Academic Appointments

Administrative Appointments

  • Epidemiologist, Northern California Cancer Center (1998 - 2003)
  • Research Scientist, Cancer Prevention Institute of California (formerly Northern California Cancer Center) (2003 - Present)
  • Lecturer, Health Research & Policy (2004 - 2007)
  • Associate Director, Surveillance Research, Greater Bay Area Cancer Registry, Cancer Prevention Institute of California (formerly Northern California Cancer Center) (2006 - 2009)
  • Consulting Assistant Professor, Health Research & Policy (2007 - 2009)
  • Consulting Associate Professor, Health Research & Policy (2009 - Present)
  • Co-Investigator, Greater Bay Area Cancer Registry, Cancer Prevention Institute of California (2009 - Present)

Professional Education

  • Ph.D., Stanford University, Epidemiology (2002)
  • M.P.H., University of Michigan, Epidemiology (1997)
  • B.A., UC Berkeley, Biochemistry, Mol & Cell Biology (1994)

Research & Scholarship

Current Research and Scholarly Interests

The racial/ethnic diversity in both the Bay Area and California and the population-based nature of cancer surveillance data provides an unparalleled resource for the detailed study of racial/ethnic patterns, and factors associated with patterns, in cancer incidence and outcomes. Dr. Gomez is an Epidemiologist at CPIC, a Visiting Associate Professor with the Department of Health Research and Policy at the School of Medicine, Stanford University, and a member of the Stanford Cancer Center. She is also the Co-Investigator of the Greater Bay Area Cancer Registry (GBACR), a participant in the SEER cancer registry and in the California Cancer Registry (CCR). Dr. Gomez conducts research with registry data for and has built a growing research program that focuses on disparities across the cancer continuum. Dr. Gomez has analyzed cancer incidence, treatment, and survival data for racial/ethnic groups, with a particular focus on specific Asian ethnic subgroups, and has conducted methodologic assessments directed toward improvements of cancer registry and hospital admissions data on race, ethnicity, and birthplace. She is/has been Principal Investigator on several SEER studies (including “Using Linked Datasets to Understand Breast Cancer Disparities”; “Obtaining Information on Language Preference among Minority Cancer Patients”; “Understanding Socioeconomic, Neighborhood Social and Built environment, and Immigration Effects on Racial/Ethnic Cancer Patterns”; “Hospital Policies and Practices in the Collection of Patient Information on Race, Ethnicity, and Birthplace”; and “Accuracy of Cancer Registry Data on Race, Ethnicity, and Birthplace”). Her surveillance research work has also focused on methodologic studies to enhance surveillance data for studying immigration effects on cancer.

Dr. Gomez is also Principal Investigator on several studies that seek to understand the role of neighborhood, institutional, family, and individual level factors on disparities in breast cancer treatment, quality of life, and survival. These studies include the Breast Cancer Treatment Choices (BCTC) Study (funded by the National Cancer Institute), the Equality in Breast Cancer Care (EBCC) Study (funded by the Department of Defense), a study to develop and test sociodemographic survey questions for research (funded by the California Breast Cancer Research Program), and a study to understand the impact of contextual factors on disparities in risk and survival of breast cancer (funded by the National Cancer Institute).


Graduate and Fellowship Programs


All Publications

  • Asian ethnicity and breast cancer subtypes: a study from the California Cancer Registry BREAST CANCER RESEARCH AND TREATMENT Telli, M. L., Chang, E. T., Kurian, A. W., Keegan, T. H., McClure, L. A., Lichtensztajn, D., Ford, J. M., Gomez, S. L. 2011; 127 (2): 471-478


    The distribution of breast cancer molecular subtypes has been shown to vary by race/ethnicity, highlighting the importance of host factors in breast tumor biology. We undertook the current analysis to determine population-based distributions of breast cancer subtypes among six ethnic Asian groups in California. We defined immunohistochemical (IHC) surrogates for each breast cancer subtype among Chinese, Japanese, Filipina, Korean, Vietnamese, and South Asian patients diagnosed with incident, primary, invasive breast cancer between 2002 and 2007 in the California Cancer Registry as: hormone receptor-positive (HR+)/HER2- [estrogen receptor-positive (ER+) and/or progesterone receptor-positive (PR+), human epidermal growth factor receptor 2-negative (HER2-)], triple-negative (ER-, PR-, and HER2-), and HER2-positive (ER±, PR±, and HER2+). We calculated frequencies of breast cancer subtypes among Asian ethnic groups and evaluated their associations with clinical and demographic factors. Complete IHC data were available for 8,140 Asian women. Compared to non-Hispanic White women, Korean [odds ratio (OR) = 1.8, 95% confidence interval (CI) = 1.5-2.2], Filipina (OR = 1.3, 95% CI = 1.2-1.5), Vietnamese (OR = 1.3, 95% CI = 1.1-1.6), and Chinese (OR = 1.1, 95% CI = 1.0-1.3) women had a significantly increased risk of being diagnosed with HER2-positive breast cancer subtypes after adjusting for age, stage, grade, socioeconomic status, histology, diagnosis year, nativity, and hospital ownership status. We report a significant ethnic disparity in HER2-positive breast cancer in a large population-based cohort enriched for Asian-Americans. Given the poor prognosis and high treatment costs of HER2-positive breast cancer, our results have implications for healthcare resource utilization, cancer biology, and clinical care.

    View details for DOI 10.1007/s10549-010-1173-8

    View details for Web of Science ID 000290227900017

    View details for PubMedID 20957431

  • The California Neighborhoods Data System: a new resource for examining the impact of neighborhood characteristics on cancer incidence and outcomes in populations CANCER CAUSES & CONTROL Gomez, S. L., Glaser, S. L., McClure, L. A., Shema, S. J., Kealey, M., Keegan, T. H., Satariano, W. A. 2011; 22 (4): 631-647


    Research on neighborhoods and health has been growing. However, studies have not investigated the association of specific neighborhood measures, including socioeconomic and built environments, with cancer incidence or outcomes. We developed the California Neighborhoods Data System (CNDS), an integrated system of small area-level measures of socioeconomic and built environments for California, which can be readily linked to individual-level geocoded records. The CNDS includes measures such as socioeconomic status, population density, racial residential segregation, ethnic enclaves, distance to hospitals, walkable destinations, and street connectivity. Linking the CNDS to geocoded cancer patient information from the California Cancer Registry, we demonstrate the variability of CNDS measures by neighborhood socioeconomic status and predominant race/ethnicity for the 7,049 California census tracts, as well as by patient race/ethnicity. The CNDS represents an efficient and cost-effective resource for cancer epidemiology and control. It expands our ability to understand the role of neighborhoods with regard to cancer incidence and outcomes. Used in conjunction with cancer registry data, these additional contextual measures enable the type of transdisciplinary, "cells-to-society" research that is now being recognized as necessary for addressing population disparities in cancer incidence and outcomes.

    View details for DOI 10.1007/s10552-011-9736-5

    View details for Web of Science ID 000288509100011

    View details for PubMedID 21318584

  • Early discontinuation and non-adherence to adjuvant hormonal therapy are associated with increased mortality in women with breast cancer BREAST CANCER RESEARCH AND TREATMENT Hershman, D. L., Shao, T., Kushi, L. H., Buono, D., Tsai, W. Y., Fehrenbacher, L., Kwan, M., Gomez, S. L., Neugut, A. I. 2011; 126 (2): 529-537


    Despite the benefit of adjuvant hormonal therapy (HT) on mortality among women with breast cancer (BC), many women are non-adherent with its use. We investigated the effects of early discontinuation and non-adherence to HT on mortality in women enrolled in Kaiser Permanente of Northern California (KPNC). We identified women diagnosed with hormone-sensitive stage I-III BC, 1996-2007, and used automated pharmacy records to identify prescriptions and dates of refill. We categorized patients as having discontinued HT early if 180 days elapsed from the prior prescription. For those who continued, we categorized patients as adherent if the medication possession ratio was ?80%. We used Cox proportional hazards models to estimate the association between discontinuation and non-adherence with all-cause mortality. Among 8,769 women who filled at least one prescription for HT, 2,761 (31%) discontinued therapy. Of those who continued HT, 1,684 (28%) were non-adherent. During a median follow-up of 4.4 years, 813 women died. Estimated survival at 10 years was 80.7% for women who continued HT versus 73.6% for those who discontinued (P < 0.001). Of those who continued, survival at 10 years was 81.7 and 77.8% in women who adhered and non-adhered, respectively (P < 0.001). Adjusting for clinical and demographic variables, both early discontinuation (HR 1.26, 95% CI 1.09-1.46) and non-adherence (HR 1.49, 95% CI 1.23-1.81), among those who continued, were independent predictors of mortality. Both early discontinuation and non-adherence to HT were common and associated with increased mortality. Interventions to improve continuation of and adherence to HT may be critical to improve BC survival.

    View details for DOI 10.1007/s10549-010-1132-4

    View details for Web of Science ID 000288251000026

    View details for PubMedID 20803066

  • Survival following Non-Small Cell Lung Cancer among Asian/Pacific Islander, Latina, and Non-Hispanic White Women Who Have Never Smoked CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION Gomez, S. L., Chang, E. T., Shema, S. J., Fish, K., Sison, J. D., Reynolds, P., Clement-Duchene, C., Wrensch, M. R., Wiencke, J. L., Wakelee, H. A. 2011; 20 (3): 545-554


    Lung cancer is the leading cause of cancer death among U.S. Asian/Pacific Islander (API) and Latina women despite low smoking prevalence. This study examined survival patterns following non-small cell lung cancer in a population-based sample of lung cancer cases from the San Francisco Bay Area Lung Cancer Study (SFBALCS).Women diagnosed with lung cancer from 1998 to 2003 and 2005 to 2008 and identified through the Greater Bay Area Cancer Registry were telephone-screened for eligibility for the SFBALCS. The screener data were linked to the cancer registry data to determine follow-up. This analysis included 187 non-Hispanic (NH) white, 23 U.S.-born Latina, 32 foreign-born Latina, 30 U.S.-born API, and 190 foreign-born API never-smokers diagnosed with lung cancer and followed through 2008.All-cause survival was poorer among APIs [HR=1.7 (95% CI: 1.0-2.8) among U.S.-born APIs and HR=1.2 (95% CI: 0.9-1.5) among foreign-born APIs] and Latinas [HR=2.1 (95% CI: 1.2-3.6) among U.S.-born Latinas; HR=1.4 (95% CI: 0.9-2.3) among foreign-born Latinas] relative to NH whites. These survival differences were not explained by differences in selected sociodemographic or clinical factors.Further research should focus on factors such as cultural behaviors, access to or attitudes toward health care, and genetic variations as possible explanations for these striking racial/ethnic differences.Latina and API female never-smokers diagnosed with lung cancer were up to two times more likely to die than NH whites, highlighting the need for additional research to identify the underlying reasons for the disparities and heightened clinical awareness.

