title: Racial/ethnic patterns of care for cancers of the oral cavity, pharynx, larynx, sinuses, and salivary glands.
abstract: BACKGROUND
  Among Americans, both incidence and mortality from cancers of the larynx, oral cavity, and pharynx are higher for African Americans than whites and for men than women. In addition, the 5-year survival rates for these sites are significantly lower for African Americans than whites for each disease stage, particularly among African American males. We examine racial/ethnic variation in tumor characteristics, treatment practices, and their relationship to survival for cancers of the oral cavity, pharynx, larynx, nasal cavity and salivary glands.
  
  
  METHODS
  Eligible individuals were age 20 or older and newly diagnosed with a primary invasive cancer of the oral cavity (excluding the lip), pharynx, larynx, sinuses or salivary glands in 1997 reported to one of nine National Cancer Institute's Surveillance Epidemiology and End Results Registries (SEER). Persons meeting the eligibility criteria for each registry were first stratified by race/ethnic group and stage then selected by random sampling within strata.
  
  
  RESULTS
  We found racial/ethnic differences in diagnoses at specific anatomic sites, disease stage and treatment. African Americans less frequently received a cancer directed treatment than both whites and Hispanics and when treated were generally less likely to receive cancer-directed surgery. In multivariate analysis, the receipt of any cancer directed treatment was significantly associated with race and age group. African Americans and Hispanics had poorer, but not significantly so, overall, but not cancer-specific, survival.
  
  
  CONCLUSIONS
  We found racial differences in the receipt of cancer treatment among patients diagnosed with selected head and neck cancers. We also found a less favorable distribution of stage for African Americans and Hispanics when compared with whites. The differences in stage we noted and the lower rates of oral cancer screening previously reported for these populations suggests that differential rates of early detection may contribute to racial differences in survival and mortality from cancers of the oral cavity and pharynx. Therefore, we conclude that more equitable receipt of cancer treatment along with preventive measures and earlier detection will help reduce racial/ethnic disparities in survival and mortality from cancers of the oral cavity, pharynx and larynx.
authors.affiliation: National Cancer Institute, Division of Cancer Control and Population Science, Applied Research Program, Health Services and Economic Branch, Bethesda, MD 20892-7344, USA. shavers@mail.nih.gov
authors.forename: Vickie L
authors.initials: VL
authors.lastname: Shavers
authors.forename: Linda C
authors.initials: LC
authors.lastname: Harlan
authors.forename: Deborah
authors.initials: D
authors.lastname: Winn
authors.forename: William W
authors.initials: WW
authors.lastname: Davis
mesh_terms: D000328:Adult; D001741:Black or African American; D003695:Delivery of Health Care; D005260:Female; D006258:Head and Neck Neoplasms / Q000208:ethnology* / Q000473:pathology / Q000628:therapy*; D006630:Hispanic or Latino; D006801:Humans; D015994:Incidence; D007822:Laryngeal Neoplasms / Q000208:ethnology / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000208:ethnology / Q000473:pathology / Q000628:therapy; D009367:Neoplasm Staging; D010255:Paranasal Sinus Neoplasms / Q000208:ethnology / Q000473:pathology / Q000628:therapy; D010610:Pharyngeal Neoplasms / Q000208:ethnology / Q000473:pathology / Q000628:therapy; D011379:Prognosis; D018426:SEER Program; D012468:Salivary Gland Neoplasms / Q000208:ethnology / Q000473:pathology / Q000628:therapy; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D044465:White People