Cancer statistics by race and ethnicity

Cancer is a major public health problem for all Americans. In 1994, about 534,300 deaths in the United States were attributed to cancer: 465,800 among whites, 59,900 among African Americans, and 8,600 among Americans of other races.1 Although the burden of cancer is high among individuals of all races and ethnicities, striking differences in cancer incidence and mortality exist among these populations. Information on these differences can help us to identify new ways to reduce the burden of cancer. Although cancer data of a national level are regularly available for African Americans and whites, data on cancer in other American racial and ethnic populations are published infrequently. In 1996, however, the Surveillance, Epidemiology and End Results Program (SEER) of the National Cancer Institute released a monograph on racial and ethnic patterns of cancer that is the most extensive compilation of this type of information published to date.2 We present key findings on cancer incidence and mortality from this monograph along with information on the prevalence of cancer risk factors and screening examinations among racial and ethnic groups in the United States. These additional data are presented to provide a rationale for differences in cancer incidence and mortality among the various groups. The information on cancer incidence and mortality in this report is from the SEER publication Racial/Ethnic Patterns of Cancer in the United States 1988–1992.2 Information on incidence is tabulated for 11 racial and ethnic groups (African American, Alaska Native, American Indian from New Mexico, Chinese, Filipino, Hawaiian, Hispanic, Japanese, Korean, Vietnamese, and white). Mortality information is presented for the same groups except Koreans and Vietnamese, for whom national data are not yet available. All of the incidence and mortality rates tabulated in the report are for the years 1988 to 1992 and have been age-adjusted to the 1970 US standard population.3 Data on cancer risk factors and screening examinations are derived from two sources. Statistics on tobacco are from the 1994 National Health Interview Survey, and statistics on other cancer-related behaviors are from the 1991–1992 Behavioral Risk Factor Surveillance System (BRFSS).4-6 In both surveys, race and ethnicity are defined according to US government standards established by the Office of Management and Budget's (OMB) Directive Number 15.7 For this reason, data on cancer risk and screening behaviors are available only for five broad categories of race and ethnicity (African Americans, American Indians, Asians and Pacific Islanders, Hispanics, and whites). The sections of this report are organized around these five categories, with an introductory section comparing overall cancer rates among racial and ethnic groups. Overall rates of cancer incidence vary considerably among US racial and ethnic populations.2 Figure 1 shows cancer incidence rates from 1988 to 1992 for the 11 racial and ethnic populations for whom SEER data were available. For men, cancer incidence rates were highest among African Americans and whites. For men, rates were highest among African Americans (560 per 100,000) and whites (469 per 100,000) and lowest among American Indians from New Mexico (196 per 100,000). Rates among Asian men were also low and ranged from 266 per 100,000 for Koreans to 326 per 100,000 for Vietnamese. Among women, overall cancer incidence rates for every racial and ethnic group were lower than those for men. Incidence was highest among Alaskan Native women (348 per 100,000) and white women (346 per 100,000) and lowest among American Indian women (180 per 100,000) and Korean women (180 per 100,000). As did Asian and American Indian men, Asian and American Indian women experienced low rates of cancer incidence. Overall mortality rates also varied considerably by race and ethnicity.2 Figure 2 shows mortality rates in the United States from 1988 to 1992 for the nine racial and ethnic groups for whom national level data are available. Among both men and women, African Americans, Hawaiians, Alaska Natives, and whites experienced mortality rates that were at least 40% higher than those of other populations. Among men, rates ranged from 105 per 100,000 for Filipinos to 319 per 100,000 for African Americans; among women rates ranged from 63 per 100,000 for Filipinos to 179 per 100,000 for Alaska Natives. For all racial and ethnic groups, mortality rates for women were lower than those for men. For both incidence and mortality rates, racial and ethnic variations for all sites combined may differ considerably from those for individual cancer sites. Some of these individual site-specific patterns of cancer incidence and mortality are described later in this article. OMB Directive Number 15 refers to African Americans as “blacks” and defines them as “persons whose lineage includes ancestors who originated from any of the black racial groups of Africa.”7 Most African Americans are descendants of slaves who were transported from Africa to the United States and the Caribbean during the 17th through the early 19th centuries.6 However, an increasing proportion of this population