    View details for DOI 10.1158/1055-9965.EPI-10-0965

    View details for Web of Science ID 000288067200017

    View details for PubMedID 21239685

  • Papillary thyroid cancer incidence rates vary significantly by birthplace in Asian American women CANCER CAUSES & CONTROL Horn-Ross, P. L., McClure, L. A., Chang, E. T., Clarke, C. A., Keegan, T. H., Rull, R. P., Quach, T., Gomez, S. L. 2011; 22 (3): 479-485


    To investigate how birthplace influences the incidence of papillary thyroid cancer among Asian American women.Birthplace- and ethnic-specific age-adjusted and age-specific incidence rates were calculated using data from the California Cancer Registry for the period 1988-2004. Birthplace was statistically imputed for 30% of cases using a validated imputation method based on age at Social Security number issuance. Population estimates were obtained from the US Census. Incidence rate ratios (IRR) and 95% confidence intervals (CI) were estimated for foreign-born vs. US-born women.Age-adjusted incidence rates of papillary thyroid cancer among Filipina (13.7 per 100,000) and Vietnamese (12.7) women were more than double those of Japanese women (6.2). US-born Chinese (IRR = 0.48, 95% CI: 0.40-0.59) and Filipina women (IRR = 0.74, 95% CI: 0.58-0.96) had significantly higher rates than those who were foreign-born; the opposite was observed for Japanese women (IRR = 1.55, 95% CI: 1.17-2.08). The age-specific patterns among all foreign-born Asian women and US-born Japanese women showed a slow steady increase in incidence until age 70. However, among US-born Asian women (except Japanese), substantially elevated incidence rates during the reproductive and menopausal years were evident.Ethnic- and birthplace-variation in papillary thyroid cancer incidence can provide insight into the etiology of this increasingly common and understudied cancer.

    View details for DOI 10.1007/s10552-010-9720-5

    View details for Web of Science ID 000288542400015

    View details for PubMedID 21207130

  • Disparities in Liver Cancer Incidence by Nativity, Acculturation, and Socioeconomic Status in California Hispanics and Asians CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION Chang, E. T., Yang, J., Alfaro-Velcamp, T., So, S. K., Glaser, S. L., Gomez, S. L. 2010; 19 (12): 3106-3118


    Asians and Hispanics have the highest incidence rates of liver cancer in the United States, but little is known about how incidence patterns in these largely immigrant populations vary by nativity, acculturation, and socioeconomic status (SES). Such variations can identify high-priority subgroups for prevention and monitoring.Incidence rates and rate ratios (IRR) by nativity among 5,400 Hispanics and 5,809 Asians diagnosed with liver cancer in 1988-2004 were calculated in the California Cancer Registry. Neighborhood ethnic enclave status and SES were classified using 2000 U.S. Census data for cases diagnosed in 1998-2002.Foreign-born Hispanic males had significantly lower liver cancer incidence rates than U.S.-born Hispanic males in 1988-2004 (e.g., IRR = 0.54, 95% confidence interval [CI] = 0.50-0.59 in 1997-2004), whereas foreign-born Hispanic females had significantly higher rates in 1988-1996 (IRR = 1.42, 95% CI = 1.18-1.71), but not 1997-2004. Foreign-born Asian males and females had up to 5-fold higher rates than the U.S.-born. Among Hispanic females, incidence rates were elevated by 21% in higher-enclave versus lower-enclave neighborhoods, and by 24% in lower- versus higher-SES neighborhoods. Among Asian males, incidence rates were elevated by 23% in higher-enclave neighborhoods and by 21% in lower-SES neighborhoods. In both racial/ethnic populations, males and females in higher-enclave, lower-SES neighborhoods had higher incidence rates.Nativity, residential enclave status, and neighborhood SES characterize Hispanics and Asians with significantly unequal incidence rates of liver cancer, implicating behavioral or environmental risk factors and revealing opportunities for prevention.Liver cancer control efforts should especially target foreign-born Asians, U.S.-born Hispanic men, and residents of lower-SES ethnic enclaves.

    View details for DOI 10.1158/1055-9965.EPI-10-0863

    View details for Web of Science ID 000285285900012

    View details for PubMedID 20940276

  • Quality of Cancer Care Among Foreign-Born and US-Born Patients With Lung Or Colorectal Cancer CANCER Nielsen, S. S., He, Y., Ayanian, J. Z., Gomez, S. L., Kahn, K. L., West, D. W., Keating, N. L. 2010; 116 (23): 5497-5506


    Disparities in care have been documented for foreign-born cancer patients in the United States. However, few data are available regarding patients with lung and colorectal cancer. In the current study, the authors assessed whether patient-reported quality and receipt of recommended care differed between US-born and foreign-born cancer patients.The authors collected surveys and medical records for a population-based cohort including white, Hispanic, and Asian adults (2205 US-born and 890 foreign-born individuals) with lung or colorectal cancer diagnosed in California from 2003 through 2005. Logistic regression was used to assess the association between nativity and patient-reported quality of care and receipt of recommended treatments (adjuvant chemotherapy for stage III colon cancer, adjuvant chemotherapy and radiotherapy for stage II/III rectal cancer, and curative surgery for stage I/II nonsmall cell lung cancer). The authors also assessed whether language explained any differences in care by nativity.Overall, 46% of patients reported excellent care, but foreign-born patients were less likely than US-born patients to report excellent quality of care (adjusted odds ratio [AOR], 0.80; 95% confidence interval [95% CI], 0.65-1.00), a difference partly explained by the language of the survey, an indicator of English proficiency. Rates of recommended therapies ranged from 64% to 85%; foreign-born patients were less likely to receive chemotherapy and radiotherapy for stage II/III rectal cancer (AOR, 0.35; 95% CI, 0.12-0.99). Rates of other treatments did not differ significantly by nativity.Foreign-born cancer patients reported lower quality of care and were less likely to receive some cancer therapies than patients born in the Unites States. Better coordination of care and communication regarding cancer treatments and expanded use of interpreters may lessen these disparities.

    View details for DOI 10.1002/cncr.25546

    View details for Web of Science ID 000284665500023

    View details for PubMedID 20672356

  • The influence of nativity and neighborhoods on breast cancer stage at diagnosis and survival among California Hispanic women BMC CANCER Keegan, T. H., Quach, T., Shema, S., Glaser, S. L., Gomez, S. L. 2010; 10


    In the US, foreign-born Hispanics tend to live in socioeconomic conditions typically associated with later stage of breast cancer diagnosis, yet they have lower breast cancer mortality rates than their US-born counterparts. We evaluated the impact of nativity (US- versus foreign-born), neighborhood socioeconomic status (SES) and Hispanic enclave (neighborhoods with high proportions of Hispanics or Hispanic immigrants) on breast cancer stage at diagnosis and survival among Hispanics.We studied 37,695 Hispanic women diagnosed from 1988 to 2005 with invasive breast cancer from the California Cancer Registry. Nativity was based on registry data or, if missing, imputed from case Social Security number. Neighborhood variables were developed from Census data. Stage at diagnosis was analyzed with logistic regression, and survival, based on vital status determined through 2007, was analyzed with Cox proportional hazards regression.Compared to US-born Hispanics, foreign-born Hispanics were more likely to be diagnosed at an advanced stage of breast cancer (adjusted odds ratio (OR) = 1.14, 95% confidence interval (CI): 1.09-1.20), but they had a somewhat lower risk of breast cancer specific death (adjusted hazard ratio (HR) = 0.94, 95% CI: 0.90-0.99). Living in low SES and high enclave neighborhoods was associated with advanced stage of diagnosis, while living in a lower SES neighborhood, but not Hispanic enclave, was associated with worse survival.Identifying the modifiable factors that facilitate this survival advantage in Hispanic immigrants could help to inform specific interventions to improve survival in this growing population.

    View details for DOI 10.1186/1471-2407-10-603

    View details for Web of Science ID 000284404300001

    View details for PubMedID 21050464



    Our aim was to determine the incidence rates of head and neck cancer in Vietnamese Californians compared with other Asian and non-Asian Californians.Age-adjusted incidence rates of head and neck cancer between 1988 and 2004 were computed for Vietnamese Californians compared with other racial/ethnic groups by time period, ethnicity, neighborhood-level socioeconomic status (SES), and sex using data from the population-based California Cancer Registry (CCR). Data by smoking and alcohol status were tabulated from the California Health Interview Survey.Vietnamese men had a higher incidence rate of head and neck cancer than other Asian men. Specifically, the laryngeal cancer rate was significantly higher for Vietnamese men (6.5/100,000; 95% confidence interval [CI], 5.0-8.2) than all other Asian men (range, 2.6-3.8/100,000), except Korean men (5.1/100,000; 95% CI, 3.9-6.4). Both Vietnamese and Korean men had the highest percentage of current smokers. Neighborhood SES was inversely related to head and neck cancer rates among Vietnamese men and women.The higher incidence rate of head and neck cancer in Vietnamese men may correspond to the higher smoking prevalence in this group. Individual-level data are needed to establish the link of tobacco, alcohol, and other risk factors with head and neck cancer in these patients.

    View details for DOI 10.1002/hed.21330

    View details for Web of Science ID 000282707500008

    View details for PubMedID 20091688

  • Early Discontinuation and Nonadherence to Adjuvant Hormonal Therapy in a Cohort of 8,769 Early-Stage Breast Cancer Patients JOURNAL OF CLINICAL ONCOLOGY Hershman, D. L., Kushi, L. H., Shao, T., Buono, D., Kershenbaum, A., Tsai, W., Fehrenbacher, L., Gomez, S. L., Miles, S., Neugut, A. I. 2010; 28 (27): 4120-4128


    While studies have found that adjuvant hormonal therapy for hormone-sensitive breast cancer (BC) dramatically reduces recurrence and mortality, adherence to medications is suboptimal. We investigated the rates and predictors of early discontinuation and nonadherence to hormonal therapy in patients enrolled in Kaiser Permanente of Northern California health system.We identified women diagnosed with hormone-sensitive stage I-III BC from 1996 to 2007 and used automated pharmacy records to identify hormonal therapy prescriptions and dates of refill. We used Cox proportional hazards regression models to analyze factors associated with early discontinuation and nonadherence (medication possession ratio < 80%) of hormonal therapy.We identified 8,769 patients with BC who met our eligibility criteria and who filled at least one prescription for tamoxifen (43%), aromatase inhibitors (26%), or both (30%) within 1 year of diagnosis. Younger or older age, lumpectomy (v mastectomy), and comorbidities were associated with earlier discontinuation, while Asian race, being married, earlier year at diagnosis, receipt of chemotherapy or radiotherapy, and longer prescription refill interval were associated with completion of 4.5 years of therapy. Of those who continued therapy, similar factors were associated with full adherence. Women age younger than 40 years had the highest risk of discontinuation (hazard ratio, 1.51; 95% CI, 1.23 to 1.85). By 4.5 years, 32% discontinued therapy, and of those who continued, 72% were fully adherent.Only 49% of patients with BC took adjuvant hormonal therapy for the full duration at the optimal schedule. Younger women are at high risk of nonadherence. Interventions to improve adherence and continuation of hormonal therapy are needed, especially for younger women.

    View details for DOI 10.1200/JCO.2009.25.9655

    View details for Web of Science ID 000281909700006

    View details for PubMedID 20585090

  • Availability and Accuracy of Medical Record Information on Language Usage of Cancer Patients from a Multi-Ethnic Population JOURNAL OF IMMIGRANT AND MINORITY HEALTH McClure, L. A., Glaser, S. L., Shema, S. J., Allen, L., Quesenberry, C., John, E. M., Gomez, S. L. 2010; 12 (4): 480-488


    Documentation of language usage in medical settings could be effective in identifying and addressing language barriers and would improve understanding of health disparities. This study evaluated the availability and accuracy of medical records information on language for 1,664 cancer patients likely to have poor English proficiency. Accuracy was assessed by comparison to language obtained from interview-based research studies. For patients diagnosed at facilities where information on language was not abstracted electronically, 81.6% had language information in their medical records, most often in admissions documents. For all 37 hospitals, agreement between medical records and interview language was 79.3% overall and was greater for those speaking English than another language. Language information is widely available in hospital medical records of cancer patients. However, for the data to be useful for research and reducing language barriers in medical care, the information must be collected in a consistent and accurate manner.

