The Surveillance, Epidemiology and End Results (SEER) Program of the National Cancer Institute (NCI) has published a study reporting on patterns of cancer in a variety of racial and ethnic groups in the United States.
The SEER monograph, Racial/Ethnic Patterns of Cancer in the United States, 1988-1992, includes average annual age-adjusted cancer incidence rates for the Alaska Native, American Indian (New Mexico), black, Chinese, Filipino, Hawaiian, Japanese, Korean, Vietnamese, and white populations. The data are also presented for Hispanic (total), white Hispanic, and white non-Hispanic populations. Cancer mortality, compiled by the NCI using data from the National Center for Health Statistics, is reported for each of these groups except Korean and Vietnamese, for whom data are unavailable.
Also included are estimates of the number of newly diagnosed cancers and cancer deaths in the United States, by cancer site, for each racial/ethnic group in 1990. Selected data from the report are reproduced below.
Reaching Those Most In Need
"We are pleased to have this study completed, because it helps us tailor our education, outreach, and intervention efforts to reach populations most in need," said Brenda K. Edwards, phd, director of NCI's Cancer Control Research Program. "We also anticipate extensive use of these data by the health care and research community."
Benjamin F. Hankey, scd, chief of NCI's Cancer Statistics Branch, added, "The data provide a basis for monitoring cancer rates in diverse populations, with unique cultures and lifestyles as well as possibly unique genetic factors that may influence cancer risk."
The SEER Program is a continuing project of NCI, responsible for monitoring the impact of cancer in the general population. It consists of a network of cancer registries that cover the states of Connecticut, Hawaii, Iowa, New Mexico, and Utah; and the metropolitan areas of Atlanta (including 10 rural counties), Detroit, Los Angeles, San Francisco/Oakland, San Jose/Monterey (California), and Seattle/Puget Sound. In addition, data were provided by the Alaska Area Native Health Service for use in the monograph.
The SEER Program covers about 14% of the US population overall, but by design includes substantially larger percentages of minority populations: 78% of
Hawaiians, 60% of Japanese, 49% of Filipinos, 43% of Chinese, 34% of Koreans, 31% of Vietnamese, 27% of American Indians, and 25% of Hispanics. This is necessary to enable the calculation of cancer rates for these smaller populations.
Broad Similarities on Some Measures of Cancer
The racial/ethnic groups were found to be broadly similar on some measures of cancer. Men have higher overall cancer rates than women in all groups. The ratio of male to female incidence rates ranges from 1.1:1 in Alaska Natives to 1.7:1 in blacks. However, in all groups, women 30 to 54 years old have higher rates than men of the same age range, due to the high incidence of female breast and gynecologic cancers.
Black men have the highest overall cancer incidence and mortality, largely due to excesses of prostate and lung cancers. Among women, cancer is most common in non-Hispanic whites, while the cancer death rate is highest in Alaska Natives.
One chapter of the report cites the five most frequently diagnosed cancers and the five most common causes of cancer death for each racial/ethnic group. Breast cancer incidence ranks first in all groups of women except Vietnamese, who have a higher rate of cervical cancer. However, breast cancer incidence rates vary fourfold, from 28.5 per 100,000 Korean women to 115.7 per 100,000 non-Hispanic white women.
In terms of mortality, lung cancer ranks first in most groups of women, and is in either first or second place in all groups except American Indians. Breast cancer mortality ranks in the top two sites for all groups of women except Alaska Natives, in whom it ranks third.
Among men, either prostate or lung cancer ranks first in each racial/ethnic group for both incidence and mortality. Prostate cancer incidence varies more than sevenfold, from 24.2 per 100,000 Koreans to 180.6 per 100,000 blacks. Colorectal cancer incidence rates also vary substantially: The Alaska Native rates are more than four times as high as the American Indian rates for both men and women.
A few generally rare cancers appear in the top five sites for specific groups. Cancer of the gallbladder ranks fourth in American Indian women in New Mexico, for instance, while thyroid cancer is fourth in Filipino women. Nasopharyngeal cancer, which is common in China and Southeast Asia, occurs much more frequently in Chinese and Vietnamese American men than in blacks, whites, and other groups, although it does not make the top five sites in any group.
A 70-year-old man with a history of localized prostate cancer treated with whole-pelvis radiation therapy with a boost to the prostate, in conjunction with androgen deprivation therapy 7 years prior, presented with lower back pain. A bone scan revealed an area of activity in the sacrum. What is the most likely diagnosis?
