Supplementary Table S1 shows the Sociodemographic, clinical, healthcare, and behavioral characteristics of Hispanic adults 50-74 years old who received a blood stool test last year between 2012 to 2020 by place of the interview and year of the interview

Supplementary Figure S1 shows the sample selection

Supplementary Table S2 shows factors associated with blood stool test use for colorectal screening among Hispanic adults living in Puerto Rico

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.

OBJECTIVE:Cancer patients are among the most vulnerable populations during and after a disaster. We evaluated the impact of treatment interruption on the survival of women with gynecologic cancer in Puerto Rico following Hurricanes Irma and María. METHODS:A retrospective cohort study among a clinic-based sample of women with gynecological cancer diagnosed between January 2016 and September 2017 (n = 112) was done. Women were followed from their diagnosis until December 2019, to assess vital status. Kaplan-Meier survival curves and Cox proportional hazards models were performed. RESULTS:Mean age was 56 (± 12.3) years; corpus uteri (58.9%) was the most common gynecologic cancer. Predominant treatments were surgery (91.1%) and chemotherapy (44.6%). Overall, 75.9% were receiving treatment before the hurricanes, 16.1% experienced treatment interruptions, and 8.9% died during the follow-up period. Factors associated with treatment interruption in bivariate analysis included younger age (≤55 years), having regional/distant disease, and receiving > 1 cancer treatment (P < 0.05). Crude analysis revealed an increased risk of death among women with treatment interruption (HR: 3.88, 95% CI: 1.09-13.77), persisting after adjusting for age and cancer stage (HR: 2.49, 95% CI: 0.69-9.01). CONCLUSIONS:Findings underscore the detrimental impact of treatment interruption on cancer survival in the aftermath of hurricanes, emphasizing the need for emergency response plans for this vulnerable population.

Abstract Background The use of markers has stimulated the development of more appropriate targeted therapies for chronic lymphocytic leukemia (CLL) and acute myeloid leukemia (AML). We assessed the use and prevalence of biological and genetic markers of CLL and AML in the homogeneous Hispanic population of Puerto Rico. Methods We used the Puerto Rico CLL/AML Population‐Based Registry, which combines information from linked databases. Logistic regression models were used to examine factors associated with biological and genetic testing. Results A total of 926 patients 18 years or older diagnosed with CLL (n = 518) and AML (n = 408) during 2011–2015 were included in this analysis. Cytogenetic testing (FISH) was reported for 441 (85.1%) of the CLL patients; of those, 24.0% had the presence of trisomy 12, 9.5% carried deletion 11q, 50.3% carried deletion 13q, and 6.3% carried deletion 17p. Regarding AML, patients with cytogenetics and molecular tests were considered to determine the risk category (254 patients), of which 39.8% showed poor or adverse risk. Older age and having more comorbidities among patients with CLL were associated with a lower likelihood of receiving a FISH test. Conclusions Although prognostic genetic testing is required for treatment decisions, the amount of testing in this Hispanic cohort is far from ideal. Furthermore, some tests were not homogeneously distributed in the population, which requires further exploration and monitoring. This study contributes to the field by informing the medical community about the use and prevalence of biological and genetic markers of CLL and AML. Similarly, it has the potential to improve the management of CLL and AML through benchmarking.

