Characterization of fire investigators' polyaromatic hydrocarbon exposures using silicone wristbands

BACKGROUND

Exposures to polyaromatic hydrocarbons (PAHs) contribute to cancer in the fire service. Fire investigators are involved in evaluations of post-fire scenes. In the US, it is estimated that there are up to 9000 fire investigators, compared to approximately 1.1 million total firefighting personnel. This exploratory study contributes initial evidence of PAH exposures sustained by this understudied group using worn silicone passive samplers.

OBJECTIVES

Evaluate PAH exposures sustained by fire investigators at post-fire scenes using worn silicone passive samplers. Assess explanatory factors and health risks of PAH exposure at post-fire scenes.

METHODS

As part of a cross-sectional study design, silicone wristbands were distributed to 16 North Carolina fire investigators, including eight public, seven private, and one public and private. Wristbands were worn during 46 post-fire scene investigations. Fire investigators completed pre- and post-surveys providing sociodemographic, occupational, and post-fire scene characteristics. Solvent extracts from wristbands were analyzed via gas chromatography-mass spectrometry (GC-MS). Results were used to estimate vapor-phase PAH concentration in the air at post-fire scenes.

RESULTS

Fire investigations lasted an average of 148 minutes, standard deviation ± 93 minutes. A significant positive correlation (r=0.455, p<.001) was found between investigation duration and PAH concentrations on wristbands. Significantly greater time-normalized PAH exposures (p=0.039) were observed for investigations of newer post-fire scenes compared to older post-fire scenes. Regulatory airborne PAH exposure limits were exceeded in six investigations, based on exposure to estimated vapor-phase PAH concentrations in the air at post-fire scenes.

DISCUSSION

Higher levels of off-gassing and suspended particulates at younger post-fire scenes may explain greater PAH exposure. Weaker correlations are found between wristband PAH concentration and investigation duration at older post-fire scenes, suggesting reduction of off-gassing PAHs over time. Exceedances of regulatory PAH limits indicate a need for protection against vapor-phase contaminants, especially at more recent post-fire scenes.

Distinct Prostate Cancer Survival Outcomes in Firefighters: A Population-Based Study

Introduction: Survival outcomes for prostate cancer among specific occupational groups prone to regular medical check-ups vis-à-vis the general population have been understudied. For firefighters, a demographic subject to rigorous medical evaluations, possessing above-average medical expertise, and exposed to specific carcinogens of interest, prostate cancer survival in the US has never been studied. Methods: We conducted a retrospective study, utilizing data from the Florida Cancer Data System spanning 2004 to 2014, coupled with firefighter certification records from the Florida State Fire Marshal's Office. Our study cohort consisted of 1058 prostate cancer cases among firefighters as well as prostate cases for the Florida general population (n = 150,623). We compared cause-specific survival between the two using Cox regression models adjusted for demographics and clinical characteristics, including PSA levels, Gleason scores, and treatment modalities. Results: Firefighters demonstrated a higher five-year cause-specific survival rate (96.1%, 95% CI: 94.7-97.1%) than the general population (94.2%, 95%CI: 94.1-94.3%). Overall, firefighters' diagnoses were established at younger ages (median age 63 vs. 67 in the general population), exhibited a higher proportion of localized stage cancers (84.7% vs. 81.1%), and had a greater utilization of surgery (46.4% vs. 37.6%), a treatment modality with a high success rate but potential side effects. In multivariable analysis, firefighters displayed a survival advantage for localized stage (adjusted hazard ratio [aHR] = 0.53; 95%CI: 0.34-0.82). However, for regional or distant stages, firefighters aged 65 and above exhibited a higher risk of death (aHR = 1.84; 95% CI: 1.18-2.86) than the general population. Conclusion: Firefighters experience enhanced prostate cancer survival, primarily in cases diagnosed at localized stages, likely due to increased PSA testing. Nonetheless, for regional or distant stage, survival among older firefighters' lags behind that of the general population. Further investigations are warranted to unravel factors influencing the development of aggressive disease beyond PSA and Gleason scores in this population, as well as to assess the impact of a higher rate of surgical treatment on firefighters' quality of life.

Incidence of Etiology-specific Hepatocellular Carcinoma: Diverging Trends and Significant Heterogeneity by Race and Ethnicity

BACKGROUND & AIMS

The main causes of hepatocellular carcinoma (HCC) include chronic hepatitis C and B viral infections (HCV, HBV), nonalcoholic fatty liver disease (NAFLD), and alcohol-related disease (ALD). Etiology-specific HCC incidence rates and temporal trends on a population-basis are needed to improve HCC control and prevention.

METHODS

All 14,420 HCC cases from the Florida statewide cancer registry were individually linked to data from the hospital discharge agency and the viral hepatitis department to determine the predominant etiology of each case diagnosed during 2010 to 2018. Age-adjusted incidence rates (AAIRs) were used to assess the intersection between etiology and detailed race-ethnicity. Etiology-specific temporal trends based on diagnosis year were assessed using Joinpoint regression.

RESULTS

HCV remains the leading cause of HCC among men, but since 2017 NAFLD-HCC is the leading cause among women. HCV-HCC AAIRs are particularly high among U.S.-born minority men, including Puerto Rican (10.9 per 100,000), African American (8.0 per 100,000), and U.S.-born Mexican American men (7.6 per 100,000). NAFLD is more common among all Hispanics and Filipinos and HBV-HCC among Asian and Haitian black men. HCV-HCC surpasses HBV-HCC in Asian women. ALD-HCC is high among specific Hispanic male groups. Population-based HCV-HCC rates experienced a rapid decline since 2015 (-9.6% annually), whereas ALD-HCC (+6.0%) and NAFLD-HCC (+4.3%) are rising (P < .05).

CONCLUSIONS

New direct acting anti-viral drugs have impacted rates of HCV-HCC, offsetting important increases in both ALD- and NAFLD-HCC. Hispanics may be a group of concern because of higher rates for ALD- and NAFLD-HCC. HCC etiology varies remarkably and may warrant specific interventions by detailed race-ethnicity.

Associations Between Neighborhood-Level Income and Triple-Negative Breast Cancer in a Majority-Minority Population

BACKGROUND

Previous studies on disparities in triple-negative breast cancer (TNBC) focus on race/ethnicity, with few exploring the impact of contextual factors such as neighborhood-level income. This study evaluates the effect of neighborhood-level income on disparities in TNBC among a racially and ethnically diverse cohort, after accounting for granular individual-level risk factors of TNBC.

PATIENTS AND METHODS

Patients with stage I-IV breast cancer from 2005 to 2017 were identified from our local tumor registry. The primary outcome was diagnosis of TNBC. Using 5-years estimates from the American Community Survey, we obtained median household income for each census tract which was categorized into quartiles. Mixed effects logistic regression was conducted and stratified by race and ethnicity, controlling for individual-level sociodemographic, comorbidities, and tumor characteristics.

RESULTS

Among 5377 breast cancer registry patients, 16.5% were diagnosed with TNBC. The majority were Hispanic (50.1%) followed by non-Hispanic Black (NHB) (28.0%). After controlling for individual-level covariables including race and ethnicity, comorbidities, and tumor characteristics, women from low-income neighborhoods had increased odds of TNBC compared with other breast cancer subtypes, compared with those in high-income neighborhoods [odds ratio (OR) 1.33; 95% confidence interval (CI) 1.04, 1.70, p < 0.001]. In stratified analyses, NHB patients from low-income neighborhoods had two times the odds of TNBC diagnosis compared with those from high-income neighborhoods (OR 2.11; 95% CI 1.02, 4.37).

CONCLUSION

We found that living in a low-income neighborhood is associated with an increased odds of TNBC independent of granular individual-level TNBC risk factors, particularly NHB race. More striking, NHB living in low-income neighborhoods had increased odds of TNBC compared with NHB living in high-income neighborhoods. Our results suggest potential unaccounted gene-environment and/or social (api)genomic interactions between neighborhood-level income and TNBC subtype development.

Identifying Neighborhoods with Cervical Cancer Disparities for Targeted Community Outreach and Engagement by an NCI-Designated Cancer Center: A Geospatial Approach

BACKGROUND

Cervical cancer disparities exist in the United States with the highest incidence in Hispanic women and the highest mortality in Black women. Effective control of cervical cancer in the population requires targeted interventions tailored to community composition in terms of race, ethnicity, and social determinants of health (SDOH).

METHODS

Using cancer registry and SDOH data, geospatial hot spot analyses were carried out to identify statistically significant neighborhood clusters with high numbers of cervical cancer cases within the catchment area of an NCI-Designated Cancer Center. The locations, racial and ethnic composition, and SDOH resources of these hot spots were used by the center's community outreach and engagement office to deploy mobile screening units (MSU) for intervention in communities with women facing heightened risk for cervical cancer.

RESULTS

Neighborhood hot spots with high numbers of cervical cancer cases in south Florida largely overlap with locations of poverty. Cervical cancer hot spots are associated with a high percentage of Hispanic cases and low SDOH status, including low income, housing tenure, and education attainment.

CONCLUSIONS

A geospatially referenced cancer surveillance platform integrating cancer registry, SDOH, and cervical screening data can effectively identify targets for cervical cancer intervention in neighborhoods experiencing disparities.

IMPACT

Guided with a data-driven surveillance system, MSUs proactively bringing prevention education and cervical screening to communities with more unscreened, at-risk women are an effective means for addressing disparities associated with cervical cancer control.

Lung cancer survival among Florida male firefighters

Introduction

Lung cancer is a leading cause of cancer incidence and death in the United States. Although most firefighters are fit and do not smoke, they are exposed to many known carcinogens during and in the aftermath of firefighting activities. Comprehensive epidemiologic investigations on lung cancer survival for both career and volunteer firefighters have not been undertaken.

