. Main Outcomes and Measures The primary outcome was cancer stage at diagnosis, defined as early-stage, late-stage, or unknown stage. Multinomial logistic regression was used to determine associations of catchment area with stage at diagnosis. Results This study had a total of 94 007 participants (46 009 male [48.94%] and 47 998 female [51.06%]; 30 195 aged 22-45 years [32.12%]; 4209 Asian [4.48%]; 2408 Hispanic [2.56%]; 16 004 non-Hispanic Black [17.02%]; 69 052 non-Hispanic White [73.45%]; and 2334 with other or unknown race or ethnicity [2.48%]), including 47 245 patients (50.26%) who received a diagnosis of early-stage cancer, 19 491 (20.73%) who received a diagnosis of late-stage cancer , and 27 271 (29.01%) with unknown stage. Living outside the main catchment area was associated with higher odds of late-stage cancers for those who received only a diagnosis (odds ratio [OR], 1.50; 95% CI, 1.10-2.05) or only treatment (OR, 1.44; 95% CI, 1.28-1.61) at SKCCC. Non-Hispanic Black patients (OR, 1.16; 95% CI, 1.10-1.23) and those with Medicaid (OR, 1.65; 95% CI, 1.46-1.86) and no insurance at time of treatment (OR, 2.12; 95% CI, 1.79-2.51) also had higher odds of receiving a late-stage cancer diagnosis. Conclusions and Relevance In this cross-sectional study of CCC data from 2010 to 2019, patients residing outside the main catchment area, non-Hispanic Black patients, and patients with Medicaid or no insurance had higher odds of late-stage diagnoses. These findings suggest that disadvantaged populations and those living outside of the main catchment area of a CCC may face barriers to screening and treatment. Care-sharing agreements among CCCs could address these issues.
Collapse
Affiliation(s)
- Michael R. Desjardins
- Department of Epidemiology and Spatial Science for Public Health Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Norma F. Kanarek
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - William G. Nelson
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jamie Bachman
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Frank C. Curriero
- Department of Epidemiology and Spatial Science for Public Health Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| |
Collapse
|
|
15
|
Lee E, Tsai KY, Zhang J, Hwang AE, Deapen D, Koh JJ, Kawaguchi ES, Buxbaum J, Hoon S, Liu L. Population-based evaluation of disparities in stomach cancer by nativity among Asian and Hispanic populations in California, 2011-2015. Cancer 2024; 130:1092-1100. [PMID: 38079517 PMCID: PMC11018353 DOI: 10.1002/cncr.35141] [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: 07/07/2023] [Revised: 10/28/2023] [Accepted: 10/31/2023] [Indexed: 03/08/2024]
Abstract
BACKGROUND Stomach cancer incidence presents significant racial/ethnic disparities among racial/ethnic minority groups in the United States, particularly among Asian and Hispanic immigrant populations. However, population-based evaluation of disparities by nativity has been scarce because of the lack of nativity-specific population denominators, especially for disaggregated Asian subgroups. Population-based stomach cancer incidence and tumor characteristics by detailed race/ethnicity and nativity were examined. METHODS Annual age-adjusted incidence rates were calculated by race/ethnicity, sex, and nativity and tumor characteristics, such as stage and anatomic subsite, were evaluated using the 2011-2015 California Cancer Registry data. For Hispanic and Asian populations, nativity-specific population counts were estimated using the US Census and the American Community Survey Public Use Microdata Sample data. RESULTS During 2011-2015 in California, 14,198 patients were diagnosed with stomach cancer. Annual age-adjusted incidence rates were higher among foreign-born individuals than their US-born counterparts. The difference was modest among Hispanics (∼1.3-fold) but larger (∼2- to 3-fold) among Chinese, Japanese, and Korean Americans. The highest incidence was observed for foreign-born Korean and Japanese Americans (33 and 33 per 100,000 for men; 15 and 12 per 100,000 for women, respectively). The proportion of localized stage disease was highest among foreign-born Korean Americans (44%); a similar proportion was observed among US-born Korean Americans, although numbers were limited. For other Asians and Hispanics, the localized stage proportion was generally lower among foreign-born than US-born individuals and lowest among foreign-born Japanese Americans (23%). CONCLUSIONS Nativity-specific investigation with disaggregated racial/ethnic groups identified substantial stomach cancer disparities among foreign-born immigrant populations.
Collapse
Affiliation(s)
- Eunjung Lee
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Kai-Ya Tsai
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Juanjuan Zhang
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Amie E. Hwang
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Dennis Deapen
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Jennifer J. Koh
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Eric S. Kawaguchi
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - James Buxbaum
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Sang Hoon
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Lihua Liu
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| |
Collapse
|
|
16
|
Hagopian GS, Bapat AC, Dottino PR, Lieber M, Kemeny MM, Li X, Kaplowitz E, Beddoe A. The impact of nativity on uterine cancer survival in the public hospital system of Queens, New York. Gynecol Oncol 2024; 181:133-140. [PMID: 38163383 DOI: 10.1016/j.ygyno.2023.12.018] [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: 10/21/2023] [Revised: 12/17/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE We studied cis-women with uterine cancer presenting to the two Public Hospitals in Queens, New York from 2006 to 2015 to examine the relationship between nativity (birthplace) and survival. METHODS A retrospective review of tumor registries identified women diagnosed with uterine cancer between January 1, 2006, and December 31, 2015. Data from 259 women were available for this analysis. RESULTS Most women were born outside the United States (US) (76% versus 24%). The majority of US-born women were black (68%). Seventy-seven women (30%) were born in Latin America, 76 in the Caribbean Islands (29%) and 44 in Asia/South Asia (17%). Most women presented with stage I/II disease (70%) and endometrioid/mucinous histology (68%) with no significant differences observed among nativity groups. Kaplan-Meier estimated survival curves stratified by birthplace demonstrated significant differences in survival distributions among the groups using the log-rank test (P < 0.0001). The most favorable survival curves were observed among all foreign-born women, whereas the least favorable survival was demonstrated in US-born women. Time to death was analyzed using the Cox proportional hazards model. Adjusting for age of diagnosis, insurance status, stage, and treatment modality, Latin American and Asia/South Asia birthplace was significantly associated with increased survival time. CONCLUSION An immigrant health paradox was defined for foreign-born Latin American and Asian/South Asian women presenting to the two Public Hospitals of Queens, New York, as women born in these geographic regions were less likely to die at any given time compared to those born in the United States.
Collapse
Affiliation(s)
- George S Hagopian
- Department of Obstetrics and Gynecology, Elmhurst Hospital Center, Elmhurst, Queens, NY, USA; Department of Obstetrics and Gynecology, Queens Hospital Center, Jamaica, Queens, NY, USA; Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Queens Cancer Center, Queens Hospital Center, Jamaica, Queens, NY, USA.
| | - Alka Chintamani Bapat
- Department of Obstetrics and Gynecology, Queens Hospital Center, Jamaica, Queens, NY, USA
| | - Peter R Dottino
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Molly Lieber
- Division of Global Health, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - M Margaret Kemeny
- Queens Cancer Center, Queens Hospital Center, Jamaica, Queens, NY, USA; Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Xilian Li
- Department of Radiation Oncology, Queens Hospital Center, Jamaica, Queens, NY, USA; Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Elianna Kaplowitz
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Annmarie Beddoe
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Division of Global Health, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
|
17
|
Huang HC, Guadamuz JS, Hoskins KF, Ko NY, Calip GS. Risk of contralateral breast cancer among Asian/Pacific Islander women in the United States. Breast Cancer Res Treat 2024; 203:533-542. [PMID: 37897647 DOI: 10.1007/s10549-023-07140-6] [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: 08/02/2023] [Accepted: 09/25/2023] [Indexed: 10/30/2023]
Abstract
PURPOSE While breast cancer studies often aggregate Asian/Pacific Islander (API) women, as a single group or exclude them, this population is heterogeneous in terms of genetic background, environmental exposures, and health-related behaviors, potentially resulting in different cancer outcomes. Our purpose was to evaluate risks of contralateral breast cancer (CBC) among subgroups of API women with breast cancer. METHODS We conducted a retrospective cohort study of women ages 18 + years diagnosed with stage I-III breast cancer between 2000 and 2016 in the Surveillance, Epidemiology and End Results registries. API subgroups included Chinese, Japanese, Filipina, Native Hawaiian, Korean, Vietnamese, Indian/Pakistani, and other API women. Asynchronous CBC was defined as breast cancer diagnosed in the opposite breast 12 + months after first primary unilateral breast cancer. Multivariable-adjusted subdistribution hazard ratios (SHR) and 95% confidence intervals (CI) were estimated and stratified by API subgroups. RESULTS From a cohort of 44,362 API women with breast cancer, 25% were Filipina, 18% were Chinese, 14% were Japanese, and 8% were Indian/Pakistani. API women as an aggregate group had increased risk of CBC (SHR 1.15, 95% CI 1.08-1.22) compared to NHW women, among whom Chinese (SHR 1.23, 95% CI 1.08-1.40), Filipina (SHR 1.37, 95% CI 1.23-1.52), and Native Hawaiian (SHR 1.69, 95% CI 1.37-2.08) women had greater risks. CONCLUSION Aggregating or excluding API patients from breast cancer studies ignores their heterogeneous health outcomes. To advance cancer health equity among API women, future research should examine inequities within the API population to design interventions that can adequately address their unique differences.
