Knowledge of Obesity's Health Related Outcomes among Hispanic Women living in Puerto Rico.

OBJECTIVE: The primary aim of this cross-sectional study was to assess, according to previous cancer diagnosis, the knowledge Puerto Rican women have on the link between obesity-endometrial, -breast, and colon cancer, and determine women's most common source for medical information. METHODS: In this cross-sectional study, eligible female patients (n=234) from the Gynecology and Gynecology-Oncology Clinics completed a self-administered survey from October 2014 to March 2016. Participants were evaluated on sociodemographic, body mass index, knowledge of the obesity-cancer link, and source of medical information. RESULTS: About 49% and 31% of women in the study were obese and overweight, respectively. Less than 52% of the women knew about the link between obesity-breast,-colon, and/or -endometrial cancers. Women with previous cancer diagnoses were more likely aware of the association between obesity-colon cancer than women without previous cancer diagnoses (58% vs. 44%, p0.05). Higher incomes showed increased odds for the knowledge obesity-cancer link among women with a cancer history, but the odds decreased for women without previous cancer diagnoses (p>0.05). Higher education showed a trend towards a better knowledge of the obesity-cancer association. The most common sources of information were the primary doctor (80%) and the internet (54%). CONCLUSION: Counseling about preventable cancer risk factors through primary care to all women must be encouraged especially in young healthy females. Further studies should address qualitative aspects of the odds differences in the obesity-cancer link knowledge observed between income categories for women with/without previous cancer diagnoses.

A comparative analysis of endometrial cancer disparities in incidence, mortality, and survival between women living in Puerto Rico, Non-Hispanic Blacks, Non-Hispanic Whites, and US Hispanics between 2000-2018.

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 histology, obesity trends, and the impact on the quality of life for this cohort.

Perceptions of preparedness, timing of cancer diagnosis, and objective emergency preparedness among gynecological cancer patients in Puerto Rico before and after Hurricane Maria.

OBJECTIVES: This study investigated the impact of cancer diagnosis status, individual feelings of preparedness, and other covariates on objective emergency preparedness among women diagnosed with gynecological cancers before or after the 2017 Hurricanes Irma and Maria in Puerto Rico. METHODS: This study included 240 women who were interviewed by telephone from 9/2019-11/2020. Objective emergency preparedness was assessed using a list of six items. Subjective emergency preparedness was assessed by asking the women how prepared they felt (well, somewhat, or not at all) to face an emergency. Crude and multivariable logistic regression analyses were conducted to assess the associations (odds ratios [ORs] and 95% confidence intervals [CIs]) between variables of interest and objective preparedness. RESULTS: Before and after the hurricanes, 60% and 66% of women, respectively, were objectively prepared. Before the hurricanes, women reporting feeling well-prepared (vs. not prepared) (OR=9.31, 95%CI:3.96-21.91) and those who were diagnosed before (vs. after) the hurricanes (OR=1.71, 95%CI:0.95-3.09) were more likely to be objectively prepared. After the hurricanes, self-perceived well-preparedness (OR=2.46, 95% CI: 1.10-5.51) was positively associated with emergency preparedness when compared to feeling unprepared. CONCLUSIONS: Perceptions of emergency preparedness and having a cancer diagnosis increased the likelihood of being objectively prepared for an emergency. POLICY SUMMARY: This study demonstrates the need for state, territorial, and federal governments to include emergency preparedness plans for cancer patients in the Comprehensive Cancer Control plans. The study also indicates a need for cancer specific emergency preparedness information to be readily available for patients.

Effect of chronic comorbidities on quality of life of gynecologic cancer patients in Puerto Rico.