Methods

Data from the Florida Cancer Data System (1981-2014) were linked with firefighter certification records from the Florida State Fire Marshal's Office to identify all patients of this occupational group; lung cancer cause-specific survival data were compared with other occupational groups using Cox regression models with occupation as the main effect. Adjusted hazard ratios (aHR) and 95% confidence intervals (95% CI) were calculated.

Results

Out of 210,541 male lung cancer cases diagnosed in Florida (1981-2014), 761 were firefighters (604 career, 157 volunteer). Lung cancer death was similar between volunteer (75.2%) and career firefighters (74.0%) but lower than non-firefighters (80.0%). Survival at 5 years was higher among firefighters (29.7%; career: 30.3%; volunteer: 27.4%) than non-firefighters (23.8%). In a multivariable model, compared with non-firefighters, firefighters have significantly higher cause-specific survival (aHR = 0.84; 95% CI: 0.77-0.91; p < 0.001). However, there were no significant survival differences between career and volunteer firefighters (1.14; 0.93-1.39; p = 0.213). In a separate multivariable model with firefighters as the comparator, other broad occupational groups had significantly lower cause-specific survival [white collar: 1.11 (1.02-1.21); blue collar: 1.15 (1.05-1.25); service: 1.13 (1.03-1.25); others/unknown: 1.21 (1.12-1.32); all p-values < 0.02].

Conclusion

Lung cancer survival is significantly higher among firefighters compared with non-firefighters, but there is no significant difference between career and volunteer firefighters. Improved survival for firefighters might be due to a healthy worker effect, lower smoking prevalence relative to other worker groups, and possibly superior treatment adherence and compliance. Many firefighters are cross-trained as EMTs/paramedics and possess a level of medical knowledge that may favorably impact treatment engagement and better navigation of complex cancer care.

Weight Status and Binge Drinking Among Male and Female Florida Firefighters

OBJECTIVE

The aim of the study is to examine the association between weight status and binge drinking among Florida firefighters.

METHODS

Health survey data collected between 2015 and 2019 among Florida firefighters participating in the Annual Cancer Survey were analyzed for weight class (healthy, overweight, obese) and binge-drinking behaviors. Binary logistic regression models were fit and stratified by sex while controlling for sociodemographic and health characteristics.

RESULTS

Among 4002 firefighter participants, 45.1% binge drink, 50.9% are overweight, and 31.3% are obese. Among male firefighters, being overweight (adjusted odds ratio = 1.34; 95% confidence interval = 1.10-1.64) or obese (1.29; 1.04-1.61) was significantly associated with binge drinking compared with healthy weight counterparts. In female firefighters, being obese (2.25; 1.21-4.22) was significantly associated with binge drinking but being overweight was not.

CONCLUSIONS

Being overweight or obese is selectively associated with binge drinking among male and female firefighters.

Cancer risk and mortality among firefighters: a meta-analytic review

Background

Firefighting is a hazardous occupation that is associated with an increased risk of select cancers. The number of studies has grown in recent years allowing for a synthesis of findings.

Methods

Following PRISMA guidelines, multiple electronic databases were searched to identify studies on firefighter cancer risk and mortality. We computed pooled standardized incidence risk (SIRE) and standardized mortality estimates (SMRE), tested for publication bias, and conducted moderator analyses.

Results

Thirty-eight studies published between 1978 and March 2022 were included for final meta-analysis. Overall, cancer incidence and mortality were significantly lower for firefighters (SIRE = 0.93; 95% CI: 0.91-0.95; SMRE = 0.93; 95% CI: 0.92 - 0.95) compared to the general population. Incident cancer risks were significantly higher for skin melanoma (SIRE = 1.14; 95% CI:1.08 - 1.21), other skin cancers (SIRE = 1.24; 95% CI:1.16-1.32), and prostate cancer (SIRE = 1.09; 95% CI: 1.04-1.14). Firefighters showed higher mortality for rectum (SMRE = 1.18; 95% CI: 1.02-1.36), testis (SMRE = 1.64; 95% CI: 1.00-2.67), and non-Hodgkin lymphoma (SMRE = 1.20; 95% CI: 1.02-1.40). There was evidence of publication bias for SIRE and SMRE estimates. Some moderators explained variations in study effects, including study quality scores.

Conclusion

Firefighters are at higher risk for several cancers; to the extent that some (e.g., melanoma and prostate) are screening amenable, more study into firefighter-specific recommendations for cancer surveillance is needed. Moreover, longitudinal studies with more detailed data on the specific length and types of exposures are necessary, as well as on unstudied subtypes of cancers (e.g., subtypes of brain cancer and leukemias) are needed.

Understanding Cancer Survivorship among Firefighters: A Mixed-Method Study

BACKGROUND

Firefighters are exposed to a unique set of carcinogens through their work environment that predispose them to several cancers, yet there is limited research related to cancer survivorship amongst this occupational group.

METHODS

A mixed-method approach was used to assess cancer survivorship amongst firefighters. Four focus groups and one in-depth interview were conducted with 29 active and retired firefighters who have been diagnosed with cancer to understand the experiences and challenges associated with cancer survivorship in the fire service and desired resources. Qualitative data were analyzed using Nvivo software. All participants completed the Functional Assessment of Cancer Therapy-General (FACT-G) survey to assess their quality of life.

RESULTS

The primary themes that emerged from the focus groups included managing health and well-being changes, navigating support systems in place, and accessing new resources. FACT-G scores (mean ± standard deviation) of the firefighter cancer survivor sample demonstrate relatively lower levels of emotional well-being (19.26 ± 4.67) and higher quality of life in the physical well-being (23.67 ± 5.08), social well-being (23.38 ± 4.16), and functional well-being (22.6 ± 4.966) domains.

CONCLUSIONS

Firefighters requested curated resources, such as support groups and department training resources, supporting the need for more cancer survivorship resources specific to firefighters.

Lung cancer in never smokers: Distinct population-based patterns by age, sex, and race/ethnicity

OBJECTIVES

Epidemiological patterns for lung cancer among never smokers (LCNS) are largely unknown, even though LCNS cases comprise 15% of lung cancers. Past studies were based on epidemiologic or health system cohorts, and not fully representative of the underlying population. The objective was to analyze rates (and trends) of LCNS by sex, age group, and race and ethnicity based on all-inclusive truly population-based sources.

MATERIALS AND METHODS

Individual-level data from 2014 to 2018 on smoking status among microscopically-confirmed lung cancer cases from Florida's cancer registry were combined with population denominators adjusted with NHIS data on smoking prevalence to compute population-based LCNS incidence rates and rate ratios. Incidence rates and proportional mortality were ranked against other cancers. Joinpoint regression analyses examined trends.

RESULTS

Proportions of LCNS ranged from 9% among White men to 83% among Chinese women. Overall, LCNS was 13% (IRR 1.13, 95%CI 1.08-1.17) more common among men than women, but variation occurred by age group, with female rates exceeding male in younger ages. Age-adjusted rates per 100,000 were highest among Asian/Pacific Islander (API) men and women (15.3 and 13.5, respectively) and Black populations (14.6, 12.9), intermediate for White (13.2, 11.8) and lowest among the Hispanic population (12.1, 10.6). Among API women, LCNS was the second leading cause of cancer death, surpassed only by breast cancer. LCNS trends were stable over time.

CONCLUSION

LCNS is the 11th most frequently occurring cancer in men and 8th in women. LCNS differences by race/ethnicity are small, within a 15% range of the White population's rates. Surprisingly, API men and women have the highest LCNS rates and proportional mortality. As smoking prevalence decreases in the US, LCNS cases will inevitably increase, warranting inquiry into risk factors across the lifespan.

Sleep Latency and Post-Traumatic Stress Disorder Among Retired Career Florida Firefighters: Evidence From the Advancing Epidemiology of Retired Firefighters Aging Longitudinally Cohort

OBJECTIVE

Our objective was to estimate the association of post-traumatic stress disorder (PTSD) and sleep latency among retired firefighters.

METHODS

Baseline health survey data collected from retried career Florida firefighters participating in an ongoing prospective cohort study from 2017 to 2021 were analyzed. Risk for PTSD was assessed using a four-item primary care PTSD screening construct, and sleep onset latency was assessed by self-reported length of time to fall asleep.

RESULTS

Among the 500 participants, 8.0% screened positive for PTSD risk and 37.6% had prolonged sleep onset latency (≥20 minutes to fall asleep). Retired firefighters with PTSD risk were 2.7 times more likely (adjusted odds ratio, 2.70; 95% confidence interval, 1.27-5.75) to have prolonged sleep latency compared with those without PTSD risk while controlling for covariates.

CONCLUSIONS

Retired firefighters who screen positive for PTSD risk are three times more likely to report delayed sleep onset latency.

A comparative analysis of histologic types of thyroid cancer between career firefighters and other occupational groups in Florida

BACKGROUND

Florida Firefighters experience a higher risk of thyroid cancer than non-firefighters. This study examines whether the histologic types and tumor stage of thyroid cancer is different among firefighters compared to other occupational groups.

METHODS

Eligible cases were firefighters (n = 120) identified in a linkage of Florida Cancer Data System (FCDS) registry records (1981-2014) and Florida State Fire Marshal's Office employment and certification records, and non-firefighters classified into: blue-collar (n = 655), service (n = 834), white-collar (n = 4,893), and other (n = 1,789). Differences in thyroid histologic type (papillary, follicular, and rare/other less common forms of thyroid cancer), tumor stage, and age at diagnosis were evaluated using multinomial logistic regression models comparing blue-collar, service, white-collar, and other occupational groups with firefighters. Univariate odds ratios as well as odds ratios adjusted for age, gender, race, tumor stage, and year of diagnosis (aOR) and 95% confidence intervals (95%CI) were reported.