Collapse
Affiliation(s)
- Hsiao-Ching Huang
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago, Chicago, IL, USA
| | - Jenny S Guadamuz
- School of Public Health, University of California, Berkeley, CA, USA
| | - Kent F Hoskins
- Division of Hematology and Oncology, Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Naomi Y Ko
- Section of Hematology/Oncology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Gregory S Calip
- Titus Family Department of Clinical Pharmacy, Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, 1985 Zonal Ave, Los Angeles, 90089, CA, USA.
| |
Collapse
|
|
18
|
Xu E, Liu MA. Consideration of Asian ethnic groups and immigration status in cancer disparities research. Med Oncol 2023; 40:346. [PMID: 37930484 PMCID: PMC11025644 DOI: 10.1007/s12032-023-02216-1] [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: 10/06/2023] [Accepted: 10/08/2023] [Indexed: 11/07/2023]
Affiliation(s)
| | - Michael A Liu
- Columbia University Medical Center, Herbert Irving Comprehensive Cancer Center, 161 Fort Washington Avenue, New York, NY, 10032, USA.
| |
Collapse
|
|
19
|
Mani SS, Schut RA. The impact of the COVID-19 pandemic on inequalities in preventive health screenings: Trends and implications for U.S. population health. Soc Sci Med 2023; 328:116003. [PMID: 37301108 PMCID: PMC10238126 DOI: 10.1016/j.socscimed.2023.116003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/26/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023]
Abstract
The COVID-19 pandemic has profoundly impacted population well-being in the United States, exacerbating existing racial and socioeconomic inequalities in health and mortality. Importantly, as the pandemic disrupted the provision of vital preventive health screenings for cardiometabolic diseases and cancers, more research is needed to understand whether this disruption had an unequal impact across racialized and socioeconomic lines. We draw on the 2019 and 2021 National Health Interview Survey to explore whether the COVID-19 pandemic contributed to racialized and schooling inequalities in the reception of preventive screenings for cardiometabolic diseases and cancers. We find striking evidence that Asian Americans, and to a lesser extent Hispanic and Black Americans, reported decreased reception of many types of cardiometabolic and cancer screenings in 2021 relative to 2019. Moreover, we find that across schooling groups, those with a bachelor's degree or higher experienced the greatest decline in screening reception for most cardiometabolic diseases and cancers, and those with less than a high school degree experienced the greatest decline in screening reception for diabetes. Findings have important implications for health inequalities and U.S. population health in the coming decades. Research and health policy attention should be directed toward ensuring that preventive health care is a key priority for public health, particularly among socially marginalized groups who may be at increased risk of delayed diagnosis for screenable diseases.
Collapse
Affiliation(s)
- Sneha Sarah Mani
- Graduate Group in Demography, University of Pennsylvania, 239 McNeil Building, 3718 Locust Walk, Philadelphia, PA, 19104, USA.
| | - Rebecca Anna Schut
- Center for Health and the Social Sciences, The University of Chicago, Chicago, IL, USA.
| |
Collapse
|
|
20
|
Wang CP, Vang SS, Cheung AJ, Lin JJ, Jandorf LH. A Community-Based Survey of Colorectal Cancer Screening Behaviors in Chinese Immigrants Residing in a Major Metropolitan Area. JOURNAL OF COMMUNITY MEDICINE & PUBLIC HEALTH 2023; 7:336. [PMID: 38765318 PMCID: PMC11101160 DOI: 10.29011/2577-2228.100336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Background Colorectal cancer is a common cause of screening preventable death in Chinese immigrants, but colorectal cancer screening rates remain low in this population. This study evaluated factors associated with colorectal cancer screening behaviors in Chinese Americans living in New York City. Methods Participants were foreign-born Chinese Americans, aged 50 years or older, who completed internet surveys between November 2020 and May 2021 regarding their colorectal cancer screening behaviors. Data were collected on demographics, health care utilization, participants' levels of health literacy, English proficiency, colorectal cancer perceptions and current colorectal cancer screening behaviors. Bivariate analyses using chi-square or t-tests were performed to examine associations between colorectal cancer screening behaviors and participant characteristics. Results 103 participants were surveyed with a mean age of 71.3 years. Most participants experienced high rates of socioeconomic disadvantage (i.e., less than a high school education, annual household income <$20,000, limited health literacy, and poor English proficiency). 92% were ever screened, 81% were up-to-date on screening, and 85% expressed intention to screen in the future. Almost all participants had a primary care provider and a language concordant provider. Individuals who intended to screen were more fearful of developing colorectal cancer (3.2 vs 2.8, p=0.02) and perceived a colorectal cancer diagnosis with greater severity (3.0 vs 2.7, p=0.07) than those without intention to screen. Conclusions In our sample, Chinese immigrants were adversely impacted by multiple social determinants of health but reported high colorectal cancer screening rates. Community-based outreach is critical to ensuring cancer-screening engagement in medically vulnerable populations.
Collapse
Affiliation(s)
- Christina P Wang
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Suzanne S Vang
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Aaron J Cheung
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- BS program, School of Industrial and Labor Relations, Cornell University, Ithaca, NY, USA
| | - Jenny J Lin
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lina H Jandorf
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
|
21
|
Shariff-Marco S, Sangaramoorthy M, Ellis L, Thomsen C, Roh JM, Kroenke C, Valice E, Kwan ML, Ambrosone C, Kushi L, Gomez SL. Impact of Racial/Ethnic Discrimination on Quality of Life Among Breast Cancer Survivors. Am J Epidemiol 2023; 192:367-376. [PMID: 36458447 PMCID: PMC10372860 DOI: 10.1093/aje/kwac208] [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: 04/19/2022] [Revised: 11/15/2022] [Accepted: 11/30/2022] [Indexed: 12/04/2022] Open
Abstract
Although racial/ethnic disparities in health-care access, treatment, and cancer outcomes are well documented, the impact of racial/ethnic discrimination on cancer survivorship is unclear. We examined associations between quality of life (QoL) and self-reported discrimination among 3,991 women with breast cancer recruited during 2006-2013 from the Pathways Study in the Kaiser Permanente Northern California integrated health-care system, using linear regression models. Overall, 31% of women reported experiencing racial/ethnic discrimination, with differences by race/ethnicity (82% among non-Hispanic Black women vs. 19% among non-Hispanic White women) and nativity (40% among foreign-born Hispanic women vs. 76% among US-born Asian-American women). Experiencing racial/ethnic discrimination was associated with lower QoL in fully adjusted models. The mean QoL score was 119.6 (95% confidence interval (CI): 102.0, 137.1) for women who did not report discrimination, 115.5 (95% CI: 98.0, 133.0) for those who reported some discrimination/less than the median level, and 110.2 (95% CI: 92.7, 127.7) for those who reported more discrimination/greater than or equal to the median level. Discrimination was associated with lower QoL among women who used passive coping strategies or lived in neighborhoods with high neighborhood socioeconomic status, neighborhoods with high levels of segregation, or non-ethnic enclaves. Among breast cancer survivors, clinically meaningful differences in QoL scores were associated with racial/ethnic discrimination. Additional studies are needed to understand potential pathways through which these social factors affect survivorship outcomes.
Collapse
Affiliation(s)
- Salma Shariff-Marco
- Correspondence to Dr. Salma Shariff-Marco, Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, 550 16th Street, MH-2633, San Francisco, CA 94158 (e-mail: )
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
22
|
Gao Y, Heller SL. Health Disparity and Breast Cancer Outcomes in Asian Women. Radiographics 2022; 42:1912-1924. [PMID: 36053846 DOI: 10.1148/rg.220074] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Health disparities in Asian women are complex and multifactorial. Screening attendance is low among Asian women, regardless of nativity or acculturation, and breast cancer detection has decreased by more than half in this population during the COVID-19 pandemic. The follow-up rate after abnormal screening results is similarly poor among Asian women compared with that among other groups, often resulting in a delay of cancer diagnosis. Yet the incidence of breast cancer in Asian women is increasing in the United States, with no such increase observed in other racial and ethnic groups in recent years. The age distribution of breast cancer in Asian women is distinct and peaks in younger women, underscoring the importance of early screening. The predilection for human epidermal growth factor receptor 2 (HER2)-enriched tumors may reflect the unique biologic characteristics of breast cancer among Asian subgroups, which are not well understood. Known biomarkers for breast cancer risk such as body mass index and mammographic density do not perform the same way in Asian women, as compared with other groups, owing to a lack of Asian population-specific data. Within that limitation, the association between body mass index and breast cancer is strongest in older Asian women, and the association between breast density and breast cancer is strongest in younger Asian women. There is an unmet need to improve breast cancer care in Asian women, a heterogeneous and growing population that is facing an increasing burden of breast cancer. An invited commentary by Leung is available online. ©RSNA, 2022.
