Cancer Statistics for Hispanics, 2003: Good News, Bad News, and the Need for a Health System Paradigm Change

In this issue of CA, Kathryn O’Brien of the American Cancer Society (ACS) and colleagues review cancer incidence, mortality, and selected cancer-related behaviors of Hispanic Americans and compare them with those of non-Hispanic Americans. The report is a classic example of a good news, bad news situation. The good news is the lower rates of incidence and mortality from the four major cancer killers; the bad news is the higher incidence and mortality from several cancers in which infectious agents play a substantial etiologic role. The good news is the lower smoking rates among Hispanic adults and youth; the bad news is that much of this difference may be among immigrants, and that secondand third-generation Hispanic Americans remain vulnerable to tobacco marketing. The good news is that use of cancer screening tests and examinations has been increasing among Hispanics and that mammography use among Hispanic women exceeds the national average; the bad news is that prevalence of screening for colorectal, cervical, and prostate cancers among Hispanics remains considerably below average. The final bad news is higher rates of overweight and obese individuals and higher rates of physical inactivity. What is clear about this report is that patterns of cancer incidence, mortality, and behavioral risk factors for Hispanics differ sharply from the patterns of other racial and ethnic groups in the United States. Finally, it should be stated, the report raises many more questions than it answers. We have to be careful when talking about Hispanics. Hispanics are a very diverse group of people with varying beliefs and identities. Hispanics are the fastest-growing and largest ethnic and minority group in the United States. Although Hispanics are united by ethnicity, language, music, culture, and traditions, they also retain some distinguishing customs from their individual homelands. Hispanics originate from 23 different countries and belong to all known human races. This reality needs to be taken into account when analyzing health-related data. It is possible that this enormous diversity may explain the different patterns of cancer incidence, mortality, and cancer-related behaviors. The main problem is that Hispanics living in the United States are disproportionately affected by some disparities. Despite having the highest rate of labor force participation of all US population groups, Hispanics are the poorest minority group. In addition, they report the highest uninsured rate among all racial or ethnic groups. According to the US Census, there were 35.3 million Hispanics living in the United States in the year 2000. During the same year, 35% of Hispanics lacked health insurance. This represents more than 12 million people for whom going to see a doctor may constitute a financial hardship. In addition, the uninsured are less likely to get preventive care such as physical examinations and cancer screening. Other barriers to adequate access to quality health care include linguistic isolation, insufficient health information, scarcity of ethnically sensitive and culturally competent health facilities, and their lack of understanding of the US medical system. The Hispanic community does not have access to the same quality of care as mainstream Americans. One fifth of this community lives in poverty (a figure twice the national average). Many do not understand the importance of early screening tests because they were not provided with linguistically and ethnically sensitive information. First-generation Hispanic migrants have higher rates of cancers etiologically related to infectious agents, again reflecting in part limited educational opportunities and public health/health care infrastructure in some of their home countries. Many Hispanic Americans, and first generation immigrants in particular, have a low awareness of services available to them; they fear the unknown, and the medical system can be seen as intimidating and impenetrable. The Dr. Huerta is Director Cancer Preventorium, Washington Cancer Institute at Washington Hospital Center, Washington, DC.