Incidence and mortality rates for colorectal cancer in Puerto Rico and among Hispanics,non‐Hispanic whites,and non‐Hispanic blacks in the United States, 1998‐2002

BACKGROUND:

Colorectal cancer (CRC) is the second most commonly diagnosed cancer in Puerto Rico (PR). In the United States, the incidence and mortality rates of CRC have great variation by sex and race/ethnicity. Age‐standardized incidence and mortality rates of CRC in PR were assessed and compared with the rates among US Hispanics (USH), non‐Hispanic whites (NHW), and non‐Hispanic blacks (NHB) in the United States for the period from 1998 through 2002. Incidence and mortality trends and relative differences among racial/ethnic groups by sex and age were determined.

METHODS:

Age‐standardized rates using the world standard population (ASR[World]) were based on cancer incidence and mortality data from the PR Central Cancer Registry and from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program using the direct method. The annual percentage changes (APC) and relative risks (RR) were calculated using Poisson regression models.

RESULTS:

During 1998 through 2002, the APC of CRC incidence and mortality increased for men in PR, whereas descending trends were observed for other racial/ethnic groups. Overall period rates indicated that, in both sexes, Puerto Ricans had CRC incidence and mortality rates similar to those for USH, but their rates were lower than those for NHW and NHB. However, Puerto Rican men and women ages 40 years to 59 years had the greatest risk of incidence and mortality compared with their USH counterparts.

CONCLUSIONS:

Areas of concern include the increasing trends of CRC in PR and the higher burden of the disease among young Puerto Ricans compared with the USH population. The authors concluded that further research should be performed to guide the design and implementation of CRC prevention and education programs in PR. Cancer 2009. © 2009 American Cancer Society.     

Breast cancer statistics, 2017, racial disparity in mortality by state

In this article, the American Cancer Society provides an overview of female breast cancer statistics in the United States, including data on incidence, mortality, survival, and screening. Approximately 252,710 new cases of invasive breast cancer and 40,610 breast cancer deaths are expected to occur among US women in 2017. From 2005 to 2014, overall breast cancer incidence rates increased among Asian/Pacific Islander (1.7% per year), non‐Hispanic black (NHB) (0.4% per year), and Hispanic (0.3% per year) women but were stable in non‐Hispanic white (NHW) and American Indian/Alaska Native (AI/AN) women. The increasing trends were driven by increases in hormone receptor‐positive breast cancer, which increased among all racial/ethnic groups, whereas rates of hormone receptor‐negative breast cancers decreased. From 1989 to 2015, breast cancer death rates decreased by 39%, which translates to 322,600 averted breast cancer deaths in the United States. During 2006 to 2015, death rates decreased in all racial/ethnic groups, including AI/ANs. However, NHB women continued to have higher breast cancer death rates than NHW women, with rates 39% higher (mortality rate ratio [MRR], 1.39; 95% confidence interval [CI], 1.35‐1.43) in NHB women in 2015, although the disparity has ceased to widen since 2011. By state, excess death rates in black women ranged from 20% in Nevada (MRR, 1.20; 95% CI, 1.01‐1.42) to 66% in Louisiana (MRR, 1.66; 95% CI, 1.54, 1.79). Notably, breast cancer death rates were not significantly different in NHB and NHW women in 7 states, perhaps reflecting an elimination of disparities and/or a lack of statistical power. Improving access to care for all populations could eliminate the racial disparity in breast cancer mortality and accelerate the reduction in deaths from this malignancy nationwide. CA Cancer J Clin 2017;67:439‐448. © 2017 American Cancer Society.     

Oral cancer in puerto rico

All cancer cases diagnosed in Puerto Rico are analyzed and registered in the Central Cancer Registry. The incidence of oral cancer in Puerto Rico is fourth-highest in the world. (In 1972 oral cancer accounted for 72% of all cancers in males in Puerto Rico.) A review of the data revealed important contrasts with reported statistics from the continental United States (e.g., 75.6% of the cases in Puerto Rico were initially treated by radiation, compared with 15.3% of the cases in Western New York State).     