Objective: To describe prevalence of chronic diseases and evaluate associations between comorbidities and quality of life in gynecologic cancer patients in Puerto Rico. Methods: A cross-sectional study among 233 women aged ≥21 years with a gynecologic cancer diagnosis. Through telephone interviews, information on comorbidities, quality of life, and other covariates were assessed. Quality of life included six items, assessing physical and mental health. Multivariate logistic regression models were used to estimate magnitude of association between the comorbidities under study (diabetes, cardiovascular and autoimmune diseases) and quality-of-life items, through adjusted prevalence odds ratio (aPOR; 95% confidence interval [CI]). Results: Most women (90.1%) reported one or more comorbidities in addition to their cancer diagnosis; cardiovascular diseases (63.1%) were more common than autoimmune diseases (37.3%) and diabetes (33.9%). Between 30% and 40% of the sample indicated dysfunctions in their general health (39.5%) and frequent physical (33.9%) and mental distress (31.8%). Adjusting for age and gross family income, women with autoimmune diseases presented higher prevalence of frequent limitations for daily activities (aPOR 2.00; 95% CI 1.05-3.81), poor general health (aPOR 3.52; 95% CI 1.90-6.49), frequent mental distress (aPOR 2.19; 95% CI 1.19-4.03), and dissatisfaction with life (aPOR 4.86; 95% CI 1.82-12.95) compared to those who did not report autoimmune diseases. No associations with cardiovascular diseases and diabetes were observed. Conclusions: Quality-of-life dysfunctions were highly prevalent in this population of gynecologic cancer patients. Suffering from autoimmune comorbidities significantly exacerbated those dysfunctions.

Effect of chronic comorbidities on quality of life of gynecologic cancer patients in Puerto Rico

[ABSTRACT]. Objective. To describe prevalence of chronic diseases and evaluate associations between comorbidities and quality of life in gynecologic cancer patients in Puerto Rico. Methods. A cross-sectional study among 233 women aged ≥21 years with a gynecologic cancer diagnosis. Through telephone interviews, information on comorbidities, quality of life, and other covariates were assessed. Quality of life included six items, assessing physical and mental health. Multivariate logistic regression models were used to estimate magnitude of association between the comorbidities under study (diabetes, cardiovascular and autoimmune diseases) and quality-of-life items, through adjusted prevalence odds ratio (aPOR; 95% confidence interval [CI]). Results. Most women (90.1%) reported one or more comorbidities in addition to their cancer diagnosis; cardiovascular diseases (63.1%) were more common than autoimmune diseases (37.3%) and diabetes (33.9%). Between 30% and 40% of the sample indicated dysfunctions in their general health (39.5%) and frequent physical (33.9%) and mental distress (31.8%). Adjusting for age and gross family income, women with autoimmune diseases presented higher prevalence of frequent limitations for daily activities (aPOR 2.00; 95% CI 1.05–3.81), poor general health (aPOR 3.52; 95% CI 1.90–6.49), frequent mental distress (aPOR 2.19; 95% CI 1.19–4.03), and dissatisfaction with life (aPOR 4.86; 95% CI 1.82–12.95) compared to those who did not report autoimmune diseases. No associations with cardiovascular diseases and diabetes were observed. Conclusions. Quality-of-life dysfunctions were highly prevalent in this population of gynecologic cancer patients. Suffering from autoimmune comorbidities significantly exacerbated those dysfunctions.

[RESUMEN]. Objetivo. Describir la prevalencia de enfermedades crónicas y evaluar la asociación entre varias comorbilidades y la calidad de vida de pacientes con cáncer ginecológico en Puerto Rico. Métodos. Se llevó a cabo un estudio transversal con 233 mujeres de 21 años o más con diagnóstico de cáncer ginecológico. Mediante entrevistas telefónicas se evaluó la información sobre comorbilidades, calidad de vida y otras covariantes; para la calidad de vida, se evaluaron seis elementos relativos a la salud física y mental. Se emplearon modelos de regresión logística con múltiples variables para estimar la magnitud de la asociación entre las comorbilidades objeto de estudio (la diabetes, las enfermedades cardiovasculares y las enfermedades autoinmunitarias) y los elementos relativos a la calidad de vida, mediante una razón de posibilidades de prevalencia ajustada (RPPa; intervalo de confianza [IC] de 95 %). Resultados. La mayoría de las mujeres (90,1 %) notificaron una o más comorbilidades además del diagnóstico de cáncer; las enfermedades cardiovasculares (63,1 %) fueron más comunes que las enfermedades autoinmunitarias (37,3 %) y la diabetes (33,9 %). Entre 30 % y 40 % de la muestra refirió disfunciones generales de salud (39,5 %) y malestar físico (33,9 %) y mental (31,8 %) frecuente. Luego de ajustar por edad e ingresos brutos familiares, las mujeres con enfermedades autoinmunitarias presentaron una mayor prevalencia de limitaciones frecuentes en las actividades cotidianas (RPPa 2,00; IC de 95 % 1,05-3,81), mala salud general (RPPa 3,52; IC de 95 % 1,90-6,49), angustia frecuente (RPPa 2,19; IC de 95 % 1,19-4,03) e insatisfacción vital (RPPa 4,86; IC de 95 % 1,82-12,95), en comparación con las mujeres que no refirieron ninguna enfermedad autoinmunitaria. No se observó ninguna asociación con enfermedades cardiovasculares o la diabetes. Conclusiones. Las disfunciones relativas a la calidad de vida tuvieron una alta prevalencia en esta población de pacientes con cáncer ginecológico. Sufrir comorbilidades autoinmunitarias agravó significativamente estas disfunciones.

