Current Trends Cancer Patient Survival by Racial/Ethnic
Group -- United States, 1973-1979
To study the survival differences by race and ethnic group of
patients with a first primary cancer, the National Cancer Institute
analyzed data from its Surveillance, Epidemiology and End Results
Program (SEER). The study included cases diagnosed in the period
1973-1979 and followed through December 31, 1981. Eight
racial/ethnic
groups in the U.S. population--Anglos, Hispanics, blacks, American
Indians, Chinese, Japanese, Filipinos, and Hawaiians--were
evaluated
(1). At the time of the analysis, the SEER program included
roughly
10% of the U.S. population (all residents of the states of
Connecticut, Hawaii, Iowa, New Mexico, and Utah and the
metropolitan
areas of Atlanta, Georgia; Detroit, Michigan; San Francisco,
California; and Seattle, Washington). Survival is reported as a
5-year relative survival rate, the ratio of the observed survival
rate
for the patient group to the expected survival rate for persons in
the
general population similar to the patient group in age, race, sex,
and
calendar year.
Survival rates for Anglo females exceeded those for Anglo males
for each major primary site except urinary bladder (Table 3). The
primary site with the highest survival rate among each group
studied
was the thyroid gland, which had a 5-year relative rate of 91% for
all
races combined. Rates were uniformly low (under 9%) for each
racial/ethnic group and both sexes for cancers of the esophagus,
liver, and pancreas. Survival rates for Hispanics were almost
identical to those for Anglos, with the largest difference observed
for females with bladder cancer. Black males experienced poorer
survival than Anglo males for cancer of the rectum, prostate,
bladder,
and thyroid; black females had poorer survival than Anglo females
for
cancers of the bladder, corpus uteri, and breast. For many primary
sites, Japanese experienced the highest survival rates, and
American
Indians, the lowest. Although numbers of cases are small, and the
survival rates are unstable, survival rates for Chinese and Native
Hawaiians are roughly comparable to those for Anglos, whereas
survival
rates for Filipinos resemble those for blacks.
Reported by JL Young, DrPH, LG Ries, ES Pollock, ScD, Operations
Research Br, LP Boss, PhD, C Baquet, MD, Cancer Control
Applications
Br, Div of Cancer Prevention and Control, National Cancer
Institute.
Editorial Note
Editorial Note: For a specific cancer site, survival time after
diagnosis is related to the extent of disease at diagnosis (stage),
the effectiveness of treatment, and biologic and behavioral
differences. If the cancer is widespread at diagnosis
(higher-stage
disease), survival time decreases. However, the extent of disease
at
diagnosis does not completely account for these differences in
survival. For breast cancer in each stage, whites had higher
survival
rates than blacks.
Japanese patients have consistently higher survival rates than
Anglo patients. Since 83% of the Japanese included in this
analysis
were residents of Hawaii, and survival rates of Anglo patients in
Hawaii exceeded those of their Anglo counterparts on the mainland,
the
high rate for Japanese patients may primarily reflect the general
high
survival rates among patient groups in Hawaii.
The effect of socioeconomic status (SES) on cancer patient
survival may partially explain these racial differences. A study
of
white cancer patients in Iowa demonstrated poorer survival among
those
of low SES, like those of blacks elsewhere (2). Likewise, in a
study
of breast cancer in blacks, using six different indicators of SES,
blacks of lower SES experienced poorer survival than blacks of
higher
SES (3).
These differences in SES may be related to differences in
treatment. In a randomized trial in New York to determine the
efficacy of breast screening, the unscreened control group showed a
lower 5-year survival rate for nonwhite women with breast cancer
than
for white women with breast cancer. In the screened group, the
breast
cancer survival rates of the two racial groups did not differ (4).
In
a Veterans Administration study, except for bladder cancer, patient
survival did not differ by race (5). It appears that treatment
differentials may play a role in the differences in survival
observed
among ethnic groups. In the Veterans Administration study, in
which
patients of all races were treated similarly, most survival
differentials did not exist. Studies are currently under way to
investigate the role of additional factors in the survival
differentials of the racial/ethnic groups.
References
Young JL Jr, Ries LG, Pollack ES. Cancer patient survival
among
ethnic groups in the United States. J National Cancer
Institute
1984;73:341-52.
Berg JW, Ross R, Latourette HB. Economic status and survival
status of cancer patients. Cancer 1977;39:467-77.
Dayal HH, Power RN, Chiu C. Race and socio-economic status in
survival from breast cancer. J Chronic Dis 1982;35:675-83.
Shapiro S, Venet W, Strax P, Venet L, Roeser R. Prospects for
eliminating racial differences in breast cancer survival rates.
Am J Public Health 1982;72:1142-5.
Page WF, Kuntz AJ. Racial and socioeconomic factors in cancer
survival. A comparison of Veterans Administration results with
selected studies. Cancer 1980;1029-40.
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