Cancer Among Hispanics and Latinos

Cacer Amog Hispaics ad Latios Itroductio The Hispaic/Latio populatio is ofte described as a mosaic of cultures. Moreover, the diversity exteds to atioality, customs, heritage, lifestyles ad socioecoomic status. The Hispaic heritage ca be traced back to Spai. Latio/a refers to persos livig i Spaish-speakig Lati America ad their heritage ca be traced back to the Lati laguage. The terms Hispaic ad Latio/a are used iterchageably i this report. The Hispaic/Latio populatio comprises early 15% of the U.S. populatio ad is the fastest growig racial/ethic group. As of 2007, a estimated 2,400,500 Hispaic/Latios reside i This report icludes the followig sectios: Health profile amog Hispaic adults Table 1. Percetage of Hispaic Residets by SAD State (raked from highest to lowest) SAD State/District Number of Hispaic Residets Percet of Total State Populatio District of Columbia 50,711 8.7% Georgia 702,087 7.5% North Carolia 598,562 6.7% Delaware 54,319 6.3% Virgiia 487,057 6.3% Marylad 340,026 6.0% South Carolia 151,248 3.5% West Virgiia 16,490 0.9% South Atlatic Divisio 2,400,500 6.1% Source: Claritas Health profile amog Hispaic youth Cacer screeig patters Cacer icidece & mortality amog Hispaics Stage at diagosis ad survival Access to care Programs to promote healthy behaviors amog Hispaics Limitatios the South Atlatic Divisio (SAD) ad they make up 6.1% of the populatio. 7 The fastest populatio growth for Hispaics is i the South; Georgia, North Carolia ad South Carolia are amog the top states with a icrease of more tha 300% i the last te years. Withi the Divisio, the District of Columbia raks highest i the proportio of Hispaic residets (8.7%), followed by Georgia at 7.5%, ad West Virgiia has the smallest proportio at 0.9%. (Table 1) Official cesus couts of the Hispaic/Latio populatio, however, are believed to be uderrepreseted due to idividual idetity preferece (black/white versus Hispaic/Latio) as well as legal status cocers of the commuity ad recet chages i immigratio patters. Overall, six out of te Hispaic/Latio residets i the SAD have reported to be from Mexico, Puerto Rico or Cuba. 8 I North Carolia, Georgia ad South Carolia, Mexicas comprise the majority of Hispaic residets, with 66.6%, 65.4% ad 63.0%, respectively. Delaware has the largest proportio of Latios of Puerto Rica descet (27.3%) ad District of Columbia has the highest proportio from Cuba (4.9%). Persos from other Hispaic/Latio coutry are most commo i the District of Columbia (76.5%), Marylad (67.6%) ad Virgiia (61.3%). (Table 2) Additioal data reveal that the District of Columbia, with more tha three-quarters of its populatio i the other Hispaic/ Latio category, is home to the largest Bolivia populatio i the U.S., the secod largest cocetratio of Salvadoras ad sigificat populatios from Peru, Colombia, Mexico, Guatemala, Hoduras, Ecuador ad Nicaragua. The District also icludes embassies ad cosulates from may Lati America coutries. Health Profile amog Hispaic Adults Experts believe that if curret kowledge about cacer prevetio ad early detectio were applied, at least half of all cacer deaths could be preveted. The America Cacer Society estimates that i 2008, about 170,000 cacer deaths will be attributed to tobacco use aloe. I additio, approximately oe-third (188,550) of the 565,650 cacer deaths expected i 2008 are attributable to poor utritio, overweight/obesity ad lack of physical activity. Cacer screeig tests ca detect pre-cacerous lesios, improve survival or decrease mortality by detectig cacer at a earlier stage whe treatmet is more effective. 3 Table 2. Distributio of Hispaic/Latio Residets by Coutry of Origi ad SAD States, 2007 populatio estimates Coutry of Origi DE DC GA MD NC SC VA WV SA* Mexico 45.8% 12.8% 65.4% 19.1% 66.6% 63.0% 25.1% 40.0% 49.3% Puerto Rico 27.3% 5.7% 7.4% 10.9% 7.5% 10.1% 10.9% 12.6% 9.2% Cuba 1.7% 4.9% 2.7% 2.3% 1.8% 1.7% 2.7% 2.9% 2.4% Other Hispaic/Latio 25.3% 76.5% 24.6% 67.6% 24.1% 25.2% 61.3% 44.5% 39.1% Total Kow Hispaic/ Latio Residets 54,319 50,711 702,087 340,026 598,562 151,248 487,057 16,490 2,400,500 Source: Cesus; *Populatio - weighted average. America Cacer Society South Atlatic Cacer Facts & Figures 2008

limited, smokig patters amog Latios i the South Atlatic Divisio do geerally follow the atioal patter where 17.9% of Hispaics are curret smokers i 2007, compared with 19.8% o-hispaic (NH) white ad 21.7% o-hispaic (NH) blacks. A exceptio is oted i Delaware, where the cigarette smokig rate amog Hispaics (24.3%) is higher tha amog o-hispaic whites (19.4%) ad o-hispaic blacks (14.6%). (Table 3) Smokig rates amog Hispaic me are about 25% lower tha i o-hispaic white me, ad Hispaic wome are about half as likely to smoke as o-hispaic white wome. 6 Cigarette smokig rates amog Hispaics bor i the U.S. are higher tha amog those bor elsewhere. 2 Tobacco Use: The Natioal Latio Coucil o Alcohol ad Tobacco Prevetio, more commoly kow as LCAT, is a oprofit 501(c)(3) atioal orgaizatio established i 1989 i order to combat alcohol ad tobacco problems ad their uderlyig causes i Latio commuities (www.lcatp.org). As the oly Latio atioal orgaizatio dedicated solely to reducig the harm caused by alcohol ad tobacco i the Latio commuity, their work is coducted through research, advocacy, policy aalysis, commuity educatio, traiig ad iformatio dissemiatio. Results of their research show that: Puerto Ricas are more likely tha other Latios to be curret smokers. For Latias, there is a positive relatioship betwee level of acculturatio ad smokig. I 2005, 22 percet of Hispaic high school studets smoked, a 19 percet icrease over the 2003 smokig rate of 18.4 percet. I 2004, 9.4 percet of Hispaic middle school studets smoked. Puerto Rica wome are early twice as likely to smoke as wome of other Hispaic groups. Lug cacer is the leadig cause of cacer deaths amog Latios livig i the Uited States. The Behavioral Risk Factor Surveillace System survey (BRFSS) is a aual survey of the Ceters for Disease Cotrol ad Prevetio (CDC) ad the U.S. states ad territories. 