1
|
Montes-Rodríguez IM, Soto-Salgado M, Torres-Cintrón CR, Tomassini-Fernandini JC, Suárez E, Clavell LA, Cadilla CL. Incidence and Mortality Rates for Childhood Acute Lymphoblastic Leukemia in Puerto Rican Hispanics, 2012-2016. Cancer Epidemiol Biomarkers Prev 2023; 32:1030-1037. [PMID: 37222662 PMCID: PMC10524932 DOI: 10.1158/1055-9965.epi-22-1227] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/24/2023] [Accepted: 05/01/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Acute lymphoblastic leukemia (ALL) accounts for 80% of all leukemias diagnosed in children. Although ALL age patterns are consistent across racial/ethnic groups, their incidence and mortality rates are highly variable. We assessed the age-standardized ALL incidence and mortality rates of Puerto Rican Hispanic (PRH) children and compared them with those of US mainland Hispanics (USH), non-Hispanic Whites (NHW), non-Hispanic Blacks (NHB), and Non-Hispanic Asian or Pacific Islanders (NHAPI). METHODS Differences between racial/ethnic groups were assessed by estimating the standardized rate ratio (SRR) for 2010 to 2014. Secondary data analyses of the Puerto Rico Central Cancer Registry and the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) databases were performed for the 2001 to 2016 period. RESULTS PRH children had 31% lower incidence rates than USH, but 86% higher incidence rates than NHB. In addition, the incidence trends of ALL increased significantly from 2001 to 2016 among PRH and USH, with 5% and 0.9% per year, respectively. Moreover, PRH have a lower 5-year overall survival (81.7%) when compared with other racial/ethnic groups. CONCLUSIONS PRH children were found to have disparities in ALL incidence and mortality rates compared with other racial/ethnic groups in the US. Additional research is warranted to identify the genetic and environmental risk factors that may be associated with the disparities observed. IMPACT This is the first study reporting the incidence and mortality rates of childhood ALL for PRH and making comparisons with other racial/ethnic groups in the US. See related commentary by Mejía-Aranguré and Núñez-Enríquez, p. 999.
Collapse
Affiliation(s)
| | - Marievelisse Soto-Salgado
- Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, PR
| | - Carlos R. Torres-Cintrón
- Puerto Rico Central Cancer Registry, University of Puerto Rico Comprehensive Cancer Center, San Juan, PR
| | | | - Erick Suárez
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, PR
| | - Luis A. Clavell
- Division of Pediatric Oncology, San Jorge Children’s Hospital, San Juan, PR
| | - Carmen L. Cadilla
- Department of Biochemistry, School of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, PR
| |
Collapse
|
2
|
Miller KD, Ortiz AP, Pinheiro PS, Bandi P, Minihan A, Fuchs HE, Martinez Tyson D, Tortolero-Luna G, Fedewa SA, Jemal AM, Siegel RL. Cancer statistics for the US Hispanic/Latino population, 2021. CA Cancer J Clin 2021; 71:466-487. [PMID: 34545941 DOI: 10.3322/caac.21695] [Citation(s) in RCA: 158] [Impact Index Per Article: 52.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/04/2021] [Indexed: 01/03/2023] Open
Abstract
The Hispanic/Latino population is the second largest racial/ethnic group in the continental United States and Hawaii, accounting for 18% (60.6 million) of the total population. An additional 3 million Hispanic Americans live in Puerto Rico. Every 3 years, the American Cancer Society reports on cancer occurrence, risk factors, and screening for Hispanic individuals in the United States using the most recent population-based data. An estimated 176,600 new cancer cases and 46,500 cancer deaths will occur among Hispanic individuals in the continental United States and Hawaii in 2021. Compared to non-Hispanic Whites (NHWs), Hispanic men and women had 25%-30% lower incidence (2014-2018) and mortality (2015-2019) rates for all cancers combined and lower rates for the most common cancers, although this gap is diminishing. For example, the colorectal cancer (CRC) incidence rate ratio for Hispanic compared with NHW individuals narrowed from 0.75 (95% CI, 0.73-0.78) in 1995 to 0.91 (95% CI, 0.89-0.93) in 2018, reflecting delayed declines in CRC rates among Hispanic individuals in part because of slower uptake of screening. In contrast, Hispanic individuals have higher rates of infection-related cancers, including approximately two-fold higher incidence of liver and stomach cancer. Cervical cancer incidence is 32% higher among Hispanic women in the continental US and Hawaii and 78% higher among women in Puerto Rico compared to NHW women, yet is largely preventable through screening. Less access to care may be similarly reflected in the low prevalence of localized-stage breast cancer among Hispanic women, 59% versus 67% among NHW women. Evidence-based strategies for decreasing the cancer burden among the Hispanic population include the use of culturally appropriate lay health advisors and patient navigators and targeted, community-based intervention programs to facilitate access to screening and promote healthy behaviors. In addition, the impact of the COVID-19 pandemic on cancer trends and disparities in the Hispanic population should be closely monitored.