is composed of either new immigrants or their first- or second-generation descendants. African Americans are currently the second largest racial group in the United States.8 The 1990 US census counted approximately 30 million African Americans in the United States, who make up about 12% of the population. According to data from the SEER program for 1988 to 1992, the three most frequently diagnosed cancers among African American men were cancers of the prostate, lung and bronchus, and colon and rectum2 (Table 1). Of the 11 racial and ethnic groups studied, African American men had the highest overall rate of cancer incidence (560 per 100,000) and the highest rates of cancers of the prostate (180.6 per 100,000), lung and bronchus (117.0 per 100,000), and oral cavity (20.4 per 100,000). Among both men and women, African Americans, Hawaiians, Alaska Natives, and whites experienced mortality rates that were at least 40% higher than those of other populations. The most frequently diagnosed cancers among African American women were cancers of the breast, colon and rectum, and lung and bronchus2 (Table 2). Among the populations studied, African American women had the second highest rates of cancers of the lung and bronchus (44.2 per 100,000) and colon and rectum (45.5 per 100,000). Alaska Native women had the highest rates of both cancers. According to vital statistics data for 1988 to 1992, the three most common causes of cancer death among African American men were cancers of the lung and bronchus, prostate, and colon and rectum (Table 3).2 For all three of these cancers, African American men had higher mortality rates than any of the other racial or ethnic groups studied. Prostate cancer mortality rates were particularly high; from 1988 to 1992, the rate for African Americans (53.7 per 100,000) was more than twice as high as the rate for whites (24.1 per 100,000). The most common causes of cancer death in African American women from 1988 to 1992 were cancers of the lung and bronchus, breast, and colon and rectum (Table 4).2 Of the populations studied, African American women had the highest breast cancer mortality rate (31.4 per 100,000) and the second highest rates of cervical cancer (6.7 per 100,000) and colorectal cancer (20.4 per 100,000). Unlike African American men, African American women did not generally experience cancer mortality rates that were higher than those for women of other races and ethnicities for most cancer sites. Obesity is a major health problem for African American men and women. According to BRFSS data, 37.7% of African American women and 28.4% of African American men were overweight in the period 1991 to 1992 (Table 5).5, 6 Of the racial and ethnic groups studied, African American women were more likely to be overweight than women of other races or ethnicities. High smoking rates are also a major health problem among African Americans.4, 6 According to 1994 data from the National Health Interview Survey, 33.9% of African American men and 21.8% of African American women reported that they currently smoked.4 Smoking rates for African American men were higher than those for men of any other group except Native Americans. Rates for both African American men and African American women were much higher than the year 2000 smoking target of 15%. Cancer Incidence Rates for All Sites Combined by Race, Ethnicity, and Sex, SEER, 1988–1992 Cancer Mortality Rates for All Sites Combined by Race, Ethnicity, and Sex, United States, 1988–1992 OMB directive Number 15 defines a person as an Asian or Pacific Islander if he or she has “origins in any of the original peoples of the Far East, Southeast Asia, the Indian subcontinent, or the Pacific Islands.”7 This population is very diverse, including individuals from at least 24 ethnic populations who speak more than 30 major languages or dialects.6 Because of immigration and high birth rates, the Asian and Pacific Islander population is growing rapidly. The 1990 US census counted 7.5 million Asians and Pacific Islanders living in the United States, who make up about 3% of the population.8 This percentage is expected to increase to 4.1% by the year 2000 and to 8.7% by 2050.9 Asian and Pacific Islander women had the lowest rates of Pap test screening and mammography and clinical breast examination of any racial or ethnic group in the United States. Rates of cancer incidence vary considerably among subgroups of the Asian and Pacific Islander population (Tables 1 and 2). For 1988 to 1992, SEER data on cancer incidence rates were available for Chinese, Filipino, Hawaiian, Japanese, Korean, and Vietnamese men and women. Among men, the three most frequently diagnosed sites included prostate, lung and bronchus, and colon and rectum, with the following exceptions.2 Stomach rather than prostate was a leading site among Korean men, and liver rather than colon and rectum was a leading site among Vietnamese men. Stomach cancer rates among Korean men (48.9 per 100,000) and liver cancer rates among Vietnamese men (41.8 per 100,000) were higher than those for any other racial or ethnic group studied. Incidence rates for prostate, lung and bronchus, and colorectal cancers among Asian men were generally lower