6 Although the state-specific data o risk behaviors amog Hispaics are Poor utritio, lack of physical activity ad beig obese or overweight are major cacer risk factors, secod oly to tobacco use. Approximately oe-third, or 188,550 of the 565,650 cacer deaths i 2008 will have bee associated with these three risk factors. This statistic would mea that 7,772 of the 23,320 U.S. cacer deaths expected amog Hispaics i 2006 could have bee preveted through a healthy diet, regular physical activity ad weight cotrol. Nutritio ad Physical Activity: The ACS Recommedatios for Nutritio ad Physical Activity, updated i 2006, highlight the importace of havig a healthy weight ad physical activity i the prevetio of cacer. 5 The recommedatios iclude the followig: Maitai a healthy weight throughout life. Balace calorie itake with physical activity. Avoid excessive weight gai throughout life. Achieve ad maitai a healthy weight if curretly overweight or obese. Adopt a physically active lifestyle. Adults: Egage i at least 30 miutes of moderate to vigorous physical activity, above usual activities, o 5 or more days of the week; 45 to 60 miutes of itetioal physical activity are preferable. Childre ad adolescets: Egage i at least 60 miutes per day of moderate to vigorous physical activity at least 5 days per week. Fruits ad Vegetables: Eatig five or more servigs of a variety of vegetables ad fruits every day is a recommedatio i the America Cacer Society s Nutritio Guidelies, updated i 2006. 5 Ufortuately, BRFSS estimates show that more tha three-quarters of adult Americas DO NOT meet the ACS rec- Cotiued Table 3. Estimated Prevalece of Curret Cigarette Smokig amog Adults (%) by Race/Ethicity for SAD States ad U.S., 2007 Hispaic 24.3 11.0 15.0 13.9 19.2 19.6 14.1 /a 17.9 16.7 NH White 19.4 8.5 19.1 17.4 23.1 22.0 18.1 27.1 19.2 19.8 NH Black 14.6 24.2 19.6 19.0 23.0 24.7 20.9 31.6 20.8 21.7 Source: BRFSS; * Populatio-weighted estimated average of SAD states with available data America Cacer Society South Atlatic Cacer Facts & Figures 2008 9

ommedatio for miimum fruit ad vegetable cosumptio. I the SAD, cosumptio is lowest amog Hispaics (79.5%), followed by NH whites (77.8%) ad NH blacks (76.3%). (Table 4) Physical Activity: Research idicates that regular physical activity ca prevet cacer by helpig reduce overweight ad obesity. Achievig ad/or maitaiig a ideal weight ca help decrease the risk of cacers of the colo/rectum, breast (premeopausal), uterus ad prostate. Regular physical activity is also beeficial i the prevetio of chroic diseases, particularly diabetes ad heart disease. The BRFSS questio do you have at 30+ miutes of moderate physical activity five or more days per week, or vigorous physical activity for 20+ miutes three or more days per week? is the measure of adult physical activity that most closely resembles the ACS guidelie listed above. The South Atlatic Divisio overall has a higher prevalece tha the U.S. of persos that DO NOT have regular physical activity i each of the race/ethicity groups show i Table 5. The rate of physical iactivity amog Hispaics i the SAD is 18% higher tha the U.S. Hispaic rate, but data are oly available for the District of Columbia, Marylad ad North Carolia. I North Carolia ad South Carolia, prevalece of physical iactivity is higher tha the U.S. amog both white ad black o-hispaics. Obesity/Overweight: Beig overweight or obese is associated with icreased risk of cacers of the breast, prostate, colo/ rectum ad uterus, i additio to other chroic diseases such as diabetes, high blood pressure, heart disease ad premature death. A commo measure to establish whether a perso is u- derweight, ormal weight, overweight or obese is the Body Mass Idex (BMI) which is determied by the perso s height ad weight. Obese is havig a BMI of 30 or higher ad overweight is defied as havig a BMI of 25 to less tha 30. Obesity has bee icreasig i the U.S. i both Hispaics ad o-hispaics. Data from the BRFSS survey, where overweight ad obese are classified based o the idividual s self-reported height ad weight, show that i the U.S. early 68 percet of Hispaic residets were overweight or obese compared with 61.7% of o-hispaic whites. No-Hispaic blacks, however, had a obesity/overweight prevalece of 72.6%. Data from other surveys suggest that the rate of obesity is higher amog Puerto Ricas ad Mexicas tha i other Hispaic subgroups. 2 I the South Atlatic Divisio, the prevalece of overweight/ obesity amog o-hispaics is similar to the U.S. rate. A exceptio is the District of Columbia, where the prevalece of overweight/obesity for NH whites at 39.3% is 36% lower tha the U.S. rate for that race/ethic group. Although data for Hispaics are oly available for 2 states ad the District of Columbia, the SA combied rate (60.7%) is lower tha the U.S ad lower tha NH whites ad NH blacks i the SA Divisio; 62.8% ad 72.7%, respectively. (Table 6) Health Profile amog Hispaic Youth The Youth Risk Behavior Surveillace Survey (YRBSS) is a aual survey that is also coducted by the Ceters for Disease Prevetio ad Cotrol. 