Report: Cancer Risk Varies Widely Among Hispanic Americans

A new report from the American Cancer Society highlights the wide variation in cancer risk within the US Hispanic/Latino population. Although health data are often only available for the Hispanic population as a whole, Cancer Statistics for Hispanics/Latinos, 2018 illustrates some of these wide differences in cancer risk by comparing newly available data from Puerto Rico, with a 99% Hispanic population, with cancer statistics for other US Hispanics. The report was published by the American Cancer Society on October 4, 2018 in CA: A Cancer Journal for Clinicians. The information was also released in a companion report, Cancer Facts and Figures for Hispanics/Latinos 2018-2020.

“What’s most striking about cancer occurrence in Hispanics is the huge diversity in rates, says Kimberly D. Miller, MPH, co-author of the study and a senior associate scientist for Surveillance Research at the American Cancer Society, “Even though Hispanics have lower rates of cancer as an aggregated group, some Hispanic subgroups have rates that approach or surpass those in non-Hispanic whites.”

The report says that men in Puerto Rico have higher prostate and colorectal cancer incidence and death rates than non-Hispanic whites in the continental US, in contrast to US Hispanics as a whole, who have lower rates for these cancers. Yet the lung cancer incidence rate in Puerto Rico is one-third that of non-Hispanic whites and two-thirds that of other US Hispanics. Prostate cancer accounts for the largest proportion of cancer deaths among men in Puerto Rico, about 1 in 6 cancer deaths, making it the only state or territory included in the report in which lung cancer is not the leading cause of cancer death among men of all races combined.

The report also reviews cancer statistics for Hispanics residing within the continental US and Hawaii. Cancer is the leading cause of death among Hispanics overall, followed by heart disease. In 2018, 42,700 cancer deaths are expected among Hispanics in the continental US and Hawaii, with lung (16%), liver (12%), and colorectal (11%) cancers expected to cause the most cancer deaths among men and breast (16%), lung (13%), and colorectal (9%) cancers expected to cause the most among women. Lung cancer accounts for 14% of cancer deaths among continental Hispanics compared to 25% in the overall population, mainly because of lower smoking rates among Hispanics.

Overall, the rates of new cancer cases and cancer deaths among Hispanics in the continental US are 25% to 30% lower than in non-Hispanic whites. However, rates among some US-born Hispanics approach those in non-Hispanic whites. The Hispanic population in the US is growing rapidly, mainly due to an increase in births, rather than immigration. This has led the study authors to predict that the cancer burden among Hispanics will grow too.

One-third of continental Hispanics are foreign-born and have a cancer risk that largely reflects their country of origin. As a group, Hispanics are less likely than non-Hispanic whites to be diagnosed with the 4 most common cancers (prostate, breast, lung, and colorectal) but have a higher risk of certain infection-related cancers (stomach, liver, and cervix), which are more frequent in Latin American countries.

This report also includes information on selected cancer risk factors and screening prevalence among US Hispanics. They are disproportionally affected by excess body weight and type 2 diabetes, for example. Although cigarette smoking prevalence among Hispanics overall is low (10% compared with 17% in non-Hispanic whites), prevalence by Hispanic origin group ranges substantially, from 6% in Dominicans and Central/South Americans to 17% in Puerto Ricans (not including island Puerto Ricans, among whom cigarette smoking prevalence was 11% in 2015).

According to the report, strategies for reducing cancer risk among Hispanics in the US, including Puerto Rico, must take into account differences among sub-populations. Recommended strategies include using culturally appropriate medical professionals, improving access to screening and vaccinations, encouraging healthy lifestyle behaviors (to reduce tobacco use, obesity, and alcohol consumption), and funding Puerto Rico–specific and subgroup-specific cancer research.”

Differences in subpopulations

Most cancer data in the US are reported for Hispanics as one group, masking important differences between Hispanic subpopulations according to place of birth and degree of acculturation. Examples from recent studies detailed in the report include:

• In one study of cancer death rates in Texas during 2008-2012, rates in US-born Hispanic men were about 60% higher than those in foreign-born Hispanic men (201 deaths per 100,000 men versus 125, respectively), and approached rates in non-Hispanic white men (210).
• A study in Florida found lung cancer death rates in Cuban men (49 deaths per 100,000 men during 2008-2012), were nearly 50% higher than those in Puerto Rican men (33 deaths per 100,000 men). Cuban men have the heaviest smoking history among Hispanic subgroups.
• In a study of Texas residents, colorectal cancer mortality rates in US-born Hispanics (24 deaths per 100,000 men and 13 deaths per 100,000 women during 2008-2012) were double those in foreign-born Hispanics (12 and 6 per 100,000 in men and women, respectively) and approached or surpassed those in non-Hispanic whites (18 and 13 per 100,000, respectively).