Lung cancer survival among Florida male firefighters

IntroductionLung 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.MethodsData 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.ResultsOut 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].ConclusionLung 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

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

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

Abstract 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</jats:p

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

Abstract 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</jats:p

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

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. 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. 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. 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. 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

Acceptability and Feasibility of Human Papilloma Virus Self-Sampling for Cervical Cancer Screening

Objectives: Women in safety-net institutions are less likely to receive cervical cancer screening. Human papilloma virus (HPV) self-sampling is an alternative method of cervical cancer screening. We examine the acceptability and feasibility of HPV self-sampling among patients and clinic staff in two safety-net clinics in Miami. Materials and Methods: Haitian and Latina women aged 30–65 years with no Pap smear in the past 3 years were recruited. Women were offered HPV self-sampling or traditional Pap smear screening. The acceptability of HPV self-sampling among patients and clinic staff was assessed. If traditional screening was preferred the medical record was reviewed. Results: A total of 180 women were recruited (134 Latinas and 46 Haitian). HPV self-sampling was selected by 67% women. Among those selecting traditional screening, 22% were not screened 5 months postrecruitment. Over 80% of women agreed HPV self-sampling was faster, more private, easy to use, and would prefer to use again. Among clinic staff, 80% agreed they would be willing to incorporate HPV self-sampling into practice. Conclusions: HPV self-sampling was both acceptable and feasible to participants and clinic staff and may help overcome barriers to screening

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

Abstract 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<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<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< 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

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

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