RESULTS

Service (aOR = 4.12; 95%CI: 1.25-13.65), white-collar (aOR = 3.51; 95%CI: 1.08-11.36), and blue-collar (aOR = 4.59; 95%CI: 1.40-15.07) workers had significantly higher odds of being diagnosed with rare histologic types of thyroid cancer vs papillary type compared to firefighters. Service (aOR = 0.42; 95%CI: 0.27-0.66), white-collar (aOR = 0.39; 95%CI: 0.26-0.59), blue-collar (aOR = 0.36; 95%CI: 0.23-0.56), and other (aOR = 0.34; 95%CI: 0.22-0.53) occupational groups have a significantly lower odds of being diagnosed with rare vs papillary type at a younger age (30-49 years) vs 50-69 years compared to firefighters. However, stage at diagnosis was not significantly different among occupational groups.

CONCLUSION

Firefighters diagnosed with thyroid cancer experience a higher odds of papillary compared to rare histologic types of thyroid cancer relative to other workers; there is no evidence of an increased odds of late-stage diagnosis in firefighters relative to other worker groups. Firefighters may benefit from routine screening and active surveillance of suspected thyroid tumors especially given the excellent treatment outcomes available for those diagnosed with early-stage papillary thyroid tumors.

Abstract 25: Per- and polyfluoroalkyl substances and obesity in Florida firefighters

Background/Objective: Per- and polyfluoroalkyl substances (PFASs) are hazardous synthetic chemicals that have been linked to adverse human health effects such as cancer and endocrine disruption. Firefighters have been shown to be occupationally exposed to PFAS through aqueous film-forming foam (AFFF) used during difficult-to-suppress fires, and in the textile liners of their safety turnout gear. PFASs have both hydrophobic and hydrophilic chemical structures, giving them strong thermal stability and making them resistant to environmental and physiological degradation. Studies of human exposures to PFAS have observed associations between some PFAS and increased risk of obesity or elevated body mass index (BMI). Given the unique occupational exposures of firefighters to PFAS, we examine the association between obesity and PFAS in a sample of Florida firefighters.

Methods: A cross-sectional study design was used to collect a health survey and a blood sample from a non-probabilistic sample of career Florida fighters between June and October 2021. The health surveys, administered on REDCap using tablet devices, assessed information on firefighter socio-demographic and work characteristics. We quantified 7 distinct PFASs using a solid-phase extraction-high-performance liquid chromatography-isotope dilution-tandem mass spectrometry approach; the limit of detection was between 0.5 and 0.05 ng/mL, depending on the analyte. All 7 PFASs, including Perfluorobutanesulfonic Acid (PFBS), Perfluoroheptanoic Acid (PFHpA), Perfluorohexanesulfonic Acid (PFHxS), Perfluorooctanoic Acid (PFNA), Perfluorononanoic Acid (PFNA), Perfluorooctanesulfonic Acid (PFOS), and Perfluoroctanesulfonamide (PFOSA), were detected in the blood samples; concentrations below the limit of detection were replaced by the limit of detection/√2.35.

Results: Among the 208 firefighters who completed the survey and provided a blood sample, 92.8% were male, 16.2% Hispanic/Latinx, 81.7% White, 89.8% used AFFF at their fire department, with a group mean age 40.2±10.3 standard deviation. Approximately 15.8% of firefighters were of healthy weight, 51.5% overweight, and 32.7% obese. Firefighter body mass index was positively correlated with serum concentrations of PFHxS (rs=.17;p=.020) and PFBS (rs=.60;p=.26). Group geometric mean of each PFAS congener (in ng/mL): PFBS (0.09), PFHpA (0.08), PFHxS (2.17), PFOA (1.38), PFNA (0.42), PFOS (2.69), and PFOSA (0.10). Total serum PFAS concentrations was highest among obese firefighters (7.62 ng/mL) and lowest in healthy weight firefighters (6.55 ng/mL).

Conclusions: Firefighters who were overweight and obese, based on body mass index, had higher total serum PFAS concentrations than those firefighters of healthy weight. Both long- and short-chain PFASs, PFHxS and PFBS respectively, were positively correlated with firefighter body mass index.

Citation Format: Alberto J. Caban-Martinez, Paola Louzado Feliciano, Simi Oduwole, Natasha Schaefer Solle, Catalina Gonzalez-Umana, Thomas Stone, Erin N. Kobetz. Per- and polyfluoroalkyl substances and obesity in Florida firefighters [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 25.

Catchment Areas, Community Outreach and Engagement Revisited: The 2021 Guidelines for Cancer Center Support Grants from the National Cancer Institute

New guidelines for Cancer Center Support Grants have recently been issued by the NCI that require increased attention to cancer center catchment areas and their community outreach and engagement activities [PAR-21-321]. Past experience with these requirements has engendered some confusion and frustration on the part of both researchers and reviewers that these new guidelines aim to dispel. In this commentary we, as experienced cancer center leaders in population sciences, offer our views on the most important aspects of the new guidelines and provide three examples of the kinds of programs that can apply cancer prevention and control research to improve cancer population health. With 71 NCI-Designated Cancer Centers in 36 states, the potential for broad impact on the reduction of the nation's cancer burden is enormous if the intended application of cancer center research to individuals and populations is fulfilled.

The vaginal microbiome is associated with endometrial cancer grade and histology

The human microbiome has been strongly correlated with disease pathology and outcomes, yet remains relatively underexplored in patients with malignant endometrial disease. In this study, vaginal microbiome samples were prospectively collected at the time of hysterectomy from 61 racially and ethnically diverse patients from three disease conditions: 1) benign gynecologic disease (controls, n=11), 2) low-grade endometrial carcinoma (n=30), and 3) high-grade endometrial carcinoma (n=20). Extracted DNA underwent shotgun metagenomics sequencing, and microbial α and β diversities were calculated. Hierarchical clustering was used to describe community state types (CST), which were then compared by microbial diversity and grade. Differential abundance was calculated, and machine learning utilized to assess the predictive value of bacterial abundance to distinguish grade and histology. Both α- and β-diversity were associated with patient tumor grade. Four vaginal CST were identified that associated with grade of disease. Different histologies also demonstrated variation in CST within tumor grades. Using supervised clustering algorithms, critical microbiome markers at the species level were used to build models that predicted benign vs carcinoma, high-grade carcinoma versus benign, and high-grade versus low-grade carcinoma with high accuracy. These results confirm that the vaginal microbiome segregates not just benign disease from endometrial cancer, but is predictive of histology and grade. Further characterization of these findings in large, prospective studies is needed to elucidate their potential clinical applications.

Structural Racism and Breast Cancer-specific Survival: Impact of Economic and Racial Residential Segregation

OBJECTIVE

To analyze the effect of economic and racial/ethnic residential segregation on breast cancer-specific survival (BCSS) in South Florida, a diverse metropolitan area that mirrors the projected demographics of many United States regions.

SUMMARY BACKGROUND DATA

Despite advances in diagnosis and treatment, racial and economic disparities in BCSS. This study evaluates these disparities through the lens of racial and economic residential segregation, which approximate the impact of structural racism.

METHODS

Retrospective cohort study of stage I to IV breast cancer patients treated at our institution from 2005 to 2017. Our exposures include index of concentration at the extremes, a measurement of economic and racial neighborhood segregation, which was computed at the census-tract level using American Community Survey data. The primary outcome was BCSS.

RESULTS

Random effects frailty models predicted that patients living in low-income neighborhoods had higher mortality compared to those living in high-income neighborhoods [hazard ratios (HR): 1.56, 95% confidence interval (CI): 1.23-2.00]. Patients living in low-income non-Hispanic Black and Hispanic neighborhoods had higher mortality compared to those living in high-income non-Hispanic White (NHW) neighborhoods (HR: 2.43, 95%CI: 1.72, 3.43) and (HR: 1.99, 95%CI: 1.39, 2.84), after controlling for patient characteristics, respectively. In adjusted race-stratified analysis, NHWs living in low-income non-Hispanic Black neighborhoods had higher mortality compared to NHWs living in high-income NHW neighborhoods (HR: 4.09, 95%CI: 2.34-7.06).

CONCLUSIONS

Extreme racial/ethnic and economic segregation were associated with lower BCSS. We add novel insight regarding NHW and Hispanics to a growing body of literature that demonstrate how the ecological effects of structural racism-expressed through poverty and residential segregation-shape cancer survival.