Collapse
Affiliation(s)
- Yiming Gao
- From the Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016
| | - Samantha L Heller
- From the Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016
| |
Collapse
|
|
23
|
Bevilacqua G. The Viral Origin of Human Breast Cancer: From the Mouse Mammary Tumor Virus (MMTV) to the Human Betaretrovirus (HBRV). Viruses 2022; 14:1704. [PMID: 36016325 PMCID: PMC9412291 DOI: 10.3390/v14081704] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/25/2022] [Accepted: 07/29/2022] [Indexed: 02/04/2023] Open
Abstract
A Human Betaretrovirus (HBRV) has been identified in humans, dating as far back as about 4500 years ago, with a high probability of it being acquired by our species around 10,000 years ago, following a species jump from mice to humans. HBRV is the human homolog of the MMTV (mouse mammary tumor virus), which is the etiological agent of murine mammary tumors. The hypothesis of a HMTV (human mammary tumor virus) was proposed about 50 years ago, and has acquired a solid scientific basis during the last 30 years, with the demonstration of a robust link with breast cancer and with PBC, primary biliary cholangitis. This article summarizes most of what is known about MMTV/HMTV/HBRV since the discovery of MMTV at the beginning of last century, to make evident both the quantity and the quality of the research supporting the existence of HBRV and its pathogenic role. Here, it is sufficient to mention that scientific evidence includes that viral sequences have been identified in breast-cancer samples in a worldwide distribution, that the complete proviral genome has been cloned from breast cancer and patients with PBC, and that saliva contains HBRV, as a possible route of inter-human infection. Controversies that have arisen concerning results obtained from human tissues, many of them outdated by new scientific evidence, are critically discussed and confuted.
Collapse
|
|
24
|
Sorice KA, Fang CY, Wiese D, Ortiz A, Chen Y, Henry KA, Lynch SM. Systematic review of neighborhood socioeconomic indices studied across the cancer control continuum. Cancer Med 2022; 11:2125-2144. [PMID: 35166051 PMCID: PMC9119356 DOI: 10.1002/cam4.4601] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/03/2021] [Accepted: 12/28/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND There is extensive interest in understanding how neighborhood socioeconomic status (nSES) may affect cancer incidence or survival. However, variability regarding items included and approaches used to form a composite nSES index presents challenges in summarizing overall associations with cancer. Given recent calls for standardized measures of neighborhood sociodemographic effects in cancer disparity research, the objective of this systematic review was to identify and compare existing nSES indices studied across the cancer continuum (incidence, screening, diagnosis, treatment, survival/mortality) and summarize associations by race/ethnicity and cancer site to inform future cancer disparity studies. METHODS Using PRISMA guidelines, peer-reviewed articles published between 2010 and 2019 containing keywords related to nSES and cancer were identified in PubMed. RESULTS Twenty-four nSES indices were identified from 75 studies. In general, findings indicated a significant association between nSES and cancer outcomes (n = 64/75 studies; 85.33%), with 42/64 (65.63%) adjusting for highly-correlated individual SES factors (e.g., education). However, the direction of association differed by cancer site, race/ethnicity, and nSES index. CONCLUSIONS This review highlights several methodologic and conceptual issues surrounding nSES measurement and potential associations with cancer disparities. Recommendations pertaining to the selection of nSES measures are provided, which may help inform disparity-related disease processes and improve the identification of vulnerable populations in need of intervention.
Collapse
Affiliation(s)
- Kristen A. Sorice
- Cancer Prevention and ControlFox Chase Cancer CenterPhiladelphiaPAUSA
| | - Carolyn Y. Fang
- Cancer Prevention and ControlFox Chase Cancer CenterPhiladelphiaPAUSA
| | - Daniel Wiese
- Geography and Urban StudiesTemple UniversityPhiladelphiaPAUSA
| | - Angel Ortiz
- Cancer Prevention and ControlFox Chase Cancer CenterPhiladelphiaPAUSA
| | - Yuku Chen
- Cancer Prevention and ControlFox Chase Cancer CenterPhiladelphiaPAUSA
| | - Kevin A. Henry
- Geography and Urban StudiesTemple UniversityPhiladelphiaPAUSA
| | - Shannon M. Lynch
- Cancer Prevention and ControlFox Chase Cancer CenterPhiladelphiaPAUSA
| |
Collapse
|
|
25
|
Yu AYL, Thomas SM, DiLalla GD, Greenup RA, Hwang ES, Hyslop T, Menendez CS, Plichta JK, Tolnitch LA, Fayanju OM. Disease characteristics and mortality among Asian women with breast cancer. Cancer 2022; 128:1024-1037. [PMID: 34792814 PMCID: PMC8837687 DOI: 10.1002/cncr.34015] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 10/11/2021] [Accepted: 10/14/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Asian women with breast cancer are often studied in aggregate, belying significant intragroup diversity. The authors sought to examine differences in breast cancer characteristics and outcomes among Asian women. METHODS Asian, non-Hispanic Black, Hispanic, and non-Hispanic White women aged 18 years and older who were diagnosed with breast cancer from 1990 to 2016 were identified in the Surveillance, Epidemiology, and End Results 18 database. Asian patients were subclassified as Chinese, Japanese, Korean, Filipino, Vietnamese, South Asian (Asian Indian or Pakistani), Southeast Asian (SEA, i.e., Cambodian, Laotian, Hmong, or Thai), or other Asian. Unadjusted overall survival (OS) and cancer-specific survival (CSS) were estimated using the Kaplan-Meier method. Cox proportional hazards models were used to estimate adjusted OS and CSS. RESULTS In total, 910,415 women were included (Asian, n = 63,405; Black, n = 92,226; Hispanic, n = 84,451; White, n = 670,333). Asian women had higher rates of human epidermal growth factor receptor 2 (HER2)-positive disease compared with White women (18.7% vs 13.8%) and had the highest 10-year unadjusted OS and CSS among all racial/ethnic groups (all P < .001). SEA women had the highest rates of stage IV disease at presentation, whereas Japanese women had the lowest rates (5.9% vs 2.7%; P < .001). Japanese women had the highest 10-year unadjusted CSS (89.4%; 95% confidence interval, 88.7%-90.1%) of any distinct Asian group, whereas SEA women had the worst unadjusted CSS (78%; 95% confidence interval, 74.1%-81.3%; P < .001). After adjustment, SEA women had the worst OS of any Asian group and were the only Asian group without improved OS compared with White women (reference category; P = .08). CONCLUSIONS Breast cancer characteristics and outcomes vary significantly among Asian women. Future research should consider disaggregation by country or region of origin to identify subgroups that are at risk for worse outcomes than aggregated data may suggest. LAY SUMMARY Asian women with breast cancer are frequently studied as a single entity. However, Asian ethnic groups differ greatly by country of origin, genetic ancestry, disease frequency, socioeconomic status, patterns of immigration, as well as dietary and cultural practices. Women of different Asian ethnicities vary significantly with regard to cancer characteristics, such as mortality and tumor subtype. Future research should disaggregate these populations to better understand, treat, and counsel Asian patients with breast cancer.
Collapse
Affiliation(s)
| | - Samantha M Thomas
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina.,Duke Cancer Institute, Durham, North Carolina
| | - Gayle D DiLalla
- Duke Cancer Institute, Durham, North Carolina.,Division of Surgical Oncology, Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Rachel A Greenup
- Duke Cancer Institute, Durham, North Carolina.,Division of Surgical Oncology, Department of Surgery, Duke University School of Medicine, Durham, North Carolina.,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - E Shelley Hwang
- Duke Cancer Institute, Durham, North Carolina.,Division of Surgical Oncology, Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Terry Hyslop
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina.,Duke Cancer Institute, Durham, North Carolina
| | - Carolyn S Menendez
- Duke Cancer Institute, Durham, North Carolina.,Division of Surgical Oncology, Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Jennifer K Plichta
- Duke Cancer Institute, Durham, North Carolina.,Division of Surgical Oncology, Department of Surgery, Duke University School of Medicine, Durham, North Carolina.,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Lisa A Tolnitch
- Duke Cancer Institute, Durham, North Carolina.,Division of Surgical Oncology, Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Oluwadamilola M Fayanju
- Duke Cancer Institute, Durham, North Carolina.,Division of Surgical Oncology, Department of Surgery, Duke University School of Medicine, Durham, North Carolina.,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina.,Department of Surgery, Durham Veterans Affairs Medical Center, Durham, North Carolina
| |
Collapse
|
|
26
|
Navarro S, Yang Y, Ochoa CY, Mejia A, Kim SE, Liu L, Lerman C, Farias AJ. Asian Ethnic Subgroup Disparities in Delays of Surgical Treatment for Breast Cancer. JNCI Cancer Spectr 2022; 6:pkab089. [PMID: 35047750 PMCID: PMC8763369 DOI: 10.1093/jncics/pkab089] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/31/2021] [Accepted: 10/07/2021] [Indexed: 11/23/2022] Open
Abstract
Background As Asian American breast cancer incidence rises, it is necessary to investigate the origins of differential breast cancer outcomes among Asian ethnic subgroups. This study aimed to examine disparities in delays of breast cancer surgery among Asian ethnic subgroups. Methods We obtained California Cancer Registry data on female breast cancer diagnoses and treatment from 2012 to 2017. Our main independent variable was patient race and ethnicity, including 6 Asian ethnic subgroups. Dependent variables included time to surgical treatment for breast cancer and receipt of surgical treatment within 30 and 90 days of diagnosis. We conducted multivariable logistic regression to determine the odds of receiving surgery within 30 and 90 days of diagnosis and multivariable Cox proportional hazards regression to determine the risk of prolonged time to surgery. Results In our cohort of 93 168 breast cancer patients, Hispanic (odds ratio [OR] = 0.86, 95% confidence interval [CI] = 0.82 to 0.89) and non-Hispanic Black (OR = 0.83, 95% CI = 0.78 to 0.88) patients were statistically significantly less likely than non-Hispanic White patients to receive surgery within 30 days of breast cancer diagnosis, whereas Asian Indian or Pakistani (OR = 1.23, 95% CI = 1.09 to 1.40) and Chinese (OR = 1.30, 95% CI = 1.20 to 1.40) patients were statistically significantly more likely to receive surgery within 30 days of diagnosis. Conclusions This large, population-based retrospective cohort study of female breast cancer patients is the first, to our knowledge, to demonstrate that time to surgical treatment is not equal for all Asians. Distinct differences among Asian ethnic subgroups suggest the necessity of further investigating breast cancer treatment patterns to fully understand and target disparities in breast cancer treatment.