    View details for DOI 10.1007/s10903-009-9282-3

    View details for Web of Science ID 000281505900007

    View details for PubMedID 19685187

  • Impact of Neighborhood Racial Composition and Metropolitan Residential Segregation on Disparities in Breast Cancer Stage at Diagnosis and Survival Between Black and White Women in California JOURNAL OF COMMUNITY HEALTH Warner, E. T., Gomez, S. L. 2010; 35 (4): 398-408


    We examined the impact of metropolitan racial residential segregation on stage at diagnosis and all-cause and breast cancer-specific survival between and within black and white women diagnosed with breast cancer in California between 1996 and 2004. We merged data from the California Cancer Registry with Census indices of five dimensions of racial residential segregation, quantifying segregation among Blacks relative to Whites; block group ("neighborhood") measures of the percentage of Blacks and a composite measure of socioeconomic status. We also examined simultaneous segregation on at least two measures ("hypersegregation"). Using logistic regression we examined effects of these measures on stage at diagnosis and Cox proportional hazards regression for survival. For all-cause and breast-cancer specific mortality, living in neighborhoods with more Blacks was associated with lower mortality among black women, but higher mortality among Whites. However, neighborhood racial composition and metropolitan segregation did not explain differences in stage or survival between Black and White women. Future research should identify mechanisms by which these measures impact breast cancer diagnosis and outcomes among Black women.

    View details for DOI 10.1007/s10900-010-9265-2

    View details for Web of Science ID 000281239700008

    View details for PubMedID 20358266

  • Disparities in Breast Cancer Survival Among Asian Women by Ethnicity and Immigrant Status: A Population-Based Study AMERICAN JOURNAL OF PUBLIC HEALTH Gomez, S. L., Clarke, C. A., Shema, S. J., Chang, E. T., Keegan, T. H., Glaser, S. L. 2010; 100 (5): 861-869


    We investigated heterogeneity in ethnic composition and immigrant status among US Asians as an explanation for disparities in breast cancer survival.We enhanced data from the California Cancer Registry and the Surveillance, Epidemiology, and End Results program through linkage and imputation to examine the effect of immigrant status, neighborhood socioeconomic status, and ethnic enclave on mortality among Chinese, Japanese, Filipino, Korean, South Asian, and Vietnamese women diagnosed with breast cancer from 1988 to 2005 and followed through 2007.US-born women had similar mortality rates in all Asian ethnic groups except the Vietnamese, who had lower mortality risk (hazard ratio [HR] = 0.3; 95% confidence interval [CI] = 0.1, 0.9). Except for Japanese women, all foreign-born women had higher mortality than did US-born Japanese, the reference group. HRs ranged from 1.4 (95% CI = 1.2, 1.7) among Koreans to 1.8 (95% CI = 1.5, 2.2) among South Asians and Vietnamese. Little of this variation was explained by differences in disease characteristics.Survival after breast cancer is poorer among foreign- than US-born Asians. Research on underlying factors is needed, along with increased awareness and targeted cancer control.

    View details for DOI 10.2105/AJPH.2009.176651

    View details for Web of Science ID 000276828800021

    View details for PubMedID 20299648

  • Breast Cancer Incidence Patterns among California Hispanic Women: Differences by Nativity and Residence in an Enclave CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION Keegan, T. H., John, E. M., Fish, K. M., Alfaro-Velcamp, T., Clarke, C. A., Gomez, S. L. 2010; 19 (5): 1208-1218


    Breast cancer incidence is higher in U.S.-born Hispanic women than foreign-born Hispanics, but no studies have examined how these rates have changed over time. To better inform cancer control efforts, we examined incidence trends by nativity and incidence patterns by neighborhood socioeconomic status (SES) and Hispanic enclave (neighborhoods with high proportions of Hispanics or Hispanic immigrants).Information about all Hispanic women diagnosed with invasive breast cancer between 1988 and 2004 was obtained from the California Cancer Registry. Nativity was imputed from Social Security number for the 27% of cases with missing birthplace information. Neighborhood variables were developed from Census data.From 1988 to 2004, incidence rates for U.S.-born Hispanics were parallel but lower than those of non-Hispanic whites, showing an annual 6% decline from 2002 to 2004. Foreign-born Hispanics had an annual 4% increase in incidence rates from 1995 to 1998 and a 1.4% decline thereafter. Rates were 38% higher for U.S.- than foreign-born Hispanics, with elevations more pronounced for localized than regional/distant disease, and for women>50 years of age. Residence in higher SES and lower Hispanic enclave neighborhoods were independently associated with higher incidence, with Hispanic enclave having a stronger association than SES.Compared with foreign-born, U.S.-born Hispanic women in California had higher prevalence of breast cancer risk factors, suggesting that incidence patterns largely reflect these differences in risk factors.Further research is needed to separate the effects of individual- and neighborhood-level factors that affect incidence in this large and growing population.

    View details for DOI 10.1158/1055-9965.EPI-10-0021

    View details for Web of Science ID 000278489800009

    View details for PubMedID 20447917

  • Racial and social class gradients in life expectancy in contemporary California SOCIAL SCIENCE & MEDICINE Clarke, C. A., Miller, T., Chang, E. T., Yin, D., Cockburn, M., Gomez, S. L. 2010; 70 (9): 1373-1380


    Life expectancy, or the estimated average age of death, is among the most basic measures of a population's health. However, monitoring differences in life expectancy among sociodemographically defined populations has been challenging, at least in the United States (US), because death certification does not include collection of markers of socioeconomic status (SES). In order to understand how SES and race/ethnicity independently and jointly affected overall health in a contemporary US population, we assigned a small-area-based measure of SES to all 689,036 deaths occurring in California during a three-year period (1999-2001) overlapping the most recent US census. Residence at death was geocoded to the smallest census area available (block group) and assigned to a quintile of a multifactorial SES index. We constructed life tables using mortality rates calculated by age, sex, race/ethnicity and neighborhood SES quintile, and produced corresponding life expectancy estimates. We found a 19.6 (+/-0.6) year gap in life expectancy between the sociodemographic groups with the longest life expectancy (highest SES quintile of Asian females; 84.9 years) and the shortest (lowest SES quintile of African-American males; 65.3 years). A positive SES gradient in life expectancy was observed among whites and African-Americans but not Hispanics or Asians. Age-specific mortality disparities varied among groups. Race/ethnicity and neighborhood SES had substantial and independent influences on life expectancy, underscoring the importance of monitoring health outcomes simultaneously by these factors. African-American males living in the poorest 20% of California neighborhoods had life expectancy comparable to that reported for males living in developing countries. Neighborhood SES represents a readily-available metric for ongoing surveillance of health disparities in the US.

    View details for DOI 10.1016/j.socscimed.2010.01.003

    View details for Web of Science ID 000277500400016

    View details for PubMedID 20171001

  • Increasing Mastectomy Rates for Early-Stage Breast Cancer? Population-Based Trends From California JOURNAL OF CLINICAL ONCOLOGY Gomez, S. L., Lichtensztajn, D., Kurian, A. W., Telli, M. L., Chang, E. T., Keegan, T. H., Glaser, S. L., Clarke, C. A. 2010; 28 (10): E155-E157

    View details for DOI 10.1200/JCO.2009.26.1032

    View details for Web of Science ID 000276152200036

    View details for PubMedID 20159812

  • Cervical Cancer Incidence Among 6 Asian Ethnic Groups in the United States, 1996 Through 2004 CANCER Wang, S. S., Carreon, J. D., Gomez, S. L., Devesa, S. S. 2010; 116 (4): 949-956


    Cervical cancer incidence was evaluated by histologic type, age at diagnosis, and disease stage for 6 Asian ethnic groups residing in the United States.Incidence rates were estimated for cervical squamous cell carcinoma (SCC) and adenocarcinoma by age and stage for 6 Asian ethnic groups-Asian Indian/Pakistani, Chinese, Filipino, Japanese, Korean, and Vietnamese-in 5 US cancer registry areas during 1996 through 2004. For comparison, rates among non-Hispanic whites, non-Hispanic blacks, and Hispanics were also calculated.During 1996 through 2004, Vietnamese women had the highest (18.9 per 100,000) and Asian Indian/Pakistani women had the lowest (4.5) incidence of cervical cancer; this pattern was consistent by histologic type. Vietnamese women also had the highest incidence for localized (7.3) and regional (5.7) SCC and for localized (2.4) adenocarcinoma. Contrary to the plateau of SCC incidence apparent among white women by age 45 years, SCC rates continued to rise with age among Chinese, Filipina, Korean, and Vietnamese women.There exists large variation in invasive cervical cancer incidence patterns among Asian ethnic groups in the United States and in comparison with rates for blacks, Hispanics, and whites. Early detection and prevention strategies for cervical cancer among Asians require targeted strategies by ethnic group.

    View details for DOI 10.1002/cncr.24843

    View details for Web of Science ID 000274315800024

    View details for PubMedID 20029972

  • Hidden Breast Cancer Disparities in Asian Women: Disaggregating Incidence Rates by Ethnicity and Migrant Status AMERICAN JOURNAL OF PUBLIC HEALTH Gomez, S. L., Quach, T., Horn-Ross, P. L., Pham, J. T., Cockburn, M., Chang, E. T., Keegan, T. H., Glaser, S. L., Clarke, C. A. 2010; 100: S125-S131


    We estimated trends in breast cancer incidence rates for specific Asian populations in California to determine if disparities exist by immigrant status and age.To calculate rates by ethnicity and immigrant status, we obtained data for 1998 through 2004 cancer diagnoses from the California Cancer Registry and imputed immigrant status from Social Security Numbers for the 26% of cases with missing birthplace information. Population estimates were obtained from the 1990 and 2000 US Censuses.Breast cancer rates were higher among US- than among foreign-born Chinese (incidence rate ratio [IRR] = 1.84; 95% confidence interval [CI] = 1.72, 1.96) and Filipina women (IRR = 1.32; 95% CI = 1.20, 1.44), but similar between US- and foreign-born Japanese women. US-born Chinese and Filipina women who were younger than 55 years had higher rates than did White women of the same age. Rates increased over time in most groups, as high as 4% per year among foreign-born Korean and US-born Filipina women. From 2000-2004, the rate among US-born Filipina women exceeded that of White women.These findings challenge the notion that breast cancer rates are uniformly low across Asians and therefore suggest a need for increased awareness, targeted cancer control, and research to better understand underlying factors.

    View details for DOI 10.2105/AJPH.2009.163931

    View details for Web of Science ID 000275937600025

    View details for PubMedID 20147696

  • Uncovering Disparities in Survival after Non-Small-Cell Lung Cancer among Asian/Pacific Islander Ethnic Populations in California CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION Chang, E. T., Shema, S. J., Wakelee, H. A., Clarke, C. A., Gomez, S. L. 2009; 18 (8): 2248-2255


    Asians may have better survival after non-small-cell lung cancer (NSCLC) than non-Asians. However, it is unknown whether survival varies among the heterogeneous U.S. Asian/Pacific Islander (API) populations. Therefore, this study aimed to quantify survival differences among APIs with NSCLC. Differences in overall and disease-specific survival were analyzed in the California Cancer Registry among 16,577 API patients diagnosed with incident NSCLC between 1988 and 2007. Adjusted hazard ratios (HR) with 95% confidence intervals (95% CI) were estimated using Cox proportional hazards regression models with separate baseline hazards by disease stage. Despite better overall and disease-specific survival among APIs compared with non-Hispanic Whites, differences were evident across API populations. Among women, Japanese (overall survival HR, 1.16; 95% CI, 1.06-1.27) and APIs other than those in the six largest ethnic groups (other APIs; HR, 1.19; 95% CI, 1.07-1.33) had significantly poorer overall and disease-specific survival than Chinese. By contrast, South Asian women had significantly better survival than Chinese (HR, 0.79; 95% CI, 0.63-0.97). Among men, Japanese (HR, 1.15; 95% CI, 1.07-1.24), Vietnamese (HR, 1.07; 95% CI, 1.00-1.16), and other APIs (HR, 1.18; 95% CI, 1.08-1.28) had significantly poorer overall and disease-specific survival than Chinese. Other factors independently associated with poorer survival were lower neighborhood socioeconomic status, involvement with a non-university hospital, unmarried status, older age, and earlier year of diagnosis. APIs have significant ethnic differences in NSCLC survival that may be related to disparate lifestyles, biology, and especially health care access or use. To reduce the nationwide burden of lung cancer mortality, it is critical to identify and ameliorate hidden survival disparities such as those among APIs.