A review of cancer in U.S. Hispanic populations

There are compelling reasons to conduct studies of cancer in Hispanics, the fastest growing major demographic group in the United States (from 15% to 30% of the U.S. population by 2050). The genetically admixed Hispanic population coupled with secular trends in environmental exposures and lifestyle/behavioral practices that are associated with immigration and acculturation offer opportunities for elucidating the effects of genetics, environment, and lifestyle on cancer risk and identifying novel risk factors. For example, traditional breast cancer risk factors explain less of the breast cancer risk in Hispanics than in non-Hispanic whites (NHW), and there is a substantially greater proportion of never-smokers with lung cancer in Hispanics than in NHW. Hispanics have higher incidence rates for cancers of the cervix, stomach, liver, and gall bladder than NHW. With respect to these cancers, there are intriguing patterns that warrant study (e.g., depending on country of origin, the five-fold difference in gastric cancer rates for Hispanic men but not Hispanic women). Also, despite a substantially higher incidence rate and increasing secular trend for liver cancer in Hispanics, there have been no studies of Hispanics reported to date. We review the literature and discuss study design options and features that should be considered in future studies.     

Comparative analysis of breast cancer risk factors among hispanic and non‐hispanic white women

BACKGROUND:

Hispanic and non‐Hispanic white (NHW) populations within the United States have different breast cancer incidence rates, yet there is limited research on how ethnic differences in the prevalence of established risk factors and their associations with breast cancer contribute to the observed differences.

METHODS:

Odds ratios and population‐attributable risk estimates for breast cancer were determined for Hispanic and NHW women in the population‐based, case‐control 4‐Corners Breast Cancer Study.

RESULTS:

When comparing NHW and Hispanic women, the authors observed differences in the prevalence of certain risk factors and in the magnitude and direction of their associations with breast cancer. Hispanic women were more likely to have characteristics associated with lower breast cancer risk, such as younger age at first birth, having more children, shorter height, less hormone use, and less alcohol consumption. Among premenopausal women, ethnic differences in risk were observed with taller height and positive family history, which were not associated with breast cancer among Hispanic women. Among postmenopausal women, associations for certain risk factors were either weaker or were not observed in Hispanics, such as recent estrogen plus progestin hormone therapy use and younger age at menarche. Among NHW women, an estimated 62% to 75% of breast cancers were attributed to the evaluated risk factors compared with 7% to 36% in Hispanic women.

CONCLUSIONS:

Breast cancer risk factors established in NHW populations had less influence on breast cancer risk in Hispanic women. These findings reflect the need to further evaluate breast cancer risk factors among different ethnic and racial populations. Cancer 2010. © 2010 American Cancer Society.     

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

Background  

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.     

Incidence and mortality rates of selected infection-related cancers in Puerto Rico and in the United States

Background  

In 2002, 17.8% of the global cancer burden was attributable to infections. This study assessed the age-standardized incidence and mortality rates of stomach, liver, and cervical cancer in Puerto Rico (PR) for the period 1992-2003 and compared them to those of Hispanics (USH), non-Hispanic Whites (NHW), and non-Hispanic Blacks (NHB) in the United States (US).     

Cancer statistics for Hispanics/Latinos, 2015

Cancer is the leading cause of death among Hispanics/Latinos, who represent the largest racial/ethnic minority group in the United States, accounting for 17.4% (55.4 million/318 million) of the total US population in 2014. Every 3 years, the American Cancer Society reports on cancer statistics for Hispanics based on incidence data from the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries and mortality data from the National Center for Health Statistics. Among Hispanics in 2015, there will be an estimated 125,900 new cancer cases diagnosed and 37,800 cancer deaths. For all cancers combined, Hispanics have 20% lower incidence rates and 30% lower death rates compared with non‐Hispanic whites (NHWs); however, death rates are slightly higher among Hispanics during adolescence (aged 15‐19 years). Hispanic cancer rates vary by country of origin and are generally lowest in Mexicans, with the exception of infection‐associated cancers. Liver cancer incidence rates in Hispanic men, which are twice those in NHW men, doubled from 1992 to 2012; however, rates in men aged younger than 50 years declined by 43% since 2003, perhaps a bellwether of future trends for this highly fatal cancer. Variations in cancer risk between Hispanics and NHWs, as well as between subpopulations, are driven by differences in exposure to cancer‐causing infectious agents, rates of screening, and lifestyle patterns. Strategies for reducing cancer risk in Hispanic populations include increasing the uptake of preventive services (eg, screening and vaccination) and targeted interventions to reduce obesity, tobacco use, and alcohol consumption. CA Cancer J Clin 2015;65:457–480 . © 2015 American Cancer Society.     

