Mariela Torres-Cintrón

Penile Cancer Disparities in Puerto Rican Men as compared to the United States Population

PURPOSE This study compares incidence and mortality of penile cancer in Puerto Rico (PR) with other racial/ethnic groups in the United States (US) and evaluates the extent in which socioeconomic position index (SEP) or its components influence incidence and mortality in PR. MATERIALS AND METHODS Age-standardized rates were calculated for incidence and mortality based on data from the PR Cancer Registry and the US National Cancer Institutes Surveillance, Epidemiology and End Results program, using the direct method. RESULTS PR men had approximately 3-fold higher incidence of penile cancer as compared to non-Hispanic white (Standardized rate ratio [SRR]: 3.33; 95%CI=2.80-3.95). A higher incidence of penile cancer was also reported in PR men as compared to non-Hispanic blacks and Hispanics men. Mortality from penile cancer was also higher for PR men as compared to all other ethnic/racial groups. PR men in the lowest SEP index had 70% higher incidence of penile cancer as compared with those PR men in the highest SEP index. However, the association was marginally significant (SRR: 1.70; 95%CI=0.97, 2.87). Only low educational attainment was statistically associated with higher penile cancer incidence (SRR: 2.18; 95%CI=1.42-3.29). CONCLUSIONS Although penile cancer is relatively uncommon, our results support significant disparities in the incidence and mortality rates among men in PR. Low educational attainment might influence the high incidence of penile cancer among PR men. Further studies are strongly recommended to explore these disparities.

Abstract 1838: Survival and gender disparities in Puerto Rican Hispanics with colorectal cancer: A five-year analysis

Proceedings: AACR 102nd Annual Meeting 2011‐‐ Apr 2‐6, 2011; Orlando, FL BACKGROUND: In Puerto Rico (PR), colorectal cancer (CRC) represents the second most common cause of cancer in men and women. Incidence and mortality of CRC are increasing in Puerto Rican Hispanics. Screening rates for CRC are lower in US and PR-Hispanics, which may result in advanced disease at diagnosis and poor outcomes. There is very limited data on survivorship among PR-Hispanic CRC patients. Hence, we examined the 5-year overall and stage-specific CRC survival for Puerto Rican Hispanics. METHODS: All malignant CRC cases were obtained from the PR Central Cancer Registry (PRCCR), a population based cancer registry. CRC cases diagnosed from the years 2001 to 2003 were selected for the survival analysis. One-, three- and five-year relative survival were calculated using the incidence case file database of PR and estimated using the Kaplan Meier method. Relative survival, defined as observed survival in the cohort divided by expected survival in the cohort, adjusted for the expected mortality from other causes of death were calculated. The 5-year survival functions were compared among demographics variables (sex, age group and stage at diagnosis) via Z-tests. CRC reported without stage and a sample of staged cases were examined and reviewed manually to ensure accuracy in the staging variable. Analyses were performed using SEER Stat 6.6.2. RESULTS: Overall CRC incidence and mortality rates were 38.9 and 15.3 per 100,000 population, respectively. A total of 3,251 individuals diagnosed with CRC during the 2001-2003 periods with complete survival data were evaluated. At diagnosis CRC was staged as localized (30.1%), regional (46.2%), and distant (11.9%). Overall CRC relative survival decreased within the 5-year observational period, with rates of 76.6%, 53.5%, and 36.6% for 1-, 3-, and 5-years, respectively. The 5-year relative survival was statistically significant better for women (40.4%) than for men (30.3%) (p=0.0023). Five-year stage-specific relative survival for localized, regional and distant CRC was 58.5%, 35.9% and 8.1%, respectively. This trend was observed for both genders, although men with localized (54.3% vs. 63.1%) and regional (33.7% vs. 38.2%) CRC had poorer 5-year survivorship compared to women. CONCLUSIONS: Our study demonstrated low overall and stage-specific CRC 5-year relative survival for PR Hispanics, compared to previously reported data for US-Hispanics, non-Hispanics Whites and non-Hispanic Blacks. PR Hispanics with localized/regional CRC had lower 5-year relative survival rates than that observed in other racial and ethnic groups. Men with CRC had worse 5-year overall and stage-specific relative survival compared to women. The observed survival and gender disparities in PR Hispanics with CRC warrant further studies evaluating the interplay of molecular, behavioral and/or environmental risk factors affecting this minority population. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 1838. doi:10.1158/1538-7445.AM2011-1838

