Juanjuan Zhang
University of Southern California
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Featured researches published by Juanjuan Zhang.
International Journal of Cancer | 2012
Lihua Liu; Juanjuan Zhang; Anna H. Wu; Malcolm C. Pike; Dennis Deapen
Racial/ethnic disparities in breast cancer incidence may contain important evidence for understanding and control of the disease. Monitoring the incidence trends of breast cancer by race/ethnicity allows identification of high risk groups and development of targeted prevention programs. Using population‐based cancer registry data from the Los Angeles Cancer Surveillance Program, we examined the invasive female breast cancer incidence trends among the diverse racial/ethnic populations in Los Angeles County, California, from 1972 to 2007. Age‐adjusted incidence rates (AAIRs) and age‐specific incidence rates (ASIRs) were calculated and examined respectively for non‐Hispanic (NH) white, black, Hispanic, Chinese, Filipina, Japanese and Korean women by calendar year and time period. Rising trends of AAIRs were found in all racial/ethnic groups during the 1980s and 1990s. The breast cancer risk increased more substantially in Japanese and Filipinas than in Chinese and Koreans. During 2000–2007, the trends of AAIRs declined significantly among NH white women and slightly in blacks, remained unchanged for Hispanics and continued to rise significantly among all Asian subgroups. The patterns of ASIRs by race/ethnicity changed dramatically over time. By 2000–2007, younger Hispanic women had the lowest breast cancer risk, replacing the Chinese and Koreans who formerly had the lowest risk. Rapidly increasing breast cancer incidence trends among Asian–Americans underline the importance of behavioral and lifestyle changes as a result of acculturation on the development of the disease. The unique trends of breast cancer incidence by race/ethnicity suggest the need for targeted breast cancer control programs for different racial/ethnic populations.
Cancer Epidemiology, Biomarkers & Prevention | 2017
Eunjung Lee; Lihua Liu; Juanjuan Zhang; Mariana C. Stern; Afsaneh Barzi; Amie E. Hwang; Andre Kim; Ann S. Hamilton; Anna H. Wu; Dennis Deapen
Background: Stomach cancer incidence shows substantial racial-ethnic disparity in the United States, with Korean Americans experiencing by far the highest incidence. We examined stomach cancer incidence trends in Korean Americans by tumor subsite, histology, and stage and compared them with incidence rates in racial-ethnic groups with the second highest rate (Japanese Americans) and the lowest rate (non-Hispanic whites; NHWs) as well as populations in South Korea and Japan. Methods: We calculated age-adjusted incidence rates by racial-ethnic groups, sex, and tumor characteristics, using the 1988–2012 California Cancer Registry data. Data on South Korea and Japan were obtained from the literature and other resources. Results: Between 1988 and 2012 in California, Korean Americans had about five times greater incidence than NHWs and twice that of Japanese Americans. Tumor characteristics differed by ethnic group and gender. The incidence in Korean Americans has declined during recent years, for both cardia and noncardia sites and for both intestinal- and diffuse-type histology. Although Korean Americans were diagnosed at an earlier stage than other Californians, the proportion with localized disease (43%) was much smaller than in South Korea (57%), where population-based screening is available. Conclusions: Stomach cancer incidence declined in the highest risk ethnic groups. However, the persistent disparity between Korean Americans and other racial-ethnic groups warrants additional strategies for prevention and earlier diagnosis. Impact: Analysis of California Cancer Registry data identified a racial-ethnic subgroup with stomach cancer disparity that may benefit from targeted prevention and screening efforts. Cancer Epidemiol Biomarkers Prev; 26(4); 587–96. ©2016 AACR.
