Explaining the Race Difference in Prostate Cancer Stage at Diagnosis

Prostate cancer is the most frequently diagnosed cancer in males in the United States, accounting for an estimated 186,320 new cases in 2008. There are striking racial or ethnic differences in prostate cancer incidence and mortality rates in the United States, with Black males 1.6 times more likely to be diagnosed and 2.4 times more likely to die with prostate cancer than Whites. The stage at diagnosis is a key prognostic factor for prostate cancer survival, with African-Americans generally diagnosed at a more advanced stage. To identify factors that explain the race-stage disparity in prostate cancer, we conducted a population-based case-case study of 251 African-American (46%) and White (54%) prostate cancer cases diagnosed in Connecticut between January 1987 and October 1990. Multivariate logistic regression was used to identify potential explanatory factors, including clinical, sociodemographic, medical care, insurance, digital rectal examination screening history, and lifestyle factors. Cox proportional hazards models assessed the impact of study variables on race differences in long-term survival. Modifiable factors such as screening practice and sociodemographic factors accounted for \u3e60% of the race difference in prostate cancer stage at diagnosis. Histologic grade (Gleason score) accounted for comparatively less. Survival analyses confirmed the importance of tumor characteristics, education, and insurance in explaining observed race differences in survival. Although cases were identified before the widespread use of prostate-specific antigen (PSA) screening, the results should also be relevant to countries that have large underserved populations and/or disparities in access to medical care and cancer screening. (Cancer Epidemiol Biomarkers Prev 2008;17(10):2825–34

Abstract B10: Variability in HPV knowledge among Hispanic women of diverse ancestry and country of origin

In the United States, women who are categorized as Hispanic for public health research purposes, experience an increased risk of developing and dying from cervical cancer. This disparity primarily reflects underutilization of Pap smear screening, the best method available for prevention and early detection of disease. Previous research has not examined, in great detail, the factors that predict screening underutilization among Hispanic women or evaluated how known determinants of screening, such as cancer literacy, function across this population sub-group. Historically, all Hispanic persons, regardless of ancestry or country of origin, have been categorized as one group for cancer research and control efforts. This practice likely masks variability in exposure to determinants of disease, as well as, risk of cancer incidence and mortality. Our research examines potential differences in HPV knowledge between Hispanic women of diverse ancestral backgrounds. HPV is the primary risk factor for cervical carcinogenesis. Insufficient knowledge about this sexually transmitted infection (STI) and its association with cervical cancer may impact willingness to be vaccinated against HPV, screening utilization, and accordingly, women9s risk of disease onset and progression. Identifying variation in HPV knowledge between women of seemingly the same ethnicity, but different ancestral backgrounds, is essential for understanding, and ultimately attenuating, cervical cancer disparities. Study data were collected as part of a cross-sectional study conducted at the National Cancer Institute (NCI), Cancer Information Service (CIS), Spanish Call Center. Between July 2007 and March 2008, all callers to this service were asked whether they were willing to answer a short survey related to their knowledge of cervical cancer and associated risk factors. Where possible, survey items were derived from previously validated instruments and questionnaires. The HPV knowledge questions, in particular, were taken from the Health Information National Trends Survey (HINTS), conducted by the National Cancer Institute (NCI) on a biennial basis, with the intent of better understanding cancer information needs and experiences in the United States. Study data suggest that knowledge of HPV was high among our respondents (n=873; 69%), relative to a representative sample of US women of diverse/racial ethnic backgrounds. However, this knowledge varied by country of origin, even after controlling for acculturation, language preference, and number of years in the United States. Women from Mexico were far more likely than their South American and Caribbean counterparts to have heard of the virus. Such findings suggest that continuing to classify persons of similar ethnicity, but different cultural backgrounds and lifetime exposures as one group for research purposes, may preclude opportunity to understand, as well as attenuate, health disparity

Contextualizing the survivorship experiences of Haitian immigrant women with breast cancer: opportunities for health promotion

To examine challenges faced by Haitian immigrant women managing a breast cancer diagnosis. Trained community health workers conducted focus groups with Haitian women who were breast cancer survivors. A grounded theory approach guided analysis of transcripts. A large community-based organization in Miami, FL. 18 women took part in three focus groups. Participants were 40 years or older, were ethnically Haitian, and had been diagnosed with breast cancer 6-12 months prior to the study. Data were collected as part of an ongoing community-based participatory research initiative in Little Haiti, the largest enclave of Haitian settlement in Miami, FL. Community health workers, integral to the initiative, recruited participants through their extensive social networks and community contacts. Screening knowledge, illness beliefs, social and economic consequences of a breast cancer diagnosis, and advice for breast health education. Emergent themes suggest that Haitian breast cancer survivors face multiple challenges, including misperceptions about screening guidelines, disease etiology, and risk; a reduced capacity to earn a living because of physical debility; and diminished social support. Future research must continue to examine the impact of breast cancer on Haitian immigrant women and identify key strategies, such as community outreach and support programs, to improve their quality of life. Nurses can play an essential role in such strategies by providing culturally relevant clinical care and partnering with community stakeholders to define the scope and focus of public health intervention