than those among African American and white men. However, incidence rates of lung and bronchus cancer among Hawaiian men (89.0 per 100,000) were considerably higher than those among whites (76.0 per 100,000), and colorectal cancer incidence rates among Japanese men (64.1 per 100,000) were higher than those for any racial or ethnic group except Alaska Natives (79.7 per 100,000). The three most commonly diagnosed cancers among Asian and Pacific Islander women included cancers of the breast, colon and rectum, and lung and bronchus with the following exceptions.2 Stomach rather than lung was a leading cancer site among Japanese and Korean women, and cervix rather than colon and rectum was a leading cancer site among Vietnamese women. Rates of cervical cancer incidence among Vietnamese women (43.0 per 100,000) were more than two and a half times higher than rates for women of any other racial or ethnic group. Asian and Pacific Islander women experienced lower rates of breast, lung and bronchus, and colorectal cancers than other racial or ethnic groups, with the following exceptions. Breast cancer rates among Hawaiian women (105.6 per 100,000) were higher than those for any group other than whites (111.8 per 100,000). Rates of lung and bronchus cancer incidence among Hawaiian women (43.1 per 100,000) were similar to those for African American women (44.2 per 100,000) and white women (41.5 per 100,000), and rates of colorectal cancer incidence among Japanese women (39.5 per 100,000) were in the same range as those for African American women (45.5 per 100,000) and white women (38.3 per 100,000). Mortality data for the United States from 1988 to 1992 are available only for four Asian and Pacific Islander ethnicities: Chinese, Filipino, Hawaiian, and Japanese. Among men, lung cancer was the most common cause of cancer death for all four of these populations (Table 3).2 Other frequent causes of cancer death varied by race and ethnicity and included liver and colorectal cancer in Chinese men; prostate and colorectal cancer in Filipino and Hawaiian men; and colorectal and stomach cancer in Japanese men. Mortality rates for stomach cancer were higher among Japanese men (17.4 per 100,000) than among men of any other racial or ethnic group studied except Alaska Natives (18.9 per 100,000). Among women, lung cancer was the leading cause of cancer death for Chinese, Hawaiians, and Japanese and the second leading cause of cancer death for Filipinos (Table 4).2 Rates ranged from 10 per 100,000 for Filipinos to 44.1 per 100,000 for Hawaiians. Other leading causes of cancer death varied by Asian and Pacific Islander ethnicity and included breast and colorectal cancer in Chinese, Filipino, and Japanese women; and breast and stomach cancer in Hawaiian women. Stomach cancer mortality rates for Hawaiian women (12.8 per 100,000) were higher than those for women of any other racial or ethnic group. Breast and lung cancer mortality rates were lower among Chinese, Filipinos, and Japanese than among Hawaiians and the other racial and ethnic groups studied. Male lung cancer mortality rates for 1988 to 1992 reflect this pattern. Rates for non-Hawaiian Asian and Pacific Islander men ranged from 29.8 per 100,000 for Filipinos to 40.1 per 100,000 for Chinese, whereas the rate for Hawaiians (88.9 per 100,000) was higher than that for any racial or ethnic group other than African Americans. Because the Asian and Pacific Islander population is so diverse, risk factor and screening prevalence rates are likely to vary considerably among subpopulations of this group. Unfortunately, data on national patterns of risk factors and screening for subgroups of Asians and Pacific Islanders currently are not available to prove or disprove this hypothesis. Data on cancer risk factors and screening for a cross-section of Asian and Pacific Islanders in the United States are presented in Table 5. Among this group, prevalence rates for tobacco use, chronic alcohol use, and obesity are lower than those for any other race or ethnic group studied.4-6 Despite these favorable patterns, the prevalence of cancer risk factors could be further reduced through targeted intervention efforts. Furthermore, cancer screening rates among Asian and Pacific Islander women could be improved. According to BRFSS data for 1991 to 1992, these women had the lowest rates of Pap test screening and mammography and clinical breast examination of any racial or ethnic group in the United States.6 The US government refers to Native Americans as American Indians and Alaska Natives and defines them as “persons having origins in the original peoples of North America, and who maintain cultural identification through tribal affiliations or community recognition.”7 American Indians and Alaska Natives represent more than 500 tribes, each with unique cultural, genetic, and sociodemographic characteristics.10 In 1990, the US census counted about 2.1 million American Indians and Alaska Natives living in all 50 states, about one-third on federal reservations and half in urban centers.8, 10 Native Americans constituted about 0.8% of the US population in Because of the of the Native American is likely that cancer incidence rates vary considerably