Ethnic and border differences on blood cancer presentation and outcomes: A Texas population-based study.

BACKGROUND: The Texas/Chihuahua (US/Mexico) border is a medically underserved region with many reported barriers for health care access. Although Hispanic ethnicity is associated with health disparities for many different diseases, the population-based estimates of incidence and survival for patients with blood cancer along the border are unknown. The authors hypothesized that Hispanic ethnicity and border proximity is associated with poor blood cancer outcomes. METHODS: Data from the Texas Cancer Registry (1995-2016) were used to investigate the primary exposures of patient ethnicity (Hispanic vs non-Hispanic) and geographic location (border vs non-border). Other confounders and covariates included sex, age, year of diagnosis, rurality, insurance status, poverty indicators, and comorbidities. The Mantel-Haenszel method and Cox regression analyses were used to determine adjusted effects of ethnicity and border proximity on the relative risk (RR) and survival of patients with different blood cancer types. RESULTS: Hispanic patients were diagnosed at a younger age than non-Hispanic patients and presented with increased comorbidities. Whereas non-Hispanics had a higher incidence of developing blood cancer compared with Hispanics overall, Hispanics demonstrated a higher incidence of acute lymphoblastic leukemia (RR, 1.92; 95% CI, 1.79-2.08; P < .001) with worse outcomes. Hispanics from the Texas/Chihuahua border demonstrated a higher incidence of chronic myeloid leukemia (RR, 1.28; 95% CI, 1.07-1.51; P = .02) and acute myeloid leukemia (RR, 1.17; 95% CI, 1.04-1.33; P = .0009) compared with Hispanics living elsewhere in Texas. CONCLUSIONS: Hispanic ethnicity and border proximity were associated with a poor presentation and an adverse prognosis despite the younger age of diagnosis. Future studies should explore differences in disease biology and treatment strategies that could drive these regional disparities.

Hereditary Breast Cancer Risk Analysis in Uninsured Mexican-Origin Women Living in the U.S.-Mexico Border Region.

PURPOSE: This article describes the risk of hereditary breast cancer (HBC) in low-income Hispanic women living on the U.S.-Mexico border using the Pedigree Assessment Tool (PAT). METHOD: The PAT was administered as part of the El Paso and Hudspeth County Breast Cancer Education, Screening and NavigaTion program (BEST). Baseline data (n = 1,966) from this program was used to analyze risk factors for HBC. Analysis was conducted to determine significant covariates associated with the presence of any PAT risk factors. RESULTS: The PAT identified 17% (95% CI [15%, 19%]) of the women in the study as having some risk of HBC. Having had a mammogram within 3 years was significantly associated with having any PAT risk factors (odds ratio [OR] = 1.79, p = .006). Women who immigrated to the United States during childbearing age (OR = 0.610, p = .009) or during peri/menopause (OR = 0.637, p = .024) were significantly less likely to have any PAT risk factors. DISCUSSION: The PAT instrument detected a substantial pool of women who may be at risk for HBC. A significant proportion of these women were not up to date mammogram. CONCLUSIONS: The PAT is an effective tool to identify women at risk for HBC and encourage regular screening.

Change in Breast Cancer Screening Knowledge is Associated With Change in Mammogram Intention in Mexican-Origin Women After an Educational Intervention.

PURPOSE: To determine the relationship between breast cancer screening knowledge and intent to receive a mammogram within 6 months in a sample of Mexican-origin women living in El Paso, Texas. METHODS: A total of 489 uninsured Mexican-origin women were assigned to treatment or control and completed surveys at pre- and postintervention. Pre-post associations between breast cancer screening knowledge and intent were tested. RESULTS: Participants were on average were 56.7 years of age and spoke primarily Spanish (92.6%). Most of the samples had not had a mammogram in 3 or more years (51.6%) and 14.6% had never had a mammogram. At baseline, the majority intended to be screened for breast cancer within the next 6 months (93.4%). At postintervention, half of the intervention group changed their 6-month intent to be screened for breast cancer from likely to unlikely. Change in intent was associated with a change in knowledge of risk of having a first child by the age of 30 and breast cancer being rare after the age of 70. DISCUSSION: Intent to be screened for breast cancer in Mexican-origin women may be influenced by the type of knowledge. CONCLUSIONS: Change in screening knowledge may influence perceived risk that influences intention to be screened.

