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This content is from the “Advancing the Science of Cancer in Latinos: 2024 Conference Proceedings.”
Cancer Deaths Among Latinos in the COVID-19 Era: National and State Trends
Dr. Rogelio Sáenz is Professor of Sociology and Demography, Dean of the College of Public Policy, and holds the Mark G. Yudof Endowed Chair at the University of Texas at San Antonio.
COVID-19 vulnerability

Dr. Sáenz’s presentation began by discussing the vulnerability of people with cancer in the COVID-19 era. Over the last four years, a significant amount of research has observed the negative impact of COVID-19 on the survivability of people with cancer, along with rising numbers of cancer incidence and death due to disrupted health care. The growing Latino population is particularly vulnerable, experiencing increased incidences and death associated with cancer, low access to health care, frequent existing comorbidities, and elevated COVID-19 death rates, and many work as essential workers.
Although there is currently limited information about changes in Latino cancer mortality in the COVID-19 era, cancer patients are at a higher risk of contracting COVID-19 due to compromised immune systems. They also experience changes in cancer treatment with greater need for virtual sessions. Changes in annual checkups and regular medical visits include delays in cancer screening, diagnosis, and treatment. These changes led to lower cancer incidence and deaths reported in 2020, followed by increases in 2021 and subsequent years. Furthermore, evidence now suggests that COVID-19 could “create a microenvironment that may support cancer cell proliferation and induce the activation of dormant cancer cells.”
Demographic insights into cancer death rates
Recent research by Dr. Sáenz and colleagues revealed that cancer deaths among Latino individuals in the US increased by 11.7% from 2019 to 2023. This is in contrast with a 0.2% decrease for Black individuals and 0.9% increase for White individuals. Because the Latino population is overall younger than the national average, an age-adjusted death rate (AADR) was also calculated. The change in AADR for the Latino population from 2019-2023 was a 1.0% increase, compared with a 4.7% decrease for the Black population and a 1.6% decrease for the White population.
The leading types of cancer deaths among Latinos were also ranked by percent change in deaths from 2019 to 2023. The cancer with the highest percent change in that time span was malignant neoplasm of the rectum, which showed a 32.0% increase in cancer deaths. The next highest cancers on the list were malignant neoplasm of the uterus, intrahepatic bile duct carcinoma, malignant neoplasm of the endometrium, and malignant neoplasm of the kidney.
When assessed based on urbanization category, Latino cancer death rates increased the most in medium metro areas, a total increase of 9.3% from 2019 to 2023. The rates increased only 4.9% in small metro areas, which represented the smallest increase in the categories studied. Other categories included large central metro, large fringe metro, micropolitan (nonmetro), and noncore (nonmetro).
At the state level, the cancer AADR among Latinos from 2019 to 2023 was highest in New Mexico, followed by Florida. Of the 12 states with the highest cancer AADR, 9 were also among the 12 states with the highest COVID-19 AADR, showing a high correlation between the two conditions. The states with the lowest cancer AADR among Latinos were Iowa, Alabama, Arkansas, Oklahoma, and Mississippi. Interestingly, these states are considered “Latino new-destination areas”, meaning the Latino population has increased in these states only in the last few decades. These populations tend to be younger, and predominantly immigrant.
From 2021 to 2023, 75.6% of states with the required data showed an increase in Latino cancer AADR. Only 64.7% of states had increases in White cancer AADR in that time frame, and 53.7% of states had increases in Black cancer AADR.
Closing remarks and limitations
The results of the analysis presented by Dr. Sáenz showed that Latino populations experienced increases in cancer deaths and cancer AADR during the pandemic era. Although a dip in Latino deaths was observed in 2020, a corresponding increase in death rates was observed in 2023 at the national level and across the states. The pandemic revealed even more starkly the inequities that exist in access to health care.
Some limitations existed in Dr. Sáenz work. For example, the data for 2022 and 2023 are provisional. Also, possibilities exist for misclassification of race/ethnicity and underlying causes and contributing causes of death. Furthermore, there is a lack of data to assess nativity variations among cancer deaths before and after the COVID-19 era. Finally, the mortality increase due to rising cancer deaths associated with the rapidly growing Latino population cannot be disentangled from deaths associated with influences of the changing COVID-19 environment, which increased vulnerability among people with cancer. Still, the use of AADR as a parameter for measuring mortality may address some of that confounding effect.
