Ethnic density and cancer: A review of the evidence

Abstract

Accumulating data suggest that factors in the social environment may be associated with cancer-related outcomes. Ethnic density, defined as the proportion of racial/ethnic minority individuals residing in a given geographic area, is 1 of the most frequently studied social environment factors, but studies on ethnic density and cancer have yielded inconsistent findings. Thus, the objective of the current review was to summarize the extant data on ethnic density and cancer-related outcomes (cancer risk, stage at diagnosis, and mortality) with the aim of identifying pathways by which ethnic density may contribute to outcomes across populations. In general, the findings indicated an association between ethnic density and increased risk for cancers of infectious origin (eg, liver, cervical) but lower risk for breast and colorectal cancers, particularly among Hispanic and Asian Americans. Hispanic ethnic density was associated with greater odds of late-stage cancer diagnosis, whereas black ethnic density was associated with greater mortality. In addition, this review highlights several methodological and conceptual issues surrounding the measurement of ethnic neighborhoods and their available resources. Clarifying the role of neighborhood ethnic density is critical to developing a greater understanding of the health risks and benefits accompanying these environments and how they may affect racial and ethnic disparities in cancer-related outcomes. Cancer 2018;124:1877-903. © 2018 American Cancer Society.

Cancer Statistics for Hispanics/Latinos, 2018

“…Hispanics are generally less likely than NHWs to be diagnosed with cancer at an early stage, with the largest disparities for melanoma and female breast cancer (Figure ). Less access to high‐quality care because of lower socioeconomic status contributes to this disparity, although some studies have shown that Hispanics are at higher risk of advanced‐stage diagnosis even when socioeconomic status and health care access are similar . Surprisingly, however, 5‐year survival among Hispanics is generally similar to that among NHWs except for melanoma, for which Hispanics, especially men, have reduced survival (78.9% [95% CI, 76.2%‐81.4%] versus 87.8% [95% CI, 87.4%‐88.1%]) (Figure ).…”

“…Hispanics are generally less likely than NHWs to be diagnosed with cancer at an early stage, with the largest disparities for melanoma and female breast cancer ( Figure 4). Less access to high-quality care because of lower socioeconomic status contributes to this disparity, 31,32 although some studies have shown that Hispanics are at higher risk of advanced-stage diagnosis even when socioeconomic status and health care access are similar. 33 Figure 5).…”

Is cancer prevention influenced by the built environment? A multidisciplinary scoping review

“…However, our search strategy far exceeds the number of databases used in other reviews. 19,20 Finally, scoping reviews are typically conducted with 2 independent reviewers. 34 In this case, one reviewer was responsible for the relevance assessment and data coding, whereas another reviewer performed checks on a random subsample at each stage of the study process.…”

“…14 More than half of the world's population currently lives in urban areas, and this is expected to reach more than 90% by 2100. 19,20 In addition, our review investigates the overlap between medical, natural, and social science sources of literature and thus fills a major methodological gap in prior reviews that investigated a few subject databases, often from only 1 field of study. 5,17,18 Previous reviews of urban environments and cancer have found sufficient medical evidence of the influence of neighborhoods on disparities in cancer risk and outcomes to warrant further investigation of how the life course, perceptions, workplaces, spatiality, and causal inferences are discussed in medical, social science, policy, and natural science disciplines.…”

“…5,17,18 Previous reviews of urban environments and cancer have found sufficient medical evidence of the influence of neighborhoods on disparities in cancer risk and outcomes to warrant further investigation of how the life course, perceptions, workplaces, spatiality, and causal inferences are discussed in medical, social science, policy, and natural science disciplines. 19,20 In addition, our review investigates the overlap between medical, natural, and social science sources of literature and thus fills a major methodological gap in prior reviews that investigated a few subject databases, often from only 1 field of study. 19,21 Thus, addressing the human-built and social environment, particularly in urban areas, as a "cause of causes" for cancer etiology is critical to reducing the burden of disease on developed and developing economies.…”