Collapse
Affiliation(s)
- Kimberly D Miller
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Ana P Ortiz
- Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Paulo S Pinheiro
- Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, Florida
| | - Priti Bandi
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Adair Minihan
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Hannah E Fuchs
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | | | - Guillermo Tortolero-Luna
- Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Stacey A Fedewa
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Ahmedin M Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Rebecca L Siegel
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| |
Collapse
|
3
|
Miller KD, Goding Sauer A, Ortiz AP, Fedewa SA, Pinheiro PS, Tortolero-Luna G, Martinez-Tyson D, Jemal A, Siegel RL. Cancer Statistics for Hispanics/Latinos, 2018. CA Cancer J Clin 2018; 68:425-445. [PMID: 30285281 DOI: 10.3322/caac.21494] [Citation(s) in RCA: 282] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 08/14/2018] [Indexed: 12/11/2022] Open
Abstract
Cancer is the leading cause of death among Hispanics/Latinos, who represent the largest racial/ethnic minority group in the United States, accounting for 17.8% (57.5 million) of the total population in the continental United States and Hawaii in 2016. In addition, more than 3 million Hispanic Americans live in the US territory of Puerto Rico. Every 3 years, the American Cancer Society reports on cancer occurrence, risk factors, and screening for Hispanics in the United States based on data from the National Cancer Institute, the North American Association of Central Cancer Registries, and the Centers for Disease Control and Prevention. For the first time, contemporary incidence and mortality rates for Puerto Rico, which has a 99% Hispanic population, are also presented. An estimated 149,100 new cancer cases and 42,700 cancer deaths will occur among Hispanics in the continental United States and Hawaii in 2018. For all cancers combined, Hispanics have 25% lower incidence and 30% lower mortality compared with non-Hispanic whites, although rates of infection-related cancers, such as liver, are up to twice as high in Hispanics. However, these aggregated data mask substantial heterogeneity within the Hispanic population because of variable cancer risk, as exemplified by the substantial differences in the cancer burden between island Puerto Ricans and other US Hispanics. For example, during 2011 to 2015, prostate cancer incidence rates in Puerto Rico (146.6 per 100,000) were 60% higher than those in other US Hispanics combined (91.6 per 100,000) and 44% higher than those in non-Hispanic whites (101.7 per 100,000). Prostate cancer is also the leading cause of cancer death among men in Puerto Rico, accounting for nearly 1 in 6 cancer deaths during 2011-2015, whereas lung cancer is the leading cause of cancer death among other US Hispanic men combined. Variations in cancer risk are driven by differences in exposure to cancer-causing infectious agents and behavioral risk factors as well as the prevalence of screening. Strategies for reducing cancer risk in Hispanic populations include targeted, culturally appropriate interventions for increasing the uptake of preventive services and reducing cancer risk factor prevalence, as well as additional funding for Puerto Rico-specific and subgroup-specific cancer research and surveillance.
