Screening History and Survival Among Women With Cervical Cancer in Puerto Rico.

OBJECTIVES: Cervical cancer incidence is rising in Puerto Rico (PR). Screening for cervical cancer could prevent the occurrence of the disease or lead to its early detection, translating to survival benefits. In this study, we evaluated the association of cervical cancer screening status with tumor diagnosis and survival among Hispanic women living in PR. METHODS: We analyzed data for 506 incident cases of primary cervical cancer diagnosed from the period 2011-2014, identified through the PR Central Cancer Registry. We ascertained screening status 3 years before cervical cancer diagnosis using data from the period 2008-2014 from the PR Central Cancer Registry-Health Insurance Linkage Database. Patients were followed until 2019. Our outcomes of interest were stage at diagnosis and survival. RESULTS: Most women (78.86%) were covered by public insurance (Medicare and/or Medicaid), and 69.57% underwent screening 3 years before their diagnosis. The proportion of cases diagnosed with localized stage was significantly greater among the screened group compared with those unscreened (43.5% vs 33.1%, p < .0001). Multivariate analysis showed that women insured through Medicaid were less likely to have been screened when compared with women with private insurance (odds ratio = 0.29; 95% CI = 0.16-0.52). Five-year survival was significantly greater among screened (72%) than unscreened (54%) women (p log-rank < 0.05). The multivariate Cox proportional hazards model showed that women who received screening had a 39% (hazard ratio [HR] = 0.61; 95% CI = 0.43-0.87) lower risk of death compared with unscreened women. CONCLUSION: Our findings exemplify survival benefits among women who underwent cervical cancer screening in PR. Interventions to improve screening uptake and adherence are a public health priority.

Assessment of Anal Cancer Screening Tools in Detecting High-Grade Anal Squamous Intraepithelial Lesions in Women.

OBJECTIVE: The aim of the study was to evaluate the validity of anal cytology against high-resolution anoscopy in the detection of anal high-grade squamous intraepithelial lesions (HSILs) among women in a clinical setting in Puerto Rico, alone and in combination with high-risk human papillomavirus (HR-HPV) typing. MATERIALS AND METHODS: A cross-sectional study was done among 128 eligible women who attended the Anal Neoplasia Clinic of the University of Puerto Rico Comprehensive Center between 2014 and 2019. Kappa (κ) coefficient, sensitivity, specificity, positive predictive value, and negative predictive value were calculated using high-resolution anoscopy with biopsy as the criterion standard test. Poisson regression was used to estimate the adjusted prevalence ratio of anal HR-HPV infection. RESULTS: Overall, 71.1% of women were HIV infected and 78.9% had anal HR-HPV infection. Squamous intraepithelial lesions were detected with anal cytology and histology in 70.3% and 81.3% of women, respectively. The κ statistic between the tests (cytology and histology) was 0.32 (p < .05). Measured against the results from histology, the sensitivity of anal cytology alone to detect HSIL was 85.4% (95% CI = 72.2%-93.9%), whereas specificity was 38.8% (95% CI = 28.1%-50.3%). Although the sensitivity of the 2 tests combined (anal cytology and HR-HPV typing) to detect histologically confirmed HSIL increased (100.0%, 95% CI = 92.6%-100.0%), the specificity decreased (16.3%, 95% CI = 9.0%-26.2%). Meanwhile, women with HSIL had a higher prevalence of anal HR-HPV infection than those with no SIL/LSIL (prevalence ratio = 6.23, 95% CI = 1.50-25.83). CONCLUSIONS: Anal cytology in combination with HR-HPV typing for the screening of anal intraepithelial neoplasia improved the detection of HSIL in women.

Cancer Statistics for Hispanics/Latinos, 2018.

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.

The association between fruit and vegetable intake, knowledge of the recommendations, and health information seeking within adults in the U.S. mainland and in Puerto Rico.

Health information correlates of fruit and vegetable intake and of knowledge of the fruit and vegetable recommendations were examined using bivariate and multivariate regressions with data from the 2007-2008 U.S. National Cancer Institute's Health Information National Trends Survey in the United States and in Puerto Rico. Residents from Puerto Rico had the lowest reported fruit and vegetable intake and the lowest knowledge of the recommended servings of fruits and vegetables to maintain good health, compared with U.S. Hispanics, non-Hispanic Whites, and Blacks. Sixty-seven percent of Puerto Rican residents and 62% of U.S. Hispanics reported never seeking information on health or medical topics. In multivariate analysis, those who never sought information on health or medical topics reported significantly lower fruit and vegetable intake (coefficient = -0.24; 95% CI [-0.38, -0.09]), and were less likely to know the fruit and vegetable recommendations (OR = 0.32; 95% CI [0.20, 0.52]), compared with those who obtained information from their health care providers. Health promotion initiatives in the United States and Puerto Rico have invested in mass media campaigns to increase consumption of and knowledge about fruit and vegetables, but populations with the lowest intake are less likely to seek information. Strategies must be multipronged to address institutional, economic, and behavioral constraints of populations who do not seek out health information from any sources.

Factors associated with perceived patient-provider communication quality among Puerto Ricans.

