The American Cancer Society reports a Latina breast cancer death rate of 17.3 per 100,000 population compared with 26.4 for whites and 35.4 for African Americans. Why do Latinas --a population with deep pockets of poverty, lack of access to doctors and a tradition of avoiding breast exams-- have a lower death rate from all cancers, including breast cancer?
Dr. Harold Freeman, director of the Center to Reduce Cancer Health Disparities at the National Cancer Institute, finds those figures fascinating.
"It's something that many of us researchers have been aware of for some time," he says. "We call it the 'Hispanic paradox.' "
Freeman says studies show that although poorer people of all races and ethnic groups have worse cancer outcomes than their wealthier counterparts, wealthy Latinas tend to do better than wealthy members of other groups. And low-income Latinas have lower cancer death rates than low-income whites and African Americans.
The reason why is unknown, but Freeman has a theory: "The best guess is that their lifestyle, including diet or some other environmental factors, gives them an advantage."
If so, he says, perhaps that behavior can be taught to others, with beneficial effects.
But Marie Dahlstrom, associate director of the Oregon Health & Science University Cancer Institute's Office of Multicultural Affairs, thinks the statistics underestimate the number of Latinas who die of breast cancer.
"There's a real problem with the way the data's collected," she says. "When a Latina goes in for a mammogram and there's an abnormality, there (may be) follow-through problems."
If a Latina is diagnosed with cancer, she might move back to her country of origin, Dahlstrom says.
If she dies, in the United States she can easily wind up categorized as "white" instead of "Hispanic."
Freeman concedes that data collection might provide a small part of the answer.
Dr. Arpana Naik, who specializes in breast surgery at OHSU, has studied differences in breast cancer outcomes among ethnic groups in New York.
Poverty, attitudes toward the disease, lack of education and unfamiliarity with the health care system conspire to make for more serious disease among Latinas than the general population nationwide, she says.
by Patrick O'Neill for the Oregonian.com