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Cancer incidence and mortality patterns among specific Asian and Pacific Islander populations in the U.S.
Miller, Barry A.
Chu, Kenneth C.
Hankey, Benjamin F.
Ries, Lynn A. G.
Cancer Causes & Control
We report cancer incidence, mortality, and stage distributions among Asians and Pacific Islanders (API) residing in the U.S. and note health disparities, using the cancer experience of the non-Hispanic white population as the referent group. New databases added to publicly available SEER*Stat software will enable public health researchers to further investigate cancer patterns among API groups.
Cancer diagnoses among API groups occurring from 1 January 1998 to 31 December 2002 were included from 14 Surveillance, Epidemiology, and End Results (SEER) Program state and regional population-based cancer registries covering 54% of the U.S. API population. Cancer deaths were included from the seven states that report death information for detailed API groups and which cover over 68% of the total U.S. API population. Using detailed racial/ethnic population data from the 2000 decennial census, we produced incidence rates centered on the census year for Asian Indians/Pakistanis, Chinese, Filipinos, Guamanians, Native Hawaiians, Japanese, Kampucheans, Koreans, Laotians, Samoans, Tongans, and Vietnamese. State vital records offices do not report API deaths separately for Kampucheans, Laotians, Pakistanis, and Tongans, so mortality rates were analyzed only for the remaining API groups.
Overall cancer incidence rates for the API groups tended be lower than overall rates for non-Hispanic whites, with the exception of Native Hawaiian women (All cancers rate = 488.5 per 100,000 vs. 448.5 for non-Hispanic white women). Among the API groups, overall cancer incidence and death rates were highest for Native Hawaiian and Samoan men and women due to high rates for cancers of the prostate, lung, and colorectum among Native Hawaiian men; cancers of the prostate, lung, liver, and stomach among Samoan men; and cancers of the breast and lung among Native Hawaiian and Samoan women. Incidence and death rates for cancers of the liver, stomach, and nasopharynx were notably high in several of the API groups and exceeded rates generally seen for non-Hispanic white men and women. Incidence rates were lowest among Asian Indian/Pakistani and Guamanian men and women and Kampuchean women. Asian Indian and Guamanian men and women also had the lowest cancer death rates. Selected API groups had less favorable distributions of stage at diagnosis for certain cancers than non-Hispanic whites.
Possible disparities in cancer incidence or mortality between specific API groups in our study and non-Hispanic whites (referent group) were identified for several cancers. Unfavorable patterns of stage at diagnosis for cancers of the colon and rectum, breast, cervix uteri, and prostate suggest a need for cancer control interventions in selected groups. The observed variation in cancer patterns among API groups indicates the importance of monitoring these groups separately, as these patterns may provide etiologic clues that could be investigated by analytic epidemiological studies.
Cancer; Incidence; Mortality; Race; Ethnicity; Asian; Pacific Islander; SEER Program
Related Articles
Uncovering disparities in survival after non-small-cell lung cancer among Asian/Pacific Islander ethnic populations in California
Chang, Ellen T.
Shema, Sarah J.
Wakelee, Heather A.
Clarke, Christina A.
Gomez, Scarlett Lin
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
Asians may have better survival after non-small-cell lung cancer (NSCLC) than non-Asians. However, it is unknown whether survival varies among the heterogeneous U.S. Asian/Pacific Islander (API) populations. Therefore, this study aimed to quantify survival differences among APIs with NSCLC. Differences in overall and disease-specific survival were analyzed in the California Cancer Registry among 16,577 API patients diagnosed with incident NSCLC between 1988 and 2007. Adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using Cox proportional hazards regression models with separate baseline hazards by disease stage. Despite better overall and disease-specific survival among APIs compared with non-Hispanic Whites, differences were evident across API populations. Among women, Japanese (overall survival HR=1.16, 95% CI=1.06–1.27) and APIs other than those in the six largest ethnic groups ("other APIs"; HR=1.19, 95% CI=1.07–1.33) had significantly poorer overall and disease-specific survival than Chinese. By contrast, South Asian women had significantly better survival than Chinese (HR=0.79, 95% CI=0.63–0.97). Among men, Japanese (HR=1.15, 95% CI=1.07–1.24), Vietnamese (HR=1.07, 95% CI=1.00–1.16), and other APIs (HR=1.18, 95% CI=1.08–1.28) had significantly poorer overall and disease-specific survival than Chinese. Other factors independently associated with poorer survival were lower neighborhood SES, involvement with a non-university-teaching hospital, unmarried status, older age, and earlier year of diagnosis. APIs have significant ethnic differences in NSCLC survival that may be related to disparate lifestyles, biology, and especially health care access or use. To reduce the nationwide burden of lung cancer mortality, it is critical to identify and ameliorate hidden survival disparities such as those among APIs.
non-small-cell lung cancer; survival; Asian Americans; Pacific Islanders; ethnic groups
Related Articles
Treatment and Outcomes of Gastric Cancer Among US-Born and Foreign-Born Asians and Pacific Islanders
DaCosta Byfield, Stacey A.
Earle, Craig C.
Ayanian, John Z.
McCarthy, Ellen P.
To investigate whether stage at diagnosis, cancer treatments and survival of Asian and Pacific Islander (API) gastric cancer patients in the US vary by birthplace.
We studied 6454 API and 10,099 non-Hispanic white (NHW) patients diagnosed with gastric cancer from the Surveillance, Epidemiology and End Results Program between 1992 and 2005. In descriptive analyses we compared stage, receipt of adequate lymph node examination (ALNE) and surgery among US-born APIs, foreign-born (FB) APIs and NHWs. Multivariable polytomous logistic and proportional hazards regression models were used to assess differences in cancer stage and survival, respectively, adjusted for clinical and demographic factors.
As a group, APIs were more likely than NHWs to present with earlier-stage diagnoses and receive surgery and ALNE (p<0.001). However, FB [aOR=0.79 (0.73–0.86)] but not US-born APIs [aOR=1.05 (0.92–1.20)] were significantly more likely to present at earlier stages than NHWs. Compared to NHW patients, FB and US-born APIs were more likely to receive surgery [aRR=1.06 (1.03–1.09) and aRR=1.09 (1.03–1.14) respectively] and ALNE [aRR=1.29 (1.19–1.41) and aRR=1.14 (1.00–1.32) respectively]. In fully adjusted models, FB [aHR= 0.86 (0.82–0.90)] but not US-born APIs [(aHR= 0.96 (0.89–1.04)] had more favorable survival than NHWs.
The earlier-stage diagnosis, more complete surgical treatment and improved survival of Asians and Pacific Islanders with gastric cancer may result from less aggressive tumors or more prompt recognition and thorough evaluation of early symptoms. Further study of these factors could improve outcomes for all patients with gastric cancer.
gastric cancer outcomes; Asian/Pacific Islanders; birthplace; ethnicity; SEER
Related Articles
Reproductive health differences among Latin American- and US-born young women
Minnis, Alexandra M.
Padian, Nancy S.
Journal of Urban Health : Bulletin of the New York Academy of Medicine
Investigations of reproductive health within Lationos living in the United States suggest that sexual behaviors and contraception use practices vary by ethnicity and between foreign- and US-born adolescents. This article compares high-risk sexual behaviors and reproductive health among foreign-born Latinas, US-born Latinas, and US-born non-Latinas aged 15–24 years. We recruited 361 females from reproductive health clinics in the San Francisco Bay Area of California between 1995 and 1998; these women completed an interview that assessed sexual risk behaviors and history of pregnancy, abortion, and sexually transmitted infections. Current chlamydial and gonococcal infections were detected through biological testing. Among participants aged 15–18 years, US-born Latinas were more likely to have been pregnant (odds ratio [OR] comparing US-born Latinas and US-born non-Latinas=3.9, 95% confidence interval [CI] 1.3, 11.4), whereas among respondents aged 19–24 years, foreign-born Latinas were more likely to have been pregnant than US-born Latinas (OR=11.3, 95% CI 1.0, 130.8) and US-born non-Latinas (OR=64.2, 95%CI 9.9, 416.3). US-born Latinas were most likely to have had an abortion (OR comparing US-born Latinas and US-born non-Latinas=2.0, 95% CI 0.9, 4.7). They were also most likely to have chlamydial infection at study enrollment (8.2% prevalence compared to 2.2% and 1.0% for foreign-born Latinas and US-born non-Latinas, respectively; P=0.009). Reproductive health differences between foreign and US-born females and within the US-born population warrant further examination and highlight the need for targeted prevention.
Abortion; Adolescence; Hispanic Americans; Immigrants; Pregnancy; Sex behavior; Sexually transmitted diseases
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The California Breast Cancer Survivorship Consortium (CBCSC): Prognostic factors associated with racial/ethnic differences in breast cancer survival
Wu, Anna H.
Gomez, Scarlett Lin
Vigen, Cheryl
Kwan, Marilyn L.
Keegan, Theresa H.M.
Lu, Yani
Shariff-Marco, Salma
Monroe, Kristine R.
Kurian, Allison W.
Cheng, Iona
Caan, Bette J.
Lee, Valerie S.
Roh, Janise M.
Sullivan-Halley, Jane
Henderson, Brian E.
Bernstein, Leslie
John, Esther M.
