Abstract B69: Cervical and anal HPV serotype-specific prevalence among high-risk indigent women in substance abuse recovery

Background: A high priority area identified by the President's Cancer Panel is increasing the uptake of human papillomavirus (HPV) vaccinations. One group at highest risk of HPV-related cancers is a hard to reach, underserved, and marginalized population – indigent women who use sex for drug money. Illicit drug users are characteristically at high risk for acquiring HPV due to risky sexual behaviors and a greater likelihood of exposure to social networks with high prevalence of sexually transmitted infections. International studies suggest these populations may have a different HPV profile. In one of the largest studies of female sex workers, cervical lesions were commonly negative for HPV 16/18, suggesting a role for other high risk HPV (hr-HPV) types or multiple co-infections. Yet there is little known about the HPV profile of street sex workers in the United States. Building on a non-traditional partnership with law enforcement and over 36 community organizations (the Dallas Prostitute Diversion Initiative, Texas), we are providing cancer prevention screening services with HPV co-testing targeting those women diverted to substance abuse treatment centers. We report here on the prevalence of HPV serotypes across cervical and anal sites and across age groups that could inform future HPV vaccination efforts in this vulnerable population.

Methods: We partnered with AIDS Arms Clinic to create a point of access for cancer screenings among women in substance abuse treatment at Nexus Recovery, the largest female-only substance abuse recovery center in North Texas. Screenings provided include cervical and anal PAP screens with HPV co-testing (16, 18, or other hr-HPV). Other high risk types included 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, or 68 and were reported in aggregate. Also included were screenings for breast, hepatitis, and HIV/sexually transmitted infections. A follow-up clinic visit was provided 7 days from the initial screen as a second opportunity to educate, explain screen findings, and navigate positives to diagnostic care. This prevention services project is ongoing through August 2016 with the goal to screen 1220 women.

Results: A total of 538 women were screened for cervical and anal HPV. The average age was 33 years, 33% were non-white, and over 80% were smokers without health insurance. One-quarter reported 50+ lifetime sex partners. Twenty-nine percent were cervical hr-HPV positive, with 87% classified as other hr-HPV serotype and 13% as HPV 16/18+. Similarly, 32% of women were positive for anal hr-HPV, with the majority being other hr-HPV (88.4%). Unexpected was the bimodal age distribution of HPV prevalence, peaking at 22 years and 48 years.

Conclusion: The HPV serotypes observed in this study provide baseline HPV prevalence rates for monitoring future HPV vaccination efforts in this and similar underserved populations. This is significant since one of the fastest growing segments of the criminal population are women offenders serving time on probation for low level offenses related to drug activity and prostitution. HPV vaccination programs in this target population may need to be broadened to include mid-adult women and other serotypes in addition to HPV 16/18.

Citation Format: Martha J. Felini, Oluwatosin Igenoza, Saritha Bangara, Kelechi Ukpaka, Opeyemi Jegede, Shuchika Gupta, Gene W. Voskuhl, Timothy Kremer, Ralph Anderson, Raquel Qualls-Hampton. Cervical and anal HPV serotype-specific prevalence among high-risk indigent women in substance abuse recovery. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B69.

Abstract A27: Risk of hematopoietic cancer associated mortality among workers in the poultry slaughtering and processing industries

Objectives: Previous occupational cohort studies among poultry workers have revealed an excess risk of cancer-related mortality, including deaths due to hematopoietic malignancies. However, specific occupational and non-occupational exposures contributing to this excess risk have yet to be identified. Poultry workers are particularly at high risk since an average of 175,000 chickens are killed daily in poultry plants in the United States. This brings poultry workers into intimate contact with their blood, organs, and secretions, which may harbor transmissible oncogenic viruses. Moreover, they are exposed to potentially carcinogenic chemicals that are emitted during packaging and preparation. Hence, our study was conducted to provide preliminary evidence of which specific poultry related and non-poultry related occupational tasks increase the risk of mortality from hematopoietic cancer among poultry workers.

Methods: A pilot case-cohort study was conducted using a combined cohort of 30,411 highly exposed poultry workers and 16,408 control subjects. Exposures pertaining to poultry and non-poultry related tasks were self-reported through telephone interviews from controls and next-of-kin for cases. Hematopoietic cancer mortality risk was assessed using logistic regression odds ratios (OR) and proportional hazard ratios (HR).

Results: One hundred fifty-two cases of hematopoietic cancer occurred in this cohort between January 1, 1990 and December 31, 2003. Since this is a feasibility study, exhaustive attempts were not made to identify study subjects and their next of kin. Thus, we report here on the first 52 (69%) of the 75 cases whose next-of-kin were traced. Similarly, of the first 214 controls that were traced, 152 (71%) completed interviews. Preliminary analysis is currently underway to identify the specific task exposures contributing to this excess risk.

Conclusion: We expect the results of our study will confirm known risk factors related to hematopoietic cancers, and uncover new risk exposures that have yet to be appreciated in the general population due to their low level exposures. Using high-risk unique populations offers an opportunity to better understand molecular mechanisms that investigators may explore to aid in future drug development.

Citation Format: Saritha Bangara, Martha J. Felini, Subhash Aryal, David Sterling, Eric S. Johnson. Risk of hematopoietic cancer associated mortality among workers in the poultry slaughtering and processing industries. [abstract]. In: Proceedings of the AACR Special Conference on Hematologic Malignancies: Translating Discoveries to Novel Therapies; Sep 20-23, 2014; Philadelphia, PA. Philadelphia (PA): AACR; Clin Cancer Res 2015;21(17 Suppl):Abstract nr A27.

Update of cancer and non-cancer mortality in the Missouri poultry cohort

BACKGROUND

workers in poultry slaughtering and processing plants have one of the highest human exposures to transmissible agents that cause cancer and other diseases in chickens and turkeys, and also have other occupational carcinogenic exposures. The general population is also exposed to these transmissible agents.

METHODS

we investigated mortality in workers who belong to a poultry union in Missouri, and estimated standardized mortality ratios.

RESULTS

significantly increased mortality was observed for some leukemias, benign neoplasms, thyroid diseases, bacterial infections, and schizophrenic disorders. The risk of breast cancer and several non-cancer conditions was significantly depressed.

CONCLUSION

the findings add to the growing evidence suggesting that workers occupationally exposed to transmissible agents and carcinogens in the poultry industry, are at increased risk of dying from certain chronic diseases, including cancer.