Nayda R. Figueroa-Vallés

Incidence and mortality rates for colorectal cancer in Puerto Rico and among Hispanics, Non-Hispanic Whites, and Non-Hispanic Blacks in the United States, 1998–2002

Colorectal cancer (CRC) is the second most commonly diagnosed cancer in Puerto Rico (PR). In the United States, the incidence and mortality rates of CRC have great variation by sex and race/ethnicity. Age‐standardized incidence and mortality rates of CRC in PR were assessed and compared with the rates among US Hispanics (USH), non‐Hispanic whites (NHW), and non‐Hispanic blacks (NHB) in the United States for the period from 1998 through 2002. Incidence and mortality trends and relative differences among racial/ethnic groups by sex and age were determined.

Cancer disparities between mainland and island Puerto Ricans

OBJECTIVES Examination of cancer rates in a single Hispanic subgroup-Puerto Ricans- and comparison of incidence rates among mainland Puerto Ricans living in the United States, island Puerto Ricans in Puerto Rico, and U.S. non-Hispanic whites to reveal ethnic-specific cancer patterns and disparities in Puerto Ricans. METHODS Incidence data were obtained from the cancer registries of Puerto Rico and three U.S. northeastern states (New York, New Jersey, and Connecticut) with a high density of mainland Puerto Ricans. Age-adjusted rates were compared by standardized rate ratios (SRRs). RESULTS Total cancer incidence was the lowest in island Puerto Ricans, intermediate for mainland Puerto Ricans, and highest in U.S. non-Hispanic whites. Compared to mainland Puerto Ricans, islanders had significantly lower rates (p<0.05) for major cancers-lung (SRRs=0.36 in males and 0.29 in females), prostate (SRR=0.71), female breast (SRR=0.73), and colon-rectum (SRRs=0.74 in males and 0.65 in females)-as well as several less common cancers (urinary bladder; non-Hodgkin lymphoma; liver; kidney and renal pelvis; pancreas; thyroid; leukemia; and skin melanoma). Overall cancer rates in mainland Puerto Ricans were modestly lower than those in U.S. non-Hispanic whites, but mainland Puerto Ricans had the highest rates for stomach, liver, and cervical cancers among the three populations. CONCLUSION Despite socioeconomic disadvantages, island Puerto Ricans have relatively low cancer incidence. Identifying contributing factors would be informative for cancer research, and understanding the reasons for increased cancer risk in their mainland counterparts would facilitate the development of ethnic-specific intervention programs.

Multidrug chemotherapy (vincristine-bleomycin-methotrexate) followed by radiotherapy in inoperable carcinomas of the head and neck: Preliminary report of a pilot study of the radiation therapy oncology group

Abstract This is a preliminary report on the Radiation Therapy Oncology Group (RTOG) pilot study 77-08, of a combination of chemotherapy with vincristine-bleomycin-methotrexate, followed by radiotherapy, for inoperable carcinomas of the bead and neck. The main objectives of the study were to determine toxicity and tumor control. Patients who were included bad untreated carcinomas, with no distant metastases, and with adequate pulmonary, renal, and liver function. Forty patients were registered for the study. Chemotherapy started with vincristine—1.5 mgs/m 2 (maximum of 2 mgs) by I,V. injection, Wowed by bleomycin drip for 48 hours (15 units/day), and then methotrexate (200 mgs/m 2 divided in equal doses 6 hours apart) with folinic acid rescue. Eleven patients received one course of the stated chemotherapy; 28 were given two courses with one week rest period between them. Radical curative radiotherapy was started usually two weeks after chemotherapy. A surgical procedure was considered if the patient was found operable after receiving a dose of 5000 rad with continuous therapy or at 3000 rad with split-course therapy. The level of toxicity that resulted from this combined therapy was considered acceptable. The percentage of complete response of the primary tumor was 6% with chemotherapy; this increased to 46% after irradiation, and to 65% when surgery was added.

Incidence and mortality rates of selected infection-related cancers in Puerto Rico and in the United States.