[RESUMO]. Objetivo. Descrever a prevalência de doenças crônicas e avaliar as associações entre comorbidades e qualidade de vida em pacientes com câncer ginecológico em Porto Rico. Métodos. Estudo transversal de 233 mulheres com idade ≥21 anos, com diagnóstico de câncer ginecológico. Mediante entrevistas telefônicas, foram avaliadas informações sobre comorbidades, qualidade de vida e outras covariáveis. A avaliação da qualidade de vida incluiu seis itens, abrangendo saúde física e mental. Foram utilizados modelos de regressão logística multivariada para estimar a magnitude da associação entre as comorbidades avaliadas (diabetes, doenças cardiovasculares e autoimunes) e os itens de qualidade de vida, por meio da razão de chances de prevalência ajustada (aPOR) com intervalo de confiança de 95% (IC 95%). Resultados. A maioria das mulheres (90,1%) relatou uma ou mais comorbidades além de seu diagnóstico de câncer; as doenças cardiovasculares (63,1%) foram mais comuns que as doenças autoimunes (37,3%) e diabetes (33,9%). Entre 30% e 40% das entrevistadas relataram problemas de saúde geral (39,5%) e frequentes problemas físicos (33,9%) e mentais (31,8%). Após ajuste para idade e renda familiar bruta, as mulheres com doenças autoimunes apresentaram maior prevalência de limitação frequente das atividades da vida diária (aPOR 2,00; IC 95% 1,05-3,81), saúde geral precária (aPOR 3,52; IC 95% 1,90-6,49), angústia mental frequente (aPOR 2,19; IC 95% 1,19-4,03) e insatisfação com a vida (aPOR 4,86; IC 95% 1,82-12,95), em comparação àquelas que não relataram doenças autoimunes. Não foram observadas associações com doenças cardiovasculares ou diabetes. Conclusões. Foi constatada uma prevalência elevada de disfunções de qualidade de vida nesta população de pacientes com câncer ginecológico. Sofrer de comorbidades autoimunes exacerbou significativamente essas disfunções.

Effect of chronic comorbidities on quality of life of gynecologic cancer patients in Puerto Rico / Efecto de las comorbilidades crónicas sobre la calidad de vida de pacientes con cáncer ginecológico en Puerto Rico / Efeito das comorbidades crônicas na qualidade de vida de pacientes com câncer ginecológico em Porto Rico