among Unfortunately, national level data on incidence patterns are not available For 1988 to 1992, cancer incidence rates were only for Alaska Natives and American Indians from New these two incidence patterns considerably (Tables 1 and 2). The most frequently diagnosed cancers among Alaska Native men were cancers of the lung and bronchus, colon and rectum, and among American Indians from New Mexico the most frequently diagnosed sites were prostate, colon and rectum, and (Table 1). cancer rates among Alaska Native men (79.7 per 100,000) and cancer rates among American Indian men per 100,000) were higher than those for any other racial or ethnic group studied. The cancer rate among Alaska Natives per 100,000) was also the is not is on than For women, the most frequently diagnosed cancers among Alaska Natives were breast, colon and rectum, and lung and bronchus, whereas the most frequently diagnosed cancers among American Indian women from New Mexico were cancers of the breast, and colon and rectum (Table 2). Alaska Native women had higher rates of colorectal cancer per 100,000) and lung and bronchus cancer per 100,000) than any other racial or ethnic group studied, and American Indian women had high rates of per 100,000) and cancers per 100,000). The cancer rate among Alaska Native women was also high; however, the rate is not is on than As with data on cancer information on cancer mortality in Native Americans has been tabulated only for Alaska Natives and American Indians from New Mexico (Tables and 1988 to 1992, the three most frequent causes of cancer death for Alaska Native men were cancers of the lung and bronchus, colon and rectum, and For American Indian men from New Mexico the three most frequent causes of cancer death were cancers of the prostate, and Among Alaska Native men, the colorectal cancer mortality rate per 100,000) was than that for any other group studied except African American men. Rates for most other sites were the of deaths were For 1988 to 1992, the three most frequent causes of cancer deaths for Alaska Native women were cancers of the lung and bronchus, colon and rectum, and for American Indian women from New Mexico the three most frequent causes of cancer deaths were cancers of the breast, and cervix lung and bronchus and colorectal cancer rates for Alaska Native women were on more than cancer For both cancers, rates for Alaska Natives were higher than those for any other population studied. Despite the of the Native American risk factor and screening data for this group are available only for a cross-section of the population. Native Americans have high of to cancer risk particularly smoking (Table According to data from the 1994 National Health Interview Survey, of Native American men and of Native American women reported that they currently smoking rates for Native American men were more than higher than those for other racial or ethnic populations. The prevalence of obesity among Native Americans was also very 6 According to BRFSS data for 1991 to 1992, about one-third of Native American men and women were In to cancer risk to health is a problem for Native Americans, who are second only to in their of health According to BRFSS data for 1991 to 1992, of Native American men and of Native American women had health are defined by OMB Directive Number 15 as “persons having origins in any of the original peoples of North or the are by the largest racial group in the United States, and health have been targeted In 1990, the US census counted about million whites, who approximately of the US population.8 Because most Americans are the leading cancer sites for whites are also the leading sites for the United States as a According to SEER data for 1988 to 1992, the three most frequently diagnosed cancers among white were cancers of the prostate, lung and bronchus, and colon and rectum (Table had higher rates of incidence of cancer per 100,000) than any other racial or ethnic two times higher than those of Hispanics, who had the second highest also had the highest rate of per 100,000), and their prostate cancer rate per 100,000) was second only to that of African Americans. The three most frequently diagnosed cancers among white women were cancers of the breast, lung and bronchus, and colon and rectum (Table Breast cancer rates among white women (111.8 per 100,000) were higher than those among women of any other racial or ethnic group studied, and rates of cancers of the per 100,000) and per 100,000) also were According to US vital statistics data for 1988 to 1992, the leading causes of cancer death among white were prostate, and colorectal cancers (Table 3).2 mortality rates for white men per 100,000) were in the same range as those for African Americans per 100,000) and Hawaiians per 100,000) and were higher than those for other racial or ethnic groups studied. The leading causes of cancer death among white were cancers of the lung and bronchus, breast, and colon and rectum (Table 4).2 Breast cancer mortality rates for whites per 100,000) were similar to those for African Americans (31.4 per 100,000) and Hawaiians per 100,000) and were higher than those for other racial and ethnic groups studied except African