Sposto, Richard
Cancer causes & control : CCC
Racial/ethnic disparities in mortality among US breast cancer patients are well-documented. Our knowledge of the contribution of lifestyle factors to disease prognosis is based primarily on non-Latina Whites and is limited for Latina, African American and Asian American women. To address this knowledge gap, the California Breast Cancer Survivorship Consortium (CBCSC) harmonized and pooled interview information (e.g., demographics, family history of breast cancer, parity, smoking, alcohol consumption) from six California-based breast cancer studies and assembled corresponding cancer registry data (clinical characteristics, mortality), resulting in 12,210 patients (6,501 non-Latina Whites, 2,060 African Americans, 2,032 Latinas, 1,505 Asian Americans, 112 other race/ethnicity) diagnosed with primary invasive breast cancer between 1993 and 2007. In total, 3,047 deaths (1,570 breast cancer-specific) were observed with a mean (SD) follow-up of 8.3 (3.5) years. Cox-proportional hazards regression models were fit to data to estimate hazards ratios (HR) and 95% confidence intervals (CI) for overall and breast cancer-specific mortality. Compared with non-Latina Whites, the HR of breast cancer-specific mortality was 1.13 (95% CI, 0.97-1.33) for African Americans, 0.84 (95% CI, 0.70-1.00) for Latinas, and 0.60 (95% CI, 0.37-0.97) for Asian Americans after adjustment for age, tumor characteristics, and select lifestyle factors. The CBCSC represents a large and racially/ethnically diverse cohort of breast cancer patients from California. This cohort will enable analyses to jointly consider a variety of clinical, lifestyle, and contextual factors in attempting to explain the long-standing disparities in breast cancer outcomes.
race/ethnicity; survival; tumor characteristics; lifestyle factors
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Trends in Breast Conserving Surgery Among Asian Americans and Pacific Islanders, 1992–2000
Goel, Mita Sanghavi
Burns, Risa B
Phillips, Russell S
Davis, Roger B
Ngo-Metzger, Quyen
McCarthy, Ellen P
Journal of General Internal Medicine
Breast-conserving surgery (BCS) has been the recommended treatment for early-stage breast cancer since 1990 yet many women still do not receive this procedure.
To examine the relationship between birthplace and use of BCS in Asian-American and Pacific-Islander (AAPI) women, and to determine whether disparities between white and AAPI women persist over time.
Retrospective cohort study.
Women with newly diagnosed stage I or II breast cancer from 1992 to 2000 in the Surveillance, Epidemiology, and End Results program.
Receipt of breast -conserving surgery for initial treatment of stage I or II breast cancer.
Overall, AAPI women had lower rates of BCS than white women (47% vs 59%; P<.01). Foreign-born AAPI women had lower rates of BCS than U.S.-born AAPI and white women (43% vs 56% vs 59%; P<.01). After adjustment for age, marital status, tumor registry, year of diagnosis, stage at diagnosis, tumor size, histology, grade, and hormone receptor status, foreign-born AAPI women (adjusted OR [aOR], 0.49; 95% CI, 0.32 to 0.76) and U.S.-born AAPI women (aOR, 0.77; 95% CI, 0.62 to 0.95) had lower odds of receiving BCS than white women. Use of BCS increased over time for each racial/ethnic group; however, foreign-born AAPI women had persistently lower rates of BCS than non-Hispanic white women.
AAPI women, especially those who are foreign born, are less likely to receive BCS than non-Hispanic white women. Of particular concern, differences in BCS use among foreign-born and U.S.-born AAPI women and non-Hispanic white women have persisted over time. These differences may reflect inequities in the treatment of early-stage breast cancer for AAPI women, particularly those born abroad.
breast neoplasms; cancer treatment; health disparities; race/ethnicity; immigrant health
Related Articles
The "Latina Epidemiologic Paradox" Revisited: The Role of Birthplace and Acculturation in Predicting Infant Low Birth Weight for Latinas in Los Angeles, CA
Hoggatt, Katherine J.
Flores, Marie
Solorio, Rosa
Wilhelm, Michelle
Ritz, Beate
Journal of immigrant and minority health / Center for Minority Public Health
The "Latina epidemiologic paradox" refers to the observation that despite socioeconomic disadvantages, Latina mothers in the United States (US) have a similar or lower risk for delivering an infant with low birth weight (LBW) compared to non-Latina White mothers. An analogous paradox may exist between foreign-born (FB) and US-born (USB) Latinas. Our goal was to assess differences in LBW in USB Latinas, FB Latinas, and non-Latina Whites in Los Angeles County in 2003 using birth records and survey data. Using logistic regression, we estimated associations between LBW and birthplace/ethnicity in a birth cohort and nested survey responder group and between LBW and acculturation in responders to a follow-up survey. USB Latinas and FB Latinas had a higher prevalence of LBW infants compared to Whites (odds ratio [OR] = 1.34, 95% confidence interval [CI] = (1.17, 1.53) and OR = 1.32, 95% CI = (1.18, 1.49), respectively); when we adjusted for additional maternal risk factors these point estimates were attenuated, and interval estimates were consistent with a modest positive or inverse association. Among Latinas only, LBW was more common for high-acculturated FB and USB Latinas compared to low-acculturated FB Latinas, and there was limited evidence that environmental or behavior risk factors had less impact in low-acculturated Latinas. In summary, adjusting only for demographics, Latinas in our study were more likely to have LBW infants compared to Whites, in contrast to the Latina paradox hypothesis. Furthermore, adjusting for environmental or behavioral factors attenuated the positive association, but there was little evidence that Latinas had a lower prevalence of LBW regardless of the variables included in the models. Finally, among Latinas, there was limited evidence that associations between known risk factors and LBW were modified by acculturation.
Low birth weight; Latina; Hispanic; US-born; foreign-born; Acculturation; Two-phase analysis
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Cigarette smoking associated with lung adenocarcinoma in situ in a large case-control study (SFBALCS)
Bracci, Paige M.
Sison, Jennette
Hansen, Helen
Walsh, Kyle M.
Quesenberry, Charles P.
Raz, Dan J.
Wrensch, Margaret
Wiencke, John K.
Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer
Adenocarcinoma in situ (AIS, formerly bronchioloalveolar carcinoma [BAC]) is an uncommon subtype of lung adenocarcinoma and accounts for approximately 3–4% of lung cancers. Compared with other lung cancer histologies, AIS cases are less likely to be smokers, yet associations with other lung cancer risk factors and differences by gender have not been determined.
A total of 338 AIS (formerly BAC) cases and frequency matched controls from the parent study (cases=6039, controls=2073) were included in these analyses. Odds ratios and 95% confidence intervals as estimates of the relative risk were obtained from multivariable unconditional logistic regression analyses.
Risk of AIS was associated with ever smoking (OR=2.7, 95% CI: 2.1, 3.6), increased 20–30% for each 10-year increase in pack-years of smoking and decreased with increased years since quitting (P for trend <0.0001). There was no evidence that risk differed by gender but there was some suggestion that risk may differ by asbestos and by second-hand tobacco smoke exposure in whites.
There is an association between AIS and smoking that is smaller in magnitude than other subtypes of non-small cell lung cancer. Our findings suggesting that effects may differ by asbestos and second-hand tobacco smoke exposure should be interpreted conservatively and warrant validation and further evaluation in larger studies of AIS.
Adenocarcinoma in situ; case-control; epidemiology; smoking; second-hand tobacco smoke
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Smoking prevalence and correlates among Chinese- and Filipino-American adults: Findings from the 2001 California Health Interview Survey
Maxwell, Annette E.
Bernaards, Coen A.
McCarthy, William J.
Preventive medicine
We report prevalence rates and correlates of cigarette smoking among a population-based sample of Chinese- and Filipino-American adults together with rates found in other racial/ethnic groups in California.
All analyses are based on the 2001 California Health Interview Survey.
The proportion of current smokers among males was lowest among Chinese Americans (14%), followed by Non-Hispanic Whites (19%), Hispanics (20%), African Americans (22%), Filipino Americans (24%), American Indians/Alaska Natives (29%), and Pacific Islanders (32%). The proportion of current smokers among females was lowest among Chinese Americans (6%), followed by Hispanics (8%), Filipino Americans (11%), Non-Hispanic Whites (17%), African Americans (20%), Pacific Islander (21%), and American Indians/Alaska Natives (32%). Smoking rates were higher among foreign-born versus U.S.-born Asian males. CHIS data show an opposite effect among Asian women: acculturation to the U.S. is associated with increased smoking prevalence rates. Multivariate analyses with Chinese and Filipino respondents showed that the likelihood of smoking varied among foreign-born versus U.S.-born men (OR 2.59 for Chinese, 1.42 for Filipino, 2.01 for all Asian men combined) and for foreign-born versus U.S.-born women (OR 0.41 for Chinese, 0.38 for Filipino, and 0.59 for all Asian women combined).
Public health intervention efforts should take into account Asian ethnic subgroup, gender, and acculturation status in targeting high-risk smoking groups.
Population-based survey; Smoking; Asian American; Correlates
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Dramatic Increases in Obesity and Overweight Prevalence among Asian Subgroups in the United States, 1992–2011
Singh, Gopal K.
Lin, Sue C.
