Inter-country and ethnic variation in colorectal cancer survival: Comparisons between a Philippine population, Filipino-Americans and CaucasiansReportar como inadecuado

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BMC Cancer

, 10:100

First Online: 16 March 2010Received: 28 September 2009Accepted: 16 March 2010DOI: 10.1186-1471-2407-10-100

Cite this article as: Redaniel, M.T., Laudico, A., Mirasol-Lumague, M.R. et al. BMC Cancer 2010 10: 100. doi:10.1186-1471-2407-10-100


BackgroundPrevious population-based studies showed differences in international and within country colorectal cancer survival estimates, but few investigated the role of prognostic factors. Using a -high resolution approach-, we aimed to determine the effect of ethnicity and health care by comparing Filipino-Americans with Philippine residents, who have the same ethnicity, and with Caucasians living in the US, who have the same health care system.

MethodsUsing databases from the Manila and Rizal Cancer Registries and the United States Surveillance, Epidemiology and End Results, age-adjusted five-year absolute and relative survival estimates were computed and compared between Filipino-American colorectal cancer patients, cancer patients from the Philippines and Caucasian patients. Cox proportional hazards modelling was used to determine factors affecting survival differences.

ResultsMuch lower 5-year relative survival estimates were obtained for Philippine residents 37% as compared to those in Filipino-Americans 60.3% and Caucasians 62.4%. Differences in age, stage and receipt of surgery explained a large proportion of the survival differences between Philippine residents and Filipino-Americans. However, strong excess risk of death for Philippine residents remained after controlling for these and other variables relative risk, RR, 2.03, 95% confidence interval, 95% CI, 1.83-2.25.

ConclusionsStrong survival disadvantages of Philippine residents compared to Filipino-American patients were disclosed, which most likely reflect differences in access to and utilization of health care. Health education and advocacy, for both patients and health practitioners, should likewise be given priority.

List of abbreviations usedAPIAsian and Pacific Islanders

ASAbsolute survival

CIConfidence intervals

CRCColorectal cancer

DCODeath certificates only

DCNDeath certificate notifications

DOH-RCRDepartment of Health-Rizal Cancer Registry

RRRelative risk

IACRInternational Association of Cancer Registries

IARCInternational Agency for Research on Cancer

ICD-OInternational Classification of Diseases for Oncology

NCRNational Capital Region

NHWnon-Hispanic White

PCS-MCRPhilippine Cancer Society-Manila Cancer Registry

RSRelative survival

SEStandard error

SEERSurveillance, Epidemiology and End Results

WSCPPWorld Standard Cancer Patient Population

USUnited States.

Maria Theresa Redaniel, Adriano Laudico, Maria Rica Mirasol-Lumague, Adam Gondos, Gemma Uy and Hermann Brenner contributed equally to this work.

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Autor: Maria Theresa Redaniel - Adriano Laudico - Maria Rica Mirasol-Lumague - Adam Gondos - Gemma Uy - Hermann Brenner


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