Collapse
Affiliation(s)
- Kimberly D Miller
- Senior Associate Scientist, Surveillance and Health Services Research, Intramural Research, American Cancer Society, Atlanta, GA
| | - Ann Goding Sauer
- Senior Associate Scientist, Surveillance and Health Services Research, Intramural Research, American Cancer Society, Atlanta, GA
| | - Ana P Ortiz
- Professor, Epidemiology and Biostatistics, University of Puerto Rico School of Public Health, San Juan, PR
| | - Stacey A Fedewa
- Senior Principal Scientist, Surveillance and Health Services Research, Intramural Research, American Cancer Society, Atlanta, GA
| | - Paulo S Pinheiro
- Research Associate Professor, Miller School of Medicine, University of Miami, Miami, FL
| | | | | | - Ahmedin Jemal
- Scientific Vice President, Surveillance and Health Services Research, Intramural Research, American Cancer Society, Atlanta, GA
| | - Rebecca L Siegel
- Scientific Director, Surveillance Research, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| |
Collapse
|
4
|
Ragin C, Banydeen R, Zhang C, Ben A, Calabrese V, Villa NN, Reville J, Dasgupta S, Bandyopadhyay M, Louden D, Dasgupta S. Breast Cancer Research in the Caribbean: Analysis of Reports From 1975 to 2017. J Glob Oncol 2018; 4:1-21. [PMID: 30481085 PMCID: PMC6818300 DOI: 10.1200/jgo.18.00044] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Breast cancer is among the leading causes of death resulting from cancer in Caribbean women. Studies examining exogenous and genetically predetermined endogenous risk factors are critical to define breast cancer susceptibility in Caribbean women. The purpose of this systematic review is to assess the existing scientific literature in the last 42 years (1975 to 2017) to describe the body of research generated for the population of this region and determine future research directions. METHODS We selected published research articles using a combination of definite keyword searches in PubMed. Only articles presenting the Caribbean population as the focus of their research objectives were included in this analysis. RESULTS Studies on breast cancer in the Caribbean are limited. A majority of publications on Caribbean populations were descriptive, focusing on cancer trends and clinicopathologic factors. High incidence and mortality rates for breast cancer are reported for the region, and there seem to be some differences between countries in the frequency of cases according to age at presentation. A limited number of epidemiologic, behavioral, and genetic and molecular studies were conducted in more recent years. CONCLUSION A regional strategy for cancer registration is needed for the Caribbean to address possible underestimates of breast cancer incidence. Furthermore, behavioral, molecular, genetic, and epidemiologic investigations of breast cancer are critical to address the concerns related to currently described high incidence and mortality rates in the Caribbean.
Collapse
Affiliation(s)
- Camille Ragin
- Camille Ragin, Fox Chase Cancer Center, Temple Health;
Camille Ragin, African Caribbean Cancer Consortium,
Philadelphia, PA; Rishika Banydeen, Centre Hospitalier
Universitaire de Martinique; Rishika Banydeen, African Caribbean
Cancer Consortium, Fort-de-France, Martinique; Christine Zhang,
Athena Ben, Victoria Calabrese, Nina N.
Villa, Jade Reville, and Subhajit Dasgupta,
Saint James School of Medicine; Subhajit Dasgupta, African
Caribbean Cancer Consortium, The Quarter; Delroy Louden, Anguilla
Community College, George Hill, Anguilla; Shaoni Dasgupta, Academic
Magnet High School; and Mausumi Bandyopadhyay, Trident Technical
College, Charleston, SC
| | - Rishika Banydeen
- Camille Ragin, Fox Chase Cancer Center, Temple Health;
Camille Ragin, African Caribbean Cancer Consortium,
Philadelphia, PA; Rishika Banydeen, Centre Hospitalier
Universitaire de Martinique; Rishika Banydeen, African Caribbean
Cancer Consortium, Fort-de-France, Martinique; Christine Zhang,
Athena Ben, Victoria Calabrese, Nina N.
Villa, Jade Reville, and Subhajit Dasgupta,
Saint James School of Medicine; Subhajit Dasgupta, African
Caribbean Cancer Consortium, The Quarter; Delroy Louden, Anguilla
Community College, George Hill, Anguilla; Shaoni Dasgupta, Academic
Magnet High School; and Mausumi Bandyopadhyay, Trident Technical
College, Charleston, SC
| | - Christine Zhang
- Camille Ragin, Fox Chase Cancer Center, Temple Health;
Camille Ragin, African Caribbean Cancer Consortium,
Philadelphia, PA; Rishika Banydeen, Centre Hospitalier
Universitaire de Martinique; Rishika Banydeen, African Caribbean
Cancer Consortium, Fort-de-France, Martinique; Christine Zhang,
Athena Ben, Victoria Calabrese, Nina N.
Villa, Jade Reville, and Subhajit Dasgupta,
Saint James School of Medicine; Subhajit Dasgupta, African
Caribbean Cancer Consortium, The Quarter; Delroy Louden, Anguilla
Community College, George Hill, Anguilla; Shaoni Dasgupta, Academic
Magnet High School; and Mausumi Bandyopadhyay, Trident Technical
College, Charleston, SC
| | - Athena Ben
- Camille Ragin, Fox Chase Cancer Center, Temple Health;
Camille Ragin, African Caribbean Cancer Consortium,
Philadelphia, PA; Rishika Banydeen, Centre Hospitalier
Universitaire de Martinique; Rishika Banydeen, African Caribbean
Cancer Consortium, Fort-de-France, Martinique; Christine Zhang,
Athena Ben, Victoria Calabrese, Nina N.