ABSTRACT Objective. To describe prevalence of chronic diseases and evaluate associations between comorbidities and quality of life in gynecologic cancer patients in Puerto Rico. Methods. A cross-sectional study among 233 women aged ≥21 years with a gynecologic cancer diagnosis. Through telephone interviews, information on comorbidities, quality of life, and other covariates were assessed. Quality of life included six items, assessing physical and mental health. Multivariate logistic regression models were used to estimate magnitude of association between the comorbidities under study (diabetes, cardiovascular and autoimmune diseases) and quality-of-life items, through adjusted prevalence odds ratio (aPOR; 95% confidence interval [CI]). Results. Most women (90.1%) reported one or more comorbidities in addition to their cancer diagnosis; cardiovascular diseases (63.1%) were more common than autoimmune diseases (37.3%) and diabetes (33.9%). Between 30% and 40% of the sample indicated dysfunctions in their general health (39.5%) and frequent physical (33.9%) and mental distress (31.8%). Adjusting for age and gross family income, women with autoimmune diseases presented higher prevalence of frequent limitations for daily activities (aPOR 2.00; 95% CI 1.05-3.81), poor general health (aPOR 3.52; 95% CI 1.90-6.49), frequent mental distress (aPOR 2.19; 95% CI 1.19-4.03), and dissatisfaction with life (aPOR 4.86; 95% CI 1.82-12.95) compared to those who did not report autoimmune diseases. No associations with cardiovascular diseases and diabetes were observed. Conclusions. Quality-of-life dysfunctions were highly prevalent in this population of gynecologic cancer patients. Suffering from autoimmune comorbidities significantly exacerbated those dysfunctions.

RESUMEN Objetivo. Describir la prevalencia de enfermedades crónicas y evaluar la asociación entre varias comorbilidades y la calidad de vida de pacientes con cáncer ginecológico en Puerto Rico. Métodos. Se llevó a cabo un estudio transversal con 233 mujeres de 21 años o más con diagnóstico de cáncer ginecológico. Mediante entrevistas telefónicas se evaluó la información sobre comorbilidades, calidad de vida y otras covariantes; para la calidad de vida, se evaluaron seis elementos relativos a la salud física y mental. Se emplearon modelos de regresión logística con múltiples variables para estimar la magnitud de la asociación entre las comorbilidades objeto de estudio (la diabetes, las enfermedades cardiovasculares y las enfermedades autoinmunitarias) y los elementos relativos a la calidad de vida, mediante una razón de posibilidades de prevalencia ajustada (RPPa; intervalo de confianza [IC] de 95 %). Resultados. La mayoría de las mujeres (90,1 %) notificaron una o más comorbilidades además del diagnóstico de cáncer; las enfermedades cardiovasculares (63,1 %) fueron más comunes que las enfermedades autoinmunitarias (37,3 %) y la diabetes (33,9 %). Entre 30 % y 40 % de la muestra refirió disfunciones generales de salud (39,5 %) y malestar físico (33,9 %) y mental (31,8 %) frecuente. Luego de ajustar por edad e ingresos brutos familiares, las mujeres con enfermedades autoinmunitarias presentaron una mayor prevalencia de limitaciones frecuentes en las actividades cotidianas (RPPa 2,00; IC de 95 % 1,05-3,81), mala salud general (RPPa 3,52; IC de 95 % 1,90-6,49), angustia frecuente (RPPa 2,19; IC de 95 % 1,19-4,03) e insatisfacción vital (RPPa 4,86; IC de 95 % 1,82-12,95), en comparación con las mujeres que no refirieron ninguna enfermedad autoinmunitaria. No se observó ninguna asociación con enfermedades cardiovasculares o la diabetes. Conclusiones. Las disfunciones relativas a la calidad de vida tuvieron una alta prevalencia en esta población de pacientes con cáncer ginecológico. Sufrir comorbilidades autoinmunitarias agravó significativamente estas disfunciones.