13 Although the data o Hispaic youth are limited at the state level, data for the etire U.S. ca provide Table 4. Estimated Prevalece of Not Eatig 5 Fruits & Vegetables per Day (%) amog Adults by Race/Ethicity for SAD States ad U.S., 2007 Hispaic 80.5 71.2 78.6 79.6 85.3 81.5 75.8 /a 79.5 75.3 NH White 79.3 64.7 75.2 72.9 76.9 80.9 73.5 80.9 77.8 75.5 NH Black 77.1 69.5 74.8 74.8 81.5 82.3 72.9 75.7 76.3 76.9 Source: BRFSS; * Populatio-weighted estimated average of SAD states with available data Table 5. Estimated Lack of Physical Activity (%) amog Adults by Race/Ethicity for SAD States ad U.S., 2007 Hispaic /a 56.2 /a 60.2 69.0 /a /a /a 65.2 55.3 NH White 50.1 33.3 50.9 48.4 53.1 51.7 49.0 54.5 50.6 48.4 NH Black 61.8 54.7 57.3 58.7 62.3 60.0 56.7 /a 59.0 58.6 Source: BRFSS; * Populatio-weighted estimated average of SAD states with available data Table 6. Estimated Prevalece of Overweight/Obesity amog Adults (%) by Race/Ethicity for SAD States ad U.S., 2007 Hispaic 57.0 57.2 63.5 56.8 62.4 58.3 56.2 /a 60.7 67.7 NH White 64.2 39.3 63.2 60.7 62.5 63.0 60.3 68.6 62.8 61.7 NH Black 73.0 68.8 69.9 74.2 74.7 73.6 72.4 55.0 72.7 72.6 Source: BRFSS; * Populatio-weighted estimated average of SAD states with available data 10 America Cacer Society South Atlatic Cacer Facts & Figures 2008

Table 7. Estimated Prevalece of Risk Behaviors amog High School Studets (%) by Race/Ethicity for the U.S., 2007 Hispaic White No-Hispaic Black No-Hispaic Risk Factor Male Female Male Female Male Female Curret Cigarette Smokig 18.7 14.6 23.8 22.5 14.9 8.4 Curret Smokeless Tobacco Use 6.7 2.7 18.0 2.5 2.0 0.5 Did Not Cosume 5 Fruits & Vegetables per Day 74.1 77.9 79.9 82.4 73.4 76.6 Did Not Meet Recommeded Level of Physical Activity 18.8 35.2 16.7 28.2 21.8 42.1 Are Overweight or Obese 38.6 30.6 30.3 19.6 35.5 39.2 Source: YRBSS, 2007 a ivaluable profile of risk behavior patters amog Hispaic studets. (Table 7) Data are show here for high school studets. Cigarette Smokig: Data from the YRBSS 2007 show that the prevalece of cigarette smokig amog white NH youth (23.8% male ad 22.5% female) is still higher tha amog Hispaic youth (18.7% male ad 14.6% female). (Table 7) Amog black o-hispaic studets, 14.9% of male ad 8.4% of female studets reported curret cigarette use (at least oe cigarette per day over the past 30 days). Although Hispaic youth i the U.S. ted to smoke less tha NH youth, these patters may chage as marketig efforts icrease i Lati America coutries, particularly amog wome, ad also target Hispaic wome ad youth i the Uited States. 2 Smokeless Tobacco Use: Smokeless tobacco products, icludig chewig tobacco ad suff, are ot safe substitutes for cigarette smokig. These products ca cause oral ad pacreatic cacers, ocacerous oral coditios ad ca lead to icotie addictio. The tobacco idustry cotiues to market ew ad existig products as supplemetal sources of icotie i smoke-free settigs ad misleadigly markets these products as a low-risk optio for smokers who are uable to quit. I Table 7 are usage rates for smokeless tobacco products amog high school studets. Amog Latios, 6.7% of male ad 2.7% of female studets used smokeless tobacco products. The highest prevalece rate was 18.0% of white NH youth usig smokeless tobacco products ad the lowest rate was 0.5% amog black o-latias. I each race/ethicity category i Table 7, male studets are more likely tha female studets to be users of smokeless tobacco products, Fruits ad Vegetables: ACS recommedatios o fruit ad vegetable cosumptio for childre/youth parallel those for adults. Amog male studets, the prevalece of ot eatig 5 or more fruits ad vegetables was highest amog white NH (72.2%) tha Hispaic (76.0%) ad black NH (75.1%). I each race/ethicity category, female studets ate more fruits ad vegetables daily tha male studets, although the differece was oly about two percetage poits i each category. (Table 7) Physical Activity: The recommeded physical activity for childre ad adolescets is to egage i at least 60 miutes per day of moderate to vigorous physical activity at least 5 days per week. I each race/ethicity category, the prevalece of studets who DO NOT meet the recommeded physical activity level is higher amog female tha male studets. Amog male studets, 18.8% of Hispaics did ot meet the physical activity requiremets; black o-hispaics had the highest rate (21.8%) ad white o-hispaics the lowest rate at 16.7%. A similar patter is see amog female studets. (Table 7) Overweight/Obesity: Sice 1990, the prevalece of overweight childre has icreased sharply i childre of all racial ad ethic groups i the U.S. Overweight childre ofte become overweight adults, with icreased risks of poor health outcomes such as high blood pressure, high cholesterol ad diabetes. 3 I Table 7 are prevalece rates for overweight/obese by geder ad ethicity/race category. As i adults, the weight category for childre is determied by the Body Mass Idex (BMI), but the formulas for the childhood BMI vary by age. Amog male youth, the rate of beig overweight/obese is highest amog Hispaic high school studets (38.6%), followed by o-hispaic black (35.5%) ad NH white (30.3%) high school studets. Amog female high school studets, o-latia blacks have the highest rate of overweight (39.2%), followed by Latias (30.6%) ad o-latia white high school studets (19.6%). Cacer Screeig Patters amog Hispaics Cacer screeig as recommeded by the America Cacer Society (ACS) ca measurably improve oe s chaces for a favorable outcome by detectig the cacer at a early stage whe treatmets are most effective. These guidelies are for people at average risk for cacer (uless otherwise specified) ad without ay Cotiued America Cacer Society South Atlatic Cacer Facts & Figures 2008 11

