The cancer burden in Puerto Rico, a U.S. territory with a 99% Hispanic population, is substantially different from that of Hispanics in the continental United States, according to Cancer Statistics for Hispanics/Latinos, 2018. The report, published every 3 years, found that men in Puerto Rico have higher prostate and colorectal cancer rates than non-Hispanic white men in the continental United States, in contrast to U.S. Hispanics as a whole, who have lower rates for these cancers. The report by Miller et al appears in CA: A Cancer Journal for Clinicians.
Prostate cancer is the leading cause of cancer death among men in Puerto Rico, accounting for nearly one in six deaths during 2011–2015, whereas lung cancer accounts for the largest percentage of cancer deaths among other U.S. Hispanic men. Further, Puerto Rico was the only state or territory included in the analysis where lung cancer was not the leading cause of cancer death among men overall. This reflects not only high prostate cancer mortality in the territory (26.7 per 100,000 in men in Puerto Rico vs 18.2 in non-Hispanic white men and 16.2 in other U.S. Hispanics during 2011–2015), but also exceptionally low lung cancer death rates among men in Puerto Rico (19.8 vs 56.3 in non-Hispanic whites and 26.5 in other U.S. Hispanics). Mortality rates for colorectal cancer in men in Puerto Rico during 2011–2015 were 17% higher than those in non-Hispanic white men and 35% higher than those of other U.S. Hispanics combined.
These differences highlight the wide variation in cancer risk within the U.S. Hispanic population, for whom population-based health data are often only available in aggregate. Although overall cancer incidence and mortality rates in Hispanics in the continental U.S. and Hawaii are 25% to 30% lower, respectively, than in non-Hispanic whites, rates among some U.S.-born Hispanics approach those in non-Hispanic whites. Given that the rapid growth of Hispanic population in the U.S. is now driven by birth rather than immigration, the authors of the report anticipate a burgeoning cancer burden among Hispanics.
Currently, however, the cancer profile in U.S. Hispanics reflects that in Latin America, as one-third of this population is foreign-born and maintains much of the cancer risk of their country of origin. As a group, Hispanics are less likely than non-Hispanic whites to be diagnosed with the four most common cancers (prostate, breast, lung and bronchus, and colorectal) but have a higher risk of infection-related cancers (stomach, liver, and cervix), which, with the exception of liver cancer, are more frequent in Latin American countries. For example, stomach cancer mortality rates among continental U.S. Hispanics are twice those in non-Hispanic whites.
In 2018, an estimated 42,700 Hispanic men and women in the United States will die from cancer. This does not include cancer deaths in Puerto Rico due to data limitations. Among Hispanic men, lung (16%), liver (12%), and colorectal (11%) cancers cause the most cancer deaths, whereas among women, these are breast (16%), lung (13%), and colorectal (9%) cancers. Lung cancer accounts for 14% of cancer deaths among Hispanics compared to 25% in the overall population because of the historical and continuing low smoking rates in Hispanics. In contrast, liver cancer accounts for 12% of cancer deaths in Hispanic men vs 6% in men overall.
Variations in cancer risk between Hispanics and non-Hispanic whites, as well as within the Hispanic community, are primarily driven by differences in exposure to cancer-causing infectious agents and behavioral risk factors. For example, the prevalence of cigarette smoking in 2017 was 17% among non-Hispanic whites compared to 10% among Hispanics residing in the continental United States, similar to the rate among island Puerto Ricans; however, within the Hispanic population smoking prevalence ranged from 6% among Dominicans and Central/South Americans to 17% among Puerto Ricans who reside stateside. Counterbalancing generally low smoking rates, continental Hispanics and those in Puerto Rico have among the highest prevalence of the second-most important cancer risk factor—excess body weight—as well as type 2 diabetes, which increases risk independent of body weight.
“Efforts to further progress in cancer control in Hispanics in the United States, including Puerto Rico, must consider the substantial differences in cancer risk within this heterogeneous population,” write the authors. “Effective strategies for decreasing cancer rates among Hispanics include the use of culturally appropriate lay health advisors and patient navigators; targeted, community-based intervention programs to increase screening and vaccination rates and encourage healthy lifestyle behaviors; and further funding for Puerto Rico–specific and subgroup-specific cancer research and surveillance.”
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.