Gem M. Le

Socioeconomic Status and Breast Carcinoma Survival in Four Racial/Ethnic Groups A Population-Based Study

Although overall survival for invasive breast carcinoma remains high, black women experience poorer survival than whites. Less is known about the survival of Hispanics and Asians, who may share clinical and socioeconomic risk factors similar to blacks. To better understand racial/ethnic survival patterns, we investigated the effect of socioeconomic status (SES) and disease stage on racial/ethnic differences in breast carcinoma survival in a large population‐based cohort.

Hospital Policy and Practice Regarding the Collection of Data on Race, Ethnicity, and Birthplace

The US population has experienced dramatic increases in racial/ethnic diversity over the last several decades, particularly with immigration from Latin America and Asia.1–5 Research that uses race and ethnicity data provides an important foundation for designing programs to reduce health disparities.6 Birthplace, which serves as an indicator of migrant status, can be used to further identify subpopulations to be targeted for disease control and to provide more specific information on disease patterns. The Surveillance, Epidemiology, and End Results cancer registries obtain data on race, Hispanic ethnicity, and birthplace primarily from hospital records.7 Because we have previously documented problems with the completeness and accuracy of these data in our registry,8–14 we were interested in assessing the policies and practices at the hospital level in the collection of patient data on race, ethnicity, and birthplace.

Breast Cancer Screening Among Vietnamese Americans. A Randomized Controlled Trial of Lay Health Worker Outreach

BACKGROUND Vietnamese-American women underutilize breast cancer screening. DESIGN An RCT was conducted comparing the effect of lay health workers (LHWs) and media education (ME) to ME alone on breast cancer screening among these women. SETTING/PARTICIPANTS Conducted in California from 2004 to 2007, the study included 1100 Vietnamese-American women aged > or = 40 years who were recruited through LHW social networks. Data were analyzed from 2007 to 2009. INTERVENTION Both groups received targeted ME. The intervention group received two LHW educational sessions and two telephone calls. MAIN OUTCOME MEASURES Change in self-reported receipt of mammography ever, mammography within 2 years, clinical breast examination (CBE) ever, or CBE within 2 years. RESULTS The LHW+ME group increased receipt of mammography ever and mammography in the past 2 years (84.1% to 91.6% and 64.7% to 82.1%, p<0.001) while the ME group did not. Both ME (73.1% to 79.0%, p<0.001) and LHW+ME (68.1% to 85.5%, p<0.001) groups increased receipt of CBE ever, but the LHW+ME group had a significantly greater increase. The results were similar for CBE within 2 years. In multivariate analyses, LHW+ME was significantly more effective than ME for all four outcomes, with ORs of 3.62 (95% CI=1.35, 9.76) for mammography ever; 3.14 (95% CI=1.98, 5.01) for mammography within 2 years; 2.94 (95% CI=1.63, 5.30) for CBE ever; and 3.04 (95% CI=2.11, 4.37) for CBE within 2 years. CONCLUSIONS Lay health workers increased breast cancer screening among Vietnamese-American women.Future research should focus on how LHWs work and whether LHW outreach can be disseminated to other ethnic groups [corrected].

Cancer incidence patterns among Vietnamese in the United States and Ha Noi, vietnam

Nearly 600,000 persons have immigrated to the United States from Vietnam since the end of the Vietnam War. Despite the rapid growth of the U.S. Vietnamese population, little is known about cancer incidence in this migrant group. Using population‐based data from the Surveillance, Epidemiology and End Results program, California Cancer Registry and International Agency for Research on Cancer, we compared cancer incidence rates for Vietnamese in the United States (1988–1992) to rates for residents of Ha Noi, Vietnam (1991–1993); non‐Hispanic whites were included to serve as the U.S. reference rates. Lung and breast cancers were the most common among Vietnamese males and females, respectively, regardless of geographic region. Rates of cancers more common to U.S. whites, such as breast, prostate and colon cancers, were elevated for U.S. Vietnamese compared to residents in Ha Noi but still lower than rates for U.S. whites. Rates of cancers more common to Asian countries, such as stomach, liver, lung and cervical cancers, were likewise elevated for U.S. Vietnamese compared to residents of Ha Noi and exceeded corresponding rates for whites. Incidence patterns for stomach, liver, lung and cervical cancers may reflect increased risk of exposures in this migrant population and should be further explored to uncover the relative contributions of environmental and genetic factors to cancer etiology.

