Survival rates of invasive breast cancer among ethnic Chinese women born in East Asia and the United States.

BACKGROUND: Few studies have compared the breast cancer survival rates of US born ethnic Chinese women and the survival rates of Chinese immigrants. The main purpose of this study is to explore the difference of breast cancer survival rates between the two populations and compare the survival rates to those of Caucasians born in the US. METHODS: Between 1973 and 2002, 365,215 women who had been diagnosed with primary invasive breast cancer (ICD-O-2 C500:C509) were recorded in the Surveillance, Epidemiology, and End Results (SEER) registries. Of the 316,881 breast cancer patients who were white, 180,835 (57%) were born in the United States, 20,983 (7%) were born elsewhere, and 115,063 (36%) had unknown birthplaces. Among the 3,634 breast cancer patients who were ethnically Chinese, 952 (26%) patients were born in the US, 1,356 (37%) were born in East Asia, 146 (4%) were born elsewhere, and 1,180 (33%) had unknown birthplaces. We compared the survival rates and estimated the risk ratios (RRs) by the Kaplan-Meier estimates and the Cox proportional hazards models. RESULTS: A lower 5-year overall survival rate of breast cancer was observed among Chinese women born in East Asia (0.74, 95% CI=0.72-0.77) than those born in the U.S. (0.79, 95% CI=0.76-0.81), with an adjusted hazards ratio of 1.22 (95% CI=1.06-1.40). The 5-year survival rates for SEER stage were higher among Chinese women born in the U.S. (localized: 0.90, 95% CI=0.87-0.93; regional: 0.71, 95% CI=66-0.77; distant: 0.16, 95% CI=0.06-0.25) than that among Chinese women born in East Asia (localized: 0.86, 95% CI=0.83-0.89; regional: 0.68, 95% CI=0.63-0.73; distant: 0.16, 95% CI=0.07-0.25). Higher 5-year survival rates among Chinese women born in the U.S. in comparison to Chinese women born in East Asia were also observed in different calendar years (1973-1980, 1981-1990, 1991-2002), in surgery and radiation therapy. CONCLUSIONS: Our analysis showed that among the Chinese breast cancer patients, women born in East Asia had lower 5-year survival rates than women born in the United States. SEER stage, grade, and tumor size appear to be important prognostic factors. The poor 5-year survival rates among Chinese women born in East Asia indicate potential problems of accessing medical facilities for early detection, diagnosis and treatment because of potential language and culture barriers, lower education level, as well as stress of the first generation of migrant Chinese women in the United States.

Obesity, breast cancer and the role of adipocytokines.

Obesity is a worldwide problem which impacts the risk and prognosis of some of the more common forms of cancer, including breast cancer in post-menopausal women. As the basis for understanding the potential mechanisms of obesity and cancer relationship has advanced, a number of new hypotheses have emerged. The adipocytokines are a complex group of biologically active polypeptides. Leptin is a growth hormone, secreted by adipose tissue, whose levels are normally elevated in obese individuals and may have a promoting effect on carcinogenesis and metastasis of breast cancer, possibly in an autocrine manner. Leptin interferes with the insulin signaling pathway and in type 2 diabetes plasma leptin levels are found to be correlated with the degree of insulin resistance, a relationship independent of body mass. This relationship might provide a mechanistic explanation for promotion potential.

Allium vegetables and stomach cancer risk in China.

Although the incidence of stomach cancer has been declining, it remains the second leading cause of cancer death worldwide. Potential protective effects of allium vegetables against cancer have been reported by a few epidemiologic studies in Chinese populations, but the sample sizes of these studies were relatively small. We examined the associations between allium vegetable consumption and stomach cancer in a large population-based case-control study in Shanghai (750 cases and 750 age- and gender-matched controls) and Qingdao (201 cases and 201 age- and gender-matched controls). Epidemiological data were collected by a standard questionnaire, and odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using conditional logistic regression in SAS. After adjusting for matching variables, education, body mass index, pack-years of smoking, alcohol drinking, salt intake, and fruit and vegetable intake, inverse relationships with dose response pattern were observed between frequency of onion intake and stomach cancer in Qingdao (P for trend=0.02) and Shanghai (P for trend=0.04) populations. In Shanghai, negative dose-response relationships were observed between monthly intake of onions (P=0.03) or garlic stalks (P=0.04) and distal, but not cardia cancer. A negative association was also noted between intake of garlic stalks (often vs. never) and risk of stomach cancer in Qingdao (OR=0.30; 95% CI: 0.12-0.77). Our results confirm protective effects of allium vegetables (especially garlic and onions) against stomach cancer.

Cancer burden and trends in the Asian Pacific Rim region.

This paper describes the current cancer burden and time trends, discusses dominant risk factors and prevention and control strategies, and makes future projections for the top eight cancers (stomach, lung, liver, colon/rectum, esophagus, breast, cervix, and leukemia) in the Asian Pacific Rim region. The future cancer trends through to the year 2050 are projected based on population dynamics, including population growth and ageing. In 2000, the Asian Pacific Rim had over 3 million new cancer cases, over 2 million cancer deaths, and 5.4 million people living with cancer. In 2050, 7.8 million new cancer cases and 5.7 million deaths from cancer are projected. The current cancer burden and the future projection provide facts that cancer is and will be a very serious public health problem in the Asian Pacific Rim region and will assist public health officers and cancer researchers in the design and establishment of public health policies, prioritization of future research, and application of current knowledge in the prevention and control of cancer.

Comparison of bladder cancer survival among Japanese, Chinese, Filipino, Hawaiian and Caucasian populations in the United States.

BACKGROUND: Racial differences for bladder cancer survival have been reported for Caucasians and African-Americans. However, the survival experience of bladder cancer patients in Asian and Pacific Islander ethnic groups in the United States have not been fully explored. The purpose of this study was to compare the bladder cancer survival rates of Japanese, Chinese, Filipinos, Hawaiians and Caucasians in the U.S. population. MATERIALS AND METHODS: The data was from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute between 1973 and 1998. Cox proportional hazard models and Kaplan-Meier's estimates were used to study differences in survival between the ethnic groups, adjusting for factors including age at diagnosis, gender, year of diagnosis, histological grade, stage, surgery type, and radiation therapy. RESULTS: The overall bladder cancer survival was 66% for Japanese patients, 64% for Chinese patients, 61% for Caucasians, 59% for Filipino patients and 52% for Hawaiian patients. Differences in bladder cancer survival rates between Japanese and Chinese populations in the United States were not observed. In the Asian population, higher relative risks and lower 5-year survival were observed with increasing age at diagnosis (p for trend<0.0001), grade (p for trend<0.0001), and stage (p for trend<0.0001). Asian women had lower survival and a higher risk of death due to bladder cancer than Asian men. CONCLUSIONS: Japanese and Chinese bladder cancer patients had higher overall survival rates than Caucasians, while Filipino and Hawaiian patients had lower survival than Caucasians.