COVID-19’s Influence on Colorectal Cancer Screening in Latino Communities: The Role of Mailed Fecal Test Outreach
Dr. Gloria Coronado is Associate Director of Population Science at the University of Arizona (UA) Cancer Center and Professor in the UA College of Public Health.
Colorectal cancer screening and COVID-19

Dr. Coronado’s presentation discussed the impact of COVID-19 on colorectal cancer screening and follow-up; she presented findings of her research using health record data and qualitative interviews with clinic staff at the nation’s largest federally qualified Health center. In 2020, modeling data suggested that cancer care reductions due to the pandemic would have profound long-term impacts, resulting in over 57,000 missed diagnoses and 10,000 excess deaths from cancer over the next decade. This modeling did not consider the specific impact that these cancer care reductions might have on underserved populations.
In response to this modeling, Dr. Coronado and colleagues partnered with the AltaMed Health System, a large federally qualified health center, to provide evidence of the impact of cancer care reduction on the Latino community. AltaMed had 245,012 patients in 2022, 93% of which were a racial and/or ethnic minority, and 85% of which were Latino. The health center also employs over 3,000 employees and 400 physicians. Their mission is to eliminate disparities in health care access and outcomes.
Overall, in national data, colorectal cancer screening increased from 2019 to 2021, indicating a robust rebound after the pandemic. However, this increase was entirely driven by increases in stool testing; there were 3.6 million more stool tests in 2021 than in 2019. Colonoscopies, however, decreased in this time frame, with 1.3 million fewer in 2021 than in 2019. Interestingly, this increase in colorectal screening was entirely driven by increases in screening on the West coast. These findings indicate that home-based testing may be key to maintaining screening levels during health care disruptions. One problem with this trend, however, is that only 57% of patients with positive stool sample tests obtain a follow-up colonoscopy within 1 year. A colonoscopy is needed to find early forms of cancer or to find and remove small growth (polyps) to prevent cancer from occurring.
When comparing data from the Behavioral Risk Factor Surveillance System (BRFSS, a nationwide database) with data from the Uniform Data System (UDS, which only includes federally qualified health centers and therefore more underrepresented populations), colorectal cancer screening numbers are vastly different. In fact, compared with BRFSS data, the UDS data shows a 30% lower colorectal screening rate in 2020.
RESTORE
Dr. Coronado and colleagues recently initiated a study called RESTORE, funded by the National Cancer Institute, assessing the long-term impacts of the COVID-19 pandemic on disparities in cancer screening and follow-up. This collaborative effort with AltaMed, RAND corporation, and the Kaiser Permanente Center for Health Research, aims to assess trends in screening and follow-up for colorectal, breast, and cervical cancers; assess long term impacts of COVID on colorectal cancer outcomes; and identify organizational-level barriers and facilitators.
Monthly colorectal cancer screening rates were evaluated during 3 time periods: pre-pandemic (March 2018-March 2020), pandemic (March 2020-December 2020), and vaccination era (January 2021-July 2022). Over 60,000 patients over the age of 50 were evaluated, 79% of which were Hispanic/Latino. Predictably, during months when mailed outreach was sent out encouraging a fecal immunochemical test (FIT), rates were higher. If these months were excluded, screening rate trends were shown to decrease during the pandemic time period. However, if data from the mailed FIT outreach was included, decreases in screening rates were mitigated. This indicates the potential utility of mailed outreach programs during national natural disasters.
Qualitative Interviews
Qualitative interviews by the RESTORE team revealed some broad impacts of the COVID-19 pandemic on cancer care. First, AltaMed clinical teams expressed being “over-run” by upper respiratory infection and COVID needs, meaning they had no time for routine and preventive care. Furthermore, no infrastructure was in place for telehealth, creating an enormous learning curve for both staff and patients. Prior disaster planning was oriented for short-term, episodic issues (e.g., winter flu, TB outbreak) and not designed for a long-term, multi-year pandemic. Finally, pre-pandemic cancer screening goals followed “year-long roadmaps;” during the pandemic screening just “happened on the side” when it was feasible according to surges and access/capacity.
Colorectal cancer screenings specifically were delayed while providers focused on patients with COVID, those with complex chronic or acute needs, and COVID tests and vaccines. Colorectal cancer awareness and education campaigns were paused. Because of the move to telehealth, fewer FIT kits were distributed during point-of-care visits, less education happened during visits, and patients wanted less information on preventive care during telehealth visits.