Breast implants following mastectomy in women with early-stage breast cancer: prevalence and impact on survival

BackgroundFew studies have examined the effect of breast implants after mastectomy on long-term survival in breast cancer patients, despite growing public health concern over potential long-term adverse health effects.MethodsWe analyzed data from the Surveillance, Epidemiology and End Results Breast Implant Surveillance Study conducted in San Francisco–Oakland, in Seattle–Puget Sound, and in Iowa. This population-based, retrospective cohort included women younger than 65 years when diagnosed with early or unstaged first primary breast cancer between 1983 and 1989, treated with mastectomy. The women were followed for a median of 12.4 years (n = 4968). Breast implant usage was validated by medical record review. Cox proportional hazards models were used to estimate hazard rate ratios for survival time until death due to breast cancer or other causes for women with and without breast implants, adjusted for relevant patient and tumor characteristics.ResultsTwenty percent of cases received postmastectomy breast implants, with silicone gel-filled implants comprising the most common type. Patients with implants were younger and more likely to have in situ disease than patients not receiving implants. Risks of breast cancer mortality (hazard ratio, 0.54; 95% confidence interval, 0.43–0.67) and nonbreast cancer mortality (hazard ratio, 0.59; 95% confidence interval, 0.41–0.85) were lower in patients with implants than in those patients without implants, following adjustment for age and year of diagnosis, race/ethnicity, stage, tumor grade, histology, and radiation therapy. Implant type did not appear to influence long-term survival.ConclusionsIn a large, population-representative sample, breast implants following mastectomy do not appear to confer any survival disadvantage following early-stage breast cancer in women younger than 65 years old.

Gender affects survival for medulloblastoma only in older children and adults: A study from the surveillance epidemiology and end results registry

Males have a higher incidence of medulloblastoma (MB) than females, but the effect of gender on survival is unclear. Studies have yielded conflicting results, possibly due to small sample sizes or differences in how researchers defined MB. We aimed to determine the effect of gender on survival in MB using a large data set and strict criteria for defining MB.

Cancer incidence patterns in Koreans in the US and in Kangwha, South Korea

Objective: In the US, Koreans are a rapidly growing group and comprised 10.5% of the total Asian population as of 2000. However, little has been published regarding cancer patterns in this subpopulation. Methods: Using data from the Surveillance, Epidemiology, and End Results program, the California Cancer Registry, and the International Association for Research on Cancer, we compared age-adjusted and age-specific incidence rates for cancers of the prostate, breast, cervix, lung, colon, rectum, stomach, liver, and esophagus in US Koreans with rates of these cancers in residents of Kangwha, South Korea, and in US whites as a reference. Results: While the most frequently diagnosed cancer was lung among US Korean males and breast among US Korean females, it was stomach cancer for both sexes in Kangwha. Rates of prostate, breast, and colon cancer were considerably higher for Koreans in the US than in Kangwha, but were not as high as in whites. Cervical and stomach cancers showed the opposite racial/ethnic pattern, with rates highest in Kangwha, intermediate among US Koreans, and lowest among whites. Rates of rectal cancer in females and esophageal cancer in males were two-times higher in Kangwha than in US Koreans but esophageal cancer rates were similar between US Koreans and whites. Liver cancer rates were similar between Kangwha residents and US Koreans, but nearly 10-times lower among whites. Conclusions: Although these comparisons may have methodologic limitations, including data quality and racial/ethnic misclassification, the differences seen in migrant and native Koreans for some cancers warrant further investigation in this growing subpopulation.

