Showing papers by "Susan L. Stewart published in 1999"

Social class, race/ethnicity, and incidence of breast, cervix, colon, lung, and prostate cancer among Asian, Black, Hispanic, and White residents of the San Francisco Bay Area, 1988-92 (United States).

Abstract: Background: To date only eight US studies have simultaneously examined cancer incidence in relation to social class and race/ethnicity; all but one included only black and white Americans To address gaps in knowledge we thus investigated socioeconomic gradients in cancer incidence among four mutually exclusive US racial/ethnic groups – Asian and Pacific Islander, black, Hispanic, and white – for five major cancer sites: breast, cervix, colon, lung, and prostate cancer Methods: We generated age-adjusted cancer incidence rates stratified by socioeconomic position using: (a) geocoded cancer registry records, (b) census population counts, and (c) 1990 census block-group socioeconomic measures Cases (n = 70,899) were diagnosed between 1988 and 1992 and lived in seven counties located in California's San Francisco Bay Area Results: Incidence rates varied as much if not more by socioeconomic position than by race/ethnicity, and for each site the magnitude – and in some cases direction – of the socioeconomic gradient differed by race/ethnicity and, where applicable, by gender Breast cancer incidence increased with affluence only among Hispanic women Incidence of cervical cancer increased with socioeconomic deprivation among all four racial/ethnic groups, with trends strongest among white women Lung cancer incidence increased with socioeconomic deprivation among all but Hispanics, for whom incidence increased with affluence Colon and prostate cancer incidence were inconsistently associated with socioeconomic position Conclusions: These complex patterns defy easy generalization and illustrate why US cancer data should be stratified by socioeconomic position, along with race/ethnicity and gender, so as to improve cancer surveillance, research, and control

Comparison of Methods for Classifying Hispanic Ethnicity in a Population-based Cancer Registry

Abstract: The accuracy of ethnic classification can substantially affect ethnic-specific cancer statistics In the Greater Bay Area Cancer Registry, which is part of the Surveillance, Epidemiology, and End Results (SEER) Program and of the statewide California Cancer Registry, Hispanic ethnicity is determined by medical record review and by matching to surname lists This study compared these classification methods with self-report Ethnic self-identification was obtained by surveying 1,154 area residents aged 20-89 years who were diagnosed with cancer in 1990 and were reported to the registry as being Hispanic or White non-Hispanic Predictive value positive, sensitivity, and relative bias were used to assess the accuracy of Hispanic classification by medical record and surname Among those persons classified as Hispanic by either or both of these sources, only two-thirds agreed (predictive value positive = 66%), and many self-identified Hispanics were classified incorrectly (sensitivity = 68%) Classification based on either medical record or surname alone had a lower sensitivity (59% and 61%, respectively) but a higher predictive value positive (77% and 70%, respectively) Ethnic classification by medical record alone resulted in an underestimate of Hispanic cancer cases and incidence rates Bias was reduced when medical records and surnames were used together to classify cancer cases as Hispanic

Cancer screening practices among primary care physicians serving Chinese Americans in San Francisco.

Abstract: Previous research has reported a lack of regular cancer screening among Chinese Americans The overall objectives of this study were to use a mail survey of primary care physicians who served Chinese Americans in San Francisco to investigate: a) the attitudes, beliefs, and practices regarding breast, cervical, and colon cancer screening and b) factors influencing the use of these cancer screening tests The sampling frame for our mail survey consisted of: a) primary care physicians affiliated with the Chinese Community Health Plan and b) primary care physicians with a Chinese surname listed in the Yellow Pages of the 1995 San Francisco Telephone Directory A 5-minute, self-administered questionnaire was developed and mailed to 80 physicians, and 51 primary care physicians completed the survey A majority reported performing regular clinical breast examinations (84%) and teaching their patients to do self-breast examinations (84%) However, the rate of performing Pap smears was only 61% and the rate of ordering annual mammograms for patients aged 50 and older was 63% The rates of ordering annual fecal occult blood testing and sigmoidoscopy at regular intervals of three to five years among patients aged 50 and older were 69% and 20%, respectively Barriers (patient-specific, provider-specific, and practice logistics) to using cancer screening tests were identified The data presented in this study provide a basis for developing interventions to increase performance of regular cancer screening among primary care physicians serving Chinese Americans Cancer screening rates may be improved by targeting the barriers to screening identified among these physicians Strategies to help physicians overcome these barriers are discussed