Collapse
Affiliation(s)
- Stephanie Navarro
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Yifei Yang
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Carol Y Ochoa
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Aaron Mejia
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Sue E Kim
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Lihua Liu
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.,Los Angeles Cancer Surveillance Program, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.,Norris Comprehensive Cancer Center, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Caryn Lerman
- Norris Comprehensive Cancer Center, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Albert J Farias
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.,Norris Comprehensive Cancer Center, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
|
27
|
Chu Q, Tang M, Chen L, Young L, Loh A, Wang C, Lu Q. Evaluating a Pilot Culturally Sensitive Psychosocial Intervention on Posttraumatic Growth for Chinese American Breast Cancer Survivors. Behav Med 2022; 48:251-260. [PMID: 33226894 PMCID: PMC9295633 DOI: 10.1080/08964289.2020.1845600] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study investigated the potential benefit of a pilot culturally sensitive group support intervention, named Joy Luck Academy (JLA), in fostering posttraumatic growth among Chinese American breast cancer survivors. Eighty-six Chinese American breast cancer survivors participated in an eight-week single-arm pre-/post-test trial of an intervention program, which included educational lectures and peer mentor support. The JLA participants were compared with an independent sample of 109 Chinese American breast cancer survivors who went through routine care. Both groups completed baseline and eight-week follow-up assessments of the five facets of posttraumatic growth (meaningful interpersonal relationships, finding new possibilities in life, personal strength, appreciation of life, and spirituality). From baseline to follow-up, the JLA participants displayed significant improvements in the total score of posttraumatic growth, meaningful interpersonal relationships, appreciation of life, finding new possibilities in life, and personal strength. In contrast, the routine care participants showed no significant change in any of these outcome variables. The findings suggest the potential benefit of a culturally sensitive group support intervention in facilitating posttraumatic growth for Chinese American breast cancer survivors, indicating the need for a randomized controlled trial. The educational lectures and peer mentor support may be adapted to tailor the needs of other ethnic minority cancer patients.
Collapse
Affiliation(s)
- Qiao Chu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, China
| | - Moni Tang
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, TX, USA
| | - Lingjun Chen
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, TX, USA
| | | | | | | | - Qian Lu
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, TX, USA,Department of Psychology, University of Houston, TX, USA
| |
Collapse
|
|
28
|
Almeida R, Fang CY, Byrne C, Tseng M. Mammographic Breast Density and Acculturation: Longitudinal Analysis in Chinese Immigrants. J Immigr Minor Health 2021; 23:1223-1231. [PMID: 33040215 PMCID: PMC8035345 DOI: 10.1007/s10903-020-01107-1] [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] [Accepted: 10/03/2020] [Indexed: 11/29/2022]
Abstract
Breast cancer is the most common cancer in women. Asian American women have experienced steadily increasing breast cancer incidence rates over the past several decades. The increased rate might be in part due to acculturation. We tested the hypothesis that higher level of acculturation was associated with higher mammographic breast density (MBD), an indicator of breast cancer risk, in a cohort of 425 premenopausal Chinese immigrant women in Philadelphia. Generalized estimating equations accounted for repeated observations and adjusted for age, type of mammographic image, body mass index, months of breastfeeding, number of live births, age at first birth, and menopausal stage (pre, early peri, late peri, post). Results indicated that acculturation level was not associated with any of the MBD measures. Findings were contrary to our hypothesis and previous, cross-sectional studies. In this study population, reproductive factors had a greater effect on MBD than acculturation-related behaviors in adulthood.
Collapse
Affiliation(s)
- Rebeca Almeida
- Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, CA, USA
| | | | - Celia Byrne
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Marilyn Tseng
- Department of Kinesiology and Public Health, California Polytechnic State University, 1 Grand Avenue, San Luis Obispo, CA, 93407, USA.
| |
Collapse
|
|
29
|
Njie-Carr VPS, Sabri B, Messing JT, Ward-Lasher A, Johnson-Agbakwu CE, McKinley C, Campion N, Childress S, Arscott J, Campbell J. Methodological and Ethical Considerations in Research With Immigrant and Refugee Survivors of Intimate Partner Violence. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP10790-NP10808. [PMID: 31549582 PMCID: PMC7089841 DOI: 10.1177/0886260519877951] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
To promote safe and positive health outcomes by utilizing culturally relevant evidence-based interventions for immigrant and refugee women survivors of intimate partner violence, their active participation in research is critical. With 43.6 million immigrants and refugees living in the United States, there is a need for research studies to eliminate health disparities in these populations. However, barriers to recruiting and retaining these populations in research prevent the provision of quality and culturally informed services to meet their needs. The aim of this article is to discuss the recruitment and retention strategies employed and analyze the methodological and ethical challenges in the context of the weWomen Study. The use of a multifaceted approach informed by best practices maximized recruitment efforts and active participation that generated high numbers of immigrant and refugee women participants. The study also substantiated the need for more community-based participatory approaches to engage community members in the development of culturally appropriate approaches that instill a sense of ownership over the research process. Active research participation of immigrant and refugee survivors will help investigators understand their unique needs and facilitate the implementation of targeted evidence-based interventions.
Collapse
Affiliation(s)
| | - Bushra Sabri
- Johns Hopkins School of Nursing, Baltimore, MD, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
|
30
|
Nwosu IO, Piccolo SR. A systematic review of datasets that can help elucidate relationships among gene expression, race, and immunohistochemistry-defined subtypes in breast cancer. Cancer Biol Ther 2021; 22:417-429. [PMID: 34412551 DOI: 10.1080/15384047.2021.1953902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Scholarly requirements have led to a massive increase of transcriptomic data in the public domain, with millions of samples available for secondary research. We identified gene-expression datasets representing 10,214 breast-cancer patients in public databases. We focused on datasets that included patient metadata on race and/or immunohistochemistry (IHC) profiling of the ER, PR, and HER-2 proteins. This review provides a summary of these datasets and describes findings from 32 research articles associated with the datasets. These studies have helped to elucidate relationships between IHC, race, and/or treatment options, as well as relationships between IHC status and the breast-cancer intrinsic subtypes. We have also identified broad themes across the analysis methodologies used in these studies, including breast cancer subtyping, deriving predictive biomarkers, identifying differentially expressed genes, and optimizing data processing. Finally, we discuss limitations of prior work and recommend future directions for reusing these datasets in secondary analyses.
Collapse
Affiliation(s)
| | - Stephen R Piccolo
- Department of Biology, Brigham Young University, Provo, Utah, United States
| |
Collapse
|
|
31
|
DeRouen MC, Thompson CA, Canchola AJ, Jin A, Nie S, Wong C, Jain J, Lichtensztajn DY, Li Y, Allen L, Patel MI, Daida YG, Luft HS, Shariff-Marco S, Reynolds P, Wakelee HA, Liang SY, Waitzfelder BE, Cheng I, Gomez SL. Integrating Electronic Health Record, Cancer Registry, and Geospatial Data to Study Lung Cancer in Asian American, Native Hawaiian, and Pacific Islander Ethnic Groups. Cancer Epidemiol Biomarkers Prev 2021; 30:1506-1516. [PMID: 34001502 PMCID: PMC8530225 DOI: 10.1158/1055-9965.epi-21-0019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/18/2021] [Accepted: 05/12/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND A relatively high proportion of Asian American, Native Hawaiian, and Pacific Islander (AANHPI) females with lung cancer have never smoked. We used an integrative data approach to assemble a large-scale cohort to study lung cancer risk among AANHPIs by smoking status with attention to representation of specific AANHPI ethnic groups. METHODS We leveraged electronic health records (EHRs) from two healthcare systems-Sutter Health in northern California and Kaiser Permanente Hawai'i-that have high representation of AANHPI populations. We linked EHR data on lung cancer risk factors (i.e., smoking, lung diseases, infections, reproductive factors, and body size) to data on incident lung cancer diagnoses from statewide population-based cancer registries of California and Hawai'i for the period between 2000 and 2013. Geocoded address data were linked to data on neighborhood contextual factors and regional air pollutants. RESULTS The dataset comprises over 2.2 million adult females and males of any race/ethnicity. Over 250,000 are AANHPI females (19.6% of the female study population). Smoking status is available for over 95% of individuals. The dataset includes 7,274 lung cancer cases, including 613 cases among AANHPI females. Prevalence of never-smoking status varied greatly among AANHPI females with incident lung cancer, from 85.7% among Asian Indian to 14.4% among Native Hawaiian females. CONCLUSION We have developed a large, multilevel dataset particularly well-suited to conduct prospective studies of lung cancer risk among AANHPI females who never smoked. IMPACT The integrative data approach is an effective way to conduct cancer research assessing multilevel factors on cancer outcomes among small populations.
