Racial disparities in AYA cancers highlight need for targeted interventions
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Key takeaways:
- A higher proportion of nonwhite individuals than white individuals received late-stage cancer diagnoses.
- Results also showed poorer survival among many nonwhite groups.
Stage at diagnosis and survival among younger individuals with cancer varied considerably by race, according to a retrospective cohort study.
The analysis of adolescents and young adults — defined as those aged 15 to 39 years — showed Asian, Black, and Native Hawaiian or Other Pacific Islander individuals had a higher risk for late-stage diagnosis than non-Hispanic white individuals.
Black, American Indian or Alaska Native, and Native Hawaiian or Other Pacific Islander individuals also exhibited a higher risk for death than non-Hispanic white individuals.
“The results were both expected and striking in their implications,” Kekoa Taparra, MD, PhD, MPH, resident in radiation oncology/radiation therapy at Stanford Medicine, told Healio. “We anticipated disparities, but the magnitude of the 10-year survival gaps — which were the worst among Native Hawaiian or Other Pacific Islander and American Indian or Alaska Native patients — was concerning.”
Background and methods
Cancer incidence among adolescents and young adults in the United States has increased, with approximately 90,000 diagnoses in 2023, according to study background.
However, adolescent and young adult cancers “remain the least studied,” and survival improvements have been limited compared with those achieved for children and adults, researchers wrote.
“Research gaps are particularly evident for Native Hawaiian or Other Pacific Islander and American Indian or Alaska Native patients due to underrepresentation in studies and trials,” Taparra said. “Our study aims to shine a light on these disparities and provide the data needed to inform more equitable cancer care strategies.”
Taparra and colleagues used the National Cancer Database to evaluate racial disparities in stage at diagnosis and OS for the 10 deadliest cancers among adolescents and young adults diagnosed between 2004 and 2017.
Investigators separated 291,899 patients (median age, 33 years; interquartile range, 28-37; 64% female) into five racial groups: American Indian or Alaska Native (1%), Asian (3%), Black (14%), Native Hawaiian or Other Pacific Islander (0.3%), and non-Hispanic white (82%).
Cancer types represented in the cohort included breast (27%), central nervous system (9%), cervical (7%), colon or rectal (8%), lung or bronchial (2%), lymphoma (16%), melanoma (13%), ovarian (3%), sarcoma (5%) and testicular (11%).
Results and next steps
Results showed significantly higher likelihood of late-stage diagnosis among Black [adjusted OR (AOR) = 1.4; 95% CI, 1.36-1.43], Native Hawaiian or Other Pacific Islander (AOR = 1.34; 95% CI, 1.16-1.55) and Asian (AOR = 1.2; 95% CI, 1.14-1.26) individuals compared with non-Hispanic white individuals.
Black individuals had increased odds of late-stage diagnosis compared with white individuals for 70% of the cancers evaluated, including melanoma (AOR = 2.49; 95% CI, 1.81-3.39) lung cancer (AOR = 1.4; 95% CI, 1.18-1.67), lymphoma (AOR = 1.37; 95% CI, 1.29-1.45) and testicular cancer (AOR = 1.37; 95% CI, 1.16-1.6).
Asian patients had increased likelihood of late-stage diagnosis compared with non-Hispanic white individuals for lung cancer (AOR = 2.89; 95% CI, 2.09-3.98) and melanoma (AOR = 1.75; 95% CI, 1.09-2.74). American Indian or Alaska Native individuals had higher odds of late-stage diagnosis for testicular cancer (AOR = 1.52; 95% CI, 1.09-2.09). Native Hawaiian or Other Pacific Islander had increased likelihood of late-stage diagnosis for melanoma (AOR = 3.21; 95% CI, 1.04-9.2).
At a median follow-up of 62 months (interquartile range, 34-102), 16% of patients had died.
Multiple racial groups exhibited significantly higher 10-year mortality risk overall compared with non-Hispanic white individuals. These included Native Hawaiian or Other Pacific Islander [adjusted HR (AHR) = 1.25; 95% CI, 1.09-1.44)], Black (AHR = 1.22; 95% CI, 1.19-1.26), and American Indian or Alaska Native patients (AHR = 1.15; 95% CI, 1.02-1.3).
“Adolescent and young adult patients have their whole lives ahead of them and, if cured, they should expect to live long, healthy lives,” Taparra said. “The fact that Indigenous adolescent and young adult patients have some of the largest survival gaps underscores a critical failure in our health care system.”
Native Hawaiian or Other Pacific Islander patients had higher risk for death compared with non-Hispanic white patients for 40% of cancers evaluated, with the greatest elevated risk observed for melanoma (AHR = 4.47; 95% CI, 2-9.99).
“The dismal 10-year melanoma survival among Native Hawaiian or Other Pacific Islander patients with a gap over 30% lower than other races was particularly surprising, suggesting potential issues beyond just late detection — for example, factors related to biology, skin tone and sun exposure,” Taparra said.
Black patients had increased mortality risk for 60% of the cancers investigated, including melanoma (AHR = 1.58; 95% CI, 1.15-2.17) and lymphoma (AHR = 1.47; 95% CI, 1.37-1.59).
American Indian or Alaska Native individuals had higher risk for death due to colon or rectum cancer (AHR = 1.38; 95% CI, 1.02-1.86).
“The most critical clinical implication is the need for targeted interventions and more culturally competent care that addresses the unique needs of Native Hawaiian or Other Pacific Islander and American Indian or Alaska Native adolescent and young adult patients,” Taparra said. “These findings highlight the importance of early detection and long-term follow-up in these populations, as the potential for cure and extended life expectancy in adolescent and young adult patients is significant if cancers are detected and treated early. The data suggest that Indigenous adolescent and young adult patients are not receiving the same level of timely care as other groups.”
Researchers acknowledged study limitations, including its retrospective nature and use of the National Cancer Database, which lacked data on causes of deaths, patient-reported outcomes and DFS.
“Future research should focus on understanding the underlying causes of the poor survival rates for specific cancers in Native Hawaiian or Other Pacific Islander and American Indian or Alaska Native populations, such as melanoma,” Taparra said. “We need to explore factors like access to care, cultural beliefs and potential biological differences that may contribute to these disparities. Additionally, it’s essential to investigate the effectiveness of culturally tailored interventions and develop strategies to improve early detection and long-term follow-up in these communities.”
For more information:
Kekoa Taparra, MD, PhD, MPH, can be reached at ktaparra@stanford.edu.
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