Sarah Enriquez-Wornow
Brown University, Undergraduate
Due to institutional and socioeconomic barriers, it is difficult for members of the Hispanic community in the United States to receive important cancer screenings that could mean the difference between catching cancer at a treatable stage versus finding the disease after it has metastasized. Despite the Hispanic population having a lower incidence of cancer than other ethnic groups, it is still the leading cause of death within the Hispanic community. Improving access to cancer screening tools and education on the importance of these tools could potentially save lives; consistent cancer screenings arguably should be a priority in addition to combating COVID-19 [1].
Lung cancer in men and breast cancer in women account for the two highest mortality rates of all cancers within the Hispanic population. One reason for these high death rates is due to the stage at which most lung and breast cancers are caught. The earlier a cancer is caught, the more likely surgery and chemotherapy will be successful in treating it. For example, if lung cancer is caught while still localized to the lung, indicating it is in an early stage, there is a 63% 5-year survival rate. However, if the cancer has spread to neighboring organs by the time it is discovered, the 5-year survival rate drops down to 35%, and if the cancer has distantly metastasized, there is only a 7% 5-year survival rate. Clearly, catching cancer as early as possible is key to preventing death [2].
Guidelines for eligibility of annual lung cancer screenings have historically placed minority groups at a disadvantage in receiving one, and as a result only 17% of lung cancer diagnoses in the Hispanic population occur at the localized stage [3]. The national guidelines used from 2013 to 2021 led to low eligibility rates of Hispanics versus non-Hispanic whites. While 24.7% of Hispanics who smoked were eligible for annual screenings under the old guidelines, an astounding 71.3% of non-Hispanic whites who smoked were eligible under the same guidelines, creating a huge disparity and lack of access to necessary screening tools for the communities that need it most [4]. This extreme difference in eligibility rates could be contributed to the previous guidelines defining “eligible” adults to be over 55 years old with a 30 pack-year history of smoking. As minority populations are typically exposed to lung cancer carcinogens at an earlier age, meaning they would also have a less extensive history of smoking, guidelines that require the individual to be older and have a longer smoking history disproportionately affect Hispanics [5]. New guidelines established in 2021 from the U.S. Preventive Services Task Force broadened the age range and reduced the required smoking history time, as they allow adults over 50 years old who have a history of smoking within the past 20 years, or who are predisposed to developing lung cancer, to be screened annually using low-dose computed tomography (LDCT) [6]. Because these guidelines are still relatively new, few studies have been published on their effects within the Hispanic community. However, they cover a much broader population than the old guidelines, giving hope that more Hispanics will now be eligible for annual screenings.
Similar to lung cancer, breast cancer is more likely to be caught in a later stage in Hispanic women compared to non-Hispanic white women due to inconsistent mammogram screening [7]. Hispanic women experience more barriers, including economic and geographic barriers, to obtaining a mammogram than other ethnicity groups, leading to fewer eligible women receiving one [8]. The longer a screening is delayed, the more likely a cancer will be caught in an advanced stage. In fact, Hispanic women are 30% more likely to die from breast cancer than non-Hispanic whites [9]. Even when Hispanic women receive mammograms, studies have shown they are less likely to have follow-up supplemental imaging ordered compared to other ethnic groups [10]. Teaching physicians the importance of supplemental imaging following an abnormal result could increase the number of women who receive a follow-up mammogram and subsequent diagnosis. Increasing breast cancer awareness and promoting early screening tools within communities are important public health priorities.
Overall, screenings for cancers, especially lung and breast cancers, are extremely important and should be obtained whenever available. Particularly important for the Hispanic community, early screenings can allow for the management of cancers during a treatable stage and prevent a surprise diagnosis of advanced cancer. Hopefully, updated guidelines, like the new lung cancer screening guidelines, will enable a more diverse population to receive life-saving screenings.
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References
[1] Cancer facts & figures for hispanics & latinos 2018-2020. American Cancer Society. (2018).
Retrieved January 15, 2022, from https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/cancer-facts-and-figures-for-hispanics-and-latinos/cancer-facts-and-figures-for-hispanics-and-latinos-2018-2020.pdf
[2] Lung cancer survival rates: 5-year survival rates for lung cancer. American Cancer Society. (2021). Retrieved January 10, 2022, from https://www.cancer.org/cancer/lung-cancer/detection-diagnosis-staging/survival-rates.html
[3] Flores, E. (2021, September 8). Increasing lung cancer screening in the Hispanic/Latinx Community. Massachusetts General Hospital. Retrieved January 15, 2022, from https://advances.massgeneral.org/radiology/journal.aspx?id=2042
[4] Olazagasti, C., & Seetharamu, N. (2021, May 26). Treatment patterns and outcomes of patients with advanced malignant pleural mesothelioma in a community practice setting. Future oncology (London, England). Retrieved January 10, 2022, from https://pubmed.ncbi.nlm.nih.gov/33769073/
[5] Flores, E., Irwin, K., Park, E., Carlos, R. (2021, May). Increasing Lung Screening in the Latino
Community. Journal of the American College of Radiology, 18(5), 633-636. https://doi.org/10.1016/j.jacr.2021.03.007
[6] Lung cancer: Screening. Recommendation: Lung Cancer: Screening | United States Preventive Services Taskforce. (2021, March 9). Retrieved January 15, 2022, from
https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/lung-cancer-screening
[7] Smith-Bindman, R., Miglioretti, D. L., Lurie, N., Abraham, L., Barbash, R. B., Strzelczyk, J., Dignan, M., Barlow, W. E., Beasley, C. M., & Kerlikowske, K. (2006). Does utilization of screening
mammography explain racial and ethnic differences in breast cancer?. Annals of internal medicine, 144(8), 541–553. https://doi.org/10.7326/0003-4819-144-8-200604180-00004
[8] Ramachandran, A., Snyder, F. R., Katz, M. L., Darnell, J. S., Dudley, D. J., Patierno, S. R., Sanders, M. R., Valverde, P. A., Simon, M. A., Warren-Mears, V., Battaglia, T. A., & Patient Navigation Research Program Investigators (2015). Barriers to health care contribute to delays in follow-up among women with abnormal cancer screening: Data from the Patient Navigation Research Program. Cancer, 121(22), 4016–4024. https://doi.org/10.1002/cncr.29607
[9] What Hispanic women and latinas need to know about breast cancer. Breast Cancer Research Foundation. (2021, October 10). Retrieved January 15, 2022, from
https://www.bcrf.org/blog/hispanic-latina-breast-cancer-facts-statistics/
[10] Ezratty, C., Vang, S., Brown, J., Margolies, L. R., Jandorf, L., & Lin, J. J. (2020). Racial/ethnic differences in supplemental imaging for breast cancer screening in women with dense breasts. Breast cancer research and treatment, 182(1), 181–185. https://doi.org/10.1007/s10549-020-05652-z
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