    View details for DOI 10.1158/1055-9965.EPI-09-0332

    View details for Web of Science ID 000268958600016

    View details for PubMedID 19622719

  • Why do Asian-American women have lower rates of breast conserving surgery: results of a survey regarding physician perceptions BMC PUBLIC HEALTH Pham, J. T., Allen, L. J., Gomez, S. L. 2009; 9


    US Asian women with early-stage breast cancer are more likely to receive a modified radical mastectomy (MRM) than White women, contrary to clinical recommendations regarding breast conserving treatment (BCT).We surveyed physicians regarding treatment decision-making for early-stage breast cancer, particularly as it applies to Asian patients. Physicians were identified through the population-based Greater Bay Area Cancer Registry. Eighty (of 147) physicians completed a questionnaire on sociodemographics, professional training, clinical practices, and perspectives on the treatment decision-making processes.The most important factors identified by physicians in the BCT/MRM decision were clinical in nature, including presence of multifocal disease (86% identified this as being an important factor for selecting MRM), tumor size (71% for MRM, 78% for BCT), cosmetic result (74% for BCT), and breast size (50% for MRM, 55% for BCT). The most important reasons cited for the Asian treatment patterns were patient attitudes toward not needing to preserve the breast (53%), smaller breast sizes (25%), and fear and cultural beliefs (12%).These survey results suggest that physicians perceive major roles of both clinical and cultural factors in the BCT/MRM decision, but cultural factors may be more relevant in explaining surgical treatment patterns among Asians.

    View details for DOI 10.1186/1471-2458-9-246

    View details for Web of Science ID 000268767200001

    View details for PubMedID 19615070

  • Impact of socioeconomic status on cancer incidence and stage at diagnosis: selected findings from the surveillance, epidemiology, and end results: National Longitudinal Mortality Study CANCER CAUSES & CONTROL Clegg, L. X., Reichman, M. E., Miller, B. A., Hankey, B. F., Singh, G. K., Lin, Y. D., Goodman, M. T., Lynch, C. F., Schwartz, S. M., Chen, V. W., Bernstein, L., Gomez, S. L., Graff, J. J., Lin, C. C., Johnson, N. J., Edwards, B. K. 2009; 20 (4): 417-435


    Population-based cancer registry data from the Surveillance, Epidemiology, and End Results (SEER) Program at the National Cancer Institute (NCI) are mainly based on medical records and administrative information. Individual-level socioeconomic data are not routinely reported by cancer registries in the United States because they are not available in patient hospital records. The U.S. representative National Longitudinal Mortality Study (NLMS) data provide self-reported, detailed demographic and socioeconomic data from the Social and Economic Supplement to the Census Bureau's Current Population Survey (CPS). In 1999, the NCI initiated the SEER-NLMS study, linking the population-based SEER cancer registry data to NLMS data. The SEER-NLMS data provide a new unique research resource that is valuable for health disparity research on cancer burden. We describe the design, methods, and limitations of this data set. We also present findings on cancer-related health disparities according to individual-level socioeconomic status (SES) and demographic characteristics for all cancers combined and for cancers of the lung, breast, prostate, cervix, and melanoma.Records of cancer patients diagnosed in 1973-2001 when residing 1 of 11 SEER registries were linked with 26 NLMS cohorts. The total number of SEER matched cancer patients that were also members of an NLMS cohort was 26,844. Of these 26,844 matched patients, 11,464 were included in the incidence analyses and 15,357 in the late-stage diagnosis analyses. Matched patients (used in the incidence analyses) and unmatched patients were compared by age group, sex, race, ethnicity, residence area, year of diagnosis, and cancer anatomic site. Cohort-based age-adjusted cancer incidence rates were computed. The impact of socioeconomic status on cancer incidence and stage of diagnosis was evaluated.Men and women with less than a high school education had elevated lung cancer rate ratios of 3.01 and 2.02, respectively, relative to their college educated counterparts. Those with family annual incomes less than $12,500 had incidence rates that were more than 1.7 times the lung cancer incidence rate of those with incomes $50,000 or higher. Lower income was also associated with a statistically significantly increased risk of distant-stage breast cancer among women and distant-stage prostate cancer among men.Socioeconomic patterns in incidence varied for specific cancers, while such patterns for stage were generally consistent across cancers, with late-stage diagnoses being associated with lower SES. These findings illustrate the potential for analyzing disparities in cancer outcomes according to a variety of individual-level socioeconomic, demographic, and health care characteristics, as well as by area measures available in the linked database.

    View details for DOI 10.1007/s10552-008-9256-0

    View details for Web of Science ID 000265018900002

    View details for PubMedID 19002764

  • Incidence of lymphoid neoplasms by subtype among six Asian ethnic groups in the United States, 1996-2004 CANCER CAUSES & CONTROL Daniel Carreon, J., Morton, L. M., Devesa, S. S., Clarke, C. A., Gomez, S. L., Glaser, S. L., Sakoda, L. C., Linet, M. S., Wang, S. S. 2008; 19 (10): 1171-1181


    To establish baseline data for lymphoid neoplasm incidence by subtype for six Asian-American ethnic groups.Incident rates were estimated by age and sex for six Asian ethnic groups--Asian Indian/Pakistani, Chinese, Filipino, Japanese, Korean, Vietnamese--in five United States cancer registry areas during 1996-2004. For comparison, rates for non-Hispanic Whites were also estimated.During 1996-2004, Filipinos had the highest (24.0) and Koreans had the lowest incidence (12.7) of total lymphoid neoplasms. By subtype, Vietnamese and Filipinos had the highest incidence for diffuse large B-cell lymphoma (DLBCL) (8.0 and 7.2); Japanese had the highest incidence of follicular lymphoma (2.3). Although a general male predominance of lymphoid neoplasms was observed, this pattern varied by lymphoid neoplasm subtype. Whites generally had higher rates than all Asian ethnic groups for all lymphoid neoplasms and most lymphoma subtypes, although the magnitude of the difference varied by both ethnicity and lymphoma subtype.The observed variations in incidence patterns among Asian ethnic groups in the United States suggest that it may be fruitful to pursue studies that compare Asian populations for postulated environmental and genetic risk factors.

    View details for DOI 10.1007/s10552-008-9184-z

    View details for Web of Science ID 000260766300017

    View details for PubMedID 18543071

  • Epidemiology of Non-small Cell Lung Cancer in Asian Americans Incidence Patterns Among Six Subgroups by Nativity JOURNAL OF THORACIC ONCOLOGY Raz, D. J., Gomez, S. L., Chang, E. T., Kim, J. Y., Keegan, T. H., Pham, J., Kukreja, J., Hiatt, R. A., Jablons, D. M. 2008; 3 (12): 1391-1397


    Differences in the epidemiology of lung cancer between Asians and non-Hispanic whites have brought to light the relative influences of genetic and environmental factors on lung cancer risk. We set out to describe the epidemiology of non-small cell lung cancer (NSCLC) among Asians living in California, and to explore the effects of acculturation on lung cancer risk by comparing lung cancer rates between U.S.-born and foreign-born Asians.Age-adjusted incidence rates of NSCLC were calculated for Chinese, Filipino, Japanese, Korean, Vietnamese, and South Asians in California between 1988 and 2003 using data from the California Cancer Registry. Incidence rates were calculated and stratified by sex and nativity. We analyzed population-based tobacco smoking prevalence data to determine whether differences in rates were associated with prevalence of tobacco smoking.Asians have overall lower incidence rates of NSCLC compared with whites (29.8 and 57.7 per 100,000, respectively). South Asians have markedly low rates of NSCLC (12.0 per 100,000). Foreign-born Asian men and women have an approximately 35% higher rate of NSCLC than U.S.-born Asian men and women. The incidence pattern by nativity is consistent with the population prevalence of smoking among Asian men; however, among women, the prevalence of smoking is higher among U.S.-born, which is counter to their incidence patterns.Foreign-born Asians have a higher rate of NSCLC than U.S.-born Asians, which may be due to environmental tobacco smoke or nontobacco exposures among women. South Asians have a remarkably low rate of NSCLC that approaches white levels among the U.S.-born. More studies with individual-level survey data are needed to identify the specific environmental factors associated with differential lung cancer risk occurring with acculturation among Asians.

    View details for Web of Science ID 000261712300006

    View details for PubMedID 19057262

  • Sex differences in lung-cancer susceptibility: a smoke screen? LANCET ONCOLOGY Wakelee, H. A., Gomez, S. L., Chang, E. T. 2008; 9 (7): 609-610

    View details for Web of Science ID 000257527400006

    View details for PubMedID 18598927

  • Disparities in mammographic screening for Asian women in California: a cross-sectional analysis to identify meaningful groups for targeted intervention BMC CANCER Gomez, S. L., Tan, S., Keegan, T. H., Clarke, C. A. 2007; 7


    Breast cancer is the most commonly diagnosed cancer among the rapidly growing population of Asian Americans; it is also the most common cause of cancer mortality among Filipinas. Asian women continue to have lower rates of mammographic screening than women of most other racial/ethnic groups. While prior studies have described the effects of sociodemographic and other characteristics of women on non-adherence to screening guidelines, they have not identified the distinct segments of the population who remain at highest risk of not being screened.To better describe characteristics of Asian women associated with not having a mammogram in the last two years, we applied recursive partitioning to population-based data (N = 1521) from the 2001 California Health Interview Survey (CHIS), for seven racial/ethnic groups of interest: Chinese, Japanese, Filipino, Korean, South Asian, Vietnamese, and all Asians combined.We identified two major subgroups of Asian women who reported not having a mammogram in the past two years and therefore, did not follow mammography screening recommendations: 1) women who have never had a pap exam to screen for cervical cancer (68% had no mammogram), and 2) women who have had a pap exam, but have no women's health issues (osteoporosis, using menopausal hormone therapies, and/or hysterectomy) nor a usual source of care (62% had no mammogram). Only 19% of Asian women who have had pap screening and have women's health issues did not have a mammogram in the past two years. In virtually all ethnic subgroups, having had pap or colorectal screening were the strongest delineators of mammography usage. Other characteristics of women least likely to have had a mammogram included: Chinese non-U.S. citizens or citizens without usual source of health care, Filipinas with no health insurance, Koreans without women's health issues and public or no health insurance, South Asians less than age 50 who were unemployed or non-citizens, and Vietnamese women who were never married.We identified distinct subgroups of Asian women at highest risk of not adhering to mammography screening guidelines; these data can inform outreach efforts aimed at reducing the disparity in mammography screening among Asian women.

