Is overdiagnosis causing the Hispanic paradox?

Hispanics and other minorities are more likely than non-Hispanic whites to be diagnosed with remote or metastatic thyroid cancer, but some experts think overdiagnosis may…
Is overdiagnosis causing the Hispanic paradox?

Non-Hispanic whites make up the majority of patients seen. (Photo: Shutterstock)

Hispanics and other minorities are more likely than non-Hispanic whites to be diagnosed with remote or metastatic thyroid cancer, but some experts think overdiagnosis may be at the heart of the disparity.

According to on-going research from the California Cancer Registry, Non-Hispanic blacks, Hispanics and Asian/Pacific Islanders all experience higher rates of more advanced thyroid disease; a disparity study authors say cannot be completely explained by socioeconomic factors.

SEE ALSO: Hispanic paradox evident in new thyroid cancer study

There are significant disparities in care and presentation that we’re seeing in all disease states throughout the nation and the world,” lead author Avital Harari, MD, said in an interview.

“It’s important to define these disparities so we can create interventions that might ameliorate the differences that we’re seeing.”

Harari and his team found that non-Hispanic blacks were the most likely to present with remote or metastatic thyroid cancer, followed by Asian/Pacific Islanders and Hispanics.

Individuals who were were poor and uninsured or those who had Medicaid were more likely to present with remote/metastatic disease by comparison with those who had private insurance, and those who were older than age 45 years were more likely than younger patients to present with remote/metastatic disease.

Men were also more likely than women to present with advanced thyroid cancer.

Overdiagnosis is also unlikely to be a factor skewing results on advanced thyroid cancer.

The thyroid is an endocrine gland located in the front of your neck. It has a critical role as it influences every cell, tissue, and organ in your body.

Despite the findings, one fact remained true: though Hispanics and Asian/Pacific Islanders experienced higher rates of advanced thyroid disease compared to non-Hispanic whites, they also had the highest overall and disease-specific survival rates of every test group.

Such a finding is consistent for Hispanics in other medical areas and has been dubbed the “Hispanic Paradox,” a phrase used to identify the trend seen among Hispanics where, despite high rates of chronic disease, the ethnic group enjoys higher longevity.

“We don’t know exactly why just yet. … obviously one would think that the issue is access to care,” said Harari.

“And I believe that is partially true in general. However, in our study we adjusted for SES (socioeconomic status) when we looked at race. And despite this adjustment, we showed there is a true difference in the way minorities present despite what level of SES they’re part of,” he said, also stating that there must be something biological on as well.

Harari added that “overdiagnosis” is also unlikely to be a factor skewing results on advanced thyroid cancer.

Overdiagnosis, or the issue of diagnosing a problem frequently among people who are seen the most in the healthcare system, is sometimes considered an issue when looking at minority studies.

According to other experts, early thyroid cancer diagnosis rates would  be highest among non-Hispanic whites because that is the group primarily seen in the clinical setting. Therefore, only those cases are being seen.

“If it is true that white Californians have better access to health care than black Californians, then we’re more likely to overdiagnose thyroid cancer in white people compared with black people, and white people will have the appearance of better prognosis,” explained Luc Morris, MD, who was not involved in the research.

“It will appear as if white people are less likely to have metastatic disease, and it will appear as if they’re less likely to have aggressive disease, and it will appear as if they’re living longer. But it’s all artificial—the result of the denominator being inflated by a large number of indolent cancers in those people who have improved access to care.”

According to Harari, however, such a theory does not impact his study because the research was done on rare and advanced cases of thyroid cancer which would not be overdiagnosed within the population.

Harari says overdiagnosis tends to occur during early stages of disease, rather than later ones.

SEE ALSO: Thyroid cancer and hyperthyroidism in Latinos: Is there a link?