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Castañeda-Avila MA, Suárez-Ramos T, Torres-Cintrón CR, Epstein MM, Gierbolini-Bermúdez A, Tortolero-Luna G, Ortiz-Ortiz KJ. Multiple myeloma incidence, mortality, and survival differences at the intersection of sex, age, and race/ethnicity: A comparison between Puerto Rico and the United States SEER population. Cancer Epidemiol 2024; 89:102537. [PMID: 38295555 DOI: 10.1016/j.canep.2024.102537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 12/15/2023] [Accepted: 01/21/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Multiple myeloma (MM) survival has increased during the last decades due to the introduction of new therapies. We investigated the intersectionality among age, sex, and race/ethnicity to better understand the pattern of MM incidence, mortality, and survival. METHODS Puerto Rico (PR) Central Cancer Registry and the United States of America (US) Surveillance, Epidemiology, and End Results (SEER) Program databases were used. We analyzed MM incidence and mortality trends from 2001 to 2019 using Joinpoint regression models to calculate annual percent change (APC). Age-standardized rate ratios (SRR) for incidence and mortality were used to compare PR with US SEER racial/ethnic groups during 2015-2019. Five-year survival analyses were also performed stratified by age and sex. RESULTS Regardless of age and race/ethnicity, males had higher MM incidence and mortality rates than females. PR had a higher increase in incidence rates of MM than other ethnic groups, regardless of sex and age (PR APC = 4.3 among males <65, 3.1 among males ≥65, 6.3 among females <65, and 2.6 among females ≥65 years old). No significant change in mortality APCs (p > 0.05) was observed in PR when stratified by age or sex while other groups showed a decrease. Among males < 65 years, PR had significantly higher incidence rates than non-Hispanic Whites (NHW), and US Hispanics (USH). However, among both males and females ≥ 65 years, PR had significantly lower MM mortality rates than NHW, non-Hispanic Blacks (NHB), USH, and US Overall. In terms of survival, PR showed the lowest 5-year overall survival among males < 65 years (54.6%, 95% CI: 47.2-61.5) and males ≥ 65 years (34.5%, 95% CI: 29.2-39.9) but not among females. CONCLUSION The incidence of MM in PR increased significantly over the study period, particularly among younger women. Despite the introduction of new therapies, mortality rates in PR have remained stable while other ethnic groups show significant decreases among all intersections of sex and age.
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Affiliation(s)
- Maira A Castañeda-Avila
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, MA, United States
| | - Tonatiuh Suárez-Ramos
- Puerto Rico Central Cancer Registry, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Carlos R Torres-Cintrón
- Puerto Rico Central Cancer Registry, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Mara M Epstein
- Division of Health Systems Science, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Axel Gierbolini-Bermúdez
- Puerto Rico Central Cancer Registry, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Guillermo Tortolero-Luna
- Puerto Rico Central Cancer Registry, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico; Cancer Control and Population Sciences Program, the University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Karen J Ortiz-Ortiz
- Puerto Rico Central Cancer Registry, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico; Cancer Control and Population Sciences Program, the University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico; Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico.
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Cruz G, Ramos-Cartagena JM, Torres-Russe JL, Colón-López V, Ortiz-Ortiz KJ, Pericchi L, Deshmukh AA, Ortiz AP. Barriers and facilitators to anal cancer screening among people living with HIV in Puerto Rico. BMC Public Health 2023; 23:1940. [PMID: 37803344 PMCID: PMC10559598 DOI: 10.1186/s12889-023-16847-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/27/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Anal cancer (AC) disproportionally affects people living with HIV (PLWH). Although there are no consensus-based AC screening guidelines, experts recommend anal pap as a primary screening tool in settings where high-resolution anoscopy (HRA) is available. We aimed to assess barriers and facilitators to anal cancer screening in a sample of Hispanic PLWH in Puerto Rico. METHODS To assess their knowledge and attitudes, we conducted a cross-sectional survey from 2020-2021 among PLWH in Puerto Rico (n = 212). Data was collected through a telephone interview that assessed information on sociodemographics, knowledge, and attitudes about AC, and the history of AC screening. The chi-square test, Fisher exact test, and logistic regression models were used to assess factors associated with screening uptake. RESULTS Anal Pap and HRA awareness were 60.4% and 30.7%, respectively. Anal Pap and HRA uptake was 51.5% and 19.3%, respectively. The most common barriers for anal Pap and HRA were lack of knowledge about the test and lack of physician recommendation. MSM were more likely to have heard of anal Pap (OR: 2.15, 95% CI:1.30-3.54) than MSW. MSM (OR: 3.04, 95% CI: 1.79-5.19) and women (OR: 3.00, 95% CI: 1.72-5.20) were also more likely to have undergone anal Pap. Similarly, individuals with a history of genital warts were more likely to have heard of anal Pap and HRA and have undergone anal Pap and HRA. Awareness of where to go for concerns about anal health was positively associated with having received anal Pap and HRA. CONCLUSIONS With emerging evidence on the effectiveness of screening and treatment for anal cancer, several organizations are steering toward generating consensus-based anal cancer screening recommendations. Our study provides foundational data on barriers and facilitators to anal cancer screening in Puerto Rico that will be critical to informing screening implementation in this US territory.
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Affiliation(s)
- Gabriela Cruz
- College of Public Health, University of South Florida, 13201 Bruce B Downs Blvd, Tampa, FL, 33612, USA
| | - Jeslie M Ramos-Cartagena
- Medical Science Campus, University of Puerto Rico/MD Anderson Cancer Center Partnership for Excellence in Cancer Research, PO BOX 365067, San Juan, 00936-5067, Puerto Rico
| | - José L Torres-Russe
- University of Puerto Rico Comprehensive Cancer Center, PO Box 363027, San Juan, 00936-3027, Puerto Rico
| | - Vivian Colón-López
- University of Puerto Rico Comprehensive Cancer Center, PO Box 363027, San Juan, 00936-3027, Puerto Rico
| | - Karen J Ortiz-Ortiz
- University of Puerto Rico Comprehensive Cancer Center, PO Box 363027, San Juan, 00936-3027, Puerto Rico
- Puerto Rico Central Cancer Registry, San Juan, Puerto Rico
| | - Luis Pericchi
- Department of Mathematics, University of Puerto Rico, Rio Piedras Campus, Medical Science Campus, PO BOX 365067, San Juan, 00936-5067, Puerto Rico
| | - Ashish A Deshmukh
- Medical University of South Carolina, 68 President St, BE 103, Charleston, SC, 29425, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Ana Patricia Ortiz
- University of Puerto Rico Comprehensive Cancer Center, PO Box 363027, San Juan, 00936-3027, Puerto Rico.
- Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico.
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Fuentes Payán W, González Lorenzo K, Gelabert Martínez F, Conte Schmidt N, Tortolero-Luna G, Ramos-Fernández MR, Gierbolini-Bérmudez A, Melin K, Ortiz-Ortiz KJ. Association Between Concurrent Use of Benzodiazepines and Opioids and Health Care Utilization Among Patients With Cancer in Puerto Rico. JCO Glob Oncol 2023; 9:e2300008. [PMID: 37797283 PMCID: PMC10664853 DOI: 10.1200/go.23.00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 06/19/2023] [Accepted: 08/19/2023] [Indexed: 10/07/2023] Open
Abstract
PURPOSE To evaluate the association between concurrent use of opioids and benzodiazepines (BZDs) and emergency room (ER) visits and hospital admissions in patients with cancer. METHODS Data were obtained from the Puerto Rico Central Cancer Registry-Health Insurance Linkage. Odds ratios (ORs) with 95% CIs and incidence rate ratio (IRR) were estimated using logistic and negative binomial regression analyses to assess the association between concurrent use of opioids and BZDs (overlap of at least 7 days) and ER visits and hospital admissions. RESULTS A total of 9,259 patients were included in the main analysis. The logistic regression results showed a significant association between concurrent use of opioids and BZDs and at least one ER visit (OR, 1.28 [95% CI, 1.07 to 1.54]) or hospital admission (OR, 1.42 [95% CI, 1.18 to 1.71]) compared with individuals with BZDs alone, after adjusting for age, sex, comorbidity index, cancer stage, health insurance, and health region. Compared with individuals with opioid use alone, the association did not reach significance. In the negative binomial regression, a significant association was observed for ER visits (IRR, 1.52 [95% CI, 1.31 to 1.76]) and hospitalizations (IRR, 1.34 [95% CI, 1.20 to 1.50]) when compared with individuals with BZDs alone. Compared with individuals with opioids alone, it only reached significance for ER visits (IRR, 1.39 [95% CI, 1.20 to 1.61]). CONCLUSION Careful evaluation must be done before prescribing concurrent opioids and BZDs in patients with cancer, as the results suggest that coprescribing may increase the odds of ER visits and hospitalizations.
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Affiliation(s)
- Wilmarie Fuentes Payán
- School of Pharmacy, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Keyla González Lorenzo
- School of Pharmacy, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | | | - Nelly Conte Schmidt
- School of Pharmacy, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Guillermo Tortolero-Luna
- Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - María R. Ramos-Fernández
- Emergency Medicine Department, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Axel Gierbolini-Bérmudez
- Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
- School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Kyle Melin
- School of Pharmacy, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Karen J. Ortiz-Ortiz
- Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
- School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
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Gopalani SV, Soman A, Shapiro JA, Miller JW, Ortiz-Ortiz KJ, Castañeda-Avila MA, Buenconsejo-Lum LE, Fredericks LE, Tortolero-Luna G, Saraiya M. Breast, cervical, and colorectal cancer screening test use in the US territories of Guam, Puerto Rico, and the US Virgin Islands. Cancer Epidemiol 2023; 84:102371. [PMID: 37105018 PMCID: PMC10594602 DOI: 10.1016/j.canep.2023.102371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/15/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND The United States Preventive Services Task Force (USPSTF) recommends breast, cervical, and colorectal cancer screening among eligible adults, but information on screening use in the US territories is limited. METHODS To estimate the proportion of adults up-to-date with breast, cervical, and colorectal cancer screening based on USPSTF recommendations, we analyzed Behavioral Risk Factor Surveillance System data from 2016, 2018, and 2020 for the 50 US states and DC (US) and US territories of Guam and Puerto Rico and from 2016 for the US Virgin Islands. Age-standardized weighted proportions for up-to-date cancer screening were examined overall and by select characteristics for each jurisdiction. RESULTS Overall, 67.2% (95% CI: 60.6-73.3) of women aged 50-74 years in the US Virgin Islands, 74.8% (70.9-78.3) in Guam, 83.4% (81.7-84.9) in Puerto Rico, and 78.3% (77.9-78.6) in the US were up-to-date with breast cancer screening. For cervical cancer screening, 71.1% (67.6-74.3) of women aged 21-65 years in Guam, 81.3% (74.6-86.5) in the US Virgin Islands, 83.0% (81.7-84.3) in Puerto Rico, and 84.5% (84.3-84.8) in the US were up-to-date. For colorectal cancer screening, 45.2% (40.0-50.5) of adults aged 50-75 years in the US Virgin Islands, 47.3% (43.6-51.0) in Guam, 61.2% (59.5-62.8) in Puerto Rico, and 69.0% (68.7-69.3) in the US were up-to-date. Adults without health care coverage reported low test use for all three cancers in all jurisdictions. In most jurisdictions, test use was lower among adults with less than a high school degree and an annual household income of < $25,000. CONCLUSION Cancer screening test use varied between the US territories, highlighting the importance of understanding and addressing territory-specific barriers. Test use was lower among groups without health care coverage and with lower income and education levels, suggesting the need for targeted evidence-based interventions.
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Affiliation(s)
- Sameer V Gopalani
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA; Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | | | - Jean A Shapiro
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jacqueline W Miller
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Karen J Ortiz-Ortiz
- Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, PR, USA
| | - Maira A Castañeda-Avila
- Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | | | - Lyña E Fredericks
- Division of Chronic Disease and Prevention, US Virgin Islands Department of Health, St. Thomas, USVI, USA
| | - Guillermo Tortolero-Luna
- Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, PR, USA
| | - Mona Saraiya
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Colón-López V, Sánchez-Cabrera Y, Soto-Salgado M, Ortiz-Ortiz KJ, Quast T, Fernández ME. 'More stressful than cancer': Treatment Experiences Lived During Hurricane Maria among Breast and Colorectal Cancer Patients in Puerto Rico. Res Sq 2023:rs.3.rs-2689228. [PMID: 37066399 PMCID: PMC10104257 DOI: 10.21203/rs.3.rs-2689228/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Background This study explored experiences in cancer care and disruption after Hurricanes Irma and Maria's aftermath in Puerto Rico (PR). Methods A total of three focus groups were conducted among breast and colorectal cancer patients diagnosed six months before the disaster. Results The most prevalent themes were (a) barriers related to their cancer treatment, (b) facilitators related to their cancer treatment, and (c) treatment experiences during the hurricane. Participants discussed struggles regarding their experience with treatment and access to care during and after Hurricanes Irma and Maria and how household limitations due to lack of electricity and water deter their intention to continue their treatment. Moreover, stressors directly linked with the disaster were the most challenging to cope with. Conclusions Our study identifies the hardships experienced by cancer patients living during a disaster. Similarly, our study highlights the impending need to address in future emergency plans the individual and system needs of cancer patients in active treatment to minimize the delay in continuing cancer care.