RESUMO Objetivo. Descrever a prevalência de doenças crônicas e avaliar as associações entre comorbidades e qualidade de vida em pacientes com câncer ginecológico em Porto Rico. Métodos. Estudo transversal de 233 mulheres com idade ≥21 anos, com diagnóstico de câncer ginecológico. Mediante entrevistas telefônicas, foram avaliadas informações sobre comorbidades, qualidade de vida e outras covariáveis. A avaliação da qualidade de vida incluiu seis itens, abrangendo saúde física e mental. Foram utilizados modelos de regressão logística multivariada para estimar a magnitude da associação entre as comorbidades avaliadas (diabetes, doenças cardiovasculares e autoimunes) e os itens de qualidade de vida, por meio da razão de chances de prevalência ajustada (aPOR) com intervalo de confiança de 95% (IC 95%). Resultados. A maioria das mulheres (90,1%) relatou uma ou mais comorbidades além de seu diagnóstico de câncer; as doenças cardiovasculares (63,1%) foram mais comuns que as doenças autoimunes (37,3%) e diabetes (33,9%). Entre 30% e 40% das entrevistadas relataram problemas de saúde geral (39,5%) e frequentes problemas físicos (33,9%) e mentais (31,8%). Após ajuste para idade e renda familiar bruta, as mulheres com doenças autoimunes apresentaram maior prevalência de limitação frequente das atividades da vida diária (aPOR 2,00; IC 95% 1,05-3,81), saúde geral precária (aPOR 3,52; IC 95% 1,90-6,49), angústia mental frequente (aPOR 2,19; IC 95% 1,19-4,03) e insatisfação com a vida (aPOR 4,86; IC 95% 1,82-12,95), em comparação àquelas que não relataram doenças autoimunes. Não foram observadas associações com doenças cardiovasculares ou diabetes. Conclusões. Foi constatada uma prevalência elevada de disfunções de qualidade de vida nesta população de pacientes com câncer ginecológico. Sofrer de comorbidades autoimunes exacerbou significativamente essas disfunções.

Knowledge among Puerto Rican Women about Risk of Infertility Associated with Overweight and Obesity.

OBJECTIVE: Our study sought to evaluate how aware the women attending gynecology clinics at the University of Puerto Rico Medical Sciences Campus (UPRMSC) were of the association between infertility and excess body weight (i.e., overweight and obesity). METHODS: Women 21 years old and older attending gynecology clinics at UPR-MSC were invited to participate in this study (n = 234). A self-administered survey was provided to all the women. Logistic regression models were performed to determine associations. RESULTS: About 56.8% of the women were found to be aware of the effects of obesity on fertility; their main source of medical information was their primary doctor. The odds (adjusted for age and annual income) of being aware of the association between obesity and infertility were about 2.41 (95% CI: 1.07-5.42) times higher in women with a BMI greater than or equal to 25 kg/m2 than they were in those with a BMI of less than 25 kg/m2. An interaction by age group (adjusted for BMI) was found for the association between annual income and knowledge of the obesity-infertility association (OR≥40 years old: 3.51, 95% CI: 1.41-8.72; OR<40 years old: 0.57, 95% CI: 0.15-2.13). CONCLUSION: Our study revealed that there is a lack of knowledge regarding the effects of obesity on fertility and identifies characteristics associated with this knowledge. The contents of health-care-provider counseling and the barriers affecting communication between patients and health care providers could be assessed in further studies.

Hereditary cancer syndromes in Latino populations: genetic characterization and surveillance guidelines.

Hereditary cancer predisposition syndromes comprise approximately 10% of diagnosed cancers; however, familial forms are believed to account for up to 30% of some cancers. In Hispanics, the most commonly diagnosed hereditary cancers include colorectal cancer syndromes such as, Lynch Syndrome, Familial Adenomatous Polyposis, and hereditary breast and ovarian cancer syndromes. Although the incidence of hereditary cancers is low, patients diagnosed with hereditary cancer syndromes are at high-risk for developing secondary cancers. Furthermore, the productivity loss that occurs after cancer diagnosis in these high-risk patients has a negative socio-economic impact. This review summarizes the genetic basis, phenotype characteristics, and the National Comprehensive Cancer Network's screening, testing, and surveillance guidelines for the leading hereditary cancer syndromes. The aim of this review is to promote a better understanding of cancer genetics and genetic testing in Hispanic patients.

Clinical Cancer Genetics Disparities among Latinos.

The three major hereditary cancer syndromes in Latinos (Hereditary Breast and Ovarian Cancer, Familial Adenomatous Polyposis and Lynch Syndrome) have been shown to exhibit geographic disparities by country of origin suggesting admixture-based disparities. A solid infrastructure of clinical genetics geared towards diagnosis and prevention could aid in reducing the mortality of these cancer syndromes in Latinos. Currently, clinical cancer genetic services in Latin America are scarce. Moreover, limited studies have investigated the mutational spectrum of these cancer syndromes in Latinos resulting in gaps in personalized medicine affecting diagnosis, treatment and prevention. The following commentary discusses available genotype and clinical information on hereditary cancer in Latinos and highlights the limited access for cancer genetic services in Latin America including barriers to genetic testing and alternatives for providing better access to genetic services. In this review, we discuss the status of clinical genetic cancer services for both US Latinos and those Latinos living in Latin America.