specific symptoms. Those that are at icreased risk for certai cacers should cosult their physicia as they may eed to follow a differet screeig schedule, such as startig at a earlier age or beig screeed more ofte. Also, persos with symptoms that could be related to cacer should see their doctor right away. 4 Breast Cacer Screeig: The ACS guidelies state that yearly mammograms are recommeded startig at age 40 ad cotiuig for as log as a woma is i good health. 2 A mammogram is a low-dose X-ray procedure that ca detect breast cacer at a early stage whe treatmet would be more effective. I 2006 i the South Atlatic Divisio, Latias have a lower rate of mammography screeig (60.7%) tha o-latia whites (62.8%) ad o-latia blacks (63.8%). (Table 8) Additioal survey data from 2003 show that wome from Cetral ad South America, ad Cuba have higher mammography screeig rates tha Mexica wome. 2 U.S. data show a screeig patter that is similar to the SAD, but the U.S. screeig rate i each race/ethicity group is 1-2 percetage poits lower tha see i the SAD. Although the mammography screeig rates amog Latias have improved cosiderably durig the past 20 years ad are approachig those of o-latias, breast cacers diagosed amog Latias are, o average, diagosed at a more advaced stage tha those diagosed amog o-latias. 2 Prostate Cacer Screeig: The ACS suggests screeig for prostate cacer by a combiatio of the prostate-specific atige (PSA) test ad digital rectal exam (DRE) at ages ad time itervals that are depedet upo each ma s race, age ad kow risk factors. 5 The BRFSS questioaire asks me ages 40 ad older if they have had a PSA (prostate-specific atige) test withi the past two years. I the U.S., Hispaic me have the lowest PSA screeig rate (43.0%), followed by NH black me (48.1%) ad NH white me (55.6%). No-Hispaic me i the SA Divisio follow the same patter as U.S. me. I fact, PSA screeig rates are lower for black NH me tha white NH me i each state i the South Atlatic Divisio, most otably i Delaware ad South Carolia. (Table 9) Colorectal Cacer Screeig: New screeig guidelies for colorectal cacer released i March 2008 iclude: (1) tests that fid polyps ad cacer ad (2) tests that maily fid cacer ad are show i detail o page 82 of this publicatio. 5 The BRFSS questioaire asks adults ages 50+ if they have ever had a sigmoidoscopy or colooscopy (i.e. a edoscopy) (Table 10). Although the ew guidelies recommed a flexible sigmoidoscopy every 5 years or a colooscopy every 10 years, the BRFSS questio ca still be used to approximate regioal as well as sex- ad race/ ethicity-specific screeig patters across the SAD. The rate of screeig by edoscopy amog South Atlatic Divisio residets ages 50+ is higher tha that see for the U.S. i each race/ethicity category. (Table 10) Although Hispaic adults have the lowest screeig rates of the three race/ethicity groups, their screeig rate i the SAD (49.2%) is early oethird higher tha that amog U.S. Hispaics (38.2%). Marylad has the highest screeig rate for Hispaics (64.3%), followed by Georgia with 55.2% screeed. Amog o-hispaic whites, the District of Columbia ad Delaware have the highest screeig Table 8. Estimated Mammography Screeig Rates amog Wome Ages 40+ by Race/Ethicity for SAD ad U.S., 2006 Hispaic /a /a 60.7 67.2 52.6 56.3 74.0 /a 60.7 58.7 NH White 68.9 62.0 63.3 63.1 64.1 56.4 63.3 62.4 62.8 61.6 NH Black 77.8 64.7 67.8 65.3 66.1 61.0 55.1 /a 63.8 62.7 Source: BRFSS; * Populatio-weighted estimated average of South Atlatic states with available data Table 9. Estimated Prostate Cacer Screeig (PSA) Rates (%) for Me Ages 40 + by Race/Ethicity for SAD ad U.S., 2006 Hispaic /a /a /a /a 32.1 /a /a /a /a 43.0 NH White 63.6 57.2 56.7 58.0 57.7 57.3 55.0 54.0 56.9 55.6 NH Black 43.5 50.0 49.9 46.9 50.4 41.2 53.7 /a 49.2 48.1 Source: BRFSS; * Populatio-weighted estimated average of South Atlatic states with available data Table 10. Estimated Colorectal Cacer Screeig (edoscopy) Rates (%) for Adults Ages 50 + by Race/Ethicity for SAD ad U.S., 2006 Hispaic /a /a 55.2 64.3 41.1 51.8 38.7 /a 49.2 38.2 NH White 61.7 62.7 50.5 57.7 54.2 51.4 58.4 46.1 54.2 51.5 NH Black 59.3 55.4 47.3 58.4 52.3 43.0 59.3 /a 52.5 49.3 Source: BRFSS; * Populatio-weighted estimated average of South Atlatic states with available data 12 America Cacer Society South Atlatic Cacer Facts & Figures 2008

rates at 62.7% ad 61.7%, respectively. No-Hispaic blacks have the highest screeig rates i Delaware ad Virgiia (both at 59.3%). The BRFSS survey also asks adults ages 50+ if they have had a blood stool test withi the past two years. (Table 11) The blood stool test, ofte referred to as the Fecal Occult Blood Test or FOBT, is also oe of the tests recommeded i the ACS guidelies. Hispaics have the lowest frequecy of FOBT screeig of the race/ethic groups i the U.S. (11.3%) ad i the SAD (10.9%). The FOBT rate amog NH blacks is higher tha or equal to the rate for NH whites i each South Atlatic Divisio state. Cervical Cacer Screeig: The ACS suggests screeig for cervical cacer by Pap tests at time itervals that are depedet upo the woma s age, risk factors ad sexual history. 