Publication Date

2009-04-26

Availability

Open access

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PHD)

Department

Epidemiology (Medicine)

Date of Defense

December 2008

First Committee Member

Lora E Fleming - Committee Chair

Second Committee Member

Jill MacKinnon - Committee Member

Third Committee Member

Youjie Huang - Committee Member

Fourth Committee Member

David J Lee - Committee Member

Fifth Committee Member

Orlando Gomez-Marin - Committee Member

Abstract

Cancer afflicts 1.4 million people in the United States annually. In 2007, 45.5 million Hispanics were the largest and fastest growing minority in the US. Although treated as a homogeneous group, Hispanics are different from cultural, socioeconomic and genetic perspectives. The cancer experience of Hispanic subpopulations has, thus far, been poorly described. The present dissertation focused on the descriptive epidemiology of Cancer in Hispanics in the US. We created and validated an algorithm, the Hispanic Origin Identification Algorithm (HOIA), to improve the assignment of ethnicity and Hispanic subpopulation. We applied the HOIA to the Florida incident cancer data of the period 1999-2001 to calculate incidence rates for Hispanics, non-Hispanic Whites and non-Hispanic Blacks, and to estimate rates for Mexican Hispanics, Puerto Ricans, Cubans and New Latinos. We compared the cancer risk of these populations in their countries of origin and in the US with US Whites. Finally, we studied colorectal cancer (CRC) as an opportunity for studying disparities in diagnosis among Hispanic subpopulations. HOIA was highly sensitive and specific to detect Hispanic ethnicity and subgroup. Cancer rates differed markedly among Hispanic subpopulations. The apparently health advantage of Hispanics in other health outcomes, was limited to Mexicans who demonstrated remarkably low rates for most cancers. Puerto Ricans and Cubans had the highest total cancer rates, in some cases similar to US Whites. Hispanics increased their risk for the most common cancers - breast, prostate, colorectal, endometrial and especially lung cancer - when they moved to the United States from their countries of origin. Finally, Hispanics were at a disadvantage in terms of stage at diagnosis for CRC compared to non-Hispanic Whites and Blacks. Cuban Americans were less likely to be diagnosed at a late stage compared to all other Hispanic populations. Focused research into the differences in cancer incidence among Hispanic subpopulations in the US should be carried out, in particular the relationship between acculturation and cancer. Research should also target the causes of persisting disparities in stage of presentation among Hispanic subpopulations. Florida is the ideal location for these studies, and should become an “Observatory for Cancer in Hispanic populations.”

Keywords

Cancer; Puerto Rican; Cuban; Hispanic; Mexican

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