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Ethnic Disparities for Gynecologic Cancers in Israel

  • Yfat KadanEmail author
  • Ami Fishman
  • Limor Helpman
Article

Abstract

Background

Israel’s unique population is comprised of two main ethnic groups—Jews (75%) and Arabs (21%), with differing socioeconomic, cultural, and genetic profiles. This study’s objective was to evaluate disparities in the incidence, presentation, and outcomes of gynecologic cancers among Israeli women of Arab and Jewish ethnicity.

Methods

Data on the Israeli female population diagnosed with gynecologic cancers during the years 2000–2012 was obtained from the National Cancer Registry and the National Population Registry. Disease incidence rates by ethnic origin were calculated, and the “Segi World standard population” was used for age standardization. Data for Jewish and Arab patients was compared using chi-square test for categorical variables and T test for continuous variables. Survival outcomes were compared using the log-rank test and Cox proportional hazards modeling.

Results

Annual ASR (age-standardized rate) for ovarian, cervical, and uterine cancers, are all significantly higher among Israeli women of Jewish ethnicity. Israeli Arab women are diagnosed with cervical cancer at an older age (mean, 60.9 vs 55.9, p < 0.001). Stage distribution for uterine, ovarian, and cervical cancers is similar in both ethnic groups. The age-adjusted hazard ratio for mortality from uterine cancer is significantly lower among Jewish Israeli women compared to Arab Israeli women (HR = 0.67, 95% CI 0.57–0.78, p < 0.0001). During the study period, there was a significant decline in the ASR for ovarian cancer among Jewish Israeli women. The ASR for pre-invasive cervical disease increased significantly in both ethnic groups.

Conclusions

Disparities in gynecological cancer rates, presentations, and outcomes are evident between two major ethnic groups in Israel. Lower cancer incidence rates among Israeli Arab women are likely multifactorial. Uterine cancer outcomes between the two ethnic groups need to be further assessed in order to identify opportunities for improved outcomes among Israeli Arab women.

Keywords

Health disparities Jews Arabs Uterine cancer Ovarian cancer Cervix cancer 

Notes

Acknowledgments

We thank Dr. Barbara Silverman and the Israeli National Cancer Registry for providing the data for this study.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have nothing to disclose

Ethical Approval

Ethical approval was not required for this type of study because the data set is de-identified (Director’s General Circular 20/10, 11.10.2010).