Lessons learned from the pandemic included the importance of being nimble and resilient, incorporating more long-term disaster planning approaches, the use of telehealth, and improving data tracking tools. Some concerns remain, including the cancer diagnoses that were missed during the pandemic, limited staffing capacity, and the social determinants of health of cancer patients. However, mailed FIT outreach, the promise of telehealth, and improved local systems for monitoring infectious diseases represent opportunities for resilience.
Cancer Patients at an Oncology Center in Mexico: Navigating COVID-19 in an Underfunded Health System
Dr. Diana Vilar-Compte is a Professor in the Department of Infectious Diseases at the Instituto Nacional de Cancerologia in Mexico.
COVID-19 and cancer in Mexico

Dr. Vilar-Compte’s presentation began by discussing healthcare conditions in Mexico at the start of the COVID-19 pandemic. According to the Organization for Economic Co-operation and Development (OECD), Mexico’s investment in healthcare is one of the lowest in the world. Government healthcare spending was only 585.5 US dollars per capita per year, which translates to only 40% of healthcare delivery being funded by the public sector. The private sector, therefore, played a key role in delivering healthcare during the pandemic, and, therefore, access to healthcare for some patients was limited due to cost.
In 2004, a program called Seguro Popular was implemented in Mexico which helped mitigate inequities in cancer care. However, in November 2019, just months before the pandemic, Seguro Popular was replaced by Instituto de Salud para el Bienestar (INSABI), a program intended to provide universal health coverage but which was plagued with problems. Because of low investment, a fragmented healthcare system, and overall corruption, 28.2% of the Mexican population (20.2 million people) did not have access to health services, and 40% had severe limitations to essential services in 2020.
Wide socio-economic and education disparities exist in Mexico, similar to other countries in Latin America, where cancer patients face innumerable barriers. Limited access to health care, resource-limited healthcare systems, forced transitions of oncology practices, and changes in treatment decisions are just a few barriers faced by cancer patients in Latin America.
This situation was made worse by the pandemic. By June 2020, 27% of world deaths from COVID-19 were occuring in Latin America. Furthermore, Mexico and Brazil had seen the highest death toll behind only the US. By the end of 2023, there had been over 7.7 million confirmed COVID-19 cases in Mexico, and over 300,000 confirmed deaths. Excess deaths have also been comparatively high in Mexico, indicating difficulties in treating chronic conditions such as cancer and cardiovascular disease.
Instituto Nacional de Cancerologia
Dr. Vilar-Compte works at Instituto Nacional de Cancerologia (INCan), a hospital in Mexico City that is an important provider of cancer care. With a 133-bed academic cancer center, INCan provided 4,700 surgeries, 52,000 ambulatory chemotherapies, and 212,523 outpatient visits in 2020. In March and April of 2020, INCan became a hybrid hospital to help with the pandemic. However, immediate problems surfaced, including a shortage of healthcare workers and ineligibility for emergency funds due to INCan’s lack of qualification as a COVID-19 dedicated hospital.
The median age of cancer patients with COVID seen at INCan in 2020 was 55 years; 31% of patients were obese and 22% had diabetes. The most common cancer seen in 2020 was breast cancer, followed by lymphoma and cervical cancer. Advance stage cancer (stage 3 or 4) was observed in 49% of patients. Of the patients with COVID-19 and cancer seen at INCan, 46% were hospitalized, 22% of which were given mechanical ventilation, and 55% of which died. These numbers were similar to other cancer institutions treating COVID-19, even though many patients presenting to INCan already had severe disease, with 35% of patients having oxygen saturation less than 90% at first medical evaluation.
Because of the combination of COVID-19 and cancer, the change in healthcare policy in Mexico, and changes in treatment decisions, breast cancer patients had many difficulties. A case-cohort analysis of 2,117 patients in 2020 and 2021 revealed that the number one reason for treatment change among chemotherapy and hormone therapy patients was unavailability of medication.
Although 9 different COVID-19 vaccines were approved in Mexico, only healthcare workers and patients over 60 years of age were prioritized. Cancer patients were not prioritized to receive early vaccination nor to receive any specific type of vaccine. Furthermore, updated vaccines were not approved until December of 2023, with no government acquisition mitigating cost, and still with no policies for high-risk groups.
In short, patients with cancer continue to be a high-risk group for developing severe COVID-19 and related sequela. Cancer patients in public hospitals in Mexico continue to face a high burden of the disease and multiple barriers to effective healthcare. Clear policies and access to vaccination and antivirals should be prioritized for all cancer patients.
By The Numbers
142
Percent
Expected rise in Latino cancer cases in coming years