# Presentation: 527191

## Racial/Ethnic Disparities in Cancer Incidence, Survival and Treatment

- Linda C. Harlan, PhD, MPH
- National Cancer Institute
- Division of Cancer Control and Population Sciences

## Disparities in Cancer

- Age
- Gender
- Marital Status
- Income
- Education
- Insurance
- Health System Characteristics
- Geographic
**Race/Ethnicity**

## Age-Adjusted US Mortality Rates for the Most Common Cancers by Race/Ethnicity for 2000-2003

- Source: US population NCHS

## Racial/Ethnic Disparities Along the Cancer Continuum

- Incidence
- Screening
- Stage at Diagnosis
- Therapy
- Survival

## Age-Adjusted Incidence Rates for the Most Common Cancers by Race/Ethnicity for 2000-2003

- Source: SEER

## Percentage of Women Age 40 and Older Reporting Having Mammography in the Past Two Years

- Source: NCHS

## Documented Time Elapsed Since Last Mammogram for Women Age 40 and Older by Racial/Ethnic Group*

- Source: Smith-Bindman, 2006

- *Adjusted for age and registry

## SEER Data

- Population-Based Registries
- Register all cancer cases within  a geographic areas
- 26% of the US population
- Detailed data on
- Demographics
- Tumor characteristic
- Treatment
- Active follow-up of cases
- Public use files, available to researchers
- Analysis program associated with data

## Stage at Diagnosis of In Situ and Invasive Breast Cancer by Race/Ethnicity for Cases Diagnosed in 2000-2003

- Source: SEER

## 5-year Cancer-Specific Survival by Race/Ethnicity and Stage for Invasive Breast Cancer Patients Diagnosed Between 1990 -2002

- Source: SEER

## Percentage of Women Receiving Radiation Following Breast Conserving Surgery by Racial/Ethnicity and Year of Diagnosis

**Tumor **_**<**_** 5cm**
**Source: SEER**

## Percent of Breast Cancer Cases Receiving Radiation Following BCS by Race/Ethnicity and County Family Poverty Rate 2000-2003

- Source: SEER

**Families at or Below Poverty Level**

## Use of Adjuvant Chemo/Hormonal Therapy for Early Stage, Node Negative Breast Cancer by Race/Ethnicity, and ER status 2000

**ER negative**

**ER positive**

- Source: Harlan
- unpublished

## Adjusted* Percentage of Patients Diagnosed 1995 through 1999 Receiving Guideline Therapy by Insurance Status and Race/Ethnicity

- *Charlson score, stage, number of positive lymph nodes, residency training program, hospital bed size, age, marital status, % high school diploma, gender, geographic region

- Source: Harlan, 2005

## Summary

- Racial/ethnic disparities occur across the cancer continuum
- Screening
- Stage at diagnosis
- Treatment
- Survival

## Data Sources

- Surveillance, Epidemiology and End-Results Data
- _[http://seer.cancer.gov/seerstat/](http://seer.cancer.gov/seerstat/)_
- Demographic, tumor characteristic, surgery and radiation
- Active follow-up for vital status
- SEER-Medicare linked file
- _[http://](http://healthservices.cancer.gov/seermedicare/obtain/)__[healthservices.cancer.gov/seermedicare/obtain](http://healthservices.cancer.gov/seermedicare/obtain/)__[/](http://healthservices.cancer.gov/seermedicare/obtain/)_
- Cancer cases age 65+ and a 5% sample of non-cancer patients
- SEER data +
- Treatment data, long-term medical follow-up, procedures
- Breast Cancer Surveillance Consortium
- Mammography registries
- _[http://](http://breastscreening.cancer.gov/work/proposal_data.html)__[breastscreening.cancer.gov/work/proposal_data.html](http://breastscreening.cancer.gov/work/proposal_data.html)_