1. Coming to America: Cancer Trends among Filipinos in Manila and Los Angeles
Andrea Sipin-Baliwas
Los Angeles Cancer Surveillance Program
University of Southern California
NAACCR/IACR Meeting
June 13, 2019
Vancouver, Canada

2. BACKGROUND
First large group of immigrants arrived in California in 1923  2,426 admitted
Earlier immigration to Hawaii
High demand for agricultural labor on the West Coast
(California, Oregon, and Washington)
Referred to as “manongs”
Education Exchange Act passed in 1948
Enabled foreign nurses to study and gain experience in the U.S.

3. DISTRIBUTION OF FILIPINO RESIDENCY
Table 1. Top concentrations by Metropolitan Area for Filipinos,
Figure 1. Top States of Residence for Filipinos in the United States,

4. FILIPINOS IN LOS ANGELES COUNTY
Filipino-Americans (FA) are the 2nd largest group making up the Asian demographic in LAC (2015)
Relatively large population in Southern California allows for robust studies focus on health issues prominent in this community
Since 1973, the overall cancer incidence rates for Filipinos have risen in LAC for both males and females, while rates have declined in Manila

5. METHODS
Most currently available population-based data from Los Angeles County, Manila (Cancer Incidence in Five Continents database), and SEER we will calculate the following trends while examining screenable cancers:
Site-specific incidence
Mortality
Survival (Relative)

6. SCREENABLE CANCERS
Prostate
Cervix
Breast
Colorectal
Lung

7. INCIDENCE (Male) USA, California, Los Angeles: Filipino (1983-2012)
Male, age [0-85+]
Cancer
Cases
Crude rate
ASR (World)
All cancers excluding non-melanoma skin (C00-96/C44)
10698
296.4
239.7
Prostate (C61)
3252
90.1
72.6
Lung (incl. trachea) (C33-34)
1795
49.7
39.7
Colon (C18)
772
21.4
17.1
Non-Hodgkin lymphoma (C82-86,C96)
560
15.5
12.6
Rectum and anus (C19-21)
546
15.1
12.3
Philippines, Manila ( )
Male, age [0-85+]
Cancer
Cases
Crude rate
ASR (World)
All cancers excluding non-melanoma skin (C00-96/C44)
79862
104.6
202.9
Lung (incl. trachea) (C33-34)
17703
23.2
48.9
Prostate (C61)
6965
9.1
24.3
Liver and intrahepatic bile ducts (C22)
8836
11.6
21.2
Colon (C18)
5294
6.9
14.4
Lip oral cavity and pharynx (C00-14)
5871
7.7
13.1
USA, SEER (9 registries): White ( )
Male, age [0-85+]
Cancer
Cases
Crude rate
ASR (World)
All cancers excluding non-melanoma skin (C00-96/C44)
501.6
360.2
Prostate (C61)
425432
143.4
101.6
Lung (incl. trachea) (C33-34)
217605
73.4
51.2
Colon (C18)
106761 36
24.3
Bladder (C67)
102257
34.5
23.2
Melanoma of skin (C43)
69443
23.4
17.6

9. INCIDENCE (Male)
Prostate, lung, and colon cancer are among the top 5 cancer sites across SEER White, Filipinos-Manila, and Filipinos-LA
Despite screening efforts, prostate cancer is the most common for Filipinos in LA and SEER White
No population screening in the Philippines (PSA)
Lung cancer is the most common for Filipinos in Manila

10. MORTALITY (Male)
*SEER 9 White and LAF rates were calculated using incidence-based (IB) mortality while Manila rates were calculated using death certificate (DC)-based mortality; IB mortality is slightly lower than DC mortality.

11. MORTALITY (Male)
*SEER 9 White and LAF rates were calculated using incidence-based (IB) mortality while Manila rates were calculated using death certificate (DC)-based mortality; IB mortality is slightly lower than DC mortality.

12. MORTALITY (Male)
*SEER 9 White and LAF rates were calculated using incidence-based (IB) mortality while Manila rates were calculated using death certificate (DC)-based mortality; IB mortality is slightly lower than DC mortality.