5 The BRFSS questioaire measures cervical cacer screeig by the questio have you had a Pap test withi the past 2 years? for wome ages 18 ad older. Although Latias have bee less likely to participate i cervical cacer screeig, their rates have improved i recet decades. Amog Latias, cervical cacer screeig rates are lowest amog Mexica wome ad amog uisured wome. 2 Latias have the lowest cervical cacer screeig rates i the South Atlatic Divisio (82.8%) as well as the U.S. (82.0%). I Delaware, however, the rate for Latias is higher tha that for o-latias, but the opposite is true (higher amog o-latias tha Latias) i the District of Columbia, Georgia, Marylad ad North Carolia. (Table 12) Cacer Icidece ad Mortality amog Hispaics About 39,940 ew cacer cases i Hispaic me ad 42,140 cases i Hispaic wome were expected to be diagosed i the U.S. i 2006. The most commoly diagosed cacers amog Hispaic me were expected to be prostate (30%), colo/rectum (11%) ad lug (8%). Amog Latias, the most commo cacers were expected to be breast (34%), colo/rectum (9%) ad lug (6%). 2 Cacer Icidece: State-specific data o cacer icidece ad mortality have ot bee published by South Atlatic Divisio state cacer registries due to the relatively small umbers of Hispaic residets i each state. Data for the Uited States, however, show that Hispaics have 30% lower icidece rates for all cacers combied whe compared to whites, but Latios geerally have higher rates of cacers associated with certai ifectios, such as cacers of the uterie cervix, liver, gallbladder ad stomach. 2 Hispaic me ad wome are 1.5 to 2 times more likely to have oe of these four cacers tha o-latios. Cacer Mortality: The umbers of cacer deaths i 2006 were expected to be 12,320 amog Hispaic me ad 11,000 i Latias i the U.S. I Hispaic me, lug cacer would accout for 21% of the deaths, followed by colo/rectum (11%) ad prostate (9%). Amog Latias, breast cacer is the leadig cause of cacer death (21% expected), followed by lug (9%) ad colo/rectum (6%). This patter is i cotrast with white o-hispaic wome, amog whom lug cacer is the most commo cause of cacer death. Childhood Cacer: Cacer is relatively rare amog childre (0-14 years) ad adolescets (15-19 years), ad the types of cacers foud i childre/adolescets are differet from those see i adults. It was estimated that 1,850 Hispaic childre would be diagosed with cacer i the U.S. i 2006. The prevalece of child/adolescet cacers i Hispaics (2.3% of all cacers) is higher tha that see i the total U.S. populatio, where oly 1% Cotiued Table 11. Estimated Fecal Occult Blood Test Rates (%) for Adults Ages 50 + by Race/Ethicity for South Atlatic Divisio ad U.S., 2006 Hispaic /a /a 11.0 23.3 9.5 12.6 2.4 /a 10.9 11.3 NH White 14.4 22.5 17.3 18.6 21.1 13.5 14.7 18.4 17.5 16.5 NH Black 16.1 22.5 19.8 21.1 21.1 17.6 15.9 /a 19.2 16.9 Source: BRFSS; * Populatio-weighted estimated average of SAD states with available data Table 12. Estimated Pap Smear Screeig Rates by Race/Ethicity Amog Wome Ages 18+ for SAD ad U.S., 2006 Hispaic 91.3 86.6 75.3 82.2 83.9 87.2 87.5 /a 82.8 82.0 NH White 89.4 90.3 87.6 87.7 86.3 85.7 85.3 83.6 86.5 84.2 NH Black 86.8 88.6 90.3 88.5 89.6 90.3 89.2 /a 89.5 87.2 Source: BRFSS; * Populatio-weighted estimated average of SAD states with available data America Cacer Society South Atlatic Cacer Facts & Figures 2008 13

of cacers are childhood cacers. Oe reaso is that the U.S. Hispaic populatio is youger o average tha the rest of the U.S. populatio; childre accout for 34% of the Hispaic populatio compared to 25% of the total U.S. populatio. 2 It was estimated that 350 Hispaic childre would die from cacer i 2006. Latios are affected by may ecoomic ad cultural disparities i health care, icludig a disproportioate lack of participatio i federally-fuded cacer research. Their lack of iclusio i health research had hidered the developmet of prevetio guidelies ad treatmets appropriate for this special populatio group. Amog Latios, iadequate screeig ad prevetive care ofte lead to late diagosis, delayed ad/or iadequate treatmet ad, with some cacers, higher mortality. The iequalities see i cacer icidece ad mortality betwee Latio ad o-latio populatios ca be reduced by elimiatig exposure to ifectious agets that cause cacer, prevetig Hispaics from adoptig traditioally-avoided high risk cacer behaviors, icreasig use of effective cliical prevetive behaviors ad assurig that every perso diagosed with cacer has affordable ad timely access to state-of-the-art, affordable cacer care. 10 Stage at Cacer Diagosis ad Survival Stage at diagosis idicates whether or ot the cacer has spread to other orgas ad regios of the body ad is oe of the tumor characteristics that is used to select a treatmet for the patiet. I geeral, cacers diagosed i the later stages (regioal ad distat) have a poorer progosis because the tumor has spread beyod the site of origi. Health care barriers such as lack of health isurace or a usual source of care are experieced by may Hispaic me ad wome i the U.S., as reflected i their lower rates of cacer screeig as well as other prevetive behaviors. Oe example of the effects of lack of access to care ca be see for female breast cacer. 14 Stages At Diagosis I Situ refers to a eoplasm that is oivasive ad cofied to a small area withi the tissue of origi Localized is a ivasive maligat cacer cofied etirely to the orga of origi Regioal is a cacer that 1) exteds beyod the limits of the orga of origi ito surroudig orgas/tissues or 2) ivolves regioal lymph odes by way of lymphatic system Distat idicates that the cacer has spread to other parts of the body, such as the lugs, liver, brai or to distat lymph odes. Breast cacer is the leadig cacer amog wome i the Uited States, represetig 32% of all cacer cases amog wome. It is estimated that 1 i 7 wome will develop breast cacer durig their lifetime. Although breast cacer icidece rates are lower amog Latias compared to o-latias, Latias are more frequetly diagosed at a later stage of breast cacer tha o-latias. Data for the U.S. below show that for female breast cacers diagosed durig 2000-2003, oly 54% of Latias compared with 63% of o-latias were diagosed i the local stage. (Chart 1) Latias are also more likely to be diagosed with larger breast tumors tha o-hispaic wome. I additio, Natioal data show that Hispaic me diagosed with prostate cacer are 3.7 times more likely to be diagosed at a later stage tha o-latios. 