Age-standardized incidence and mortality rates of oral and pharyngeal cancer in Puerto Rico and among Non-Hispanics Whites, Non-Hispanic Blacks, and Hispanics in the USA

<p>Abstract</p> <p>Background</p> <p>In the American region, Puerto Rico (PR) has the highest incidence of oral and pharyngeal cancer (OPC), but racial/ethnic differences have never been assessed and compared with other groups in the United States of America (USA). We compared the age-adjusted incidence and mortality rates of OPC between PR and among USA Hispanics (USH), Non-Hispanic Whites (NHW), and Non-Hispanic Blacks (NHB) to assess the burden of this cancer in PR.</p> <p>Methods</p> <p>Analysis of the age-standardized rates (per 100,000) was performed using the direct method with the world standard population (ASR(World)) from 1998–2002. Annual percent change (APC) and Relative Risks (RR) were calculated using the Poisson regression model.</p> <p>Results</p> <p>The incidence ASR(World) for men in PR was constant (APC ≈ 0.0%), in contrast, a decrease was observed among NHW, NHB, and USH men, although only USH showed statistical significance (APC = -4.9%, p < 0.05). In women, the highest increase in incidence (APC = 5.3%) and the lowest decrease in mortality (APC = -1.4%) was observed in PR. The ratio of the ASR(World) showed that in all racial/ethnic groups, men had approximately 2–4 fold increased incidence and mortality risk of OPC than women (p < 0.05). Men in PR had a higher mortality risk (p < 0.05) of OPC as compared to USH, NHW, and NHB; but among women, PR showed a significant excess of mortality only as compared to USH (est. SRR = 1.82, 95% CI = 1.41, 2.33).</p> <p>Conclusion</p> <p>The overall higher incidence of OPC in men in PR as compared to USH, NHB, and NHW could be explained by the effect of gene-environment interactions. Meanwhile, the higher mortality from OPC in PR suggests limitations in the health-care access within this population. Further research is warranted to elucidate these findings.</p

Disparities in lung cancer survival and receipt of surgical treatment

•While lung cancer survival in Nevada is uniformly low, 15.6%, disparities exist.•The populous Las Vegas metropolitan area has worse survival than Northern Nevada.•Southern Nevadans have lower odds of receiving surgery even for curative stages.•No discernible racial/ethnic survival disparities in the Mountain West state. Lung cancer accounts for the greatest proportion of cancer deaths in the United States. This study aims to characterize lung cancer survival by racial/ethnic group and ascertain any modifiable determinants of identified disparities in the newly diverse Mountain West by using the state of Nevada. 12,964 first primary lung cancer cases diagnosed between 2003 and 2010 were identified for analysis from the Nevada Central Cancer Registry and followed for vital status until December 31, 2011. Standardized age-adjusted five-year survival stratified by race/ethnicity was computed using life table methods. Hazard ratios adjusted for covariates were estimated using Cox proportional hazards regression modeling. Adjusted odds of receiving surgical treatment for localized non-small cell lung cancer by region of Nevada were compared using logistic regression. By the end of the follow-up period, 86% of lung cancer cases in Nevada were deceased. Five-year overall survival was 12.3% (95%CI: 11.5–13.1) for males and 18.9% (95%CI: 17.9–19.9) for females. Compared to cases in Northwestern Nevada, patients in Southern and Rural Nevada had 9% (HR:1.09; 95% CI:1.04–1.14) and 10% (HR:1.10; 95% CI:1.02–1.19) higher risk of dying from lung cancer, respectively. For localized non-small cell lung cancer (NSCLC), which is potentially curable, Southern Nevadans had 67% higher odds of not receiving surgical treatment than Northwestern Nevadans (OR 1.67; 95%CI: 1.30–2.13). While the prognosis for lung cancer survival in Nevada is poor for all populations, there is no racial/ethnic disparity. However, there is a considerable survival disparity by geographic region, with Southern Nevadans disproportionately impacted. Potential modifiable factors include treatment differences, particularly in receipt of surgery for potentially curative tumor types such as localized NSCLC. Further studies are required to identify barriers to receipt of surgery in Southern Nevada