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Editor's Correspondence |

Cancer Survival in US Racial/Ethnic Groups: Heterogeneity Among Asian Ethnic Subgroups—Reply

Limin X. Clegg; Frederick P. Li; Benjamin F. Hankey; Kenneth Chu; Brenda K. Edwards
Arch Intern Med. 2003;163(5):632. doi:10.1001/archinte.163.5.631.
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We recognize, as is pointed out by Gomez et al, that Asian Americans are a heterogeneous mix of ethnic subgroups. This is true of most, if not all, racial groups in the United States. Both [Lin] Gomez et al1 and we2 analyzed SEER data for cancer survival by race and ethnicity. We analyzed cancer-specific survival data for 1.8 million US whites and 5 major minority groups including Asian Americans who were diagnosed between 1975 and 1997, whereas the Gomez et al study was limited to 260 000 whites and Asian Americans (Chinese, Japanese, and Filipino) diagnosed between 1988 and 1994. Neither study included other subgroups of Asian Americans because of small numbers. We also excluded data from the 2 newer registries in California (Los Angeles and San Jose/Monterey) that joined the SEER program in 1992 because we compared survival differences for the periods 1975-1987 and 1988-1997. In contrast, Gomez et al studied a much shorter time interval (1988-1994), and did not examine temporal trends. We examined racial/ethnic survival disparities throughout the follow-up time period (up to 11 years), adjusting for tumor stage and age at diagnosis; Gomez et al reported unadjusted and stage-specific survival at one point (5 years after diagnosis). However, confidence intervals of their 5-year stage-specific survivals overlapped among racial/ethnic groups for each stage by primary site, so that differences in survival were not statistically significant by race/ethnicity. Gomez et al indicated that some Asian subgroups experienced worse survival than non-Hispanic whites after diagnosis of female breast, colorectal, and prostate cancer based on their unadjusted 5-year survival. To further examine this survival pattern after accounting for age and tumor stage, we calculated adjusted relative risks (hazard ratios) of cancer deaths over a 5-year follow-up for each Asian subgroup (with non-Hispanic whites as the reference group) using stratified Cox models and our 1988-1997 data (Table 1). Table 1 shows that every Asian ethnic subgroup experienced better, or at least comparable, 5-year survival rates than Non-Hispanic whites after adjusting for age and tumor stage. This result generally supports the notion that Asian Americans tended to experience more favorable survival than non-Hispanic whites and other race groups we examined after adjusting for age and stage.3

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