Patient-provider communication is an important factor influencing patients' health outcomes. This study examined the relationship between patient-provider communication quality and sociodemographic, health care access, trusted information sources, and health status variables. Data were from a representative sample of 450 Puerto Rican adults who participated in the Health Information National Trends Survey. A composite score rating perceived patient-provider communication quality was created from five items (Cronbach's alpha = 0.87). A multivariate linear regression analysis was conducted. Patient-provider communication ratings were lower among the unemployed (p = 0.049), those who do not trust a lot in the information provided by their providers (p = 0.003), and respondents with higher depressive symptoms scores (p = 0.036). Perceived patient-provider communication quality, however, was higher among respondents who visited their providers five or more times in the last year (p = 0.023). Understanding patient perceptions of provider communication may serve to develop system-level interventions aimed at eliminating communication disparities and improving patients' health outcomes.

Using a socioeconomic position index to assess disparities in cancer incidence and mortality, Puerto Rico, 1995-2004.

INTRODUCTION: Evaluation of the extent of socioeconomic inequalities in cancer incidence and mortality is essential to generate hypotheses in population health research and provides evidence for population-based strategies for comprehensive cancer control. The objective of this study was to create an area-based socioeconomic position (SEP) index to assess possible socioeconomic disparities in incidence and mortality of selected cancers in Puerto Rico. METHODS: Data for cancer incidence and mortality from 1995 to 2004 were obtained from the Puerto Rico Central Cancer Registry and the Puerto Rico Department of Health, and Puerto Rico socioeconomic data were obtained from the US Census 2000. We used principal component and factor analysis methods to construct the SEP index at the municipality level. We calculated age-adjusted incidence and mortality for each SEP area and used rate ratios to evaluate the differences by SEP. RESULTS: Incidence and mortality of cancer in Puerto Rico varied by SEP area. In general, the incidence and mortality for cancers of the esophagus and stomach were higher for municipalities with the lowest SEP; in contrast, rates for breast, colorectal, kidney, pancreas, prostate, and thyroid were higher for areas with the highest SEP. CONCLUSION: These results highlight cancer disparities in Puerto Rico by SEP level that warrant further research.

Knowledge of viral hepatitis among Puerto Rican adults: implications for prevention.

Although primary prevention of HAV and HBV can be achieved through vaccination, the burden of HCV can only be reduced through behavioral interventions to reduce its risk factors. This study evaluated knowledge regarding transmission, clinical manifestations and prevention of viral hepatitis in Puerto Rico. We assessed the level of knowledge about HAV (six questions), HBV (12 questions) and HCV (eight questions) among non-institutionalized Puerto Rican adults aged 21-64 years. Demographic characteristics and self-reported knowledge of these infections were determined through a face-to-face interview. A mean knowledge score was computed by summing correct responses to each scale. Mean knowledge scores according to demographics were compared using ANOVA or the Kruskal-Wallis test. Mean knowledge scores for HAV, HBV and HCV infections were 2.6 ± 1.5, 6.1 ± 2.4, and 3.6 ± 1.1, respectively. For HAV and HBV infections, the mean knowledge score significantly (P < 0.05) increased with age, level of counseling received and number of sources of information. However, for HCV infection the mean knowledge score significantly increased with decreasing age, increased educational level and increased annual family income. Contrary to HBV, a higher HAV and HCV knowledge score was observed among individuals with history of vaccination for HAV and HBV, seropositive status for HAV and HCV, and history of drug use. A sizeable proportion of adults in this study demonstrated an inadequate level of knowledge, especially about transmission routes. Health education must be focused on transmission and prevention methods, including the availability of a vaccine for HAV and HBV, especially among those with chronic liver disease.

Burden of human papillomavirus infection and related comorbidities in men: implications for research, disease prevention and health promotion among Hispanic men.

Genital human papillomavirus (HPV) infection is one of the most commonly diagnosed sexually transmitted infections world-wide. Over the last two decades, research has established a strong causal link between specific types of HPV infection and cancer, particularly cervical, anal, vulvar/vaginal, penile, and oropharyngeal cancer. Limited epidemiological studies of anogenital HPV infection have been conducted in Hispanic populations (including Puerto Rico), and population-based incidence and prevalence estimates of HPV infection among Hispanics are limited. Studies that evaluate knowledge and awareness of HPV among men are also scarce. With the world-wide introduction of two new prophylactic vaccines against high-risk HPVs causing cervical cancer, and the recent FDA approval of the quadrivalent vaccine in preventing genital warts in men, there is an urgency to determine the burden of HPV in Hispanic populations before vaccine programs are implemented on a widespread basis. Knowledge and acceptability of the vaccine prior to implementation of these programs are also necessary to allow a targeted assessment. This review article summarizes existing research on HPV infection and HPV-related morbidities in men, with a particular emphasis on Hispanic men in the United States and Puerto Rico. Three major areas are discussed: (1) genital warts, (2) HPV and related cancers and (3) biobehavioral and psychosocial factors related to HPV infection and vaccination. Specific recommendations for advancing HPV research and knowledge among Hispanic populations also are suggested.