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Affiliation(s)
- Vivian Colón-López
- Cancer Control and Population Sciences Division, University of Puerto Rico Comprehensive Cancer Center, San Juan
| | - Yara Sánchez-Cabrera
- University of Puerto Rico/MD Anderson Cancer Center Partnership for Excellence in Cancer Research, San Juan
| | - Marievelisse Soto-Salgado
- Cancer Control and Population Sciences Division, University of Puerto Rico Comprehensive Cancer Center, San Juan
| | - Karen J Ortiz-Ortiz
- Cancer Control and Population Sciences Division, University of Puerto Rico Comprehensive Cancer Center, San Juan
| | - Troy Quast
- University of South Florida, College of Public Health, Tampa, FL
| | - María E Fernández
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center, Houston, TX
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Castaneda-Avila MA, Oyinbo AG, Epstein MM, Ortiz-Ortiz KJ, Tortolero-Luna G, Lapane KL. Trends and Factors Associated with Fecal Occult Blood Test Utilization among Hispanic Adults in Puerto Rico and the United States: BRFSS 2012-2020. Cancer Prev Res (Phila) 2023; 16:229-237. [PMID: 36720120 PMCID: PMC10073332 DOI: 10.1158/1940-6207.capr-22-0423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 12/03/2022] [Accepted: 01/27/2023] [Indexed: 02/02/2023]
Abstract
Identifying factors associated with colorectal cancer screening utilization is important to guide colorectal cancer prevention and control programs. We evaluated trends and factors associated with previous-year fecal occult blood test (FOBT) use among Hispanic adults living in Puerto Rico and the U.S. mainland. Using data from the Behavioral Risk Factor Surveillance System (2012-2020), trends in FOBT use were analyzed using joinpoint regression to estimate annual percentage change (APC). Logistic regression stratified by location identified factors associated with FOBT use. FOBT was more common among Hispanic adults ages 50 to 75 years living in Puerto Rico than in the U.S. mainland [Puerto Rico: 20.5%[2012] to 45.6%[2020], APC = 11.4%; U.S. mainland: 9.9%[2012] to 16.7%[2020], APC = 5.9%]. Factors inversely associated with FOBT use were similar in Puerto Rico and the U.S. mainland, including lack of health insurance, not having a personal doctor, having a checkup >12 months ago, and not being able to see a doctor due to cost, as were factors associated with higher FOBT use, including older age, retirement, or having two or more chronic diseases. Among Hispanics living in the U.S. mainland, lack of exercise and less education were inversely associated with FOBT. Factors related to poor access to healthcare were associated with lower use of FOBT among Hispanics. Efforts to improve colorectal cancer screening in Hispanics are necessary to address health disparities across the colorectal cancer care continuum. PREVENTION RELEVANCE Colorectal cancer screening reduces cancer incidence and mortality. All screening modalities, including less invasive FOBT tests, are underutilized, especially in non-White and low-income populations. Evaluation of trends and factors associated with the increase in the use of colorectal cancer screening can inform programs to address the lack of screening among racial minorities.
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Affiliation(s)
- Maira A. Castaneda-Avila
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA
| | - Atinuke G. Oyinbo
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA
| | - Mara M. Epstein
- Division of Health Systems Science, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA
| | - Karen J. Ortiz-Ortiz
- Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
- Puerto Rico Central Cancer Registry, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Guillermo Tortolero-Luna
- Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
- Puerto Rico Central Cancer Registry, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Kate L. Lapane
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA
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Damgacioglu H, Lin YY, Ortiz AP, Wu CF, Shahmoradi Z, Shyu SS, Li R, Nyitray AG, Sigel K, Clifford GM, Jay N, Lopez VC, Barnell GM, Chiao EY, Stier EA, Ortiz-Ortiz KJ, Ramos-Cartagena JM, Sonawane K, Deshmukh AA. State Variation in Squamous Cell Carcinoma of the Anus Incidence and Mortality, and Association With HIV/AIDS and Smoking in the United States. J Clin Oncol 2023; 41:1228-1238. [PMID: 36441987 PMCID: PMC9937095 DOI: 10.1200/jco.22.01390] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 10/04/2022] [Accepted: 10/13/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Squamous cell carcinoma of the anus (SCCA) incidence and mortality rates are rising in the United States. Understanding state-level incidence and mortality patterns and associations with smoking and AIDS prevalence (key risk factors) could help unravel disparities and provide etiologic clues. METHODS Using the US Cancer Statistics and the National Center for Health Statistics data sets, we estimated state-level SCCA incidence and mortality rates. Rate ratios (RRs) were calculated to compare incidence and mortality in 2014-2018 versus 2001-2005. The correlations between SCCA incidence with current smoking (from the Behavioral Risk Factor Surveillance System) and AIDS (from the HIV Surveillance system) prevalence were evaluated using Spearman's rank correlation coefficient. RESULTS Nationally, SCCA incidence and mortality rates (per 100,000) increased among men (incidence, 2.29-3.36, mortality, 0.46-0.74) and women (incidence, 3.88-6.30, mortality, 0.65-1.02) age ≥ 50 years, but decreased among men age < 50 years and were stable among similar-aged women. In state-level analysis, a marked increase in incidence (≥ 1.5-fold for men and ≥ two-fold for women) and mortality (≥ two-fold) for persons age ≥ 50 years was largely concentrated in the Midwestern and Southeastern states. State-level SCCA incidence rates in recent years (2014-2018) among men were correlated (r = 0.47, P < .001) with state-level AIDS prevalence patterns. For women, a correlation was observed between state-level SCCA incidence rates and smoking prevalence (r = 0.49, P < .001). CONCLUSION During 2001-2005 to 2014-2018, SCCA incidence and mortality nearly doubled among men and women age ≥ 50 years living in Midwest and Southeast. State variation in AIDS and smoking patterns may explain variation in SCCA incidence. Improved and targeted prevention is needed to combat the rise in SCCA incidence and mitigate magnifying geographic disparities.
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Affiliation(s)
- Haluk Damgacioglu
- Center for Health Services Research, Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, TX
| | - Yueh-Yun Lin
- Center for Health Services Research, Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, TX
| | - Ana Patricia Ortiz
- University of Puerto Rico (UPR) Comprehensive Cancer Center, Division of Cancer Control and Population Sciences, San Juan, Puerto Rico
| | - Chi-Fang Wu
- Department of Health Services Research, MD Anderson Cancer Center, Houston, TX
| | - Zahed Shahmoradi
- Center for Health Services Research, Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, TX
| | - Shiang Shiuan Shyu
- Center for Health Services Research, Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, TX
- Department of Biostatistics and Data Science, UTHealth School of Public Health, Houston, TX
| | - Ruosha Li
- Department of Biostatistics and Data Science, UTHealth School of Public Health, Houston, TX
| | - Alan G. Nyitray
- Clinical Cancer Center, Medical College of Wisconsin, Milwaukee, WI
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI
| | - Keith Sigel
- Department of General Internal Medicine, Department of Medicine, Mt Sinai Icahn School of Medicine, New York, NY
| | - Gary M. Clifford
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Naomi Jay
- Anal Neoplasia Clinic, Research, and Education Center, University of California San Francisco, San Francisco, CA
| | - Vivian Colon Lopez
- University of Puerto Rico (UPR) Comprehensive Cancer Center, Division of Cancer Control and Population Sciences, San Juan, Puerto Rico
| | - Gregory M. Barnell
- Kaiser Permanente, Oakland Medical Center, Department of Surgery, Oakland, CA
| | | | - Elizabeth A. Stier
- Department of Obstetrics and Gynecology, Boston Medical Center/Boston University School of Medicine, Boston, MA
| | - Karen J. Ortiz-Ortiz
- University of Puerto Rico (UPR) Comprehensive Cancer Center, Division of Cancer Control and Population Sciences, San Juan, Puerto Rico
| | - Jeslie M. Ramos-Cartagena
- The University of Puerto Rico/MD Anderson Cancer Center Partnership for Excellence in Cancer Research Program, San Juan, Puerto Rico
| | - Kalyani Sonawane
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - Ashish A. Deshmukh
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
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Castañeda-Avila MA, Ramos TS, Torres-Cintrón CR, Gierbolini-Bermúdez A, Tortolero-Luna G, Ortiz-Ortiz KJ. Monoclonal Gammopathy of Undetermined Significance and Multiple Myeloma Survival Among Hispanics Living in Puerto Rico. J Registry Manag 2023; 50:167-169. [PMID: 38504710 PMCID: PMC10945921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
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Alvarado Ortiz M, Suárez Ramos T, Torres Cintrón CR, Zavala Zegarra D, Tortolero Luna G, Ortiz-Ortiz KJ, Castaneda-Avila MA. Racial/ethnic disparities for leukemias in Puerto Rico and the United States of America, 2015-2019. PLoS One 2023; 18:e0285547. [PMID: 37196029 DOI: 10.1371/journal.pone.0285547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 04/25/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Leukemia is a cancer of the early-forming cells. Over the past decade, leukemia racial/ethnic disparities have been documented in the United States of America (USA). Although the Puerto Rican population in the USA represents the second-largest Hispanic population in the nation, most of the existing studies do not include Puerto Rico. We compared the incidence and mortality rates for leukemia and its subtypes in Puerto Rico and four racial/ethnic groups in the USA. METHODS We used data from the Puerto Rico Central Cancer Registry and the Surveillance, Epidemiology, and End Results Program (2015-2019). The racial/ethnic groups studied were non-Hispanic whites (NHW), non-Hispanic blacks (NHB), Hispanics (USH), and Asian/Pacific Islanders (NHAPI) living in the USA and the Puerto Rico population. We calculated the incidence and mortality rates. The relative risk of developing or dying due to leukemia was also calculated. RESULTS Compared with Puerto Rico, NHW [standardized incidence rate (SIR) = 1.47; 95%CI = 1.40-1.53; standardized mortality rates (SMR) = 1.55; 95%CI = 1.45-1.65)] and NHB (SIR = 1.09; 95%CI = 1.04-1.15; SMR = 1.27; 95%CI = 1.19-1.35) had higher incidence and mortality rates; but lower than the NHAPI (SIR = 0.78; 95%CI = 0.74-0.82; SMR = 0.83; 95%CI = 0.77-0.89); and similar to USH. However, we found differences among leukemia subtypes. For example, NHAPI and USH had lower risk of developing chronic leukemias than Puerto Rico. We found a lower risk to develop acute lymphocytic leukemia in NHB than in Puerto Rico. CONCLUSIONS Our study provides a better understanding of leukemia's racial/ethnic disparities and fills a knowledge gap by examining the incidence and mortality rates in Puerto Rico. Future studies are needed to better understand the factors influencing the differences found in the incidence and mortality of leukemia among different racial/ethnic groups.
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Affiliation(s)
- Mariela Alvarado Ortiz
- Puerto Rico Central Cancer Registry, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico
- Department of Social Science, Graduated School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Tonatiuh Suárez Ramos
- Puerto Rico Central Cancer Registry, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Carlos R Torres Cintrón
- Puerto Rico Central Cancer Registry, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Diego Zavala Zegarra
- Puerto Rico Central Cancer Registry, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Guillermo Tortolero Luna
- Puerto Rico Central Cancer Registry, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico
- Division of Cancer Control and Population Sciences Program, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Karen J Ortiz-Ortiz
- Puerto Rico Central Cancer Registry, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico
- Division of Cancer Control and Population Sciences Program, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Maira A Castaneda-Avila
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, United States of America
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10
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Castaneda-Avila MA, Suárez Ramos T, Torres-Cintrón CR, Cotto-Santana LA, Tortolero-Luna G, Ortiz-Ortiz KJ. Induction Therapy and Survival for Acute Myeloid Leukemia in Hispanic Adults from Puerto Rico. Clin Lymphoma Myeloma Leuk 2022; 22:e922-e930. [PMID: 35853812 DOI: 10.1016/j.clml.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/15/2022] [Accepted: 06/17/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Acute myeloid leukemia (AML) is the most common type of leukemia in adults. There are no previous studies evaluating AML treatment patterns in Puerto Rico. We describe the first-line therapy patterns and survival of patients diagnosed with AML in Puerto Rico using the Puerto Rico Central Cancer Registry Health Insurance Linkage Database (2011-2015). METHODS We describe patient characteristics according to intensive, non-intensive, and non-treatment status. We used Cox proportional hazard models to evaluate the factors associated with the risk of death stratified by intensive and non-intensive therapy. For this study, 385 patients with AML were included. RESULTS The mean age was 67 years old and 50.1% were female. Nearly half of AML patients (46.8%) received intensive treatment, 23.6% received non-intensive treatment, and 26.2% did not receive treatment. The overall 3-year survival rate was 17.9%. Among those who received intensive therapy, the risk of death among females was lower than males (hazard ratio [HR]: 0.64, 95% confidence interval [CI]: 0.44-0.93). Patients 60 years or older who received intensive treatment had a higher risk of death than younger patients (HR: 1.67, 95% CI: 1.09-2.55). Patients with poor/adverse risk receiving intensive (HR: 3.43, 95% CI: 1.76-6.69) or non-intensive (HR: 4.32, 95% CI: 1.66-11.28) treatment had a higher risk of death than patients with a favorable risk category. CONCLUSION Our findings are the first step to monitor the quality of care of patients with AML in Puerto Rico, particularly related to the administration of appropriate induction therapies, which is one of the most important predictors of AML survival.