Incidence of esophageal and gastric cancers among Hispanics,non-Hispanic whites and non-Hispanic blacks in the United States: subsite and histology differences

Objective We examined subsite- and histology-specific esophageal and gastric cancer incidence patterns among Hispanics/Latinos and compared them with non-Hispanic whites and non-Hispanic blacks. Methods Data on newly diagnosed esophageal and gastric cancers for 1998–2002 were obtained from 37 population-based central cancer registries, representing 66% of the Hispanic population in the United States. Age-adjusted incidence rates (2000 US) were computed by race/ethnicity, sex, anatomic subsite, and histology. The differences in incidence rates between Hispanics and non-Hispanics were examined using the two-tailed z-statistic. Results Squamous cell carcinoma accounted for 50% and 57% of esophageal cancers among Hispanic men and women, respectively, while adenocarcinoma accounted for 43% among Hispanic men and 35% among Hispanic women. The incidence rate of squamous cell carcinoma was 48% higher among Hispanic men (2.94 per 100,000) than non-Hispanic white men (1.99 per 100,000) but about 70% lower among Hispanics than non-Hispanic blacks, for both men and women. In contrast, the incidence rates of esophageal adenocarcinoma were lower among Hispanics than non-Hispanic whites (58% lower for men and 33% for women) but higher than non-Hispanic blacks (70% higher for men and 64% for women). Cardia adenocarcinoma accounted for 10–15% of gastric cancers among Hispanics, and the incidence rate among Hispanic men (2.42 per 100,000) was 33% lower than the rate of non-Hispanic white men (3.62 per 100,000) but 37% higher than that of non-Hispanic black men. The rate among Hispanic women (0.86 per 100,000), however, was 20% higher than that of non-Hispanic white women (0.72 per 100,000) and 51% higher than for non-Hispanic black women. Gastric non-cardia cancer accounted for approximately 50% of gastric cancers among Hispanics (8.32 per 100,000 for men and 4.90 per 100,000 for women), and the rates were almost two times higher than for non-Hispanic whites (2.95 per 100,000 for men and 1.72 per 100,000 for women) but about the same as the non-Hispanic blacks. Conclusion Subsite- and histology-specific incidence rates of esophageal and gastric cancers among Hispanics/Latinos differ from non-Hispanics. The incidence rates of gastric non-cardia cancer are almost two times higher among Hispanics than non-Hispanic whites, both men and women. The rates of gastric cardia cancer are lower among Hispanics than non-Hispanic whites for men but higher for women. The rates of esophageal and gastric cardia adenocarcinomas are higher among Hispanics than non-Hispanic blacks.     

Family history and age at onset of breast cancer in Hispanic and non-Hispanic white women

Objectives  To evaluate the association between family history of breast cancer and breast cancer risk among Hispanic and non-Hispanic white (NHW) women. Methods  Logistic regression models were used to compute unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) using data collected from the 4-Corners Breast Cancer Study, a population-based case–control study of breast cancer conducted in the Southwest United States (3,074 NHW and 1,647 Hispanic women). Results  The association between family history of breast cancer and early-onset breast cancer risk differs among NHW and Hispanic women. Among women <50 years old, having a family history of breast cancer was associated with a greater increase in risk among NHWs, with an OR of 2.34 (95% CI: 1.64–3.35) when compared to an OR of 1.32 (95% CI: 0.82–2.19) for Hispanics. This difference in risk was not observed among women 50 years and older, with an OR of 1.69 (95% CI: 1.34–2.13) for NHW and 1.47 (95% CI: 1.03–2.10) for Hispanics. Conclusions  Family history of breast cancer poses a greater risk for early-onset breast cancers among NHW when compared to Hispanic women and may reflect ethnic differences in certain predisposing genetic factors that promote breast cancer development.     

Disparities in colorectal cancer incidence among Latino subpopulations in California defined by country of origin

Purpose

In California, colorectal cancer (CRC) is the second most common cancer in Latinos. Using data from the California Cancer Registry, we investigated demographic and clinical characteristics of 36,133 Latinos with CRC living in California during 1995–2011 taking into account subpopulations defined by country of origin.

Methods

Cases were defined as Latino according to the North American Association of Central Cancer Registries Hispanic Identification Algorithm, which was also used to group cases by country of origin: Mexico (9,678, 27 %), Central or South America (2,636, 7 %), Cuban (558, 2 %), Puerto Rico (295, 1 %), and other or unknown origin (22,966, 64 %; Other/NOS). 174,710 non-Hispanic white (NHW) CRC cases were included for comparison purposes. Annual age-adjusted incidence rates (AAIR) and proportional incidence ratios (PIRs) were calculated.