BackgroundIn 2002, 17.8% of the global cancer burden was attributable to infections. This study assessed the age-standardized incidence and mortality rates of stomach, liver, and cervical cancer in Puerto Rico (PR) for the period 1992-2003 and compared them to those of Hispanics (USH), non-Hispanic Whites (NHW), and non-Hispanic Blacks (NHB) in the United States (US).MethodsAge-standardized rates [ASR(World)] were calculated based on cancer incidence and mortality data from the PR Cancer Central Registry and SEER, using the direct method and the world population as the standard. Annual percent changes (APC) were calculated using the Poisson regression model from 1992-2003.ResultsThe incidence and mortality rates from stomach, liver and cervical cancer were lower in NHW than PR; with the exception of mortality from cervical cancer which was similar in both populations. Meanwhile, the incidence rates of stomach, liver and cervical cancers were similar between NHB and PR; except for NHB women who had a lower incidence rate of liver cancer than women in PR. NHB had a lower mortality from liver cancer than persons in PR, and similar mortality from stomach cancer.ConclusionsThe burden of liver, stomach, and cervical cancer in PR compares to that of USH and NHB and continues to be a public health priority. Public health efforts are necessary to further decrease the burden of cancers associated to infections in these groups, the largest minority population groups in the US. Future studies need to identify factors that may prevent infections with cancer-related agents in these populations. Strategies to increase the use of preventive strategies, such as vaccination and screening, among minority populations should also be developed.

Disparities in breast cancer in Puerto Rico and among Hispanics, non-Hispanic whites, and non-Hispanics blacks in the United States, 1992-2004.

To the Editor: Breast cancer (BC) is the most common cancer type and the most common cause of cancer death among women in Puerto Rico (PR) (1). Historical studies suggest a lower incidence of BC in PR as compared to the United States (US) (2,3); however, limited data exists regarding the current burden of this malignancy in PR and how it compares with other racial ⁄ ethnic groups. This study assessed the age-standardized incidence and mortality rates of BC in PR and compared them to those of Hispanics (USH), Non-Hispanic whites (NHW), and Non-Hispanic blacks (NHB) in the US for the period 1992–2004. Incident and death cases of invasive BC (ICD-O-3: C50.0–C50.9) were obtained from the PR Central Cancer Registry (PRCCR) (4,5) and the Surveillance, Epidemiology and End Results Program (SEER) (6,7), respectively. Annual age-standardized [ASR(world)] incidence and mortality rates (per 100,000) were calculated for each racial ⁄ ethnic group using the direct method (world population). The annual percent change (APC) of the ASR(World) was estimated using the Joinpoint Regression Program from SEER. To assess differences in BC incidence and mortality rates between PR as compared to other racial ⁄ ethnic groups, the ASR(World) were grouped from 2000 to 2004. Then, the standardized rate ratio (SRR) was estimated with its 95% confidence interval. Although the BC incidence ASR(World) in PR was lower than in other racial ⁄ ethnic groups in the US, the incidence of BC increased during the study period in PR (APC = 1.41%, p < 0.05), whereas it remained stable for USH (APC = 0.08%), NHW ()0.18%), and NHB ()0.40%) (p > 0.05) (Fig. 1). Compared to women in PR, USH, NHW, and NHB women had a 14%, 88%, and 57% higher risk of BC, respectively (Table 1). Meanwhile, women in PR had similar BC mortality ASR(World) than USH women (p > 0.05); whereas, NHW and NHB women had a 56% and a 98% higher risk of dying from BC than women in PR, respectively. In addition to these differences, a decreasing trend in BC mortality was observed in all US racial ⁄ ethnic groups (Fig. 1), while trends for PR remained stable (p > 0.05). The lower burden of BC in PR than in the continental US population is consistent with previous studies (2,3). Nonetheless, the similar age-adjusted mortality rates of BC among USH and PR suggests a potential health disparity between these groups, as the incidence of the disease was in fact lower in PR. It could be hypothesized that this disparity may be the result of differences in access to treatment between these groups. However, further research is warranted. No study has assessed the reasons for the increasing trend of BC incidence in PR, although our data is consistent with trends observed since the 1950s (1,3). The stabilization of the incidence trends in all racial ⁄ ethnic groups in the US is also consistent with previous reports, although their reasons are not yet well understood (8,9). Even though an increase in BC mortality in PR was reported from 1950 to 1990 (3), it seems to have stabilized since then. This is supported by previous reports of the PRCCR (1). Meanwhile, although in the US (8) it is hypothesized that the decline in BC mortality is due to improvements in access to early detection and treatment services, this decline is not yet observed in PR. Overall, the observed incidence and mortality trends from BC in PR might also be explained by factors such as acculturation, changes in lifestyle, screening practices, genetic factors, and access to care. As previously described for Puerto Ricans and Hispanics (3,10,11), these populations have acquired western habits that mirror those of industrialized nations, Address correspondence and reprints request to: Ana P. Ortiz, PhD, MPH, Department of Biostatistics and Epidemiology, Graduate School of Public Health & University of Puerto Rico Comprehensive Cancer Center, UPR, or e-mail: ana.ortiz7@upr.edu. Financial support: Grants U54CA96297, G12RR03051, 5P20RR011126, and U58DP000782-01.