Neuroepidemiology | 2018
Lilyana Amezcua; Erica Rivas; Sarah Joseph; Juanjuan Zhang; Lihua Liu
Background: Multiple sclerosis (MS) carries high morbidity and shortens life span. While there is recent recognition of other US minority populations such as blacks and Hispanics being affected with MS, examination of MS-specific mortality trends by race/ethnicity has been lacking. Objective: To investigate MS mortality rates and trends in the United States by sex, age, and race/ethnicity. Methods: We used the Compressed Mortality data file for 1999–2015 in the Wide-ranging online Data for Epidemiological Research system developed by the Center for Disease Control and Prevention to calculate the age-adjusted (US 2000 standard population) and age-specific MS mortality rate (per 100,000) by race/ethnicity and sex over time. Five mutually exclusive racial/ethnic groups were included in the analysis: non-Hispanic (NH) white, NH black, NH Asian or Pacific Islander (API), NH American Indian or Alaska Native, and Hispanic. Results: The average annual age-adjusted MS mortality rate was highest among NH whites (0.90 for males and 1.50 for females) immediately followed by NH blacks (0.75 for males and 1.42 for females), and lowest among APIs (0.05 for males and 0.12 for females). Statistically significant, increasing trend in age-adjusted MS mortality was observed during 1999–2015 among NH whites and NH blacks regardless of sex, more substantially in the latter. Age-specific MS mortality patterns showed NH blacks had the highest rate under age 55 and NH whites had the highest rate after that age point. For these 2 groups, MS mortality increased with age in both sexes and peaked at ages 55–64 for NH blacks and 65–74 for NH whites before declining substantially, while for Hispanic and API groups the risk plateaued after age 55. Conclusion: MS-specific mortality trends demonstrate distinctive differences by race/ethnicity and age. The observations that whites and females are more likely to die from MS is in line with the overall understanding that these groups are affected more by MS. However, the findings of blacks dying at an earlier age and having more substantially increasing mortality trends than whites suggest that MS burden weighs unequally by race. Further investigation into these trends may provide additional evidence into risk or protective factors within each group.
Journal of the National Cancer Institute | 2018
C H Pham; Tse-Ling Fong; Juanjuan Zhang; Lihua Liu
Background Hepatocellular carcinoma (HCC) is characterized by disparate risk patterns by race/ethnicity. We examined HCC incidence patterns and temporal trends among detailed racial/ethnic populations, including disaggregated Asian-American subgroups. Methods Using data from the population-based California Cancer Registry, we identified 41 929 invasive HCC cases diagnosed during 1988-2012. Patients were grouped into mutually exclusive racial/ethnic groups of non-Hispanic (NH) white, NH black, Hispanic, and NH Asian/Pacific Islander (API), as well as Asian subgroups of Chinese, Filipino, Japanese, Korean, Vietnamese, Cambodian, Laotian, and South Asian. Age-adjusted and age-specific incidence rates by sex, race/ethnicity, and time period were calculated. The average annual percent change (AAPC) in incidence rates was estimated using joinpoint regression. All estimates were provided with the 95% confidence intervals (CIs). Results Aggregated NH API had higher HCC risk than NH whites, NH blacks, and Hispanics. When disaggregated, Southeast Asians (Vietnamese, Cambodians, and Laotians) had overall HCC incidence rates eight to nine times higher than NH whites and more than twice that of other ethnic Asians. Statistically significant rising temporal trends of HCC were found in NH whites, NH blacks, and Hispanics, especially those older than age 50 years. Overall HCC risk declined in Chinese males (AAPC = -1.3%, 95% CI = -2.0 to -0.6), but rose in Filipino (AAPC = +1.2%, 95% CI = 0.3 to 2.1) and Japanese males (AAPC = +3.0%, 95% CI = 0.4 to 5.6) and Vietnamese (AAPC = +4.5%, 95% CI = 0.7 to 8.5) and Laotian (+3.4%, 95% CI = 0.1 to 6.8) females. Conclusions Our findings provide valuable information for the identification of at-risk ethnic subgroups of Asian Americans while underscoring the importance of disaggregating ethnic populations in cancer research.
