CANCER

As in Blacks and non-Hispanic whites, cancer is the second leading cause of death in Hispanics. However, there are significant differences in the rate at which Hispanics die from cancer.

Table 4. Death rates for malignant neoplasms, by race and Hispanic origin, 1988-1990

	Deaths / 100,000 Persons greater than or equal to 45 Years Old
	Hispanic	White	Black
Male	345.4	565.1	866.8
Female	229.4	378.9	452.4

1Age adjusted to 1940 U.S. population

Assignment:

Review Table 4 and answer the following questions.
1) Calculate the risk ratios (relative risks) of overall cancer death in Hispanic males compared with white males and Black males.
2) Calculate the risk ratios (relative risks) of overall cancer death in Hispanic females compared with white and Black females.
3) List as many factors as you can think of that might account for the differences in cancer mortality observed in the three race/ethnic groups shown in Table 4.

Table 5 lists overall cancer mortality rates and mortality rates for selected sites in males and females in Texas.

Table 5. Age-adjusted cancer death rates per 1000,000, Texas, 1992.

	Ethnic Group
	White		Hispanic		Black
	Male	Female	Male	Female	Male	Female
All sites	218.53	143.04	156.14	106.11	335.99	174.60
Stomach	6.57	2.95	10.93	5.21	12.42	4.91
Lung	81.263	7.44	37.02	14.44	117.48	33.56
Breast	—	25.77	—	18.74	—	32.25
Cervix	—	2.51	—	5.25	—	8.50
Prostate	23.79	—	16.73	—	52.55	—

Source: TCDC, November 18, 1994

Assignment:

Review the mortality rates in Table 5 and answer the following questions: 1) Does the national pattern in overall cancer mortality risk presented in Table 5 hold for Hispanics, Blacks, and whites in Texas?
2) Are there any cancer sites for which Hispanics have a greater mortality risk than Whites? Are there any cancer sites for which Hispanics have a higher mortality risk than Blacks?
3) For which cancer site shown in the table do Hispanics have the lowest mortality risk relative to Whites and Blacks?

Carcinogenesis is a complex process thought to involve multiple steps that occur over a long period of time. The process of carcinogenesis may be triggered by chemical, physical, biologic and/or genetic insults to cells, such as those caused by smoking, occupational and environmental chemicals, radiation, dietary factors, and specific viruses (Greenwald et al., 1995).

Smoking is known to cause lung cancer. Smoking prevalence data from the Behavioral Risk Factor Surveillance System 1992 survey were presented in the section on CARDIOVASCULAR DISEASES {a hypertext link}. The lower mortality from lung cancer among His panics has been attributed in part to a lower prevalence of smoking, particularly among women. There is concern that targeting of Hispanic populations by cigarette manufacturers will increase tobacco use among Hispanics, and thereby increase their lung c ancer risk (Haynes et al., 1990).

Dietary exposures, particularly fat intake and micronutrients, including folic acid, vitamins A, C, and E, and the minerals calcium and selenium, have also been linked to cancer risk. Individuals who consume large quantities of vegetables rich in Vita min A and -carotene are at reduced risk for lung cancer. High fat intake has been linked to both breast and prostate cancer risk. The dramatic difference in cancer risk observed between Hispanics and the two other major racial/ethnic groups in the U.S. has been hypothesized to be attributable in part to differences in dietary intake.

Guendelman et al. (1995) examined the dietary intake of selected nutrients among first and second-generation Mexican-American women surveyed for the Hispanic Health Examination and Nutrition Survey (HHANES) and White non-Hispanic women who participated in the NHANES II (1976-1980 National Health and Nutrition Examination Survey). This study was designed to assess the extent to which acculturation among Mexican-Americans changes traditional dietary habits. Table 6 contains the results of Guendelman et al.'s comparison of dietary intake among Hispanic and non-Hispanic White women.

Table 6. Mean Dietary Intake of Selected Nutrients, by Ethnicity and Generational Status for Mexican-American Women

	First-Generation Mexican-Americans (n=475)		Second-Generation Mexican-Americans (n=898)		White Non-Hispanics (n=2326)
	Mean	SE	Mean	SE	Mean	SE
Energy, kcal	1722.2	36.5	1637.3	28.7	1653.9	17.1
Protein, g	74.3c	1.7	68.3b	1.6	63.9a	0.8
Carbohydrate, g	205.2	4.0	184.8a	2.9	186.8a	2.1
Total fat, g	68.6	2.2	68.7	1.9	67.6	0.9
% of calories as fat	35.3ab	0.5	36.8c	0.4	36.1ab	0.2
Cholesterol, mg	352.5c	8.7	305.5b	11.5	267.1a	5.1
Vitamin A, IU	6347.4b	432.2	4240.8a	228.0	4596.5a	179.8
Vitamin C, mg	104.1b	4.7	84.1a	3.9	87.9a	2.5
Vitamin E	7.9	0.5	7.3	0.3	7.5	0.2
Folic acid, µg	266.5b	12.2	205.5a	5.2	200.2a	3.9
Calcium, mg	778.8b	23.8	644.5a	32.5	677.7a	16.3
Iron, mg	11.7b	0.3	10.6ab	0.2	10.9ab	0.2
Zinc, mg	11.1b	0.3	10.6	0.7	10.2a	0.2

