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Charting cancer risks

By creating a disease profile of Latinos, doctors hope to raise awareness of early screening.

August 18, 2003|Jane E. Allen | Times Staff Writer

Latinos in America are less likely than white Americans to develop and die from cancer, particularly the most common deadly types -- lung, breast, prostate and colon, a new analysis has found. But they're more prone to developing the less-common malignancies of the stomach, cervix, liver and gallbladder.

Risk factors differ as well. Latinos have a greater tendency to be overweight and sedentary, which boosts the likelihood of some types of cancer, the analysis shows. They're less likely to be screened for colon, prostate and cervical disease -- despite major educational campaigns to inform Americans about their risks. And they're more likely to be diagnosed at a later stage, when the cancer is harder to treat.

By creating the risk profile for the country's largest and fastest-growing minority group, the American Cancer Society hopes to more easily spread the word to Latinos that many cancers, when caught early through screening, are survivable with proper treatment. Latinos now comprise more than 13% of Americans and 25.4% of Californians.

"The purpose of these studies is to ... call attention to where the problems are," said epidemiologist Elizabeth Ward, the American Cancer Society's director of surveillance research.

Doctors and epidemiologists add that health agencies and community groups need to do a better job of making screening and treatment readily available.

Scientists attribute some of Latinos' unique cancer risks to poverty, a lack of access to health insurance and a lack of regular medical care -- often exacerbated by linguistic barriers, cultural isolation and cultural barriers such as a sense of fatalism about sickness and death. In 1999-2000, for example, 30.4% of Latinos reported no regular source of health care, compared with 16.8% of whites; and 39.7% of Latinos were identified as poor, compared with 22.7% of whites, according to the National Health Interview Survey from the Centers for Disease Control and Prevention.

Olga Zamora, a 65-year-old former dental assistant and cafeteria worker from Panorama City, knows the perils of being poor and not having insurance. Although she managed to get Pap smears and breast exams through county clinics, she went without tests after a 1997 accident left her disabled and eventually homeless.

Her family had a history of cancer but, she says, "I had no insurance, no money, I was in the middle of nowhere."

Then in 2002, troubling abdominal symptoms led her to see a doctor at her own expense. The eventual diagnosis was cancer of the ovaries, uterus and cervix. She postponed surgery because she was awaiting a spot in senior housing. By the time she finally enrolled in Medicare and Medi-Cal, her cancer had spread to the stomach, pancreas, liver and colon.

Zamora, originally from Mexico, underwent surgery in October 2002 and just completed chemotherapy. She hopes to advise other Spanish-speakers on how to get basic and preventive care.

The new report, which appears in the July/August issue of CA: A Cancer Journal for Clinicians, is based on cancer incidence statistics from the National Cancer Institute, mortality data from the National Center for Health Statistics, population data from the Census Bureau, screening data from the CDC and state and national surveys on behavioral risks such as smoking. Latinos in the study are those who identified themselves in federal surveys as Hispanic.

Their natural protections and distinct vulnerabilities likely result from a combination of environment and genetics, said Dr. Felix Aguilar, a public health physician for the city of Long Beach, and should be considered when targeting educational and prevention programs.

Immigrants from developing countries, for example, come here with greater exposure to such cancer risk factors as H. pylori, the bacterium implicated in stomach ulcers that also may have a role in stomach cancer. They're also more likely to have been infected with hepatitis B and hepatitis C, diseases that increase the risk of liver cancer years later.

"The No. 1 thing we need is to have Latino women have Pap smears," Aguilar said. "It's not uncommon for me to see a 55-year-old Latina who has never had a Pap smear, breast exam or mammogram, and never had the preventive health services."

Prevention programs also need to overcome fatalism, he added. "People think, 'If I get cancer, I'm going to die anyway, so why should I do anything?' " he said. As a result, he and other doctors try to emphasize to mothers that taking care of their own health "is important to do for your family."

Ward suggested that to help support healthier aspects of Latino culture, "we need to counteract the influence of the culture here, such as advertising pressure to start smoking." Education needs to help preserve aspects of the traditional diet that are good, such as eating fruits and vegetables, and teach Latinos how to resist the attraction of readily available but less healthy fast and processed foods.

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