Cancer Epidemiology, Biomarkers & Prevention | 2014
Afsaneh Barzi; Mariana C. Stern; Juanjuan Zhang; Dennis Deapen; Lihua Liu
Gastric cancer (GC) is the 4th cause of cancer death worldwide. In the US, GC results in more than 10,000 cancer related deaths annually. Furthermore, it is associated with significant morbidity in the affected individuals. The disease has a high incidence in Asian and Hispanic population. In the US, California has the highest number of GC cases per year, possibly due to high number of Asian and Hispanic population. We designed a study to explore the disparities in the presentation and outcome of GC in the Asian population. Using data from the California Cancer Registry (CCR), we investigated the GC incidence and survival rates among Asians in California from 2000-2010. We explored the significance of demographics in the anatomic presentation of gastric cancer and survival in the Asian population compared to non-Hispanic Whites (NHW). We identified 18,377 GC cases (inclusive of NHW and Asians) in this time period. In this population 70% were NHW, 8% Chinese, 7% Korean and 5% Japanese, the rest included Filipino, Vietnamese and other Asian sub-groups. Koreans have the highest age adjusted incidence rate of GC compared to NHW and all other Asian groups. Moreover, the frequencies of stomach cancer by anatomical subsites were statistically significantly different between Asians and NWH for both males and females (p Despite higher incidence, Koreans have better survival than NHW when adjusted for age, gender, SES, nativity, stage, anatomical subsite, and type of treatment received. Prognostic factors for death from gastric cancer included age > 65 and immigration status, with immigrants doing better than US born. The differences in the anatomical distribution of GC and outcome in the Asian population may be due to differences in etiologic factors that deserve further exploration. In Japan and Korea, early detection had resulted in a dramatic decline in mortality and morbidity. Although overall low incidence of the disease in US is prohibitive for a generalized screening program, there are subpopulations that may benefit from screening. Given that early detection has proven to be effective and cost saving in Asian countries with high incidence of gastric cancer consideration of screening for this population is intriguing and should be explored. Citation Format: Afsaneh Barzi, Mariana Stern, Juanjuan Zhang, Dennis Deapen, Lihua Liu. Gastric cancer presentation and survival among California Asians. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B48. doi:10.1158/1538-7755.DISP13-B48
Cancer Epidemiology, Biomarkers & Prevention | 2014
Mariana C. Stern; Afsaneh Barzi; Juanjuan Zhang; Dennis Deapen; Lihua Liu
Among US Hispanics, stomach cancer has incidence and mortality rates that are more than double the rates observed among non-Hispanic white (NHW) individuals, for both men and women. Disparities in the incidence rates by stomach anatomic subsites have been reported between Hispanics and NHW, suggesting differences in the prevalence of various risk factors between these two populations. Moreover, the decline in mortality due to stomach cancer among Hispanics has been reported to be smaller than among other ethnic groups. Given the heterogeneity among US Hispanics, analyses of cancer clinical characteristics and survival patterns among the major Hispanic subgroups are warranted. We investigated the frequency of demographic and clinical characteristics of stomach cancer patients and survival rates of Hispanics living in California taking into account subgroups defined by the following country or regions of origin: Mexico, Caribbean (Cuba, Puerto Rico, Dominican Republic), South or Central America, and “other”, which includes Hispanics of no identified origin. Using data from the California Cancer Registry (CCR), we identified 8,268 invasive stomach cancer cases diagnosed during 2000-2010 and defined as Hispanic according to the NAACCR Hispanic Identification Algorithm (NHIA). We identified country of origin using information from NHIA registry variables ‘birthplace’ and ‘Spanish origin’, and also searched Death Records to identify cases of Hispanic origin, for a total of 4,891 cases (59%) of Mexican origin, 1,384 cases (17%) of South or Central American origin, 257 cases (3%) of Caribbean origin, and 1,736 cases (21%) of other/no identified origin. We also included 12,997 NHW for comparisons. Overall, the frequencies of stomach cancer by anatomical subsites were statistically significantly different between Hispanics and NWH for both males and females (p Hazard ratios from Cox regression models adjusted for age, gender, SES, nativity, stage, anatomical subsite, and type of treatment received, using data from 2004-2010, showed that being of Mexican origin is associated with greater risk of cancer death compared to being NHW (HR = 1.3; 95% CI = 1.2-1.4; p Our findings highlight the importance of taking into account the heterogeneity within the Hispanic population when studying cancer patterns, as this may help understand cancer determinants and clinical characteristic in this minority population. Citation Format: Mariana C. Stern, Afsaneh Barzi, JuanJuan Zhang, Dennis Deapen, Lihua Liu. Disparities in stomach cancer characteristics and survival among Hispanics in California. