Research underscores the need to subdivide Hispanics and other racial and ethnic groups to fully understand actual disparities.
In a massive study, clinical researchers at Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, Memorial Sloan Kettering Cancer Center and other facilities have found that, based on nation of origin, Hispanic men who present with localized prostate cancer have significant variations in their risk for aggressive cancer and are less likely to be treated for high-risk disease. The study was published in Prostate Cancer and Prostatic Diseases.
“Hispanic men in general have a greater chance of presenting with higher-risk localized prostate cancer than non-Hispanic white men,” said co-senior author Brandon Mahal, M.D., assistant professor of radiation oncology at Sylvester. “However, when we looked at Hispanic men by country of origin, there’s wide variation in the risk of presenting with advanced disease. That’s important because it can be difficult for individuals to understand what their risk may be for aggressive cancer.”
To understand this, the researchers subdivided Hispanic study participants by country of origin. Interrogating an enormous sample of more than 895,000 patients, they found wide variations in patients’ prostate cancer journeys. For example, men with Mexican heritage were at greatest risk for high-grade disease when first diagnosed and were less likely to receive the most advanced care.
On the other side, the risks for men of Cuban descent were much lower and more in line with non-Hispanic white men. While socioeconomic status mitigated some of these variations, distinctions based on ancestry still persisted.
“This study suggests there are different environmental, societal and cultural exposures,” said Dr. Mahal. “Some of these may be related to genetic ancestry, but it’s probably a lot more complicated than that.”
This research highlights a number of variables that will need to be further studied. Are some men more culturally predisposed to preventive care? Do they have better overall access to care? Do they seek out second opinions? Are they and their families more likely to self-advocate? Additional factors might include insurance coverage, diet, exercise, pollution, access to public parks and many others.
The authors believe unwinding these complex relationships could drive public health interventions and improve prostate cancer outcomes among Hispanic men and other groups.
For Dr. Mahal and colleagues, the next steps will be to dive even deeper into the data to better understand the many factors that may be influencing prostate cancer care and outcomes in each disaggregated group. In addition, these results might encourage researchers to more closely examine subpopulations in other groups.
“This initial study shows the importance of looking at Hispanic men by desegregated groups, but it’s not just Hispanic men,” said Dr. Mahal. “I would argue that the same approach could be applied to country of origin for Black or Asians and Pacific islanders, any heterogeneous group that has been broadly defined.”