Background: Myelodysplastic syndromes (MDS) are a group of rare blood cancers with a wide range of clinical outcomes and a highly variable prognosis. Usually, most population-based registries do not collect cancer-related biological and genetic markers, which limits the use of population-based registries to address critical research questions. We leveraged the Puerto Rico (PR) Central Cancer Registry (PRCCR) to collect this data and analyze clinical characteristics and outcomes of patients diagnosed with MDS in PR. Methods: The study population includes patients diagnosed with MDS in PR between 2015 and 2019. Descriptive statistics and frequency analysis were used to describe the variables of interest. Logistic regression models were used to examine factors associated with the use of genetic marker tests. Bivariate analyses were performed to evaluate association between treatment patterns and patients’ characteristics. Three-year survival curves were estimated using Kaplan-Meier (with log-rank test to assess differences between survival curves). Multivariable Cox regression models were used to estimate the magnitude of association between the risk of dying among patients with MDS and different genetic markers/clinical characteristics. Results: The study cohort consisted of 475 patients. Between 67.2% and 81.7% of cases reported information of laboratory tests and prognostic markers. The abnormal karyotype had the highest presence in patients with MDS among those that reported the test with 47.4%. After adjusting for variables of interest, the risk of dying in MDS patients who did not have a del(5q) or a mutation of TP53, EZH2, or NRAS was 53%-85% lower than the risk of dying in patients who had either one of the mutations (p<0.05). Almost half of the MDS patients (47.4%) received treatment and of those, almost a third (29.3%) received it within the first 30 days after the diagnosis of MDS. The most common first-course treatment was azacitidine (52.0%), followed by lenalidomide (20.0%). Patients with a very low IPSS-R had a 3-year survival of 72.8% and those with a very high IPSS-R had a 3-year survival of 7.8%. Conclusion: The data from the PRCCR confirm the prognostic value of the IPSS-R and the role of the cytogenetic and molecular abnormalities on the patient’s outcomes. Citation Format: Karen J. Ortiz-Ortiz, Tonatiuh Suárez Ramos, Maira A. Castañeda-Avila, Carlos R. Torres-Cintrón, Axel Gierbolini-Bermúdez, Guillermo Tortolero-Luna. Patterns of care and patients’ outcomes for myelodysplastic syndromes in Puerto Rico: A real-world data analysis [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C032.

PURPOSETo evaluate the association between concurrent use of opioids and benzodiazepines (BZDs) and emergency room (ER) visits and hospital admissions in patients with cancer.METHODSData 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.RESULTSA 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]).CONCLUSIONCareful 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.

Background: High-intensity care with undue suffering at the end of life (EoL) among cancer patients is associated with poor quality of life (QoL). Timely palliative and hospice care along with advance care planning can reduce the use of potentially avoidable aggressive care and enhance the QoL of cancer patients nearing death by providing pain and symptom management. We described the patterns of care at EoL and evaluated the predictors of intensive care among Hispanic cancer patients. Methods: We used data from the Puerto Rico Central Cancer Registry-Health Insurance Linkage Database to examine patients aged 18 to 64 years diagnosed with cancer between 2010 and 2019, with a recorded date of death, who died of cancer between 2017 and 2019, and who were enrolled in Medicaid or private insurance 30 days before death (N=1,637). High-intensity EoL care indicators included the following services in the 30 days before death: ≥2 emergency room (ER) visits, >1 hospitalization, ≥1 intensive care unit (ICU) admission, and ≥1 life-extending procedure. A logistic regression model was used to examine factors associated with high-intensity EoL care. Results: More than half of the patients were 55 to 64 years old (58.7%), 52.9% were female, and 83.1% were enrolled in Medicaid. Most of the patients had solid tumors (91.0%) and 51.1% survived ≤12 months after diagnosis. More than half of the patients had at least one ER visit (54.2%) and nearly three-fourths had at least one hospitalization (73.7%). In addition, 28.2% of patients had ≥2 ER visits, 25.8% had >1 hospitalization, 11.3% were in the ICU, and 13.7% received life-extending procedures. A compound indicator of high-intensity care at EoL showed that 53.0% of patients had at least one of the selected high-intensity indicators, whereas a compound indicator of recommended care at EoL showed that only 29.6% of patients had at least one of the selected recommended care indicators, which included hospice and palliative care and advance care planning. Patients without recommended care at EoL were more likely to receive high-intensity EoL care than patients with recommended care at EoL (adjusted odds ratio 2.53; 95% confidence interval 2.02 – 3.16). High-intensity EoL care was more likely in patients with hematologic cancers than those with solid tumors (P=0.009), patients who survived ≤12 months after diagnosis compared to those who survived >12 months (P<0.001), and patients 18 to 44 years old compared to those 55 to 64 years old (P=0.023). Conclusion: These findings suggest that a higher proportion of Hispanic cancer patients living in Puerto Rico have unmet palliative care needs and potentially lower QoL at EoL. Recommended care can provide prompt pain and symptom management, reduce emotional distress, ensure medical care consistent with individual preferences, and reduce the cost of medical care by eliminating treatments and procedures that may have no or low benefit. Future research evaluating strategies to improve the use of hospice, palliative consultation, and advance care planning is needed. Citation Format: Jessica Velazquez, Barbara Cassese, Guillermo Tortolero-Luna, María R. Ramos-Fernández, Maira A. Castañeda-Avila, Karen J. Ortiz-Ortiz. High-intensity end-of-life care among young and middle-aged Hispanic adults with cancer living in Puerto Rico: A population-based study [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A031.

