A.1. Population in Michigan According to the Arab American Institute, metropolitan Detroit is home to the largest concentration of Arab Americans in the U.S. Estimates of the population in the metropolitan Detroit area range from 136,000 to 490,000. About two-thirds of Arab Americans in the Detroit area are from Lebanon or Iraq, and include both Muslims and Christians. The cancer burden in this population group is largely unknown because Arab Americans and other Middle Eastern Americans are classified racially as White by most federal agencies and thus few health statistics exist for this population sub-group. Given SEER?s commitment to describing the cancer burden in all population sub-groups, immigrants and ancestors of Arab and other Middle East countries are a valid subgroup to study. Although they include a group diverse in country of origin and religious background, there are cultural beliefs and practices common to this sub-group that have important implications to cancer in this population. As an example, there are often cultural barriers to cancer screening and detection, such as gender preferences for healthcare providers, modesty, and misconceptions about illness etiology. There also may be dietary risk factors, beyond the gradual westernization of diet, that are important to cancer risk in this group. Arab American women are documented to have decreased levels of vitamin D, including women who do not routinely cover themselves. Other studies of the metropolitan Detroit Arab American population indicate there is an increase in behavioral risk factors, particularly physical inactivity and increased body mass index, which may increase cancer risk. A.2. Use of name for identification Ethnic identification for Hispanics is routinely performed in large datasets using a Hispanic surname list. Surname lists also have been constructed for Asian Americans. The North American Association for Central Cancer Registries has developed naming algorithms for Hispanics and Asian Pacific Islanders for use in cancer registries. In Great Britain, a South Asian Name and Group Recognition Algorithm is used for health database research. Hence, there is precedent for the use of surname lists as a method of identifying ethnic population sub-groups. A.3. Preliminary work in Michigan Over the past few years, Dr. Schwartz at the Metropolitan Detroit Cancer Surveillance System (MDCSS) has worked to better describe the cancer burden among Arab Americans in metropolitan Detroit by developing and validating a name database and algorithm to calculate proportional incidence ratios comparing Arab Americans and non-Arab Whites. Furthermore, Drs. Schwartz and others have separately worked on methods that will provide a denominator estimate for the purpose of calculating age-adjusted incidence and mortality rates. In Detroit, using responses from three questions on the 2000 U.S. Census Bureau long-form (also available in the PUMS dataset), namely ancestry, country of origin, and language spoken at home, provides a reasonable denominator estimate for Arab American rates (manuscript in progress). For this project, the best denominator to use will be determined and implications the 2010 census count methods may have on the use of this denominator will be examined. The creation and maintenance of name databases for this population group is not only important for cancer surveillance activities;it also is valuable for research activities specifically focused on this group. For instance, using the name database, potential households for a telephone survey of mammography use among women 40 years and older were identified. Among the 400 women who self-identified as Arab or Chaldean and completed the survey, only five were not first-generation immigrants. The respondents were less likely to be adherent to mammography screening guidelines, especially those over age 65 years, as compared to Michigan women. Predictors of non-adherence include factors seen in other immigrant populations such as less number of years in the U.S. and not having healthcare insurance;however, cultural factors including fear of a cancer diagnosis and being embarrassed by having a mammogram, were significantly associated with mammography non-adherence. Dr. Schwartz found a lower than expected number of lung cancer cases among Detroit Arab Americans compared to non-Arab whites. Tobacco use is a risk factor for coronary artery disease, chronic obstructive pulmonary disease and lung cancer;however there is little information about the use of tobacco by Middle East immigrants in this country. The prevalence of tobacco use among men from this part of the world is quite high although it may be lower for immigrants. Such findings provide opportunities for future research to understand the different disease patterns in this population group. Use of name databases is one method to identify potential research participants, especially in a population-based setting. The proposed project intends to build on the work of Drs. Schwartz and others by creating an enhanced Middle Eastern Surname database that is able to identify Arabs and non-Arabs from the Middle East with high confidence. A first name database to improve specificity for surnames that are equivocal (i.e. common to both European and Middle Eastern ancestry) will be developed. As much as possible, algorithms to identify the ethnic origin of the Arab and other Middle Eastern names will be developed;for example, specific letter combinations that will identify Lebanese, Iraqi, and Iranian surnames. Methods to estimate denominators for the calculation of incidence and mortality rates will be developed and standardized. Finally, methods will be tested to identify probable first generation immigrants for the study of migration effects in this population. MDCSS and CCC are two SEER registries that have experience in this area and large populations of Arabs and other Middle Easterners in their registry catchment areas. By working together a product will be created that is a trusted and valuable resource available for use by any SEER registry with an interest in this population. Partners include NAACCR to determine opportunities for collaboration. At this time, there is no information on the creation of a similar database by NAACCR. The significance of this effort will be the characterization of the cancer burden in this growing population sub-group, which is important for healthcare planning and policy. As an example, based on our previous work, there is a need for mammography screening education among metropolitan Detroit Arab American immigrant women. The name lists and algorithms will also prove valuable to identify potential cancer cases in a registry for population-based cancer research. Additionally, in recent years NCI has supported cancer registry in the Middle Eastern countries of Cyprus, Egypt, Israel, and Jordan, which make up the Middle East Cancer Consortium (MECC). With improved cancer surveillance activities in Middle East countries, one will be able to perform more accurate migration studies. In the MECC monograph, rates in these four countries were compared with U.S. SEER rates (from 13 registries). Overall cancer incidence was found to be lower for the MECC countries;however, there were certain cancer sites (e.g., liver in Egypt and colorectal in Israel) that were higher. The use of scientifically valid Middle Eastern name lists would allow for more sophisticated comparisons between Middle East countries and Middle East descendents in the U.S. In addition, by developing a method to identify first generation immigrants in the U.S. there will be the ability to discern differences in rates between the Middle East, first generation immigrants and more acculturated U.S. Middle Easterners.