2 A cacer survival rate idicates the percetage of patiets who are alive for a give time period, usually five years, after a diagosis of cacer. SEER data show that Hispaic me ad wome have lower survival rates for most cacers, eve after adjustig for differece i age ad stage distributio. For example, a Hispaic ma diagosed with stomach cacer is 26% more likely to die from stomach cacer durig the five years after diagosis compared to a o-hispaic white ma of the same age ad same stage at diagosis. SEER data show that five-year survival from breast cacer for Latias durig 1992-2000 was oly 83.0% compared to 87.5% for o-latias. I additio, whe survival is adjusted for stage ad age at diagosis, Latias were 22% more likely to die from breast cacer tha white o-latias. 2 These differeces may reflect poorer access to timely, adequate health care. Access to Care Health disparities have log bee documeted amog Latios ad other special ethic ad/or racial miority groups i the U.S. Research studies, however, cosistetly show that whe patiets from ethic ad racial miority groups receive the same quality of health care as o-hispaic whites, for example, their health outcomes are very similar. Although the Spaish laguage is the secod most commo laguage i the U.S. ad the Natio has the fifth largest Spaish-speakig populatio i the world, laguage barriers prevet may Latios from uderstadig iformatio from a doctor s office or istructios for prescriptio medicie. Lack of culturally-appropriate services adds to barriers for Hispaics to access adequate health care services ad for them to be able to avigate successfully through the complex health care system. I additio, Hispaics i the U.S. are less likely to have health isurace coverage tha o-hispaics. 2 The Hispaic populatio comprises 15% of the U.S. populatio but Hispaics make up 31.3% of the Natio s uisured. 11 Data from the 2007 BRFSS survey show that whe asked Do you have Chart 1. Stage at Diagosis of Female Breast Cacer Cases for Latias ad White No-Latias, U.S., 2000-2003 Latia ethicity No-Latia white 0 10 20 30 40 50 60 70 80 90 100 Local Regioal Distat Ukow/Ustaged America Cacer Society South Atlatic Cacer Facts & Figures 2008

ay usual source of health care coverage?, Hispaics are more likely to aswer o tha o-hispaics. I the SAD, sparse data from the BRFSS also show that the proportio of adults without ay usual source of health care coverage is markedly higher amog Hispaic (58.9%) tha o-hispaic whites (12.7%) ad blacks (22.8%). (Table 13) Although data are limited to three states, the weighted average of these states estimates that 58.9% of South Atlatic Divisio Hispaics do ot have access to health care, compared to 43.3% for the U.S. I the SAD, 12.7% of o-hispaic whites ad 22.8% of o-hispaic blacks do ot have a usual source of health care coverage compared with 13.0% ad 22.9%, respectively, for the U.S. Several measures of disparities amog Hispaics are 9 : Demographics: Hispaics/Latios (H/L) are twice as likely to live i poverty as white o-hispaics (WN-H). H/L have a media icome that is 39% lower tha WN-H ad oe-third lower tha the atioal average H/L have lower rates of educatioal attaimet tha WN-H; oly 57% of H/L have completed a high school educatio compared with 89% of W-NH Health Status: 51% of H/L compared with 65% of WN-H ad 51% of BN-H report their health status as fair or poor. Access to Health Care: H/L are 2.5 times more likely to report ot havig a doctor tha WN-H. This disparity holds eve whe cotrollig for icome ad isurace status. H/L are more likely (54%) tha WN-H (43%) ad BN-H (44%) to go without eeded care. H/L are most likely to use a commuity health ceter, as their usual place of care (21% vs. 9% WN-H). Health Isurace Coverage: H/L are three times more likely to lack health isurace coverage tha NH-W (35% H/L vs. 12% WN-H). Eve at high icome levels, Hispaics are more likely to be uisured. Nearly half of Hispaics report beig uisured at some poit i the past year. H/L are least likely to have cotiuous isurace coverage eve whe a family member has full-time employmet (53% H/L vs. 82% WN-H). Quality Care (i additio to cacer screeig patters): H/L (140/1,000 discharges with complicatios), alog with Asia/Pacific Isladers (155/1,000), are more likely to die from complicatios i hospital care tha WN-H ad BN-H (both 133/1,000). Hispaics (55%) ad Asias (54%) are less likely to get a same day or ext day appoitmet tha WN-H (66%), ad more likely to wait six days or loger to see a doctor (26% H/L ad 18% Asia compared with 14% WN-H ad 19% BN-H). Hispaics ad Asias are less likely to uderstad their doctor ad less likely to feel their doctor listeed to them tha WN-H ad BN-H. H/L are twice as likely as WN-H to leave the doctor s office with uasked questios. America Cacer Society South Atlatic Cacer Facts & Figures 2008 15 Programs to Promote Healthy Behaviors amog Hispaics The lack of access to health care amog Hispaics as well as other disadvataged populatios ca adversely affect cacer icidece ad mortality throughout the cacer spectrum, from cacer prevetio ad early detectio to treatmet, survivorship ad palliative care. Studies have show, however, that social support offered i local outreach programs ad culturally-appropriate itervetios will help icrease participatio i these services. Lay Hispaic health advisors, alog with physicia ecouragemet, are a effective strategy to improve participatio i cacer screeig as well as prevetio iitiatives. 