Endometrial cancer is the fourth most commonly diagnosed cancer among women in the United States (US) and Puerto Rico (PR). Diagnosis in younger women has been noticed in clinical settings in PR. The study aimed to evaluate endometrial cancer trends in incidence, mortality, and survival among women in PR compared to Non-Hispanic Whites (NHW), Non-Hispanic Blacks (NHB), and US Hispanics (USH), to assess whether disparities exist by age and stage at diagnosis on the outcomes of interest and to describe incidence rates by histologic types, including epithelial, mesenchymal, and carcinosarcoma.

Background: Research on the genetic markers, treatment, and survival of multiple myeloma (MM) among Hispanics is limited. Most population-based registries do not comprehensively collect cancer-related biological and genetic markers, which limits the use of these registries to address critical research questions. We used the Puerto Rico Central Cancer Registry (PRCCR) and the PRCCR-Health Insurance Linkage Database (PRCCR-HILD) to evaluate these factors among patients diagnosed with MM in Puerto Rico (PR). Methods: A retrospective cohort study was conducted among MM patients in PR between 2015 and 2019. We developed a robust sub-database that expands the quality and quantity of data regularly collected by the PRCCR and health insurance claims by integrating data from PRCCR’s cancer database, Electronic Medical Records, Pathology Reports database, and PRCCR-HILD. Descriptive statistics were used to present an epidemiological profile of the study group. Bivariate analyses were performed to evaluate associations between treatment patterns and patient characteristics. Multivariable Cox regression models were used to estimate the magnitude of the association between overall mortality among patients with MM and different characteristics. Results: The study cohort consisted of 716 patients; 49.6% were male, the median age at diagnosis was 69 years, and 76.7% had a comorbidity index score ³2. High-risk chromosomal abnormalities (HRCAs), which include at least one of t(4;14), t(14;16), Del(17p), and t(14;20), were found in 23.2% of patients. Around 88% of MM patients had documented evidence of treatment, and nearly half of all patients began treatment after 30 days (49.1%) of diagnosis. The most common treatment was bortezomib-based triplet (29.1%), followed by bortezomib-based doublet (25.9%). Based on the multivariable Cox models, the risk of dying was greater among patients who had chromosome 1 abnormalities (C1As) (HRAdjusted: 1.28, 95% CI: 0.99-1.66) or HRCAs (HRAdjusted: 1.39, 95% CI: 1.04-1.86) than patients without C1As or HRCAs, respectively. Furthermore, the risk of dying was lower among those receiving treatment after controlling by potential confounders (HRAdjusted: 0.44, 95% CI: 0.32-0.61). Among those receiving treatment, the bortezomib triplet showed better results than dexamethasone (HRAdjusted: 2.62, 95% CI: 1.63-4.20) and bortezomib-based doublet (HRAdjusted: 1.72, 95% CI: 1.14-2.60). Conclusion: This study provides the first description of the prevalence of genetic markers in patients with MM in PR, integrating epidemiological, clinical, and health claims data. Our analysis confirms that HRCAs and C1As remain as important predictor factors in determining the outcomes of MM patients. In addition, treatment patterns in PR Hispanic population suggest a longer median time to treatment initiation than other US studies, which warrants follow-up. These findings highlight the importance of establishing a broader understanding of the genetic and treatment-related factors associated with MM outcomes in different racial/ethnic groups. Citation Format: Tonatiuh Suárez Ramos, Maira A. Castañeda-Avila, Carlos R. Torres-Cintrón, Axel Gierbolini-Bermúdez, Guillermo Tortolero-Luna, Karen J. Ortiz-Ortiz. Genetic markers, first-line treatment, and survival among Hispanic patients with multiple myeloma: A population-based study in Puerto Rico [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B020.

