ASPO Abstracts
Ethnic Disparities in Gastric Cancer Presentation and Screening Practice in the United States: An Analysis of 1997-2010 SEER-Medicare Data
Category: Cancer Health Disparities, Early Detection & Risk Prediction
Conference Year: 2018
Abstract Body:
Purpose: Describe differences in Helicobacter pylori (H. pylori) screening among a Surveillance, Epidemiology and End Results (SEER)-Medicare elderly population by ethnicity, place of birth, and gastric cancer (GC)-related conditions, as chronic infection with H. pylori is the strongest risk factor for distal GC. Methods: We used the National Cancer Institute’s population-based SEER-Medicare cancer database for GC (1997-2010). We extracted demographic, location and disease staging information from the SEER data file, Patient Entitlement and Diagnosis Summary File. We obtained information on frequencies of various GC-related conditions (e.g. peptic ulcer, gastric ulcer, gastritis) and screening (H. pylori testing and endoscopy) from inpatient hospital and physician/outpatient services claims. Results: Data from 34,730 subjects were analyzed. The majority of Asian American/Pacific Islanders (AAPIs), 65.1%, were foreign-born, while majority of Non-Hispanic Whites (NHW), Hispanics and Blacks were US-born (88.7%, 51.3%, and 96.9%, respectively). NHWs were oldest at diagnosis (74.7 y.); Hispanic and Black cases were the youngest (72.4 and 72.9 y., respectively). For NHWs, the most frequently diagnosed GC site was the cardia (36.1%), while for AAPIs, Hispanics and Blacks, the most diagnosed sites were non-cardia (>80%, P<0.001). Over 55% of NHW, Hispanic and Black cases were diagnosed at regional or distant stage, while 55% of AAPIs were diagnosed at local or regional stage. Over 57% of all cases had a history of GC-related conditions (AAPIs were highest at 64.1%). However, only 11.2% of total cases showed evidence of H. pylori testing. H. pylori testing was more frequent for foreign-born than US-born (2-fold increase in proportions) and AAPIs exhibited the highest proportion of H. pylori testing (22.6% among those with a GC-related condition). Conclusions: Screening for H. pylori was low for all GC cases, despite race/ethnic groups exhibiting conditions for which H. pylori testing is recommended. AAPI GC cases had the highest frequency of H. pylori testing with tumors staged locally or regionally; increased testing could lead to earlier stage of tumor at diagnosis. Future studies should investigate why screening rates are low in patients with GC-related conditions.
Keywords: Gastric cancer; SEER- Medicare; Screening; H. pylori