Endometrial cancer in Puerto Rico: incidence, mortality and survival (1992-2003)

BackgroundEndometrial cancer is the most common gynecologic malignancy in Puerto Rico and the United States (US).MethodsWe compare the age-specific and age-adjusted incidence and mortality rates and the survival of endometrial cancer in Puerto Rico with that of non-Hispanic whites (NHW), non-Hispanic blacks (NHB) and Hispanics in the US. Data from the Puerto Rico Central Cancer Registry and the Surveillance, Epidemiology, and End Results program were analyzed from 1992-2003.ResultsAge-standardized incidence rates of endometrial cancer increased significantly (p < 0.05) in Puerto Rico (APC = 2.8%) and among NHB (APC = 1.9%) and remained constant (p > 0.05) for NHW (APC = -0.1%) and Hispanics in the US (APC = 0.4%). Mortality trends remained constant in all racial/ethnic groups (p > 0.05). For 1999-2003, women in Puerto Rico had similar incidence of endometrial cancer as Hispanics (Standardized rate ratio [SRR] = 0.94, 95% CI = 0.87-1.01), although their risk was lower than that of NHW (SRR = 0.56, 95% CI = 0.53-0.59) and NHB (SRR = 0.91, 95% CI = 0.84-0.98). Meanwhile, women in Puerto Rico had 15% higher risk of death than Hispanic women (SRR = 1.15, 95% CI = 1.03-1.30) similar risk than NHW (SRR = 0.93, 95% CI = 0.83-1.03), and lower risk than NHB (SRR = 0.51, 95% CI = 0.46-0.57). Puerto Rico (63.1%) and NHB (56.8%) had a lower 5-year survival than NHW (78.4%) and Hispanics (79.5%). An age-adjusted Cox proportional hazards model showed that compared with women in Puerto Rico, Hispanic women in the United States had 37% lower mortality risk (HR = 0.63, 95% CI = 0.56-0.71) and NHW had 53% lower mortality risk (HR = 0.47, 95% CI = 0.43-0.52) after 5 years of diagnosis; NHB women had 22% higher mortality risk than women in Puerto Rico (HR = 1.22, 95% CI = 1.09-1.36).ConclusionsThe lower burden of endometrial cancer in Puerto Rico suggests the presence of protective factors or lower exposure to risk factors in this population, although increases in incidence suggest changes in the occurrence of lifestyles and environmental risk factors. Meanwhile, the lower five-year survival from endometrial cancer among Puerto Ricans suggests a health disparity for this group in areas such as quality of care and/or differences in terms of stage at diagnosis and associated comorbidities. Assessment of disease risk factors and characteristics, and access and response to treatment is required to further understand these results.

Multidrug chemotherapy (vincristine-bleomycin-methotrexate) followed by radiotherapy in inoperable carcinomas of the head and neck A pilot study of the Radiation Therapy Oncology Group

This IS A REPORT on the Radiation Therapy Oncology Group (RTOG) Pilot Study 77–08, of a combination of chemotherapy with vineristine-bleomycin-methotrexate, followed by curative radiotherapy for inoperable carcinomas of the head and neck. The main objectives of the study were to determine toxicity, tumor control, and survival. Included were patients with untreated advanced carcinomas, with no distant metastasis. Chemotherapy started with vincris-tine–1.5 mg/m2 (maximum of 2 mg) by I. V. injection, followed by bleomycin drip of 48 hours (15 units per day), and then methotrexate (200 mgs/m2 divided in equal doses 6 hours apart) with folinic acid rescue. Forty patients were registered for the study. Eleven of these received 1 course of the stated chemotherapy, and 28 were given 2 courses, with a 1-week rest period between them. Radical curative radiotherapy was usually started 2 weeks after chemotherapy. Salvage surgery was considered for persistent or recurrent tumor in the primary area, neck, or both. The level of toxicity that resulted from this combined therapy was considered acceptable. The percentage of complete response in the primary tumor was 6% with chemotherapy; 46% after irradiation; and 65% when surgery was added. The complete response (C.R.) in the primary tumor ranged from 54% for T-4 to 100% for T-2. By 3 years, 50% of T-2, 20% of T-3, and 13% of T-4 remained under control. The control of T and N with this therapeutic regime was–41% initially, 24% at one year, 19% at two years, and 16% at three years. The survival at one, two and three years after beginning radiotherapy was 54%, 30%, and 16%, respectively. This is considered a very satisfactory result for these very advanced inoperable patients.

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.