Results

Differences were observed for age at diagnosis, sex distribution, socioeconomic status (SES), nativity (US born vs. foreign born), stage, and tumor localization across Latino subpopulations and compared to NHW. Mexican Latinos had the lowest AAIR and Cuban Latinos had the highest. PIRs adjusted for age, SES, and nativity showed an excess of CRC males and female cases from Cuba, female cases from Puerto Rico and reduced number of female cases from Mexico.

Conclusions

Differences in cancer incidence patterns and tumor characteristics were observed among Latino subpopulations in California. These disparities may reflect differences in cancer determinants among Latinos; therefore, given that country of origin information is unavailable for a large proportion of these patients, greater efforts to collect these data are warranted.

     

Cancer incidence and mortality in the Caribbean

Background: Nearly 10% of immigrants to the United States come from the Caribbean region. In this paper, we analyzed incidence and mortality rates of the major cancers in the Bahamas, Barbados, Cuba, the Dominican Republic, Haiti, Jamaica, Puerto Rico, and Trinidad and Tobago, and compared them with US patterns. Methods: We obtained age-standardized, sex-specific cancer incidence and mortality rates for cancers of the bladder, breast, cervix, esophagus, large bowel, liver, lung, pancreas, prostate, and stomach for 8 Caribbean countries and the United States from the GLOBOCAN program of the International Agency for Research in Cancer (IARC) and for the U.S. population from the Surveillance, Epidemiology, and End Results (SEER) Program of the NCI. Results: GLOBOCAN incidence and mortality rates for the overall United States were lower than but correlated with overall SEER rates. Based on GLOBOCAN data, the incidence and mortality rates of cancers of the breast, prostate, large bowel, and lung, and, among males, bladder cancer were lower in the Caribbean countries than the United States. Caribbean countries had higher rates of cancers of the cervix, esophagus, liver, and stomach. Haiti had the highest incidence and mortality rates of cervix and liver cancers. Jamaica and Haiti had the highest rates of stomach cancer. Conclusions: Cancer incidence and mortality in the Caribbean generally follow known patterns of association with economic development, infectious agents, and racial/ethnic origin. Studying these patterns and how immigration changes them may yield clues to cancer etiology. A better understanding of cancer incidence and mortality rates may help health policymakers to implement state-of-the-art treatment and preventive services for people of Caribbean descent both in their native countries and in immigrant communities in the United States.     

Comparative analysis of clinicopathologic features, treatment, and survival of Asian women with a breast cancer diagnosis residing in the United States

BACKGROUND:

It has been established that disparities by ethnicity in the rates of breast cancer diagnoses and disease‐specific survival (DSS) exist in the United States. However, few studies have assessed differences specifically between Asians and other ethnic groups or among Asian subgroups.

METHODS:

The authors used the Surveillance, Epidemiology, and End Results database to identify patients who were diagnosed with invasive breast cancer between 1988 and 2008. Clinicopathologic features, treatment, and DSS rates were compared among broad ethnic groups and among Asian subgroups.

RESULTS:

In total, there were 658,691 patients in the study, including 511,701 non‐Hispanic white (NHW) women (77.7%), 57,890 black women (8.8%), 45,461 Hispanic white (HW) women (6.9%), and 43,639 Asian women (6.6%). The Asian cohort was divided into the following subgroups: Filipino, Chinese, Japanese, Indian/Pakistani, Korean, Vietnamese, Hawaiian/Pacific Islander, and other. Patients in all the Asian subgroups, except Japanese, were younger at diagnosis than NHW patients. After adjustment for disease stage, Japanese patients diagnosed with stage I through III disease had better DSS rates than patients in the NHW group or in the other Asian subgroups. Hawaiian/Pacific Islander patients with stage III or IV disease had worse DSS rates than NHW patients and patients in the other Asian subgroups. All other Asian subgroups had DSS rates similar to the DSS rate in the NHW group.

CONCLUSIONS:

The current results indicated that disparities exist for Asian women with breast cancer who reside in the United States compared with NHW groups and among Asian subgroups. Differences in presenting clinicopathologic features may affect DSS rates, suggesting that further investigation of these disparities is warranted to increase early detection and treatment for specific subgroups. Cancer 2012. © 2012 American Cancer Society.     