Collapse
Affiliation(s)
- Mindy C DeRouen
- 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
| | - Caroline A Thompson
- San Diego State University School of Public Health, San Diego, California
- University of California San Diego School of Medicine, San Diego, California
- Sutter Health Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Alison J Canchola
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
- Greater Bay Area Cancer Registry, University of California San Francisco, San Fransisco, California
| | - Anqi Jin
- Sutter Health Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Sixiang Nie
- Kaiser Permanente Hawai'i Center for Integrated Health Care Research, Honolulu, Hawaii
| | - Carmen Wong
- Kaiser Permanente Hawai'i Center for Integrated Health Care Research, Honolulu, Hawaii
| | - Jennifer Jain
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Daphne Y Lichtensztajn
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
- Greater Bay Area Cancer Registry, University of California San Francisco, San Fransisco, California
| | - Yuqing Li
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Laura Allen
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Manali I Patel
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, California
- VA Palo Alto Health Care System, Palo Alto, California
| | - Yihe G Daida
- Kaiser Permanente Hawai'i Center for Integrated Health Care Research, Honolulu, Hawaii
| | - Harold S Luft
- Sutter Health Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Salma Shariff-Marco
- 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
- Greater Bay Area Cancer Registry, University of California San Francisco, San Fransisco, California
| | - Peggy Reynolds
- 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
| | - Heather A Wakelee
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Su-Ying Liang
- Sutter Health Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Beth E Waitzfelder
- Kaiser Permanente Hawai'i Center for Integrated Health Care Research, Honolulu, Hawaii
| | - Iona Cheng
- 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
- Greater Bay Area Cancer Registry, University of California San Francisco, San Fransisco, California
| | - Scarlett L 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
- Greater Bay Area Cancer Registry, University of California San Francisco, San Fransisco, California
| |
Collapse
|
|
32
|
Lim DW, Giannakeas V, Narod SA. Survival Differences in Chinese Versus White Women With Breast Cancer in the United States: A SEER-Based Analysis. JCO Glob Oncol 2021; 6:1582-1592. [PMID: 33079607 PMCID: PMC7605368 DOI: 10.1200/go.20.00316] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE The affect of race on breast cancer prognosis is not well understood. We compared crude and adjusted breast cancer survival rates of Chinese women versus White women in the United States. METHODS We conducted a cohort study of Chinese and White women with breast cancer diagnosed between 2004 to 2015 in the SEER 18 registries database. We abstracted information on age at diagnosis, tumor size, grade, lymph node status, receptor status, surgical treatment, receipt of radiotherapy and chemotherapy, and death. We compared crude breast cancer–specific mortality between the two ethnic groups. We calculated adjusted hazard ratios (HRs) in a propensity-matched design using the Cox proportional hazards model. P < .05 was considered statistically significant. RESULTS There were 7,553 Chinese women (1.8%) and 414,618 White women (98.2%) with stage I-IV breast cancer in the SEER database. There were small differences in demographics, nodal burden, and clinical stage between Chinese and White women. Ten-year breast cancer–specific survival was 88.8% for Chinese women and 85.6% for White women (HR, 0.73; 95% CI, 0.67 to 0.80; P < .0001). In a propensity-matched analysis among women with stage I–IIIC breast cancer, the HR was 0.71 (95% CI, 0.62 to 0.81; P < .0001). Annual mortality rates in White women exceeded those in Chinese women for the first 9 years after diagnosis. CONCLUSION Chinese women in the United States have superior breast cancer–specific survival compared with White women. The reason for the observed difference is not clear. Differences in demographic and tumor features between Chinese and White women with breast cancer may contribute to the disparity, as may the possibility of intrinsic biologic differences.
Collapse
Affiliation(s)
- David W Lim
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Vasily Giannakeas
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Steven A Narod
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
|
33
|
Dee EC, Chen S, Santos PMG, Wu SZ, Cheng I, Gomez SL. Anti-Asian American Racism: A Wake-Up Call for Population-Based Cancer Research. Cancer Epidemiol Biomarkers Prev 2021; 30:1455-1458. [PMID: 34233916 DOI: 10.1158/1055-9965.epi-21-0445] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/13/2021] [Accepted: 05/10/2021] [Indexed: 11/16/2022] Open
Abstract
Since the start of the COVID-19 pandemic, Asian Americans have been subjected to rising overt discrimination and violent hate crimes, highlighting the health implications of racism toward Asian Americans. As Asian Americans are the only group for whom cancer is the leading cause of death, these manifestations of anti-Asian racism provoke the question of the impact of racism across the cancer continuum for Asian Americans. In this Commentary, we describe how the myth of the "model minority" overlooks the diversity of Asian Americans. Ignoring such diversity in sociocultural trends, immigration patterns, socioeconomic status, health behaviors, and barriers to care masks disparities in cancer risk, access to care, and outcomes across Asian American populations. We recommend cancer epidemiologists, population science researchers, and oncology providers direct attention toward: (i) studying the impacts of structural and personally mediated racism on cancer risk and outcomes; (ii) ensuring studies reflect the uniqueness of individual ethnic groups, including intersectionality, and uncover underlying disparities; and (iii) applying a critical race theory approach that considers the unique lived experiences of each group. A more nuanced understanding of cancer health disparities, and how drivers of these disparities are associated with race and differ across Asian American ethnicities, may elucidate means through which these disparities can be alleviated.
Collapse
Affiliation(s)
| | - Sophia Chen
- NYU Grossman School of Medicine, New York, New York
| | | | - Shirley Z Wu
- NYU Grossman School of Medicine, New York, New York
| | - Iona Cheng
- UCSF Department of Epidemiology & Biostatistics, and Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Scarlett Lin Gomez
- UCSF Department of Epidemiology & Biostatistics, and Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California.
| |
Collapse
|
|
34
|
Falcone M, Liu L, Farias A, Zhang J, Kang I, Li M, Stern MC, Lerman C. Evidence for racial/ethnic disparities in emergency department visits following breast cancer surgery among women in California: a population-based study. Breast Cancer Res Treat 2021; 187:831-841. [PMID: 33675489 PMCID: PMC10373425 DOI: 10.1007/s10549-021-06119-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/27/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Racial/ethnic disparities in breast cancer outcomes may be related to quality of care and reflected in emergency department (ED) visits following primary treatment. We examined racial/ethnic variation in ED visits following breast cancer surgery. METHODS Using linked data from the California Cancer Registry and California Office of Statewide Health Planning and Development, we identified 151,229 women diagnosed with stage 0-III breast cancer between 2005 and 2013 who received surgical treatment. Differences in odds of having at least one breast cancer-related ED visit within 90 days post-surgery were estimated with logistic regression controlling for clinical and sociodemographic variables. Secondary analyses examined health care-related moderators of disparities. RESULTS Hispanics and non-Hispanic (NH) Blacks had an increased likelihood of having an ED visit within 90 days of surgery compared to NH Whites [OR = 1.11 (1.04-1.18), p = 0.0016; OR = 1.38 (1.27-1.50), p < 0.0001, respectively]; the likelihood was reduced in Asian/Pacific Islanders [aOR = 0.77 (0.71-0.84), p < 0.0001]. Medicaid and Medicare (vs. commercial insurance) increased the likelihood of ED visit for NH Whites, and to a lesser degree for Hispanics and NH Blacks (p < 0.0001 for interaction). Receipt of surgery at an NCI-designated Comprehensive Cancer Center or at a for-profit (vs. non-profit) hospital was associated with reduced likelihood of ED visits for all groups. CONCLUSION Racial/ethnic disparities in ED visits following breast cancer surgery persist after controlling for clinical and sociodemographic variables. Improving quality of care following breast cancer surgery could improve outcomes for all groups.
Collapse
Affiliation(s)
- Mary Falcone
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Ezralow Tower, 1441 Eastlake Ave, Suite 8302L, Los Angeles, CA, 99003, USA
| | - Lihua Liu
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Ezralow Tower, 1441 Eastlake Ave, Suite 8302L, Los Angeles, CA, 99003, USA
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Albert Farias
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Ezralow Tower, 1441 Eastlake Ave, Suite 8302L, Los Angeles, CA, 99003, USA
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - JuanJuan Zhang
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Ezralow Tower, 1441 Eastlake Ave, Suite 8302L, Los Angeles, CA, 99003, USA
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Irene Kang
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Ezralow Tower, 1441 Eastlake Ave, Suite 8302L, Los Angeles, CA, 99003, USA
| | - Ming Li
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Ezralow Tower, 1441 Eastlake Ave, Suite 8302L, Los Angeles, CA, 99003, USA
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mariana C Stern
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Ezralow Tower, 1441 Eastlake Ave, Suite 8302L, Los Angeles, CA, 99003, USA
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Caryn Lerman
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Ezralow Tower, 1441 Eastlake Ave, Suite 8302L, Los Angeles, CA, 99003, USA.
| |
Collapse
|
|
35
|
Tsai W, Zhang L, Park JS, Tan YL, Kwon SC. The importance of community and culture for the recruitment, engagement, and retention of Chinese American immigrants in health interventions. Transl Behav Med 2021; 11:1682-1690. [PMID: 33963414 PMCID: PMC8442562 DOI: 10.1093/tbm/ibab053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Chinese Americans experience cancer health disparities throughout the entire cancer continuum. Yet, they remain underrepresented in health research in part due to barriers in recruitment, engagement, and retention. This paper describes the strategies that we devised, by drawing upon our experiences with conducting two culturally sensitive cancer intervention studies, to help researchers improve their recruitment and retention rates of Chinese Americans in health research and address the gap in knowledge on intervention research with this population. The first study assessed the efficacy, adoption, and impact of an intervention, delivered by community health workers, to improve adherence to recommended stomach cancer prevention guidelines for at-risk Chinese Americans. The second study evaluated the feasibility and preliminary efficacy of a culturally adapted version of the Expressive Helping intervention for Chinese American cancer patients and survivors. Our main recruitment strategies revolved around building community relationships, developing culturally sensitive materials, and establishing good first impressions with participants. Our main engagement and retention strategies focused on attending to cultural sensitivity, fostering relationships, and using technology. Harnessing the community's inherent strengths and prioritizing cultural understanding is crucial for culturally sensitive health research with Chinese Americans.