Abstract 3767: Familial colorectal cancer registry in Hispanics: A feasibility study

Proceedings: AACR 102nd Annual Meeting 2011‐‐ Apr 2‐6, 2011; Orlando, FL BACKGROUND: In Puerto Rico (PR), colorectal cancer (CRC) represents the second most common cause of cancer in men and women. Incidence and mortality of CRC are increasing in Puerto Rican Hispanics, especially among young individuals. Screening rates for CRC are lower in Hispanic-American individuals compared to non-Hispanic patients. However, there is limited data on genetic epidemiological CRC disparities in Hispanic patients. OBJECTIVES: (1) To prospectively identify and recruit 30 probands with a family history of CRC and 15 family-history negative (2) To prospectively identify and recruit selected relatives from the 45 probands. METHODS: Eligible cases are Hispanic patients with incident diagnosis of CRC, ≥ 21 years old. We identified the probands and their selected family members using the Puerto Rico Central Cancer Registry from July 1, 2007 to the present. PRELIMINARY DATA AND RECRUITMENT: Seven hundred and fifty-one communications were sent to the physicians, three hundred and seventy-four communications were responded (374/751=49.8%).Three hundred and forty-one communications were sent to the patients, one hundred and forty-seven letters were responded (147/341=43.1%) and 16 refused. One hundred and fifty-nine participants (probands and relatives) were enrolled. One hundred and two probands (mean age 56.9 ±13.3 yrs., 54.9% male); 30 with and 72 without family history of CRC. At present, we collected 153 (96.2%) risk factors questionnaires, 135 (84.9%) blood samples and 60 (52.6%) blocks of tissue. CONCLUSIONS: Successful implementation of logistics for identification of incident CRC through the PR Central Cancer Registry during a three-year period. We established the first Familial CRC island-wide registry in Puerto Rico through the implementation of a network of community physicians, laboratories and professional societies. We are developing a tissue and blood bank with epidemiological, nutritional, and demographic data that will assist us to understand the genetic epidemiology of CRC in Puerto Ricans. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 3767. doi:10.1158/1538-7445.AM2011-3767

Abstract A68: Familial colorectal cancer registry in Hispanics: A feasibility study

Background: In Puerto Rico (PR), colorectal cancer (CRC) represents the second most common cause of cancer in men and women. Incidence and mortality of CRC are increasing in Puerto Rican Hispanics, especially among young individuals. Screening rates for CRC are lower in Hispanic-American individuals compared to non-Hispanic patients. However, there is limited data on genetic epidemiological CRC disparities in Hispanic patients. Objectives: (1) To prospectively identify and recruit 30 probands with a family history of CRC and 15 family-history negative. (2) To prospectively identify and recruit selected relatives from the 45 probands. Methods: Eligible cases are Hispanic patients with incident diagnosis of CRC, ≥ 21 years old. We identified the probands and their selected family members using the Puerto Rico Central Cancer Registry from July 1, 2007 to the present. Preliminary data and recruitment: Seven hundred and fifty-one communications were sent to the physicians, three hundred and seventy-four communications were responded (374/751=49.8%). Three hundred and forty-one communications were sent to the patients, one hundred and forty-seven letters were responded (147/341=43.1%) and 16 refused. One hundred and fifty-nine participants (probands and relatives) were enrolled. One-hundred and two probands (mean age 56.9 ± 13.3 yrs., 54.9% male); 30 with and 72 without family history of CRC. At present, we collected 153 (96.2%) risk factors questionnaires, 135 (84.9%) blood samples and 60 (52.6%) blocks of tissue. Successful implementation of logistics for identification of incident CRC through the PR Central Cancer Registry during a three-year period. We established the first Familial CRC island-wide registry in Puerto Rico through the implementation of a network of community physicians, laboratories and professional societies. We are developing a tissue and blood bank with epidemiological, nutritional, and demographic data that will assist us to understand the genetic epidemiology of CRC in Puerto Ricans. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A68.

