BackgroundIn the American region, Puerto Rico (PR) has the highest incidence of oral and pharyngeal cancer (OPC), but racial/ethnic differences have never been assessed and compared with other groups in the United States of America (USA). We compared the age-adjusted incidence and mortality rates of OPC between PR and among USA Hispanics (USH), Non-Hispanic Whites (NHW), and Non-Hispanic Blacks (NHB) to assess the burden of this cancer in PR.MethodsAnalysis of the age-standardized rates (per 100,000) was performed using the direct method with the world standard population (ASR(World)) from 1998–2002. Annual percent change (APC) and Relative Risks (RR) were calculated using the Poisson regression model.ResultsThe incidence ASR(World) for men in PR was constant (APC ≈ 0.0%), in contrast, a decrease was observed among NHW, NHB, and USH men, although only USH showed statistical significance (APC = -4.9%, p < 0.05). In women, the highest increase in incidence (APC = 5.3%) and the lowest decrease in mortality (APC = -1.4%) was observed in PR. The ratio of the ASR(World) showed that in all racial/ethnic groups, men had approximately 2–4 fold increased incidence and mortality risk of OPC than women (p < 0.05). Men in PR had a higher mortality risk (p < 0.05) of OPC as compared to USH, NHW, and NHB; but among women, PR showed a significant excess of mortality only as compared to USH (est. SRR = 1.82, 95% CI = 1.41, 2.33).ConclusionThe overall higher incidence of OPC in men in PR as compared to USH, NHB, and NHW could be explained by the effect of gene-environment interactions. Meanwhile, the higher mortality from OPC in PR suggests limitations in the health-care access within this population. Further research is warranted to elucidate these findings.

Prostate cancer is the number 1 cancer killer among Puerto Rican (PR) men. Plant foods have been inversely associated with prostate cancer. Legumes play a significant role in the PR diet; consumption of legumes in PR (14 lb/capita) was double that of the United States (7 lb/capita). We examined dietary protein consumption (from baseline 24-h dietary recalls) and prostate cancer mortality in the PR Heart Health Program, a cohort study of 9,824 men aged 35-79 years at baseline (1964) with follow-up until 2005. Total protein intake in the cohort was 85 g/day, and sources of protein were 30% vegetable, 30% dairy, 31% animal, and 8% seafood protein. Legume intake was 2.3 servings/day (1/4 cup each). Legume intake was not associated with prostate cancer mortality [comparing highest quartile to lowest quartile-odds ratio (OR) 1.40 [95% confidence interval (CI) 0.91-2.18], P trend 0.17]-nor were total protein, animal, seafood, dairy, or vegetable protein intakes. Consuming 1-2 servings of fruit was inversely associated (OR 0.50, 95% CI 0.32-0.77), whereas consuming more than 2 servings of fruit was not associated with prostate cancer mortality. Thus, we find no association between legumes or protein intake and prostate cancer mortality in this longitudinal cohort study of PR men.

We evaluated a possible disparity in the detection of very early oral cancers in Puerto Rico relative to the United States. The percentage of in situ (noninvasive) cases among all oral cancer cases was calculated separately for Puerto Rico and the United States using population-based cancer registry data (1992-2001). In situ cancers constituted 1.2% of oral cancer cases in Puerto Rico and 3.4% in the United States (P<.001). These findings suggest a disparity in very early oral cancer detection in Puerto Rico compared with the United States.

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