    View details for DOI 10.1186/1471-2407-7-201

    View details for Web of Science ID 000252447400001

    View details for PubMedID 17961259

  • Longitudinal, population-based study of racial/ethnic differences in colorectal cancer survival: impact of neighborhood socioeconomic status, treatment and comorbidity BMC CANCER Gomez, S. L., O'Malley, C. D., Stroup, A., Shema, S. J., Satariano, W. A. 2007; 7


    Colorectal cancer, if detected early, has greater than 90% 5-year survival. However, survival has been shown to vary across racial/ethnic groups in the United States, despite the availability of early detection methods.This study evaluated the joint effects of sociodemographic factors, tumor characteristics, census-based socioeconomic status (SES), treatment, and comorbidities on survival after colorectal cancer among and within racial/ethnic groups, using the SEER-Medicare database for patients diagnosed in 1992-1996, and followed through 1999.Unadjusted colorectal cancer-specific mortality rates were higher among Blacks and Hispanic males than whites (relative rates (95% confidence intervals) = 1.34 (1.26-1.42) and 1.16 (1.04-1.29), respectively), and lower among Japanese (0.78 (0.70-0.88)). These patterns were evident for all-cause mortality, although the magnitude of the disparity was larger for colorectal cancer mortality. Adjustment for stage accounted for the higher rate among Hispanic males and most of the lower rate among Japanese. Among Blacks, stage and SES accounted for about half of the higher rate relative to Whites, and within stage III colon and stages II/III rectal cancer, SES completely accounted for the small differentials in survival between Blacks and Whites. Comorbidity did not appear to explain the Black-White differentials in colorectal-specific nor all-cause mortality, beyond stage, and treatment (surgery, radiation, chemotherapy) explained a very small proportion of the Black-White difference. The fully-adjusted relative mortality rates comparing Blacks to Whites was 1.14 (1.09-1.20) for all-cause mortality and 1.21 (1.14-1.29) for colorectal cancer specific mortality. The sociodemographic, tumor, and treatment characteristics also had different impacts on mortality within racial/ethnic groups.In this comprehensive analysis, race/ethnic-specific models revealed differential effects of covariates on survival after colorectal cancer within each group, suggesting that different strategies may be necessary to improve survival in each group. Among Blacks, half of the differential in survival after colorectal cancer was primarily attributable to stage and SES, but differences in survival between Blacks and Whites remain unexplained with the data available in this comprehensive, population-based, analysis.

    View details for DOI 10.1186/1471-2407-7-193

    View details for Web of Science ID 000253162100001

    View details for PubMedID 17939875

  • Differences in prognostic factors and survival among white and Asian men with prostate cancer, California, 1995-2004 CANCER Robbins, A. S., Koppie, T. M., Gomez, S. L., Parikh-Patel, A., Mills, P. K. 2007; 110 (6): 1255-1263


    There are very limited data concerning survival from prostate cancer among Asian subgroups living in the U.S., a large proportion of whom reside in California. There do not appear to be any published data on prostate cancer survival for the more recently immigrated Asian subgroups (Korean, South Asian [SA], and Vietnamese).A study of prognostic factors and survival from prostate cancer was conducted in non-Hispanic whites and 6 Asian subgroups (Chinese, Filipino, Japanese, Korean, SA, and Vietnamese), using data from all men in California diagnosed with incident prostate cancer during 1995-2004 and followed through 2004 (n = 116,916). Survival was analyzed using Cox proportional hazards models.Whites and Asians demonstrated significant racial differences in all prognostic factors: age, summary stage, primary treatment, histologic grade, socioeconomic status, and year of diagnosis. Every Asian subgroup had a risk factor profile that put them at a survival disadvantage compared with whites. Overall, the 10-year risk of death from prostate cancer was 11.9%. However, in unadjusted analyses Japanese men had significantly better survival than whites; Chinese, Filipino, Korean, and Vietnamese men had statistically equal survival; and SA men had significantly lower survival. On multivariate analyses adjusting for all prognostic factors, all subgroups except SA and Vietnamese men had significantly better survival than whites; the latter 2 groups had statistically equal survival.Traditional prognostic factors for survival from prostate cancer do not explain why most Asian men have better survival compared with whites, but they do explain the poorer survival of SA men compared with whites.

    View details for DOI 10.1002/cncr.22872

    View details for Web of Science ID 000249304000012

    View details for PubMedID 17701951

  • The burden of liver cancer in Asians and Pacific Islanders in the greater San Francisco Bay Area, 1990 through 2004 CANCER Chang, E. T., Keegan, T. H., Gomez, S. L., Le, G. M., Clarke, C. A., So, S. K., Glaser, S. L. 2007; 109 (10): 2100-2108


    To the authors' knowledge, no previous U.S. study has examined time trends in the incidence rate of liver cancer in the high-risk Asian/Pacific Islander population. In this study, liver cancer incidence trends were evaluated in Chinese, Filipino, Japanese, Korean, and Vietnamese men and women in the Greater San Francisco Bay Area of California between 1990 and 2004.Populations at risk were estimated by using the cohort-component demographic method. Annual percentage changes (APCs) in age-adjusted incidence rates of primary liver cancer among Asians/Pacific Islanders in the Greater Bay Area Cancer Registry were calculated by using joinpoint regression analysis.The incidence rate of liver cancer between 1990 and 2004 did not change significantly in Asian/Pacific Islander men or women overall. However, the incidence rate declined, although the decline was not statistically significant, among Chinese men (APC, -1.6%; 95% confidence interval [95% CI], -3.4-0.3%), Japanese men (APC, -4.9%; 95% CI, -10.7-1.2%), and Japanese women (APC, -3.6%; 95% CI, -8.9-2%). Incidence rates remained consistently high for Vietnamese, Korean, and Filipino men and women. Trends in the incidence rate of hepatocellular carcinoma were comparable to those for liver cancer. Although disparities in liver cancer incidence between Asians/Pacific Islanders and other racial/ethnic groups diminished between the period from 1990 through 1994 and the period from 2000 through 2004, the disparities among Asian subgroups increased.Liver cancer continues to affect Asian/Pacific Islander Americans disproportionately, with consistently high incidence rates in most subgroups. Culturally targeted prevention methods are needed to reduce the high rates of liver cancer in this growing population in the U.S.

    View details for DOI 10.1002/cncr.22642

    View details for Web of Science ID 000246252800024

    View details for PubMedID 17385214

  • Recent trends in breast cancer incidence among 6 Asian groups in the Greater Bay Area of Northern California INTERNATIONAL JOURNAL OF CANCER Keegan, T. H., Gomez, S. L., Clarke, C. A., Chan, J. K., Glaser, S. L. 2007; 120 (6): 1324-1329


    Asians and Pacific Islanders are typically aggregated in United States (US) cancer statistics even though the few studies that have considered subgroups separately have found marked differences in cancer incidence. The objective of this study was to evaluate trends in breast cancer incidence rates separately for US Chinese, Japanese, Filipino, Korean, South Asian and Vietnamese women overall and by age at diagnosis, histologic subtype and stage at diagnosis. Age-adjusted incidence rates and annual percent changes (APC) of new, primary breast cancer diagnosed in the Greater Bay Area Cancer Registry of Northern California (1990-2002) were calculated using SEER*Stat. In women under 50 years of age, annual incidence rates decreased for Japanese (APC = -4.1, p = 0.02) and Filipinas (APC = -1.9, p = 0.11), and increased or fluctuated in other subgroups over the study period. In women 50 years or older, rates of invasive breast cancer increased for most subgroups, except Filipinas (APC = -1.3, p = 0.32), and in Japanese until 1998-2000. Rates of breast cancer in situ increased in most subgroups from 1990 to 2002, as did rates of lobular breast cancer for Chinese (APC = +7.46, p < 0.01) women. In Japanese women, rates of lobular breast cancer were highest in 1995-1997 and decreased thereafter. Our data support the notion that the prevalence of established risk factors influence breast cancer incidence, as breast cancer rates increased for more recently immigrated groups and decreased among more established groups, and may suggest leads into other avenues of research, such as genetic differences, that may explain differences in incidence rates among Asian subgroups.

    View details for DOI 10.1002/ijc.22432

    View details for Web of Science ID 000244118600022

    View details for PubMedID 17163416

  • Quality of race, Hispanic ethnicity, and immigrant status in population-based cancer registry data: implications for health disparity studies CANCER CAUSES & CONTROL Clegg, L. X., Reichman, M. E., Hankey, B. F., Miller, B. A., Lin, Y. D., Johnson, N. J., Schwartz, S. M., Bernstein, L., Chen, V. W., Goodman, M. T., Gomez, S. L., Graff, J. J., Lynch, C. F., Lin, C. C., Edwards, B. K. 2007; 18 (2): 177-187


    Population-based cancer registry data from the Surveillance, Epidemiology, and End Results (SEER) Program at the National Cancer Institute are based on medical records and administrative information. Although SEER data have been used extensively in health disparities research, the quality of information concerning race, Hispanic ethnicity, and immigrant status has not been systematically evaluated. The quality of this information was determined by comparing SEER data with self-reported data among 13,538 cancer patients diagnosed between 1973-2001 in the SEER--National Longitudinal Mortality Study linked database. The overall agreement was excellent on race (kappa = 0.90, 95% CI = 0.88-0.91), moderate to substantial on Hispanic ethnicity (kappa = 0.61, 95% CI = 0.58-0.64), and low on immigrant status (kappa = 0.21. 95% CI = 0.10, 0.23). The effect of these disagreements was that SEER data tended to under-classify patient numbers when compared to self-identifications, except for the non-Hispanic group which was slightly over-classified. These disagreements translated into varying racial-, ethnic-, and immigrant status-specific cancer statistics, depending on whether self-reported or SEER data were used. In particular, the 5-year Kaplan-Meier survival and the median survival time from all causes for American Indians/Alaska Natives were substantially higher when based on self-classification (59% and 140 months, respectively) than when based on SEER classification (44% and 53 months, respectively), although the number of patients is small. These results can serve as a useful guide to researchers contemplating the use of population-based registry data to ascertain disparities in cancer burden. In particular, the study results caution against evaluating health disparities by using birthplace as a measure of immigrant status and race information for American Indians/Alaska Natives.

    View details for DOI 10.1007/s10552-006-0089-4

    View details for Web of Science ID 000244065700007

    View details for PubMedID 17219013

  • Lung cancer incidence in never smokers JOURNAL OF CLINICAL ONCOLOGY Wakelee, H. A., Chang, E. T., Gomez, S. L., Keegan, T. H., Feskanich, D., Clarke, C. A., Holmberg, L., Yong, L. C., Kolonel, L. N., Gould, M. K., West, D. W. 2007; 25 (5): 472-478


    Lung cancer is a leading cause of cancer death worldwide. Although smoking remains the predominant cause of lung cancer, lung cancer in never smokers is an increasingly prominent public health issue. However, data on this topic, particularly lung cancer incidence rates in never smokers, are limited.We reviewed the existing literature on lung cancer incidence and mortality rates among never smokers and present new data regarding rates in never smokers from the following large, prospective cohorts: Nurses' Health Study; Health Professionals Follow-Up Study; California Teachers Study; Multiethnic Cohort Study; Swedish Lung Cancer Register in the Uppsala/Orebro region; and First National Health and Nutrition Examination Survey Epidemiologic Follow-Up Study.Truncated age-adjusted incidence rates of lung cancer among never smokers age 40 to 79 years in these six cohorts ranged from 14.4 to 20.8 per 100,000 person-years in women and 4.8 to 13.7 per 100,000 person-years in men, supporting earlier observations that women are more likely than men to have non-smoking-associated lung cancer. The distinct biology of lung cancer in never smokers is apparent in differential responses to epidermal growth factor receptor inhibitors and an increased prevalence of adenocarcinoma histology in never smokers.Lung cancer in never smokers is an important public health issue, and further exploration of its incidence patterns, etiology, and biology is needed.