Abstract P3-13-05: Comprehensive analysis of global genetic ancestry and socioeconomic status on breast cancer outcomes

Purpose: Disparities in breast cancer outcomes have been a long-standing and persistent challenge. Earlier onset, advanced stage at diagnosis, aggressive tumor subtypes [triple negative breast cancer (TNBC)], and worse overall survival (OS) are some of the characteristic features of breast cancer in non-Hispanic Black (NHB) women compared to their non-Hispanic White (NHW) counterparts, denoting one of the most significant examples of racial/ethnic differences in oncology. Given our location in South Florida, gateway to Latin America and the Caribbean, we discovered that these disparities in tumor characteristics and outcomes among NHB and NHW also extend to Hispanic Blacks (HB) compared to Hispanic Whites (HW). Since Hispanics are the second largest ethnic group in the US and have a rich genetic architecture with contributions from European (EU), West African (WA), and Native American (NA) populations, we sought to investigate genomic associations between observed inter and intra-racial/ethnic differences and breast cancer characteristics and outcomes. Methods: Patients with stage I-IV breast cancer were included. Patient socioeconomnic status (SES), tumor and treatment characteristics, and follow-up data were collected for each patient. Genomic analysis was performed on the peripheral blood from a cohort of 309 patients with breast cancer. This breast cancer cohort was comprised of 192 self-reported HW, 12 HB, 46 NHW, 47 NHB, and 12 unknown (declined to report) patients. Leukocyte DNA from each patient was genotyped, generating whole genome single nucleotide polymorphism (SNP) profiles. Global ancestral estimates, using &gt;100,000 SNPs, were calculated against reference samples from EU, WA, NA, and East Asian (EA) ancestral populations. A genomic diversity space was generated via principal component analysis and ADMIXTURE was used to estimate the ancestral proportions among the patients. Results: The genetic structure of individual patient sample revealed a diverse ancestral admixture where average EU, WA, NA, and EA ancestries were 64.5%, 21.8%, 11.2%, and 2.5%, respectively. Multinomial logistic regression revealed a significant association between increasing WA ancestry and aggressive tumor subtypes (ER-/HER2+ and TNBC), p=0.009 and p=0.031, respectively. These findings remained significant when correcting for patient age and tumor stage; however, when adjusting for income, the association between WA ancestry and ER-/HER2+ and TNBC was no longer significant. Kaplan Meier survival curves showed a significant difference in 5-year OS for patients with &gt;70% WA ancestry compared to those with &lt;70% WA ancestry, p=0.023. Conclusions: In this first integrative approach studying genetic ancestry and SES on breast cancer characteristics and outcomes, we found a significant association between increasing WA ancestry and aggressive breast cancer subtypes, even after adjusting for known covariates. More striking, this association was negated when adjusting for income, suggesting potential gene-environment interactions not accounted for by genetic race. We also discovered that Hispanics have a more complex genetic architecture than non-Hispanic patients, which may in-turn drive genetically-associated survival patterns of resiliency with improved survival in HW compared to NHB patients. Furthermore, the OS differences based on quantitative genetic ancestry cut-offs may serve as a future tool in patient prognosis. Collectively, our results show that genetic ancestry and SES influence breast cancer subtypes and survival. This lays a foundation for future studies to investigate complex genomic relationships between race/ethnicity, SES, and breast cancer characteristics and outcomes through the lens of gene-environment interactions.

Citation Format: Daniel A Rodriguez, Sina Yadegarynia, J. William Harbour, Nipun B. Merchant, Erin N. Kobetz, Neha Goel. Comprehensive analysis of global genetic ancestry and socioeconomic status on breast cancer outcomes [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-13-05.

Mapping carcinogen exposure across urban fire incident response arenas using passive silicone-based samplers

Carcinogens are emitted in significant quantities at fire scenes and are a major contributor in the increased cancer risk observed in firefighters when compared to the general population. A knowledge gap exists in the current understanding of the distribution of these toxic compounds within a localized fire incident response arena. Here, we employ stationary silicone-based passive samplers at controlled live fire trainings to evaluate the deposition behavior of polyaromatic hydrocarbons (PAHs) emitted by fires. Our findings indicate significantly greater total PAH exposure in fires fueled by biomass and wood compared to fires burning cleaner fuels, such as propane. A 22% increase in total PAH deposition and a 68% increase in high molecular weight PAH deposition was recorded for biomass fueled fires compared to propane fueled fires. Furthermore, we observe that heavier molecular weight PAHs exhibit a pronounced deposition front within a certain radius of the hot zone, whereas low molecular weight PAHs are more uniformly distributed throughout the area. These findings highlight that the warm zones and cold zones of fire situations yield elevated levels of carcinogen exposure to first responders within them. We anticipate that these findings will help inform decisions made by emergency personnel when evaluating risk for the hot zone, warm zone, and cold zone of urban fires helping ease the carcinogenic risk experienced.

New insights into the burden of COVID-19 mortality for U.S. Hispanics and Blacks when examined by country/region of origin: An observational study

Background

Florida's diverse population composition includes persons from throughout Latin America and the Caribbean. This facilitated an insightful examination of disparities in 2020 Florida COVID-19 deaths not only among racial/ethnic populations in the aggregate (non-Hispanic White, non-Hispanic Black, Hispanic) but also at the level of country/region of origin.

Methods

Age-adjusted mortality rates (AAMRs) for 2020 Florida COVID-19 deaths were calculated by race, ethnicity, and country/region of origin along with mean age at death, mean number of comorbidities, and percentage of decedents who had not completed secondary education. Regression-derived mortality rate ratios (MRRs) compared death rates for each racial/ethnic/country-of-origin population to non-Hispanic whites.

Findings

The overall AAMR (per 100,000) for 18,342 Florida COVID-19 deaths in 2020 was 55.4, with a much lower AAMR for non-Hispanic Whites (39.3) than for Hispanics (86.8) or Blacks (107.6). Marked differences in AAMRs were observed for specific Black and Hispanic ethnic groups from varied countries/regions of origin. COVID-19 decedents from Mexico and Central America had the highest AAMRs (170.7 and 168.8 per 100,000, respectively), lowest age at death, lowest educational level, and fewest comorbidities. Mean comorbidities were highest for Blacks (all origins) and Cuban Hispanics.

Interpretation

Florida Blacks and Hispanics experienced disproportionately high COVID-19 mortality rates throughout 2020, with notable variability based on country/region of origin. Inequities were particularly pronounced for Hispanic populations from Mexico and Central America. To better understand these heterogeneous COVID-19 mortality trends, more nuanced racial/ethnic analyses and detailed data on social determinants of health are needed.

Funding

Supplemental funding was provided by the Sylvester Comprehensive Cancer Center at University of Miami Miller School of Medicine. Research reported in this publication was also supported by the National Cancer Institute of the National Institutes of Health under Award Number P30CA240139.

Endometrial Cancer Type 2 Incidence and Survival Disparities Within Subsets of the US Black Population

Introduction

Endometrial cancer type 2 (EC2) carries a worse prognosis compared to EC type 1. EC2 disproportionately affects Black women among whom incidence is higher and survival is poorer compared to Whites. Here we assessed EC2 incidence and survival patterns among US Black ethnic groups: US-born Blacks (UBB), Caribbean-born Blacks (CBB), and Black Hispanics (BH).

Methods

We analyzed population-based data (n=24,387) for the entire states of Florida and New York (2005–2016). Hysterectomy-corrected EC2 incidence rates were computed by racial-ethnic group, and survival disparities were examined using Cox regression adjusting for tumor characteristics, poverty level, and insurance status.

Results

EC2 incidence rates were highest among UBB (24.4 per 100,000), followed by CBB (18.2), Whites (11.1), and Hispanics of all races (10.1). Compared to Whites, the age-adjusted cause-specific survival was worse for non-Hispanic Blacks (aHR: 1.61; 95%CI 1.52–1.71) and Hispanics of all races (aHR:1.09; 95% CI:1.01–1.18). In relation to Whites, survival was worse for non-Hispanic Blacks: UBB (aHR:1.62; 95%CI 1.52–1.74) and CBB (aHR:1.59; 95% CI:1.44–1.76) than for BH (aHR:1.30; 95% CI:1.05–1.61). Surgical resection was associated with a lower risk of death, while carcinosarcoma subtype and advanced stage at diagnosis were associated with a greater risk.

Conclusions

Although higher EC2 incidence and lower survival are observed among all African-descent groups, there are significant intra-racial differences among UBB, CBB, and BH. This heterogeneity in EC2 patterns among Black populations suggests an interplay between genetic and socioenvironmental factors.

Kidney cancer mortality disparities among Hispanics in the US

INTRODUCTION

Kidney cancer incidence is increasing among Hispanics but rate differences by distinct group, such as Cuban, Puerto Rican, and Mexican have not been studied. To fill this knowledge gap, we use mortality data, reflecting fatal kidney cancers, to examine patterns by race-ethnicity, including detailed Hispanic groups, and correlate the mortality rates with each group's prevalence of known kidney cancer risk factors: smoking, obesity, hypertension, diabetes, and chronic kidney disease.

METHODS

We used individual-level death data for California, Florida, and New York (2008-2018), and population prevalence data from the National Health Interview Surveys (2008-2018). Age-adjusted mortality rates (AAMRs) and regression-derived mortality rate ratios (MRRs) were computed. Pearson correlation analyses assessed the extent to which group-specific risk factor prevalence explained variability in observed AAMRs.

RESULTS

US-born Mexican Americans and American Indians had the highest rates and MRRs compared to Whites: 1.44 (95 %CI: 1.35-1.53) and 1.51 (1.38-1.64) for Mexican American men and women, respectively, and 1.54 (95 %CI: 1.25-1.89) and 1.53 (95 %CI: 1.15-2.04) for American Indians. In contrast, non-Mexican Hispanics had lower rates than Whites. Among males, positive correlations between AAMRs and smoking, obesity, and chronic kidney disease prevalence by race-ethnicity were found.

CONCLUSION

Mexican Americans and American Indians are high-risk for fatal kidney cancer. Disparities are only partially attributable to higher smoking and obesity prevalence, and more so among men than women. A shared risk factor profile, as well as possible genetic similarities, may explain their disproportionately higher kidney cancer mortality, but further research is warranted.

Comparing cancer risk estimates using occupational record linkage approaches in male Florida firefighters

BACKGROUND

Firefighters have an increased risk of cancer, but variations in reported results could be due to differences in occupational case ascertainment. This study compares cancer risk estimates generated by identifying firefighters from their occupational title available in the Florida Cancer Data System (FCDS) versus identification by a linkage method between the FCDS and the Florida State Fire Marshal's Office.

