Cancer is the second leading cause of death among Hispanic adults in the United States and accounts for 20% of all deaths among Hispanics. Similar to the general U.S. population, 1:2 Hispanic men and 1:3 Hispanic women will be diagnosed with cancer in their lifetime, and 1:5 Hispanic men and 1:6 Hispanic women will die from the disease. The purpose of the Puerto Rico Community Cancer Control Outreach Program (CCCOP) is to develop comprehensive, sustainable partnerships for increasing outreach, education, research, and training related to cancer prevention and control in Puerto Rico (PR), with a specific focus on tobacco control, breast and cervical cancer screening and prevention, and recruitment and retention of Puerto Ricans into clinical trials and prevention protocols. Tobacco is the leading cause of preventable death and disability among adults in the U.S. and almost onethird of all cancers are directly attributable to tobacco use. Although the prevalence of smoking among Puerto Ricans living in PR is lower (13.1%) than in the continental United States (20.6%), the five leading causes of death in PR (i.e., heart disease, malignant neoplasms, stroke, hypertension and chronic pulmonary disease) are associated with smoking. Moreover, 11.5% of all deaths and 10% of all health care costs in PR are attributable to smoking. Thus, reducing tobacco use remains a cornerstone of cancer prevention and control. However, there are very few resources currently available that focus on tobacco control in PR. The Outreach Pilot Program (OPP), from the ongoing Partnership, has begun to address these issues and the proposed CCCOP will considerably extend and maintain our efforts related to tobacco control through capacity building and community-based approaches. Despite lower incidence and prevalence rates of breast cancer among Hispanic women in the U.S., and mong women in PR than among non-Hispanic Whites in the U.S., Hispanic women are more likely to be agnosed at more advanced stages of the disease, to receive substandard treatment, and to have poorer fiveyear survival than non-Hispanic Whites. Additionally, among Puerto Rican women, breast cancer is the most commonly diagnosed neoplasm (35% of all cancers) and the leading cause of cancer deaths (15% of all cancer-related deaths). Unlike breast cancer, incidence rates for cervical cancer are nearly two-times higher among Hispanic women than among non-Hispanic white women, and mortality rates are 30% higher among Hispanics than non-Hispanic Whites. Cervical cancer is also responsible for a greater proportion of cancer deaths among Hispanics as compared to non-Hispanic Whites (3% vs. 1.4% of all cancer deaths respectively). Among Puerto Ricans living on the island, cervical cancer is the 41h most commonly diagnosed neoplasm, accounting for 4% of all newly diagnosed cancers, and 2.4% of all cancer-related deaths in women. To accomplish the goals proposed for the CCCOP, all program components will build upon the collaborations, infrastructure, network development, and outreach successes of the existing OPP.
The specific aims of the program are to: 1. Maintain, strengthen, and further develop a cancer control outreach network that will build upon existing relationships and develop new collaborations among the University of Puerto Rico (UPR), The University of Texas M. D. Anderson Cancer Center (MDACC), and key Puerto Rican community and health organizations;2. Conduct a community assessment of needs and resources for breast and cervical cancer (BCCS) prevention and screening, tobacco control, and the elimination of disparities related to these cancers and behaviors;3. Together with community partners, jointly identify, adapt, and/or develop culturally competent cancer control outreach and education programs to address disparities in breast and cervical cancers, tobacco control, and participation in clinical trials;4. Develop and implement strategies for sustaining outreach, networking, and dissemination efforts beyond the funding period of the CCCOP;5. Provide active mentoring and career development opportunities to U54 researchers and community partners to build capacity in cancer control and community-based participatory research. The proposed study provides benefits to both the UPRCCC and MDACC as each partner brings unique xpertise to the Partnership. The CCCOP also includes major career development components devoted to rther development of UPR and MDACC investigators.
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