Experiences and Perceptions of Medical Discrimination Among a Multiethnic Sample of Breast Cancer Patients in the Greater San Francisco Bay Area, California

OBJECTIVES We conducted qualitative interviews with breast cancer survivors to identify themes related to institutional, personally mediated, and internalized discrimination in the medical setting. METHODS We conducted 7 focus groups and 23 one-on-one interviews with a multiethnic sample of breast cancer survivors randomly selected from a population-based registry covering the Greater San Francisco Bay Area, California. RESULTS Participants reported experiencing different forms of medical discrimination related to class, race, and language. Among African Americans, participants reported experiencing internalized discrimination and personal or group discrimination discrepancy-perceiving discrimination against them as a racial/ethnic group, yet not perceiving or discussing personal experiences of discrimination. Among Asian immigrants, participants reported experiencing institutional and personally mediated overt types of discrimination, including lack of access to quality and readily available translation services. Our results also indicated well-established coping mechanisms in response to discrimination experiences in both groups. CONCLUSIONS Participants reported experiencing medical discrimination at all 3 levels, which may have deleterious health effects through the biopsychosocial stress pathway and through active coping mechanisms that could lead to delayed- or underutilization of the health care system to avoid discrimination.

Medulloblastoma incidence has not changed over time: a CBTRUS study.

Earlier studies have reported changes in the incidence of medulloblastoma (MB) but have conflicted, likely because of small sample size or misclassification of MB with primitive neuroectodermal tumor (PNET). The incidence of MB and PNET from 1985 to 2002 was determined from the Central Brain Tumor Registry of the United States, a large population-based cancer registry, using strict histologic and site codes. No statistically significant change in MB incidence was observed over the last 2 decades, but there was an increase in MB and PNET combined.

Colorectal Cancer Screening and Chinese Americans: Efficacy of Lay Health Worker Outreach and Print Materials

INTRODUCTION Chinese Americans have low colorectal cancer (CRC) screening rates. Evidence-based interventions to increase CRC screening in this population are lacking. This study aims to compare the efficacy of two interventions in increasing CRC screening among Chinese Americans. DESIGN Cluster randomized comparative trial. SETTING/PARTICIPANTS From 2010 to 2014, a community-academic team conducted this study in San Francisco, CA with Chinese Americans aged 50-75 years who spoke English, Cantonese, or Mandarin. INTERVENTION Lay health worker (LHW) intervention plus in-language brochure (LHW+Print) versus brochure (Print). LHWs in the LHW+Print arm were trained to teach participants about CRC in two small group sessions and two telephone calls. MAIN OUTCOME MEASURES Change in self-reports of ever having had CRC screening and being up to date for CRC screening from baseline to 6 months post-intervention. Statistical analysis was performed from 2014 to 2015. RESULTS This study recruited 58 LHWs, who in turn recruited 725 participants. The average age of the participants was 62.2 years, with 81.1% women and 99.4% foreign born. Knowledge increase was significant (p<0.002) for nine measures in the LHW+Print group and six in the Print group. Both groups had increases in having ever been screened for CRC (LHW+Print, 73.9%-88.3%, p<0.0001; Print, 72.3%-79.5%, p=0.0003) and being up to date for CRC screening (LHW+Print, 60.0%-78.1%, p<0.0001; Print, 58.1%-64.1%, p=0.0003). In multivariable analyses, the intervention OR for LHW+Print versus Print was 1.94 (95% CI=1.34, 2.79) for ever screening and 2.02 (95% CI=1.40, 2.90) for being up to date. CONCLUSIONS Both in-language print materials and LHW outreach plus print materials increased CRC screening among Chinese Americans. The combination of LHW+Print was more effective than Print alone. These findings can guide clinicians and policymakers in choosing appropriate interventions to increase CRC screening among Chinese American immigrants. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT00947206.