Medical advances and racial/ethnic disparities in cancer survival.
BACKGROUND
Although advances in early detection and treatment of cancer improve overall population survival, these advances may not benefit all population groups equally and may heighten racial/ethnic differences in survival.


METHODS
We identified cancer cases in the Surveillance, Epidemiology and End Results program, who were ages > or = 20 years and diagnosed with one invasive cancer in 1995 to 1999 (n = 580,225). We used 5-year relative survival rates to measure the degree to which mortality from each cancer is amenable to medical interventions (amenability index). We used Kaplan-Meier methods and Cox proportional hazards regression to estimate survival differences between each racial/ethnic minority group relative to Whites, by the overall amenability index, and three levels of amenability (nonamenable, partly amenable, and mostly amenable cancers, corresponding to cancers with 5-year relative survival rate < 40%, 40-69%, and > or = 70%, respectively), adjusting for gender, age, disease stage, and county-level poverty concentration.


RESULTS
As amenability increased, racial/ethnic differences in cancer survival increased for African Americans, American Indians/Native Alaskans, and Hispanics relative to Whites. For example, the hazard ratios (95% confidence intervals) for African Americans versus Whites from nonamenable, partly amenable, and mostly amenable cancers were 1.05 (1.03-1.07), 1.38 (1.34-1.41), and 1.41 (1.37-1.46), respectively. Asians/Pacific Islanders had similar or longer survival relative to Whites across amenability levels; however, several subgroups experienced increasingly poorer survival with increasing amenability.


CONCLUSIONS
Cancer survival disparities for most racial/ethnic minority populations widen as cancers become more amenable to medical interventions. Efforts in developing cancer control measures must be coupled with specific strategies for reducing the expected disparities.
Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th, New York, NY 10032, USA. pt140@columbia.edu
Parisa
P
Tehranifar
Alfred I
AI
Neugut
Jo C
JC
Phelan
Bruce G
BG
Link
Yuyan
Y
Liao
Manisha
M
Desai
Mary Beth
MB
Terry
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005006:Ethnicity; D054625:Healthcare Disparities; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D009369:Neoplasms / Q000208:ethnology* / Q000401:mortality* / Q000628:therapy; D015996:Survival Rate; D055815:Young Adult