ISRN Preventive Medicine
We examined trends in adult obesity and overweight prevalence among major Asian/Pacific Islander (API) subgroups and the non-Hispanic whites from 1992 to 2011. Using 1992–2011 National Health Interview Surveys, obesity, overweight, and BMI differentials were analyzed by logistic, linear, and log-linear regression. Between 1992 and 2011, obesity prevalence doubled for the Chinese, the Asian Indians, the Japanese, and the Hawaiians/Pacific Islanders; and tripled for the Filipinos. Obesity prevalence among API adults tripled from 3.7% in 1992 to 13.3% in 2010, and overweight prevalence doubled from 23.2% to 43.1%. Immigrants in each API subgroup had lower prevalence than their US-born counterparts, with immigrants' obesity and overweight risks increasing with increasing duration of residence. During 2006–2011, obesity prevalence ranged from 3.3% for Chinese immigrants to 22.3% for the US-born Filipinos and 41.1% for the Native Hawaiians/Pacific Islanders. The Asian Indians, the Filipinos, and the Hawaiians/Pacific Islanders had, respectively, 3.1, 3.8, and 10.9 times higher odds of obesity than those of the Chinese adults. Compared with Chinese immigrants, the adjusted odds of obesity were 3.5–4.6 times higher for the US-born Chinese and the foreign-born Filipinos, 9 times higher for the US-born Filipinos and whites, 3.8–5.5 times higher for the US-born and foreign-born Asian Indians, and 21.9 times higher for the Native Hawaiians. Substantial ethnic heterogeneity and rising prevalence underscore the need for increased monitoring of obesity and obesity-related risk factors among API subgroups.
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Lung Cancer Occurrence in Never-Smokers: An Analysis of 13 Cohorts and 22 Cancer Registry Studies
Thun, Michael J
Hannan, Lindsay M
Adams-Campbell, Lucile L
Boffetta, Paolo
Buring, Julie E
Feskanich, Diane
Flanders, W. Dana
Jee, Sun Ha
Katanoda, Kota
Kolonel, Laurence N
Lee, I-Min
Marugame, Tomomi
Palmer, Julie R
Riboli, Elio
Sobue, Tomotaka
Avila-Tang, Erika
Wilkens, Lynne R
Samet, Jon M
PLoS Medicine
Better information on lung cancer occurrence in lifelong nonsmokers is needed to understand gender and racial disparities and to examine how factors other than active smoking influence risk in different time periods and geographic regions.
Methods and Findings
We pooled information on lung cancer incidence and/or death rates among self-reported never-smokers from 13 large cohort studies, representing over 630,000 and 1.8 million persons for incidence and mortality, respectively. We also abstracted population-based data for women from 22 cancer registries and ten countries in time periods and geographic regions where few women smoked. Our main findings were: (1) Men had higher death rates from lung cancer than women in all age and racial groups studied; (2) male and female incidence rates were similar when standardized across all ages 40+ y, albeit with some variation by age; (3) African Americans and Asians living in Korea and Japan (but not in the US) had higher death rates from lung cancer than individuals of European descent; (4) no temporal trends were seen when comparing incidence and death rates among US women age 40–69 y during the 1930s to contemporary populations where few women smoke, or in temporal comparisons of never-smokers in two large American Cancer Society cohorts from 1959 to 2004; and (5) lung cancer incidence rates were higher and more variable among women in East Asia than in other geographic areas with low female smoking.
These comprehensive analyses support claims that the death rate from lung cancer among never-smokers is higher in men than in women, and in African Americans and Asians residing in Asia than in individuals of European descent, but contradict assertions that risk is increasing or that women have a higher incidence rate than men. Further research is needed on the high and variable lung cancer rates among women in Pacific Rim countries.
Michael Thun and colleagues pooled and analyzed comprehensive data on lung cancer incidence and death rates among never-smokers to examine what factors other than active smoking affect lung cancer risk.
Editors' Summary
Every year, more than 1.4 million people die from lung cancer, a leading cause of cancer deaths worldwide. In the US alone, more than 161,000 people will die from lung cancer this year. Like all cancers, lung cancer occurs when cells begin to divide uncontrollably because of changes in their genes. The main trigger for these changes in lung cancer is exposure to the chemicals in cigarette smoke—either directly through smoking cigarettes or indirectly through exposure to secondhand smoke. Eighty-five to 90% of lung cancer deaths are caused by exposure to cigarette smoke and, on average, current smokers are 15 times more likely to die from lung cancer than lifelong nonsmokers (never smokers). Furthermore, a person's cumulative lifetime risk of developing lung cancer is related to how much they smoke, to how many years they are a smoker, and—if they give up smoking—to the age at which they stop smoking.
Why Was This Study Done?
Because lung cancer is so common, even the small fraction of lung cancer that occurs in lifelong nonsmokers represents a large number of people. For example, about 20,000 of this year's US lung cancer deaths will be in never-smokers. However, very little is known about how age, sex, or race affects the incidence (the annual number of new cases of diseases in a population) or death rates from lung cancer among never-smokers. A better understanding of the patterns of lung cancer incidence and death rates among never-smokers could provide useful information about the factors other than cigarette smoke that increase the likelihood of not only never-smokers, but also former smokers and current smokers developing lung cancer. In this study, therefore, the researchers pooled and analyzed a large amount of information about lung cancer incidence and death rates among never smokers to examine what factors other than active smoking affect lung cancer risk.
What Did the Researchers Do and Find?
The researchers analyzed information on lung cancer incidence and/or death rates among nearly 2.5 million self-reported never smokers (men and women) from 13 large studies investigating the health of people in North America, Europe, and Asia. They also analyzed similar information for women taken from cancer registries in ten countries at times when very few women were smokers (for example, the US in the late 1930s). The researchers' detailed statistical analyses reveal, for example, that lung cancer death rates in African Americans and in Asians living in Korea and Japan (but not among Asians living in the US) are higher than those in people of the European continental ancestry group. They also show that men have higher death rates from lung cancer than women irrespective of racial group, but that women aged 40–59 years have a slightly higher incidence of lung cancer than men of a similar age. This difference disappears at older ages. Finally, an analysis of lung cancer incidence and death rates at different times during the past 70 years shows no evidence of an increase in the lung cancer burden among never smokers over time.
What Do These Findings Mean?
Although some of the findings described above have been hinted at in previous, smaller studies, these and other findings provide a much more accurate picture of lung cancer incidence and death rates among never smokers. Most importantly the underlying data used in these analyses are now freely available and should provide an excellent resource for future studies of lung cancer in never smokers.
Additional Information.
Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.0050185.
The US National Cancer Institute provides detailed information for patients and health professionals about all aspects of lung cancer and information on smoking and cancer (in English and Spanish)
Links to other US-based resources dealing with lung cancer are provided by MedlinePlus (in English and Spanish)
Cancer Research UK provides key facts about the link between lung cancer and smoking and information about all other aspects of lung cancer
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Cancer Mortality among Asians and Pacific Islanders in New York City, 2001–2010
Huang, Vivian
Li, Wenhui
Tsai, Josephine
Begier, Elizabeth
Journal of Cancer Epidemiology
Asians and Pacific Islanders' (APIs) leading cause of death is cancer. We compared APIs' age-adjusted cancer mortality rates to other racial/ethnic groups and by API subgroup (i.e., Chinese, Koreans, Asian Indians, and Filipinos) using New York City (NYC) Mortality data and Census Bureau population estimates for 2001–2010. While other racial/ethnic groups' overall cancer mortality rates declined in NYC during the last decade, APIs remained stable. APIs overall had the lowest mortality rates for more common cancer types (i.e., lung, colorectal, breast, and prostate), but the highest mortality rates for certain less common cancers (i.e., nasopharyngeal, stomach, and liver). Chinese New Yorkers' lung cancer death rates were very high compared to other APIs and comparable to non-Hispanic whites (47.1/100,000 versus 49.5/100,000, resp.). Chinese men had much higher nasopharyngeal cancer mortality rates (4.5/100,000 versus 0.3/100,000 for non-Hispanic whites). Korean men had the highest liver and stomach cancer mortality rates (25.3/100,000 and 27.7/100,000, resp., versus 7.9/100,000 and 6.0/100,000 for non-Hispanic whites). Analysis of cancer rates by API subgroup provides the detailed information needed to plan cancer prevention efforts. These findings warrant consideration of targeted cancer mortality prevention efforts for affected subgroups, including hepatitis vaccination, screening, and treatment; smoking cessation; and cancer screening.
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Return to Work in Low-Income Latina and Non-Latina White Breast Cancer Survivors: A Three-Year Longitudinal Study
Blinder, Victoria S.
Patil, Sujata
Thind, Amardeep
Diamant, Allison
Hudis, Clifford A.
Basch, Ethan
Maly, Rose C.
Prior research has found an 80% return-to-work rate in mid-income White breast cancer survivors, but little is known about the employment trajectory of low-income minorities or Whites. We set out to compare the trajectories of low-income Latina and non-Latina White survivors and to identify correlates of employment status.
Participants were low-income women who had localized breast cancer, spoke English or Spanish, and were employed at the time of diagnosis. Interviews were conducted 6, 18, and 36 months after diagnosis. Multivariate logistic regression was used to identify independent correlates of employment status at 18 months.
Of 290 participants, 62% were Latina. Latinas were less likely than non-Latina Whites to be working 6 months (27% vs. 49%, p=0.0002) and 18 months (45% vs. 59%, p=0.02) after diagnosis, but at 36 months there was no significant difference (53% vs. 59%, p=0.29). Latinas were more likely to be manual laborers than were non-Latina Whites (p<0.0001). Baseline job type and receipt of axillary node dissection were associated with employment status among Latinas but not non-Latina Whites.