Villa, Jade Reville, and Subhajit Dasgupta,
Saint James School of Medicine; Subhajit Dasgupta, African
Caribbean Cancer Consortium, The Quarter; Delroy Louden, Anguilla
Community College, George Hill, Anguilla; Shaoni Dasgupta, Academic
Magnet High School; and Mausumi Bandyopadhyay, Trident Technical
College, Charleston, SC
| | - Victoria Calabrese
- Camille Ragin, Fox Chase Cancer Center, Temple Health;
Camille Ragin, African Caribbean Cancer Consortium,
Philadelphia, PA; Rishika Banydeen, Centre Hospitalier
Universitaire de Martinique; Rishika Banydeen, African Caribbean
Cancer Consortium, Fort-de-France, Martinique; Christine Zhang,
Athena Ben, Victoria Calabrese, Nina N.
Villa, Jade Reville, and Subhajit Dasgupta,
Saint James School of Medicine; Subhajit Dasgupta, African
Caribbean Cancer Consortium, The Quarter; Delroy Louden, Anguilla
Community College, George Hill, Anguilla; Shaoni Dasgupta, Academic
Magnet High School; and Mausumi Bandyopadhyay, Trident Technical
College, Charleston, SC
| | - Nina N. Villa
- Camille Ragin, Fox Chase Cancer Center, Temple Health;
Camille Ragin, African Caribbean Cancer Consortium,
Philadelphia, PA; Rishika Banydeen, Centre Hospitalier
Universitaire de Martinique; Rishika Banydeen, African Caribbean
Cancer Consortium, Fort-de-France, Martinique; Christine Zhang,
Athena Ben, Victoria Calabrese, Nina N.
Villa, Jade Reville, and Subhajit Dasgupta,
Saint James School of Medicine; Subhajit Dasgupta, African
Caribbean Cancer Consortium, The Quarter; Delroy Louden, Anguilla
Community College, George Hill, Anguilla; Shaoni Dasgupta, Academic
Magnet High School; and Mausumi Bandyopadhyay, Trident Technical
College, Charleston, SC
| | - Jade Reville
- Camille Ragin, Fox Chase Cancer Center, Temple Health;
Camille Ragin, African Caribbean Cancer Consortium,
Philadelphia, PA; Rishika Banydeen, Centre Hospitalier
Universitaire de Martinique; Rishika Banydeen, African Caribbean
Cancer Consortium, Fort-de-France, Martinique; Christine Zhang,
Athena Ben, Victoria Calabrese, Nina N.
Villa, Jade Reville, and Subhajit Dasgupta,
Saint James School of Medicine; Subhajit Dasgupta, African
Caribbean Cancer Consortium, The Quarter; Delroy Louden, Anguilla
Community College, George Hill, Anguilla; Shaoni Dasgupta, Academic
Magnet High School; and Mausumi Bandyopadhyay, Trident Technical
College, Charleston, SC
| | - Shaoni Dasgupta
- Camille Ragin, Fox Chase Cancer Center, Temple Health;
Camille Ragin, African Caribbean Cancer Consortium,
Philadelphia, PA; Rishika Banydeen, Centre Hospitalier
Universitaire de Martinique; Rishika Banydeen, African Caribbean
Cancer Consortium, Fort-de-France, Martinique; Christine Zhang,
Athena Ben, Victoria Calabrese, Nina N.
Villa, Jade Reville, and Subhajit Dasgupta,
Saint James School of Medicine; Subhajit Dasgupta, African
Caribbean Cancer Consortium, The Quarter; Delroy Louden, Anguilla
Community College, George Hill, Anguilla; Shaoni Dasgupta, Academic
Magnet High School; and Mausumi Bandyopadhyay, Trident Technical
College, Charleston, SC
| | - Mausumi Bandyopadhyay
- Camille Ragin, Fox Chase Cancer Center, Temple Health;
Camille Ragin, African Caribbean Cancer Consortium,
Philadelphia, PA; Rishika Banydeen, Centre Hospitalier
Universitaire de Martinique; Rishika Banydeen, African Caribbean
Cancer Consortium, Fort-de-France, Martinique; Christine Zhang,
Athena Ben, Victoria Calabrese, Nina N.