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Affiliation(s)
- Maira A Castaneda-Avila
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA
| | - Tonatiuh Suárez Ramos
- Puerto Rico Central Cancer Registry, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Carlos R Torres-Cintrón
- Puerto Rico Central Cancer Registry, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico
| | | | - Guillermo Tortolero-Luna
- Puerto Rico Central Cancer Registry, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico; Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Karen J Ortiz-Ortiz
- Puerto Rico Central Cancer Registry, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico; Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico; Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico.
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11
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Jiménez Nieves Y, Ortiz-Ortiz KJ, Ríos Motta RE, Castañeda-Avila MA, Tortolero-Luna G. Granulocyte colony stimulating factor use and adherence to clinical practice guidelines among women with breast cancer living in Puerto Rico: a population-based study. BMC Health Serv Res 2022; 22:935. [PMID: 35858914 PMCID: PMC9299407 DOI: 10.1186/s12913-022-08325-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/07/2022] [Indexed: 11/23/2022] Open
Abstract
Background Febrile Neutropenia (FN) is a common and serious condition related to cancer chemotherapy. Human recombinant Granulocyte-Colony Stimulating Factor (G-CSF) prevents and attenuates the severity and duration of FN. We evaluated the use and predictors of G-CSF adherence among women with breast cancer with a high risk of FN in Puerto Rico. Methods This retrospective cohort study used the Puerto Rico Central Cancer Registry-Health Insurance Linkage Database. Women with invasive breast cancer diagnosed during 2009-2015 who received selected chemotherapy regimens (n = 816) were included. The risk of FN was categorized as high and low risk based on the chemotherapy regimens according to the National Comprehensive Cancer Network guidelines and literature. Adherence was defined as the use or no use of G-CSF at the start of the first chemotherapy cycle among women with breast cancer based on the risk of developing FN. We used a multivariate logistic model to identify factors associated with G-CSF use in women classified at high risk for FN. Results Adherence to G-CSF clinical practice guidelines was low (38.2%) among women with a high risk of FN. Women at high risk of FN with Medicaid (aOR: 0.14; CI 95%: 0.08, 0.24) and Medicare/Medicaid (aOR: 0.33; CI 95%: 0.15, 0.73) were less likely to receive G-CSF than women with private health insurance. Women with regional stage (aOR: 1.82; CI 95%: 1.15, 2.88) were more likely to receive G-CSF than women with localized cancers. Conclusions Adherence to clinical practice guidelines was poor among women with a high risk of FN. Furthermore, disparities in the adherence to G-CSF use in terms of health insurance, health region, and cancer stage granted the opportunity to implement strategies to follow the recommended guidelines for using G-CSF as part of cancer treatment.
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Affiliation(s)
- Yarixabeth Jiménez Nieves
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Karen J Ortiz-Ortiz
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico. .,Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, PO Box 363027, San Juan, 00936-3027, Puerto Rico. .,Puerto Rico Central Cancer Registry, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico.
| | - Ruth E Ríos Motta
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Maira A Castañeda-Avila
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Guillermo Tortolero-Luna
- Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, PO Box 363027, San Juan, 00936-3027, Puerto Rico.,Puerto Rico Central Cancer Registry, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
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12
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Keller KG, Pearce CL, Ortiz-Ortiz KJ, Ramos-Cartagena JM, Guiot H, Colón-López V, Deshmukh AA, Tirado-Gómez M, Ortiz AP. Abstract 2241: Evaluating anal cancer screening approaches in high-risk populations in Puerto Rico. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-2241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Anal cancer incidence has been rising rapidly in Puerto Rico. The ANCHOR study showed that treating high-grade squamous intraepithelial lesions (HSILs) significantly reduces anal cancer incidence. Limited research has been done to understand the validity and associated costs of screening tools used to detect anal lesions in Hispanic populations. We aimed to evaluate the clinical performance (sensitivity, specificity, positive predictive value [PPV], and negative predictive value [NPV]) and screening test costs in the clinic-based sample. Understanding the accuracy and costs of screening tools can guide interventions in resource-limited settings to broaden the availability of effective, low-cost screening options and promote anal cancer prevention.
Methods: The cross-sectionally analyzed data was collected (May 2015 - June 2021) by the Anal Neoplasia Clinic of the University of Puerto Rico Comprehensive Cancer Center. The clinic predominantly serves referred adults (≥18 years old). Patients were included in the analyses if they had complete results for anal cytology, high-resolution anoscopy (HRA) with biopsy, and anal high-risk HPV (HR-HPV) typing (n=436). Sensitivity, specificity, PPV, and NPV were estimated to evaluate the clinical performance of anal cytology alone and in combination with HR-HPV typing in the detection of histologically confirmed anal HSIL (Gold standard). Analyses were stratified by risk group (women, MSM, and heterosexual men) and HIV status. Evaluation of cost-effective alternative screening strategies is currently ongoing.
Results: The mean age of our sample was 44 ± 13 years; more than half (67%) were male. HIV-infected MSM, HIV-infected women, and HIV-negative MSM comprised 45.4%, 22.2%, 13.3% of our sample, respectively. 40% of the sample had HSIL and 69% tested positive for HR-HPV. Measured against the gold standard, we found that co-testing (anal cytology and HR-HPV typing) increased the sensitivity in the groups evaluated and decreased specificity in some. Among HIV-infected MSM, the sensitivity of anal cytology alone to detect HSIL was 84.7%, whereas specificity was 30.0%. Although the sensitivity of the 2 tests combined (anal cytology and HR-HPV typing) to detect histologically confirmed HSIL increased (91.8%), the specificity decreased (22.0%). Overall, the sensitivity of cytology alone was higher in women compared to men and among PLWH compared to HIV-negative individuals.
Conclusion: While higher sensitivity for HSIL detection was seen for cytology alone for women and HIV-infected populations, co-testing increased the sensitivity for HSILs detection. Understanding the accuracy and cost of screening tools can guide interventions to broaden the availability of effective, low-cost screening options and promote anal cancer prevention. Access and availability of these tools in a wide context of communities must be considered.
Citation Format: Kandyce G. Keller, Celeste Leigh Pearce, Karen J. Ortiz-Ortiz, Jeslie M. Ramos-Cartagena, Humberto Guiot, Vivian Colón-López, Ashish A. Deshmukh, Maribel Tirado-Gómez, Ana Patricia Ortiz. Evaluating anal cancer screening approaches in high-risk populations in Puerto Rico [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 2241.
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13
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Quirindongo-Rivera C, Rullán-Varela V, Underill Z, Rivera M, Ortiz-Ortiz KJ, Martínez-Montemayor MM. Characterization of Inflammatory Breast Cancer in Hispanic Women from Puerto Rico. J Cancer 2022; 13:3495-3502. [PMID: 36484009 PMCID: PMC9723992 DOI: 10.7150/jca.77108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/21/2022] [Indexed: 01/25/2023] Open
Abstract
Background: Breast cancer (BC) is the most diagnosed cancer and the leading cause of cancer death among women in Puerto Rico (PR). Inflammatory breast cancer (IBC) is considered the most aggressive BC subtype. This study characterized the IBC population of Hispanic women living in Puerto Rico and aimed to estimate the IBC survival rate using data from the Puerto Rico Central Cancer Registry (PRCCR). Methods: This is a retrospective, population-based study using the PRCCR database and the Health Insurance Linkage Database (PRCCR-HILD). We analyzed data from patients that were diagnosed with IBC from January 1, 2008 to December 31, 2018. Patients were identified using the International Classification of Diseases for Oncology, 3rd edition (ICD-O-3) site codes C50.0-C50.9 and histology code 8530. Variables such as age at diagnosis, marital status, health insurance, geographic area of residence, staging variables, tumor receptor subtypes, treatment received, and overall survival (OS) were studied. Statistical analysis methods were employed to describe the population, estimate survival curves and examine the risk of dying. Results: The data of 51 patients were included. The mean age at diagnosis of IBC in the current study was 59 years old. A total of 62.8% of patients had no metastases at diagnosis and 64.7% were diagnosed with stage III disease. Most tumors presented with ER+/PR+/Her2- (21.6%), or a triple negative (ER-/PR-/Her2-, 15.7%) tumor concordance. The OS during the first year was 66% (90% CI: 0.54-0.76), whereas 36 months post-diagnosis was at a low 39% (90% CI: 0.27-0.59). The triple-negative subtype had the worst survival at 36 months (36% [90% CI: 0.11-0.62]). This study revealed through Cox regression analysis that women with stage IV disease and those with ER-/PR- tumor subtype have a higher risk of dying (HR 4.99; [90% CI: 2.30-10.83] and HR 4.74; [90% CI: 1.88-11.95]), respectively. Conclusions: Our results suggest that the Puerto Rican IBC patient population presents unique characteristics. This is the first research to describe the patient profile and characteristics of women diagnosed with IBC in PR. This research increases awareness about this lethal disease in PR.
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Affiliation(s)
- Camiled Quirindongo-Rivera
- University of Puerto Rico Comprehensive Cancer Center, San Juan, PR
- Public Health Program, Ponce Health Science University, Ponce, PR
| | | | | | | | - Karen J. Ortiz-Ortiz
- University of Puerto Rico Comprehensive Cancer Center, San Juan, PR
- Puerto Rico Central Cancer Registry, San Juan, PR
| | - Michelle M. Martínez-Montemayor
- Universidad Central del Caribe-School of Medicine, Bayamón, PR
- ✉ Corresponding author: Michelle M. Martínez-Montemayor, ; Universidad Central del Caribe - School of Medicine, P.O. Box 60327, Bayamón, Puerto Rico, 00960
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14
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Ortiz AP, Gierbolini-Bermúdez A, Ramos-Cartagena JM, Colón-López V, Sonawane K, Deshmukh AA, Ortiz-Ortiz KJ. Cervical Cancer Screening Among Medicaid Patients During Natural Disasters and the COVID-19 Pandemic in Puerto Rico, 2016 to 2020. JAMA Netw Open 2021; 4:e2128806. [PMID: 34652451 PMCID: PMC8520125 DOI: 10.1001/jamanetworkopen.2021.28806] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This cohort study examines rates of cervical cancer screening in Puerto Rico among women with Medicaid health coverage following the 2017 hurricanes, earthquakes in late 2019-2020, and the 2020 COVID-19 lockdown.
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Affiliation(s)
- Ana Patricia Ortiz
- University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Axel Gierbolini-Bermúdez
- Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Jeslie M. Ramos-Cartagena
- Department of University of Puerto Rico/MD Anderson Cancer Center Partnership for Excellence in Cancer Research Program, San Juan, Puerto Rico
| | - Vivian Colón-López
- University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Kalyani Sonawane
- Center for Health Services Research, Department of Management, Policy, and Community Health, University of Texas Health School of Public Health, Houston
| | - Ashish A. Deshmukh
- Center for Health Services Research, Department of Management, Policy, and Community Health, University of Texas Health School of Public Health, Houston
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15
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Quiñones-Avila V, Ortiz-Ortiz KJ, Ríos-Motta R, Marín-Centeno H, Tortolero-Luna G. Use of palliative radiotherapy among patients with metastatic non-small-cell lung cancer in Puerto Rico. BMC Palliat Care 2021; 20:127. [PMID: 34389004 PMCID: PMC8364074 DOI: 10.1186/s12904-021-00819-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 07/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Palliative radiotherapy (RT) represents an important treatment opportunity for improving the quality of life in metastatic non-small cell lung cancer (NSCLC) patients through the management of symptoms within the course of the illness. The aim of the study is to determine the proportion of patients who had palliative RT within 12 months of diagnosis and evaluate the factors associated with it. METHODS A retrospective cohort study was performed using secondary data analysis from 2009 to 2015 from the Puerto Rico Central Cancer Registry-Health Insurance Linkage Database (PRCCR-HILD). A logistic regression model was used to examine factors associated with palliative RT. RESULTS Among the 929 patients identified with metastatic NSCLC, 33.80% received palliative RT within the first year after diagnosis. After adjusting for other covariates, receipt of chemotherapy (ORAdj = 3.90; 95% CI = 2.91-5.45; P < 0.001) and presence of symptoms (ORAdj = 1.41; 95% CI =1.00-1.98; P = 0.045) were associated with increased odds of palliative RT use. Although marginally significant, patients with private health insurance had increased odds of palliative RT use (ORAdj = 1.50; 95% CI = 0.98-2.29; P = 0.061) when compared to beneficiaries of Medicaid, after adjusting by other covariates. CONCLUSIONS The results of this study reveal concerning underuse of palliative RT among patients with metastatic NSCLC in Puerto Rico. Additional research is necessary to further understand the barriers to using palliative RT on the island.
