Cancer Statistics for Hispanics/Latinos, 2018
Abstract
Cancer is the leading cause of death among Hispanics/Latinos, who represent the largest racial/ethnic minority group in the United States, accounting for 17.8% (57.5 million) of the total population in the continental United States and Hawaii in 2016. In addition, more than 3 million Hispanic Americans live in the US territory of Puerto Rico. Every 3 years, the American Cancer Society reports on cancer occurrence, risk factors, and screening for Hispanics in the United States based on data from the National Cancer Institute, the North American Association of Central Cancer Registries, and the Centers for Disease Control and Prevention. For the first time, contemporary incidence and mortality rates for Puerto Rico, which has a 99% Hispanic population, are also presented. An estimated 149,100 new cancer cases and 42,700 cancer deaths will occur among Hispanics in the continental United States and Hawaii in 2018. For all cancers combined, Hispanics have 25% lower incidence and 30% lower mortality compared with non‐Hispanic whites, although rates of infection‐related cancers, such as liver, are up to twice as high in Hispanics. However, these aggregated data mask substantial heterogeneity within the Hispanic population because of variable cancer risk, as exemplified by the substantial differences in the cancer burden between island Puerto Ricans and other US Hispanics. For example, during 2011 to 2015, prostate cancer incidence rates in Puerto Rico (146.6 per 100,000) were 60% higher than those in other US Hispanics combined (91.6 per 100,000) and 44% higher than those in non‐Hispanic whites (101.7 per 100,000). Prostate cancer is also the leading cause of cancer death among men in Puerto Rico, accounting for nearly 1 in 6 cancer deaths during 2011‐2015, whereas lung cancer is the leading cause of cancer death among other US Hispanic men combined. Variations in cancer risk are driven by differences in exposure to cancer‐causing infectious agents and behavioral risk factors as well as the prevalence of screening. Strategies for reducing cancer risk in Hispanic populations include targeted, culturally appropriate interventions for increasing the uptake of preventive services and reducing cancer risk factor prevalence, as well as additional funding for Puerto Rico‐specific and subgroup‐specific cancer research and surveillance.
Hispanics are the second largest racial/ethnic group in the United States after non‐Hispanic whites (NHWs). The US Census Bureau estimated that approximately 57.5 million Hispanics lived in the continental United States and Hawaii in 2016, comprising 17.8% of the total population and more than one‐third of the populations in some Southern and Western states (eg, California, Texas, and New Mexico).1, 2 In addition, more than 3 million Hispanic US citizens live in Puerto Rico, a US territory where 98.9% of the population identifies as Hispanic.2 The term Hispanic is used to refer to persons of Mexican, Cuban, Puerto Rican, South or Central American, Dominican, or other Spanish descent. According to US Census Bureau estimates, the majority of Hispanics in the continental US and Hawaii self‐identify as Mexican (63.2%), followed by Puerto Rican (9.5%), Cuban (3.9%), Salvadoran (3.8%), and Dominican (3.3%).3 Federal standards currently define race and ethnicity as separate and distinct concepts; therefore, people of Hispanic origin may identify as any race, including various combinations of European, American Indian, and African ancestry. Cancer patterns in US Hispanics are an important public health focus for several reasons. First, Hispanics are especially vulnerable to cancer inequalities because of disproportionate poverty and other barriers to optimal health. For example, among nonelderly (those aged 18‐64 years) patients diagnosed with cancer during 2007 through 2012, Hispanics were more than twice as likely as NHWs to be uninsured or Medicaid‐insured.4 In addition, Hispanics as an aggregate group have among the highest prevalence of certain cancer risk factors, including obesity and type 2 diabetes.5, 6 Third, the Hispanic population is one of the most rapidly growing in the United States and is expected to nearly double by 2060,1which has important implications for the future US cancer burden. This report provides current cancer incidence, survival, and mortality statistics for Hispanics living in the continental United States and Hawaii, including the projected numbers of new cases and deaths in 2018, as well as the prevalence of selected cancer risk factors and screening uptake. In addition, cancer incidence and mortality rates for Puerto Rico, which were not included in previous iterations of this report because of limitations in incidence data completeness and reliability, are presented herein to highlight differences in the cancer burden from the continental United States. Cancer incidence data in the United States are collected and disseminated by the National Cancer Institute’s (NCI’s) Surveillance, Epidemiology, and End Results (SEER) program and the Centers for Disease Control and Prevention’s (CDC’s) National Program of Cancer Registries (NPCR). The SEER program reports population‐based incidence and survival data, covering approximately 28% of the US population and 38% of US Hispanics in the most recent time period, and began coding Hispanic ethnicity in 1992. Twelve SEER registries were the source for incidence trends from 1992 through 2015 (Connecticut, Hawaii, Iowa, New Mexico, Utah, rural Georgia, and the metropolitan areas of Atlanta, Detroit, Los Angeles, San Francisco‐Oakland, San Jose‐Monterey, and Seattle‐Puget Sound).7 In 2000, 5 additional catchment areas were added to the SEER program (Kentucky, Greater California, New Jersey, Louisiana, and Greater Georgia); collectively, these 17 registries were the source for the lifetime probability of developing cancer (2013‐2015) and 5‐year cause‐specific survival rates (2008‐2014).8 Cause‐specific survival is a net‐survival