Evaluation of race as a prognostic factor in multiple myeloma. An ancillary of Southwest Oncology Group Study 8229.

PURPOSE: The objective of this investigation was to assess the impact of race (black v white) on the survival of patients with multiple myeloma treated within the context of a large clinical trial. PATIENTS AND METHODS: A cohort of patients randomized to receive one of two treatment regimens and monitored for at least 10 years was studied to assess the impact of race as a prognostic factor, after adjusting for other known factors such as stage of disease. Patients were recruited from the referral network of the Southwest Oncology Group (SWOG), a national multiinstitutional consortium that includes both academic and community treatment centers. Patients had a diagnosis of multiple myeloma and had not previously been treated for this disease. They were carefully characterized as to demographic and clinical features, and were randomized to receive one of two treatment regimens, which proved to have virtually identical outcomes. The outcome measure was survival, measured from the date of randomization to the date of last contact. Patients still alive at last contact date were treated as censored observation. RESULTS: Survival for black myeloma patients was similar to that for white patients, both overall and adjusted for prognostic factors such as stage. CONCLUSION: Observed differences in mortality between blacks and whites cannot be attributed to differences in survival after diagnosis, given comparable treatment.

Cancer in Hispanics: issues of concern.

Hispanics are among the fastest growing minorities in the United States, after Asian-Americans and Pacific-Islanders. Hispanics, Latinos, Chicanos, Mexican-Americans, Puerto Ricans, Cuban-Americans, etc. are all designations used to describe this large, heterogeneous population with different cultural, ethnic, geographic, and social backgrounds. There is still no clear definition of the term "Hispanic." The data available regarding the incidence, morbidity, and mortality from cancer in Hispanics are scarce, scattered, outdated, and often incomplete. From the studies looking at the accessibility and availability of medical care for this population, few have examined in detail the variability within the entire Hispanic population. The aggregation of culturally distinct subgroups, which have resided in the United States for different periods of time, into a more inclusive Hispanic category assumes that all persons of Mexican, Cuban, and Puerto Rican extraction have similar needs and experience similar barriers in using health services. There is, however, no clear evidence for this assumption. On the contrary, there is evidence that each group has specific characteristics that make it different and independent from another, despite the fact that they also share some commonalities. Because of the lower overall prevalence of cancer in this population, potential protective factors need to be explored. Hispanics, however, appear to have a less favorable stage of disease at presentation and have overall lower death rates from cancer than non-Hispanic whites, but lower overall survival in certain cancers. Demographic and epidemiologic data collection need to be updated and improved.(ABSTRACT TRUNCATED AT 250 WORDS)

Professional and consumer concerns about the environment, lifestyle, and cancer.

Although it cannot be said that "everything causes cancer," our environment will never be carcinogen-free. As a result, there are many substances we come in contact with daily that could be potentially harmful to our health. Even with the growing knowledge of the mechanisms of carcinogenesis, it is difficult to single out the exact cancer-causing or -promoting effects of single substances. The confusion that exists about the environment, lifestyle, and cancer can be overwhelming for everyone. Garfinkel offered the following suggestions for health care providers to use in putting this issue into better perspective for consumers: (1) no single study of cancer risk factors should be used as a basis for writing or changing public health policy; (2) animal studies should be supportive of findings in epidemiological studies; (3) any environmental factor-cancer effect relationship should be demonstrated biologically; (4) regulatory agencies such as the EPA tend to be conservative in their interpretation of study results, and may suggest caution even when the risk of developing cancer is low; (5) regulatory agencies have been known to extrapolate future effects of carcinogen exposure from current incomplete or limited information about the carcinogen in question. With the knowledge that we do have, we must strive to take personal control over life-style factors that may cause cancer.