Neither low-income Latinas nor non-Latina Whites approached the 80% rate of return to work seen in wealthier White populations. Latinas followed a protracted return-to-work trajectory compared to non-Latina Whites, and differences in job type appear to have played an important role. Manual laborers may be disproportionately impacted by surgical procedures that limit physical activity. This can inform the development of rehabilitative interventions and may have important implications for the surgical and postsurgical management of patients.
disparities; employment; breast cancer; survivorship
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Time to definitive diagnosis of breast cancer in Latina and non-Hispanic white women: the six cities study
Ramirez, Amelie G
Pérez-Stable, Eliseo J
Talavera, Gregory A
Penedo, Frank J
Carrillo, J Emilio
Fernandez, Maria E
Muñoz, Edgar
Long Parma, Dorothy
Holden, Alan EC
San Miguel de Majors, Sandra
Nápoles, Anna
Castañeda, Sheila F
Gallion, Kipling J
Time delay after an abnormal screening mammogram may have a critical impact on tumor size, stage at diagnosis, treatment, prognosis, and survival of subsequent breast cancer. This study was undertaken to evaluate disparities between Latina and non-Hispanic white (NHW) women in time to definitive diagnosis of breast cancer after an abnormal screening mammogram, as well as factors contributing to such disparities.
As part of the activities of the National Cancer Institute (NCI)-funded Redes En Acción research network, clinical records of 186 Latinas and 74 NHWs who received abnormal screening mammogram results were reviewed to determine the time to obtain a definitive diagnosis. Data was obtained from participating clinics in six U.S. cities and included demographics, clinical history, and mammogram characteristics. Kaplan-Meier estimates and Cox proportional hazards models were used to test differences in median time to definitive diagnosis by ethnicity after adjusting for clinic site, demographics, and clinical characteristics.
Time-to-event analysis showed that Latinas took 2.2 times longer to reach 50% definitively diagnosed with breast cancer relative to NHWs, and three times longer to reach 80% diagnosed (p=0.001). Latinas' median time to definitive diagnosis was 60 days compared to 27 for NHWs, a 59% gap in diagnosis rates (adjusted Hazard Ratio [aHR] = 1.59, 95% CI = 1.09, 2.31; p=0.015). BI-RADS-4/5 women's diagnosis rate was more than twice that of BI-RADS-3 (aHR = 2.11, 95% CI = 1.18, 3.78; p=0.011).
Disparities in time between receipt of abnormal screening result and definitive diagnosis adversely affect Latinas compared to NHWs, and remain significant after adjusting for demographic and clinical variables. With cancer now the leading cause of mortality among Latinos, a greater need exists for ethnically and culturally appropriate interventions like patient navigation to facilitate Latinas' successful entry into, and progression through, the cancer care system.
Health disparities; Breast cancer screening; Definitive diagnosis; Latinas; Six cities study
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How Do Social Factors Explain Outcomes in Non–Small-Cell Lung Cancer Among Hispanics in California? Explaining the Hispanic Paradox
Patel, Manali I.
Schupp, Clayton W.
Gomez, Scarlett L.
Chang, Ellen T.
Wakelee, Heather A.
Journal of Clinical Oncology
Hispanics in the United States have lower age-adjusted mortality resulting from non–small-cell lung cancer (NSCLC) compared with non-Hispanic whites (NHWs). The purpose of this study was to evaluate individual, clinical, and neighborhood factors in survival among Hispanics with NSCLC.
Patients and Methods
We performed a retrospective analysis of NHWs and Hispanics with NSCLC between 1998 and 2007 in the California Cancer Registry (follow-up to December 2009). Kaplan-Meier curves depict survival by nativity for Hispanics with NSCLC. Cox proportional hazards models estimated hazard of mortality by race with adjustment for individual (age, sex, marital status), clinical (histologic grade, surgery, irradiation, chemotherapy), and neighborhood factors (neighborhood socioeconomic status, ethnic enclave).
We included 14,280 Hispanic patients with NSCLC. Foreign-born Hispanics had 15% decreased risk of disease-specific mortality resulting from NSCLC compared with NHWs (hazard ratio [HR], 0.85; 95% CI, 0.83 to 0.88) after adjustment for individual, clinical, and neighborhood factors. After adjustment for individual factors, compared with US-born Hispanics, foreign-born Hispanics had 10% decreased risk of disease-specific mortality (HR, 0.90; 95% CI, 0.87 to 0.96). Clinical and neighborhood factors slightly moderated the survival benefit for foreign-born patients. A modestly more pronounced survival advantage was seen for foreign-born Hispanics living in low socioeconomic and high Hispanic enclave neighborhoods as compared with US-born Hispanics (HR, 0.86; 95% CI, 0.81 to 0.90).
Foreign-born Hispanics with NSCLC have a decreased risk of disease-specific mortality compared with NHWs and US-born Hispanics with NSCLC. Neighborhood factors slightly moderate this survival advantage. This survival advantage is slightly more pronounced in lower socioeconomic and higher Hispanic enclave neighborhoods.
Related Articles
Cancer incidence in the south Asian population of California, 1988–2000
Jain, Ratnali V
Mills, Paul K
Parikh-Patel, Arti
Journal of Carcinogenesis
Although South Asians (SA) form a large majority of the Asian population of U.S., very little is known about cancer in this immigrant population. SAs comprise people having origins mainly in India, Pakistan, Bangladesh and Sri Lanka. We calculated age-adjusted incidence and time trends of cancer in the SA population of California (state with the largest concentration of SAs) between 1988–2000 and compared these rates to rates in native Asian Indians as well as to those experienced by the Asian/Pacific Islander (API) and White, non-Hispanic population (NHW) population of California.
Age adjusted incidence rates observed among the SA population of California during the time period 1988–2000 were calculated. To correctly identify the ethnicity of cancer cases, 'Nam Pehchan' (British developed software) was used to identify numerator cases of SA origin from the population-based cancer registry in California (CCR). Denominators were obtained from the U.S. Census Bureau. Incidence rates in SAs were calculated and a time trend analysis was also performed. Comparison data on the API and the NHW population of California were also obtained from CCR and rates from Globocan 2002 were used to determine rates in India.
Between 1988–2000, 5192 cancers were diagnosed in SAs of California.
Compared to rates in native Asian Indians, rates of cancer in SAs in California were higher for all sites except oropharyngeal, oesophageal and cervical cancers. Compared to APIs of California, SA population experienced more cancers of oesophagus, gall bladder, prostate, breast, ovary and uterus, as well as lymphomas, leukemias and multiple myelomas. Compared to NHW population of California, SAs experienced more cancers of the stomach, liver and bile duct, gall bladder, cervix and multiple myelomas. Significantly increasing time trends were observed in colon and breast cancer incidence.
SA population of California experiences unique patterns of cancer incidence most likely associated with acculturation, screening and tobacco habits. There is need for early diagnosis of leading cancers in SA. If necessary steps are not taken to curb the growth of breast, colon and lung cancer, rates in SA will soon approximate those of the NHW population of California.
Related Articles
Decreasing Disparity in Liver Transplantation among White and Asian Patients with Hepatocellular Carcinoma, California, 1998–2005
Robbins, Anthony S.
Daily, Michael F.
Aoki, Christopher A.
Chen, Moon S.
Troppmann, Christoph
Perez, Richard V.
A preliminary study using national cancer surveillance data from 1998–2002 suggested there were significant differences between non-Hispanic whites ("whites") and Asian/Pacific Islanders (APIs) in the use of liver transplantation as a treatment for hepatocellular carcinoma (HCC).
We conducted a study to examine whether differences in liver transplantation between white and API HCC patients were changing over time. Using a population-based statewide cancer registry, we obtained data on all HCC cases diagnosed in California between 1998 and 2005, but limited the study to white and API patients with non-metastatic HCC, sized ≤ 5.0 cm (n = 1728).
During 1998–2003 (n = 1051), the odds of receiving a liver transplant were 2.56 times higher for white patients than for API patients (95% confidence interval [CI], 1.72 to 3.80 times higher), even after adjusting for age, sex, marital status, year of diagnosis, TNM stage, and tumor grade. In contrast, during 2004–2005 (n = 677), there were no significant differences in the odds of receiving a transplant. Between 2002 and 2004, changes in liver transplantation policy assigned priority points to HCC patients (initially to stage I and II, then to stage II only). After the policy changes, API HCC patients experienced a significant increase in stage II diagnoses, while white patients did not.
In California, there was a large and significant disparity in liver transplantation among white and API patients with HCC during 1998–2003, but not during 2004–2005. Changes in liver transplantation policy during 2002–2004 may have played a role in decreasing this difference.
hepatocellular carcinoma; liver transplantation; whites; Asians
Related Articles
Genetic ancestry and risk of mortality among U.S. Latinas with breast cancer
Fejerman, Laura
Hu, Donglei
Huntsman, Scott
John, Esther M.
Stern, Mariana C.
Haiman, Christopher A.
Pérez-Stable, Eliseo J.
