Chartbook for Hispanic Health Care

• Thirty years ago, the Heckler Report found that:
  • Overall age-adjusted cancer incidence rates for Hispanics were lower than for Blacks or nonminorities. Specific sites of excess incidence among Hispanics were the stomach, prostate, esophagus, pancreas, and cervix.
  • The overall 5-year relative survival rate of Hispanic males was almost identical to that of nonminorities. Hispanic females had somewhat lower survival rates than nonminority females.
  • Mortality data are derived from the National Center for Health Statistics (NCHS) through the vital statistics system. This system classifies Hispanics as Whites, so no death statistics on Hispanics are presented.
• Today, death statistics on Hispanics are available. In addition, quality care for cancer has changed. Evidence-based mass screening is recommended in specific populations for four cancers: breast, cervical, colorectal, and lung cancer. Screening is the first step in the process of cancer prevention (Pap testing for cervical and colonoscopy for colorectal) and early detection (mammography for breast and CT scan for lung) in the process of cancer control. Hence, screenable cancers have been selected for inclusion in this chartbook.

Breast Cancer Care for Hispanics

• Trends: Most measures of breast cancer care for Hispanics were improving.
• Groups With Disparities:
  • Rates of mammography were similar between Hispanic and White women. This represents the elimination of a previously observed disparity.
  • Rates of diagnosis with advanced stage breast cancer and death due to breast cancer were lower among Hispanics compared with non-Hispanic Whites and these disparities were not changing over time.
  • Hispanic women were more likely to receive axillary node dissection at time of surgery and this disparity did not change over time.
  • Hispanics were less likely to receive radiation therapy after breast-conserving surgery compared with Whites. This disparity did not change over time.

Breast Cancer Treatment

Women under age 70 treated for breast cancer with breast-conserving surgery who received radiation therapy to the breast within 1 year of diagnosis, by race/ethnicity and Hispanic group, 2004-2011

Left Graph:

2008 Achievable Benchmark: 94%.

Right Graph:

2008 Achievable Benchmark: 94%.

Source: Commission on Cancer, American College of Surgeons and American Cancer Society, National Cancer Data Base, 2004-2011.
Denominator: Women under age 70 treated for breast cancer with breast-conserving surgery.
Note: Puerto Ricans include patients receiving cancer care in hospitals in Puerto Rico.

• Importance: Radiation therapy after breast-conserving surgery reduces the risk of cancer recurrence and death.
• Trends: From 2004 to 2011, the percentage of women with breast-conserving surgery who received radiation therapy to the breast improved overall and among all ethnic groups.
• Groups With Disparities:
  • In all years, Hispanic and Black women were less likely to receive radiation therapy to the breast compared with White women.
  • In all years, Mexicans and other Hispanics were also less likely to receive radiation therapy to the breast compared with White women.
• Achievable Benchmark:
  • The 2008 top 5 State achievable benchmark was 94%. The top 5 States that contributed to the achievable benchmark are Kansas, Minnesota, Montana, North Dakota, and Wisconsin.
  • At the current rates of improvement, the benchmark could not be achieved overall for about 17 years.
  • At the current rates of improvement, Whites would need 14 years to achieve the benchmark, and Hispanics would need 25 years.

Colorectal Cancer Care for Hispanics

• Trends: All measures of colorectal cancer care for Hispanics were improving.
• Groups With Disparities:
  • Hispanics were less likely to receive colorectal cancer screening than Whites and this disparity was growing over time.
  • Rates of diagnosis with advanced stage colorectal cancer and death due to colorectal cancer were lower among Hispanics compared with Whites. These disparities were growing over time.
  • Rates of surgical resection of colon cancer that included at least 12 lymph nodes pathologically examined were similar between Hispanics and Whites.

Colorectal Cancer Screening

Men and women ages 50-75 who report that they had appropriate colorectal cancer screening, by race/ethnicity and by family income among Hispanics, 2000-2010

Left Graph:

Right Graph (Hispanics):

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey, 2000-2010.
Denominator: Adults ages 50-75.
Note: Measure is age adjusted.

