Cancer mortality rates vary considerably within the growing Hispanic population in the U.S., with significant differences among the major Hispanic ethnic groups, according to a study published in Cancer Epidemiology, Biomarkers & Prevention (doi: 10.1158/1055-9965.EPI-16-0684).
"Hispanic populations are all different, reflecting their country of origin, cultural experiences, and socioeconomic status," said the study's lead author, Paulo S. Pinheiro, MD, PhD, an Associate Professor of Epidemiology at the School of Community Health Sciences at the University of Nevada, Las Vegas. "If we can detect the differences among them, we can more easily identify public health strategies that could decrease their cancer risk and improve health outcomes."
Hispanics accounted for 17 percent of the U.S. population in 2014 and are expected to account for 29 percent of the population by 2060. Cancer is the leading cause of death among Hispanics. In general, cancer incidence and mortality rates are calculated on an aggregate basis, without separating the Hispanic population based on ethnicity or nation of origin.
In order to compare cancer mortality among various Hispanic ethnic groups, Pinheiro and colleagues analyzed mortality data in Florida residents during the years 2008-2012. The researchers chose to base their study on Florida data because it is the only state with statistically significant representation from all major Hispanic ethnic groups: Cuban, Puerto Rican, Mexican, Central American, Dominican, and South American.
Overall, Pinheiro said, the study showed that Hispanics had a 30 percent lower risk of dying of cancer than non-Hispanic whites. Hispanics had higher mortality rates from stomach and prostate cancer, but lower rates for lung, pancreas, and breast cancer, compared with non-Hispanic whites.
When the researchers examined mortality rates by ethnicity, they found wide variations among groups. Key findings of the study, included:
• Cubans had the highest overall mortality rate for both sexes: 174.1 deaths per 100,000 men and 104.1 deaths per 100,000 women, compared with 158.5 deaths per 100,000 among all Hispanic men and 99.6 per 100,000 for all Hispanic women. By comparison, the mortality rate for non-Hispanic white men was 204.4 deaths per 100,000 and for non-Hispanic white women, the mortality rate was 144.8 deaths per 100,000. Cubans had the highest lung cancer mortality rates of all ethnic groups, which Pinheiro attributed to high smoking prevalence.
• Puerto Ricans had the highest rates of liver cancer among all groups analyzed. Pinheiro said this group may benefit from efforts to increase awareness of risk factors for liver cancer, such as the hepatitis C virus.
• Cubans and Puerto Ricans had higher than average mortality rates from colorectal and endometrial cancers, two types that have been linked to obesity. Pinheiro said this reflects a tendency for immigrants to the U.S. to gain weight as they adopt a typical American diet. Cuban and Puerto Rican women also had higher mortality rates from breast cancer than the other groups. Pinheiro said these women tended to follow the American trend of having fewer children, which has been shown to increase breast cancer risk.
• Prostate cancer mortality among Dominicans was nearly double that of the non-Hispanic whites. Pinheiro said the disparity may reflect the fact that many Dominicans have African ancestry; prostate cancer incidence and mortality is higher in men of African descent.
The study results suggest that as more Hispanics settle in the U.S., they should be cautious about adopting the typical American diet. "They would do well to remember the diets of their home countries," Pinheiro said. "Rice and beans, grains, and fresh fruits and vegetables may be more beneficial than the food they will be exposed to in America."
He added that physicians should counsel their Hispanic patients to follow all recommendations for cancer screening.
"There is undoubtedly better access to screening here than in their home countries, so they should take advantage of it," Pinheiro said. "Depending on where they come from, their doctor could have a more targeted conversation about their cancer risk."
Pinheiro noted that Florida's Hispanic population is mostly foreign-born. He said he expects that the trends shown in this study would apply to Hispanics in most parts of the U.S., but may differ in states like California and Texas, where many Hispanic families have lived for several generations. A limitation of the study is that the amount of time spent in the U.S. was not available for each study participant.