Bibliometric assessment of cancer research in Puerto Rico, 1903-2005.

OBJECTIVE: The analysis of scientific production in Puerto Rico is largely unexplored. The main aim of this study is to present the characteristics and trends of cancer publications in Puerto Rico's biomedical journals and their relationship with the island's cancer mortality. METHODS: A PubMed and a hard-copy search were performed to retrieve cancer-related articles published in the Puerto Rico Health Sciences Journal and the Boletín de la Asociación Médica de Puerto Rico from 1903 to 2005. Bibliometric indicators studied included the number of authors and references by article, first author's institutional affiliation and country, document type, and language. The study type and tumor classification were also recorded. Cancer proportional mortality (M%) in Puerto Rico and the proportion of cancer-related articles (P%) published were also evaluated. The annual percent change (APC) was estimated to assess trends. RESULTS: A total of 369 articles were retrieved. The institutions with the majority of publications were universities (39.6%), English was the predominant publication language (72.1%), and the principal document type was original papers (69.6%). Epidemiologic studies were the dominant study type (62.1%), and the most studied cancers were digestive (15.4%) and gynecologic (9.6%). Although the P% has increased since 1913 (APC = 1.2%), the M% increased at a faster pace (APC = 2.7%). CONCLUSIONS: Although a growth in the number of cancer publications is observed in these journals, it does not parallel the increase in proportional mortality. A better understanding of the cancer publications in Puerto Rico is essential to establish priorities, define future areas of research, and develop cancer control strategies.

Bibliometric assessment of cancer research in Puerto Rico, 1903-2005 / Evaluación bibliométrica de la investigación sobre cáncer en Puerto Rico, 1903-2005

OBJECTIVE: The analysis of scientific production in Puerto Rico is largely unexplored. The main aim of this study is to present the characteristics and trends of cancer publications in Puerto Rico's biomedical journals and their relationship with the island's cancer mortality. METHODS:A PubMed and a hard-copy search were performed to retrieve cancer-related articles published in the Puerto Rico Health Sciences Journal and the Boletín de la Asociación Médica de Puerto Rico from 1903 to 2005. Bibliometric indicators studied included the number of authors and references by article, first author's institutional affiliation and country, document type, and language. The study type and tumor classification were also recorded. Cancer proportional mortality (M percent) in Puerto Rico and the proportion of cancer-related articles (P percent) published were also evaluated. The annual percent change (APC) was estimated to assess trends. RESULTS:A total of 369 articles were retrieved. The institutions with the majority of publications were universities (39.6 percent), English was the predominant publication language (72.1 percent), and the principal document type was original papers (69.6 percent). Epidemiologic studies were the dominant study type (62.1 percent), and the most studied cancers were digestive (15.4 percent) and gynecologic (9.6 percent). Although the P percent has increased since 1913 (APC = 1.2 percent), the M percent increased at a faster pace (APC = 2.7 percent). CONCLUSIONS: Although a growth in the number of cancer publications is observed in these journals, it does not parallel the increase in proportional mortality. A better understanding of the cancer publications in Puerto Rico is essential to establish priorities, define future areas of research, and develop cancer control strategies.

OBJETIVO: El análisis de la producción científica de Puerto Rico está aún en gran parte pendiente. El objetivo principal de este estudio es presentar las características y las tendencias de las publicaciones sobre cáncer en las revistas biomédicas de Puerto Rico y su relación con la mortalidad por cáncer en la Isla. MÉTODOS: Se realizó una búsqueda en PubMed y revistas impresas para localizar los artículos relacionados con cáncer publicados entre 1903 y 2005 en Puerto Rico Health Sciences Journal y el Boletín de la Asociación Médica de Puerto Rico. Entre los indicadores bibliométricos estudiados están el número de autores y referencias por artículo, la afiliación institucional y el país del primer autor, el tipo de documento y el idioma; se recogió también el tipo de estudio y de cáncer. Se evaluaron la mortalidad proporcional por cáncer (M por ciento) en Puerto Rico y la proporción de artículos publicados relacionados con el cáncer (P por ciento). Para evaluar las tendencias se estimó el cambio porcentual anual (APC). RESULTADOS: Se localizaron 369 artículos. Predominaron los artículos originales (69,6 por ciento), de universidades (39,6 por ciento) y en inglés (72,1 por ciento). Los estudios epidemiológicos fueron los más frecuentes (62,1 por ciento) y los tipos de cáncer más estudiados fueron los del sistema digestivo (15,4 por ciento) y los ginecológicos (9,6 por ciento). Aunque el valor de P por ciento ha aumentado desde 1913 (APC = 1,2 por ciento), el valor de M por ciento aumentó más rápidamente (APC = 2,7 por ciento). CONCLUSIONES: Aunque se observó un incremento en el número de publicaciones sobre cáncer en estas revistas, este no se correspondió con el aumento en la mortalidad proporcional por esta causa. Es imprescindible comprender mejor lo relacionado con la publicación científica sobre cáncer en Puerto Rico para establecer prioridades, definir áreas futuras de investigación y desarrollar estrategias para el control del cáncer.