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B47. doi:10.1158/1538-7755.DISP13-B47
Cancer Epidemiology, Biomarkers & Prevention | 2012
Mariana C. Stern; Juanjuan Zhang; Juan Pablo Lewinger; Dennis Deapen; Lihua Liu
In California, colorectal cancer (CRC) is the second most common cancer in Latino men and women with incidence rates that are 12% and 23% lower than those for non-Hispanic white (NHW) men and women, respectively. Given the heterogeneity among US Hispanics, analyses of cancer incidence and clinical characteristics among the major Hispanic subgroups are warranted. However, for a considerable proportion of US Hispanics the specific country of origin of the patient, or their parents if US-born, is unknown. Therefore, estimated Hispanic subgroup specific cancer incidence rates will tend to underestimate the true incidence rates for those subgroups. Using data from the California Cancer Registry (CCR), we investigated the CRC incidence and survival rates of Latinos living in California for 1995-2005 by demographic and clinical characteristics of CRC patients. We identified 20,236 CRC cases diagnosed during 1995-2005 and defined as Hispanic according to the NAACCR Hispanic Identification Algorithm (NHIA). We also used information in the Death Certificates and identified additional 6,369 CRC cases of Hispanic origin for a total of 26,605 CRC cases. Based on the NHIA definition and information on birthplace, we further grouped these cases by country of origin: Mexico, Puerto Rico, Cuba, Central America, and South America. To overcome the large proportion of cases with unspecified information on country of origin, we allocated these cases into specific Hispanic subgroups using different approaches. Annual and age-adjusted incidence rates (AAIR) and survival by Hispanic subgroup were calculated. Hispanics showed lower proportion of carcinoma in situ and stages I and II tumors than NHW, with Latinos of Puerto Rican or South American origin having the highest proportions of Stage IV tumors. The AAIR for all Hispanics combined when using data from the CCR only were 16.6% and 21.4% lower than rates for NHW, with Hispanics of Mexican origin having the lowest AAIRs, and Hispanics of South American origin the highest. Inclusion of cases detected through Death Records showed an AAIR for all Latinos combined (72.2/100,000 in men and 49.9/100,000 in women) that was slightly higher than NHW, with Mexicans and Central Americans showing the lowest AAIRs and Cubans and Puerto Ricans showing the highest. Allocation of ‘Other Hispanics’ using both methods elevated all subgroup-specific AAIRs, but did not significantly change the disparities observed across subgroups. Hazard ratios from Cox regression models adjusted for SES, immigration status, demographics, stage, and type of treatment received showed that being of Cuban or Puerto Rican origin is associated with greater risk of cancer death compared to being Mexican. Being from South American, Central American, or from ‘other’ Hispanic origin was associated with reduced risk of cancer death when compared to being of Mexican origin. Our findings highlight the importance of taking into account the heterogeneity within the Hispanic population when studying cancer incidence patterns, as this may help understand the true cancer risk and cancer determinants in this minority population. Citation Format: Mariana C. Stern, JuanJuan Zhang, Juan Pablo Lewinger, Dennis Deapen, Lihua Liu. Disparities in colorectal cancer incidence and survival among Hispanics in California. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr B73.
Cancer Causes & Control | 2016
Mariana C. Stern; Juanjuan Zhang; Eunjung Lee; Dennis Deapen; Lihua Liu
Journal of Clinical Oncology | 2014
Afsaneh Barzi; Mariana C. Stern; Juanjuan Zhang; Heinz-Josef Lenz; Syma Iqbal; Lihua Liu
Journal of the National Cancer Institute | 2018
Lihua Liu; Diana Moke; Kai-Ya Tsai; Amie Hwang; David R. Freyer; Ann S. Hamilton; Juanjuan Zhang; Myles Cockburn; Dennis Deapen