Cancer Reigns as Leading Cause of Death in US Hispanics

Pam Harrison

September 16, 2015

Cancer continues to be the leading cause of death among Hispanics living in the United States, researchers from the American Cancer Society report in the current issue of CA: A Cancer Journal for Clinicians.

Hispanics are the second largest racial/ethnic group in the United States, with an estimated 55.4 million Hispanics living in the United States in 2014. They make up 17.4% of the total population. For the non-Hispianic population in the Unites States, cancer is the second leading cause of death after heart disease.

But cancer overtook heart disease as the leading cause of death in US Hispanics in 2012, as reported at the time. In fact, that statistical event took place in 2009, the most recent year for which complete data were available for analysis in the earlier report.

"The new thing that we are highlighting this time is that liver cancer incidence rates, which have typically been much higher in Hispanics than in non-Hispanic whites [NHWs], are actually decreasing in younger Hispanics, which might be a bellwether of future trends, so this is good news," coauthor Kim Miller, MPH, American Cancer Society, Atlanta, Georgia, told Medscape Medical News.

The investigators report that 125,900 new cancers are expected to be diagnosed among Hispanics in 2015.

"The most common cancer in men is prostate (22%)," investigators observe, "followed by cancers of the colorectum (11%) and lung and bronchus (9%)."

Among Hispanic women, the most common cancers were breast (29%), thyroid (9%), and colorectal disease (8%).

As researchers note, thyroid cancer has become the second most common cancer in Hispanic women, both because patients with thyroid cancer have a younger median age at diagnosis compared with patients with other cancers and because the incidence of thyroid cancer has been increasing rapidly in both Hispanic and NHW women in the United States.

The incidence of uterine cancer is also increasing rapidly in Hispanic women younger than 50 years, they add. Rates have remained relatively stable in young NHW women.

Lung cancer is the leading cause of mortality from cancer among Hispanic men, at 17% followed, by liver cancer, at 12%.

Indeed, it is projected that liver cancer will surpass colorectal cancer to become the second most common cause of cancer death among Hispanic men.

Liver cancer incidence and death rates in both men and women of Hispanic origin are approximately double those in NHWs.

Among Hispanic women, the leading cause of mortality from cancer is breast cancer, at 16%, followed by lung cancer, at 13%, and colorectal, at 9%.

In 1987, lung cancer surpassed breast cancer as the leading cause of death from cancer among women overall in the United States.

However, lung cancer death rates in Hispanic women are 70% lower than those in NHW women because of the low prevalence of smoking among Hispanic women compared with NHW women.

"Overall cancer death rates are 30% lower in Hispanics compared with NHWs," researchers observe — although this mortality advantage is confined to middle-aged and older adults and not to adults younger than 25 years.

Incidence rates of cancer are also 20% lower in Hispanics overall and are lower for every age group except for young Hispanics between the ages of 5 and 14 years, for whom the rates are the same as for NHW youth.

This is mainly because Hispanics are less likely than NHWs to be diagnosed with the four most common cancers — prostate, breast, lung/bronchus, and colorectal, the authors note.

On the other hand, Hispanics have a higher risk for cancers associated with infectious agents, such as those of the stomach, liver, and cervix.

For example, incidence and death rates from stomach and liver cancer are double in Hispanics compared with rates in NHWs.

"Obesity and diabetes may be big factors in the development of liver cancer for Hispanics," Dr Miller observed.

"And this is an area where interventions that reduce obesity and increase physical activity could have a huge impact."

That said, incidence rates of liver cancer in men have doubled in both Hispanics and NHW men, an increase that has largely been attributed to hepatitis C infection, which peaked in the late 1980s.

Between 2003 and 2012, incidence rates of liver cancer in Hispanics increased by about 2% per year in both men and women, but analysis of more recent data by age indicates that rates in adults younger than 50 years have decreased by more than 4% a year in men, for a total reduction in liver cancer incidence of 43% since 2003.

Rates of liver cancer have begun to decline in Hispanic women as well.

Hispanic Subpopulations

"There are sizeable differences in cancer death rates between Hispanic subpopulations," the authors continue.

For example, death rates from cancer among Puerto Ricans and Cubans are more similar to those in NHWs than in Mexicans.

Death rates in Cuban men and women from liver cancer are only about half of those reported in Mexican men and women.

As researchers point out, Hispanics are generally less likely than NHWs to be diagnosed at an early stage of cancer, especially for melanoma and breast cancer.

Lack of access to high-quality care due to the generally lower socioeconomic standing among Hispanics likely contributes to this disparity, but some studies have shown that Hispanics are at high risk for advanced-stage disease even when socioeconomic status and healthcare access are similar to those of NHWs.

"The growth in the population of US residents of Hispanic origin is now driven primarily by births, not immigration, which will probably change the future cancer risk profile of this group," Dr Siegel said in a statement.

"The second generation, born and raised in the US and more intertwined in our lifestyle, including our diet, has higher cancer rates than first-generation immigrants, so we may see a higher cancer burden in this group in the future."

CA Cancer J Clin. Published online September 16, 2015. Full text

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