13. INCIDENCE (Female) Philippines, Manila (1983-2012) Female, age [0-85+]
Cancer
Cases
Crude rate
ASR (World)
All cancers excluding non-melanoma skin (C00-96/C44)
106793
133.6
198.7
Breast (C50)
30127
37.7
55.2
Cervix Uteri (C53)
11290
14.1
19.6
Lung (incl. trachea) (C33-34)
6862
8.6
14.8
Ovary (C56)
6728
8.4
11.7
Colon (C18)
5237
6.5
11.1
USA, California, Los Angeles: Filipinas ( )
Female, age [0-85+]
Cancer
Cases
Crude rate
ASR (World)
All cancers excluding non-melanoma skin (C00-96/C44)
13094
310.6
220.4
Breast (C50)
4921
116.7
84.6
Thyroid (C73)
944
22.4
16.9
Corpus uteri (C54)
961
22.8
16.6
Lung (incl. trachea) (C33-34)
936
22.2
14.4
Colon (C18)
784
18.6
12.1
USA, SEER (9 registries): White ( )
Female, age [0-85+]
Cancer
Cases
Crude rate
ASR (World)
All cancers excluding non-melanoma skin (C00-96/C44)
454.6
287
Breast (C50)
409960
135.2
90.5
Lung (incl. trachea) (C33-34)
170646
56.3 33
Corpus uteri (C54)
86871
28.6
19.1
Colon (C18)
114840
37.9 19
Melanoma of skin (C43)
55958
18.4
13.7

15. INCIDENCE (Female)
Breast, lung, and colon cancer are among the top 5 cancer sites across SEER White, Filipinas-Manila, and Filipinas-LA
Despite screening efforts, breast cancer is the most common for all three groups
According to a randomized trial in the Philippines, breast cancer cases generally present at advanced stages
Too expensive to have a nationwide program that requires screening every 2 years for women between 50 and 69
Main reasons to refuse follow up in the Philippines:
Cost
Lack of trust in health system
Fear of having the disease

16. INCIDENCE (Female)
Among Filipinas in Manila, cervical cancer is the 2nd most common
(Not a top 5 site for LAF or SEER White)
Low uptake of pap smear screening
Human Papillomavirus (HPV) types 16 and 18 are most common
HPV vaccination recently introduced
Screening programs such as pap smears, visual inspection w/ acetic acid and cryotherapy, and colposcopy are available  low uptake
Pap smear first introduced in the Philippines in the 1990’s (women ages , once in a lifetime)

18. MORTALITY (Female)
*SEER 9 White and LAF rates were calculated using incidence-based (IB) mortality while Manila rates were calculated using death certificate (DC)-based mortality; IB mortality is slightly lower than DC mortality.

19. MORTALITY (Female)
*SEER 9 White and LAF rates were calculated using incidence-based (IB) mortality while Manila rates were calculated using death certificate (DC)-based mortality; IB mortality is slightly lower than DC mortality.

20. MORTALITY (Female)
*SEER 9 White and LAF rates were calculated using incidence-based (IB) mortality while Manila rates were calculated using death certificate (DC)-based mortality; IB mortality is slightly lower than DC mortality.

21. MORTALITY (Female)
*SEER 9 White and LAF rates were calculated using incidence-based (IB) mortality while Manila rates were calculated using death certificate (DC)-based mortality; IB mortality is slightly lower than DC mortality.

22. Survival
Laudico, A., & Mapua, C. (2011). Cancer survival in Manila, Philippines, Cancer survival in Africa, Asia, the Caribbean and Central America. IARC Scientific Publications, 162,

23. Survival
Laudico, A., & Mapua, C. (2011). Cancer survival in Manila, Philippines, Cancer survival in Africa, Asia, the Caribbean and Central America. IARC Scientific Publications, 162,

24. Survival
Laudico, A., & Mapua, C. (2011). Cancer survival in Manila, Philippines, Cancer survival in Africa, Asia, the Caribbean and Central America. IARC Scientific Publications, 162,

25. CONCLUSION
Males and females across all three groups share some of the same most common cancer sites
Filipino males in Los Angeles have similar mortality rates to SEER Whites for prostate, lung, and colon cancer
Filipino females in Los Angeles have very similar mortality rates to SEER Whites for breast cancer only
Filipinos in Manila have poorer survival across three of the most common cancer sites (M/F colon, F cervical and breast)
Need to improve efforts to decrease mortality rates in screenable cancer sites
Incidence and mortality rates are higher in SEER White and LAF
Further analyses needed

26. THANK YOU
Co-Authors: Dennis Deapen, DrPH Amie Hwang, PhD Lihua Liu, PhD Ziwei Song
Acknowledgements:
Juanjuan Zhang
Joshua Hack
James Huynh
The collection of cancer incidence data used in this study was supported by the California Department of Public Health pursuant to California Health and Safety Code Section ; Centers for Disease Control and Prevention’s (CDC) National Program of Cancer Registries, under cooperative agreement 5NU58DP006344; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract HHSN I awarded to the University of California, San Francisco, contract HHSN I awarded to the University of Southern California, and contract HHSN I awarded to the Public Health Institute.  The ideas and opinions expressed herein are those of the author(s) and do not necessarily reflect the opinions of the State of California, Department of Public Health, the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors.

27. Watsonville, CA 1956