Ovarian cancer clinical trial endpoints: Society of Gynecologic Oncology white paper.

OBJECTIVE: To explore the value of multiple clinical endpoints in the unique setting of ovarian cancer. METHODS: A clinical trial workgroup was established by the Society of Gynecologic Oncology to develop a consensus statement via multiple conference calls, meetings and white paper drafts. RESULTS: Clinical trial endpoints have profound effects on late phase clinical trial design, result interpretation, drug development, and regulatory approval of therapeutics. Selection of the optimal clinical trial endpoint is particularly provocative in ovarian cancer where long overall survival (OS) is observed. The lack of new regulatory approvals and the lack of harmony between regulatory bodies globally for ovarian cancer therapeutics are of concern. The advantages and disadvantages of the numerous endpoints available are herein discussed within the unique context of ovarian cancer where both crossover and post-progression therapies potentially uncouple surrogacy between progression-free survival (PFS) and OS, the two most widely supported and utilized endpoints. The roles of patient reported outcomes (PRO) and health related quality of life (HRQoL) are discussed, but even these widely supported parameters are affected by the unique characteristics of ovarian cancer where a significant percentage of patients may be asymptomatic. Original data regarding the endpoint preferences of ovarian cancer advocates is presented. CONCLUSIONS: Endpoint selection in ovarian cancer clinical trials should reflect the impact on disease burden and unique characteristics of the treatment cohort while reflecting true patient benefit. Both OS and PFS have led to regulatory approvals and are clinically important. OS remains the most objective and accepted endpoint because it is least vulnerable to bias; however, the feasibility of OS in ovarian cancer is compromised by the requirement for large trial size, prolonged time-line for final analysis, and potential for unintended loss of treatment effect from active post-progression therapies. A large magnitude of effect in PFS improvement should establish benefit, and further communication with regulatory authorities to clarify acceptable endpoints should be undertaken.

Racial and ethnic disparities in lifetime risk of corpus uterine cancer: a comparative study of Puerto Rico and the United States SEER population.

BACKGROUND: Corpus uterine cancer is the most common gynecologic malignancy in Puerto Rico and the United States. METHODS: We assessed the lifetime risk of developing and dying of corpus uterine cancer in women living in Puerto Rico (PR) and among Hispanics, non-Hispanic whites (NHW), and non-Hispanic blacks (NHB) in the United States. Data from the PR Central Cancer Registry and the Surveillance, Epidemiology, and End Results program were analyzed from 1993-2004. RESULTS: In PR, the probability of developing corpus uterine cancer increased from 1.21% in 1993-1995 to 1.69% in 2002-2004. The probability of developing this malignancy from 2002-2004 was 1.59% for NHB, 1.80% for Hispanics and 2.54% for NHW. The ratio of estimated probabilities only showed significant lower risk in PR as compared to NHW (.67, 95% CI = .59-.74). The probability of dying from corpus uterine cancer during 2002-2004 was .47% for Hispanics, .49% for NHW, .53% for PR and .76% for NHB. The ratio of estimated probabilities only showed significant lower risk of death in PR as compared to NHB (.70, 95% CI = .54-.85). CONCLUSIONS: The lifetime risk of developing corpus uterine cancer has increased in PR, suggesting higher exposure to risk factors in this population. Despite the lower lifetime risk of this malignancy in PR as compared to NHW, the similar lifetime risk of death in these groups suggests a disparity that may be influenced by differences in disease etiology and/or access or response to treatment. Assessment of risk factors, in addition to access to health services, is required to further understand these patterns.

Case-case study of factors associated to hMLH1, hMSH2, and hMSH6 protein expression among endometrial cancer patients of the University District Hospital of San Juan, Puerto Rico.