METHODS

Florida firefighter employment records (1972-2012; n = 109,009) were linked with FCDS data (1981-2014; ~3.3 million records), identifying 3760 primary cancers in male firefighters. Using the FCDS occupational data field we identified 1831 male cancer cases in those classified as firefighters, first-line supervisors of firefighting and prevention workers, fire inspectors, emergency medical technicians, or paramedics. Age and calendar year-adjusted odds ratios (aOR) and 95% confidence intervals for firefighters versus non-firefighters were calculated for both groups.

RESULTS

For skin cancers the risk estimate for FCDS-indentified firefighters was substantially lower than in the employment-record-linked firefighters (aOR = 1.06; 0.87-1.29 vs. 1.54; 1.37-1.73), but for endocrine system cancers it was greater (aOR = 2.36; 1.77-3.14 vs. 2.08; 1.71-2.53). Remaining cancer risk estimates were in the same direction for the two samples except for lymphoma (aOR = 1.10; 0.90-1.34 vs. 0.86; 0.75-0.99).

CONCLUSION

Reliance on occupational title in cancer registry records to characterize firefighter cancer risk may result in estimates that are over- or underestimated depending on cancer site. The authors recommend moving toward national linkages between cancer registries and certification or other administrative records, which are a vital resource for firefighter cancer research.

Evaluation of silicone-based wristbands as passive sampling systems using PAHs as an exposure proxy for carcinogen monitoring in firefighters: Evidence from the firefighter cancer initiative

Compared to the general population, firefighters are known to sustain greater levels of exposure to hazardous compounds, despite their personal protective equipment, also known as turnout gear. Among the most significant toxins that firefighters are chronically exposed to are polycyclic aromatic hydrocarbons (PAHs). Additionally, firefighters have also been noted to exhibit an increased incidence of certain types of cancer. Considering a probable link between exposure to PAHs and increased rates of cancer in the fire service, we aim to document ambient chemical concentrations in the firefighter work environment. Our strategy involves the use of silicone-based wristbands that have the capacity to passively sorb PAHs. To determine if wristbands can serve as an effective chemical monitoring device for the fire service, silicone wristbands were pilot-tested as personal sampling devices for work environment risk monitoring in active-duty firefighters. Recovered wristbands underwent multiple extraction steps, followed by GC-MS analysis to demonstrate their efficacy in monitoring PAHs in the firefighter environment. Initial findings from all wristband samples taken from firefighters showed multiple exposures to various PAHs of concern for the health of the firefighters when in a fire environment. In addition to PAH monitoring, we examined known and potential sources of PAH contamination in their work environment. To that end, profiles of elevated PAH concentrations were documented at various fire stations throughout South Florida, for individual firefighters both during station duties and active fire response.

Abstract PO-005: Where you live matters: Impact of economic, racial/ethnic, and racialized economic residential segregation on breast cancer survival

Background Racial and economic residential segregation remains a problem within the United States (US). Although advances in screening, detection, diagnosis, and treatment have reduced overall breast cancer mortality, well-documented socioeconomic and racial/ethnic survival disparities persist. The objective of this study was to analyze the effect of economic and racial/ethnic residential segregation, as measured by the Index of Concentration at the Extremes (ICE), on breast cancer survival. Methods Patients treated at our medical campus, comprised of a safety-net hospital and an academic cancer center, with stage I-IV breast cancer from 2005-2017 were identified from our tumor registry. Census tracts were used as neighborhood proxies. Using 5-year estimates from the American Community Survey, 5 ICE variables were computed: economic (high vs. low), race/ethnicity (non- Hispanic White (NHW) vs. non-Hispanic Black (NHB) and NHW vs. Hispanic) and racialized economic (low-income NHB vs high-income NHW and low-income Hispanics vs. high-income NHW) segregation. ICE uniquely captures spatial economic and racial/ethnic segregation by mapping social inequality not otherwise captured by evaluating a population of a specific socioeconomic level or belonging to a particular racial/ethnic group. Random effects frailty models were conducted for all patients and then stratified by race/ethnicity controlling for demographics, tumor characteristics, and NCCN-guideline appropriate treatment subtype. Results The study population included 6,145 breast cancer patients. 52.6% were Hispanic, 26.3% were NHW, and 17.2% were NHB. After controlling for multiple covariates, those living in extreme economically disadvantaged neighborhoods had an increased hazard ratio (HR) of death compared to those living in more economically advantaged neighborhoods (HR: 1.58 95% CI: 1.29-1.92, p&lt;0.001). Patients living in an economically disadvantaged NHB neighborhood also had an increased HR compared to those living in more economically advantaged NHW neighborhoods (HR: 2.0 95% CI:1.54-2.60, p&lt;0.001). In race-stratified analyses, a NHW living in an economically disadvantaged NHB neighborhood had an increased HR compared to a NHW living in an economically advantaged NHW neighborhood (HR: 2.02 95% CI:1.19-3.41, p&lt; 0.0071), even when controlling for demographics, tumor subtype, and appropriate treatment. Conclusion This study is the first to evaluate breast cancer survival by ICE, which brings social inequality to the forefront. Our study suggests that survival disparities persist at the extremes of economic deprivation/privilege and racial/ethnic residential segregation, even when accounting for demographics, tumor characteristics, and appropriate treatment, suggesting social/environmental factors are also impacting survival. To address these disparities, effective interventions are needed that account for the social and environmental contexts in which cancer patients live and are treated.

Citation Format: Neha Goel, Sina Yadegarynia, Kristin N. Kelly, Susan B. Kesmodel, Erin N. Kobetz, Ashly Westrick. Where you live matters: Impact of economic, racial/ethnic, and racialized economic residential segregation on breast cancer survival [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-005.

Disparities in the use of antineoplastic immunotherapy in pediatric malignant adrenal tumors

Dinutuximab is a costly life-prolonging immunotherapy for high-risk neuroblastoma. We used a large pediatric inpatient database to analyze the use of antineoplastic immunotherapy in patients with malignant adrenal tumors 1 year after Food and Drug Administration approval of dinutuximab for high-risk neuroblastoma. On multivariate modeling, children of Black race (odds ratio [OR] 0.62, P = .04; referent non-Black) and the lowest ZIP code income quartile (OR 0.74, P = .03; referent wealthier 3 quartiles) were significantly less like to receive antineoplastic immunotherapy. These results suggest substantial disparities in the distribution of a vital therapy in children with advanced cancer.

The role of histology on endometrial cancer survival disparities in diverse Florida

Background

Endometrial cancer (EC) mortality is particularly high among non-Hispanic Blacks and is twice that of non-Hispanic Whites. However, comparisons of EC survival outcomes by race/ethnicity are often confounded by histology and grade. Here, we analyze EC survival disparities in multiracial Florida with a focus on EC types (1 and 2) and subtypes, defined according to histology and grade.

Methods

All 27,809 cases of EC diagnosed during 2005–2016 were obtained from the Florida Cancer Registry. Age-standardized, 5-year cause-specific survival by race/ethnicity and histological type were calculated. Fine and Gray competing risk regression was used to estimate sub-distribution hazard ratios (sHRs) for associations between risk of death due to EC and potential predictive factors such as histology/grade, age, stage at diagnosis, and insurance.

Results

Type 2 EC accounted for only 38.7% of all incident EC-cases but 74.6% of all EC-deaths. Blacks were disproportionately affected by type 2 EC (57.6%) compared to Whites, Hispanics, and Asians (35.6%, 37.7%, and 43.0%, respectively). Age-adjusted 5-year survival for types 1 and 2 were 85.3% and 51.6%, respectively; however, there was wide variation within type 2 subtypes, ranging from 60.2% for mixed cell EC to as low as 30.1% for carcinosarcoma. In the multivariable model, Blacks with type 2 EC had a 23% higher risk of death due to EC (sHR: 1.23, 95%CI: 1.12–1.36) compared to Whites.

Conclusions

Population-based analyses should consider the histological heterogeneity of EC because the less common type 2 EC drives racial/ethnic survival disparities in EC. Black women have a higher proportion of more aggressive histological types and an overall higher risk of death due to EC than Whites. To the extent that some of these histological types may be considered different diseases and require specific treatment approaches, further research on etiology and prognosis for detailed type 2 EC subtypes is warranted.

Abstract A29: Silicone-based wristband passive samplers in the detection of firefighter occupational carcinogenic exposures

Introduction: First responders (i.e., paramedics and firefighters) are exposed to hazardous chemicals such as polycyclic aromatic hydrocarbons (PAHs)in the conduct of their work duties. Linking mixed chemical exposures to health conditions (e.g., cancer) is difficult given the latency period of disease, the magnitude of the potential doses, or interactions of carcinogenic compounds present while firefighting. To understand the relationship between environmental exposures and resulting toxicity, passive personal sampling devices (PSDs) have been used to monitor. In the present study, we 1) describe the type of chemical exposures encountered by firefighters in their work environment, 2) characterize and compare chemical exposures by work-shift activities (e.g., fire suppression, emergency medical services, hazmat), and 3) field test the use of silicone-based wristbands for monitoring chemical exposures in firefighters.

Methods: Twenty-four wristbands were deployed across various fire services throughout South Florida. Prior to deployment, bands were cleaned using a standardized cleaning protocol to remove contamination and optimize the surface for absorption. Wristbands were then packaged in airtight bags to prevent contamination. Wristbands were worn on fire service personnel and collected at the end of a 24-hour work shift. Chemical contaminants were then extracted from the wristband and analyzed for PAHs—identified using the EPA IRIS, California Proposition 65, and IRAC datasets—using gas chromatography-mass spectrometry.