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Affiliation(s)
- Valerie Quiñones-Avila
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, P.O. Box 363027, San Juan, 00936-3027, Puerto Rico
| | - Karen J Ortiz-Ortiz
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, P.O. Box 363027, San Juan, 00936-3027, Puerto Rico. .,Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico. .,Puerto Rico Central Cancer Registry, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico.
| | - Ruth Ríos-Motta
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, P.O. Box 363027, San Juan, 00936-3027, Puerto Rico
| | - Heriberto Marín-Centeno
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, P.O. Box 363027, San Juan, 00936-3027, Puerto Rico
| | - Guillermo Tortolero-Luna
- Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico.,Puerto Rico Central Cancer Registry, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico
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16
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Ramos-Fernández MR, Ortiz-Ortiz KJ, Torres-Cintrón CR, Tortolero-Luna G. Patterns of End-of-Life Care as Measured by Emergency Room Visits Among Cancer Patients in Puerto Rico. Am J Hosp Palliat Care 2021; 39:72-78. [PMID: 34231422 DOI: 10.1177/10499091211025743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Community palliative care (PC) services are scarce in Puerto Rico (PR). Patients with advanced cancer commonly visit the emergency department(ED) at the end of life (EoL). Recognition of patients with limited life expectancies and PC needs may improve the EoL trajectory of these patients. Our objective was to characterize ED visits of cancer patients at the EoL by examining the patterns of ED visits in PR using the PR Central Cancer Registry-Health Insurance Linkage Database (PRCCR-HILD). METHODS The cohort consisted of patients aged ≥18 years with a primary invasive that died between 2011- 2017, with a recorded date of death, and who had insurance claims during their last three months. EoL indicators were ED visits, ED death, and hospice care use. RESULTS The study cohort included 10,755 cancer patients. 49.6% had ≥1 ED visit, 20.3% had ≥2 ED visits, and 9.7% died in the ED. In the adjusted model, female patients (aOR 0.80; 95% CI 0.68-0.93; p-value < 0.01), patients aged ≥80 years (aOR 0.47; 95% CI 0.36-0.63; p-value < 0.01), being enrolled in Medicare (aOR 0.74; 95% CI 0.61-0.90; p-value < 0.01) or being enrolled in Medicaid/Medicare (aOR 0.76; 95% CI 0.62-0.93; p-value = 0.01) were less likely to have an ED visit the date of death. Patients with distant stage are more likely to have ED ≥ 2visits (p-value < 0.05). Conclusions: ED visits at EoL can be interpreted as poor quality cancer care and awareness of the potential of ED-initiated PC is needed in PR.
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Affiliation(s)
- María R Ramos-Fernández
- Emergency Medicine Department, 12320University of Puerto Rico, San Juan, Puerto Rico.,Supportive Oncology, 12320University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Karen J Ortiz-Ortiz
- Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico.,Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Carlos R Torres-Cintrón
- Puerto Rico Central Cancer Registry, 591857University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Guillermo Tortolero-Luna
- Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico.,Puerto Rico Central Cancer Registry, 591857University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
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17
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Ortiz-Ortiz KJ, Tortolero-Luna G, Torres-Cintrón CR, Zavala-Zegarra DE, Gierbolini-Bermúdez A, Ramos-Fernández MR. High-Intensity End-of-Life Care Among Patients With GI Cancer in Puerto Rico: A Population-Based Study. JCO Oncol Pract 2021; 17:e168-e177. [PMID: 33567240 PMCID: PMC8202061 DOI: 10.1200/op.20.00541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
High-intensity care with undue suffering among patients with cancer at the end of life (EoL) is associated with poor quality of life. We examined the pattern and predictors of high-intensity care among patients with GI cancer in Puerto Rico.
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Affiliation(s)
- Karen J Ortiz-Ortiz
- Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico.,Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Guillermo Tortolero-Luna
- Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Carlos R Torres-Cintrón
- Puerto Rico Central Cancer Registry, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Diego E Zavala-Zegarra
- Puerto Rico Central Cancer Registry, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Axel Gierbolini-Bermúdez
- Department of Social Science, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - María R Ramos-Fernández
- Department of Emergency Medicine, School of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
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18
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Ortiz AP, Ortiz-Ortiz KJ, Colón-López V, Tortolero-Luna G, Torres-Cintrón CR, Wu CF, Deshmukh AA. Incidence of Cervical Cancer in Puerto Rico, 2001-2017. JAMA Oncol 2021; 7:456-458. [PMID: 33443548 DOI: 10.1001/jamaoncol.2020.7488] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ana Patricia Ortiz
- Comprehensive Cancer Center, The University of Puerto Rico, San Juan, Puerto Rico.,Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Karen J Ortiz-Ortiz
- Comprehensive Cancer Center, The University of Puerto Rico, San Juan, Puerto Rico.,Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico.,Puerto Rico Central Cancer Registry, Cancer Control and Population Sciences Division, Comprehensive Cancer Center, The University of Puerto Rico, San Juan, Puerto Rico
| | - Vivian Colón-López
- Comprehensive Cancer Center, The University of Puerto Rico, San Juan, Puerto Rico
| | - Guillermo Tortolero-Luna
- Comprehensive Cancer Center, The University of Puerto Rico, San Juan, Puerto Rico.,Puerto Rico Central Cancer Registry, Cancer Control and Population Sciences Division, Comprehensive Cancer Center, The University of Puerto Rico, San Juan, Puerto Rico
| | - Carlos R Torres-Cintrón
- Puerto Rico Central Cancer Registry, Cancer Control and Population Sciences Division, Comprehensive Cancer Center, The University of Puerto Rico, San Juan, Puerto Rico
| | - Chi-Fang Wu
- Center for Health Services Research, Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, Texas
| | - Ashish A Deshmukh
- Center for Health Services Research, Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, Texas
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19
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Ortiz-Ortiz KJ, Ramos-Cartagena JM, Deshmukh AA, Torres-Cintrón CR, Colón-López V, Ortiz AP. Squamous Cell Carcinoma of the Anus Incidence, Mortality, and Survival Among the General Population and Persons Living With HIV in Puerto Rico, 2000-2016. JCO Glob Oncol 2021; 7:133-143. [PMID: 33493020 PMCID: PMC8081504 DOI: 10.1200/go.20.00299] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/29/2020] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Squamous cell carcinoma of the anus (SCCA) is common among persons living with HIV (PLWH). We described SCCA incidence and survival among the general population and among PLWH in Puerto Rico (PR), along with mortality of anal cancer. METHODS PR HIV/AIDS Surveillance Program and the PR Central Cancer Registry databases were linked (2000-2016). Incidence rates (IRs) and trends (annual percent change [APC]) in SCCA and mortality rates and trends for anal cancer were estimated. Relative survival and relative excess risk (RER) of death were calculated. RESULTS From 2000 to 2016, 991 individuals in PR were diagnosed with anal cancer; 73% of cases were SCCA 9.1% of SCCA and 1.5% of non-SCCA cases were in PLWH (P < .0001). SCCA incidence was higher among PLWH than the general population (IR = 27.7/100,000). Among PLWH, SCCA incidence (per 100,000) was the highest among men who have sex with men (IR = 60.5). From 2001-2016, SCCA incidence increased among the general population (APC: 4.90, P < .05); however, no significant change was observed among PLWH (APC = 0.19 and P = .96). The APC for anal cancer mortality in the general population was positive (3.9%) from 2000 to 2016, but not significant (P > .05). The 5-year relative survival of SCCA was 56.9% among PLWH and 66.8% among the general population. In multivariate analysis, the RER of death for SCCA 5 years postdiagnosis was affected by stage at diagnosis (distant: RER = 7.6, 95% CI, 2.36 to 24.25) but not by PLWH status (RER = 1.4, 95% CI, 0.67 to 3.01). CONCLUSION Our findings highlight the relevance of anal cancer screening in PLWH and HPV vaccination in both PLWH and the general population in PR, which could have an impact on the disease trend in the next few decades.
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Affiliation(s)
- Karen J. Ortiz-Ortiz
- Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
- Puerto Rico Central Cancer Registry, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Jeslie M. Ramos-Cartagena
- University of Puerto Rico/MD Anderson Cancer Center Partnership for Excellence in Cancer Research Program, San Juan, Puerto Rico
| | - Ashish A. Deshmukh
- Center for Health Services Research, Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, TX
| | - Carlos R. Torres-Cintrón
- Puerto Rico Central Cancer Registry, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Vivian Colón-López
- Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Ana P. Ortiz
- Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
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Sánchez-Cabrera Y, Cardona-Cintrón Y, Soto-Salgado M, Ortiz-Ortiz KJ, Quast T, Fernández ME, Colón-López V. Abstract PO-106: “More stressful than cancer”: Treatment experiences lived during Hurricane Maria among breast and colorectal cancer patients in Puerto Rico. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp20-po-106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background: In September 2017, Hurricanes Irma and Maria devastated the Caribbean region, among them, the US territory of Puerto Rico (PR), with estimates indicating between 800 and 8,500 excess deaths related to the hurricane through the end of December 2017. This detrimental impact on human life is added to massive infrastructure and economics loss. Few studies have assessed the impact of natural disasters on chronic diseases such as cancer, since it remains uncertain how such a disruption will affect access to treatment especially those patients with breast and colorectal cancer, two of the most common cancers in incidence and mortality in PR. Therefore, the objective of this study is to evaluate factors associated with cancer care disruption and time since continuation of care in the aftermath of Hurricanes Irma and Maria. For this, we partnered with the Puerto Rico Central Cancer Registry, one of the oldest registries in America, to develop a systematic methodology to use this registry to recruit cancer patients for population-based science research.
Methods: We used a qualitative design through focus groups with cancer patients to accomplish the proposed objective. A modified grounded theory approach was used for data collection and analysis. The inclusion criteria for participating in this focus groups were the following: (1) patients ≥ 40 years old being diagnosed with breast or colorectal cancer between March-September 2017; (2) being under active cancer treatment before, during and after September 2017, and (3) lived and received treatment in PR during the aftermath of the events. Results: The most emerging topics discussed were the participants experience with their treatment during the hurricane which ranges from provisions taken prior the hurricane, such as more stocking up on medications or make earlier appointments with oncologists or providers. Although most participants described that their treatment was not affected, individual discussions led to the researchers to infer that their treatment might be delayed due to the disasters. Barriers (e.g. communication, transportation, and basic utility services (electricity and water)) were also discussed by the study participants in relation to how the lack of these will deter or interfere with access or treatment. It was mentioned that stressors related to the impact of the hurricane where more difficult to overcome, than being in active treatment during this period. Conclusions: Although participants discussed struggles in regards their experience with treatment and access to care during and after the hurricane, were stressors directly linked with the disasters which were most difficult to cope. Our data highlights the impending need to address in future emergency plans individual and system needs of cancer patients in active treatment to minimize the delay in the continuation of care.
Citation Format: Yara Sánchez-Cabrera, Yahisha Cardona-Cintrón, Marievelisse Soto-Salgado, Karen J. Ortiz-Ortiz, Troy Quast, María E. Fernández, Vivian Colón-López. “More stressful than cancer”: Treatment experiences lived during Hurricane Maria among breast and colorectal cancer patients in Puerto Rico [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-106.
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Affiliation(s)
| | | | | | | | - Troy Quast
- 3University of South Florida, Tampa, FL,
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Gómez-Vargas V, Almodóvar-Rivera I, Ortiz-Ortiz KJ, Torres-Cintrón CR, Ortiz-Martínez AP. Abstract C023: Cervical cancer survival analysis based on screening practices and the socioeconomic position index in Puerto Rico. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp19-c023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background: Cervical cancer ranks as the 7th most diagnosed cancer among women in Puerto Rico (PR). When compared to all the states and territories of the United States of America (USA), PR has the highest rate of cervical cancer. Cervical cancer is preventable through screening. While the Healthy People’s 2020 goal is a screening rate of 93%, PR falls short at 77%. There is extensive research on how women with screen-detected cancers have better survival than those whose cancer is detected symptomatically. Cancer stage is the primary prognostic factor affecting survival. Yet, stage at diagnosis is a complex interaction among many factors, including social and economic inequities. Evaluating how socioeconomic status and screening behavior affect survival will provide insight into how disparities affect health outcomes. Objective: The purpose of this study is to evaluate the effect of screening behavior and socioeconomic position on the survivorship of cervical cancer patients diagnosed in PR during the period of 2011-2014. Methods: The Puerto Rico Central Cancer Registry (PRCCR) was used to identify all incident cases of primary cervical cancer in women 21 years of age or older, determine the occurrence of the event of interest, and obtain study variables. The database acquired through the PRCCR was linked with health insurance data claims. Through this linkage, cervical cancer screening behavior was documented for at least 3 years before patients’ diagnosis. From 937 patients with primary cervical cancer diagnosed during this period, 44% (n=408) were included for this analysis as they had complete information on insurance coverage during the past 3 years (continuous enrollment) and had a microscopically confirmed diagnosis. These patients were followed up to 2017 in order to measure 3-year survival. The Kaplan-Meier Method was used to describe 3-year survival. Also, the Cox Model was used to estimate the risk of death from cervical cancer depending on screening behavior, while controlling for potential confounders. Results: Over half of the patients (52.7%) were insured by Medicaid, 41.2% resided in the area of lowest socioeconomic position (SEP), and only 72.1% were screened 3 years before their diagnosis. Although there weren’t any observable differences in survival curves by SEP, 3-year survival was 77% (95% CI 71.3-81.0) among screened patients and 60% (95% CI 50.1-84.6) among unscreened patients. The overall 25th percentile survival time was about 31 months. The 25th percentile survival time was higher for screened patients (42 months) when compared to unscreened patients (14 months). After controlling for age, stage, histology, and tumor stage, screened patients had lower risk of death when compared to unscreened patients (HR= 0.53, 95% CI 0.4-0.8). Conclusions: Screening behavior is an important predictor in cervical cancer survival. Study findings highlight the relevance to continue increasing compliance with screening guidelines in PR in order to positively impact patient survival.