AbstractIdentifying 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.

Objective: Endometrial cancer diagnosis in younger women is increasing in Puerto Rico and the United States. The study aims to evaluate the endometrial cancer trends in incidence, mortality, and survival by comparing US ethnic groups (NHW, NHB, and Hispanic) to women living in PR to assess whether disparities exist by age and stage at diagnosis on outcomes of interest.Methods: We performed a secondary data analysis and comparison of the age-specific and age-adjusted incidence rates, mortality rates, and the survival of endometrial cancer in PR with that of NHB, NHW, and Hispanic using data from the PR Central Cancer Registry, the SEER Program, and PR Demographic Registry from 2000 to 2018. Results: PR had the highest incidence rates (41.3 per 100,000 women) of endometrial cancer, followed by NHW, NHB, and Hispanic. Women in PR younger than 65 years old had higher incidence rates of endometrial cancer than compared groups. NHB have higher overall mortality rates (12.5 per 100,000 women). Between ages 20-34 and 35-49, women in PR have the highest mortality rates, and after age 50, mortality rates are higher for NHB. Conclusions: Women in PR had higher endometrial cancer incidence rates in increasing trend from 2000 to 2018 compared to similar NHB, Hispanic, and NHW cohorts. Also, women in PR experienced higher incidence and mortality rates below 50 years old among all races and ethnicities. Future studies are needed to evaluate his-tology, obesity trends, and the impact on the quality of life for this cohort.

Background: Multiple myeloma (MM) is an incurable malignancy of plasma cells. Overall 5-year survival rate has increased in recent years due to new treatments. However, this improvement has not been equal across sociodemographic groups. Older adults, males, and non-Hispanic Blacks (NHB) are at higher risk of developing and dying from MM. Therefore, this study investigated the intersectionality among age, sex, and race/ethnicity to better understand the patterning of MM incidence, mortality, and survival. These groups are usually considered separately, which may mask the inequities experienced among them. Methods: The sources of information for this study were the Puerto Rico (PR) Central Cancer Registry database and the US Surveillance, Epidemiology, and End Results (SEER) Program database. We analyzed incidence and mortality trends of MM from 2001 to 2019 using joinpoint regression models to calculate Annual Percent Change (APC). Age-standardized rate ratios (SRR) for MM incidence and mortality were used to compare PR with US racial/ethnic groups from 2015 to 2019. The SRRs were stratified by two age groups (<65, ≥65) and sex. Furthermore, 5-year survival analyses of MM were performed. Results: Regardless of age and race/ethnicity, males have higher incidence and mortality rates of MM than females. In terms of trends, PR had a higher increase in MM incidence rates than other racial/ethnic groups, regardless of sex and age (PR annual percent change [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 during the study period when stratified by age or sex. Across categories of age and sex, NHB had higher MM incidence and mortality rates than the other racial/ethnic groups. Nevertheless, when comparing males <65 years, PR has significantly higher incidence rates than non-Hispanic Whites (NHW) and US Hispanics (USH). However, PR has significantly lower mortality rates than NHW, NHB, and USH in the ≥65 age group. In terms of survival, PR showed the lowest observed 5-year survival rate among males <65 years (54.6%, 95% CI: 47.2-61.5) and males ≥65 years (33.8%, 95% CI: 28.5-39.1). Among females, USH showed the lowest observed 5-year survival for the age group <65 years (59.4%, 95% CI: 55.2-63.4) and NHW showed the lowest observed 5-year survival for the age group ≥65 years (37.0%, 95% CI: 35.4-38.6). In most categories, the highest observed 5-year survival rates were similar between two or more racial/ethnic groups. Conclusion: The incidence of MM increased in every racial/ethnic group over the study period, with PR having the highest APCs in all categories. Despite the introduction of new therapies, the mortality rates in PR have remained stable while the other racial/ethnic groups show significant decreases across categories of sex and age. These results highlight the need for more research in MM to better understand these disparities. Citation Format: Carlos R. Torres-Cintrón, Tonatiuh Suárez-Ramos, Maira A. Castañeda-Avila, Mara M. Epstein, Guillermo Tortolero-Luna, Karen J. Ortiz-Ortiz. Multiple myeloma incidence, mortality and survival differences at the intersection of sex, age, and race/ethnicity in the United States and Puerto Rico: 2015-2019 [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C125.