Risk of thyroid cancer among Caribbean Hispanic patients with familial adenomatous polyposis

Familial adenomatous polyposis (FAP) is an inherited form of colorectal cancer characterized by hundreds of adenomatous polyps in the colon and rectum. FAP is also associated with thyroid cancer (TC), but the lifetime risk is still unclear. This study reports the standardized incidence ratio (SIR) of TC in Hispanic FAP patients. TC incidence rates in patients with FAP between the periods of January 1, 2006 to December 31, 2013 were compared with the general population through direct database linkage from the Puerto Rico Central Cancer Registry (PRCCR) and the Puerto Rico Familial Colorectal Cancer Registry (PURIFICAR). The study population consisted of 51 Hispanic patients with FAP and 3239 with TC from the general population. The SIR was calculated using the Indirect Method, defined as observed TC incidence among patients with FAP in PURIFICAR’s cohort (2006–2013) divided by the expected TC incidence based on the PR population rates (2006–2010). SIR values were estimated by sex (male, female, and overall). This study received IRB approval (protocol #A2210207). In Hispanic patients with FAP, the SIR (95 % CI) for TC was 251.73 (51.91–735.65), with higher risk for females 461.18 (55.85–1665.94) than males 131.91 (3.34–734.95). Hispanic FAP patients are at a high risk for TC compared to the general population. Our incidence rates are higher than previous studies, suggesting that this community may be at a higher risk for TC than previously assumed. Implementation of clinical surveillance guidelines and regular ultrasound neck screening in Hispanic FAP patients is recommended.     

Breast cancer statistics, 2015: Convergence of incidence rates between black and white women

In this article, the American Cancer Society provides an overview of female breast cancer statistics in the United States, including data on incidence, mortality, survival, and screening. Approximately 231,840 new cases of invasive breast cancer and 40,290 breast cancer deaths are expected to occur among US women in 2015. Breast cancer incidence rates increased among non‐Hispanic black (black) and Asian/Pacific Islander women and were stable among non‐Hispanic white (white), Hispanic, and American Indian/Alaska Native women from 2008 to 2012. Although white women have historically had higher incidence rates than black women, in 2012, the rates converged. Notably, during 2008 through 2012, incidence rates were significantly higher in black women compared with white women in 7 states, primarily located in the South. From 1989 to 2012, breast cancer death rates decreased by 36%, which translates to 249,000 breast cancer deaths averted in the United States over this period. This decrease in death rates was evident in all racial/ethnic groups except American Indians/Alaska Natives. However, the mortality disparity between black and white women nationwide has continued to widen; and, by 2012, death rates were 42% higher in black women than in white women. During 2003 through 2012, breast cancer death rates declined for white women in all 50 states; but, for black women, declines occurred in 27 of 30 states that had sufficient data to analyze trends. In 3 states (Mississippi, Oklahoma, and Wisconsin), breast cancer death rates in black women were stable during 2003 through 2012. Widening racial disparities in breast cancer mortality are likely to continue, at least in the short term, in view of the increasing trends in breast cancer incidence rates in black women. CA Cancer J Clin 2016;31–42. © 2015 American Cancer Society.     

Cancer incidence in the Puerto Rican-born population of Connecticut.

There are few published reports on cancer incidence in the Puerto Rican-born populations of the northeastern United States. In Connecticut, in the Puerto Rican-born population, which was of low socioeconomic status (i.e., 42% below the poverty level in the 1980 Census), the standardized incidence ratio (SIR) for all invasive cancers diagnosed in 1980-1986 was significantly reduced for female patients (SIR = 0.77) but not for male patients (SIR = 1.16), on the basis of expected numbers derived from incidence rates for the entire state of Connecticut. For female patients, only the SIR for cancers of the stomach, esophagus, and cervix were elevated significantly, whereas those for colorectal, lung, breast, and ovarian cancer were significantly reduced. For male patients, SIR were elevated significantly for cancer of the oral cavity, esophagus, and stomach and for leukemia, whereas none of the sites (including lung) had significantly reduced SIR. When incidence rates for Puerto Rico were used, the SIR for all sites combined was 1.99 (95% confidence interval = 1.78-2.22) for male patients but only 1.39 (95% confidence interval = 1.24-1.56) for female patients. These findings suggest sex differences in acculturation and lifestyle changes relevant to cancer risks in immigrants from Puerto Rico residing in Connecticut. Comparisons were made with cancer incidence and mortality data from other Puerto Rican immigrant populations.     