Villa, Jade Reville, and Subhajit Dasgupta,
Saint James School of Medicine; Subhajit Dasgupta, African
Caribbean Cancer Consortium, The Quarter; Delroy Louden, Anguilla
Community College, George Hill, Anguilla; Shaoni Dasgupta, Academic
Magnet High School; and Mausumi Bandyopadhyay, Trident Technical
College, Charleston, SC
| | - Delroy Louden
- Camille Ragin, Fox Chase Cancer Center, Temple Health;
Camille Ragin, African Caribbean Cancer Consortium,
Philadelphia, PA; Rishika Banydeen, Centre Hospitalier
Universitaire de Martinique; Rishika Banydeen, African Caribbean
Cancer Consortium, Fort-de-France, Martinique; Christine Zhang,
Athena Ben, Victoria Calabrese, Nina N.
Villa, Jade Reville, and Subhajit Dasgupta,
Saint James School of Medicine; Subhajit Dasgupta, African
Caribbean Cancer Consortium, The Quarter; Delroy Louden, Anguilla
Community College, George Hill, Anguilla; Shaoni Dasgupta, Academic
Magnet High School; and Mausumi Bandyopadhyay, Trident Technical
College, Charleston, SC
| | - Subhajit Dasgupta
- Camille Ragin, Fox Chase Cancer Center, Temple Health;
Camille Ragin, African Caribbean Cancer Consortium,
Philadelphia, PA; Rishika Banydeen, Centre Hospitalier
Universitaire de Martinique; Rishika Banydeen, African Caribbean
Cancer Consortium, Fort-de-France, Martinique; Christine Zhang,
Athena Ben, Victoria Calabrese, Nina N.
Villa, Jade Reville, and Subhajit Dasgupta,
Saint James School of Medicine; Subhajit Dasgupta, African
Caribbean Cancer Consortium, The Quarter; Delroy Louden, Anguilla
Community College, George Hill, Anguilla; Shaoni Dasgupta, Academic
Magnet High School; and Mausumi Bandyopadhyay, Trident Technical
College, Charleston, SC
| |
Collapse
|
5
|
Prieto D, Soto-Ferrari M, Tija R, Peña L, Burke L, Miller L, Berndt K, Hill B, Haghsenas J, Maltz E, White E, Atwood M, Norman E. Literature review of data-based models for identification of factors associated with racial disparities in breast cancer mortality. Health Syst (Basingstoke) 2018; 8:75-98. [PMID: 31275571 DOI: 10.1080/20476965.2018.1440925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 01/29/2018] [Accepted: 02/08/2018] [Indexed: 01/03/2023] Open
Abstract
In the United States, early detection methods have contributed to the reduction of overall breast cancer mortality but this pattern has not been observed uniformly across all racial groups. A vast body of research literature shows a set of health care, socio-economic, biological, physical, and behavioural factors influencing the mortality disparity. In this paper, we review the modelling frameworks, statistical tests, and databases used in understanding influential factors, and we discuss the factors documented in the modelling literature. Our findings suggest that disparities research relies on conventional modelling and statistical tools for quantitative analysis, and there exist opportunities to implement data-based modelling frameworks for (1) exploring mechanisms triggering disparities, (2) increasing the collection of behavioural data, and (3) monitoring factors associated with the mortality disparity across time.
Collapse
Affiliation(s)
- Diana Prieto
- College of Engineering and Applied Sciences, Western Michigan University, Kalamazoo, MI, USA.,Johns Hopkins Carey Business School, Baltimore, MD, USA
| | - Milton Soto-Ferrari
- College of Engineering and Applied Sciences, Western Michigan University, Kalamazoo, MI, USA.,Department of Marketing and Operations, Scott College of Business, Terre Haute, IN, USA
| | - Rindy Tija
- College of Engineering and Applied Sciences, Western Michigan University, Kalamazoo, MI, USA
| | - Lorena Peña
- College of Engineering and Applied Sciences, Western Michigan University, Kalamazoo, MI, USA
| | - Leandra Burke
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Lisa Miller
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Kelsey Berndt
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Brian Hill
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Jafar Haghsenas
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Ethan Maltz
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Evan White
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Maggie Atwood
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Earl Norman
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| |
Collapse
|
6
|
Abstract
PURPOSE The incidence of anal cancer is increasing, particularly among HIV and men who have sex with men (MSM) groups. The vast majority of cases are associated with human papillomavirus (HPV), the most common sexually transmitted infection. Epidemiological studies have also documented low survival, which might be linked to lack of appropriate screening, access, and utilization of pertinent health care services. Our objective was to assess the relative survival (1 and 3 years) of anal cancer in Puerto Rico for men and women during the period from 2000-2007. METHODS All histological types of cancer of anus, anal canal, and anorectum (ICD-O-3 codes C210-C218), except for sarcomas, were included. Relative survival was estimated with the use of life tables from the population of Puerto Rico. In addition, the excess survival was compared by age at diagnosis, histology, and stage (defined as local, regional, or distant), using the Poisson regression model. RESULTS The overall 3-year relative survival in Puerto Rico was the same (53 %) for men and women. CONCLUSIONS Our findings establish baseline survival data for anal cancer in Hispanics from Puerto Rico. Since now, the national guidelines for anal cancer screening and treatment are on their way to be determined; baseline information about survival will allow monitoring the efficacy that standardized screening programs may eventually have in increasing anal cancer survival in this population.