Collapse
Affiliation(s)
- William Tsai
- Department of Applied Psychology, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY, USA
| | - Liwei Zhang
- School of Social Work, Rutgers University, New Brunswick, NJ, USA
| | - James S Park
- Department of Medicine, NYU Langone Health, New York, NY, USA
| | - Yi-Ling Tan
- Department of Population Health, NYU Langone Health, New York, NY, USA
| | - Simona C Kwon
- Department of Population Health, NYU Langone Health, New York, NY, USA
| |
Collapse
|
|
36
|
Kim JHJ, Lu Q, Stanton AL. Overcoming constraints of the model minority stereotype to advance Asian American health. AMERICAN PSYCHOLOGIST 2021; 76:611-626. [PMID: 34410738 PMCID: PMC8384115 DOI: 10.1037/amp0000799] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Asian Americans are the fastest growing U.S. immigrant group, projected to become the largest immigrant group by 2065, but the quantity of research on Asian Americans' health has not mirrored changing demographics. Asian Americans have been understudied for more than 25 years, with only 0.17% of National Institutes of Health (NIH) expenditures allocated to projects including Asian American, Native Hawaiian, and Pacific Islander populations (Ðoàn et al., 2019). This disproportionality may result in part from the model minority stereotype (MMS) being extended to health, perpetuating the ideas that Asian Americans are well-positioned with regard to health status and that associated research is not essential. Accordingly, the aims for this article are threefold: (a) bring attention to the inadequate representation of the Asian American population in health-related science, (b) question the MMS in health, and (c) outline potential pathways through which the MMS limits what is knowable on Asian American health issues and needs. We discuss the limited meaningfulness of nonrepresentative aggregated statistics purporting the model minority image and provide counterexamples. We also present a stereotype-constraints model with the MMS contributing to a bottleneck for Asian American health-related knowledge, accompanied by present-day circumstances (e.g., sparse data, few psychologists/behavioral medicine scientists focused on Asian American health). We conclude with initial recommendations for addressing MMS-associated constraints in psychology and more broadly. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Collapse
Affiliation(s)
| | - Qian Lu
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center
| | - Annette L. Stanton
- Department of Psychology, University of California, Los Angeles
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles
| |
Collapse
|
|
37
|
Shariff-Marco S, DeRouen MC, Yang J, Jain J, Nelson DO, Weden MM, Gomez SL. Neighborhood archetypes and breast cancer survival in California. Ann Epidemiol 2021; 57:22-29. [PMID: 33577928 PMCID: PMC8133764 DOI: 10.1016/j.annepidem.2021.01.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE Previous studies on neighborhoods and breast cancer survival examined neighborhood variables as unidimensional measures (e.g. walkability or deprivation) individually and thus cannot inform how the multitude of highly correlated neighborhood domains interact to impact breast cancer survival. Neighborhood archetypes were developed that consider interactions among a broad range of neighborhood social and built environment attributes and examine their associations with breast cancer survival. METHODS Archetypes were measured using latent class analysis (LCA) fit to California census tract-level data. Thirty-nine social and built environment attributes relevant to eight neighborhood domains (socioeconomic status (SES), urbanicity, demographics, housing, land use, commuting and traffic, residential mobility, and food environment) were included. The archetypes were linked to cancer registry data on breast cancer cases (diagnosed 1996-2005 with follow-up through Dec 31, 2017) to evaluate their associations with overall and breast cancer-specific survival using Cox proportional hazards models. Analyses were stratified by race/ethnicity. RESULTS California neighborhoods were best described by nine archetypal patterns that were differentially associated with overall and breast cancer-specific survival. The lowest risk of overall death was observed in the upper middle class suburb (reference) and high status neighborhoods, while the highest was observed among inner city residents with a 39% greater risk of death (95% CI = 1.35 to 1.44). Results were similar for breast cancer-specific survival. Stratified analyses indicated that differences in survival by neighborhood archetypes varied according to individuals' race/ethnicity. CONCLUSIONS By describing neighborhood archetypes that differentiate survival following breast cancer diagnosis, the study provides direction for policy and clinical practice addressing contextually-rooted social determinants of health including SES, unhealthy food environments, and greenspace.
Collapse
Affiliation(s)
- Salma Shariff-Marco
- Department of Epidemiology & Biostatistics, University of California, San Francisco (UCSF), San Francisco, CA; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Greater Bay Area Cancer Registry, San Francisco, CA.
| | - Mindy C DeRouen
- Department of Epidemiology & Biostatistics, University of California, San Francisco (UCSF), San Francisco, CA; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Juan Yang
- Department of Epidemiology & Biostatistics, University of California, San Francisco (UCSF), San Francisco, CA; Greater Bay Area Cancer Registry, San Francisco, CA
| | - Jennifer Jain
- Department of Epidemiology & Biostatistics, University of California, San Francisco (UCSF), San Francisco, CA; Greater Bay Area Cancer Registry, San Francisco, CA
| | | | | | - Scarlett L Gomez
- Department of Epidemiology & Biostatistics, University of California, San Francisco (UCSF), San Francisco, CA; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Greater Bay Area Cancer Registry, San Francisco, CA
| |
Collapse
|
|
38
|
Fung J, Vang S, Margolies LR, Li A, Blondeau-Lecomte E, Li A, Jandorf L. Developing a Culturally and Linguistically Targeted Breast Cancer Educational Program for a Multicultural Population. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:395-400. [PMID: 31713105 PMCID: PMC7211551 DOI: 10.1007/s13187-019-01643-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Breast cancer is the most commonly diagnosed cancer among women in the USA. Despite the availability of screening mammograms, significant disparities still exist in breast cancer outcomes of racial/ethnic and sexual/gender minorities. To address these disparities, the Mount Sinai Mobile Breast Health Program in New York City collaborated with local organizations to develop culturally and linguistically appropriate breast cancer education programs aimed at increasing screening mammogram utilization. Literature review of the barriers to mammography screening formed the basis to allow us to draft a narrative presentation for each targeted cultural group: African American, African-born, Chinese, Latina, and Muslim women, as well as LGBTQ individuals. The presentations were then tested with focus groups comprised of gatekeepers and members from local community and faith-based organizations which served the targeted populations. Feedback from focus groups and gatekeepers was incorporated into the presentations, and if necessary, the presentations were translated. Subsequently, the presentations were re-tested for appropriateness and reviewed for consistency in message, design, educational information, and slide sequencing. Our experience demonstrated the importance of collaborating with community organizations to provide educational content that is culturally and linguistically appropriate for minority groups facing barriers to uptake of screening mammography.
Collapse
Affiliation(s)
- Jenny Fung
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029, USA
| | - Suzanne Vang
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029, USA.
| | - Laurie R Margolies
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alicia Li
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029, USA
| | - Esther Blondeau-Lecomte
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029, USA
| | - Alice Li
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029, USA
| | - Lina Jandorf
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029, USA
| |
Collapse
|
|
39
|
Jin SW, Lee J, Lee HY. Analyzing factors associated with decisional stage of adopting breast cancer screening among Korean American women using precaution adoption process model. ETHNICITY & HEALTH 2021; 26:431-447. [PMID: 30326735 PMCID: PMC6531354 DOI: 10.1080/13557858.2018.1520813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 08/30/2018] [Indexed: 06/08/2023]
Abstract
Background: Korean American (KA) women have experienced higher prevalence and lower survival rates of breast cancer (BC) than other ethnic groups in the United States. However, BC screening rates for KA women remain significantly lower than the national target (81.1%) specified by Healthy People 2020. Few studies have explained how the decision to adopt BC screening occurs and progresses and what factors contribute to this decision among KA women. This study used Weinstein's Precaution Adoption Process Model (PAPM) as a theoretical framework to examine characteristics and factors associated with the decisional stage of mammography adoption.Methods: A cross-sectional self-report survey was administered among KA women (N = 308) ages 50-80 from the Atlanta metropolitan area. A total of 281 KA women completed the survey, answering questions about socio-demographics, health-related information, mammography history, doctor recommendation, BC screening knowledge, self-efficacy for BC screening, decisional balance scores on attitudes and beliefs pertaining to mammography, and the seven-stage PAPM.Results: KA women reported a low rate of mammography uptake with about 24% and 35% of the participants undergoing mammography within the last year and two years, respectively. KA women in stages 5 (decided yes), 6 (action), and 7 (maintenance) were likely to have increased screening-related knowledge, positive decisional balance, and regular medical check-up compared to those in stages 1 (unaware), 2 (unengaged), and 3 (deciding).Conclusion: This study highlights important factors that could potentially facilitate BC screening among KA women in Georgia. The findings also provide implications for interventions and practice for increasing mammography screening among medically underserved populations.