UNLABELLED: Lynch syndrome (LS) is an autosomal dominant disorder caused by DNA mismatch repair (MMR) system deficiencies. Women affected by LS present a 40% to 60% lifetime risk of endometrial cancer (EC). OBJECTIVE: This case-case study aims to determine the frequency of the hMLH1, hMSH2, and hMSH6 MMR proteins and the factors (age, family history of cancer [FHC] related to LS, and body mass index [BMI]) associated to their absence in EC patients attending the University District Hospital of San Juan, Puerto Rico. MATERIALS AND METHODS: Twenty cases were preliminary evaluated for the MMR protein expression by immunohistochemistry testing and classified as positive cases (presence of protein) or negative cases (absence of protein). The statistical analysis was based on the logistic regression model using the maximum likelihood estimation (MLE). The Bayesian approach was used to determine the posterior probability (posterior Pr[odds ratio {OR} > 1]). RESULTS: Results showed absence for at least 1 MMR protein in 25% of the cases, 15% for hMLH1, and 10% for hMSH2. None of the cases showed an absence for hMSH6. The MLE demonstrated that women diagnosed with EC before the age of 50 (OR: 12.4; 95% confidence interval [CI] = 0.5-322.7), having FHC related to LS (OR: 17.7; 95% CI = 0.6-534.6), and having lower BMI (OR: 2.38; 95% CI = 0.39-14.28) present higher odds than their counterparts of lacking an MMR protein, once adjusted for potential predictors (P > 0.05). The posterior probability that an excess risk of lacking an MMR protein occurs was 95% or greater for each predictor. CONCLUSIONS: Our study in this Hispanic population supports previous studies in that younger age, FHC, and lower BMI are associated with increased odds of having an absence of MMR protein expression. Further studies with larger sample sizes should be performed.

Risk factors for abnormal cervical cytology in pregnant women attending the high-risk obstetrics clinic at the University Hospital in San Juan, Puerto Rico.

OBJECTIVE: Approximately 30% of women diagnosed with cervical cancer are in their childbearing years, and 5-8% of pregnant women seeking prenatal care are found to have an abnormal Papanicolaou smear. Prenatal visits are an excellent opportunity for cervical cytology testing and patient education because of close follow-up. The objective of this study is to examine the overall prevalence of cervical dysplasia and associated risk factors in pregnant women aged 15 to 30 years attending the high-risk obstetrics clinics at the University Hospital in San Juan, Puerto Rico between December 2005 and May 2007. METHODS: We performed a systematic review of 237 prenatal charts from patients attending the high-risk obstetrics clinics at the University Hospital in San Juan. The variables studied were age, place of birth, gestational age at first visit, gravidity, age at first coitus, number of sexual partners, tobacco use, Papanicolaou smear results, and cervical gonorrhea and Chlamydia test results. The relationship between cervical cytology results and the aforementioned variables was statistically assessed. RESULTS: Abnormal cervical cytology was found in 16 (6.8%) of the patients. Of these, 75% were atypical squamous cells of unknown significance (ASCUS), 19% low-grade squamous intraepithelial lesion (LGSIL), and 6% high-grade squamous intraepithelial lesion (HGSIL). Gravidity > 3 was observed in 16.5% of the patients, and 48.7% were in their second trimester of gestation. Their first coitus was at age 17 or earlier (66.5%), and 78% had between 1 and 3 sexual partners. Having a positive Chlamydia test was significantly (p < 0.05) associated with the risk of having an abnormal cervical cytology. Other variables such as gravidity, age at first coitus, number of sexual partners, and tobacco use were not statistically associated with an abnormal cervical cytology test. CONCLUSION: The overall prevalence of cervical dysplasia among pregnant women who attend the high-risk obstetrics clinic at the University Hospital in San Juan, Puerto Rico is similar to what has been reported elsewhere. Among all variables studied, only a positive Chlamydia test was found to be associated with an abnormal cervical cytology test. Given the high number of women seeking prenatal care and the close follow-up provided during this period, prenatal care is an excellent opportunity for cervical cytology testing and patient education.

Clinic-based case-control study of the association between body mass index and endometrial cancer in Puerto Rican women.