Collapse
|
7
|
Colón-López V, Banerjee G, Gertz AM, Ortiz AP, Calo W, Finney-Rutten LJ, Colón-Ramos U, Hesse BW, Tortolero G. Behavioral correlates of fruit and vegetable intake in Puerto Rico: results from the Health Information National Trends Survey. PUERTO RICO HEALTH SCIENCES JOURNAL 2013; 32:194-9. [PMID: 24397217 PMCID: PMC4994519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE A diet high in fruit and vegetables (FV) is associated with a decreased risk for chronic diseases, such as cancer. Limited information exists regarding the factors associated with FV intake in persons living in Puerto Rico. The objective of this study was to examine sociodemographic, behavioral, and health-belief factors associated with dietary habits in Puerto Rico. METHODS Secondary data analysis of adults aged 18 years and older from the Puerto Rico Health Information National Trends Survey (HINTS-PR) conducted in 2009. Multivariate logistic regression models were used to identify factors associated with meeting the established recommendations for FV consumption. RESULTS Only 14.5% of the adults in Puerto Rico met the recommendations for daily FV intake, and the vast majority (90.9%) were unaware of current recommendations. Bivariate analyses demonstrated that being obese, having lower than a high school education, and not knowing the recommendations were significantly associated with not meeting these recommendations. In the multivariate logistic regression analysis, being obese (OR = 3.77; 95% CI = 1.41-10.08) and not being aware of the current dietary recommendations (OR = 9.26; 95% CI = 3.77-22.73) continued to be significantly associated with not meeting the FV intake recommendations. CONCLUSION The Puerto Rican population is far from meeting FV consumption recommendations, with prevalence estimates of consumption that are below the US median. Low FV intake might put the population in Puerto Rico at increased risk of developing cancer as well as a number of other chronic diseases that are secondary both to improper nutrition and to obesity.
Collapse
Affiliation(s)
- Vivian Colón-López
- Graduate School of Public Health, Department of Health Services Administration, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico.
| | - Geetanjoli Banerjee
- Cancer Control and Population Sciences Program, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico. Department of Epidemiology, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Alida María Gertz
- Department of Internal Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Ana Patricia Ortiz
- Cancer Control and Population Sciences Program, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico. Department of Epidemiology, Yale University School of Public Health, New Haven, Connecticut, USA
| | - William Calo
- Division of Management, Policy and Community Health, The University of Texas School of Public Health, Houston, Texas, USA
| | | | - Uriyoán Colón-Ramos
- Departmentof Global Health, School of Public Health and Health Services, George Washington University, Washington DC, USA
| | | | - Guillermo Tortolero
- Cancer Control and Population Sciences Program, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico. Department of Epidemiology, Yale University School of Public Health, New Haven, Connecticut, USA
| |
Collapse
|
8
|
Colón-López V, Ortiz AP, Soto-Salgado M, Torres-Cintrón M, Mercado-Acosta JJ, Suárez E. Anal cancer incidence and mortality in Puerto Rico. PUERTO RICO HEALTH SCIENCES JOURNAL 2013; 32:76-81. [PMID: 23781623 PMCID: PMC3770822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Anal cancer is a rare tumor that is associated with oncogenic HPV genotypes. This study aims to compare the age-standardized rates (ASRs) of anal cancer incidence and mortality in men and women living in Puerto Rico (PR) with those of non-Hispanic whites (NHW), non-Hispanic blacks (NHB), and Hispanics (USH) living in the continental United States (US). METHODS ASRs were calculated based on cancer data that came from the PR Cancer Central Registry and from the Surveillance, Epidemiology, and End Results (SEER) program. The age-specific relative risks (RR) and 95% Confidence Interval (95% CI) were estimated using Poisson regression models. RESULTS Comparing the period of 2001 to 2004 to that of 1992 to 1996, the incidence of anal cancer increased among NHW, NHB, and PR men. In females, an increase in the incidence was observed for all racial groups except for Puerto Rican women. When evaluating findings by age groups, Puerto Rican men younger than 60 years old had a 20% higher incidence of anal cancer than did USH men of the same age strata (RR: 2.20; 95% CI = 1.48-3.29). However, Puerto Rican females had a lower incidence of anal cancer than NHW and NHB women. An increased percent change in mortality was observed only in NHW and NHB men. A decreasing trend was observed in all racial/ethnic groups except for NHW women. CONCLUSION Our results support the notion that there are racial/ethnic differences in anal cancer incidence and mortality, with potential disparities among men and women in PR compared with USH men and women. Given the increasing incidence trends in anal cancer, particularly among PR, NHW, and NHB men, further investigation is needed to better elucidate screening practices that can aid in the prevention of anal cancer.