Results: The average number of chemicals found across all wristbands (n=24) was 23 with 4 categorized as carcinogenic to humans (i.e., benzo[b]fluoranthene, benzo[j]fluoranthene, chrysene, and naphthalene). All bands had at least one PAH present, specifically, 87.5% contained benzo[b]fluoranthene (mean=5.23 ng/band), 50% contained benzo[j]fluoranthene (mean=2.05 ng/band), 79.2% contained chrysene (mean=9.55 ng/band), and 100% contained napthalene (mean=176.53 ng/band). Actual types of exposure compounds are likely to be larger than the observed data as the group of PAHs detected was limited to three existing datasets.

Discussion: Silicone-based wristbands are feasible to use within the fire service to detect and characterize ambient hazardous chemical compounds. These personal self-samplers used during a 24-hour collection period identified various PAHs in the firefighter work environment. Objective measures of harmful chemical exposures in the fire service should be monitored with a comprehensive surveillance system that includes personal sampler devices.

Citation Format: Alberto J. Caban-Martinez, Katerina M. Santiago, Jeramy Baum, Natasha N. Schaefer Solle, Sylvia Daunert, Sapna Deo, Erin N. Kobetz. Silicone-based wristband passive samplers in the detection of firefighter occupational carcinogenic exposures [abstract]. In: Proceedings of the AACR Special Conference on Environmental Carcinogenesis: Potential Pathway to Cancer Prevention; 2019 Jun 22-24; Charlotte, NC. Philadelphia (PA): AACR; Can Prev Res 2020;13(7 Suppl): Abstract nr A29.

Objective Measurement of Carcinogens Among Dominican Republic Firefighters Using Silicone-Based Wristbands

PURPOSE

Firefighters around the world are exposed to physical hazards and toxic chemical agents during fire incident response. Occupational epidemiologic studies of the firefighter workforce have documented an excess cancer risk for brain, digestive, genitourinary, and lymphohematopoietic organs compared with the general population. Despite the elevated cancer risk, little is known about what specific types of carcinogenic chemicals first responders encounter during a typical work shift, particularly in low-resources settings, like the Dominican Republic. This pilot study characterizes objective measurements of carcinogenic exposure using passive sampling silicone-based wristbands among Dominican firefighters.

METHODS

Firefighters from a metropolitan fire service in the Dominican Republic were asked to wear a silicone-based wristband during one typical 24-hour shift. A pre- and postshift survey was administered to the firefighter to assess their self-reported sociodemographic, employment, and work shift characteristics. Wristbands were collected after their 24-hour shift and processed for the type and quantity of polycyclic aromatic hydrocarbons (PAHs), a family of known carcinogenic compounds, to which firefighters were exposed.

RESULTS

Among 15 firefighters who wore a wristband during their 24-hour shift, 73.3% responded to a fire with an average of 3.7 calls during the shift. Fire incident responses included structural fires (54.5%), outside and other fires (36.4%), and vehicle fires (9.1%). Total PAH exposure was significantly higher among Dominican firefighters who responded to a fire compared with firefighters with no fire during their shift (261 parts per billion [ppb] v 117 ppb, respectively; P = .003). Among the 19 PAHs quantified, low-molecular-weight phenanthrene was present in the highest concentration (32 ppb) among firefighters not responding to fires.

CONCLUSION

Passive objective sampling of PAHs using silicone-based wristbands among Dominican firefighters showed direct exposure to carcinogenic compounds during a typical 24-hour firefighter shift. Firefighters not attending a fire had lower levels of PAHs, suggesting carcinogenic contaminants are present at the fire station.

Abstract C056: Cancer patterns and trends in Costa Rica: A population-based tumor registry study

Background: Recent economic and social changes in low- and middle-income countries in Latin American have influenced the raise of noncommunicable diseases, including cancer. Data from cancer registries are critical for surveilling disease trends during periods of epidemiologic transition. The aim of this study is to generate population estimates of cancer incidence rates in Costa Rica and to evaluate geographical differences.

Methods: The National Tumor Registry in Costa Rica was queried for cancer cases diagnosed between 2009-2014. Population data were used to calculate sex, country and region-specific age standardized rates (ASR) per 100,000 people using the World Health Organization's 2000 standard population. Standardized incidence ratios (SIR) and 95% confidence intervals (CI) were calculated to assess the effect of sex and geographic regions.

Results: The overall cancer incidence rate in Costa Rica was 219.24 cases per 100,000. Females had a higher cancer rates relative to males (SIR: 1.1, 95% CI: 1.08-1.11, p &lt; .001). The leading cancers were prostate (ASR: 53.09, 95% CI: 51.75-54.46), female breast (ASR: 48.73; 95% CI: 47.54-49.94), cervical (ASR: 30.78; 95% CI: 29.77-31.62), stomach (ASR: 17.45; 95% CI: 16.93-17.99), colorectal (ASR: 16.49; 95% CI: 15.98-17.00) and thyroid (ASR: 12.96; 95% CI: 12.54-13.40) cancers. San Jose had the highest breast and colon cancers rates whereas, Cartago had the highest rates for gastric and thyroid cancers.

Conclusion: Costa Rica has a growing cancer burden involving preventable cancers. Continued monitoring of trends in incidence rates is needed to implement cancer control actions. Further involvement to create cancer prevention strategies and programs aimed to reduce cancer burden is warranted.

Citation Format: Omar Picado, Jordan Baeker-Bispo, Layla Bouzoubaa, Raymond R. Balise, Gilberto Lopes, Erin N. Kobetz. Cancer patterns and trends in Costa Rica: A population-based tumor registry study [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C056.

Cancer mortality among US blacks: Variability between African Americans, Afro-Caribbeans, and Africans

INTRODUCTION

Aggregation of all Black populations in US cancer mortality profiles masks remarkable heterogeneity by place of birth. Comparing U.S-born African Americans with African and Afro-Caribbean immigrants may highlight specific cancer prevention and control needs and clarify global cancer epidemiology. Such a comparison has yet to be undertaken on a population basis.

METHODS

Using 2012-2017 vital statistics data from California, Florida, Minnesota and New York, age-standardized cancer mortality rates were computed for distinct Black populations. Comparisons were made to the majority White population using mortality rate ratios (MRR) obtained from negative binomial regression.

RESULTS

Of the 83,460 cancer deaths analyzed among Blacks, nearly 20 % were immigrants. African males and females had the lowest all-sites-combined cancer mortality rates (121 and 99 per 100,000, respectively), African Americans had the highest (232 and 163), while Afro-Caribbean were in between (140 and 106 respectively). The average Black:White MRR was significant for prostate (2.11), endometrial (2.05), stomach (2.02), multiple myeloma (1.87), premenopausal breast (1.66), liver (1.58) and cervical (1.56) cancers, (P < 0.05).

CONCLUSION

While, in aggregate, Blacks in the US have high cancer mortality rates, race itself is not the primary determinant of these disparities. Black immigrant populations show lower cancer mortality than both African Americans and Whites, especially for cancers where environmental factors feature more predominantly: lung, colorectal and breast. Even for cancers with high mortality among all African-descent groups, this study suggests a complex interplay between genetic and environmental factors. Endometrial cancer was unique; mortality rates were similarly high for all three analyzed Black groups.

The association between etiology of hepatocellular carcinoma and race-ethnicity in Florida

BACKGROUND AND AIM

The incidence of hepatocellular carcinoma (HCC) has risen considerably in the US since 1980. The main causes include metabolic disorders (NAFLD, diabetes, obesity, metabolic syndrome), alcohol-related disease (ALD) and hepatitis C and B virus infections (HCV, HBV). Etiology-specific HCC incidence rates by detailed race-ethnicity are needed to improve HCC control and prevention efforts.

METHODS

All HCC cases diagnosed in Florida during 2014-2015 were linked to statewide hospital discharge data to determine etiology. Age-specific and age-adjusted rates were used to assess the intersection between etiology and detailed racial-ethnicities, including White, African American, Afro-Caribbean, Asian, Cuban, Puerto Rican and Continental Hispanic (Mexican, South and Central American).

RESULTS

Of 3666 HCC cases, 2594 matched with discharge data. HCV was the leading cause of HCC among men and women (50% and 43% respectively), followed by metabolic disorders (25% and 37%) and ALD (16% and 9%). Puerto Rican and African American men had the highest HCV-HCC rates, 7.9 and 6.3 per 100 000 respectively. Age-specific rates for HCV-HCC peaked among baby boomers (those born in 1945-1965). Metabolic-HCC rates were highest among populations above age 70 and among Continental Hispanics. Afro-Caribbean men had high rates of HBV-HCC, whereas Puerto Rican men had high ALD-HCC.

CONCLUSIONS

HCC etiology is associated with specific race/ethnicity. While HCV-related HCC rates are projected to decrease soon, HCC will continue to affect Hispanics disproportionately, based on higher rates of metabolic-HCC (and ALD-HCC) among Continental Hispanics, who demographically represent 80% of all US Hispanics. Multifaceted approaches for HCC control and prevention are needed.

Cancer risk among career male and female Florida firefighters: Evidence from the Florida Firefighter Cancer Registry (1981-2014)

BACKGROUND

Firefighters are at increased risk for select cancers. However, many studies are limited by relatively small samples, with virtually no data on the cancer experience of female firefighters. This study examines cancer risk in over 100,000 career Florida firefighters including 5000 + females assessed over a 34-year period.

METHODS

Florida firefighter employment records (n = 109 009) were linked with Florida Cancer Data System registry data (1981-2014; ~3.3 million records), identifying 3760 male and 168 female-linked primary cancers. Gender-specific age and calendar year-adjusted odds ratios (aOR) and 95% confidence intervals for firefighters vs non-firefighters were calculated.