Ziv, Elad
Cancer research
Multiple studies have reported that Latina women in the U.S. are diagnosed with breast cancer at more advanced stages and have poorer survival than non-Latina White women. However, Latinas are a heterogeneous group with individuals having different proportions of European, Indigenous American and African genetic ancestry. In this study we evaluated the association between genetic ancestry and survival after breast cancer diagnosis among 899 Latina women from the San Francisco Bay Area. Genetic ancestry was estimated from single nucleotide polymorphisms from an Affymetrix 6.0 array and we used Cox proportional hazards models to evaluate the association between genetic ancestry and breast cancer-specific mortality (tests were two-sided). Women were followed for an average of 9 years during which 75 died from breast cancer. Our results showed that Individuals with higher Indigenous American ancestry had increased risk of breast cancer-specific mortality [hazard ratio (HR): 1.57 per 25% increase in Indigenous American ancestry; 95% confidence interval (CI): 1.08–2.29]. Adjustment for demographic factors, tumor characteristics, and some treatment information did not explain the observed association [HR: 1.75, 95%CI: 1.12–2.74]. In an analysis in which ancestry was dichotomized, the hazard of mortality showed a two-fold increase when comparing women with <50% Indigenous American ancestry to women with ≥50% [HR: 1.89, 95%CI: 1.10–3.24]. This was also reflected by Kaplan-Meier survival estimates (P for Log-Rank test of 0.003). Overall, results suggest that genetic factors and/or unmeasured differences in treatment or access to care should be further explored to understand and reduce ethnic disparities in breast cancer outcomes.
Breast cancer mortality; U.S. Latinas; Genetic ancestry
Related Articles
Obesity and Mortality After Breast Cancer by Race/Ethnicity: The California Breast Cancer Survivorship Consortium
Kwan, Marilyn L.
John, Esther M.
Caan, Bette J.
Lee, Valerie S.
Bernstein, Leslie
Cheng, Iona
Gomez, Scarlett Lin
Henderson, Brian E.
Keegan, Theresa H.M.
Kurian, Allison W.
Lu, Yani
Monroe, Kristine R.
Roh, Janise M.
Shariff-Marco, Salma
Sposto, Richard
Vigen, Cheryl
Wu, Anna H.
American Journal of Epidemiology
We investigated body size and survival by race/ethnicity in 11,351 breast cancer patients diagnosed from 1993 to 2007 with follow-up through 2009 by using data from questionnaires and the California Cancer Registry. We calculated hazard ratios and 95% confidence intervals from multivariable Cox proportional hazard model–estimated associations of body size (body mass index (BMI) (weight (kg)/height (m)2) and waist-hip ratio (WHR)) with breast cancer–specific and all-cause mortality. Among 2,744 ascertained deaths, 1,445 were related to breast cancer. Being underweight (BMI <18.5) was associated with increased risk of breast cancer mortality compared with being normal weight in non-Latina whites (hazard ratio (HR) = 1.91, 95% confidence interval (CI): 1.14, 3.20), whereas morbid obesity (BMI ≥40) was suggestive of increased risk (HR = 1.43, 95% CI: 0.84, 2.43). In Latinas, only the morbidly obese were at high risk of death (HR = 2.26, 95% CI: 1.23, 4.15). No BMI–mortality associations were apparent in African Americans and Asian Americans. High WHR (quartile 4 vs. quartile 1) was associated with breast cancer mortality in Asian Americans (HR = 2.21, 95% CI: 1.21, 4.03; P for trend = 0.01), whereas no associations were found in African Americans, Latinas, or non-Latina whites. For all-cause mortality, even stronger BMI and WHR associations were observed. The impact of obesity and body fat distribution on breast cancer patients' risk of death may vary across racial/ethnic groups.
adiposity; body mass index; breast cancer; mortality; obesity; race/ethnicity; survival; waist-hip ratio
Related Articles
Knowledge, Awareness and Medical Practice of Asian Americans/Pacific Islanders on Chronic Hepatitis B Infection
Do, ThuyQuynh N.
Nam, Sanggon
Pogon sahoe yon'gu
The purpose of this review is to conduct a concise review of the literature to evaluate the knowledge, awareness, and medical practice of Asian Americans/Pacific Islanders (API) supporting the relationship of chronic hepatitis B infection. Liver cancer is the fifth most common cause of cancer death in men and the ninth most common cause of death in women in the United States. On average, Asian Americans are three times more likely to die from liver cancer than other racial/ethnic groups, with Chinese Americans at six times, Koreans eight times and Vietnamese 13 times higher than non-Hispanic Whites. In the United States, about 80% of liver cancer is etiologically associated with hepatitis B virus (HBV) infection. Asian Americans and Pacific Islanders (API) account for over half of the 1.3 million chronic hepatitis B cases and for over half of the deaths resulting from chronic hepatitis B infection. Relevant studies were identified in PubMed (Medline) using the following search structure: (Hepatitis B or synonyms) AND (liver cancer or synonyms) AND (Asian Americans or synonyms). Further studies were identified by citations in retrieved papers and by consultation with experts. Twenty publications were included in this review. Compared to other racial/ethnic groups, Asians, especially those born in China or Southeast Asia, have significantly poorer knowledge regarding hepatitis B and liver cancer. Knowledge, awareness and medical practice among Asian Americans regarding HBV infection were dependent upon age, gender, race/ethnicity, immigrant status and length of residency. Despite increased risk for chronic hepatitis B and liver cancer, many Asian Americans are uninformed, untested, and unprotected against the disease.
Knowledge; Awareness and Medical Practice; Hepatitis B; Liver Cancer; Asian Americans; Pacific Islanders
Related Articles
Racial/Ethnic Differences in Adequacy of Information and Support for Women with Breast Cancer
Janz, Nancy K.
Mujahid, Mahasin S.
Hawley, Sarah T.
Griggs, Jennifer J.
Hamilton, Ann S.
Katz, Steven J.
Providing breast cancer patients with needed information and support is an essential component of quality care. This study investigated racial/ethnic variation in information received and in availability of peer support.
1766 women diagnosed with non-metastatic breast cancer and reported to the Los Angeles County, SEER registry from June 2005–May 2006 were mailed a survey after initial treatment. Among accrued cases, 96.2% met eligibility criteria (n=1698), and 72.0% completed the survey. Race/ethnicity categories were white, African American, and Latinas (two categories indicating low or high acculturation, determined by the Short Acculturation Scale for Hispanics). Outcomes included receipt and need for treatment- and survivorship-related information, difficulty understanding information, and support from women with breast cancer.
More women reported receiving treatment-related than survivorship-related information. After adjusting for sociodemographic, clinical, and treatment factors, a higher percentage of low acculturated Latina women desired more information on treatment-related and survivorship-related issues (p<.001). Significantly more Latina low acculturated women than white women reported difficulty understanding written materials, with 74.5% requiring help from others. A higher percentage of all minority groups compared to whites, reported no contact with other women with breast cancer (p< 0.05) and, reported less contact through family/friends (p< 0.05). Women rated the benefit of talking to other women high, particularly with emotional issues.
Continued efforts to provide culturally appropriate information and support needs to women with breast cancer are necessary to achieve quality care. Latinas with low acculturation reported more unmet information and care support needs than other racial/ethnic groups.
Related Articles
Breast Cancer Treatment Decision Making among Latinas and non-Latina Whites: A Communication Model Predicting Decisional Outcomes and Quality of Life
Yanez, Betina
Stanton, Annette L.
Maly, Rose C.
Health psychology : official journal of the Division of Health Psychology, American Psychological Association
Deciding among medical treatment options is a pivotal event following cancer diagnosis, a task that can be particularly daunting for individuals uncomfortable with communication in a medical context. Few studies have explored the surgical decision-making process and associated outcomes among Latinas. We propose a model to elucidate pathways though which acculturation (indicated by language use) and reports of communication effectiveness specific to medical decision making contribute to decisional outcomes (i.e., congruency between preferred and actual involvement in decision making, treatment satisfaction) and quality of life among Latinas and non-Latina White women with breast cancer.
Latinas (N = 326) and non-Latina Whites (N = 168) completed measures six months after breast cancer diagnosis, and quality of life was assessed 18 months after diagnosis. Structural equation modeling was used to examine relationships between language use, communication effectiveness, and outcomes.
Among Latinas, 63% reported congruency in decision making, whereas 76% of non-Latina Whites reported congruency. In Latinas, greater use of English was related to better reported communication effectiveness. Effectiveness in communication was not related to congruency in decision making, but several indicators of effectiveness in communication were related to greater treatment satisfaction, as was greater congruency in decision making. Greater treatment satisfaction predicted more favorable quality of life. The final model fit the data well only for Latinas. Differences in quality of life and effectiveness in communication were observed between racial/ethnic groups.
Findings underscore the importance of developing targeted interventions for physicians and Latinas with breast cancer to enhance communication in decision making.
breast cancer; medical communication; decision making; Latina; quality of life
Related Articles
Household Structure, Family Ties, and Psychological Distress among US-born and Immigrant Latino Women
Molina, Kristine M.
Alcántara, Carmela
Journal of family psychology : JFP : journal of the Division of Family Psychology of the American Psychological Association (Division 43)
Latino women endorse the highest rates of past-month depressive symptoms relative to Latino men and to non-Latino White men and women. Yet, research into the specific domains of family life that reduce or engender psychological distress among Latinas is sparse. We examine the hypothesis that indicators of household structure and family ties will relate to psychological distress among Latinas in the USA, and that these associations will vary by nativity status. We employed nationally representative data of Latina adults (N = 1,427) from the National Latino and Asian American Study. Nativity-stratified regression analyses revealed that strained family ties (i.e., family burden, family cultural conflict) were associated with greater levels of past-month psychological distress for both US-born and immigrant Latinas. Yet, the effect of household structures on psychological distress differed by nativity status. Adjusting for sociodemographic factors, lower levels of household income were associated with greater psychological distress; and having children/adolescents in the household was associated with lower levels of psychological distress among US-born Latinas. In contrast, for immigrant Latinas, being out of the labor force was associated with greater levels of psychological distress. Results suggest that dynamics of both the household and family context predict differential as well as similar mental health outcomes across segments of the Latina population in the USA. These findings underscore the need to understand the pathways by which different facets of family life—structural and social domains—relate to mental health status among subgroups of Latinas. Our results also have implications for the development of tailored interventions to meet the specific needs of Latinas.
psychological distress; Hispanic; nativity; socioeconomic status; cultural values
Related Articles
The effect of system-level access factors on receipt of reconstruction among Latina and white women with DCIS
Kaplan, Celia Patricia
Karliner, Leah S.
