At a recent Yale Cancer Center Grand Rounds lecture, Dr. Beth Jones, Research Scientist, Epidemiology and Public Health, discussed the disparities that exist in breast cancer in the United States, focusing mainly on Hispanic and Latino women. By the year 2050 Hispanic/Latinos will represent close to 1/3 of the U.S. population. Although the incidence of cancer is lower among Hispanic/Latinos, the mortality rate is higher than that of whites. Access to care and cultural differences may play a part in this trend.
During her lecture, Dr. Jones stressed the fact that while there are many factors that come into play when discussing cancer disparities, there are certain areas of vulnerability that are important to focus on. These include acculturation, or the adopting of traits of another culture, socio-economic factors, institutionalized racism, and cultural sensitivity. There has been great progress made in understanding the differences between African Americans and whites in terms of cancer, and now the same is being done for the Hispanic/Latino population.
“The population of Hispanic/Latinos is increasing in this country, and many Hispanic/Latino women are getting closer to the age when breast cancer is more common. Acculturation plays a part in the number of Hispanic/Latino women that may get breast cancer as well,” said Dr. Jones. “Women are having fewer children, and delaying childbearing, both of which have an effect on breast cancer risk.” Of some concern is that like African American women, there is a trend to earlier age at diagnosis, later stage disease, and poorer survival for Hispanic/Latinas when compared with White women. Literacy and lack of communication can lead to a more advanced stage at diagnosis. It is reported that some ethnic groups are less likely to receive their results of screening and to follow-up on abnormal exams. Discrimination based on ‘immigration status’ and language barriers may also play a role.
Dr. Jones made the point that the issues around any sort of disparities problem are complex.
Disparities in breast cancer outcomes result from group based differences across a wide range of factors, which suggest multiple opportunities for intervention such as reducing obesity, increasing awareness and access to mammography, and access to treatment. Delay of care has been thought to be a reason that certain ethnic groups are being diagnosed at later stages. However, Dr. Jones commented that while correcting these delays are important for individuals, it is not a significant explanatory reason as the delay of care is generally not long enough to be clinically meaningful.
“While we are making great progress in terms of identifying methods of treatment based on understanding better the tumor characteristic differences across racial ethnic groups, there is a whole lot more going on here that we know about and certainly should take into consideration if we want to avoid the deepening disparities that might come with the changing population,” said Dr. Jones.
There is a new study currently underway where Dr. Jones and her team are looking at breast cancer screening behaviors and outcomes for Hispanic/Latinos in the Northeast. Up until this point, the data that exists for Hispanic/Latinos has come out of areas like the Southwest, and Miami, but very few studies have been conducted looking at the Northeast population. The study is in its second year.
It is apparent from Dr. Jones’ lecture that there are many challenges to face when dealing with disparities in breast cancer for Hispanic/Latinos in the United States, and these issues have become a priority for Yale Cancer Center. Cultural differences play a role in access to care, and awareness of the disease itself. Dr. Jones explained that we can reasonably predict that the changing composition of the US population may mean that there are many more individuals who lack the necessary resources to promote good health, prevent chronic disease, and access the necessary health care. It is clear that when it comes to cancer disparities in this country, we need to start thinking pro-actively.
To watch Dr. Jones’ Grand Rounds lecture, please go to https://www.yalecancercenter.org/research/education/grand-rounds/index.aspx