References

  1. 1.
    Noa Levi (Central Bureau of Statistics). The population of Israel [Internet]. 2014 [cited 2019 May 18]. Available from: https://www.cbs.gov.il/he/Statistical/isr_pop_heb143.pdf.
  2. 2.
    Bureau UC. Section 1. Population [Internet]. [cited 2019 Sep 7]. Available from: https://www.census.gov/library/publications/2011/compendia/statab/131ed/population.html.
  3. 3.
    Bureau USC. American FactFinder - Results [Internet]. [cited 2019 Sep 7]. Available from: https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_17_5YR_DP02&src=pt.
  4. 4.
    Zlotogora J, van Baal S, Patrinos GP. The Israeli national genetic database. Isr Med Assoc J. 2009;11(6):373–5.PubMedGoogle Scholar
  5. 5.
    Rosenberg D, Lewin AC. Marriage patterns among Jewish immigrants in Israel. J Ethn Migr Stud. 2019.Google Scholar
  6. 6.
    Na’amnih W, Romano-Zelekha O, Kabaha A, Rubin LP, Bilenko N, Jaber L, et al. Continuous decrease of consanguineous marriages among arabs in Israel. Am J Hum Biol. 2015;27(1):94–8 [cited 2019 Sep 21]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25156400.CrossRefGoogle Scholar
  7. 7.
    The Arab society in Israel (in Hebrew). 2013. p. http://www.abrahamfund.org/.
  8. 8.
    Statistics CB of. Total enrolment rates in twelfth grade and total matriculation certificate entitlement rates, by sector and cohort [Internet]. [cited 2019 Nov 6]. Available from: https://old.cbs.gov.il/publications16/xii12_1639/pdf/t01.pdf.
  9. 9.
    Statistics CB of. Students at universities, by degree, sex age, population group, religion and place of birth [Internet]. [cited 2019 Nov 6]. Available from: https://old.cbs.gov.il/publications12/1475_haskhala_gvoha08_09/pdf/t2_14.pdf.
  10. 10.
    Shavers VL, Brown ML. Racial and ethnic disparities in the receipt of cancer treatment. J Natl Cancer Inst. 2002;94(5):334–57 [cited 2019 Oct 4]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11880473.CrossRefGoogle Scholar
  11. 11.
    Lifshitz I, Dichtier R, Fishler Y, Silverman B, Keinan Boker L. Incidence and mortality from cancer for 2013 (in Hebrew). 2013;2:2–7.Google Scholar
  12. 12.
  13. 13.
  14. 14.
    TOTAL POPULATION(3) (3) [Internet]. 2014 [cited 2019 May 18]. Available from: https://www.cbs.gov.il/he/publications/DocLib/2015/3.ShnatonVitalStatistics/st03_13.pdf.
  15. 15.
    Israel Center for Disease Control ICDC. Israel National health Interview Survey (INHIS-2) 2007-2010. 2012;(July).Google Scholar
  16. 16.
    Saabneh AM. Arab-Jewish gap in life expectancy in Israel. Eur J Pub Health. 2016;26(3):433–8.CrossRefGoogle Scholar
  17. 17.
    Ward KK, Shah NR, Saenz CC, McHale MT, Alvarez EA, Plaxe SC. Cardiovascular disease is the leading cause of death among endometrial cancer patients. Gynecol Oncol. 2012;126(2):176–9 [cited 2019 Oct 4]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22507532.CrossRefGoogle Scholar
  18. 18.
    Hirsh-Yechezkel G, Chetrit A, Lubin F, Friedman E, Peretz T, Gershoni R, et al. Population attributes affecting the prevalence of BRCA mutation carriers in epithelial ovarian cancer cases in Israel. Gynecol Oncol. 2003;89(3):494–8.CrossRefGoogle Scholar
  19. 19.
    Eccles DM, Balmaña J, Clune J, Ehlken B, Gohlke A, Hirst C, et al. Selecting patients with ovarian cancer for germline BRCA mutation testing: findings from guidelines and a systematic literature review. Adv Ther. 2016;33(2):129–50 [cited 2016 Oct 16]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26809252.CrossRefGoogle Scholar
  20. 20.
    WHO. Globocan 2012: Estimated incidence, mortality and prevalence worldwide in 2012. Globocan 2012 (Iarc). 2014. p. http://globocan.iarc.fr/Pages/fact_sheets_cancer.a. Available from: http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx.
  21. 21.
    Laitman Y, Vaisman Y, Feldman D, Helpman L, Gitly M, Paluch Shimon S, et al. Rates of risk-reducing surgery in Israeli BRCA1 and BRCA2 mutation carriers. Clin Genet. 2014;85(1):68–71 [cited 2016 Oct 17]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23517234.CrossRefGoogle Scholar
  22. 22.
    Zimlichman E, Mandel D, Mimouni FB, Wartenfeld R, Huerta M, Grotto I, et al. Oral contraceptive use and smoking habits in young Israeli women: a cross-sectional study. Isr Med Assoc J. 2004;6(9):546–9 [cited 2016 Oct 17]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15373313.PubMedGoogle Scholar
  23. 23.
    Wilder EI. The contraceptive revolution in Israel: changing family planning practices among ethnoimmigrant groups. Soc Sci Res. 2000;29(1):70–91 [cited 2016 Oct 17]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11624454.CrossRefGoogle Scholar
  24. 24.
    Berrington de González A, Green J, International Collaboration of Epidemiological Studies of Cervical Cancer. Comparison of risk factors for invasive squamous cell carcinoma and adenocarcinoma of the cervix: collaborative reanalysis of individual data on 8,097 women with squamous cell carcinoma and 1,374 women with adenocarcinoma from 12 epidemiological studies. Int J Cancer. 2007;120(4):885–91 [cited 2016 Oct 15]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17131323.CrossRefGoogle Scholar
  25. 25.
    Hetsroni A. Differences between Jewish-Israeli and Arab-Israeli college students in attitudes toward date selection and sex relations: a research note. 2002;9:507–17.Google Scholar
  26. 26.
    Central bureau of statistics I. Natural movement: marriage and divorce 2014-2013. 2017 [cited 2019 Sep 21]. Available from: https://www.cbs.gov.il/he/publications/Pages/2017/תנועה-טבעית-נישואין-וגירושין-2014-2013-.aspx.
  27. 27.
    Massad SG, Karam R, Brown R, Glick P, Shaheen M, Linnemayr S, et al. Perceptions of sexual risk behavior among Palestinian youth in the West Bank: a qualitative investigation. BMC Public Health. 2014;14:1213 [cited 2016 Oct 18]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25420532.CrossRefGoogle Scholar
  28. 28.
    Shilo G, Mor Z. Sexual activity and condom use among Israeli adolescents. J Sex Med. 2015;12(8):1732–6 [cited 2016 Oct 18]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26137977.CrossRefGoogle Scholar
  29. 29.
  30. 30.
    Editors MMSS, Goff B, Editor FD. 1/10/2016 Epithelial carcinoma of the ovary, fallopian tube, and peritoneum: clinical features and diagnosis ­ UpToDate. 2016;1–11. Available from: https://www-uptodate-com.meir-ez.medlcp.tau.ac.il/contents/epithelial-carcinoma-of-the-ovary-fallopian-tube-and-peritoneum-clinical-features-and-diagnosis?source=search_result&search=ovariancancer&selectedTitle=1~150

Copyright information

© W. Montague Cobb-NMA Health Institute 2019

Authors and Affiliations

  1. 1.Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Meir Medical Center, affiliated with Sackler Faculty of MedicineTel Aviv UniversityKefar SavaIsrael
  2. 2.Division of Gynecologic Oncology, Juravinski Cancer CenterMcMaster UniversityHamiltonCanada

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