Hwang, E. Shelley
Bloom, Joan
Stewart, Susan
Nickleach, Dana
Quinn, Jessica
Thrasher, Angela
Nápoles, Anna Maria
Breast cancer research and treatment
Treatment decisions associated with ductal carcinoma in situ (DCIS), including the decision to undergo breast reconstruction, may be more problematic for Latinas due to access and language issues. To help understand the factors that influence patients' receipt of reconstruction following mastectomy for DCIS, we conducted a population- based study of English- and Spanish-speaking Latina and non-Latina white women from 35 California counties. The objectives of this study were to identify the role of ethnicity and language in the receipt of reconstruction, the relationship between system-level factors and the receipt of reconstruction, and women's reasons for not undergoing reconstruction. Women aged 18 and older, who self-identified as Latina or non-Latino white and were diagnosed with DCIS between 2002 and 2005 were selected from eight California Cancer Registry (CCR) regions encompassing 35 counties. Approximately 24 months after diagnosis, they were surveyed about their DCIS treatment decisions. Survey data were merged with CCR records to obtain tumor and treatment data. The survey was successfully completed by 745 women, 239 of whom had a mastectomy and represent the sample included in this study. Whites had a higher completion rate than Latinas (67 and 55%, respectively). Analysis included descriptive statistics and logistic regression modeling. Mean age was 54 years. A greater proportion of whites had reconstruction (72%) compared to English-speaking Latinas (69%) and Spanish-speaking Latinas (40%).Multivariate analysis showed thatwomenwho were aged 65 and older, unemployed, and had a lower ratio of plastic surgeons in their county were less likely to have reconstructive surgery after mastectomy. The most frequent reasonsmentioned not to receive reconstruction included lack of importance and desire to avoid additional surgery. Although ethnic/language differences in treatment selection were observed, multivariable analysis suggests that these differences could be explained by differential employment levels and geographic availability of plastic surgeons.
Ductal carcinoma in situ; Latinas; Reconstruction; Treatment decisions
Related Articles
The Effect of Two Church-based Interventions on Breast Cancer Screening Rates Among Medicaid-Insured Latinas
Sauaia, Angela
Welsh, Adrienne L
Byers, Tim
Min, Sung-joon
Jacobellis, Jillian
Preventing Chronic Disease
Latinas face disparities in cancer screening rates compared with non-Latina whites. The Tepeyac Project aims to reduce these disparities by using a church-based approach to increase breast cancer screening among Latinas in Colorado. The objective of this study was to compare the effect of two Tepeyac Project interventions on the mammogram rates of Latinas and non-Latina whites enrolled in the Medicaid fee-for-service program.
Two intervention groups were compared: 209 churches in Colorado that received educational printed materials in Spanish and English (the printed statewide intervention) and four churches in the Denver area that received personalized education from promotoras, or peer counselors (the promotora intervention), in addition to the printed statewide intervention. Biennial Medicaid mammogram claim rates in Colorado before the interventions (1998–1999) and after (2000–2001) were used to compare the effect of the interventions on mammogram use among Latinas and non-Latina whites aged 50 to 64 years who were enrolled in the Medicaid fee-for-service program. Adjusted rates were computed using generalized estimating equations.
Small, nonsignificant increases in screening were observed among Latinas exposed to the promotora intervention (from 25% at baseline to 30% at follow-up [P = .30]) as compared with 45% at baseline and 43% at follow-up for the printed statewide intervention (P = .27). Screening among non-Latina whites increased by 6% in the promotora intervention area (from 32% at baseline to 38% at follow-up [P = .40]) and by 3% in the printed statewide intervention (from 41% at baseline to 44% at follow-up [P = .02]). No significant disparities in breast cancer screening were detected between Latinas and non-Latina whites. After adjustment for the confounders by generalized estimating equations, the promotora intervention had a marginally greater impact than the printed statewide intervention in increasing mammogram use among Latinas (generalized estimating equation, P = .07).
A personalized community-based education was only modestly effective in increasing breast cancer screening among Medicaid-insured Latinas. Education alone may not be the answer for this population. The barriers for these Medicaid enrollees must be investigated so that interventions can be tailored to address their needs.
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Memphis eyes another deep NCAA run
Seniors Robert Dozier and Antonio Anderson have won 12 NCAA tournament games, second only to UCLA's duo of seniors Darren Collison's and Alfred Aboya's 14 (senior Josh Shipp was injured for one of the three straight Final Four runs). The dozen postseason wins ties the run Florida's junior class had over a two-year period from 2006-07 in winning consecutive titles.
"We're used to it now and it's what we expect around here,'' Dozier said on the eve of Memphis' second-round game against No. 10 seed Maryland on Saturday at the Sprint Center (3:20 p.m. ET). "Anything else is a disappointment. We expect the Final Four and a national championship. Those are our goals.''
Memphis lost to Kansas in overtime in the national title game a year ago in San Antonio. The Tigers lost in the Elite Eight the previous two seasons. The Tigers are a No. 2 seed this season, were a No. 1 a year ago, a No. 2 in 2007 and a No. 1 in 2006. The seeding and the NCAA tournament finish are related.
In 2004, the Tigers were a No. 7 and lost in the second round. In 2003, the Tigers were a No. 7 and lost in the first round.
"It's hard to advance when you're in a non-BCS league to get in position to get a higher seed,'' Memphis coach John Calipari said.
Calipari went on to say that non power-conference teams have to play one of the top schedules in the country, win almost every game and then win the conference tournament. Memphis did most of that the past few seasons. The Tigers lost three non-conference games this past season, but didn't lose a Conference USA game.
"Whether it's fair or not, that's the way it is,'' Calipari said. "For us to get a high seed four years in a row shows how the committee has been fair to us. We've proven them right by how far we've advanced.''
But advancing to even the second round was a bit harder than Memphis imagined against No. 15 Cal State-Northridge. The Matadors jumped on the Tigers and had them on their heels early and often.
"I wasn't ready for us to play that way,'' Calipari said. "So I got on guys and then with six minutes to go I told them to just make plays.''
Conference affiliation means nothing in the NCAA tournament. Advancing to the second weekend normally means a team has played quality competition.
"They've been playing against really good teams to do that,'' Maryland coach Gary Williams said of the Tigers' recent run to three straight Elite Eights, including one national title game. "At this time of the year, conference affiliation doesn't matter.''
The Tigers expect to be playing the second weekend. Getting to the Sweet 16 can take a solid season and turn it into a great one.
"That's where you want to be, the second weekend and nobody sneaks in there,'' Williams said.
Michigan is playing in its first NCAA tournament since 1998. Beating Clemson in the first round gave the Wolverines immense confidence. Beating No. 2 Oklahoma in Saturday's second game (5:50 p.m. ET) would elevate the program, and coach John Beilein's rebuilding process to another level.
"Hopefully we can become like the [Bill] Frieder, [Steve] Fisher and Johnny Orr teams that are always there in March,'' Beilein said.
To do that then they'll have to get past Oklahoma's Blake Griffin, the favorite for national player of the year. Griffin was fine Friday after Thursday's flip by Morgan State's Ameer Ali. The take down got Ali ejected. Morgan State coach Todd Bozeman apologized to Oklahoma coach Jeff Capel on the Sooners' team bus late Friday night and Ali issued a statement Friday through Bozeman saying there was no malicious intent and that he hoped Griffin and the Sooners had a great run in the tournament.
Griffin wasn't that sore Friday. He did say his mother, though, was quite ticked. So much that after she saw the takedown she was ready to head onto the court.
"She said she almost tackled a security guard to get down there,'' Griffin said. "That's the first time [I've been flipped] since my brother Taylor did that to me when we were kids.''
Griffin said his tail bone was a bit sore, but "it shouldn't slow me down.''

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Comment Redundancy (Score 1) 92
Only big business and congress
But sir, you repeat yourself.
Only big business and congress
But sir, you repeat yourself.
The illegal / immoral / ethically questionable activity will continue until someone catches it.
Headline on the story just below this one:
"Microsoft Can't Shield User Data From Government, Says Government"
That certainly does make for a ringing endorsement that you should buy an Xbox one and attach an always on microphone...
Going to a technical conference for a language that is popular or that you know well does not offer that much value, because almost anything you learn there could have been learned online quicker.
Going to a conference filled with niche languages or higher level ideas is great because it's much more mind-expanding, and even if ideas seem esoteric there's always some interesting twist you can take back into languages you know better or are more practical to work with. It also helps keep you from getting too pigeon-holed by ignoring changes in the world around you, as I see many object-oriented die-hards doing...
I think you'd need to make the wall go even further down, the tunnels the Clintons built to smuggle in under-age Mexican girls for Bill, and to smuggle out incriminating evidence against Hillary out of the country is probably at least 200 feet down.
Trump doesn't follow the platform, so why should it matter what it says?
I think you are confused and ignorant of what is really going on now.
I'll bet in fact YOU have not read the platform and just believe someone else's lies as to what is really in it.
I forget where I read it but I think I remember reading an article some years ago where someone stood up a free Wifi network named something along the lines of "get hacked" and it still had many, many users...
