Earlier age at diagnosis: Another dimension in cancer disparity?

https://doi.org/10.1016/j.cdp.2006.11.004Get rights and content

Abstract

Background: The age at diagnosis is of vital consideration for maximizing the benefits of screening recommendations, prevention initiatives, and treatment strategies. The current study compared the age at diagnosis in African Americans (AA) and whites for the 12 most frequently occurring cancers from 1996 to 2002. Using three criteria, this study determined whether cancers in most anatomic sites were more likely to occur at an earlier age in AA than in whites in the United States. Methods: The Surveillance, Epidemiology, and End Results (SEER) Program was used to collect publicly accessible cancer data from 1996 through 2002 for AA and whites. Frequency, population size, and median age at diagnosis were collected for each of the 12 most commonly occurring cancers. These included: prostate, breast, lung, colon, urinary bladder, corpus uteri, non-Hodgkin's lymphoma, ovary, kidney, leukemia, oral cavity and pancreas. Poisson and logistic regression were used to investigate the possible association between race/ethnicity and an earlier age at cancer diagnosis. Results: In general, AA had an earlier age at diagnosis for invasive cancer compared with whites. According to the median age at diagnosis, all 12 frequently occurring cancers from 1996 to 2002 were diagnosed significantly earlier in AA than in whites. Eight of the 12 cancers reached an arbitrary rate of ≥3 cases per 100,000 persons at a significantly younger age in AA than in whites. However, the relative risk of a cancer diagnosis for persons 5–45 years of age was significantly greater for only 3 of the 12 cancers in AA. Conclusion: Cancers in general have an earlier age at diagnosis in AA than in whites. Earlier age at diagnosis may be another indicator of disparity since cancers that arise at a younger age tend to be more aggressive and frequently result in a less favorable outcome.

Introduction

The age at cancer diagnosis is of vital consideration for maximizing the benefits of screening recommendations, prevention initiatives, and treatment strategies. The U.S. Preventive Services Task Force, for instance, has recommended that PSA testing begin in AA men at age 45 and in white men at age 50 because AA men have an earlier diagnosis of prostate cancer than whites. Furthermore, cancers that arise at a younger age tend to be more aggressive, may be found at a more advanced stage, and frequently result in a less favorable outcome than cancers that develop later in life [1]. Differences regarding age at diagnosis have been observed among different racial/ethnic populations in the U.S. [2], [3], [4]. According to the Surveillance, Epidemiology, and End Results (SEER) Program, AA women below the age of 42 have higher rates of breast cancer than white women [5]. From 1996 to 2000, the median age at diagnosis for invasive breast cancer for white women was 64 years, and for AA women it was 57 years [5]. AA men have higher rates of prostate cancer at a younger age than white men [6]. AA are 2 to four times more likely than whites to be diagnosed before the age of 50 for all head and neck cancers except those arising in the salivary glands [7]. The median age at diagnosis for multiple myeloma is also lower in AA than whites (67 years compared with 71 years) [8]. Based on the observations that a number of cancers are diagnosed at an earlier age in AA than in whites, we wanted to determine whether early diagnosis was limited to a few common cancers or whether it was a more general characteristic of cancer in AA.

Nearly all investigators comparing age at cancer diagnosis in different populations have used the median age at diagnosis. However, this method does not take into account the differences in the age distributions in different populations. Therefore, to more fully investigate the age at cancer diagnosis between AA and whites, we compared the median age at diagnosis to two other methods.

Section snippets

Materials and methods

The SEER Program of the National Cancer Institute provided all cancer data for this study [5]. SEER collects and publishes cancer incidence and survival data from approximately 14% of the population [5]. Data concerning patient demographics, diagnosis, stage of disease, morphology, primary tumor site, and follow-up for vital status between 1973 and 2002 identify changing trends and racial/ethnic disparities for all cancer sites. Information pertaining to patients’ race/ethnicity from the SEER

Median age at diagnosis

Table 1 shows the results for the median age at diagnosis for the 12 most common cancers for both AA and whites. The median age at diagnosis for AA was earlier for all of the 12 most frequently occurring cancers. Odds ratios of less than one indicate that AA are more likely than whites to receive a diagnosis of cancer before the median age of the total population. The median age at diagnosis in the total population for each cancer (AA plus whites) is also listed in Table 1.