Collapse
Affiliation(s)
- Seok Won Jin
- School of Social Work, The University of Memphis, 226 McCord Hall. Memphis, TN 38152. Tel: 901-678-2616, Fax:
901-678-2981. ()
| | - Jongwook Lee
- candidate and a Research Professional, Department of Applied Economics, University of Minnesota, 218G Ruttan Hall,
1994 Buford Avenue, St. Paul, MN 55108. Tel: 612-624-4218. ()
| | - Hee Yun Lee
- Associate Dean for Research, Endowed Academic Chair on Social Work (Health), School of Social Work, University of
Alabama, Tuscaloosa, 1022 Little Hall, Box 870314, Tuscaloosa, AL 35487. Tel: 205-348-6553.
()
| |
Collapse
|
|
40
|
Mindfulness-based interventions for breast cancer patients in China across outcome domains: a systematic review and meta-analysis of the Chinese literature. Support Care Cancer 2021; 29:5611-5621. [PMID: 33770259 DOI: 10.1007/s00520-021-06166-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/18/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This study aims to evaluate the treatment effect of a mindfulness-based intervention for Chinese breast cancer patients across outcome domains, including symptom-related, psychosocial, and quality of life outcomes. METHODS Following the Cochrane Systematic Review guideline, we searched across five electronic databases, reference lists of eligible studies, professional websites, and major academic journals in Chinese. Publication bias was assessed using funnel plot and Vevea and Woods sensitivity analysis, and risk of bias was evaluated using the revised Cochrane risk of bias tool for randomized trials and risk of bias in non-randomized studies of interventions. A meta-analysis of Hedges' g was conducted using meta-regression with robust variance estimation. RESULTS Final analysis included a total of 45 controlled trials containing 286 effect size estimates. Across outcome domains, studies reported an overall large and statistically significant treatment effect, d = 0.921, 95% CI (0.805, 1.040), p < 0.001. Subgroup analyses of specific domains of outcome reported overall significant treatment effects for (1) symptom-related outcomes, d = 0.885, 95% CI (0.657, 1.110), p < 0.001; (2) psychosocial wellness outcomes, d = 0.984, 95% CI (0.879, 1.090), p < 0.001; and (3) quality of life, d = 0.990, 95% CI (0.776, 1.200), p < 0.001. Moderator analysis did not identify any significant moderator. CONCLUSION Chinese literature reported an overall statistically significant and large treatment effect of a mindfulness-based intervention for breast cancer patients in China. Except for physical symptom outcomes, e.g., nausea/vomiting and pain, a mindfulness-based intervention was effective across outcome domains among Chinese breast cancer patients.
Collapse
|
|
41
|
Wolfson JA. Poverty and Survival in Childhood Cancer: A Framework to Move Toward Systemic Change. J Natl Cancer Inst 2021; 113:227-230. [PMID: 33227815 DOI: 10.1093/jnci/djaa108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 07/24/2020] [Indexed: 12/30/2022] Open
Affiliation(s)
- Julie Anna Wolfson
- Division of Pediatric Hematology-Oncology, Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
|
42
|
Dixit N, Rugo H, Burke NJ. Navigating a Path to Equity in Cancer Care: The Role of Patient Navigation. Am Soc Clin Oncol Educ Book 2021; 41:1-8. [PMID: 33830828 DOI: 10.1200/edbk_100026] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Notable barriers exist in the delivery of equitable care for all patients with cancers. Social determinants of health at distal, intermediate, and proximal levels impact cancer care. Patient navigation is a patient-centered intervention that functions across these overlapping determinants to increase access to cancer services throughout the cancer care continuum. There is a need to standardize patient navigation training while remaining responsive to local contexts of care and a need to implement patient navigation programs with a health equity lens to address cancer care inequities.
Collapse
Affiliation(s)
- Niharika Dixit
- University of California San Francisco/Zuckerberg San Francisco General Hospital, San Francisco, CA
| | - Hope Rugo
- The Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA
| | | |
Collapse
|
|
43
|
Huang RJ, Sharp N, Talamoa R, Kapphahn K, Sathye V, Lin B, Srinivasan M, Palaniappan LP. Disaggregated mortality from gastrointestinal cancers in Asian Americans: Analysis of United States death records. Int J Cancer 2021; 148:2954-2963. [PMID: 33527405 DOI: 10.1002/ijc.33490] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/15/2020] [Accepted: 01/04/2021] [Indexed: 12/13/2022]
Abstract
Asian Americans (AAs) are heterogeneous, and aggregation of diverse AA populations in national reporting may mask high-risk groups. Gastrointestinal (GI) cancers constitute one-third of global cancer mortality, and an improved understanding of GI cancer mortality by disaggregated AA subgroups may inform future primary and secondary prevention strategies. Using national mortality records from the United States from 2003 to 2017, we report age-standardized mortality rates, standardized mortality ratios and annual percent change trends from GI cancers (esophageal, gastric, colorectal, liver and pancreatic) for the six largest AA subgroups (Asian Indians, Chinese, Filipinos, Japanese, Koreans and Vietnamese). Non-Hispanic Whites (NHWs) are used as the reference population. We found that mortality from GI cancers demonstrated nearly 3-fold difference between the highest (Koreans, 61 per 100 000 person-years) and lowest (Asian Indians, 21 per 100 000 person-years) subgroups. The distribution of GI cancer mortality demonstrates high variability between subgroups, with Korean Americans demonstrating high mortality from gastric cancer (16 per 100 000), and Vietnamese Americans demonstrating high mortality from liver cancer (19 per 100 000). Divergent temporal trends emerged, such as increasing liver cancer burden in Vietnamese Americans, which exacerbated existing mortality differences. There exist striking differences in the mortality burden of GI cancers by disaggregated AA subgroups. These data highlight the need for disaggregated data reporting, and the importance of race-specific and personalized strategies of screening and prevention.
Collapse
Affiliation(s)
- Robert J Huang
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA.,Stanford Center for Asian Health Research and Education (CARE), Stanford University School of Medicine, Stanford, California, USA
| | - Nora Sharp
- Stanford Center for Asian Health Research and Education (CARE), Stanford University School of Medicine, Stanford, California, USA
| | - Ruth Talamoa
- Stanford Center for Asian Health Research and Education (CARE), Stanford University School of Medicine, Stanford, California, USA
| | - Kristopher Kapphahn
- Quantitative Science Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Vedant Sathye
- Division of Hematology and Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - Bryant Lin
- Stanford Center for Asian Health Research and Education (CARE), Stanford University School of Medicine, Stanford, California, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Malathi Srinivasan
- Stanford Center for Asian Health Research and Education (CARE), Stanford University School of Medicine, Stanford, California, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Latha P Palaniappan
- Stanford Center for Asian Health Research and Education (CARE), Stanford University School of Medicine, Stanford, California, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|
|
44
|
Improvement in quality of life and psychological well-being associated with a culturally based psychosocial intervention for Chinese American breast cancer survivors. Support Care Cancer 2021; 29:4565-4573. [PMID: 33481114 DOI: 10.1007/s00520-020-05942-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 12/10/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this study was to investigate improvements in quality of life and psychological well-being among Chinese American breast cancer survivors who participated in a pilot community education and peer-mentor support program. METHODS One hundred and twenty-nine Chinese American breast cancer survivors who recently completed treatment participated in eight cohorts of the program, Joy Luck Academy, which included weekly education and peer-mentor support sessions. The education sessions covered topics designed to help participants adjust to new life after breast cancer treatment. The peer-mentor support component was designed to provide social support. Quality of life and psychological well-being (e.g., depressive symptoms, anxiety, and low- and high-arousal positive and negative affect) were assessed at baseline and immediately after the intervention. RESULTS Paired samples t tests indicated improvements in quality of life, low- and high-arousal positive affect, and reductions in depressive symptoms, anxiety, and low-arousal negative affect. CONCLUSION Our findings suggest that a psychosocial group intervention may improve quality of life and psychological well-being among Chinese American breast cancer survivors. Our intervention has the potential to be applied to other ethnic-minority cancer survivors. Future randomized controlled trials are warranted.
Collapse
|
|
45
|
Lockhart JS, Oberleitner MG, Nolfi DA. The Asian Immigrant Cancer Survivor Experience in the United States: A Scoping Review of the Literature. Cancer Nurs 2020; 43:177-199. [PMID: 32195706 DOI: 10.1097/ncc.0000000000000797] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Cancer is the leading cause of death for Asian Americans, a growing population in the United States. While cancer survivors often experience complex issues after diagnosis, being an immigrant and having cancer pose additional challenges. OBJECTIVE This scoping review analyzed research about immigrant cancer survivors of Asian ethnicity in the United States and provided a structured method to understand an area of research and evidence. Aims focused on immigrants' experiences and how findings could tailor evidence-based interventions, programs, and resources. METHODS The PubMed, CINAHL, and Scopus databases were searched to identify studies in English (2009-2018) targeting Asian immigrant cancer survivors in the United States. While 385 records were initially identified, 32 studies met the inclusion criteria. RESULTS Thematic analysis of charted study elements revealed 4 themes with subthemes: (1) survival patterns, (2) barriers, (3) culturally informed care, and (4) quality of life (QOL). While qualitative studies provided insight about the cancer experience from immigrants' perspectives, quantitative designs posed descriptions and associations among QOL concepts. CONCLUSIONS Study results illustrate the need for survival research that explores outcomes by Asian ethnic subgroups and tracks the influence of acculturation. Future research should test culturally informed interventions that minimize barriers and foster QOL across the cancer continuum. Culturally tailored instruments can expedite larger-scaled studies that allow generalization. IMPLICATIONS FOR PRACTICE Asian immigrants comprise an underserved, vulnerable, and growing group with various cancers. Nurses who care for immigrants and their families should be cognizant of cultural beliefs, values, practices, and issues related to communication, care access, and socioeconomics.