RESULTS

Male firefighters were at increased risk of melanoma (aOR = 1.56; 1.39-1.76), prostate (1.36; 1.27-1.46), testicular (1.66; 1.34-2.06), thyroid (2.17; 1.78-2.66) and late-stage colon cancer (1.19;1.00-1.41). Female firefighters showed significantly elevated risk of brain (2.54; 1.19-5.42) and thyroid (2.42; 1.56-3.74) cancers and an elevated risk of melanoma that approached statistical significance (1.68; 0.97-2.90). Among male firefighters there was additional evidence of increased cancer risk younger than the age of 50 vs 50 years and older for thyroid (2.55; 1.96-3.31 vs 1.69; 1.22-2.34), prostate (1.88; 1.49-2.36 vs 1.36; 1.26-1.47), testicular (1.60; 1.28-2.01 vs 1.47; 0.73-2.94), and melanoma (1.87; 1.55-2.26 vs 1.42; 1.22-1.66) cancers.

CONCLUSION

Male career firefighters in Florida are at increased risk for five cancers with typically stronger associations in those diagnosed younger than the age of 50, while there was evidence for increased thyroid and brain cancer, and possibly melanoma risk in female firefighters. Larger cohorts with adequate female representation, along with the collection of well-characterized exposure histories, are needed to more precisely examine cancer risk in this occupational group.

Liver cancer: A leading cause of cancer death in the United States and the role of the 1945-1965 birth cohort by ethnicity

Liver cancer is highly fatal and the most rapidly increasing cancer in the US, where chronic hepatitis C (HCV) infection is the leading etiology. HCV is particularly prevalent among the 1945-1965 birth cohort, the so-called “baby boomers”. Focusing on this cohort-etiology link, we aim to characterize liver cancer patterns for 15 unique US populations: White, African American, Mexican Immigrant, Mexican American, Cuban and Chinese, among others.

Methods

Individual-level mortality data from 2012–2016 from the health departments of 3 large states – California, Florida, New York – were pooled to compute liver cancer mortality rates for each racial/ethnic group and for 2 birth cohorts of interest: “1945–1965 cohort” and “older cohort”.

Results

Liver cancer is a major cause of cancer death among all US male groups and the leading cause in Mexican American men. Over 50% of the age-adjusted liver cancer mortality of White, African American, Mexican American, and Puerto Rican males came from the 1945-1965 birth cohort. In contrast, foreign-born male and all female populations had higher liver cancer mortality originating from the older cohort. Internationally, US White male baby boomers had a 49% higher liver cancer mortality rate than their counterparts in Europe (mortality rate ratio 1.49; 95% CI 1.43–1.56).

Conclusions

Populations burdened disproportionately by liver cancer in the 1945–1965 cohort include US-born males who were all present in the US during the 1960s–1990s when significant HCV transmission took place; these individuals will benefit most from HCV screening and treatment. For the others, including all women, Asian subgroups, and especially burgeoning Hispanic immigrant populations, comprehensive liver cancer prevention efforts will require detailed study of the distribution of etiologies.

Lay summary

Liver cancer, a major cause of cancer death among US males, is increasing. The causes of liver cancer are varied, including hepatitis C, hepatitis B, alcohol-related liver disease, and non-alcoholic fatty liver disease. Racial/ethnic groups are impacted differently, but the highest rates are seen among US-born men born between 1945–1965, the so-called “baby boomers”, whether White, Black, or Hispanic, likely linked to the known high prevalence of hepatitis C infection among this cohort.

•

Liver cancer is now the leading cause of cancer death among Mexican American males.

•

Rates vary intra-racially: e.g. Vietnamese have high rates; South Asians have low.

•

US-born male “baby boomers” of any race/ethnicity have the highest liver cancer mortality.

•

Foreign-born men and all women have higher mortality at older ages, 70 or more.

•

In the “baby boomer” cohort, US Whites have higher liver cancer mortality than Europeans.

Abstract 4249: Disparities in cancer screening between Latino and non-Latino firefighters: Evidence from the Sylvester Firefighter Cancer Initiative

Firefighters face an increased risk for work-related exposures to hazardous environmental carcinogens during fire incidence response. A growing body of epidemiologic studies suggest that firefighter site-specific cancer incidence and mortality rates are higher when compared to the general US population. As the fastest-growing ethnic subgroup in the US, Latinos have been increasingly represented in the first responder workforce. Latinos relative to non-Latinos vary in cancer-related risk factors including rates of smoking, alcohol consumption, physical activity patterns, and rates of cancer morbidity and mortality. Despite these differences in risk factors, there is limited literature on the cancer screening behavior of Latino firefighters who may be at an increased risk for cancer. In the present study, we characterize sociodemographic and work characteristics in addition to cancer screening behaviors between Latino and non-Latino active firefighters. The Annual Cancer Survey (ACS) research project of the Firefighter Cancer Initiative launched with a 127-item comprehensive cancer questionnaire administered online to a non-probabilistic sample of firefighters employed in South Florida. We present ACS data collected during the first 12-months of this cross-sectional, convenience sample. Firefighters were invited and consented by the study team to complete the ACS using a secure iPad device during their regular work shift. Univariable and multivariable logistic regression models were fitted to predict history of cancer screening behaviors. Among the 3,152 study participants, the mean age was 40.4 years (± 9.1 years standard deviation), 34.3% were Latino, 10% female, and had been employed on average 14.0 years (± 8.6) as a firefighter. The number of Latino firefighters who had not seen a doctor in the past 12 months (5.1%) or visited a primary care physician for routine care (25.5%) was significantly more relative to non-Latino Firefighters (4.2% and 19.3%, respectively; both p&lt;0.01). Across cancer screening behaviors, the number of Latino firefighters who ever had a PSA test to screen for prostate cancer (24.7% vs 38.1%, p&lt;0.01) and a colonoscopy (20.0% vs. 29.0%, p&lt;0.01) was significantly less than non-Latino firefighters. Latino firefighters are significantly less likely than their non-Latino colleagues to report a full body skin exam by their doctor (adjusted odds ratio 0.35; 95% CI 0.29-0.42) while controlling for age, gender, race, educational attainment, household income, health insurance type, routine access to primary care and tenure as a firefighter. Florida firefighters of Latino ethnicity tend to participate less in routine cancer screening practices. Strategies at the fire station or at the individual worker-level are needed to improve cancer screening disparities within this high-risk minority workforce.

Citation Format: Alberto J. Caban-Martinez, Natasha Schaefer Solle, Tulay Koru-Sengul, Katerina M. Santiago, Kevin J. Moore, Feng Miao, David J. Lee, Erin N. Kobetz. Disparities in cancer screening between Latino and non-Latino firefighters: Evidence from the Sylvester Firefighter Cancer Initiative [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4249.

Safety Gear Decontamination Practices Among Florida Firefighters: Analysis of a Text-Based Survey Methodology

Despite the National Fire Protection Association (NFPA) 1851 Personal Protective Equipment Care and Maintenance guidelines, little is known about the routine cleaning of firefighter bunker gear. In collaboration with a large Florida firefighter union, a mobile phone text survey was administered, which included eight questions in an item logic format. In total, 250 firefighters participated in the survey of which 65% reported cleaning their bunker gear in the past 12 months. Approximately 32% ( n = 52) indicated that they had above average confidence in gear cleaning procedures. Arriving at a fire incident response was a significant predictor of gear cleaning in the 12 months preceding survey administration. Using mobile phone-based texting for periodic queries on adherence to NFPA cleaning guidelines and safety message distribution may assist firefighters to increase decontamination procedure frequency.

Ethnic heterogeneity and prostate cancer mortality in Hispanic/Latino men: a population-based study

BACKGROUND

Few studies focus on prostate cancer (PCa) outcomes in Hispanic/Latino men. Our study explores whether Hispanic/Latino subgroups demonstrate significantly different prostate cancer-specific mortality (PCSM) relative to Non-Hispanic White (NHW) and Non-Hispanic Black (NHB) men.

METHODS

We extracted a population-based cohort of men diagnosed with local-regional PCa from 2000-2013 (n= 486,865). PCSM was measured in racial/ethnic groups: NHW (n=352,886), NHB (n= 70,983), Hispanic/Latino (n= 40,462), and Asian American/Pacific Islander (n= 22,534). PCSM was also measured in Hispanic/Latino subgroups: Mexican (n= 8,077), Puerto Rican (n= 1,284), South or Central American (n= 3,021), Cuban (n= 788), and Dominican (n= 300). We conducted univariable and multivariable analyses (MVA) to compare risk for PCSM.

RESULTS

Compared to NHW men, results showed worse outcomes for NHB men with similar outcomes for Hispanic/Latino men. In MVA with NHW men as a reference, NHB (HR= 1.15, p <0.001) men had significantly worse PCSM and Hispanic/Latino (HR= 1.02, p= 0.534) men did not show a significant difference. In a second MVA, Puerto Rican (HR= 1.71, p <0.001) and Mexican (HR= 1.21, p= 0.008) men had significantly higher PCSM. With NHB men as a reference, the MVA showed Puerto Rican (HR= 1.50, p= 0.006) men with higher PCSM and Mexican (HR= 1.08, p= 0.307) men with no significant difference.

CONCLUSIONS

Our findings indicate previously unknown disparities in PCSM for Puerto Rican and Mexican American men.

Black Heterogeneity in Cancer Mortality: US-Blacks, Haitians, and Jamaicans

INTRODUCTION

The quantitative intraracial burden of cancer incidence, survival and mortality within black populations in the United States is virtually unknown.

