Cancer survival among Latinos and the Hispanic Paradox

Cancer survival is a key indicator of the effectiveness and social justice of health services. However, little is known about cancer survival among Hispanics, how it varies by Hispanic subgroup (Mexicans, Puerto Ricans, Cubans, and Others), and how their survival patterns relate to the Hispanic Paradox.

We studied all 1.2 million cancer cases diagnosed during 1995-2003, in two states, Florida and Texas, according to three categories of outcome: highly fatal outcome, poor outcome, and moderate outcome. All were followed up until December 31, 2006. We calculated survival rates for each Hispanic subgroup, and using Cox regression, we studied the risk of death for each Hispanic subgroup compared with non-Hispanic Whites, adjusted for age, cancer site, and stage at diagnosis.

Important differences in cancer survival were found according to Hispanic subgroup. For cancers of moderate outcome, the adjusted risk of death was higher among all Hispanic populations in comparison with non-Hispanic Whites: 6% higher for Cubans, 11% for Puerto Ricans, and 13% for US-born Mexicans. Foreign-born Mexicans, even with incomplete follow-up, had a 24% higher risk of death. For foreign-born Hispanics, except Cubans, the mortality follow-up of cancers of highly fatal outcome was insufficient, resulting in missing deaths and thus unrealistically high survival rates.

No evidence of a Hispanic advantage was found in cancer survival. Improvement in mortality follow-up procedures for Latinos, especially for those without a valid social security number, is critical. By considering Hispanics as a whole rather than by subgroup, existing survival disparities are being missed.