Cancer 101: A Cancer Education and Training Program for [Target Population] Date Location Presented by: Presenter 1 Presenter 2 1

Cancer Among [Target Population] Learning Module 1

Learning Objectives At the completion of Module 1, you will be able to: Give two reasons why cancer is a growing health concern among [target population]. Discuss two facts about how data contributes to understanding about the cancer health concern for [target population]. NOTE: These learning objectives should be updated to match the objectives in the curriculum’s Module 1.

Learning Objectives (cont’d) Discuss two facts that contribute to poor survival for [target population] diagnosed with cancer. Describe two factors that are likely to improve cancer survival rates for [target population].

Actual Causes of Death Tobacco, poor diet and physical inactivity account for more than 2/3rds of cancer deaths in the United States each year and also contribute to other conditions such as diabetes and CVD. Source: 1. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. 2004;291(10):1238-1246. 2. Miniño AM, Arias E, Kochanek KD, Murphy SL, Smith BL. Deaths: final data for 2000. National Vital Statistics Reports 2002; 50(15):1–120.

Cancer Background Cancer is a growing health concern among [target population] because: They are the largest minority group in the U.S. They are a heterogeneous group Acculturation to U.S. culture increases cancer risk NOTE: This information should be updated to match the content in the curriculum’s Module 1. According to the U.S. Census Bureau, in 2008 Hispanics numbered 46.9 million and comprised about 15% of the total U.S. population. Hispanics are the country’s largest minority group and since 2000 have accounted for approximately 50.5% of the overall population growth in the United States. However, due to the fact that Hispanics comprise a heterogeneous group, it is important to note that there are differences between Hispanic populations by country of origin. In addition to country of origin, other characteristics that may have an impact on health status include: length of time in the U.S., income levels, household size, level of education, language(s) spoken, insurance coverage, and connection with the healthcare system However, as Hispanic immigrants become more acculturated to U.S. culture, some studies have shown that descendants of immigrants have cancer rates similar to those of non-Hispanic whites. Studies suggest lifestyles that include attention to proper nutrition and diet (rich in natural foods), limited alcohol use, daily exercise, healthy weight, and the avoidance of known carcinogens, such as tobacco, may reduce one’s risk for developing cancer; these are the same negative health related behaviors associated with acculturation.

Data Tell Us Cancer incidence rates are lower among Hispanics than whites or African-Americans for major cancer sites However, Hispanics are more likely to be diagnosed with cancer at an advanced stage NOTE: This information should be updated for your target population and made to match the content in the curriculum’s Module 1. Incidence = number of new cases diagnosed The data in the graph shows cancer incidence rates in the U .S. by race/ethnicity (2001-2005). Rates are per 100,000, age adjusted to the 2000 U.S. standard population. Cancer incidence rates among Hispanics are lower than rates among non-Hispanic whites or non-Hispanic blacks for major cancer sites (lung, colon and rectum, breast and prostate). However, Hispanics are more likely to be diagnosed with cancer at an advanced stage. Cancer screening data suggests that there may be differences in incidence rates among Hispanic sub-groups. Source: American Cancer Society Facts & Figures 2009

Data Tell Us Cancer is the 2nd leading cause of death for Hispanics. Patterns for certain types of cancers vary among Hispanics when compared to other racial/ethnic groups. For example, Hispanics have higher incidence and mortality rates for stomach, cervix, liver and gallbladder cancers. Median age of cancer diagnosis is 62 among Hispanics compared to 68 for whites. NOTE: This information should be updated for your target population and made to match the content in the curriculum’s Module 1.

Data Tell Us Collective data for Hispanics may not be representative of the cancer burden among all sub-groups Risks may be different for Hispanics of different ethnicities NOTE: This information should be updated for your target population and made to match the content in the curriculum’s Module 1. Notes: Data shows Proportional Incidence Ratio (PIR) for selected cancers among Hispanic subgroups using the age-specific proportions among the non-Hispanic white population as the reference. Data is for selected areas (38 state cancer registries) in the U.S. between 1999-2003. Source: SEER & NPCR, 1999-2003

Limitations of the Data Inconsistent reporting of ethnicity on medical records and death certificates Undercounting Broad grouping for Hispanics NOTE: This information should be updated for your target population and made to match the content in the curriculum’s Module 1. The term limitations refers to how the accuracy of the current data may be influenced. Undercounting due in part to inconsistent reporting of ethnicity and possibility that recent Hispanic immigrants return to their country after a cancer diagnosis. Broad groupings for Hispanics may mask variations in the cancer burden among specific sub-populations (by country of origin, socio-economic status, or recent immigration status).

Cancer Survival among [target population] While Hispanics have cancer survival rates similar to non-Hispanic whites, there are a number of factors that potentially influence their survival: Lower socio-economic status Culture & values Obesity Infectious agents Elevated environmental exposures NOTE: This information should be updated for your target population and made to match the content in the curriculum’s Module 1. Lower socioeconomic status (education, income, health literacy) Role of culture and values in shaping beliefs, attitudes, and behaviors about cancer. Being overweight or obese (Mexican American women have higher rates of obesity than non-Hispanic white women) Infectious agents as risk factors for cancers Hispanics suffer a higher burden of (Hepatitis B & C infection in relation to liver cancer, HPV in relation to cervical cancer, Helicobacter pylori infection in relation to stomach cancer). Elevated environmental exposures in farming and industrial work (occupations which tend to be held by Hispanics)

Barriers to Care Lack of: insurance regular source of medical care access to screening and treatment culturally sensitive or bilingual/bicultural health providers culturally relevant cancer materials and programs accessible educational and training opportunities NOTE: This information should be updated for your target population and made to match the content in the curriculum’s Module 1. Lack of: insurance (Hispanics have the highest uninsured rates in the country) regular source of medical care (Hispanics are less likely than non-Hispanic whites and blacks to have a regular doctor) timely access to state-of-the-art screening, diagnostic or treatment methods and result in late detection of cancer culturally sensitive or bilingual/bicultural health providers (language barriers and poor provider/patient communication have led to negative experiences with the medical system) culturally relevant materials and programs about cancer accessible educational and training opportunities,

Improving Survival Survival can be improved by: Increasing participation in screening and early detection services Reducing barriers to care Reducing risk factors for cancer Promoting healthy lifestyles NOTE: This information should be updated for your target population and made to match the content in the curriculum’s Module 1.

In Summary… You now have an understanding of: How data affects our understanding of cancer as a health concern for [target population] Factors that contribute to later-stage cancer diagnosis among [target population] Ways to improve survival rates NOTE: This information should be updated for your target population and made to match the content in the curriculum’s Module 1.