    View details for DOI 10.1200/JCO.2006.07.2983

    View details for Web of Science ID 000244176000003

    View details for PubMedID 17290054

  • Validity of cancer registry medicaid status against enrollment files - Implications for population-based studies of cancer outcomes MEDICAL CARE Chan, J. K., Gomez, S. L., O'Malley, C. D., Perkins, C. I., Clarke, C. A. 2006; 44 (10): 952-955


    Poor access to or inadequate health insurance contributes to disparities in cancer incidence and mortality. Cancer registry "payer source" data is collected by many cancer registries in the United States and has been used to compare cancer outcomes across insurance types.We evaluated the validity of cancer registry data on patient Medicaid status against enrollment data from Medi-Cal, California's Medicaid program.Data from the statewide California Cancer Registry for persons under age 65 years diagnosed with 1) any cancer in 1998 and 1999 or 2) with invasive cervical cancer between 1996 and 1999 were obtained and linked probabilistically to Medi-Cal enrollment files. We compared registry Medicaid status, determined from payer source information, against linkage results and used crosstabulations to calculate sensitivity, specificity, and positive predictive value. These measures were compared across different hospital and patient characteristics and cancer types.Cancer registry Medicaid status data had poor sensitivity (48%), good specificity (98%), and moderate positive predictive value (77%). Measures of validity did not vary substantially by cancer type, stage, patient age, sex, vital status, race/ethnicity, socioeconomic status, or diagnosing hospital size. Registry data undercounted the number of Medicaid patients by 52% and incorrectly assigned Medicaid as a payer to approximately 2% of patients.As a result of the poor validity of cancer registry Medicaid status data, caution should be used when interpreting cancer outcomes by insurance type calculated from registry payer source data. Linkage of registry data to Medicaid enrollment files represents a more accurate means of identifying Medicaid insurance status.

    View details for Web of Science ID 000241115500010

    View details for PubMedID 17001267

  • Misclassification of race/ethnicity in a population-based cancer registry (United States) CANCER CAUSES & CONTROL Gomez, S. L., Glaser, S. L. 2006; 17 (6): 771-781


    Cancer registry data on race/ethnicity are vital for understanding cancer patterns in population subgroups, as they inform public health policies for allocating resources and form the bases of etiologic hypotheses. However, accuracy of cancer registry data on race/ethnicity has not been systematically evaluated. By comparing race/ethnicity in the Greater Bay Area Cancer Registry to self-reported race/ethnicity for patients from 14 racial/ethnic groups, we determined the accuracy of this variable and the patient and hospital characteristics associated with disagreement. The extent of misclassification (measured by sensitivity and predictive value positive (PV+)) varied across racial/ethnic groups (total n=11,676). Sensitivities and PV+'s were high (exceeding 90%) for non-Hispanic Whites and Blacks, moderate for Hispanics and some Asian subgroups (70-90%), and very low for American Indians (<20%). Overall, registry and interview race/ethnicity disagreed for 11% of the sample. In a multivariate model, disagreement was associated with non-White race/ethnicity, younger age, being married, being foreign-born but preferring to speak English, and diagnosis in a large hospital. Improving data quality for race/ethnicity will be most effectively attempted at the reporting source. We advocate a concerted effort to systematize collection of these patient data across all facilities, which may be more feasible given electronic medical admissions forms.

    View details for DOI 10.1007/s10552-006-0013-y

    View details for Web of Science ID 000238340000003

    View details for PubMedID 16783605

  • Improved survival of Asians with corpus cancer compared with whites - An analysis of underlying factors OBSTETRICS AND GYNECOLOGY Zhang, M. M., Cheung, M. K., Osann, K., Lee, M. M., Gomez, S. S., Whittemore, A. S., Husain, A., Teng, N. N., Chan, J. K. 2006; 107 (2): 329-335


    To compare the clinicopathologic prognosticators and survival of Asians and whites with corpus cancer.Demographic, clinicopathologic, and survival data were obtained from the 1992-2001 Surveillance, Epidemiology, and End Results Program. Statistical analyses were performed by Kaplan-Meier methods and Cox proportional hazards model.A total of 2,144 Asians and 32,999 whites with corpus cancer were identified. The age-adjusted incidence of uterine cancer in Asians compared with whites was 16.8 compared with 26.1 per 100,000. Asians presented at a younger age (mean 58.4 years compared with 65.1; P < .01) and with more advanced stage disease than whites (21.5% compared with 15.4%; P < .01). The 5-year survival rate for Asians was 79.4% compared with 75.2% for whites (P < .01). Asians with stage I-II and III-IV cancers had 5-year survival rates of 89.3% and 41.2% compared with 82.3% and 34.0% for the whites, respectively (P < .01, early stage; P < .01, advanced stage). The survival advantage of Asians persists in endometrioid (P < .01) and uterine papillary serous carcinomas (P < .01), but not in clear cell carcinoma (P = .62) or sarcomas (P = .78). In multivariate analysis, younger age (P < .01), earlier stage (P < .01), favorable histology (P < .01), and lower grade (P < .01) remained as significant independent prognosticators for improved survival. However, race was not an important prognosticator.The overall survival advantage experienced by Asians with uterine cancer is attributable to their younger age at diagnosis. Because Asian women present at a younger age with more advanced disease, physicians should have an increased index of suspicion for malignancy in young Asian women with suspicious symptoms and consider a lower age threshold for biopsy in this group.II-2.

    View details for Web of Science ID 000241295400019

    View details for PubMedID 16449120

  • Cancer surveillance research: A vital subdiscipline of cancer epidemiology CANCER CAUSES & CONTROL Glaser, S. L., Clarke, C. A., Gomez, S. L., O'Malley, C. D., Purdie, D. M., West, D. W. 2005; 16 (9): 1009-1019


    Public health surveillance systems relevant to cancer, centered around population-based cancer registration, have produced extensive, high-quality data for evaluating the cancer burden. However, these resources are underutilized by the epidemiology community due, we postulate, to under-appreciation of their scope and of the methods and software for using them. To remedy these misperceptions, this paper defines cancer surveillance research, reviews selected prior contributions, describes current resources, and presents challenges to and recommendations for advancing the field. Cancer surveillance research, in which systematically collected patient and population data are analyzed to examine and test hypotheses about cancer predictors, incidence, and outcomes in geographically defined populations over time, has produced not only cancer statistics and etiologic hypotheses but also information for public health education and for cancer prevention and control. Data on cancer patients are now available for all US states and, within SEER, since 1973, and have been enhanced by linkage to other population-based resources. Appropriate statistical methods and sophisticated interactive analytic software are readily available. Yet, publication of papers, funding opportunities, and professional training for cancer surveillance research remain inadequate. Improvement is necessary in these realms to permit cancer surveillance research to realize its potential in resolving the growing cancer burden.

    View details for DOI 10.1007/s10552-005-4501-2

    View details for Web of Science ID 000232139900002

    View details for PubMedID 16184466

  • Quality of cancer registry birthplace data for Hispanics living in the United States CANCER CAUSES & CONTROL Gomez, S. L., Glaser, S. L. 2005; 16 (6): 713-723


    Patient birthplace from the SEER population-based cancer registries is potentially useful for identifying disparities in cancer occurrence and for studying cancer etiology. However, for Hispanics, completeness and accuracy of registry birthplace is unknown. By comparing registry birthplace to self-reported birthplace from 13 interview studies, we determined the completeness and accuracy of this variable and the associations of these measures with patient and hospital characteristics in the Greater Bay Area. Registry birthplace was unrecorded for 46% of 1277 Hispanic cancer cases, and unrecorded birthplace (i.e., incompleteness) was associated with younger age, higher education, English language preference, US birthplace, and admission at certain hospitals. For 691 Hispanics with available registry birthplace, sensitivity and positive predictive value compared to self-report (i.e., accuracy) were 96.3 and 97.3 among foreign-born, and 96.8 and 95.6 among US-born. US-born Hispanics misclassified in the registry as foreign-born were more likely to have unavailable education information, be deceased, prefer a language besides English, and be diagnosed at a smaller hospital or before 1996. Among self-reported foreign-born Hispanics, those misclassified as US-born were less likely to have been diagnosed at an HMO. Although the completeness and accuracy of birthplace information may vary across registries, this variable appears to be limited for analyses involving Hispanics.

    View details for DOI 10.1007/s10552-005-0694-7

    View details for Web of Science ID 000230844600011

    View details for PubMedID 16049810

  • Inconsistencies between self-reported ethnicity and ethnicity recorded in a health maintenance organization ANNALS OF EPIDEMIOLOGY Gomez, S. L., Kelsey, J. L., Glaser, S. L., Lee, M. M., Sidney, S. 2005; 15 (1): 71-79


    Information on patient ethnicity in hospital admissions databases is often used in epidemiologic and health services research. However, the extent of consistency of these data with self-reported ethnicity is not well studied, particularly for specific Asian subgroups. We examined agreement between ethnicity in records of a sample of members of five Northern California Kaiser Permanente medical centers with self-reported ethnicity.Subjects were 3168 cases and 2413 controls aged 45 years and older from a study of fractures. Ethnicity recorded in the Kaiser admissions database (primarily inpatient) was compared with self-reported ethnicity from the study interviews.Among study subjects with available Kaiser ethnicity, sensitivities and positive predictive values of the Kaiser classification were high among blacks (0.95 for both measures) and whites (0.98 and 0.94, respectively), slightly lower among Asians (0.88 and 0.95, respectively), and considerably lower among Hispanics (0.55 and 0.81, respectively) and American Indians (0.47 and 0.50, respectively). Among Asian subgroups, the proportion classified as Asian was high among Chinese (0.94) and Japanese (0.99) but lower among Filipinos (0.79) and other Asians (0.74). Among the 228 (4%) subjects who self-identified with multiple ethnicities, 13 of 18 white + Hispanic subjects were classified as being white, and of the 77 subjects identifying as part American Indian, only one was classified as being American Indian in the Kaiser database.Given the importance of ethnicity information, medical facilities should be encouraged to adopt policies toward collecting high quality data.

    View details for DOI 10.1016/j.annepidem.2004.03.002

    View details for Web of Science ID 000225798100010

    View details for PubMedID 15571996

  • Immigration and acculturation in relation to health and health-related risk factors among specific Asian subgroups in a health maintenance organization AMERICAN JOURNAL OF PUBLIC HEALTH Gomez, S. L., Kelsey, J. L., Glaser, S. L., Lee, M. M., Sidney, S. 2004; 94 (11): 1977-1984


    We sought to determine how risk factors for disease vary among Asian subgroups.Using data from a case-control study conducted at Northern California Kaiser Medical Centers (from 1996 to 2001), we compared prevalence of selected risk factors among Asian subgroups and evaluated the associations of these risk factors with sociodemographic factors.Chinese and Japanese patients had a lower body mass index (kg/m(2)) than did other Asians. In all subgroups, being born in the United States was associated with having a body mass index greater than 25 kg/m(2). Compared with other Asians, more Japanese and multiple-race Asians smoked, and more Filipino and multiple-race Asian smokers started smoking at 18 years or younger. Filipinos and multiple-race Asians also were more likely to report diabetes.These data support the importance of efforts to distinguish among Asian subgroups in public health practice and research.

    View details for Web of Science ID 000224780800033

    View details for PubMedID 15514240

  • Attenuation of social class and reproductive risk factor associations for Hodgkin lymphoma due to selection bias in controls CANCER CAUSES & CONTROL Glaser, S. L., Clarke, C. A., Keegan, T. H., Gomez, S. L., Nugent, R. A., Topol, B., Stearns, C. B., Stewart, S. L. 2004; 15 (7): 731-739


    Hodgkin lymphoma (HL) risk has been linked with higher social class and lower parity, but our prior population-based case-control study in adult women had unexpected null findings for these variables. Because subject participation was 87% for cases but 65% for random digit-dialing (RDD) controls, we examined representativeness of our controls and the impact of detected bias on prior results.Using data from RDD enumeration, abbreviated interviews with nonparticipating controls, and the US census, we compared participating and nonparticipating RDD controls across several age groups and then recomputed odds ratios for risk factor associations adjusted for bias.The 325 RDD control participants were younger, more likely to be white, better educated, and of lower birth order and lower parity than the nonparticipants. Adjustment of odds ratios for bias strengthened previously null findings for education and for parity, breast-feeding and miscarriages in young adult women; these latter changes eliminated previously apparent age modification of risks.Selection bias in female RDD controls resulted from differential participation by socioeconomic factors, varied with age, and produced underestimations of several associations in young women, including reproductive factors. Thus, our prior conclusions of etiologic irrelevance for some study variables may have been inaccurate.