measure that relies on specified cause of death instead of life tables, which are necessary for calculating relative survival and have historically been unavailable for populations other than whites and blacks.9 Stage at diagnosis was classified based on SEER summary stage 2000 except for gallbladder cancer, which was based on derived SEER summary stage 2000 (2004 and later). The lifetime probability of developing cancer was calculated using the NCI’s DevCan software (version 6.7.6).10 The North American Association of Central Cancer Registries (NAACCR) compiles and reports incidence data for 1995 forward from US cancer registries that participate in the SEER program and/or the NPCR and certifies registries according to data quality, completeness, and timeliness. Data that met the NAACCR’s highest quality certification standards were the source for 5‐year average annual incidence rates (2011‐2015), stage at diagnosis (2011‐2015), and the 2018 new cancer case projections (2006‐2015) for the United States combined.11, 12 Mortality data by Hispanic origin for the United States have been available since 1990 from the CDC’s National Center for Health Statistics.13 However, long‐term mortality trends (1990‐2016) exclude deaths from Louisiana, New Hampshire, and Oklahoma because information on Hispanic origin for these states was not available for one or more years between 1990 and 1996. All other mortality statistics for the United States combined were based on data from all 50 states and the District of Columbia. All cancer cases were classified according to the International Classification of Diseases for Oncology.14, 15 Causes of death were classified according to the International Classification of Diseases 9th and 10th revisions.16, 17 Incidence and death rates are expressed per 100,000 population and were calculated using SEER*Stat software (version 8.3.5) based on population estimates from the US Census Bureau and age adjusted to the 2000 US standard population. Ten‐year trends in incidence and mortality during 2006 through 2015 are based on the average annual percent change in rates using joinpoint regression analysis (Joinpoint version 4.6.0.0; National Cancer Institute, Rockville, Maryland). Trends were deemed increasing or decreasing when the slope of the fitted line segment was statistically different from zero (2‐sided P value < .05). The Puerto Rico Central Cancer Registry has collected information on cancer cases in the territory since 1950 and joined the NPCR in 1997.18, 19 Incidence data for Puerto Rico have historically been available through the CDC’s United States Cancer Statistics; however, the registry first achieved NAACCR gold certification for the most recent data submission year (2017), indicating the highest levels of data completeness, quality, and reliability. Puerto Rico mortality rates (2011‐2015) for selected cancers herein were previously published in volume 3 of NAACCR’s Cancer Incidence in North America.20 Puerto Rico cancer incidence and mortality rates are presented for all races and ethnicities combined; however, because the population is 98.9% Hispanic,2 rates are unlikely to be influenced by cases among non‐Hispanics. The most recent year for which cancer incidence and mortality data are available lags 2 to 4 years behind the current year because of the time required for data collection, compilation, and dissemination. Therefore, we projected the numbers of new cancer cases and deaths among Hispanics in the continental US and Hawaii in 2018 to provide an estimate of the contemporary cancer burden. First, the complete number of cases diagnosed each year from 2006 through 2015 was estimated by applying age‐specific and sex‐specific incidence rates, based on data from 46 states that met NAACCR’s high quality standards for all 10 years (covering 96% of the US Hispanic population), to the corresponding US Census Bureau’s population estimates. Estimated case counts were adjusted for delays in case reporting using age‐specific, composite delay factors derived from the NAACCR 2017 data submission (personal communication, Don Green [Information Management Services on behalf of NAACCR] and Eric Feuer [NCI]). Then, case counts were projected to 2018 based on the average annual percent change from 2006 through 2015 generated by joinpoint regression modeling. The number of cancer deaths was estimated using the annual percent change for the most recent joinpoint trend based on the actual numbers of cancer deaths from 2002 through 2016. For the complete details of this methodology, please refer to Chen et al.21 Data on behavioral risk factors (cigarette smoking, excess body weight, physical inactivity, and alcohol consumption), receipt of cancer screening, and vaccination coverage were obtained from national population‐based surveys. All statistics for adults in the continental US and Hawaii were derived from the National Health Interview Survey (NHIS)22 with the exception of excess body weight, which was obtained from the National Health and Nutrition Examination Survey (NHANES).23 Risk factor and cancer screening information by Hispanic subgroup for adults is limited in NHANES and is available only for Mexicans. Human papillomavirus vaccination coverage among adolescents in the continental US and Hawaii was obtained from the National Immunization Survey for Teens.24 Previously published estimates from the Behavioral Risk Factor Surveillance System were used for risk factor and screening prevalence in Puerto Rico; these estimates are not directly comparable to NHIS or NHANES estimates. NHIS and NHANES were analyzed using SUDAAN (version 11.0.1; RTI International, Research Triangle Park, NC) to obtain weighted prevalence estimates, which are considered representative of the noninstitutionalized civilian population. https://onlinelibrary.wiley.com/doi/full/10.3322/caac.21494Introduction
Materials and Methods
Incidence and Mortality
Puerto Rico Incidence and Mortality
Projected Cancer Cases and Deaths in 2018
Risk Factors and Screening