Americans. Mortality rates for cancer among whites per 100,000) were higher than those for any other racial or ethnic group. Of the racial and ethnic groups studied, whites not have the highest rates of tobacco use, chronic of or obesity (Table However, to these risk factors could help to reduce overall rates of cancer Among white women, rates of Pap test screening and mammography screening with clinical breast examination are in the same range as those for other racial and ethnic men and white women are more likely to have a health than individuals of other racial or ethnic groups. men and women are about two and a half times more likely than men and women to report having health The US government defines as “persons of or American, or other or of The is also to individuals in this population. The 1990 census counted million Hispanics, about of the US population.8 Because of high birth and immigration rates, the population is growing rapidly. According to US census by the year African Americans as the largest US racial or ethnic group, and by the year of the US population be are in every racial group. In 1990, the US census reported that of the population was African American, Native American, and Asian and Pacific According to SEER data for 1988 to 1992, the most commonly diagnosed cancers among men and women were the same as those for prostate, breast, lung and bronchus, and colon and rectum (Tables 1 and Incidence rates for all four leading sites were lower among than among whites. Other cancers commonly diagnosed among cancers of the and stomach in men and cancers of the cervix and in women. Among women in the racial and ethnic groups studied, had the highest cervical cancer incidence rates per 100,000) of any group other than Vietnamese. According to vital statistics data for 1988 to 1992, the leading causes of cancer deaths for were the same as those for lung and bronchus, prostate, breast, and colon and rectum (Tables and 4).2 As with incidence rates, mortality rates for all four sites were lower among than among whites. In rates among were of the same as those for Chinese, Filipino, and Japanese men and women. The most striking and as of any race who are not of with to their risk factor and health is that men and women are about two and a half times more likely than men and women to report having health (Table that this be the of the of who are as or in in health is not as a For every racial and ethnic group, overall cancer incidence rates and mortality rates for women were lower than those for men. Despite this in health women were about as likely as women to have had a Pap test or and clinical breast The prevalence of chronic alcohol and that of obesity were also similar in and 6 Although of the reported variations in cancer patterns racial and ethnic populations may be with and cultural may be of the to the The of data on cancer risk and screening behaviors have been described in In four of are to the and of data by race and and low may the of information in cancer and also may be by the to race and ethnicity to and In a National for Health Statistics that race information from with information by that of who reported as African American were as white by the and that of Asians and of Native Americans were as white or African 15 rates are with and data that have been to the more This type of could in or of cancer incidence and mortality rates and risk factor and screening of race and ethnicity may in or For SEER, the National Health Interview Survey, and the census all race and ethnicity to be not This to can be to individuals of who to be of In the 1990 of to For racial and ethnic groups, data from a of the population may not represent the population as a For have that cancer incidence and mortality rates vary among American Indian Because is not to the cancer incidence patterns among American Indians from New Mexico differ from those for the American Indian cancer statistics for American Indians from New Mexico to the American Indian population as a may not be BRFSS data are from a of the Native American population. in this are Because rates are particularly low among American Indians and Alaska Natives is likely that the cancer experience of the of the Native American population with may not be of that of in the In data from a more cross-section of the population are to the cancer of the group as a and ethnicity are with and with factors as and According to data from the US of the and vary considerably by race and The percentage of the US population living in included of African Americans, 12% of Asians and Pacific Islanders, of Native Americans, of whites, and of The percentage of the population a high included of African Americans, of Asian and Pacific Islanders, of Native Americans, of whites, and of Because race and ethnicity are so with of the differences in cancer incidence and mortality rates that exist among racial and ethnic groups are the of rather than and cultural of race and Despite these the information that have presented a for cancer and for cancer efforts. the health of all races and ethnicities are can the and screening to reduce the of cancer on all Americans. 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