If it's free WiFi people will use it regardless of potential danger, the name is literally nothing.
Neither do the Republicans - one of the signature speakers at the RNC was gay after all.
Isn't it better than the Democrats approach which is to treat the gay community like garbage because they assume the gay community will always vote democratic? Nothing like being taken for granted.
At this point the Democrats are by far the worst party to support if you are gay, because after all if you aren't having sex 24/7 you are just like everyone else being screwed over by terrible immigration policy, or the after-effects of super bad treaties like the TPP (which both Clinton and her VP pick support).
Surely they plan to do the same thing at the Democratic convention - does anyone doubt the results would be similar? People in general, no matter political affiliation, are prone to connect to insecure WiFi. How is that even news?
Many GOP candidates have been against TPP. A large number of Republicans re pro gay marriage.
Basically Republicans have been on the right side of many arguments for some times, but that fact has been obscured by the media so you don't understand the true party of fascism really is. This election season, in large part because Trump is not afraid of the media disliking him, the mask is slipping, the Democrats think that power is so assured they no longer fear showing you just what they really support...
After all, Hillary supports all of the same things her VP pick does.
Liberal: "I want someone who'll fight for others, while leaving me specifically alone and excluded from whatever the fight entails as far as limitations on rights or additional law."
The FBI said she was guilty, just that they wouldn't prosecute. You sure are bad at understanding things. But I guess that's to be expected of a mouth-breather that supports putting known "connected" felons directly in charge of public funds.
It's why I almost want to vote for Trump even though he's a pompous vapid xenophobe who may get us all nuked.
As opposed to the corporate connected felon who will CERTAINLY get us nuked, and nuke a few countries of her own just to show she can?
After all, between Trump and Hillary, only Hillary has actually started any wars.
There is a third choice you know.
Unlike you, I'm not trolling, just informing people of seemingly forgotten history and options.
On the other hand here you are posting under a real username while looking like a moronic asshat who can't even read summaries correctly. Ironic!
Good points, but $299 or $399 or $499 for those as features?
For less than $1 a day (considering using the watch for two years, for many it will be even longer), absolutely - not to mention less substantial but still useful benefit from other watch applications.
or, better yet, untether myself from my phone
That's a large benefit of having a smartwatch is I no longer car if my phone is on my person at home. I know you kind of meant the opposite but in essence the lack of physical presence is just as nice either way.
"What if" is a trademark of Hewlett Packard, so stop using it in your sentences without permission, or risk being sued.


text:
Method Dryer Activated Fabric Softener in Fresh Air
- In stock: 6
- In stock: 6
Method's plant-based, dryer-activated fabric softener spray is like a fabric softener and dryer sheet in one. The ultra-concentrated, hypoallergenic formula with smartsoft technology® softens fabric, reduces static + leaves clothes smelling fresh. All with no waste. How 'bout that?
Ingredients: water (aqua), dicocoylethyl hydroxyethylmonium methosulfate, propanediol, glycol distearate, glyceryl oleate*/stearate, propylene glycol, cocamidopropylamine oxide, phenoxyethanol, calcium chloride, methylisothiazolinone, fragrance oil blend
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Liz: a few months ago
Absolutely love this product. I've come to Well.ca to repurchase it after buying it locally and trying it out. The smell is absolutely perfect; 4-5 sprays on a medium to large sized load of laundry and every piece of clothing in there comes out smelling fantastic. I particularly love the scent on my towels, as it lingers on them a bit longer than clothes. Super satisfied with this product. The only improvement I would ask Method to make is to the nozzle on the bottle. I found it clogged and I could not un-clog it (white vinegar, hot water soak, etc.) no matter what I tried, so I have had to put the product into a different spray bottle. Please fix this packaging issue, Method, but don't change the actual product inside!!!
Dani: a few months ago
Love this scent for my towels because this scent is fresh, like clothes line dried. My big problem with this product however is that the spray nozzle quits working on many of these bottles. I would suggest that anyone who likes this form of fabric softener to keep an old bottle around because the chances that a bottle will not work is really good. This is disappointing and should be fixed by well asap.
Sarah: more than a year ago
I think this product is utterly useless. It smelled very nice, but it does NOT remove static from the load. I've been using dryer balls lately but missed having my clothes and towels have that 'dryer sheet' perfume. Dryer balls don't remove all the static all the time, but they're a more sustainable option so you can forgive a little static with fleece hoodies, for example. The first load of laundry I dried with this product was a big ball of static. It was shocking, particularly because there weren't any fleece garments or other high-static producing fabrics. I had used the recommended amount of product so the second load of laundry I put through I used double the amount. This batch of clothes was full of static, too. I'm going to use the rest of the bottle in conjunction with my dryer balls so that it isn't wasted - as I mentioned, it smells nice - but if you're looking for static control in a fabric softener, do not buy this product.


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Skip to comments.Astronomers: Dark Matter Guides Universe's Structure
Posted on 04/05/2009 12:46:41 PM PDT by BuckeyeTexan
A 10-year study of 100,000 galaxies close to our own offers compelling proof that long-hypothesized "dark matter" does exist and is in fact a guiding force behind the structure of the universe, a team of Australian, British, and American astronomers revealed this week.
Saying that "the universe we see is really quite structured," one of the lead researchers explained that the 10-year "census" of galaxies near our own Milky Way offers powerful evidence that this invisible dark matter "seems to hold the galaxies together."
The dark matter's influence on galaxies "stops their constituent stars from flying off and it seems to be driving the large-scale galaxy clusters and super clusters" that are the largest objects in the universe, said Dr. Heath Jones of the Anglo Australian Observatory in an article on the website of the Australian Broadcasting Corporation.
Offering rich details about the direction, speed, shape, and evolving structure of 100,000 galaxies, the 10-year study offered great promise because of its exhaustive scope: it analyzed those dynamic properties for a much larger number of galaxies than any other study had ever attempted.
In reviewing the data from the study, Jones said, it became clear that directly observable visible objects could not possibly have exerted sufficient gravitational force to account for all of the movement and dynamics of the galaxies being studied.
And in hypothesing about what other, nonvisible forces could account for that additional gravitational effect, theories about dark matter completed that equation very nicely, he told the ABC:
"The galaxies just aren't uniform. They are scattered throughout the universe," he said. "What we find is that they tend to clump and cluster together. So you'll get galaxies clustering along nice delicate filamentary chains. You get some galaxies that will congregate in their clusters and you will get clusters of galaxies collecting in super clusters of galaxies, so the universe that we see is really quite structured . "Astronomers know that this dark matter must exist in the universe," he said. "We can't see it with our telescopes directly, but by studying large objects like galaxies and how they move with respect to each other we can infer its existence quite accurately."
In addition to the compelling evidence the study provides for the existence of dark matter, Jones said, it also offers equally compelling proof that the universe is expanding and will continue to do so, rather than at some point collapsing back in upon itself as some astronomers have theorized.
So back in the world of IT which for a while looked like it, too, would expand infinitely -- perhaps dark matter will turn out to be the devilish factor that has long distorted ERP projects and seems to torment most government IT efforts; maybe Jones and his team can tackle that in a future study.
And in the meantime, the new evidence that the universe is expanding forever will be of no comfort to the existentially tormented boyhood character of Alvie Singer in the classic movie, "Annie Hall."
"There is in the world more things than are dreamt of in your philosophy Horatio." (paraphrase)
Gosh. I seem to remember gravity having the same sort of behavior.
I don't know much about astronomy or science, but I have a deep suspicion that in the grand scheme of things we are incredibly tiny.
PelosiDoddReid are huddling now writing a bill to tax something to halt the expansion of the universe. It's Bush's fault.
There is little doubt that there is an abundance of dark matter. What we are lacking is an abundance of gray matter.
Flying rocks = dark matter.
Well, at least one thing; Alvie Singer did come up with the perfect reason not to do your homework.
No we're not. We are destroying the planet just by exhaling the "pollutant" CO2. Haven't you heard?
The presence of dark matter is inferred by its presumed gravitational interaction with visible matter.
That's because "Space is big. Really big. You just won't believe how vastly hugely mindbogglingly big it is. I mean you may think its a long way down the road to the chemist, but thats just peanuts to space. "
" invisible dark matter "seems to hold the galaxies together."
Kind of like duck tape
Maybe the universe is alive, a big hungry creature, and we are in its tummy.
One of the reasons for the study was that gravity can't account for what is being observed. I'm no expert, but that's what I've read.
Gravity does, but there is insufficient observable matter to account for all of the gravity necessary to explain the structures we see. Therefore some non-observable matter must account for the extra gravity. Hence, dark matter.
Thanks to all for clearing it up.
That is one funny graphic. Al Gore's secret global warming model, perhaps?
so is dark matter wimpy, neutrino-y, or axion-y?
Image courtesy of the Infrared Processing and Analysis Center at the Jet Propulsion Laboratory operated by CalTech with data from the Two Micron All Sky Survey by UMass and funded by you and I. The nearest objects are in blue and then follow the order of the spectrum to the most distant objects in red.
So is everything, relatively speaking.
Ouch, I guess the haples naturalists have to go with the multi-verse thing now.
· Google ·
It's dark because it doesn't interact with the electromagnetic force, thus it doesn't emit or absorb light, but it does have mass.
Hi SunkenCiv,
Can you please add me to the string theory list?
At least in comparison to wondering what is going to hold this country (my galaxy) together with the hundreds of trillions (maybe even light-years) worth of funny money being printed by the current administration.
