{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T08:23:44Z","timestamp":1794299024955,"version":"4.9.0"},"reference-count":16,"publisher":"Oxford University Press (OUP)","issue":"11","funder":[{"DOI":"10.13039\/100000054","name":"NCI","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,11,1]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Apparent survival advantages for Hispanic and non-Hispanic Asian and Pacific Islander individuals, often labeled the \u201cHispanic paradox\u201d or \u201chealthy immigrant effect,\u201d have been reported for multiple cancers compared with non-Hispanic White and non-Hispanic Black persons. Higher proportions of loss to follow-up among Hispanic and non-Hispanic Asian and Pacific Islander persons overestimate survival because of informative censoring. We developed a sensitivity analysis\u2013based method to address potential impacts of differential loss to follow-up.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We estimated 5-year age-standardized cancer-specific survival for non-Hispanic White (reference), non-Hispanic Black, Hispanic, non-Hispanic Asian and Pacific Islander, Hispanic, and non-Hispanic American Indian or Alaska Native persons diagnosed between 2005 and 2019 in 22 Surveillance, Epidemiology, and End Results Program registries. Persons alive with less than 5\u2009years or maximum possible follow-up were classified as lost to follow-up. For each cancer stage\u2013race and ethnicity combination, for cases lost to follow-up exceeding levels for non-Hispanic White persons, we modeled 2 plausible scenarios relative to survival of non-Hispanic White patients: (1) \u201clower\u201d survival and (2) \u201chigher\u201d survival. Across 1000 simulations, we constructed a sensitivity interval spanning the average lower 95% confidence bound of \u201clower\u201d survival to the average upper 95% confidence bound of \u201chigher\u201d survival.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Loss to follow-up was higher for Hispanic and non-Hispanic Asian and Pacific Islander persons and Hispanic individuals across cancer sites (range\u2009=\u20092.2%-20.7%) than for non-Hispanic White persons (range\u2009=\u20090.4%-5.4%). Sensitivity intervals were consistently wider than standard 95% CIs. After accounting for differential loss to follow-up, previously observed equivalent or higher survival disappeared for Hispanic and non-Hispanic Asian and Pacific Islander persons (eg, prostate cancer) and Hispanic persons (eg, lung cancer).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Ignoring differential loss to follow-up overstates survival advantages among racial and ethnic minorities. Sensitivity analysis revealed that reported survival advantages are artifacts of higher loss to follow-up, underscoring the need to address this censoring bias in population-based survival studies.<\/jats:p>\n <\/jats:sec>","DOI":"10.1093\/jnci\/djag181","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T11:44:10Z","timestamp":1780487050000},"page":"2062-2072","source":"Crossref","is-referenced-by-count":2,"title":["Adjusting survival estimates for differential loss to follow-up by race and ethnicity: a SEER analysis"],"prefix":"10.1093","volume":"118","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0348-1407","authenticated-orcid":false,"given":"Theresa P","family":"Devasia","sequence":"first","affiliation":[{"name":"Division of Cancer Control and Population Sciences, National Cancer Institute , Bethesda, MD,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulo S","family":"Pinheiro","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, Miller School of Medicine, and Sylvester Comprehensive Cancer Center, University of Miami , Miami, FL,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mandi","family":"Yu","sequence":"additional","affiliation":[{"name":"Division of Cancer Control and Population Sciences, National Cancer Institute , Bethesda, MD,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,4]]},"reference":[{"key":"2026111002523586500_djag181-B1","doi-asserted-by":"publisher","first-page":"1237","DOI":"10.1001\/jama.1994.03510400023017","article-title":"Mortality among 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