Redaniel et al. BMC Cancer 2010, 10:100 http://www.biomedcentral.com/1471-2407/10/100 R E S E A R C H A R T I C L E Open Access Inter-country and ethnic variation in colorectal cancer survival: Comparisons between a Philippine population, Filipino-Americans and Caucasians Maria Theresa Redaniel1†, Adriano Laudico2,3,4†, Maria Rica Mirasol-Lumague4†, Adam Gondos1†, Gemma Uy3†, Hermann Brenner1*† Abstract Background: Previous population-based studies showed differences in international and within country colorectal cancer survival estimates, but few investigated the role of prognostic factors. Using a “high resolution approach”, we aimed to determine the effect of ethnicity and health care by comparing Filipino-Americans with Philippine residents, who have the same ethnicity, and with Caucasians living in the US, who have the same health care system. Methods: Using databases from the Manila and Rizal Cancer Registries and the United States Surveillance, Epidemiology and End Results, age-adjusted five-year absolute and relative survival estimates were computed and compared between Filipino-American colorectal cancer patients, cancer patients from the Philippines and Caucasian patients. Cox proportional hazards modelling was used to determine factors affecting survival differences. Results: Much lower 5-year relative survival estimates were obtained for Philippine residents (37%) as compared to those in Filipino-Americans (60.3%) and Caucasians (62.4%). Differences in age, stage and receipt of surgery explained a large proportion of the survival differences between Philippine residents and Filipino-Americans. However, strong excess risk of death for Philippine residents remained after controlling for these and other variables (relative risk, RR, 2.03, 95% confidence interval, 95% CI, 1.83-2.25). Conclusions: Strong survival disadvantages of Philippine residents compared to Filipino-American patients were disclosed, which most likely reflect differences in access to and utilization of health care. Health education and advocacy, for both patients and health practitioners, should likewise be given priority. Background Colorectal cancer (CRC) is among the most common cancers worldwide, ranking fourth in men and third in women [1]. Incidence is higher in developed countries than in less developed nations, with the ratio of colon to rectal cancer incidence being 2:1 in the high-risk coun- tries as compared to an almost equal distribution in low-risk nations [1]. Similarly, survival estimates were * Correspondence: h.brenner@dkfz-heidelberg.de † Contributed equally 1Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany also reported to be higher in developed countries, with the exception of Eastern Europe, in comparison to less developed nations [1,2]. Within countries, incidence, mortality and survival rates were reported to vary. In the United States, incidence and mortality among Caucasians were lower than among Afri- can-Americans, but higher than among Asian and Pacific Islanders (API) and Hispanics [3]. Five-year survival was found similar in non-Hispanic whites (NHW) and Asian Americans, including Filipino-Americans [4-6]. While international and interracial CRC survival com- parisons have been reported, high resolution studies that © 2010 Redaniel et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.