Cancer incidence trends among native Hawaiians and other Pacific Islanders in the United States, 1990-2008

Abstract

Background: Lack of annual population estimates for disaggregated Native Hawaiian and Other Pacific Islander (NHOPI) populations limits the ability to examine cancer incidence rates and trends to understand the cancer burdens among NHOPIs.

Methods: Utilizing 1990 and 2000 population census data, we estimated the annual populations by age and sex for Native Hawaiians, Samoans, and Guamanians/Chamorros for 1990-2008 in regions covered by 13 of the National Cancer Institute's SEER registries. Cancer diagnoses during 1990-2008 from these registries were used to calculate the age-adjusted (2000 US Standard) incidence rates by sex, calendar year/period, and cancer type for each population. The annual percentage change (APC) in incidence rates was estimated with the 95% confidence intervals (95% CIs) calculated for both the rate and APC estimates.

Results: Statistically significant declining trends were found in Native Hawaiians, in men for lung and stomach cancers (APC = -2.3%; 95% CI = -3.3 to -1.3; and APC = -3.8%; 95% CI = -6.0 to -1.6, respectively), and in women for breast cancer (APC = -4.1%; 95% CI = -5.7 to -2.5) since 1998 and lung cancer (APC = -6.4%; 95% CI = -10.7 to -1.8) since 2001. Rising incidence trends were experienced by Samoans, especially by Samoan women for breast (APC = 2.7%; 95% CI = 0.9 to 4.5) and uterus (APC = 7.3%; 95% CI = 6.2 to 8.4) cancers. With limited data, Guamanians/Chamorros demonstrated lower, but increasing, incidence rates than other NHOPIs.

Conclusions: Population-based cancer incidence rates for disaggregated NHOPI populations help identify disparities in cancer burden and provide valuable information to improve cancer control efforts among NHOPIs.

Figure 1.

Trends of age-adjusted incidence rates and annual percentage change (APC) by racial/ethnic group for the five most common cancers among males, 1990–2008. A) Trends for non-Hispanic whites are shown. The 95% confidence intervals are as follows: All Sites segment 1: –0.8 to 10.2, segment 2: –9.4 to 0.3, segment 3: –1.0 to 2.2, segment 4: –1.5 to –0.4; Prostate segment 1: 1.1 to 38.1, segment 2: –25.1 to 2.0, segment 3: –2.8 to 7.7, segment 4: –3.8 to –0.6; Lung: –2.0 to –1.8; CRC segment 1: –3.4 to –2.4, segment 2: –1.0 to 3.5, segment 3: –3.2 to –2.8; NHL: 0.2 to 0.6; Liver: 3.5 to 4.2; Stomach: –2.5 to –2.1 . B) Trends for Native Hawaiians are shown. The 95% confidence intervals are as follows: All Sites segment 1: –0.7 to 2.1, segment 2: –4.3 to –1.1; Prostate: –1.7 to 0.9; Lung: –3.3 to –1.3; CRC: –2.2 to 0.5; NHL: –4.0 to 2.2; Stomach: –6.0 to –1.6. C) Trends for Samoans are shown. The 95% confidence intervals are as follows: All Sites: –1.9 to 1.2; Prostate: –2.0 to 3.8; Lung: –3.4 to 0.9; CRC: –5.7 to 6.6; Liver: –4.6 to 2.6; Stomach: –21.1 to 3.1. *Statistically significantly different APCs. †Joinpoint and observed rates are based on 2-year groups (1990–1991, 1992–1993, ..., 2004–2005, 2006–2007, 2008). ‡Joinpoint and observed rates are based on five-year groups (1990–1994, 1995–1999, 2000–2004, 2005–2008). CRC = colon and rectum, Liver = liver and intrahepatic bile duct, Lung = lung and bronchus, NHL = non-Hodgkin lymphoma.

Figure 2.

Trends of age-adjusted incidence rates and annual percentage change (APC) by racial/ethnic group for the five most common cancers among females, 1990–2008. A) Trends for non-Hispanic whites are shown. The 95% confidence intervals are as follows: All Sites segment 1: –1.2 to 0.6, segment 2: –0.1 to 2.8, segment 3: –0.7 to –0.2; Breast segment 1: –2.0 to 1.3, segment 2: 0.3 to 3.4, segment 3: –3.3 to –1.1, segment 4: –1.9 to 3.4; Lung segment 1: 0.6 to 1.3, segment 2: –0.6 to –0.1; CRC segment 1: –3.0 to –1.4, segment 2: –1.7 to 5.1, segment 3: –2.6 to –2.1; Uterus segment 1: –0.1 to 1.1, segment 2: –4.6 to 0.5, segment 3: 0.1 to 2.5; Pancreas segment 1: –0.5 to 0.2, segment 2: 0.7 to 2.1; Stomach: –2.4 to –1.6. B) Trends for Native Hawaiians are shown. The 95% confidence intervals are as follows: All Sites segment 1: 0.3 to 3.6, segment 2: –4.3 to –2.4; Breast segment 1: 1.2 to 7.2, segment 2: –5.7 to –2.5; Lung segment 1: –1.6 to 4.3, segment 2: –10.7 to –1.8; Uterus: –1.5 to 1.5; CRC: –4.3 to –1.0; Pancreas: –3.4 to 3.2. C) Trends for Samoans are shown. The 95% confidence intervals are as follows: All Sites: –0.1 to 2.8; Breast: 0.9 to 4.5; Uterus: 6.2 to 8.4; Lung: –8.1 to 5.7; CRC: –9.1 to 22.9; Stomach: –12.5 to –0.5. *Statistically significantly different APCs. †Joinpoint and observed rates are based on two-year groups (1990–1991, 1992–1993, ..., 2004–2005, 2006–2007, 2008). ‡Joinpoint and observed rates are based on five-year groups (1990–1994, 1995–1999, 2000–2004, 2005–2008). CRC = colon and rectum, Liver = liver and intrahepatic bile duct, Lung = lung and bronchus, Uterus = corpus uteri and uterus not otherwise specified.