• Importance: Screening can detect abnormal colorectal growths before they develop into cancer. Early detection increases treatment options and the chances for cure. Effective screening modalities include fecal occult blood testing (FOBT), FOBT with flexible sigmoidoscopy, and colonoscopy.
• Trends: From 2000 to 2010, the percentage of adults ages 50-75 who received appropriate colorectal cancer screening increased overall and among all ethnic groups.
• Groups With Disparities:
  • In all years, the percentage of adults who received appropriate colorectal cancer screening was lower among Hispanics and Blacks compared with Whites.
  • In all years, the percentage of adults who received appropriate colorectal cancer screening was lower among poor and low-income Hispanics compared with high-income Hispanics.

Colon Cancer Treatment

Patients with colon cancer who received surgical resection of colon cancer that included at least 12 lymph nodes pathologically examined, by race/ethnicity and by Hispanic group, 2004-2011

Left Graph:

2008 Achievable Benchmark: 90%.

Right Graph:

2008 Achievable Benchmark: 90%.

Source: Commission on Cancer, American College of Surgeons and American Cancer Society, National Cancer Data Base, 2004-2011.
Denominator: People with colon cancer undergoing resection of colon.
Note: Puerto Ricans include patients receiving cancer care in hospitals in Puerto Rico.

• Importance: Recommended cancer treatment depends on different factors, such as the stage or extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. Colon cancer typically begins as a benign polyp that may become cancerous and then spread to local lymph nodes. Hence, ensuring adequate examination of lymph nodes when surgery is performed is important.
• Trends: From 2004 to 2011, the percentage of patients with colon cancer who received surgical resection of colon cancer that included at least 12 lymph nodes pathologically examined improved overall and for all ethnic groups.
• Groups With Disparities:
  • In all but 1 year, Puerto Ricans were less likely than Whites to have surgical resection of colon cancer that included at least 12 lymph nodes examined.
• Achievable Benchmark:
  • The 2008 top 5 State achievable benchmark was 90%. The top 5 States that contributed to the achievable benchmark are Delaware, Missouri, Utah, Vermont, and Wisconsin.
  • At the current rates of improvement, the achievable benchmark could be attained overall and for all ethnic groups within a year.
  • Cubans have already achieved the benchmark while Puerto Ricans would not reach the benchmark for 4 years.

Other Cancer Care for Hispanics

• Trends: Most measures of other cancer care for Hispanics were improving.
• Groups With Disparities:
  • Death rates were lower among Hispanics compared with Whites and were not changing over time for:
    • All cancers in aggregate.
    • Lung cancer.
  • Hispanics were less likely to receive appropriate Pap testing and more likely to develop invasive cervical cancer compared with Whites. These disparities were narrowing over time.

Cervical Cancer Screening

Women ages 21-65 who received a Pap smear in the last 3 years, by race/ethnicity and by insurance among Hispanics, 2000-2010

Left Graph:

Right Graph (Hispanics):

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey, 2000-2010.
Denominator: Women ages 21-65.
Note: Measure is age adjusted.

• Importance: Screening with Pap smears can detect high-grade precancerous cervical lesions that can be removed before they become cancerous.
• Trends: From 2000 to 2010, the percentage of women ages 21-65 who received a Pap smear in the last 3 years decreased overall and among White women; no statistically significant changes were noted among Hispanic women.
• Groups With Disparities:
  • In all years, the percentage of women who received a Pap smear was lower among Hispanic women compared with White women.
  • In all years, the percentage of women who received a Pap smear was lower among uninsured Hispanic women compared with privately insured Hispanic women.

AHRQ Health Care Innovations in Cancer Screening

Family Health Partnership Clinic

• Location: McHenry County, Illinois.
• Population: Rural, low-income Hispanic women >40.
• Intervention: Celebremos La Vida seeks to enhance access to culturally competent cancer screening and educational information by providing a monthly women's clinic.
• Outcomes: Enhanced access to breast and cervical cancer screening, increased use of primary care services, and high levels of patient satisfaction.

Return to Contents