a,b,c Groups sharing a common superscript are not significantly different from each other at = .05.
Source: Guendelman S, Abrams B. Dietary intake among Mexican-American women: generational differences and a comparison with white non-Hispanic women. Am J Public Health 1995;85:20-25.

Assignment:

Review Table 6 and answer the following questions. 1) Which of the three groups studied by Guendelman has the highest caloric intake?
2) Dietary fat intake of over 25% of total calories from fat has been associated with increased risk of breast and colon cancer. Does the percentage of total calories from fat among first and second generation Mexican-American women suggest that this fac tor is related to their decreased cancer risk?
3) Does acculturation appear to have an impact on the distribution of vitamin, and other micronutrient intake? In what way?

Winkleby et al. (1994) compared dietary intake of Hispanics and non-Hispanic Whites with less than a high school education. The dietary intake data were collected in four California communities in the 1980's. The purpose of limiting the analysis to pers ons with less than a high school education was to control for the effect of socioeconomic status on dietary comparisons across ethnic groups. The authors of this study analyzed dietary intake data obtained from adults ages 20-64 and youths ages 12-19 in the same households. Table 7 reports the distribution of major nutrient sources in the two ethnic groups.

Table 7. 24-hr Dietary Recall Variables for Adult and Youth Hispanic/White Samples Drawn from Low-Educated Households, Three Cross-sectional Surveys, 1981-1990

	Adult sample, ages 20-64			Youth sample, ages 12-19
	Hispanic(n=149)	White(n=187)	Pa	Hispanic(n=51)	White(n=35)	P
Total calories	2152.0 ± 1140.9b	2060.7 ± 1187.4	ns	2143.9 ± 768.0	2173.9 ± 889.9	ns
% Calories from
Total fat	33.3 ± 10.02	37.7 ± 11.0	0.001	35.9 ± 8.8	38.0 ±7.6	ns
Saturated fat	11.8 ± 4.7	13.7 ± 4.7	0.001	13.7 ± 4.7	14.6 ± 4.0	ns
Carbohydrates	49.7 ± 11.5	45.5 ± 12.2	0.001	50.0 ± 9.8	47.3 ± 9.1	ns
Protein	15.6 ± 4.2	15.2 ± 5.3	ns	14.0 ± 3.5	14.7 ± 4.5	ns
Alcohol	l1.4 ± 4.7	1.6 ± 5.1	ns	0.1 ± 0.6	0.0 ± 0.0	ns
Dietary Fiber (g)	26.0 ± 21.0	17.1 ± 13.7	0.001	21.1 ± 16.2	16.0 ± 13.2	ns
Fruits (servings/day)c	0.7 ± 1.0	0.8 ± 1.1	ns	0.9 ±1.2	0.3 ± 0.5	ns
Vegetables (servings/day)d	2.3 ± 1.8	2.3 ± 2.3	ns	1.6 ± 1.6	1.5 ± 1.9	ns

a P values indicate a significant effect of ethnicity, when P < 0.05.
b Mean ± standard deviation.
c Excludes fruit drinks
d Excludes corn and potatoes
Source: Winkleby MA, Albright CL, Howard-Pitney B, Lin J, Fortman SP. Hispanic/white differences in dietary fat intake among low educated adults and children. Preventive Medicine 1994; 23:465-473.

Assignment:

Review Table 7 and answer the following questions.
1) What are the major differences in nutrient intake between adult whites Hispanics?
2) Which group has a more favorable dietary pattern, based on what is currently known about dietary intake and cancer and heart disease risk--Hispanic or White adults?
3) What does the distribution of nutrients among Hispanic and White youth suggest about maintenance of differences in dietary intake between the two ethnic groups?
4)Do you believe that health promotion messages targeted to Mexican-Americans should encourage maintenance of traditional eating patterns? Are there traditional eating patterns that you feel should be changed?

Summary of Cancer Mortality and Risk Factors in Hispanics

Hispanics, particularly Mexican-Americans, are clearly at lower risk for many of the common cancers that affect residents of the United States. It is likely that this protection comes from one or more characteristics of the traditional Hispanic lifestyle , such as diet, smoking habits, and reproductive patterns. The challenge for health professionals is to identify these factors and develop health promotion programs that encourage Hispanics to maintain the protective behaviors.