Collapse
Affiliation(s)
- Vivian Colón-López
- Department of Health Services Administration, Graduate School of Public Health, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico.
| | | | | | | | | | | |
Collapse
|
9
|
Ortiz AP, Frías O, Pérez J, Cabanillas F, Martínez L, Sánchez C, Capó-Ramos DE, González-Keelan C, Mora E, Suárez E. Breast cancer molecular subtypes and survival in a hospital-based sample in Puerto Rico. Cancer Med 2013; 2:343-50. [PMID: 23930211 PMCID: PMC3699846 DOI: 10.1002/cam4.78] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 02/27/2013] [Accepted: 03/08/2013] [Indexed: 12/31/2022] Open
Abstract
Information on the impact of hormone receptor status subtypes in breast cancer (BC) prognosis is still limited for Hispanics. We aimed to evaluate the association of BC molecular subtypes and other clinical factors with survival in a hospital-based female population of BC cases in Puerto Rico. We analyzed 663 cases of invasive BC diagnosed between 2002 and 2005. Information on HER-2/neu (HER-2) overexpression, estrogen (ER), and progesterone (PR) receptor status and clinical characteristics were retrieved from hospitals cancer registries and record review. Survival probabilities by covariates of interest were described using the Kaplan–Meier estimators. Cox proportional hazards models were employed to assess factors associated with risk of BC death. Overall, 17.3% of BC cases were triple-negative (TN), 61.8% were Luminal-A, 13.3% were Luminal-B, and 7.5% were HER-2 overexpressed. In the multivariate Cox model, among patients with localized stage, women with TN BC had higher risk of death (adjusted hazard ratio [HR]: 2.57, 95% confidence interval [CI]: 1.29–5.12) as compared to those with Luminal-A status, after adjusting for age at diagnosis. In addition, among women with regional/distant stage at diagnosis, those with TN BC (HR: 5.48, 95% CI: 2.63–11.47) and those HER-2+, including HER-2 overexpressed and Luminal-B, (HR: 2.73, 95% CI:1.30–5.75) had a higher mortality. This is the most comprehensive epidemiological study to date on the impact of hormone receptor expression subtypes in BC survival in Puerto Rico. Consistent to results in other populations, the TN subtype and HER-2+ tumors were associated with decreased survival.