Maybe dark matter (or dark anti-matter), in some parts of the universe, pushes things apart instead of holding them together?
Ever wonder why scientists give Christians so much crap when a buttload of their theories demand just as much if not more FAITH?
If you cannot PROVE it and still believe it, you're taking it on faith.
I never liked 'fudge factors'. Dark matter is one of them. The assumption that the gravitational force and the rate of time has remained consistent throughout the lifetime of the Universe should be scrutinized more carefully IMO. In short, question the model that doesn't fit without mysterious, unseen additions.
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[Please do not post in uppercase & SHOUT at us. Post title de-capped.]
I have installed and tested the Quick Chat plugin. It's slow to display new messages within the 2 seconds that we selected for the time. Is there any way to improve the display of messages WITHOUT refreshing the IE webpage?


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Comment Re:Analogue vs Digital, and DRM (Score 1) 315
USB Type-C allows for analog out to a pair of dumb headphones. You can either connect a pair of native Type-C dumb headphones (dumbphones?) or a 3.5mm set of dumbphones to a $3 adapter.
There will also be digital headphones and powered dumphones, but USB Type-C can totally be used to pass an analog signal from inside the phone, directly to a tiny set of speakers strapped to your head. There's no DRM in analog audio signals.


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Thursday, August 18, 2016
Join us for our August Wine Party, featuring the wines of the Collefrisio Vineyards of Abruzzi, Italy, with Vance Kalos,importer of the Collefrisio products!Cystic Fibrosis Foundation "A Passion for Wine"
Thursday, September 15, 2016
It's an event of prizes, wine and fun in support of finding a cure for CF.
Source: Pittsburgh Tribune-Review
July 27, 2016
Tribune-Review writer Sarah Sudar recognizes the Priory Hotel's Monks' Bar as one of the five best hotel bars in Western Pennsylvania, giving a special shout out to the house specialty the Monktini!
Stash Hotel Rewards is a program which allows you to earn points towards free rooms at The Priory Hotel and other unique independent hotels all across the U.S. It's free to join - so click the logo and start earning points today!
Finally, a hotel rewards program that lets you
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The Priory Hotel is now a part of Stash Hotel Rewards
* Points earned apply to room reservation only.
The Priory offers its "Ambassador Club" program for frequent guests. It works like this: Returning guests may sign up for the program and gather points toward a cool prize (IPad, ITouch, IPod, digital camera, etc.). It also puts members in touch with excellent discounts and special offers for Priory stays and overnight packages.
Guests can start earning points the moment they sign up. Points accrue at 1 point for every dollar spent on hotel overnights and add-ons such as food and beverage purchases or purchases of items for sale. Points do not accrue for sales or hotel occupancy tax.
The Priory also offers its Express Check In program for frequent guests, where the guest is pre-registered with us – there's no telephoning in credit card and contact information and no waiting in line when you arrive. Simply telephone or e-mail that you are coming, and we will have your key waiting for you when you arrive. Seamless.


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30-second Theories: The 50 Most Thought-provoking Theories in Science - 30 Second (Hardback)Paul Parsons, Dr. Paul Parsons, Martin Rees, Susan Blackmore
Hardback Published: 06/05/2010
- 10+ in stock
Click & Collect From your local shop
When it comes to big science, very few things are conclusively known. From Quantum Mechanics to Natural Selection, what we have instead are theories - ideas explain why things happen the way they do. We don't know for certain these are correct - no one ever saw the Big Bang - but with them we can paint beautiful, breathtaking pictures of everything from human behaviour to what the future may hold. Profiling the key scientists behind each theory, "30-Second Theories" presents each entry in a unique, eye-catching full-colour design, with thought-provoking extras and stylish illustrations. It is essential for anyone keen on expanding their mind with science's most thrilling ideas.
Publisher: Icon Books Ltd
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Kontokali Bay Hotel Corfu Hotel
Kontokali, Kontokali, Corfu, Greece
What's Included
- Breakfast
- Linen
- Towel
- Air conditioning
- Free Breakfast
- 24 Hour Reception
- Bar
- Business Centre"
- Café
- Currency Exchange
- Elevator
- Fitness Centre"
- Free Parking
- Hair Dryers
- Hot Showers
- Internet Access
- Laundry Facilities
- Luggage Storage
- Mini-bar
- Outdoor Swimming Pool
- Parking
- Restaurant
- Safe Deposit Box
- Swimming Pool
- Telephone Fax Facilities
- Tours/Travel Desk
Important Information
Cancellation within 9 days before arrival: 50% charge of the full amount of the booking.
Cancellation within 7 days prior to arival, no show, early check out or reduction of original booking: 100% charge.
In order to proceed with your reservation we require valid credit card. The remaining amount of the reservation will be preauthorized on booking date and charged on arrival date by Travelmed Hotels Group. In case the pre-authorisation fails, we shall contact you for alternative card details. This should be arranged within 24 hours of our email, otherwise the booking will be cancelled without a refund of the advance payment.
Check-in / Check-out
Earliest check-in: 00:00
Latest Check-out: 11:00
Group booking?
Group of 15 or more traveling to Corfu?
Private Rooms
Standard Single Private Ensuite
Sleeps 1
Room types
Private Room
Private Bathroom
Standard Double Bed Private Ensuite
Sleeps 2
Room types
Private Room
Private Bathroom
Standard 3 Bed PRIVATE Ensuite
Sleeps 3
Room types
Private Room
Private Bathroom
About Kontokali Bay Hotel Corfu
The Main Building of the Kontokali Bay overlooks both the sparkling blue waters of the Ionian Sea that separates Corfu from the taupe, coastal mountains of the Greek Mainland and the Gouvia Marina.
The Bungalows are set in the midst of pine and cypress-laden garden.
Impeccably friendly service, tranquil surroundings and excellent quality are the secrets of the success of our Restaurants and Bars. Dining options include Main Restaurant, beach tavern and two a la cart restaurants (operate weather permitted). We are also taking into consideration our guests wishes for: vegetarian - low calorie - diabetic - organic choices in all buffets. Beside this, there is also main bar and beach bar.
You can relax on one of our two sandy beaches or by the pool (including children's pool). Sport activities include water-skiing, paragliding, tennis, fitness room, mountain bike center and table tennis.
The newly built Spa & wellness center is located next to the hotel's main building and includes: indoor heated swimming pool, heated treatment pool, jacuzzi, 2 saunas, steam room (hammam), gymnasium (fully equipped), aerobics room, relaxation room and 9 treatment rooms.
Accommodation Information
All the room types have the following amenities: balcony / terrace, central heating & A/C, direct dial telephone, satellite TV, radio channels, mini bar, safety deposit box (note book size), hairdryer,free Wi-Fi internet access. As a warm welcome guests receive in all rooms: complimentary bottle of wine and a bottle of mineral water upon arrival, bathrobes and slippers.
Location Information
The whole of the island is within easy reach for those who wish to explore it by car. Corfu Town is accessible both by the frequent local bus service, by taxi and also a courtesy hotel bus, running (once daily), to and from Corfu Town, which can be arranged by the Hotel Reception.
Cancellation Policy
Customers can cancel their reservation free of charge up to 3 days before arrival. After this date, charges will be applied by the property up to the first nights cost of the reservation, unless otherwise stated in the property's conditions. Deposits paid are non refundable.


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Berkeley, MO
Online Offers
Berkeley is an inner-ring suburb of St. Louis, located in St. Louis County, Missouri, United States. The population was 10,063 at the 2000 census. Portions of Lambert-St. Louis International Airport are within the city limits.
Berkeley incorporated in 1937.
Berkeley is located at 38°44′32″N 90°20′0″W / 38.74222°N 90.333333°W / 38.74222; -90.333333 (38.742250, -90.333288).


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If you have troubles since the update to WordPress 4.5 please read this post before opening a new thread.
I have an issue when hovering over my image thumbnails on my store page. When I hover over the first item it will zoom, but after this it doesn't zoom out again, and none of the other product thumbnails will zoom when hovererd over.
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Howie Kurtz Continues His Undying Support of Donald Trump/
Howard Kurtz is chastising the media for picking on his friend Donald.
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Internationalization of Services
News created on Aug 11, 2011 by Jb.pt
- Internationalization of Services: This year began with the internationalization of Greslar sales to Lebanon, Spain, Luxembourg and France. We are also developing contacts for export to North Africa and PALOPs.
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There is a phrase that goes "a X of riches" which suggests that one had so much to choose from, lots of good choices. What is the missing word?
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There is also the phrase, "an embarrassment of riches"
... not to forget, a plethora of riches.
I've heard the expression a wealth of riches to mean an abundance of choices or appealing options, such as found in these examples:
If the number of choices seems almost too great – enough to cause the fortunate one to perhaps blush – there's also the idiom embarrassment of riches.
I've heard of people using "a world of riches" and that was the first that sprung to mind. A google search delivers some wide ranging usage (search with the quotes).
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New Ford Dealership in Port Richey, FL
Welcome to Ford of Port Richey! Our Ford dealership proudly serves the entire Port Richey area with outstanding service, including the surrounding areas of Bayonet Point, Jasmine Estates, Seven Springs, Spring Hill, Hudson, Trinity, and beyond. We take pride in fulfilling our customer's needs from new and used car sales to auto repair and car financing. Our dedicated team at Ford of Port Richey looks forward to welcoming you to our family and serving you for years to come.
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