    View details for Web of Science ID 000223620900011

    View details for PubMedID 15280631

  • Smoking and Hodgkin lymphoma risk in women United States CANCER CAUSES & CONTROL Glaser, S. L., Keegan, T. H., Clarke, C. A., Darrow, L. A., Gomez, S. L., Dorfman, R. F., Mann, R. B., DiGiuseppe, J. A., Ambinder, R. F. 2004; 15 (4): 387-397


    Smoking has received little consideration as a risk factor for Hodgkin lymphoma (HL) in women, despite recent significant findings in men and gender differences in HL incidence. We investigated the association of HL with lifetime cigarette smoking and household environmental tobacco smoke (ETS) exposure in women.In data from a population-based case-control study in women ages 19-79, we analyzed HL risk associated with self-reported smoking and household ETS exposure in 312 diagnostically re-reviewed cases and 325 random-digit dialing controls using logistic regression. Epstein-Barr virus (EBV) presence was determined in tumors of 269 cases.In 253 cases compared to 254 controls ages 19-44, risks of HL overall, and of nodular sclerosis and EBV-negative HL, were increased 50% with ETS exposure in childhood; for 11 cases of mixed cellularity (MC) HL, current smoking and adult ETS exposure also increased risk; for 24 cases of EBV-positive HL, risk was elevated for current smoking, greater smoking intensity and duration, and ETS exposure. In 59 cases and 71 controls ages 45-79, most smoking characteristics did not appear to affect risk.Apparent effects of current smoking on risks of MC HL and EBV-positive HL and of household ETS on risk of all HL in young adult females may broaden the evidence implicating tobacco smoke exposures in HL etiology.

    View details for Web of Science ID 000221360300006

    View details for PubMedID 15141139

  • Bias in completeness of birthplace data for Asian groups in a population-based cancer registry (United States) CANCER CAUSES & CONTROL Gomez, S. L., Glaser, S. L., Kelsey, J. L., Lee, M. M. 2004; 15 (3): 243-253


    Data on place of birth are routinely collected by population-based cancer registries in the United States and are used to study effects of immigration on cancer patterns in Asian migrants, who comprise about a quarter of the US immigrant population. However, the quality of this research, which has the potential for informing cancer etiology and control, is unclear because registry birthplace information is incomplete, and its accuracy has not been examined. We quantified misclassification of birthplace data for Asian cancer patients in the Greater Bay Area Cancer Registry in northern California by comparing registry birthplace information with self-reported birthplace from interview, and then identified sociodemographic and hospital characteristics associated with birthplace completeness and misclassification. Of the 1836 eligible Asian patients, 649 (35%) had unrecorded registry birthplace. For all except Vietnamese, these persons were less likely than those with recorded birthplace to be foreign-born (OR = 0.5, 95% CI = 0.4-0.7), to be diagnosed in public than private hospitals (OR = 0.7, 95% CI = 0.5-0.8) and in teaching than non-teaching hospitals (OR = 0.8, 95% CI = 0.6-1.1), and were more likely to have been diagnosed at a large regional health maintenance organization (OR = 1.7, 95% CI = 1.3-2.2) and after 1995 (OR = 1.6, 95% CI = 1.1-2.1). Among Asians with registry birthplace information (n = 1187), sensitivity and predictive value positive for birthplace exceeded 90% for both US- and foreign-born, except for Japanese (predictive value positive = 85.7%). Among US-born Asians, those misclassified as foreign-born were more likely than those correctly classified to prefer a non-English primary language (OR = 29.4, 95% CI = 1.9-459.9). These results suggest that cancer registry birthplace data for Asians should not be used if they continue to be differentially incomplete for a large proportion of the subjects.

    View details for Web of Science ID 000220868600003

    View details for PubMedID 15090719

  • Quality of birthplace information obtained from death certificates for Hispanics, Asians, and Pacific Islanders ETHNICITY & DISEASE Gomez, S. L., Glaser, S. L. 2004; 14 (2): 292-?

    View details for Web of Science ID 000221035900016

    View details for PubMedID 15132217

  • Socioeconomic status, immigration/acculturation, and ethnic variations in breast conserving surgery, San Francisco Bay area ETHNICITY & DISEASE Gomez, S. L., France, A. M., Lee, M. M. 2004; 14 (1): 134-140


    Previous studies have demonstrated substantial variations in breast conserving surgery (BCS) across sociodemographic groups. This study explored the joint influences of socioeconomic, immigration/acculturation, and clinical factors on ethnic differences in breast cancer surgery for early-stage disease.The study used interview data for 297 women, under the age of 70, who resided in the San Francisco Bay area, and had been diagnosed with primary early-stage breast cancer (carcinoma in-situ or invasive) between January 1990 and December 1992.The proportion of patients who either had undergone BCS or had no surgery was 45%, 20%, 45%, and 34%, among Whites, Chinese, Blacks, and Hispanics, respectively. The proportion of patients diagnosed at in-situ or localized stages, with tumors of less than 4 centimeters, was higher among those who received BCS or no surgery, compared to those who had undergone a mastectomy. White women who received BCS/no surgery tended to be younger than their counterparts who underwent mastectomies, but Chinese and Black women who received BCS/no surgery were older. The proportion of women diagnosed in smaller, private hospitals was higher among those receiving BCS/no surgery, although these associations varied by ethnicity. Women who had undergone BCS/no surgery were characterized as being of higher socioeconomic status, more acculturated, and less likely to be recent immigrants. In a multivariate regression model adjusting for clinical, socioeconomic, and immigration/acculturation factors, Chinese women were more likely than Whites to have a mastectomy, rather than BCS/no surgery (odds ratio, 2.8; 95% confidence interval, 1.0-7.8).Use of BCS or no surgery was associated with various clinical, socioeconomic, and immigration/acculturation characteristics, although some of the associations varied by ethnicity. However, these factors did not account for the reduced presence of BCS, or no surgery, among Chinese women.

    View details for Web of Science ID 000220239600019

    View details for PubMedID 15002933

  • Hospital policy and practice regarding the collection of data on race, ethnicity, and birthplace AMERICAN JOURNAL OF PUBLIC HEALTH Gomez, S. L., Le, G. M., West, D. W., Satariano, W. A., O'Connor, L. 2003; 93 (10): 1685-1688

    View details for Web of Science ID 000185881100020

    View details for PubMedID 14534222

  • Soy and isoflavone consumption in relation to prostate cancer risk in China CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION Lee, M. M., Gomez, S. L., Chang, J. S., Wey, M., Wang, R. T., Hsing, A. W. 2003; 12 (7): 665-668


    This case-control study in China evaluated the effect of soy food consumption and isoflavones (genistein and daidzein) on the risk of prostate cancer. One hundred and thirty-three cases and 265 age- and residential community-matched controls between the ages of 50 and 89 years were interviewed in person between 1989 and 1992. Usual consumption of soy foods and isoflavones was assessed using a food frequency questionnaire developed in China and a nutrient database developed and validated in Asian-American populations. The age- and total calorie-adjusted odds ratio (OR) of prostate cancer risk comparing the highest tertile of tofu intake to the lowest tertile was 0.58 [95% confidence interval (CI), 0.35-0.96]. There were also statistically significant associations comparing the highest quartile of intake of soy foods (OR, 0.51; 95% CI, 0.28-0.95) and genistein (OR, 0.53; 95% CI, 0.29-0.97) with the lowest quartiles. There was also an indication of a reduced risk associated with intake of daidzein (OR, 0.56; 95% CI, 0.31-1.04 for the highest versus lowest quartile). Our results indicate a reduced risk of prostate cancer associated with consumption of soy foods and isoflavones. These findings should be confirmed in longitudinal follow-up studies in populations with varying risk of prostate cancer.

    View details for Web of Science ID 000184311700014

    View details for PubMedID 12869409

  • The importance of race and ethnic background in biomedical research and clinical practice NEW ENGLAND JOURNAL OF MEDICINE Burchard, E. G., Ziv, E., Coyle, N., Gomez, S. L., Tang, H., Karter, A. J., Mountain, J. L., Perez-Stable, E. J., Sheppard, D., Risch, N. 2003; 348 (12): 1170-1175

    View details for Web of Science ID 000181628400015

    View details for PubMedID 12646676

  • Cancer survival in US racial/ethnic groups: Heterogeneity among Asian ethnic subgroups ARCHIVES OF INTERNAL MEDICINE Gomez, S. L., Clarke, C. A., Glaser, S. L. 2003; 163 (5): 631-632

    View details for Web of Science ID 000181561000018

    View details for PubMedID 12622614

  • Cancer incidence patterns in Koreans in the US and in Kangwha, South Korea CANCER CAUSES & CONTROL Gomez, S. L., Le, G. M., Clarke, C. A., Glaser, S. L., France, A. M., West, D. W. 2003; 14 (2): 167-174


    In the US, Koreans are a rapidly growing group and comprised 10.5% of the total Asian population as of 2000. However, little has been published regarding cancer patterns in this subpopulation.Using data from the Surveillance, Epidemiology, and End Results program, the California Cancer Registry, and the International Association for Research on Cancer, we compared age-adjusted and age-specific incidence rates for cancers of the prostate, breast, cervix, lung, colon, rectum, stomach, liver, and esophagus in US Koreans with rates of these cancers in residents of Kangwha, South Korea, and in US whites as a reference.While the most frequently diagnosed cancer was lung among US Korean males and breast among US Korean females, it was stomach cancer for both sexes in Kangwha. Rates of prostate, breast, and colon cancer were considerably higher for Koreans in the US than in Kangwha, but were not as high as in whites. Cervical and stomach cancers showed the opposite racial/ethnic pattern, with rates highest in Kangwha, intermediate among US Koreans, and lowest among whites. Rates of rectal cancer in females and esophageal cancer in males were two-times higher in Kangwha than in US Koreans but esophageal cancer rates were similar between US Koreans and whites. Liver cancer rates were similar between Kangwha residents and US Koreans, but nearly 10-times lower among whites.Although these comparisons may have methodologic limitations, including data quality and racial/ethnic misclassification, the differences seen in migrant and native Koreans for some cancers warrant further investigation in this growing subpopulation.

    View details for Web of Science ID 000182447400008

    View details for PubMedID 12749722

  • Cancer incidence patterns among Vietnamese in the United States and Ha Noi, Vietnam INTERNATIONAL JOURNAL OF CANCER Le, G. M., Gomez, S. L., Clarke, C. A., Glaser, S. L., West, D. W. 2002; 102 (4): 412-417


    Nearly 600,000 persons have immigrated to the United States from Vietnam since the end of the Vietnam War. Despite the rapid growth of the U.S. Vietnamese population, little is known about cancer incidence in this migrant group. Using population-based data from the Surveillance, Epidemiology and End Results program, California Cancer Registry and International Agency for Research on Cancer, we compared cancer incidence rates for Vietnamese in the United States (1988-1992) to rates for residents of Ha Noi, Vietnam (1991-1993); non-Hispanic whites were included to serve as the U.S. reference rates. Lung and breast cancers were the most common among Vietnamese males and females, respectively, regardless of geographic region. Rates of cancers more common to U.S. whites, such as breast, prostate and colon cancers, were elevated for U.S. Vietnamese compared to residents in Ha Noi but still lower than rates for U.S. whites. Rates of cancers more common to Asian countries, such as stomach, liver, lung and cervical cancers, were likewise elevated for U.S. Vietnamese compared to residents of Ha Noi and exceeded corresponding rates for whites. Incidence patterns for stomach, liver, lung and cervical cancers may reflect increased risk of exposures in this migrant population and should be further explored to uncover the relative contributions of environmental and genetic factors to cancer etiology.