Trends in Distant-Stage Breast, Colorectal, and Prostate Cancer Incidence Rates from 1992 to 2004: Potential Influences of Screening and Hormonal Factors

Differential utilization of cancer screening between populations could lead to changes in cancer disparities. Evaluating incidence rates trends is one means of monitoring these disparities. Using Surveillance, Epidemiology, and End Results data, we compared annual percent changes (APC) in age-adjusted incidence rates of distant-stage breast, colorectal, and prostate cancer between non-Hispanic whites (NHW) and African Americans (AA). From 1992 to 2004, distant-stage breast cancer incidence rates remained essentially constant among both AA and NHW women, though rates were 30–90% higher among AA women throughout. NHW men and women experienced declines in distant-stage colorectal cancer incidence rates [APC?=??1.6, 95% confidence interval (CI) ?2.3, ?0.9], but AA men and women did not. Distant-stage prostate cancer incidence rates declined for both AA (APC?=??5.8, 95% CI ?7.9, ?3.8) and NHW (APC?=??5.1, 95% CI ?6.7, -3.4). Despite now having nearly equal mammography screening rates, the persistent breast cancer disparity observed among AAs compared to NHWs may be due to the greater susceptibility of AAs to more aggressive tumors, particularly hormone-receptor-negative disease, which is more difficult to detect by mammography. For colorectal cancer, greater utilization of screening tests among NHWs vs. AAs is likely a primary contributor to the observed widening disparity. Wider recognition of AA race as a prostate cancer risk factor may contribute to the narrowing disparity in the incidence of disease.     

Breast cancer statistics, 2013

In this article, the American Cancer Society provides an overview of female breast cancer statistics in the United States, including data on incidence, mortality, survival, and screening. Approximately 232,340 new cases of invasive breast cancer and 39,620 breast cancer deaths are expected to occur among US women in 2013. One in 8 women in the United States will develop breast cancer in her lifetime. Breast cancer incidence rates increased slightly among African American women; decreased among Hispanic women; and were stable among whites, Asian Americans/Pacific Islanders, and American Indians/Alaska Natives from 2006 to 2010. Historically, white women have had the highest breast cancer incidence rates among women aged 40 years and older; however, incidence rates are converging among white and African American women, particularly among women aged 50 years to 59 years. Incidence rates increased for estrogen receptor‐positive breast cancers in the youngest white women, Hispanic women aged 60 years to 69 years, and all but the oldest African American women. In contrast, estrogen receptor‐negative breast cancers declined among most age and racial/ethnic groups. These divergent trends may reflect etiologic heterogeneity and the differing effects of some factors, such as obesity and parity, on risk by tumor subtype. Since 1990, breast cancer death rates have dropped by 34% and this decrease was evident in all racial/ethnic groups except American Indians/Alaska Natives. Nevertheless, survival disparities persist by race/ethnicity, with African American women having the poorest breast cancer survival of any racial/ethnic group. Continued progress in the control of breast cancer will require sustained and increased efforts to provide high‐quality screening, diagnosis, and treatment to all segments of the population. CA Cancer J Clin 2014;64:52–62. ^© 2013 American Cancer Society, Inc.     

Colorectal cancer screening among Latinos from U.S. cities along the Texas–Mexico border

Colorectal cancer (CRC) screening rates are comparatively low for U.S. Hispanics. To learn more about the factors influencing CRC screening among Hispanics living along the U.S.–Mexico border, 12 focus groups were conducted with Hispanic men and women aged 50 years and older in three Texas counties; Cameron County (Brownsville), Webb County (Laredo), and El Paso County, (El Paso). The focus group guide contained questions about health care behavior, knowledge about CRC, experiences with cancer, and factors that influence CRC screening. A total of 92 individuals participated with the majority aged 50–69 (75%). Twenty percent were born in the United States and 51% had lived in the United States for more than 20 years. Participants had low levels of education, income, and insurance coverage. The analysis revealed several overarching and contextual themes relating to knowledge, attitudes, beliefs, and emotions about cancer and CRC screening. A prevalent theme that emerged from all groups was frustration and a lack of confidence in the U.S. healthcare system. Few participants had been advised by their providers to obtain CRC screening. Lack of patient knowledge about colorectal cancer and screening appeared to be a critical factor influencing screening. Themes about death and pain due to cancer were prevalent as were cultural factors such as machismo and embarrassment. System level barriers such as cost, medical insurance and transportation also impacted screening. These findings suggest that strategies are needed to educate Hispanic residents of border communities about CRC and to motivate them to undergo CRC screening. The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the U.S. Centers for Disease Control and Prevention.