Working with cancer: Health and disability disparities among employed cancer survivors in the U.S

Approximately 40% of Americans annually diagnosed with cancer are working-age adults. Using a nationally representative database, we characterized differences in health status and occupation of working cancer survivors and persons without cancer. Cross-sectional data pooled from the 1997–2009 US National Health Interview Survey for adults with self-reported physician-diagnosed cancer (n=22,952) and those without (n=358,495), were analyzed. Multivariable logistic regression was used to compare the health and disability status of employed cancer survivors across occupational sectors relative to workers without a cancer history and unemployed cancer survivors. Relative to workers with no cancer history, cancer survivors were more likely (OR; 95%CI) to be white-collar workers and less likely to be service workers. Working cancer survivors were significantly less likely than unemployed survivors, but more likely than workers with no cancer history, to report poor–fair health (0.25; 0.24–0.26) and (2.06; 1.96–2.17) respectively, and ≥2 functional limitations (0.37; 0.35–0.38) and (1.72; 1.64–1.80) respectively. Among employed cancer survivors, blue-collar workers reported worse health outcomes, yet they reported fewer workdays missed than white-collar workers. Blue-collar cancer survivors are working with high levels of poor health and disability. These findings support the need for workplace accommodations for cancer survivors in all occupational sectors, especially blue-collar workers. ► We examine differences in reported health and disability by cancer history. ► We compare health and disability status by occupation sector. ► Working survivors have poorer health than workers with no cancer history. ► Blue-collar workers report poorer health compared to other occupations. ► Blue-collar workers may work post diagnosis out of necessity rather than desire

Working with cancer: Health and disability disparities among employed cancer survivors in the U.S.

INTRODUCTION: Approximately 40% of Americans annually diagnosed with cancer are working-age adults. Using a nationally representative database, we characterized differences in health status and occupation of working cancer survivors and persons without cancer. METHODS: Cross-sectional data pooled from the 1997–2009 US National Health Interview Survey for adults with self-reported physician-diagnosed cancer (n=22,952) and those without (n=358,495), were analyzed. Multivariable logistic regression was used to compare the health and disability status of employed cancer survivors across occupational sectors relative to workers without a cancer history and unemployed cancer survivors. RESULTS: Relative to workers with no cancer history, cancer survivors were more likely to be white-collar workers and less likely to be service workers. Working cancer survivors were significantly less likely than unemployed survivors, but more likely than workers with no cancer history, to report poor-fair health (0.25; 0.24–0.26) and (2.06;1.96–2.17) respectively, and ≥2 functional limitations (0.37;0.35–0.38) and (1.72;1.64–1.80) respectively. Among employed cancer survivors, blue-collar workers reported worse health outcomes, yet they reported fewer workdays missed than white-collar workers. CONCLUSION: Blue-collar cancer survivors are working with high levels of poor health and disability. These findings support the need for workplace accommodations for cancer survivors in all occupational sectors, especially blue-collar workers

Contextualizing the Survivorship Experiences of Haitian Immigrant Women With Breast Cancer: Opportunities for Health Promotion

To examine challenges faced by Haitian immigrant women managing a breast cancer diagnosis. Trained community health workers conducted focus groups with Haitian women who were breast cancer survivors. A grounded theory approach guided analysis of transcripts. A large community-based organization in Miami, FL. 18 women took part in three focus groups. Participants were 40 years or older, were ethnically Haitian, and had been diagnosed with breast cancer 6-12 months prior to the study. Data were collected as part of an ongoing community-based participatory research initiative in Little Haiti, the largest enclave of Haitian settlement in Miami, FL. Community health workers, integral to the initiative, recruited participants through their extensive social networks and community contacts. Screening knowledge, illness beliefs, social and economic consequences of a breast cancer diagnosis, and advice for breast health education. Emergent themes suggest that Haitian breast cancer survivors face multiple challenges, including misperceptions about screening guidelines, disease etiology, and risk; a reduced capacity to earn a living because of physical debility; and diminished social support. Future research must continue to examine the impact of breast cancer on Haitian immigrant women and identify key strategies, such as community outreach and support programs, to improve their quality of life. Nurses can play an essential role in such strategies by providing culturally relevant clinical care and partnering with community stakeholders to define the scope and focus of public health intervention