The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) of the Centers for Disease Control and Prevention (CDC) reported that for the month of In April 2020, screening tests for breast cancer decreased by 87% and for cervical cancer by 84% compared to the previous 5-year averages for that month. In response to this finding, the Puerto Rico Breast and Cervical Cancer Prevention and Early Detection Program (PR-BCCPEDP) in collaboration with the insurer Triple S-Salud, implemented a virtual educational intervention and/or face-to-face for breast and cervical cancer in the health centers where Triple-S Salud insurer provides services. The purpose of this initiative was aimed at strengthen knowledge in the early detection of breast and cervical cancer, increase the use of screening tests in the population of interest, and increase the reach of women who do not have health insurance who can qualify for the Program. Methodology: The PR-BCCPEDP entered into a collaborative agreement with the insurer Triple-S Salud to implement an educational intervention for breast and cervical cancer in 12 primary health centers around the island. In the period from October to December 2020, 12 health educators from the Triple-S Salud insurer carried out 131 educational activities with the participation of 875 participants. The educational activities were carried out in person through educational flip charts and virtually using an educational PowerPoint on both types of cancer. The educational materials included topics related to breast and cervical cancer such as: statistics, risk factors, signs and symptoms, early detection guidelines, myths and facts, and barriers to not having early detection tests. Results: The educational intervention in breast and cervical cancer obtained the following results: A total of 875 participated in the intervention, where 100% were women, with an average age of 50 years and the majority (97%) had coverage from the government health plan. The towns with the most registered participants were Bayamón with 18% and Mayagüez with 16% respectively. The virtual form was the most used by the participants (58%) compared to the face-to-face form. Regarding screening tests for breast and cervical cancer, of 75 women who had overdue the breast cancer guidelines, 20% had a mammogram after the intervention. Similarly, 142 women had overdue the cervical cancer guidelines, and 22.6% were carried out the tests after the intervention. Other hand, of the women, referred to the PR-BCCPEDP, 3% indicated not having health insurance, of which 29.6% were recruited and cared for by the Program. Conclusion: Despite security restrictions as a result of the pandemic, collaborations with a health system helped reach a greater number of women to provide education and awareness about breast and cervical cancer. In addition, it can be inferred that the virtual form allowed for increasing the scope of participation in times of pandemic. Lastly, I also helped reach women without health insurance who were recruited into the Program. Citation Format: Omayra Salgado-Cruz, Nelybeth Santiago-Yance, Mirza Rivera-Lugo, Guillermo Tortolero-Luna. Increasing breast and cervical cancer knowledge in the COVID-19 pandemic in the health system [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B060.

Preventable risk factors are responsible of at least 40% of cases and almost 45% of all cancer deaths worldwide. Cancer is already the leading cause of death in almost half of the Latin American and the Caribbean countries constituting a public health problem. Cost-effective measures to reduce exposures through primary prevention and screening of certain types of cancers are critical in the fight against cancer but need to be tailored to the local needs and scenarios. The Latin America and the Caribbean (LAC) Code Against Cancer, 1st edition, consists of 17 evidence-based recommendations for the general public, based on the most recent solid evidence on lifestyle, environmental, occupational, and infectious risk factors, and medical interventions. Each recommendation is accompanied by recommendations for policymakers to guide governments establishing the infrastructure needed to enable the public adopting the recommendations. The LAC Code Against Cancer has been developed in a collaborative effort by a large number of experts from the region, under the umbrella strategy and authoritative methodology of the World Code Against Cancer Framework. The Code is a structured instrument ideal for cancer prevention and control that aims to raise awareness and educate the public, while building capacity and competencies to policymakers, health professionals, stakeholders, to contribute to reduce the burden of cancer in LAC.

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 under-standing 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.