Collapse
Affiliation(s)
- Ana Patricia Ortiz
- Cancer Control and Population Sciences Program, University of Puerto Rico Comprehensive Cancer Center, San Juan, PR 00927, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Finney Rutten LJ, Hesse BW, Moser RP, Ortiz Martinez AP, Kornfeld J, Vanderpool RC, Byrne M, Tortolero Luna G. Socioeconomic and geographic disparities in health information seeking and Internet use in Puerto Rico. J Med Internet Res 2012; 14:e104. [PMID: 22849971 PMCID: PMC3409614 DOI: 10.2196/jmir.2007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 02/13/2012] [Accepted: 03/10/2012] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Geographically isolated Hispanic populations, such as those living in Puerto Rico, may face unique barriers to health information access. However, little is known about health information access and health information-seeking behaviors of this population. OBJECTIVE To examine differences in health and cancer information seeking among survey respondents who ever used the Internet and those who did not, and to explore sociodemographic and geographic trends. METHODS Data for our analyses were from a special implementation of the Health Information National Trends Survey conducted in Puerto Rico in 2009. We collected data through random digit dialing, computer-assisted telephone interviews (N = 639). The sample was drawn from the eight geographic regions of the Puerto Rico Department of Health. To account for complex survey design and perform weighted analyses to obtain population estimates, we analyzed the data using SUDAAN. Frequencies, cross-tabulation with chi-square, and logistic regression analyses were conducted. Geographic information system maps were developed to examine geographic distributions of Internet use and information seeking. RESULTS Of 639 participants, 142 (weighted percentage 32.7%) indicated that they had ever gone online to access the Internet or World Wide Web; this proportion was substantially lower than that of US mainland Hispanics who reported using the Internet (49%). While 101 of 142 (weighted percentage 59.6%) respondents who used the Web had ever sought health information, only 118 of 497 (weighted percentage 20.0%) of those who did not use the Web had sought health information. The pattern was similar for cancer information: 76 of 142 respondents (weighted percentage 47.2%) who used the Web had ever sought cancer information compared with 105 of 497 (weighted percentage 18.8%) of those who had not used the Web. These results were slightly lower but generally consistent with US mainland Hispanics' health (50.9%) and cancer (26.4%) information seeking. Results of separate logistic regression models controlling for sociodemographic characteristics demonstrated that, compared with individuals who did not seek health or cancer information, those who did were over 5 times as likely to have used the Internet (odds ratio 5.11, P < .001). Those who sought cancer information were over twice as likely to have used the Internet (odds ratio 2.5, P < .05). The frequency of Internet use and health and cancer information seeking was higher in the San Juan metro region than in more rural areas. CONCLUSIONS Our results contribute to the evidence base for health and cancer communication planning for Puerto Rico, and suggest that health education and outreach efforts should explore the use of available and trusted methods of dissemination such as radio and television, as well as community-based health care providers and organizations, to supplement and encourage use of the Internet as a source of health information.
Collapse
Affiliation(s)
- Lila J Finney Rutten
- Clinical Monitoring Research Program, SAIC-Frederick, Inc, National Cancer Institute at Frederick, Frederick, MD 21702, USA.
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Ortiz AP, Frías O, González-Keelan C, Suárez E, Capó D, Pérez J, Cabanillas F, Mora E. Clinicopathological factors associated to HER-2 status in a hospital-based sample of breast cancer patients in Puerto Rico. PUERTO RICO HEALTH SCIENCES JOURNAL 2010; 29:265-271. [PMID: 20799514 PMCID: PMC3827955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Breast cancer is the most common female malignancy in Puerto Rico. Cases with human epidermal growth factor receptor 2 (HER-2) oncoprotein overamplification are associated with aggressive clinical behavior. Given the limited availability of information for Puerto Rico, we aimed to evaluate the prevalence and clinical correlates of HER-2 gene overexpression among a hospital-based female population of breast cancer cases. We analyzed data from 1,049 female patients with invasive breast cancer (diagnosed 2000-2005) at the I. González Martínez Oncologic Hospital and the Auxilio Mutuo Hospital. HER-2 status and other clinical characteristics were retrieved from the hospitals' cancer registries, from the Puerto Rico Central Cancer Registry, and from a review of medical and pathological records. Prevalence odds ratios were estimated with 95% confidence intervals, using logistic regression models to quantify the association between HER-2 status and different clinicophatological factors. The overall prevalence of positive HER-2 expression was 22.5%. In the multivariate logistic regression model, factors significantly associated with HER-2 positivity included a diagnosis age of < 50 years, having a tumor with negative progesterone receptor (PR) status, and having regional disease (p < 0.05). No significant differences in HER-2 positivity were observed by tumor histology or estrogen receptor (ER) status (p > 0.05). This is the most comprehensive epidemiological study to date on HER-2 status in Puerto Rico. The prevalence and correlates of HER-2 overexpression in this study are comparable to those observed in US populations. Study results will aid in the development of breast cancer control strategies in Puerto Rico.
Collapse
Affiliation(s)
- Ana P Ortiz
- Cancer Control and Population Sciences Program, University of Puerto Rico Comprehensive Cancer Center, San Juan.
| | | | | | | | | | | | | | | |
Collapse
|