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Racial/Ethnic Disparities in Cancer Incidence, Survival and Treatment

Racial/Ethnic Disparities in Cancer Incidence, Survival and Treatment. Linda C. Harlan, PhD, MPH National Cancer Institute Division of Cancer Control and Population Sciences. Disparities in Cancer. Age Gender Marital Status Income Education Insurance Health System Characteristics

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Racial/Ethnic Disparities in Cancer Incidence, Survival and Treatment

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  1. Racial/Ethnic Disparities in Cancer Incidence, Survival and Treatment Linda C. Harlan, PhD, MPH National Cancer Institute Division of Cancer Control and Population Sciences

  2. Disparities in Cancer • Age • Gender • Marital Status • Income • Education • Insurance • Health System Characteristics • Geographic • Race/Ethnicity

  3. Age-Adjusted US Mortality Rates for the Most Common Cancers by Race/Ethnicity for 2000-2003 Source: US population NCHS

  4. Racial/Ethnic Disparities Along the Cancer Continuum • Incidence • Screening • Stage at Diagnosis • Therapy • Survival

  5. Age-Adjusted Incidence Rates for the Most Common Cancers by Race/Ethnicity for 2000-2003 Source: SEER

  6. Percentage of Women Age 40 and Older Reporting Having Mammography in the Past Two Years Source: NCHS

  7. Documented Time Elapsed Since Last Mammogram for Women Age 40 and Older by Racial/Ethnic Group* *Adjusted for age and registry Source: Smith-Bindman, 2006

  8. SEER Data • Population-Based Registries • Register all cancer cases within a geographic areas • 26% of the US population • Detailed data on • Demographics • Tumor characteristic • Treatment • Active follow-up of cases • Public use files, available to researchers • Analysis program associated with data

  9. Stage at Diagnosis of In Situ and Invasive Breast Cancer by Race/Ethnicity for Cases Diagnosed in 2000-2003 Source: SEER

  10. 5-year Cancer-Specific Survival by Race/Ethnicity and Stage for Invasive Breast Cancer Patients Diagnosed Between 1990 -2002 Source: SEER

  11. Percentage of Women Receiving Radiation Following Breast Conserving Surgery by Racial/Ethnicity and Year of Diagnosis Tumor < 5cm Source: SEER

  12. Percent of Breast Cancer Cases Receiving Radiation Following BCS by Race/Ethnicity and County Family Poverty Rate 2000-2003 Source: SEER Families at or Below Poverty Level

  13. Use of Adjuvant Chemo/Hormonal Therapy for Early Stage, Node Negative Breast Cancer by Race/Ethnicity, and ER status 2000 Source: Harlan unpublished ER negative ER positive

  14. Adjusted* Percentage of Patients Diagnosed 1995 through 1999 Receiving Guideline Therapy by Insurance Status and Race/Ethnicity *Charlson score, stage, number of positive lymph nodes, residency training program, hospital bed size, age, marital status, % high school diploma, gender, geographic region Source: Harlan, 2005

  15. Summary • Racial/ethnic disparities occur across the cancer continuum • Screening • Stage at diagnosis • Treatment • Survival

  16. Data Sources • Surveillance, Epidemiology and End-Results Data • http://seer.cancer.gov/seerstat/ • Demographic, tumor characteristic, surgery and radiation • Active follow-up for vital status • SEER-Medicare linked file • http://healthservices.cancer.gov/seermedicare/obtain/ • Cancer cases age 65+ and a 5% sample of non-cancer patients • SEER data + • Treatment data, long-term medical follow-up, procedures • Breast Cancer Surveillance Consortium • Mammography registries • http://breastscreening.cancer.gov/work/proposal_data.html

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