METHODS

We computed cancer mortality rates of US- and Caribbean-born residents of Florida, specifically focusing on black populations (United States, Haiti, Jamaica) and compared them using age-adjusted mortality ratios obtained from Poisson regression models. We compared the mortality of Haitians and Jamaicans residing in Florida to populations in their countries of origin using Globocan.

RESULTS

We analyzed 185,113 cancer deaths from 2008 to 2012, of which 20,312 occurred in black populations. The overall risk of death from cancer was 2.1 (95% CI: 1.97-2.17) and 1.6 (95% CI: 1.55-1.71) times higher for US-born blacks than black Caribbean men and women, respectively (P < .001).

CONCLUSIONS

Race alone is not a determinant of cancer mortality. Among all analyzed races and ethnicities, including Whites and Hispanics, US-born blacks had the highest mortality rates while black Caribbeans had the lowest. The biggest intraracial difference was observed for lung cancer, for which US-blacks had nearly 4 times greater mortality risk than black Caribbeans. Migration from the islands of Haiti and Jamaica to Florida resulted in lower cancer mortality for most cancers including cervical, stomach, and prostate, but increased or stable mortality for 2 obesity-related cancers, colorectal and endometrial cancers. Mortality results in Florida suggest that US-born blacks have the highest incidence rate of "aggressive" prostate cancer in the world, rather than Caribbean men.

Abstract A36: Community involvement in prevention research: A model for reducing cancer disparities

This presentation describes a campus-community partnership established to address cancer disparities in a medically-underserved neighborhood within a large metropolitan urban area. Over the past several decades, the historically African American area has become increasingly isolated and disenfranchised due to demographic changes in surrounding communities. Pilot studies we conducted show higher than expected mortality rates from certain cancers, a high rate of behaviors that increase their risk for cancer (e.g., tobacco use), and a low rate of routine cancer screening and timely access to cancer treatment. As part of our university cancer center's cancer control and community research initiative to decrease local disparities, we created a network of Community Advisory Boards (CAB) throughout our catchment area. The CAB described here was developed to address documented cancer disparities in an area in close proximity to the university's medical campus. We identified community leaders and conducted 20 key informant interviews. With guidance from the CAB, we conducted a door-to-door survey of 250 randomly-selected households in a public housing development to assess community needs related to cancer and barriers to accessing services. A community-based participatory research (CBPR) model was used to engage the community and establish an economic partnership that benefits the community. Benefits include services and employment opportunities. Employing residents as research assistants has been found to maximize recruitment and community acceptance. To date, funded investigations have been conducted on the following: reducing the high prevalence of tobacco use, early detection of oral cancers using biomarkers, stress management for cancer survivors, and screening for conditions related to other chronic diseases such as diabetes. In addition, the university responded to request for services by conducting free annual health screening and education fairs and offering ongoing smoking cessation resources. We will discuss the successes and challenges of this partnership with a community that has minimal infrastructure but is motivated to improve the health of its residents. We will also describe how CAB members are taking ownership of the process and bringing additional resources to the table.

Citation Format: Dorothy F. Parker, Tracy Kelley, Eric Thompson, Erin N. Kobetz. Community involvement in prevention research: A model for reducing cancer disparities. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A36. doi:10.1158/1538-7755.DISP13-A36

Abstract A19: Acceptability of the Pap test versus an HPV self-sampler for cervical cancer screening among women of Haitian descent

Purpose: Cervical cancer screening disparities have been acknowledged in cities with growing Haitian populations. These disparities are attributed to high incidence and low cervical screening rates. There are barriers leading to increased disease incidence and hindering cervical cancer screenings. The purpose of this research is to replicate an evidence-based cervical cancer screening intervention Pap tes Lakay (Haitian Creole for at home Pap test). Implementing this intervention may serve as an effective strategy to help eliminate cervical cancer screening barriers in at-risk communities, including women of Haitian descent in Metro-Atlanta. Pursuit of this research endeavor will also assess cervical cancer screening preference (Self-Sampling for Human papillomavirus versus Papanicolaou test) among program participants.

Methods: Pap tes Lakay is a culturally-effective approach to the cervical cancer screening disparity among Haitian women. Through this community-based participatory research (CBPR) intervention, Kobetz et al. disseminated linguistically- and culturally-appropriate cervical cancer prevention education to Haitian women utilizing community health workers (CHWs). CHWs demonstrated proper use of an HPV Self-Sampler, a device that detects abnormal cervical cell growth and other abnormalities. Investigators will replicate this evidence-based cervical cancer screening intervention and recruit and train bilingual Haitian American CHWs. CHWs will solicit participant informed consent, administer baseline surveys, deliver education, demonstrate proper Self-Sampler use, and administer post surveys.

Results: A University of Miami study demonstrated high acceptability of an at-home HPV Self-Sampler. Implementation of Pap tes Lakay proved efficacious in increasing cervical cancer screening among Haitian women in South Florida. Previous results indicate 98% would recommend the HPV Self-Sampler to friends and family; 96% felt comfortable using it and 95% thought that it was easy to use.

Discussion: The high rates of acceptance indicate that self-sampling may be a viable alternative to increasing cervical cancer prevention among this underserved population. This demonstrates Pap tes Lakay is a culturally-appropriate method to address cervical cancer screening disparities among women of Haitian heritage. Future plans include implementation of this evidence-based intervention in Metro Atlanta and assessing cervical screening preference among women of Haitian descent.

Citation Format: Francesca Damus, Selina A. Smith, Ernest Alema-Mensah, Erin N. Kobetz. Acceptability of the Pap test versus an HPV self-sampler for cervical cancer screening among women of Haitian descent. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A19. doi:10.1158/1538-7755.DISP13-A19

HPV in HIV-Infected Women: Implications for Primary Prevention

Background: There is growing evidence that human immunodeficiency virus (HIV)-infected women might have a different human papillomavirus (HPV) type distribution in cervical dysplasia specimens as compared to the general population. This has implications for primary prevention.

Objective: We aimed to obtain preliminary data on the HPV genotypes prevalent in histological samples of HIV-infected women with cervical intraepithelial neoplasia (CIN) 3/CIS of the cervix in Miami, FL, USA.

Methods: Retrospective data were collected on HIV-infected women referred to the University of Miami-Jackson Memorial Hospital colposcopy clinic between years 2000 and 2008. The histology slides of CIN 3/CIS biopsies underwent pathological review and sections were cut from these archived specimens for HPV DNA extraction. HPV genotyping was then performed using the GeneSquare™ HPV genotyping assay. We report on our first set of 23 samples.

Results: Eight high-risk HPV types were detected. Types in decreasing order of frequency were 16, 35, 45, 52, 59, 31, 58, and 56. Most cases had multiple infections. HPV type 16 was the most common (45%) followed by HPV-35 and -45 with equal frequency (40%). No samples contained HPV-18.

Conclusion: Our preliminary results suggest that cervical dysplasia specimens of HIV-infected women more likely (55%) contain non-16 and -18 high-risk HPV types. We show that this held true for histologically confirmed severe dysplasia and carcinoma-in situ. Epidemiological studies guide vaccine development, therefore HPV type prevalence in CIS and invasive cervical cancer among HIV-infected women should be more rigorously explored to ensure that this highly vulnerable population receives appropriate primary prevention.

Developing an urban community-campus partnership: lessons learned in infrastructure development and communication

BACKGROUND

A low-income, African American neighborhood in Miami, Florida, experiences health disparities including an excess burden of cancer. Many residents are disenfranchised from the healthcare system, and may not participate in cancer prevention and screening services.

OBJECTIVE

We sought to describe the development of a partnership between a university and this community and lessons learned in using a community-based participatory research (CBPR) model.

METHODS

To better understand the community's health behaviors and status, a randomized door-to-door survey was conducted in collaboration with a community partner.

LESSONS LEARNED

This collaboration helped foster a mutual understanding of the benefits of CBPR. We also describe challenges of adhering to study protocols, quality control, and sharing fiscal responsibility with organizations that do not have an established infrastructure.

CONCLUSIONS

Understanding the organizational dynamics of a community is necessary for developing a CBPR model that will be effective in that community. Once established, it can help to inform future collaborations.

Women with HIV are more commonly infected with non-16 and -18 high-risk HPV types

OBJECTIVE

To review and summarize evidence from clinical, translational and epidemiologic studies which have examined the clinically relevant aspects of HPV type prevalence and cervical dysplasia in HIV-infected women.

METHODS

Relevant studies were identified through a MEDLINE search. References of identified reports were also used to identify additional published articles for review.

RESULTS

HIV-infected women in different geographic regions (such as Zambia, Brazil, Rochester NY) appear to be infected with less prevalent types of HR-HPV as compared to the general population who, across all continents, are more commonly infected with types 16 and 18. Secondly, integration of HPV DNA into the host genome is no longer thought to be a necessary cause of malignant transformation of cervical cells. However, rate of integration appears to differ by the type of HPV. In fact, the types of HPV which appear to be more common in cervical dysplasia of HIV-infected women are the same types which are more likely to require integration for malignant transformation. Finally, HPV types found in HIV-infected women are relatively common and likely to persist. The most common among these types belong to the alpha-9 and -7 species which are the most carcinogenic species.

CONCLUSION

Given that current vaccines target HR-HPV-16/18, the findings from the above mentioned studies may have important implications for the design of HPV vaccines that target the types of HPV associated with disease risk in HIV-infected women. HPV typing and assessment of the physical state (whether it is integrated or episomal) appear to be two valuable parameters for the prognostic evaluation of dysplastic lesions of the uterine cervix. This, however, has not yet been assessed in HIV-infected women. Recent data about the immune response in HPV/HIV co-infection may lead to understanding potential mechanisms for less virulent HPV causing malignant transformation in HIV-infected women.