Citation Format: Vanessa Gómez-Vargas, Israel Almodóvar-Rivera, Karen J Ortiz-Ortiz, Carlos R Torres-Cintrón, Ana P Ortiz-Martínez. Cervical cancer survival analysis based on screening practices and the socioeconomic position index in Puerto Rico [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C023.
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Affiliation(s)
- Vanessa Gómez-Vargas
- 1Graduate School of Public Health, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico,
| | - Israel Almodóvar-Rivera
- 1Graduate School of Public Health, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico,
| | - Karen J Ortiz-Ortiz
- 2Puerto Rico Central Cancer Registry, Cancer Control and Population Sciences Division, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico,
| | - Carlos R Torres-Cintrón
- 3Puerto Rico Central Cancer Registry, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico,
| | - Ana P Ortiz-Martínez
- 4Graduate School of Public Health, University of Puerto Rico Medical Sciences Campus, Cancer Control and Population Sciences Division, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
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Castañeda-Avila M, Torres-Cintrón CR, Cruz-Benítez A, Fuentes-Payán W, Maldonado-Albertorio A, Nieves-Ferrer L, Padró-Juarbe P, Soto-Abreu R, Perez-Ríos N, Ortiz-Ortiz KJ, Magno P, Ortiz AP. Pancreatic Cancer Incidence, Mortality, and Survival in Puerto Rico, 2001-2015. P R Health Sci J 2019; 38:148-155. [PMID: 31536627 PMCID: PMC8330132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To perform an epidemiologic profile of pancreatic cancer (PC) in Puerto Rico (PR) with data gathered from 2001 to 2015. METHODS Using data from the PR Central Cancer Registry we estimated incidence and mortality rates and trends of PC in PR, and performed survival analyses. We also compared the age-standardized incidence and mortality rates of PC in people in PR with those of Hispanics, non-Hispanic whites, and non Hispanic blacks in the United States (US). RESULTS From 2011 to 2015, 7.8 per 100,000 persons were diagnosed with PC in PR; higher rates were observed in men than in women (9.2 vs. 6.7 per 100,000, respectively) and in persons 65 years old and older (42.7 per 100,000 persons). For the same period, 6.7 per 100,000 persons died from PC; men and persons 65 years and older had higher mortality rates. Incidence and mortality trends of PC in PR increased from 2001-2015 (annual percent change [APC] = 3.8% and 1.9%, respectively (p<0.05). Lower risk of being diagnosed with and dying from PC was seen in PR than in members of several racial/ethnic groups in the US. The median survival time for PC cases diagnosed in PR during the period of 2008 to 2012 was 5.3 months. CONCLUSION We observed increasing mortality rates and low survival in PC patients in PR. Research on access and response to treatment is needed to elucidate the reasons for the observed results and have a positive impact on PC burden and survival.
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Affiliation(s)
- M Castañeda-Avila
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico Medical Sciences Campus, San Juan, PR
| | - C R Torres-Cintrón
- Puerto Rico Central Cancer Registry, University of Puerto Rico Comprehensive Cancer Center
| | - A Cruz-Benítez
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico Medical Sciences Campus, San Juan, PR
| | - W Fuentes-Payán
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico Medical Sciences Campus, San Juan, PR
| | - A Maldonado-Albertorio
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico Medical Sciences Campus, San Juan, PR
| | - L Nieves-Ferrer
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico Medical Sciences Campus, San Juan, PR
| | - P Padró-Juarbe
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico Medical Sciences Campus, San Juan, PR
| | - R Soto-Abreu
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico Medical Sciences Campus, San Juan, PR
| | - N Perez-Ríos
- Cancer Control and Population Sciences Program, University of Puerto Rico Comprehensive Cancer Center
| | - K J Ortiz-Ortiz
- Cancer Control and Population Sciences Program, University of Puerto Rico Comprehensive Cancer Center
| | - P Magno
- Cancer Medicine Program, University of Puerto Rico Comprehensive Cancer Center
| | - A P Ortiz
- Cancer Control and Population Sciences Program, University of Puerto Rico Comprehensive Cancer Center
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Tortolero-Luna G, Torres-Cintrón CR, Alvarado-Ortiz M, Ortiz-Ortiz KJ, Zavala-Zegarra DE, Mora-Piñero E. Incidence of thyroid cancer in Puerto Rico and the US by racial/ethnic group, 2011-2015. BMC Cancer 2019; 19:637. [PMID: 31253133 PMCID: PMC6599344 DOI: 10.1186/s12885-019-5854-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 06/19/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Puerto Rico has the highest incidence rate of thyroid cancer (TC) in the Americas and the third highest rate worldwide. The purpose of this study was to compare the burden of TC between the population of PR and United States (US) non-Hispanic Whites (NHW), non-Hispanic Blacks (NHB), and US Hispanics (USH) during the period 2011-2015. METHODS TC data for the period 2011-2015 was obtained from the Puerto Rico Central Cancer Registry (PRCCR) and the Surveillance Epidemiology and Ends Results Program (SEER) 18 Registries Research Data. TC was categorized in: papillary carcinoma (PTC), and other TC histologic types. Data was analyzed by sex, age groups, and histologic type. Racial/ethnic differences by sex, age, and histologic types were assessed using the Standardized Rate Ratio (SRR) and its 95% CI. RESULTS During the period 2011-2015 there were 5175 and 65,528 cases of TC diagnosed in PR and the US, respectively. The overall age-adjusted incidence rate of PTC was almost two-fold higher in PR than in the US (25.8/100,000 vs. 12.9/100,000). Among PR women, the incidence rate of PTC was 40.0/100,000 compared to 19.4/100,000 in US. PR women had 83% increased risk of being diagnosed with PTC than NHW women, a 2.25-fold increased risk than USH, and 3.45-fold increased risk than NHB women. For men, PR had 34% increased risk of being diagnosed with PTC than NHW men, 2.2-fold increased risk than USH men, and 3.2-fold higher risk than in NHB men. CONCLUSION Further research is needed to understand this disparity in the island. This research should address the extent of overdiagnosis in PR, the role of health insurance status and insurance type, characteristics of the healthcare delivery system as well as the role of patient and environmental factors.
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Affiliation(s)
- Guillermo Tortolero-Luna
- Puerto Rico Central Cancer Registry, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
- Division of Cancer Control and Population Sciences, University of Puerto Rico, Comprehensive Cancer Center, PO Box 70344, San Juan, PR 00936-8344 Puerto Rico
| | - Carlos R. Torres-Cintrón
- Puerto Rico Central Cancer Registry, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Mariela Alvarado-Ortiz
- Puerto Rico Central Cancer Registry, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
- Department of Social Sciences, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Karen J. Ortiz-Ortiz
- Puerto Rico Central Cancer Registry, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
- Division of Cancer Control and Population Sciences, University of Puerto Rico, Comprehensive Cancer Center, PO Box 70344, San Juan, PR 00936-8344 Puerto Rico
| | - Diego E. Zavala-Zegarra
- Puerto Rico Central Cancer Registry, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Edna Mora-Piñero
- Division of Cancer Control and Population Sciences, University of Puerto Rico, Comprehensive Cancer Center, PO Box 70344, San Juan, PR 00936-8344 Puerto Rico
- Department of Surgery, School of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
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Castañeda-Avila MA, Ortiz-Ortiz KJ, Torres-Cintrón CR, Birmann BM, Epstein MM. Trends in cause of death among patients with multiple myeloma in Puerto Rico and the United States SEER population, 1987-2013. Int J Cancer 2019; 146:35-43. [PMID: 30802944 DOI: 10.1002/ijc.32232] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 01/25/2019] [Accepted: 02/01/2019] [Indexed: 01/10/2023]
Abstract
Multiple myeloma (MM) survival has improved due to recent developments in MM treatment. As a result, other co-morbid conditions may be of increasing importance to MM patients' long-term survival. This study examines trends in common causes of death among patients with MM in Puerto Rico, and in the US Surveillance, Epidemiology, and End Results (SEER) population. We analyzed the primary cause of death among incident MM cases recorded in the Puerto Rico Central Cancer Registry (n = 3,018) and the US SEER Program (n = 67,733) between 1987 and 2013. We calculated the cumulative incidence of death due to the eight most common causes and analyzed temporal trends in mortality rates using joinpoint regression. Analyses of SEER were also stratified by Hispanic ethnicity. MM accounted for approximately 72% of all reported deaths among persons diagnosed with MM in Puerto Rico and in SEER. In both populations, the proportion of patients who died from MM decreased with increasing time since diagnosis. Age-standardized temporal trends showed a decreased MM-specific mortality rate among US SEER (annual percent change [APC] = -5.0) and Puerto Rican (APC = -1.8) patients during the study period, and particularly after 2003 in non-Hispanic SEER patients. Temporal decline in non-MM causes of death was also observed among US SEER (APC = -2.1) and Puerto Rican (APC = -0.1) populations. MM-specific mortality decreased, yet remained the predominant cause of death for individuals diagnosed with MM over a 26-year period. The most pronounced decreases in MM-specific death occurred after 2003, which suggests a possible influence of more recently developed MM therapies.
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Affiliation(s)
- Maira A Castañeda-Avila
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Karen J Ortiz-Ortiz
- Puerto Rico Central Cancer Registry, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Carlos R Torres-Cintrón
- Puerto Rico Central Cancer Registry, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Brenda M Birmann
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Mara M Epstein
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA.,Meyers Primary Care Institute and the Department of Medicine, University of Massachusetts Medical School, Worcester, MA
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Castañeda-Avila MA, Ortiz-Ortiz KJ, Torres-Cintrón CR, Epstein MM. Abstract A32: Trends in cause of death among Puerto Rican and United States multiple myeloma patients. Cancer Epidemiol Biomarkers Prev 2018. [DOI: 10.1158/1538-7755.disp17-a32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background/objective: Multiple myeloma (MM) is an incurable, yet treatable, cancer of plasma cells. Due to recent improvements in treatment, people diagnosed with MM have been living longer, and other comorbid conditions may be of increasing importance. This study examines temporal trends in specific causes of death among MM patients in Puerto Rico (PR) and the United States (U.S.).
Methods: We analyzed primary cause of death among all incident MM cancer cases recorded in the Puerto Rico Central Cancer Registry (PRCCR) (n=3,018) and the US Surveillance, Epidemiology, and End Results Program (SEER) (n=67,733) between 1987-2013, overall and by follow-up time, age, and sex. We calculated the cumulative incidence of death due to seven selected causes and analyzed age-adjusted mortality trends by MM and other causes using joinpoint regression.
Results: MM accounted for 71.7% and 71.3% of all reported deaths in PR and the U.S., respectively, among people diagnosed with MM. In PR, the proportion of patients who died from MM decreased with increasing follow-up time since diagnosis (72.3% of deaths with ≤2 years vs 65.6% with >5 years of follow-up) and the proportion of patients who died from circulatory (4.6% vs 9.0%) and respiratory system (3.7% vs 5.0%) diseases increased slightly. A similar trend of decreasing MM deaths with follow-up time was observed in the U.S. (73.2% of deaths with ≤2 years vs 66.5% with >5 years of follow-up). Joinpoint regression showed a decreasing trend in MM mortality in the U.S. and PR.
Conclusion: In both PR and the U.S., people diagnosed with MM are still more likely to die from MM than from another cause. However, a decrease in MM mortality is evident, particularly in more recent years, but this decrease is lower in Puerto Rico.
Citation Format: Maira A. Castañeda-Avila, Karen J. Ortiz-Ortiz, Carlos R. Torres-Cintrón, Mara M. Epstein. Trends in cause of death among Puerto Rican and United States multiple myeloma patients [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr A32.
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Affiliation(s)
| | - Karen J. Ortiz-Ortiz
- 2Puerto Rico Central Cancer Registry, University of Puerto Rico, San Juan, Puerto Rico
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Ortiz-Ortiz KJ, Tortolero-Luna G, Ríos-Motta R, Veintidós-Feliú A, Hunter-Mellado R, Torres-Cintrón CR, Suárez-Ramos T, Magno P. Use of adjuvant chemotherapy in patients with stage III colon cancer in Puerto Rico: A population-based study. PLoS One 2018; 13:e0194415. [PMID: 29584752 PMCID: PMC5870969 DOI: 10.1371/journal.pone.0194415] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 03/03/2018] [Indexed: 12/27/2022] Open
Abstract
Objective This study aims to examine factors associated with the use of adjuvant chemotherapy and the use of oxaliplatin after curative resection in stage III colon cancer patients and assesses the effect of their use in three-year survival. Methods This retrospective cohort study was conducted using Puerto Rico Central Cancer Registry-Health Insurance Linkage Database. The study cohort consisted of stage III colon cancer patients with a curative surgery in the period 2008–2012. Multivariate logistic regression was used to estimate adjusted odds ratios. Kaplan-Meier methods and Cox proportional hazards models were used to assess the association between adjuvant chemotherapy and oxaliplatin use and overall survival and risk of death, respectively. Results Overall, 75% of the study population received adjuvant chemotherapy during the study period. Factors statistically associated with receiving adjuvant chemotherapy within four months after resection included being married (adjusted odds ratio [AOR] 1.64; 95% CI 1.18–2.28; p = 0.003), and being enrolled in Medicare (AOR 1.68; 95% CI: 1.03–2.75; p = 0.039) or Medicaid and Medicare dual eligible (AOR 1.66; 95% CI: 1.06–2.60; p = 0.028). However, patients aged ≥70 years were less likely to receive adjuvant chemotherapy (AOR 0.22; 95%CI 0.14–0.36; p<0.001). Discussion We observed a significant reduction in mortality in adjuvant chemotherapy treated patients. Similarly, patients <70 years treated with oxaliplatin had significantly lower risk of death than those who did not, although for patients ≥70 years no statistical significance was achieved. Future studies should assess effective interventions to reduce barriers to access guideline-based recommended colon cancer treatment.
