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Melissa McCracken, Miho Olsen, Moon S. Chen, Jr., Ahmedin Jemal, Michael Thun, Vilma Cokkinides, Dennis Deapen, and Elizabeth Ward
Cancer Incidence, Mortality, and Associated Risk Factors Among Asian Americans of Chinese, Filipino, Vietnamese, Korean, and Japanese Ethnicities
CA Cancer J Clin 2007; 57: 190-205 [Abstract] [Full text] [PDF]

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Response to McCracken et al.: Cancer surveillance among Asian Americans: Scarlett L Gomez, Christina A. Clarke, Ellen T. Chang, Theresa H.M. Keegan, Dee W. West, Sam So, and Sally L. Glaser (28 August 2007)

Response to McCracken et al.: Cancer surveillance among Asian Americans 28 August 2007

Scarlett L Gomez,
Research Scientist
Northern California Cancer Center,
Christina A. Clarke, Ellen T. Chang, Theresa H.M. Keegan, Dee W. West, Sam So, and Sally L. Glaser
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Re: Response to McCracken et al.: Cancer surveillance among Asian Americans

scarlett{at}nccc.org Scarlett L Gomez, et al.

Dear Editor:
We read with interest the informative paper “Cancer incidence, mortality, and associated risk factors among Asian Americans of Chinese, Filipino, Vietnamese, Korean, and Japanese Ethnicities” by McCracken and colleagues [1]. We agree that examining cancer patterns for specific Asian subgroups can both illuminate understanding of cancer etiology and provide more targeted data for public health services and clinicians, as also indicated by our work documenting cancer incidence patterns among Asian subgroups [2-11]. McCracken et al. also presented estimated rates from GloboCan for selected Asian countries. Likewise, we have previously compared rates between Asians in the US and Asia, using data collected by the International Agency for Research on Cancer [12-15]. This type of study can be particularly valuable for informing the respective roles of genetic and environmental risk factors in cancer causation. Future work comparing cancer rates and trends among Asian Americans by immigration status and length of residence in the US should also be informative, albeit challenging to conduct, given the strong bias in the availability of patient birthplace in population-based cancer registry data that we have documented [4, 7, 9, 16].
McCracken et al. note that updated national cancer statistics on specific Asian subgroups are not available. This deficiency is a result of the inconsistent availability of high-quality data on Asian population counts for specific geographic areas needed for cancer rate denominators. The US Census Bureau provides counts for detailed Asian subgroups as part of the decennial census but not for intercensal years, thus limiting analyses of detailed trends in cancer rates in these groups. To overcome these limitations, we have produced annual intercensal population estimates for Chinese, Filipinos, Japanese, Vietnamese, Koreans, and South Asians (six of the largest Asian subgroups in California), using a demographic population estimation method [17] that enhances simple linear interpolation/extrapolation. Using these annual population estimates, we have documented important subgroup variations and changes over time in liver and breast cancer incidence in the Greater San Francisco Bay Area [17-19]. We observed more than a two-fold difference in incidence rates of breast cancer across the Asian subgroups, with a rate increase over time (1990-2002) in Chinese, Koreans, Vietnamese, and South Asians (groupswith a generally higher proportion of recent immigrants) that is not apparent in Japanese and Filipina women; the rate increase among Chinese women is more pronounced for lobular carcinoma, a trend that may be attributable to patterns of postmenopausal hormone therapy use [19]. McCracken et al. showed that liver cancer rates were highest among Vietnamese and Koreans; our recent analysis showed consistently high liver cancer incidence rates over time among Vietnamese, Koreans, and Filipinos between 1990 and 2004, but not Chinese men (who have also traditionally experienced high rates of liver cancer) or Japanese men or women [18]. These patterns suggest a changing distribution in the burden of liver cancer across Asian subgroups but a continuing need for targeted prevention methods given their persistently high rates.
In their analysis, McCracken et al. did not include South Asians, despite their status as the third largest as well as the fastest growing Asian subgroup in this country [20]. We have shown that incidence rates in this group are generally lower than those in other Asian subgroups for most cancers, except for oral, prostate, and breast [21]. For the latter two malignancies, rates in South Asians have increased steadily since the early 1990s and lie between those of more acculturated (i.e., Japanese), and less acculturated (i.e., Koreans and Vietnamese) subgroups [17, 19]. Continued study of cancer incidence in South Asians has clinical and public health relevance as well as the potential to enhance understanding of cancer etiology, given the unique lifestyle, dietary characteristics, and immigration patterns of this group.
As noted by McCracken et al., Asians in the US are a highly heterogeneous and growing population—the fastest growing racial group in the US [22]. Understanding cancer occurrence and outcome in specific Asian subgroups is important from clinical, public health, and epidemiological perspectives [23-31]. As the Asian populations continue to expand and diversify, thus comprising recent immigrants, distant past immigrants, and US-born Asians, all with distinct lifestyles and cancer patterns, it will be critical to collect, analyze, and report cancer data among Asian Americans over time. To facilitate this work, we should advocate for routine production by the Census or other government agencies of detailed, yearly population estimates similar to those being produced for other racial/ethnic groups. Only by documenting cancer occurrence by Asian subgroups, and comparing cancer incidence and mortality patterns and trends among these varied groups, can we understand the reasons for the unique distribution and disparities in cancer occurrence in this heterogeneous population.
Regards,
Scarlett Lin Gomez, PhD 1,2
Christina A. Clarke, PhD 1,2
Ellen T. Chang, ScD 1,2,3
Theresa H.M. Keegan, PhD 1,2
Dee W. West, PhD 1,2
Samuel So, MD 3
Sally L. Glaser, PhD 1,2

1 Northern California Cancer Center, Fremont, CA
2 Division of Epidemiology, Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA
3 Asian Liver Center, Stanford University School of Medicine, Stanford, CA
Acknowledgments:
The collection of cancer incidence data used in this study was supported by the California Department of Health Services as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract N01-PC-35136 awarded to the Northern California Cancer Center, and contract N02-PC-15105 awarded to the Public Health Institute; and the Centers for Disease Control and Prevention’s National Program of Cancer Registries, under agreement #U55/CCR921930-02 awarded to the Public Health Institute. The ideas and opinions expressed herein are those of the author(s) and endorsement by the State of California, Department of Health Services, the National Cancer Institute, and the Centers for Disease Control and Prevention or their contractors and subcontractors is not intended nor should be inferred.
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