2 Numerous Hispaic outreach programs have bee active or are i various phases of developmet i the South Atlatic Divisio. Below are just a few examples of such programs desiged to improve access to care amog Hispaics ad help improve the overall health amog Latios i the SAD. Dedicated staff members for Hispaic outreach are strategically placed i regios with the highest Hispaic populatio. The SAD has hired biligual ad/or bicultural staff employed i key positios, icludig commuity outreach to specific populatios, patiet avigatio, ad Cacer Resource Network iformatio specialists. I some istaces, the South Atlatic Divisio was able to ifluece, ad i some cases, provide fudig for hirig of full time staff dedicated to Hispaic/Latio Outreach: Hispaic Parterships Project Maager, Hispaic Outreach Project Maager, Biligual Missio Delivery Maager ad Missio Delivery Maager. I. Promotores de Salud - Promoters of Health Promotores de Salud (Promoters of Health) are ofte referred to as Commuity Health Advisors or Commuity Health Workers. These terms are used iterchageably Table 13. Estimated Proportio of Adults With o Usual Source of Health Care Coverage by Race/Ethicity for South Atlatic Divisio ad U.S., 2007 Cotiued Hispaic /a 22.2 /a 53.5 64.7 /a /a /a 58.9 43.3 NH White 8.5 2.4 14.1 8.6 15.1 14.2 10.0 20.6 12.7 13.0 NH Black 8.5 12.7 28.2 15.8 25.4 27.8 17.8 /a 22.8 22.9 Source: BRFSS; * Populatio-weighted estimated average of SAD states with available data

implemetig a coordiated health commuicatio campaig targetig the Hispaic commuity i the greater Columbia area ad (3) recruit ad trai four Promotoras o use of the adapted Spaish Cacer Educatio Guide ad have them deliver cacer educatioal sessios to groups of te Spaish-speakig Hispaics. Promotoras will also distribute the Su Salud ewsletters ad promote activities of the Partership for Cacer Prevetio i their commuities. II. Vetailla de Salud (VDS) - Health Widow here with the ackowledgemet that cultural uaces exist betwee Promotores ad Commuity Health Worker (CHW) programs. The Promotores are members of a commuity who provide educatio ad other assistace to fellow commuity members so that their health eeds may be met. They each use their uique stregths of their ow experiece ad cultural backgroud to provide health educatio, help others avigate through health care systems, provide support as eeded so that others may access iformatio ad eeded care, moitor vital sigs ad/or advise o selfmaagemet of chroic diseases. Although Promotores have traditioally performed their duties i a advocacy role without pay or with a small stiped ad perhaps some support services, such as providig a place to keep records ad materials, they ca also be paid for their work. A. Baltimore City, MD: Oe example of Promotores i the South Atlatic Divisio is the Latio Provider Network that works for the rights of Latios through (1) exchage of iformatio amog providers ad (2) advocacy ad educatio to Latias i the City of Baltimore. The primary objective is to promote early detectio, prevetio ad successful treatmet of breast ad cervical cacer usig Promotoras de Salud. These wome dissemiate breast ad cervical cacer educatio materials ad iformatio o where to obtai free or low-cost breast ad cervical cacer screeig to the Latia commuity i Baltimore. B. South Carolia: A secod Promotores program i the SAD is called the Partership for Cacer Prevetio Latio/a Iitiative i South Carolia. The objectives of the Iitiative are to: (1) promote access to cacer prevetio ad early detectio health services amog Hispaics i South Carolia who are ot proficiet i Eglish through the developmet of resources that ca be used by members of the partership, cacer cotrol agecies ad healthcare providers withi the South Atlatic Divisio, (2) to promote partership activities ad icrease commuity awareess of cacer prevetio ad cotrol resources by developig ad The Vetailla de Salud (VDS) or Health Widow program is a partership amog local health advocacy ad health service orgaizatios ad the Mexica cosular etwork. This partership is led by local Uited States 501(c)3 service agecies with the appropriate admiistrative capacity ad techical expertise to maage ad implemet the program. The Istitute of Mexicas Abroad (IME), a divisio of the Secretary of Foreig Affairs of Mexico, has established VDS program guidelies ad officially promoted the developmet of this program sice 2004. The America Cacer Society is curretly i parterships with the Mexica cosulates i the District of Columbia; Raleigh, North Carolia ad Atlata, Georgia. The VDS Program Objectives are (1) to provide persoal ad culturally sesitive couselig ad referral services osite to cosular cliets ad their families o how to access available health services i both coutries, (2) whe ecessary ad appropriate, provide backup legal advocacy to cosular cliets o health-related issues such as erollmet i public health isurace programs ad establishig medical homes, (3) to educate ad iform cosular cliets o health issues ad prevetio topics relevat to their commuity ad their specific eeds ad (4) to build a close, direct partership likage of cliet referral ad health educatio amog local Mexica cosulates, local health departmets, commuity health orgaizatios ad the major health istitutios i Mexico. VDS or Health Widows icorporates biligual, bicultural ad highly traied health educators ad health advocates ito the regular flow of cosular services to provide o-site assessmet, referral ad likage to available health services. Advocates assess cosulate cliets for eligibility for govermet-fuded health isurace ad for other primary care services, facilitated by a tool called Guide to Health Programs. I additio, health educators coduct 15 to 30 miute cosumer educatio sessios for a large umber of persos per day. The educatioal presetatios iclude a array of importat public health ad health care access topics. Materials such as Public Service Aoucemets ad short health educatio videos are ofte used to ehace the presetatios. 16 America Cacer Society South Atlatic Cacer Facts & Figures 2008