Eradication Rate of Helicobacter pylori on the US-Mexico Border Using the Urea Breath Test.

OBJECTIVES: Helicobacter pylori is prevalent worldwide, especially in Latin America. Triple and quadruple antibiotic therapies have been relatively effective; however, resistance has emerged in recent years. The treatment success rate of these regimens on the border of the United States and Mexico is unknown. Our study attempted to determine eradication rates of two major regimens based on urea breath test (UBT) results in patients previously diagnosed as having H. pylori in a single center in El Paso, Texas, a city on the geographic border with Mexico. METHODS: This was a retrospective cohort study of adult patients with H. pylori who underwent UBT after being treated with triple therapy (amoxicillin/clarithromycin/proton pump inhibitor for 14 days), quadruple therapy (tetracycline/metronidazole/bismuth/proton pump inhibitor, usually for 10 days), or both for H. pylori from 2010 to 2015 in a county hospital. Patients were excluded if they did not complete therapy or if their treatment regimen was unknown. The Student t test and the χ2 test were used to analyze the data. The cumulative incidence and 95% confidence interval (CI) for treatment success were estimated. RESULTS: A total of 104 patients completed the treatment for H. pylori and had UBT. Mean age was 53 years, 76% were women, 85% were Hispanic, and mean body mass index was 30.5 kg/m2. Of the 104 patients diagnosed as having H. pylori, 88 received triple therapy (84.6%) and 16 received quadruple therapy: 12 (11.5%) standard quadruple therapy, 4 (3.9%) triple therapy plus metronidazole. There were no differences between groups regarding age, sex, body mass index, or ethnicity. Overall, 90 (86.5%, 95% CI 78-92) patients had negative UBT after initial treatment. Based on posttreatment UBT, the triple therapy group had a similar eradication rate compared with the quadruple therapy group (78/88, 88.6% vs 12/16, 75.0%, P = 0.22). Of the 14 patients with positive posttreatment UBT, 12 (85.7%) received retreatment (2 were lost to follow-up), 11 (91.7%) received quadruple therapy, and 1 (8.3%) received triple therapy. Eradication was successful in 9 of 12 (75%, 95% CI 43-95) patients at retreatment. As such, of the initial 104 patients, 99/104 (95.2%) achieved H. pylori eradication posttreatment (either initial or retreatment). CONCLUSIONS: In a predominantly Hispanic population on the US-Mexico border, H. pylori eradication rates based on UBT results were relatively high and were similar for triple therapy and quadruple therapy. Quadruple therapy was effective for those who failed the initial H. pylori treatment. This may have implications for cost-effective therapy in our region.

Prevalence of Low Vitamin D in Patients with Breast Cancer in a Predominantly Hispanic Population at the American-Mexican Border.

INTRODUCTION: Low level of vitamin D (VD) has been linked with a higher risk of cancers. The aim of this study was to assess the prevalence of low VD in patients with breast cancer in a predominantly Mexican Hispanic/Latino patient population, a fast growing and relatively understudied population. MATERIALS/METHODS: We sought to evaluate the serum VD levels in breast cancer patients diagnosed at the Texas Tech University Breast Cancer Center in El Paso, TX, between May 2013 and May2014 via a retrospective chart review of the Electronic Medical Records. RESULTS: We identified a total of 83 consecutive breast cancer patients with available VD levels. Mean age 57 yr, 94% were Hispanics. VD was insufficient (<30 ng/ml) in 86% of patients (95% CI: 0.76-0.92) and it was deficient (<20 ng/ml) in 39% (95% CI: 0.28-0.50). CONCLUSION: VD deficiency is widely prevalent in Hispanic/Latino patients with breast cancer. This is quite alarming in view of possible increased risk of cancer with low VD and potentially worse cancer outcomes. This calls for increased efforts to screen for, diagnose, and treat VD deficiency in this patient population. Further pharmacogenomics studies are warranted to explore the underlying etiology of VD deficiency in this paradoxically sunny region.