Age at diagnosis at ≥3 cases per 100,000 persons

Table 2 illustrates

Discussion

According to the median age, the 12 most commonly occurring cancers recorded from 1996 to 2002 were diagnosed significantly earlier in AA than in whites. This was evident even when we examined the median age at diagnosis for all sites combined. The white population had a 4-year greater median age at diagnosis, 68 years, compared with the AA population, 64 years [5]. Even more evident was the younger median age at diagnosis for all cancer sites combined in AA females; white females had a 5-year

Conflict of interest

None.

References (35)

  • D.E. Henson et al.

    Histological grade, stage, and survival in breast cancer: comparison of African American and Caucasian women

    Cancer

    (2003)
  • D.P. Rose et al.

    Tumor biology and prognosis in black breast cancer patients: a review

    Cancer Detect Prev

    (2001)
  • A.M. Morris et al.

    Racial disparities in rectal cancer treatment: a population-based analysis

    Arch Surg

    (2004)
  • H. Aziz et al.

    Early onset of breast carcinoma in African American women with poor prognostic factors

    Am J Clin Oncol

    (1999)
  • National Cancer Institute. Surveillance epidemiology and end results: about SEER. United States National Institutes of...
  • J.W. Moul et al.

    Prostate-specific antigen values at the time of prostate cancer diagnosis in African-American men

    JAMA

    (1995)
  • K. Lee et al.

    Head and neck cancer in blacks

    J Natl Med Assoc

    (1994)
  • Ries LAG, Miller BA, Hankey BF, Kosary CL, Harras A, Edwards BK et al. SEER Cancer Statistics Review, 1991. Tables and...
  • D.A. Patel et al.

    Evaluation of African-American and white racial classification in a surveillance, epidemiology, and end results cancer registry

    Ethn Dis

    (2005)
  • G.G. Koch et al.

    Poisson regression

  • Statistical analysis system (SAS). 8.2 ed.

    (1999–2001)
  • Median age of cancer patients at diagnosis by primary site, race/ethnicity, and sex California. California Cancer...
  • W.A. Satariano et al.

    Racial differences in cancer incidence: the significance of age-specific patterns

    Cancer

    (1988)
  • T.Y. Flanders et al.

    Pancreatic adenocarcinoma: epidemiology and genetics

    J Med Genet

    (1996)
  • D.S. Michaud

    Epidemiology of pancreatic cancer

    Minerva Chir

    (2004)
  • D.M. Parkin et al.

    Cancer incidence in five continents. Comparability and quality of data

    IARC Sci Publ

    (1992)
  • T.D. Sterling et al.

    Comparison of smoking-related risk factors among black and white males

    Am J Ind Med

    (1989)
  • Cited by (50)

    • Patient Characteristics at Prostate Cancer Diagnosis in Different Races at an Academic Center Serving a Diverse Population

      2019, Clinical Genitourinary Cancer
      Citation Excerpt :

      In accordance with the National Comprehensive Cancer Network, for NHB men, it is “reasonable” to begin discussing the use of PSA screening earlier and to consider more frequent screening intervals (annually) but no definitive strategy has been recommended. NHB men have been diagnosed with PCa at an earlier age,3,4,29 with a lower optimal PSA threshold of detection of closer to 1.9.30 The current guidelines are not adequate for detecting PCa in our minority patients, especially Hispanic patients for whom no formal recommendations are available for earlier or more aggressive screening.

    • Maternal stress and early-onset colorectal cancer

      2018, Medical Hypotheses
      Citation Excerpt :

      EOCRC is most frequently seen in American Indian/Alaskan Natives (annual % change: 5.3%), then Hispanics (2.4%), Caucasians (2%), and Asian/Pacific Islanders (1%). Although EOCRC does not appear to be increasing in African Americans [60,61], the proportion of EOCRC remains nearly double among African Americans compared to Caucasians [62]; so disparities remain in EOCRC [3,5,6,13,18,36,61,63–73]. Finally, although there is a tendency toward the increasing rates of EOCRC occurring in males [2,5,6,34–36], the disease affects both males and females [1,3].

    • Screening for prostate cancer

      2017, Seminars in Oncology
    • Race, Ethnicity, Marital Status, Literacy, and Prostate Cancer Outcomes in the United States

      2016, Prostate Cancer: Science and Clinical Practice: Second Edition
    View all citing articles on Scopus
    View full text