Cancer Disparities between Mainland and Island Puerto Ricans

Authors: HO, GLORIA - EINSTEIN COLLEGE OF MED; FIGUEROA-VALLES, NAYDA - UNIV OF PUERTO RICO; DE LA TORREFELICIANO, TAINA - PR CENTRAL CANCER REGISTR; Tucker, Katherine; RIVERA, WINNA - UNIV OF PUERTO RICO; ORTIZ-MARTINEZ, ANA PATRICIA - UNIV OF PUERTO RICO; TORTOLERO-LUNA, GUILLERMO - UNIV OF PUERTO RICO; JIMENEZ-VELAZQUEZ, IVONNE - UNIV OF PUERTO RICO; ROHAN, THOMAS - EINSTEIN COLLEGE OF MED

Submitted to: Revista Panamericana de Salud Publica/Pan American Journal of Public Health
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 11/27/2008
Publication Date: 5/1/2009
Citation: Ho, G.Y., Figueroa-Valles, N.R., De La Torrefeliciano, T., Tucker, K., Rivera, W.T., Ortiz-Martinez, A., Tortolero-Luna, G., Jimenez-Velazquez, I.Z., Rohan, T.E. 2009. Cancer Disparities between Mainland and Island Puerto Ricans. Revista Panamericana de Salud Publica/Pan American Journal of Public Health. 15(5):394-400.

Interpretive Summary: Cancer incidence is generally lower in Hispanics than non-Hispanic whites in the U.S. However, these data should be interpreted with caution, as Hispanics are ethnically heterogeneous. This study examined cancer rates in a single Hispanic subgroup – Puerto Ricans – and compared incidence rates among island Puerto Ricans in Puerto Rico, mainland Puerto Ricans, and non-Hispanic whites. Incidence data were obtained from the cancer registries of Puerto Rico and three northeastern states (New York, New Jersey, and Connecticut). Nine counties in these three states have >70% of Puerto Ricans among Hispanics. Total cancer incidence was the lowest in island Puerto Ricans, intermediate for mainland Puerto Ricans, and highest in non-Hispanic whites. As compared to mainland Puerto Ricans, islanders had significantly lower rates for major cancers including lung, prostate, breast, and colon-rectum, and several other cancer sites. Contrarily, cancer rates in mainland Puerto Ricans were modestly lower than those in U.S. non-Hispanic whites. Mainland Puerto Ricans had the highest rates for stomach, liver, and cervical cancers among the three populations. Examining cancer patterns by Hispanic ethnicity may help to pinpoint cancer disparities in Hispanics. Despite socio-economic disadvantages, island Puerto Ricans have relatively low cancer incidence, and identifying contributing factors such as diet would be informative for cancer research. Understanding the reasons for increased cancer risk in their mainland counterparts would facilitate development of ethnic-specific intervention programs.

Technical Abstract: Cancer incidence is generally lower in Hispanics than non-Hispanic whites in the U.S. These data should be interpreted with caution, as Hispanics are ethnically heterogeneous. This study examined cancer rates in a single Hispanic subgroup – Puerto Ricans – and compared incidence rates among mainland Puerto Ricans living in the U.S., island Puerto Ricans in Puerto Rico, and U.S. non-Hispanic whites to reveal the ethnic-specific cancer patterns and disparities in Puerto Ricans. Incidence data were obtained from the cancer registries of Puerto Rico and three northeastern states (New York, New Jersey, and Connecticut) in the U.S. where mainland Puerto Ricans populate. Age-adjusted rates were compared by standardized rate ratios (SRR). Total cancer incidence was the lowest in island Puerto Ricans, intermediate for mainland Puerto Ricans, and highest in U.S. non-Hispanic whites. As compared to mainland Puerto Ricans, islanders had significantly lower rates for major cancers (P < 0.05) – lung (SRRs = 0.36 in males and 0.29 in females), prostate (SRR=0.71), breast (SRR=0.73), and colon-rectum (SRRs = 0.74 in males and 0.65 in females) – and several other cancer sites. Contrarily, cancer rates in mainland Puerto Ricans were modestly lower than those in U.S. non-Hispanic whites. Mainland Puerto Ricans had the highest rates for stomach, liver, and cervical cancers among the three populations. Despite socio-economic disadvantages, island Puerto Ricans have relatively low cancer incidence, and identifying contributing factors would be informative for cancer research. Understanding the reasons for increased cancer risk in their mainland counterparts would facilitate development of ethnic-specific intervention programs.