Abstract A83: Survival in Puerto Rican Hispanics, non-Hispanic whites, non-Hispanic blacks, and U.S. Hispanics with colorectal cancer: A five-year analysis

Background: In Puerto Rico (PR), colorectal cancer (CRC) represents the second most common cause of cancer in men and women. Incidence and mortality of CRC are increasing in Puerto Rican Hispanics (PRH). Screening rates for CRC are lower in US and PR-Hispanics, which may result in advanced disease at diagnosis and poor outcomes. There is very limited data on survivorship among PR-Hispanic CRC patients. Hence, we compared the stage-specific five-year survival of Puerto Rican CRC patients with the stage-specific five-year survival of non-Hispanic Whites (NHW), non-Hispanic Blacks (NHB) and US Hispanics (USH) from mainland USA using SEER data during the 2001–2003 time period. Methods: All malignant CRC cases were obtained from the PR Central Cancer Registry (PRCCR), an island-wide population based cancer registry and the Surveillance, Epidemiology and End Results (SEER) Program, a multi-center cancer registry covering approximately 26 percent of the United States (US) population. CRC cases diagnosed from the years 2001 to 2003 were selected for the survival analysis. One-, three- and five-year relative survival were calculated using the incidence case file database of the PRCCR and the SEER and estimated using the Kaplan Meier method. Relative survival, defined as observed survival in the cohort divided by expected survival in the cohort, adjusted for the expected mortality from other causes of death were calculated. The 5-year survival functions were compared among demographics variables (sex, age group, racial/ethnic group and stage at diagnosis) via Z-tests. CRC reported in PR without stage and a sample of staged cases were examined and reviewed manually to ensure accuracy in the staging variable. Analyses were performed using SEER Stat 6.6.2. Results: Overall CRC incidence and mortality rates in PRH were 40.2 and 16.6; in NHW were 53.1 and 19.4; in NHB were 64.0 and 27.5; in USH were 39.4 and 13.8 per 100,000 population, respectively. A total of 3,359 PRH, 59,686 NHW, 7,700 NHB and 5,699 USH diagnosed with CRC during the 2001–2003 periods with complete survival data were evaluated. Overall CRC relative survival in PRH decreased within the 5-year observational period, with rates of 80.4%, 67.9%, and 62.9% for 1-, 3-, and 5-years, respectively. Overall CRC relative survival in NHW was 82.1%, 71.1% and 66.1%; in NHB was 75.7%, 61.0%, and 54.8% and in USH was 81.2%, 68.3%, and 62.1% each of them for 1-, 3-, and 5-years, respectively. Five-year stage-specific relative survival for localized, regional and distant CRC in PRH was 85.0%, 59.3% and 16.7%; in NHW was 91.4%, 69.4% and 10.1%; in NHB was 83.0%, 61.4% and 7.2% and in USH was 90.0%, 65.1% and 12.0%, respectively. Conclusions: Our study demonstrated low overall and stage-specific CRC 5-year relative survival for PR Hispanics, compared to previously reported data for US-Hispanics and non-Hispanic Whites. PR Hispanics with localized/regional CRC had lower 5-year relative survival rates than that observed in non-Hispanic Whites and US-Hispanics. The observed survival disparities in PR Hispanics with CRC warrant further studies evaluating the interplay of molecular, behavioral and/or environmental risk factors affecting this minority population. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A83.