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Affiliation(s)
- Karen J Ortiz-Ortiz
- Cancer Control and Population Sciences Program, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico.,Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico0
| | - Guillermo Tortolero-Luna
- Cancer Control and Population Sciences Program, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico.,Puerto Rico Central Cancer Registry, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Ruth Ríos-Motta
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico0
| | | | - Robert Hunter-Mellado
- Division of Cancer Medicine, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Carlos R Torres-Cintrón
- Puerto Rico Central Cancer Registry, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Tonatiuh Suárez-Ramos
- College of Natural Science, University of Puerto Rico, Río Piedras Campus, San Juan, Puerto Rico
| | - Priscilla Magno
- Division of Cancer Medicine, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
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Ortiz AP, Ortiz-Ortiz KJ, Ríos M, Laborde J, Kulkarni A, Pillsbury M, Lauschke A, Monsanto HA, Marques-Goyco C. Modelling the effects of quadrivalent Human Papillomavirus (HPV) vaccination in Puerto Rico. PLoS One 2017; 12:e0184540. [PMID: 29190725 PMCID: PMC5708664 DOI: 10.1371/journal.pone.0184540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 08/25/2017] [Indexed: 11/18/2022] Open
Abstract
Background No study has estimated the potential impact of Human Papillomavirus (HPV) vaccination in Puerto Rico, a population with considerable burden of HPV-related morbidities. We evaluated the health and economic impacts of implementing a vaccination strategy for females and males in Puerto Rico, with the quadrivalent HPV (HPV4) vaccine, under different vaccination scenarios. Methods We adapted a mathematical model which estimates the direct and indirect health benefits and costs of HPV4 vaccination in a dynamic population. The model compared three vaccination scenarios against screening only (no-vaccination) for three doses of HPV4 vaccine among individuals aged 11–15 years in Puerto Rico: 1) 34% for females and 13% for males (34%F/13%M), 2) 50% for females and 40% for males (50%F/40%M), and 3) 80% for female and 64% for male (80%F/64%M). Data specific to Puerto Rico was used. When not available, values from the United States were used. Input data consisted of demographic, behavioral, epidemiological, screening, and economic parameters. Results The model predicted decreases in: 1) HPV infection prevalence for females and males, 2) cervical intraepithelial neoplasia and cervical cancer incidence for females, 3) genital warts incidence for females and males, and 4) cervical cancer deaths among females, when various vaccination program scenarios were considered. In addition, when the vaccination percentage was increased in every scenario, the reduction was greater and began earlier. The analysis also evidenced an incremental cost effectiveness ratio (ICER) of $1,964 per quality–adjusted life year gained for the 80%F/64%M uptake scenario. Conclusions HPV vaccine can prove its cost effectiveness and substantially reduce the burden and costs associated to various HPV-related conditions when targeted to the adequate population together with an organized HPV vaccination program.
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Affiliation(s)
- Ana Patricia Ortiz
- Cancer Control and Population Sciences Program, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
- Graduate School of Public Health, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
- * E-mail:
| | - Karen J. Ortiz-Ortiz
- Cancer Control and Population Sciences Program, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Moraima Ríos
- Graduate School of Public Health, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - José Laborde
- Department of Economics, University of Puerto Rico, Rio Piedras Campus, San Juan, Puerto Rico
| | - Amit Kulkarni
- Merck & Co., Inc., Kenilworth, New Jersey, United States of America
| | | | - Andreas Lauschke
- Lauschke Consulting, New York, New York, United States of America
| | - Homero A. Monsanto
- Health Outcomes Research Regional Lead, Latin America Medical Affairs, Merck & Co, San Juan, Puerto Rico
| | - Cecile Marques-Goyco
- Health Outcomes Research Regional Lead, Latin America Medical Affairs, Merck & Co, San Juan, Puerto Rico
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Chance WW, Ortiz-Ortiz KJ, Liao KP, Zavala Zegarra DE, Stauder MC, Giordano SH, Tortolero-Luna G, Guadagnolo BA. Underuse of Radiation Therapy After Breast Conservation Surgery in Puerto Rico: A Puerto Rico Central Cancer Registry-Health Insurance Linkage Database Study. J Glob Oncol 2017; 4:1-9. [PMID: 30241162 PMCID: PMC6180809 DOI: 10.1200/jgo.2016.008664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Purpose To identify rates of postoperative radiation therapy (RT) after breast
conservation surgery (BCS) in women with stage I or II invasive breast
cancer treated in Puerto Rico and to examine the sociodemographic and health
services characteristics associated with variations in receipt of RT. Methods The Puerto Rico Central Cancer Registry–Health Insurance Linkage
Database was used to identify patients diagnosed with invasive breast cancer
between 2008 and 2012 in Puerto Rico. Claims codes identified the type of
surgery and the use of RT. Logistic regression models were used to examine
the independent association between sociodemographic and clinical
covariates. Results Among women who received BCS as their primary definitive treatment, 64%
received adjuvant RT. Significant predictors of RT after BCS included
enrollment in Medicare (odds ratio [OR], 2.14; 95% CI, 1.46 to 3.13;
P ≤ .01) and dual eligibility for Medicare and
Medicaid (OR, 1.61; 95% CI, 1.14 to 2.27; P < .01).
In addition, it was found that RT was more likely to have been received in
certain geographic locations, including the Metro-North (OR, 2.20; 95% CI,
1.48 to 3.28; P < .01), North (OR, 1.78; 95% CI,
1.20 to 2.64; P < .01), West (OR, 4.04; 95% CI, 2.61
to 6.25; P < .01), and Southwest (OR, 2.79; 95% CI,
1.70 to 4.59; P < .01). Furthermore, patients with
tumor size > 2.0 cm and ≤ 5.0 cm (OR, 0.61; 95% CI, 0.40 to
0.93; P = .02) and those with tumor size > 5.0 cm
(OR, 0.37; 95% CI, 0.15 to 0.92; P = .03) were found to be
significantly less likely to receive RT. Conclusion Underuse of RT after BCS was identified in Puerto Rico. Patients enrolled in
Medicare and those who were dually eligible for Medicaid and Medicare were
more likely to receive RT after BCS compared with patients with Medicaid
alone. There were geographic variations in the receipt of RT on the
island.
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Affiliation(s)
- William W Chance
- William W. Chance, Kai-Ping Liao, Michael C. Stauder, Sharon H. Giordano, and B. Ashleigh Guadagnolo, The University of Texas MD Anderson Cancer Center, Houston, TX; and Karen J. Ortiz-Ortiz, Diego E. Zavala Zegarra, and Guillermo Tortolero-Luna, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Karen J Ortiz-Ortiz
- William W. Chance, Kai-Ping Liao, Michael C. Stauder, Sharon H. Giordano, and B. Ashleigh Guadagnolo, The University of Texas MD Anderson Cancer Center, Houston, TX; and Karen J. Ortiz-Ortiz, Diego E. Zavala Zegarra, and Guillermo Tortolero-Luna, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Kai-Ping Liao
- William W. Chance, Kai-Ping Liao, Michael C. Stauder, Sharon H. Giordano, and B. Ashleigh Guadagnolo, The University of Texas MD Anderson Cancer Center, Houston, TX; and Karen J. Ortiz-Ortiz, Diego E. Zavala Zegarra, and Guillermo Tortolero-Luna, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Diego E Zavala Zegarra
- William W. Chance, Kai-Ping Liao, Michael C. Stauder, Sharon H. Giordano, and B. Ashleigh Guadagnolo, The University of Texas MD Anderson Cancer Center, Houston, TX; and Karen J. Ortiz-Ortiz, Diego E. Zavala Zegarra, and Guillermo Tortolero-Luna, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Michael C Stauder
- William W. Chance, Kai-Ping Liao, Michael C. Stauder, Sharon H. Giordano, and B. Ashleigh Guadagnolo, The University of Texas MD Anderson Cancer Center, Houston, TX; and Karen J. Ortiz-Ortiz, Diego E. Zavala Zegarra, and Guillermo Tortolero-Luna, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Sharon H Giordano
- William W. Chance, Kai-Ping Liao, Michael C. Stauder, Sharon H. Giordano, and B. Ashleigh Guadagnolo, The University of Texas MD Anderson Cancer Center, Houston, TX; and Karen J. Ortiz-Ortiz, Diego E. Zavala Zegarra, and Guillermo Tortolero-Luna, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Guillermo Tortolero-Luna
- William W. Chance, Kai-Ping Liao, Michael C. Stauder, Sharon H. Giordano, and B. Ashleigh Guadagnolo, The University of Texas MD Anderson Cancer Center, Houston, TX; and Karen J. Ortiz-Ortiz, Diego E. Zavala Zegarra, and Guillermo Tortolero-Luna, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - B Ashleigh Guadagnolo
- William W. Chance, Kai-Ping Liao, Michael C. Stauder, Sharon H. Giordano, and B. Ashleigh Guadagnolo, The University of Texas MD Anderson Cancer Center, Houston, TX; and Karen J. Ortiz-Ortiz, Diego E. Zavala Zegarra, and Guillermo Tortolero-Luna, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
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Ortiz-Ortiz KJ, Ríos-Motta R, Marín-Centeno H, Cruz-Correa M, Ortiz AP. Factors associated with late stage at diagnosis among Puerto Rico's government health plan colorectal cancer patients: a cross-sectional study. BMC Health Serv Res 2016; 16:344. [PMID: 27488381 PMCID: PMC4971714 DOI: 10.1186/s12913-016-1590-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 07/27/2016] [Indexed: 11/13/2022] Open
Abstract
Background Late stage at diagnosis of cancer is considered a key predictor factor for a lower survival rate. Knowing and understanding the barriers to an early diagnosis of colorectal cancer is critical in the fight to reduce the social and economic burden caused by cancer in Puerto Rico. This study evaluates factors associated to colorectal cancer stage at diagnosis among Puerto Rico’s Government Health Plan (GHP) patients. Methods We conducted a cross-sectional study based on a secondary data analysis using information from the Puerto Rico Central Cancer Registry (PRCCR) and the Puerto Rico Health Insurance Administration (PRHIA). Logistic regression models were used to estimate the unadjusted odds ratio (ORs) and adjusted odds ratio (AORs), and their 95 % confidence intervals (CIs). Colorectal cancer cases diagnosed between January 1, 2012 and December 31, 2012, among persons 50 to 64 years of age, participants of the GHP and with a cancer diagnosis reported to the PRCCR were included in the study. Results There were 68 (35.79 %) colorectal cancer patients diagnosed at early stage while 122 (64.21 %) where diagnosed at late stage. In the multivariate analysis having a diagnostic delay of more than 59 days (AOR 2.94, 95 % CI: 1.32 to 6.52) and having the first visit through the emergency room (AOR 3.48, 95 % CI: 1.60 to 7.60) were strong predictors of being diagnosed with colorectal cancer at a late stage. Conclusions These results are relevant to understand the factors that influence the outcomes of colorectal cancer patients in the GHP. Therefore, it is important to continue developing studies to understand the Government Health Plan patient’s pathways to a cancer diagnosis, in order to promote assertive decisions to improve patient outcomes.