Collapse
Affiliation(s)
- Joan Such Lockhart
- Author Affiliations: Duquesne University School of Nursing, Pittsburgh, Pennsylvania (Dr Lockhart); University of Louisiana at Lafayette, College of Nursing and Allied Health Professions, Lafayette, Louisiana (Dr Oberleitner); and Duquesne University Gumberg Library, Pittsburgh, Pennsylvania (Mr Nolfi)
| | | | | |
Collapse
|
|
46
|
Kcomt L, Gorey KM. Chinese enclave protections among married Chinese American women: exploratory secondary analysis of colon cancer survival. ETHNICITY & HEALTH 2020; 25:1089-1102. [PMID: 29945459 DOI: 10.1080/13557858.2018.1493432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 06/06/2018] [Indexed: 06/08/2023]
Abstract
Objective: Like the barrio advantage theory related to Mexican Americans, a theory about the protective effects of Chinese American enclaves is developing. Such protections were examined among socioeconomically vulnerable people with colon cancer. Design: A colon cancer cohort established in California between 1995 and 2000, and followed until the enactment of the Affordable Care Act was utilized in this study. Secondary analysis was conducted on the 5-year survival among 127 Chinese Americans and 4524 other Americans (3810 non-Hispanic white and 714 Hispanic people). A third of the original cohort was selected from high poverty neighborhoods. Chinese American enclaves were neighborhoods where typically 25% or more of the residents were Chinese Americans. Effects were tested with Cox regressions and group differences described with age and stage-standardized survival rate ratios (RR). Results: Though they were less adequately insured, Chinese American women residing in Chinese American enclaves (63%) were more likely to survive than were other Americans (50%, RR = 1.26). The protective effect of being married was also larger for Chinese Americans (RR = 1.31) than for others (RR = 1.17). Chinese American women (61%) were more likely than men (46%) to live in such enclaves and a large enclave survival advantage was observed among Chinese American women only (RR = 1.59). Conclusions: There is consistent evidence of the relatively protected status of Chinese American women, particularly those who were married and resided in Chinese American enclaves. Mechanisms that explain their apparent advantages are not yet well understood, though relatively large, kin-based social networks seem instrumental. Research on the influence of social networks as well as the possible effects of acculturation is needed. This study also exposed structural inequities related to the institutions of marriage, health care and communities that disadvantage others. Policy makers ought to be aware of them as future reforms of American health care are considered.
Collapse
Affiliation(s)
- Luisa Kcomt
- School of Social Work, University of Windsor, Windsor, Canada
| | - Kevin M Gorey
- School of Social Work, University of Windsor, Windsor, Canada
| |
Collapse
|
|
47
|
Mukand NH, Zolekar A, Ko NY, Calip GS. Risks of Second Primary Gynecologic Cancers following Ovarian Cancer Treatment in Asian Ethnic Subgroups in the United States, 2000-2016. Cancer Epidemiol Biomarkers Prev 2020; 29:2220-2229. [PMID: 32856609 PMCID: PMC10772992 DOI: 10.1158/1055-9965.epi-20-0095] [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: 01/18/2020] [Revised: 04/03/2020] [Accepted: 08/04/2020] [Indexed: 11/16/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Nita H Mukand
- University of Illinois at Chicago, College of Pharmacy, Chicago, Illinois
- University of Illinois Cancer Center, Chicago, Illinois
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Ashwini Zolekar
- University of Illinois at Chicago, College of Pharmacy, Chicago, Illinois
| | - Naomi Y Ko
- Section of Hematology Oncology, Boston University School of Medicine, Boston, Massachusetts
| | - Gregory S Calip
- University of Illinois at Chicago, College of Pharmacy, Chicago, Illinois.
- University of Illinois Cancer Center, Chicago, Illinois
- Flatiron Health, New York, New York
| |
Collapse
|
|
48
|
Liver Cancer Incidence and Area-Level Geographic Disparities in Pennsylvania-A Geo-Additive Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207526. [PMID: 33081168 PMCID: PMC7588924 DOI: 10.3390/ijerph17207526] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/04/2020] [Accepted: 10/12/2020] [Indexed: 02/07/2023]
Abstract
Many neighborhood socioeconomic index measures (nSES) that capture neighborhood deprivation exist but the impact of measure selection on liver cancer (LC) geographic disparities remains unclear. We introduce a Bayesian geoadditive modeling approach to identify clusters in Pennsylvania (PA) with higher than expected LC incidence rates, adjusted for individual-level factors (age, sex, race, diagnosis year) and compared them to models with 7 different nSES index measures to elucidate the impact of nSES and measure selection on LC geospatial variation. LC cases diagnosed from 2007–2014 were obtained from the PA Cancer Registry and linked to nSES measures from U.S. census at the Census Tract (CT) level. Relative Risks (RR) were estimated for each CT, adjusted for individual-level factors (baseline model). Each nSES measure was added to the baseline model and changes in model fit, geographic disparity and state-wide RR ranges were compared. All 7 nSES measures were strongly associated with high risk clusters. Tract-level RR ranges and geographic disparity from the baseline model were attenuated after adjustment for nSES measures. Depending on the nSES measure selected, up to 60% of the LC burden could be explained, suggesting methodologic evaluations of multiple nSES measures may be warranted in future studies to inform LC prevention efforts.
Collapse
|
|
49
|
Seo JY, Strauss SM. Association of Cancer History and Health Care Utilization Among Female Immigrants Using NHANES 2007-2016 Data. J Immigr Minor Health 2020; 22:1208-1216. [PMID: 32975742 DOI: 10.1007/s10903-020-01090-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite health disparities in preventive care among adult female immigrants, the extent to which their health service utilization is influenced by a cancer history remains largely unknown. METHODS Using Andersen's behavioral model, 2007-2016 National Health and Nutrition Examination Survey data were analyzed to examine the influence of a cancer history on health service utilization among adult immigrant women. Multivariate logistic regression models assessed factors related to past year health care utilization, operationalized as an outpatient doctor's visit and an inpatient overnight hospital stay. RESULTS Once other factors were considered, a past cancer history increased the likelihood of a past year inpatient overnight hospital stay, but was not associated with a past year outpatient doctor's visit. DISCUSSION An outpatient doctor's visit for adult female immigrant cancer survivors would provide an opportunity for essential preventive health services. They must be educated about the importance of ongoing outpatient care for cancer surveillance and health maintenance.
Collapse
Affiliation(s)
- Jin Young Seo
- Hunter-Bellevue School of Nursing, Hunter College, 425 East 25th Street, Rm.416W, New York, NY, 10010, USA.
| | - Shiela M Strauss
- Hunter-Bellevue School of Nursing, Hunter College, 425 East 25th Street, Rm.416W, New York, NY, 10010, USA
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| |
Collapse
|
|
50
|
Herbach EL, Weeks KS, O'Rorke M, Novak NL, Schweizer ML. Disparities in breast cancer stage at diagnosis between immigrant and native-born women: A meta-analysis. Ann Epidemiol 2020; 54:64-72.e7. [PMID: 32950654 DOI: 10.1016/j.annepidem.2020.09.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/10/2020] [Accepted: 09/13/2020] [Indexed: 01/15/2023]
Abstract
PURPOSE To synthesize existing observational evidence to identify disparities in stage at breast cancer diagnosis between foreign- and native-born women. We hypothesized immigrant women would be less likely than natives to be diagnosed at a localized stage. METHODS Systematic searches for studies detailing stage at breast cancer diagnosis by birthplace in PubMed, Embase, and Web of Science yielded 11 relevant cohort studies from six countries. Odds ratios were pooled using random effects models. RESULTS Foreign-born women were 12% less likely to be diagnosed with breast cancer at a localized stage than natives (OR 0.88, 95% CI 0.82-0.95). A similar disadvantage was observed in immigrants from Asia, Eastern Europe, Latin America and the Caribbean, and developing or in transition nations; immigrants from developed countries experienced the least disparity. CONCLUSIONS This meta-analysis confirmed the presence of significant differences in breast cancer stage at diagnosis as per nativity. Across diverse immigrant groups and host countries, foreign-born women were significantly less likely to be diagnosed with localized breast cancer than native women; the magnitude of the disparity varied by region and economic condition of immigrants' birthplace.
Collapse
Affiliation(s)
- Emma L Herbach
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City.
| | - Kristin S Weeks
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City
| | - Michael O'Rorke
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City
| | - Nicole L Novak
- Department of Community and Behavioral Health, University of Iowa, Iowa City
| | - Marin L Schweizer
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City; Center for Access & Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA
| |
Collapse
|