Usual yardsticks don’t predict Asian American survival
Source: (cancerfacts.com)
Monday, August 13, 2007

 

 

 

ATLANTA – Aug. 13, 2007 – Standard factors used by clinicians to diagnose and evaluate men with prostate cancer do not predict survival outcomes in Asian-Americans as well as they do in other ethnic groups, according to the first comprehensive study of such men.

The study led by Dr. Anthony Robbins of the California Cancer Registry in Sacramento, showed that compared to white men, most Asian ethnic groups, except South Asians, paradoxically have better outcomes despite having worse prognostic profiles at the time of diagnosis.

“These results argue that traditional prognostic factors for survival from prostate cancer (stage, grade, treatment, age, year of diagnosis, and socioeconomic status),” the authors wrote, “do not explain why most Asian men have better survival compared to whites, but they do explain the poorer survival of South Asian men compared to whites.”

The study is the first to report prostate cancer survival data for Korean, South Asian and Vietnamese men living in the U.S. The results posted online today will be published in the Sept. 15, 2007 issue of CANCER.

Established prognostic factors include age, stage, primary treatment, cell type (histologic) grade, socioeconomic status, and year of diagnosis.
Robbins and co-investigators compared prognostic factors and survival rates of 116,916 men (108,076 whites and 8,840 Asians from the six largest represented Asian ethnicities – Chinese, Filipino, Japanese, Korean, South Asian, and Vietnamese) diagnosed with prostate cancer.

They found that for each Asian ethnic subgroup, prognostic risk profiles were worse compared to whites. For example, all Asian ethnicities were more likely to have more advanced disease and use non-curative therapies.

For all Asian ethnicities except South Asians (Indians, Pakistanis Bangladesh, etc.) however, survival rates were equal to or better than whites. Japanese-Americans, for example, had a 34 percent lower risk of dying from the disease compared to non-Hispanic white Americans. In contrast, South Asian-Americans had a 40 percent higher risk compared to non-Hispanic white Americans.

Epidemiologic studies have identified racial differences in prostate cancer incidence and mortality, with African-American men being at greater risk than other races. Asian-American men as a single, ethnic group have the lowest incidence of the disease and the lowest mortality rate. The reasons for these racial differences remain unclear and relatively unexamined. In particular, the risk among different Asian ethnicities is poorly understood, in part, because most studies have aggregated all Asians into a single racial category, ignoring the diverse ethnicities that make up Asia.

The few that have tried to analyze by Asian ethnicity have typically analyzed only a few ethnicities, missing significant Asian-American ethnic populations in the process. Interestingly, the data to date show that compared to non-Hispanic white Americans, some Asian ethnicities, such as Japanese-Americans, have higher survival rates, despite worse clinical disease, whereas others, such as Filipino-Americans, have worse survival rates. However, South Asians who represent the third largest Asian subgroup in America, have never been studied for prostate cancer.

The study should help physicians more accurately apply prognostic factors to their prostate cancer patients. In the U.S. in 2007, over 218,000 men are expected to be diagnosed with prostate cancer and over 27,000 will die.

SOURCE: Article: “Differences in Prognostic Factors and Survival Among White and Asian Men With Prostate Cancer, California, 1995-2004,” Published Online: Aug. 13, 2007. Print Issue Date: Sept. 15, 2007.