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Affiliation(s)
- Karen J Ortiz-Ortiz
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico. .,Cancer Control and Population Sciences Program, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico.
| | - Ruth Ríos-Motta
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Heriberto Marín-Centeno
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Marcia Cruz-Correa
- Department of Surgery, Biochemistry and Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Ana Patricia Ortiz
- Cancer Control and Population Sciences Program, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico.,Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
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Ortiz-Ortiz KJ, Ríos-Motta R, Marín-Centeno H, Cruz-Correa MR, Ortiz AP. Emergency Presentation and Short-Term Survival Among Patients With Colorectal Cancer Enrolled in the Government Health Plan of Puerto Rico. Health Serv Res Manag Epidemiol 2016; 3:2333392816646670. [PMID: 28462276 PMCID: PMC5266457 DOI: 10.1177/2333392816646670] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 04/05/2016] [Indexed: 12/31/2022] Open
Abstract
Objective: In this study, we examine factors associated with the use of the emergency room (ER) as an entry point into the health-care system to initiate a cancer diagnosis among Puerto Rico’s Government Health Plan (GHP) patients and compare the 1-year survival of GHP patients that initiated cancer diagnosis in the emergency room (ER) presentation with those that initiated the diagnosis in a physician’s office. Methods: Data for patients with colorectal cancer (CRC) aged 50 to 64 years and diagnosed in 2012 were obtained from the Puerto Rico Central Cancer Registry and linked to the Puerto Rico Health Insurance Administration database (n = 190). Crude odds ratio, adjusted odds ratio, and their 95% confidence intervals were reported. We used the Kaplan-Meier method to generate survival curves. Multivariate Cox regression analysis was performed to evaluate the association between ER presentation and 1-year cause-specific survival. Results: We found that 37.37% of the study population had an ER presentation. Male patients had a higher occurrence of having an ER presentation (66.20%), while 76.06% of the patients with an ER presentation were diagnosed in late stage. Emergency room presentation was a highly predictive factor for cancer mortality in the year following the diagnosis. These patients had between 3.99 to 4.24 times higher mortality risk than non-ER presentation patients (P < .05). Conclusion: Late presentation for CRC diagnosis through an ER visit is a significant concern that influences negatively on the patient’s outcome. Efforts at increasing primary care visits and routine screening tests among GHP beneficiaries could improve survival.
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Affiliation(s)
- Karen J Ortiz-Ortiz
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, PR, USA.,Cancer Control and Population Sciences Program, University of Puerto Rico Comprehensive Cancer Center, San Juan, PR, USA
| | - Ruth Ríos-Motta
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, PR, USA
| | - Heriberto Marín-Centeno
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, PR, USA
| | - Marcia R Cruz-Correa
- Department of Gastrointestinal Oncology and Genetics, University of Puerto Rico Comprehensive Cancer Center, San Juan, PR, USA
| | - Ana P Ortiz
- Cancer Control and Population Sciences Program, University of Puerto Rico Comprehensive Cancer Center, San Juan, PR, USA.,Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, PR, USA
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Castañeda-Ávila M, Cruz-Benítez A, Fuentes-Payán W, Maldonado-Albertorio A, Nieves-Ferrer L, Padró-Juarbe P, Soto-Abreu R, Pérez-Ríos N, Torres-Cintrón CR, Ortiz-Ortiz KJ, Ortiz Martinez AP. Epidemiology of Pancreatic Cancer in Puerto Rico (1987-2010): Incidence, Mortality and Survival. Austin J Gastroenterol 2016; 3:1058. [PMID: 34368452 PMCID: PMC8341429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND & OBJECTIVE Pancreatic cancer is an uncommon type of cancer worldwide. Nonetheless, even with early diagnosis, mortality rates are high. This study aims to perform an epidemiologic profile of pancreatic cancer in Puerto Rico (PR) from 1987-2010. METHODS Using data from the Puerto Rico Central Cancer Registry, age-standardized incidence and mortality rates of pancreatic cancer in PR were compared with Hispanics, non-Hispanic Whites, and non-Hispanic Blacks in the United States of America (USA). Incidence and mortality trends of pancreatic cancer were estimated, and survival analyses were also performed. RESULTS In 2005-2010, 5.8 per 100,000 persons were diagnosed with pancreatic cancer in PR and mortality rates were similar. Pancreatic cancer was more frequent in men (6.5 per 100,000 men) than women (5.2 per 100,000 women), and in persons older than 65 years (32.0 per 100,000 persons). Moreover, the median survival for the people diagnosed with pancreatic cancer in PR during 2006-2007 was 4 months and at the end of the third year after diagnosis, only 13% of the patients survived. Incidence trends of pancreatic cancer showed an increase for men (APC=13.0%, p<0.05) from 2006 to 2010, but not for women (APC=-0.4, p>0.05). However, mortality trends showed a slight decrease for men (APC=-1.0%, p<0.05), but not for women (APC=1.4, p>0.05) in the period of 1987 to 2010. Meanwhile, Puerto Ricans in comparison to other racial/ethnic groups living in the USA showed a lower risk for being diagnosed and of dying from pancreatic cancer. CONCLUSION Our results highlight the need for additional research in pancreatic cancer, in order to have an impact in disease survival in PR.
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Affiliation(s)
- M Castañeda-Ávila
- Department of Biostatistics and Epidemiology, University of Puerto Rico, Puerto Rico
| | - A Cruz-Benítez
- Department of Biostatistics and Epidemiology, University of Puerto Rico, Puerto Rico
| | - W Fuentes-Payán
- Department of Biostatistics and Epidemiology, University of Puerto Rico, Puerto Rico
| | | | - L Nieves-Ferrer
- Department of Biostatistics and Epidemiology, University of Puerto Rico, Puerto Rico
| | - P Padró-Juarbe
- Department of Biostatistics and Epidemiology, University of Puerto Rico, Puerto Rico
| | - R Soto-Abreu
- Department of Biostatistics and Epidemiology, University of Puerto Rico, Puerto Rico
| | - N Pérez-Ríos
- Puerto Rico Central Cancer Registry, University of Puerto Rico, Puerto Rico
| | - C R Torres-Cintrón
- Puerto Rico Central Cancer Registry, University of Puerto Rico, Puerto Rico
| | - K J Ortiz-Ortiz
- Puerto Rico Central Cancer Registry, University of Puerto Rico, Puerto Rico
| | - A P Ortiz Martinez
- Department of Biostatistics and Epidemiology, University of Puerto Rico, Puerto Rico
- Cancer Control and Population Sciences Program, University of Puerto Rico, Puerto Rico
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O’Neil ME, Henley SJ, Singh SD, Wilson RJ, Ortiz-Ortiz KJ, Ríos NP, Torres Cintrón CR, Luna GT, Zavala Zegarra DE, Ryerson AB. Invasive cancer incidence - Puerto Rico, 2007-2011. MMWR Morb Mortal Wkly Rep 2015; 64:389-93. [PMID: 25879898 PMCID: PMC5779544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
UNLABELLED Cancer is a leading cause of morbidity and death in Puerto Rico. To set a baseline for identifying new trends and patterns of cancer incidence, Puerto Rico Central Cancer Registry staff and CDC analyzed data from Puerto Rico included in U.S. Cancer Statistics (USCS) for 2007-2011, the most recent data available. This is the first report of invasive cancer incidence rates for 2007-2011 among Puerto Rican residents by sex, age, cancer site, and municipality. Cancer incidence rates in Puerto Rico were compared with those in the U.S. population for 2011. A total of 68,312 invasive cancers were diagnosed and reported in Puerto Rico during 2007-2011. The average annual incidence rate was 330 cases per 100,000 persons. The cancer sites with the highest cancer incidence rates included prostate (152), female breast (84), and colon and rectum (43). Cancer incidence rates varied by municipality, particularly for prostate, lung and bronchus, and colon and rectum cancers. In 2011, cancer incidence rates in Puerto Rico were lower for all cancer sites and lung and bronchus, but higher for prostate and thyroid cancers, compared with rates within the U.S. POPULATION Identifying these variations can aid evaluation of factors associated with high incidence, such as cancer screening practices, and development of targeted cancer prevention and control efforts. Public health professionals can monitor cancer incidence trends and use these findings to evaluate the impact of prevention efforts, such as legislation prohibiting tobacco use in the workplace and public places and the Puerto Rico Cessation Quitline in decreasing lung and other tobacco-related cancers.
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Affiliation(s)
- Mary Elizabeth O’Neil
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - S. Jane Henley
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Simple D. Singh
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Reda J. Wilson
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | | | | | | | | | | | - A. Blythe Ryerson
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC
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Ortiz-Ortiz KJ, Ortiz-Martínez de Andino JJ, Torres-Cintrón CR, Tirado-Gómez M, González-Falero A, Caballero-Varona D, Ortiz AP, Pérez-Ríos N. Effect of type of health insurance coverage on leukemia survival in adults in Puerto Rico. P R Health Sci J 2014; 33:132-135. [PMID: 25244883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE In Puerto Rico, leukemia is among the top 10 cancers in terms of incidence and mortality. The aim of the study described herein was to establish the overall leukemia survival rate in Puerto Rico and determine whether there are differences in leukemia survival by type of health insurance coverage. METHODS Data for adult patients (aged > or = 20 years) diagnosed with leukemia were provided by the Puerto Rico Central Cancer Registry. The relative survival rates (1, 3, and 5 years) were estimated for leukemia patients (diagnosed from 2004 through 2006) by type of health insurance (government health plan [GHP] or non-government health plan [NGHP]). Relative survival is defined as observed survival in the cohort divided by expected survival in the cohort. A Poisson regression model was used to analyze the relative excess risk of death for both the GHP and the NGHP groups. RESULTS A total of 516 leukemia patients were eligible for analysis. The overall survival rates of leukemia patients in PR for 1, 3, and 5 years after diagnosis were 55.8%, 40.5%, and 34.7%, respectively. Relative survival rates were lower for patients with GHP (1 year = 52.8%; 3 years = 36.4%; 5 years = 32.2%) than they were in people with NGHP (1 year = 57.5%; 3 years = 42.8%; 5 years = 36.1%). Among patients aged 65+ years, those with GHP had a 1.58-fold (95% CI: 1.11-2.27) higher risk of death than did those patients with NGHP. CONCLUSION Several factors could explain the disparities observed in leukemia survival rates (as grouped by health insurance status) in PR. Some of them include differences in patterns of healthcare coverage, in delays in treatment, in quality of service, in risk factors, and co-morbidities present in the older population studied.
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Ortiz-Ortiz KJ, Ramírez-García R, Cruz-Correa M, Ríos-González MY, Ortiz AP. Effects of type of health insurance coverage on colorectal cancer survival in Puerto Rico: a population-based study. PLoS One 2014; 9:e96746. [PMID: 24796444 PMCID: PMC4010542 DOI: 10.1371/journal.pone.0096746] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Accepted: 04/10/2014] [Indexed: 11/18/2022] Open
Abstract
Colorectal cancer represents a major health problem and an important economic burden in Puerto Rico. In the 1990's, the Commonwealth of Puerto Rico implemented a health care reform through the privatization of the public health system. The goal was to ensure access to health services, eliminate disparities for medically indigent citizens and provide special coverage for high-risk conditions such as cancer. This study estimates the 5-year relative survival rate of colorectal cancer and the relative excess risk of death in Puerto Rico for 2004-2005, by type of health insurance coverage; Government Health Plan vs. Non-Government Health Plan. Colorectal cancer in advanced stages was more common in Government Health Plan patients compared with Non-Government Health Plan patients (44.29% vs. 40.24 had regional extent and 13.58% versus 10.42% had distant involvement, respectively). Government Health Plan patients in the 50-64 (RR = 6.59; CI: 2.85-15.24) and ≥65 (RR = 2.4; CI: 1.72-4.04) age-groups had the greater excess risk of death compared with Non-Government Health Plan patients. Further studies evaluating the interplay of access to health services and the barriers affecting the Government Health Plan population are warranted.
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Affiliation(s)
- Karen J. Ortiz-Ortiz
- Puerto Rico Central Cancer Registry, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Roberto Ramírez-García
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Marcia Cruz-Correa
- University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Moraima Y. Ríos-González
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Ana Patricia Ortiz
- Cancer Control and Population Sciences Program, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
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Ortiz AP, Ortiz-Ortiz KJ, Traverso-Ortiz M, Ríos MY, Colón-López V, Palefsky JM. Anal cancer trends in Puerto Rico from 1985 to 2005: the potential impact of the AIDS epidemic. AIDS Patient Care STDS 2014; 28:165-7. [PMID: 24660788 DOI: 10.1089/apc.2013.0365] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Ana Patricia Ortiz
- University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
- Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico (UPR), San Juan, Puerto Rico
| | - Karen J. Ortiz-Ortiz
- University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
- Puerto Rico Central Cancer Registry, San Juan, Puerto Rico
- Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico (UPR), San Juan, Puerto Rico
| | - Maricarmen Traverso-Ortiz
- University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
- Puerto Rico Central Cancer Registry, San Juan, Puerto Rico
- Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico (UPR), San Juan, Puerto Rico
| | - Moraima Y. Ríos
- University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
- Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico (UPR), San Juan, Puerto Rico
| | - Vivian Colón-López
- University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
- Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico (UPR), San Juan, Puerto Rico
- Cancer Control and Population Sciences Program, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Joel M. Palefsky
- Division of Infectious Diseases, School of Medicine, University of California, San Francisco, California
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Ortiz AP, Ortiz-Ortiz KJ, Traverso M, Ríos M, Colón-Lopez V, Palefsky J. 29. Anal cancer trends in Puerto Rico (PR) from 1985 to 2005: impact of HIV status. Sex Health 2013. [DOI: 10.1071/shv10n6ab29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background
PR is one of the US jurisdictions with the highest burden of HIV/AIDS. We describe the proportion of HIV+ anal cancer cases in PR and the impact of HIV status on anal cancer incidence trends, by sex and age. Methods: The PR Central Cancer Registry (PRCCR) and the PR AIDS Surveillance Program databases were linked using a probabilistic linkage algorithm with Link Plus v.2.0 software. The proportion of anal cancer cases with and without HIV in PR were calculated. Temporal trends (1985–2005) in the incidence rates (standardised US 2000 population) of anal cancer (overall and after exclusion of HIV+ cancer cases) were calculated through annual per cent changes (APC) and 95% confidence intervals (CIs), using a Joinpoint log-linear model. Results: From 1985 to 2005, 736 cases of anal cancer were diagnosed in PR; 26 cases were HIV+. While most anal cancer patients were female (70.8%), the proportion of HIV+ patients was higher in males (11.4%) than females (0.77%). In men, incidence increased significantly (APC = 3.23, P < 0.05) when HIV+ cases were considered; the increase was reduced (APC = 0.97) when these were excluded (P > 0.05). In females, incidence increased (APC = 2.01) when HIV+ cases were considered, whereas the increase was reduced (APC = 0.85) when these were excluded; these increases were non-significant (P > 0.05). Conclusions: Consistent with data from the US, the increasing anal cancer incidence rates in PR were strongly influenced by the HIV epidemic in males but were independent of HIV infection in females.