BACKGROUND: Obesity is an established risk factor for endometrial cancer (EC). This association, however, has not been studied in Puerto Rico, where overweight and obesity have reached epidemic levels (38% and 26%, respectively). METHODS: A hospital based case-control study was designed to evaluate the association between body mass index (BMI) and EC in women older than 21 years of age. Seventy-four prevalent EC cases diagnosed between January 2004 and August 2007 and a random sample of 88 healthy controls were recruited from gynecology clinics of the Medical Sciences Campus, University of Puerto Rico. Demographic, reproductive, lifestyle, and clinical information was obtained via structured telephone interviews and medical chart review. Unconditional logistic regression models were used to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI). RESULTS: A significant trend was observed between BMI and EC in bivariate analyses (p < 0.05). Results showed that overweight (25.0 > BMI < 29.9 kg/m2) (OR = 4.4, 95% CI = 1.6-12.3) and obese (BMI < or = 30 kg/m2) (OR = 9.9, 95% CI = 3.6-26.9) women were more likely to have EC when compared to non-obese women. In multivariate analysis, obese women had a 4-fold greater possibility of EC (OR = 4.1; 95% CI: 1.8-8.6) than nonobese women, after adjusting for age, education, employment status, hypertension and diabetes diagnosis, use of oral contraceptives and consumption of poultry. CONCLUSION: Consistent with previous studies worldwide, adult obesity was a strong predictor for EC in this sample of Puerto Rican women. Thus, cancer control strategies should promote weight reduction strategies to reduce disease risk in this population.

A rare case of cutaneous metastasis of postpartum choriocarcinoma.

Gestational trophoblastic disease has been reported to be responsive to chemotherapy, with a 90% cure rate. Several factors place patients at high risk of experiencing treatment failure with single agent chemotherapy. Choriocarcinoma following term pregnancy is very rare and associated with a poor prognosis and a mortality rate of 33-40%. We present a rare case of cutaneous metastasis of choriocarcinoma to the left third digit.

Major histocompatibility complex class II polymorphisms and risk of cervical cancer in Puerto Rican women.

Association between HLA antigens and cervical squamous cell carcinoma has been described in several populations. To verify whether HLA-DRB1 and DQB1 diversity is related to cervical cancer in Puerto Rican women, 40 cases and 50 controls were HLA typed. DRB1*16 (POR=2.89) and DRB1*11 (POR=1.74) were positively associated with cervical cancer. A negative association was found with DRB1*01 (POR=0.52), DRB1*04 (POR=0.60), DRB1*14 (POR=0.33), DRB1*15 (POR=0.65), DQB1*04 (POR=0.33), DQB1*05 (POR=0.64) and DQB1*06 (POR=0.65). We suggest that HLA Class H polymorphisms are involved in genetic susceptibility to cervical cancer in Puerto Rican women. These results should be confirmed in studies with larger sample size to preclude the possibility of false positive observations.

Comparison of the endocervical brush and the endocervical curettage for the evaluation of the endocervical canal

OBJECTIVE: To evaluate and compare the efficacy in obtaining an adequate endocervical sampling using the endocervical brush and the endocervical curettage. METHODS: Analysis of the cytology and histology of samples obtained from patients referred to the University of Puerto Rico School of Medicine Tertiary Care Center Anaplasia Clinics for colposcopy due to an abnormal Pap smear having atypical cells or higher as classified according to the Bethesda System. All patients underwent evaluation of the endocervical canal with an endocervical brush and an endocervical curettage. RESULTS: Fifty three of fifty-eight patients had correlating endocervical brush Papanicolaou smear and endocervical curettage. Only five patients presented discrepancies. All endocervical brush samples had sufficient tissue for diagnosis. CONCLUSION: The endocervical curettage is operator dependent, is difficult to perform in patients with a stenotic cervical os or in menopausal patients. The endocervical brush is easier to use, malleable and has a lower processing cost. In view of these findings evaluation of the endocervix can be safely performed with the use of an endocervical brush. When used properly, the endocervical brush has a sensitivity of 90 per cent , a specificity of 92.1 per cent and a positive predictive value of 87.5 per cent