    View details for DOI 10.1002/ijc.10725

    View details for Web of Science ID 000179013100015

    View details for PubMedID 12402312

  • Studying cancer incidence and outcomes in immigrants: Methodological concerns AMERICAN JOURNAL OF PUBLIC HEALTH Lin, S. S., Clarke, C. A., O'Malley, C. D., Le, G. M. 2002; 92 (11): 1757-1759

    View details for Web of Science ID 000178868600022

    View details for PubMedID 12406802

  • Reliability of self-reported reproductive factors and childhood social class indicators in a case-control study in women ANNALS OF EPIDEMIOLOGY Lin, S. S., Glaser, S. L., Stewart, S. L. 2002; 12 (4): 242-247


    Reproductive factors are often evaluated in epidemiologic interview studies as risk factors for diseases in women. Similarly, childhood social class has been implicated in the etiology of several diseases. Nevertheless, questions related to these factors have not been thoroughly evaluated for test-retest reliability. This research measured the test-retest reliability of reproductive and childhood social class variables, and determined whether reliability differed by case-control status, age, educational level, time between interviews, and interviewer-rated quality of the interview.Subjects were participants in a population-based case-control in-person interview study of Hodgkin's disease in northern California women. Twenty-four cases and 22 controls were reinterviewed by telephone between 1992 and 1995, with an average interval of 8 months between interviews. Reliability was assessed using kappa or intraclass correlation coefficients; mean reliability coefficients and 95% confidence intervals (CIs) were estimated using the bootstrap method.Reliability was excellent for all variables (reliability coefficients between 0.76 and 0.96) and did not differ by case-control status (mean reliability = 0.82 for cases and 0.84 for controls), age (mean reliability = 0.85 for age < 40 and 0.82 for age > or = 40), time between interviews (mean reliability = 0.75 for 0-5 months, 0.88 for 6-11 months, and 0.87 for 1 year or more), or interviewer-rated quality of the validity of the original responses (mean reliability = 0.93 for "not too confident" and 0.83 for "confident"). However, reliability was consistently lower among less educated women (mean reliability = 0.56 for high school or less and 0.88 for more than high school), a finding consistent with results of prior studies.These results indicate that questions about reproductive experience and childhood social class posed in in-person interviews can be answered reliably. However, inclusion of subjects at lower socioeconomic status may result in lower reliability for some interview responses.

    View details for Web of Science ID 000175129300005

    View details for PubMedID 11988412

  • Birthplace and survival among Asian women diagnosed with breast cancer in cancer registry data: the impact of selection bias INTERNATIONAL JOURNAL OF EPIDEMIOLOGY Lin, S. S., O'Malley, C. D., Clarke, C. A., Le, G. M. 2002; 31 (2): 511-513

    View details for Web of Science ID 000175882500049

    View details for PubMedID 11980831

  • Breast cancer characteristics of Vietnamese women in the Greater San Francisco Bay Area WESTERN JOURNAL OF MEDICINE Lin, S. S., Phan, J. C., LIN, A. Y. 2002; 176 (2): 87-91


    To examine breast cancer characteristics of women of Vietnamese ancestry living in the San Francisco Bay Area in comparison with those of other racial or ethnic groups in the same area.Data were obtained from the population-based Greater Bay Area Cancer Registry, part of the Surveillance, Epidemiology, and End Results program. We included breast cancer cases diagnosed from 1988 to 1999 and compared the age at diagnosis, stage and histologic grade at diagnosis, estrogen- and progesterone-receptor status, and surgery types across racial or ethnic groups. We also modeled the effect of patient and clinical characteristics and hospital and physician on the racial or ethnic variations in surgery type.Vietnamese women were younger at diagnosis than other racial or ethnic subgroups (mean age, 51.0 years), with 49.6% of the diagnoses occurring in patients younger than 50. They were also significantly more likely to have received mastectomy for their in situ and localized tumors (61.1% having mastectomy) than women of other racial or ethnic groups. The increased likelihood of having mastectomy among Vietnamese women was not affected greatly by age, year of diagnosis, tumor stage, histologic grade, or physician, but was partly attributable to the hospital of diagnosis.The effects of a lower mean age at diagnosis and the reasons for an unexpectedly higher percentage of mastectomies in this Asian subgroup should be further explored.

    View details for Web of Science ID 000174415000007

    View details for PubMedID 11897726

  • Survival differences among Asian subpopulations in the United States after prostate, colorectal, breast, and cervical carcinomas Lin, S. S., Clarke, C. A., Prehn, A. W., Glaser, S. L., West, D. W., O'Malley, C. D. JOHN WILEY & SONS INC. 2002: 1175-1182


    Information is limited for Asian subgroups regarding survival after diagnosis of the common cancers amenable to routine screening. The authors examined survival after carcinomas of the prostate, colon/rectum, breast, and cervix separately for Chinese, Japanese, Filipinos, and non-Hispanic whites in the United States.Using data from the Surveillance, Epidemiology, and End Results program, the authors compared the distributions of stage at diagnosis and computed 5-year cause specific survival probabilities, overall and by stage of disease, for cancer patients whose diagnosis was in 1988-1994 and who were observed through 1997.Among males, Filipinos were more likely to be diagnosed with advanced stage colorectal and prostate carcinomas than other Asians and non-Hispanic whites; they also experienced worse survival after these cancers. This survival deficit occurred across all stages of colorectal carcinoma and remained apparent within distant stage prostate carcinoma. Among females, Chinese were less likely to receive diagnoses of early stage colorectal carcinoma than Japanese and Filipinas. In addition, their survival was consistently lower across more advanced stages of disease. Chinese also experienced somewhat worse survival after diagnosis of early stage cervical carcinoma. Japanese were more likely to be diagnosed with early stage carcinomas but also tended to experience better survival after prostate, colorectal, and breast carcinomas regardless of stage.Chinese, Japanese, and Filipinos experienced unequal survival after these screenable carcinomas, indicating that certain groups may benefit from more aggressive screening efforts. The heterogeneity of cancer outcomes observed within the community classified as Asian reinforces the need for cancer statistics to be reported for disaggregated subgroups.

    View details for DOI 10.1002/cncr.10319

    View details for Web of Science ID 000173907600037

    View details for PubMedID 11920489

  • Factors associated with missing birthplace information in a population-based cancer registry. Ethnicity & disease Lin, S. S., O'Malley, C. D., Lui, S. W. 2001; 11 (4): 598-605


    Differences in cancer occurrence within a racial/ethnic group may be influenced by migrant status or level of acculturation, which can indicate variations in environmental exposures. When immigration and acculturation data on individual patients are not available, birthplace may serve as a proxy. As part of a larger study intended to assess the utility of the birthplace variable in the Greater Bay Area Cancer Registry (GBACR), part of the Surveillance, Epidemiology, and End Results (SEER) program, we measured its completeness, and determined whether missing birthplace is associated with patient and hospital reporting source characteristics. Subjects were persons diagnosed with cancer within the GBACR surveillance area during the period 1988-1996. Of the 204,553 subjects, 67% had birthplace recorded in the registry. Deceased persons were 10 times more likely than living persons to have data on birthplace. Racial/ethnic groups which included more foreign-born persons, such as Southeast Asians, tended to have more complete birthplace information than did groups with fewer foreign-born, such as Japanese and Hispanics. The effects of patient and reporting source characteristics on birthplace completeness differed across racial/ethnic groups. These data indicate that completeness of the birthplace variable in the GBACR is biased, and that investigators considering birthplace in analyses of SEER data should consider these biases. For birthplace data to be useful, completeness needs to be improved at the level of the diagnosing facility.

    View details for PubMedID 11763284

  • Alternative therapies used by women with breast cancer in four ethnic populations JOURNAL OF THE NATIONAL CANCER INSTITUTE Lee, M. M., Lin, S. S., Wrensch, M. R., Adler, S. R., Eisenberg, D. 2000; 92 (1): 42-47


    Interest in alternative therapies is growing rapidly in the United States. We studied the types and prevalence of conventional and alternative therapies used by women in four ethnic groups (Latino, white, black, and Chinese) diagnosed with breast cancer from 1990 through 1992 in San Francisco, CA, and explored factors influencing the choices of their therapies.Subjects (n = 379) completed a 30-minute telephone interview in their preferred language. Logistic regression models assessed factors associated with the use of alternative therapies after a diagnosis of breast cancer.About one half of the women used at least one type of alternative therapy, and about one third used two types; most therapies were used for a duration of less than 6 months. Both the alternative therapies used and factors influencing the choice of therapy varied by ethnicity. Blacks most often used spiritual healing (36%), Chinese most often used herbal remedies (22%), and Latino women most often used dietary therapies (30%) and spiritual healing (26%). Among whites, 35% used dietary methods and 21% used physical methods, such as massage and acupuncture. In general, women who had a higher educational level or income, were of younger age, had private insurance, and exercised or attended support groups were more likely to use alternative therapies. About half of the women using alternative therapies reported discussing this use with their physicians. More than 90% of the subjects found the therapies helpful and would recommend them to their friends.Given the high prevalence of alternative therapies used in San Francisco by the four ethnic groups and the relatively poor communication between patients and doctors, physicians who treat patients with breast cancer should initiate dialogues on this topic to better understand patients' choices with regard to treatment options.

    View details for Web of Science ID 000084568300011

    View details for PubMedID 10620632

  • Use of race and ethnicity in epidemiologic research: Concepts, methodological issues, and suggestions for research EPIDEMIOLOGIC REVIEWS Lin, S. S., Kelsey, J. L. 2000; 22 (2): 187-202

    View details for Web of Science ID 000166573100001

    View details for PubMedID 11218371

  • Dietary fat and breast cancer ANNUAL REVIEW OF NUTRITION Lee, M. M., Lin, S. S. 2000; 20: 221-248


    One of the most often studied associations in epidemiology is dietary fat and breast cancer risk. That migrants from low-risk countries increase their risk on immigrating to higher-risk countries suggests that some modifiable lifestyle or environmental factor is responsible for the development of breast cancer. Although early international correlational studies and experimental animals studies support dietary fat as a risk factor for breast cancer, more recent data from case-control studies and cohort studies have been equivocal, thus the analytical data do not support a strong positive association. The conflicting results from analytic studies may be due to methodologic issues associated with study design, dietary assessment tools, measurement error, improper statistical analyses, and a lack of heterogeneity in fat intake among the study population. Moreover, current dietary questionnaires may be inadequate in capturing true dietary intakes or capturing the risk with exposure during earlier periods of a woman's life. Although two large clinical trials investigating the fat/breast cancer relationships issue are underway, researchers are generally skeptical at their ability to detect an independent association between fat and breast cancer risk. Further epidemiologic studies using current methodology may not prove to be fruitful in generating definitive answers to shed light on this controversial issue. In addition, rather than concentrating on dietary fat, researchers should focus on diets that are not only low in saturated fat, but also high in fruit and vegetable consumption. Researchers should take advantage of advances in molecular and genetic technology for a different perspective in examining the issue. For example, markers of susceptibility to breast cancer that can detect women at higher risk for breast cancer may be helpful in clarifying the role of dietary fat. More comprehensive and multiple approaches to studying dietary factors and breast cancer are recommended.

    View details for Web of Science ID 000089332200011

    View details for PubMedID 10940333

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