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Ortiz AP, Otero Y, Svensson K, García-Rodríguez O, Garced S, Santiago E, Umpierre S, Figueroa N, Ortiz-Ortiz KJ. Racial and ethnic disparities in lifetime risk of corpus uterine cancer: a comparative study of Puerto Rico and the United States SEER population. Ethn Dis 2012; 22:90-5. [PMID: 22774315 PMCID: PMC4170919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Corpus uterine cancer is the most common gynecologic malignancy in Puerto Rico and the United States. METHODS We assessed the lifetime risk of developing and dying of corpus uterine cancer in women living in Puerto Rico (PR) and among Hispanics, non-Hispanic whites (NHW), and non-Hispanic blacks (NHB) in the United States. Data from the PR Central Cancer Registry and the Surveillance, Epidemiology, and End Results program were analyzed from 1993-2004. RESULTS In PR, the probability of developing corpus uterine cancer increased from 1.21% in 1993-1995 to 1.69% in 2002-2004. The probability of developing this malignancy from 2002-2004 was 1.59% for NHB, 1.80% for Hispanics and 2.54% for NHW. The ratio of estimated probabilities only showed significant lower risk in PR as compared to NHW (.67, 95% CI = .59-.74). The probability of dying from corpus uterine cancer during 2002-2004 was .47% for Hispanics, .49% for NHW, .53% for PR and .76% for NHB. The ratio of estimated probabilities only showed significant lower risk of death in PR as compared to NHB (.70, 95% CI = .54-.85). CONCLUSIONS The lifetime risk of developing corpus uterine cancer has increased in PR, suggesting higher exposure to risk factors in this population. Despite the lower lifetime risk of this malignancy in PR as compared to NHW, the similar lifetime risk of death in these groups suggests a disparity that may be influenced by differences in disease etiology and/or access or response to treatment. Assessment of risk factors, in addition to access to health services, is required to further understand these patterns.
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Affiliation(s)
- Ana Patricia Ortiz
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan.
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Torres-Cintrón M, Ortiz AP, Ortiz-Ortiz KJ, Figueroa-Vallés NR, Pérez-Irizarry J, De La Torre-Feliciano T, Díaz-Medina G, Suárez-Pérez E. Using a socioeconomic position index to assess disparities in cancer incidence and mortality, Puerto Rico, 1995-2004. Prev Chronic Dis 2011; 9:E15. [PMID: 22172182 PMCID: PMC3298767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
| | - Ana P. Ortiz
- University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico. Dr Ortiz is also affiliated with the Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Karen J. Ortiz-Ortiz
- Puerto Rico Central Cancer Registry, Cancer Control and Population Sciences Program, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Nayda R. Figueroa-Vallés
- Puerto Rico Central Cancer Registry, Cancer Control and Population Sciences Program, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Javier Pérez-Irizarry
- Puerto Rico Central Cancer Registry, Cancer Control and Population Sciences Program, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Taína De La Torre-Feliciano
- Puerto Rico Central Cancer Registry, Cancer Control and Population Sciences Program, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Gwendolyn Díaz-Medina
- Natural Sciences Faculty, Río Piedras Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Erick Suárez-Pérez
- Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
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Torres-Cintrón M, Ortiz AP, Ortiz-Ortiz KJ, Figueroa-Vallés NR, Pérez-Irizarry J, Díaz-Medina G. Using a Socioeconomic Position Index to Assess Disparities in Cancer Incidence and Mortality, Puerto Rico, 1995-2004. Prev Chronic Dis 2011. [DOI: 10.5888/pcd9.100271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Otero Y, Ortiz-Ortiz KJ, Torres M, Perez J, Figueroa N, Ortiz AP. Abstract A76: Cervical cancer survival in Puerto Rico: Disparities by health care coverage. Cancer Epidemiol Biomarkers Prev 2011. [DOI: 10.1158/1055-9965.disp-11-a76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background: Studies have demonstrated that early diagnosis and receiving appropriate treatment may greatly increase the chances of survival of cancer patients. Although sociodemographic factors and the type of insurance status have been shown to be associated to the patient's survival, fewer studies have considered the joint effects of these variables on disease outcomes, particularly among Hispanics. Studies have shown that access to health insurance influences the quality of the health-care received. To ensure access to health and to eliminate disparities in medical care, the government of Puerto Rico (PR) implemented during the 1990's a Health Care Reform. The PR Government Health Care (GHC) program is available for medically indigent citizens and it covers approximately 40% of the Puerto Rican population. Objective: This study aimed to describe the 3-year relative survival of cervical cancer in PR and evaluate the effect of the type of health insurance coverage (GHC vs. Non-GHC) on patient's survival.
Methods: Women with a diagnosis of cervical cancer reported to the Puerto Rico Central Cancer Registry database from 2004 to 2005 were linked with health insurance claims data from the GHC from the same time period, to identify GHC patients (61.6%) and those without GHC coverage (38.4%). The maximum relative survival ratio was compared by health insurance groups. A Poisson regression model was used to assess relative excess risks of death.
Results: In the period 2004–2005, 333 out of the 344 (96.8%) primary cases of invasive cervical cancer reported among residents of PR were eligible for analysis. A higher than expected percent of the cases had GHC (62%) as compared to the general population in PR (40%). The higher percent of cases were among women 35–49 years-old (36%). When the effect of Health Care Plan was analyzed, the overall 3-year relative survival was 65.7% for GHC women and 78.9% for Non-GHC women. Consistent with previous studies, 3-year relative survival decreased with more advanced disease stage: 82% at localized, 62% at regional and 29% at distant. Survival was also lower among cases with GHC (77% at localized, 54% at regional and 25% at distant) than among those with Non-GHC (88% at localized, 78% at regional and 35% at distant), at all cancer stages. Analyses of the excess of risk showed that the GHC patients had a 2.1 (p=0.004) increased risk of death than Non-GHC patients, after adjusting for age and stage.
Conclusions: Three-year relative survival is lower among women in PR with cervical cancer who have GHC as compared to their counterparts. This study shows disparities related to health care coverage among a United States (US) Hispanic population living outside the US that warrants further research. This study will help to formulate strategies to improve cervical cancer survival and to reduce inequalities in cancer care.
Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A76.
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Affiliation(s)
- Yomayra Otero
- 1UPR-Medical Sciences Campus-Graduate School of Public Health, San Juan, PR,
| | | | | | - Javier Perez
- 2Puerto Rico Comprehensive Cancer Center, San Juan, PR
| | | | - Ana P. Ortiz
- 2Puerto Rico Comprehensive Cancer Center, San Juan, PR
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Pérez-Irizarry J, Nazario-Delgado CM, De la Torre T, Ortiz-Ortiz KJ, Torres-Cintrón M, Figueroa-Vallés NR. Incidence trends of cervical cancer in Puerto Rico, 1987-2004. P R Health Sci J 2010; 29:364-371. [PMID: 21261175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Cervical cancer was the leading malignancy among women in Puerto Rico when the Central Cancer Registry was first established by law in 1950. The screening program for cervical cancer in PR was initiated in 1961 when cytological laboratories were established in regional hospitals throughout the island, reaching its peak in 1973. In 2004, invasive cervical cancer ranked fifth among the top cancers in women in PR, representing 4% of all newly diagnosed cancers and 2% of all cancer-related deaths among women. The purpose of this study was to evaluate the incidence trends of cervical cancer by histology type in PR. METHODS Cervical cancer cases (n = 3,516) diagnosed from 1987-2004 were obtained from the Puerto Rico Central Cancer Registry. Age-adjusted and age-specific incidence rates by histological type were calculated. Annual percent changes were estimated to evaluate the incidence trends from 1987 to 2004. RESULTS From 1987 to 2004, the incidence of cervical cancer showed a downward trend (APC = -2.1%). Seventy-six percent (76.3%) of invasive cervical cancer cases were squamous cell carcinoma (SCC), 15.4% were adenocarcinoma (ADC), and 8.3% had other histologies. When histology was considered, a decreasing trend was observed for the incidence rates of SCC (APC = -3.2%, p < 0.05), with the greatest decrease being seen in women aged 60-74 (APC = -6.6%, p < 0.05). While the overall incidence rate of ADC remained stable (APC = 0.8%, p > 0.05), it increased in women aged 30-44 (APC = 3.8%, p < 0.05). CONCLUSION Overall, the incidence rates for cervical cancer (SCC in particular), have decreased in PR. However, ADC does not present a similar decreasing trend. This trend, which is similar with other populations, could be explained, in part, by a decreasing prevalence of risk factors. Nevertheless, analysis by specific age group shows variations in the risk, which need careful consideration since they could imply changes in factors associated with each of the histological types.
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Affiliation(s)
- Javier Pérez-Irizarry
- Puerto Rico Central Cancer Registry, Cancer Control and Population Sciences Program, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
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Ortiz-Ortiz KJ, Pérez-Irizarry J, Marín-Centeno H, Ortiz AP, Torres-Berrios N, Torres-Cintrón M, de la Torre-Feliciano T, Laborde-Rivera J, Calo WA, Figueroa-Vallés NR. Productivity loss in Puerto Rico's labor market due to cancer mortality. P R Health Sci J 2010; 29:241-249. [PMID: 20799511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND In Puerto Rico (PR), cancer is the second leading cause of death and the disease that causes most premature deaths, representing about 15% of them. Thus, premature death due to cancer decreases the productivity capacity in PR. OBJECTIVE This study aimed to estimate the labor-market productivity loss in PR during 2004 as a result of premature mortality due to overall cancer and cause-specific cancers. METHODS A model based in the incidence-based approach and in the human capital approach was developed to estimate the labor-market productivity loss. Economic data were obtained from the Public Use Microdata Sample (PUMS) of the PR Community Survey (PRCS). Mortality data were obtained from the Vital Statistics of the PR Department of Health. RESULTS The productivity costs of all cancer deaths were estimated to be approximately $64 million (in constant value). The cancer deaths that contributed the most to productivity loss were lung and bronchus, colorectal, breast, and liver and intrahepatic bile duct. CONCLUSIONS Although these results must be interpreted with caution, this study contributes to show a broader picture that includes the economic dimension of cancer in our society. These estimates imply that productivity cost due to cancer mortality have a great burden in PR. The leading cancer sites that generate most productivity losses are highly preventable or can be diagnosed early or are related to tobacco consumption. This study should be considered within the framework of future cost analyses for the development of health and cancer control policies.
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Affiliation(s)
- Karen J Ortiz-Ortiz
- Puerto Rico Central Cancer Registry, Cancer Control and Population Sciences Program, University of Puerto Rico Comprehensive Cancer Center, San Juan, PR
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Torres-Cintrón M, Ortiz AP, Pérez-Irizarry J, Soto-Salgado M, Figueroa-Vallés NR, De La Torre-Feliciano T, Ortiz-Ortiz KJ, Calo WA, Suárez-Pérez E. Incidence and mortality of the leading cancer types in Puerto Rico: 1987-2004. P R Health Sci J 2010; 29:317-329. [PMID: 20799522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Cancer remains one of the leading causes of morbidity and mortality worldwide and is the second cause of death in Puerto Rico (PR). This article describes the incidence and the mortality from cancer in PR for the period of 1987 to 2004. METHODS We analyzed data from the PR Central Cancer Registry and the PR Demographic Registry from 1987-2004, for the leading cancer types in men and women in PR. Age-adjusted incidence and mortality rates were estimated by sex, municipality, health region and primary site and were age-standardized to the 2000 PR population. RESULTS Incidence rates for overall cancer remained constant in men and increased in women (APC = 0.6%, p < 0.05), while mortality rates decreased (APC = -1.0%) for both sexes. A significant increase was observed in the cancer incidence rates for colorectal cancer in men, while in women, an increase in breast, colorectal, and corpus and uterus cancer was observed. Mortality rates decreased for most of the major cancers types in both sexes, except for colorectal cancer in men which showed a significant increase (p < 0.05). CONCLUSION The most important cancer types in PR (prostate, breast, colorectal, and lung) for both incidence and mortality are susceptible to primary prevention (eliminating or reducing risk factors) or to secondary prevention (early diagnosis) strategies. Our results are essential for the development of cancer prevention and control strategies in the Island.
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Affiliation(s)
- Mariela Torres-Cintrón
- Puerto Rico Central Cancer Registry, Cancer Control and Population Sciences Program, University of Puerto Rico Comprehensive Cancer Center, San Juan, PR
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