III. Estacio de Salud y Servicios de El Cosulado de El Salvador - Health ad Services Statio of the Salvadora Cosulate The Hispaic Istitute for Blidess Prevetio (HIBP) is a o-profit orgaizatio (status 501 (3)) whose missio is to cotribute to lowerig the risk of blidess by focusig o uderserved families, miorities ad other groups who are more likely to be at risk of eye-related diseases. Sice November 2005, HIBP has partered with the Salvadora Cosulate ad other local ad federal agecies to create ad implemet a Program called Estacio de Salud y Servicios de El Cosulado de El Salvador (Health ad Services Statio of the Salvadora Cosulate). HIBP is the leadig agecy for this program i both the Cosulates of El Salvador i Washigto, D.C. ad Woodbridge, VA. The goal of this partership is to help overcome barriers such as laguage, educatio, opportuity ad icome that limit access to existig health programs, commuity health resources ad public health isurace programs. The Salvadora Cosulate Program improves cacer awareess amog Salvadora families who atted the cosulate for their legal eeds. Through a o-site cliic for prevetive health care, family members receive health screeigs for chroic diseases ad culturally-appropriate iformatio through educatioal sessios, speakers, prit ad audiovisual materials. For example, patiets who receive a screeig for diabetes, hypertesio or other disease risk factors will also have a oe-o-oe cacer educatio sessio which icludes persoalized cacer iformatio ad referral for cacer screeig as appropriate for age ad geder of the patiet. Topics iclude cacer prevetio, early detectio ad treatmet for the most commo types of cacer amog Hispaics, as well as iformatio o commuity programs that offer free or low-cost screeigs for the uderserved. Limitatios These data should be iterpreted with cautio. Although BRFSS ad YRBSS data i this report are suppressed if less tha 50 persos, the relatively small umbers of resposes preseted here may result i variatios due to small umbers aloe. The risk factor data, however, ca give a geeral idicatio of the cacer risk behaviors amog Latios relative to o-hispaic whites ad o-hispaic blacks. Also, cacer icidece ad mortality data for U.S. Hispaics caot easily be extrapolated to the experieces of Hispaics withi the South Atlatic Divisio states because of regioal ad cultural differeces. Idetificatio of ethic populatios is still icosistet ad uderreported i medical records ad death certificates. I additio to the suspected uderrepresetatio of the Hispaic/ Latio populatio i U.S. Cesus data, aecdotal reports are that Hispaic immigrats may retur to their ative couty after a diagosis of cacer, which would result i uderreportig of cacer deaths amog Latios. 10 Refereces 1. ACS-1 America Cacer Society, Cacer Facts & Figures, 2008, 2. ACS-2 America Cacer Society, Cacer Facts & Figures for Hispaics, 2006-2008, http://www.cacer.org/dowloads/stt/caff2006hispp- WSecured.pdf 3. ACS-3 America Cacer Society, Cacer Prevetio & Early Detectio Facts ad Figures 2008, http://www.cacer.org/dowloads/stt/cped_ 2008.pdf 4. ACS-4 America Cacer Society Guidelies for the Early Detectio of Cacer, http://www.cacer.org/docroot/ped/ped_2.asp?sitearea=ped 5. ACS-5 America Cacer Society Guidelies o Nutritio ad Physical Activity for Cacer Prevetio, http://www.cacer.org/docroot/ped/ped_ 3.asp?siteare=PED 6. BRFSS Behavioral Risk Factor Surveillace System Survey. Atlata, Georgia: U.S. Departmet of Health ad Huma Services, Ceters for Disease Cotrol ad Prevetio, 2007, 2008, http://www.cdc.gov/brfss/ 7. Claritas Ic., Copyright 2008 Thomso Healthcare. ALL RIGHTS RE- SERVED 8. Cesus America Fact Fider, U.S. Cesus Bureau: http://factfider. cesus.gov/ 9. CWF The Commowealth Fud: H Mead, L Cartwright-Smith, K Joes, C Ramos, K Woods ad B Siegel, Racial ad Ethic Disparities i U.S. Health Care: A Chartbook, March 2008. 10. NAACCR Aual Report to the Natio o the Status of Cacer, 1975-1993, Featurig Cacer Amog U.S. Hispaic/Latio Populatios. HL Howe, X Wu, LA Ries, et al. Cacer 2006; (107):1711-42. 11. NCHS Natioal Ceter for Health Statistics, Health, Uited States, 2007, With Chartbook o Treds i the Health of Americas, Hyattsville, MD: 2007. 12. SEER LAG Ries, D Melbert, M Krapcho, et al (eds). SEER Cacer Statistics Review, 1975-2005, Natioal Cacer Istitute. Bethesda, MD, http://seer.cacer.gov/csr/1975_2005/, based o November 2007 SEER data submissio, posted to the SEER web site, 2008. 13. YRBSS Youth Risk Behavior Surveillace System Survey, Atlata, Georgia: U.S. Departmet of Health ad Huma Services, Ceters for Disease Cotrol ad Prevetio, 2008, http://www.cdc.gov/healthyyouth/yrbs/ Begiig i 1995, cacer rates ca ow be geerated by site ad sex for most of the U.S. populatio stratified by ethicity ad three major race groups. Broad racial ad ethic groupigs, however, may mask wide variatios i the cacer burde for specific high-risk populatios defied by cultural characteristics such as urbaicity, ecoomic depravatio ad recet immigratio. 10 America Cacer Society South Atlatic Cacer Facts & Figures 2008 17