Cervical cancer is the second most common female tumor worldwide, and its incidence is disproportionately high (>80%) in the developing world. In the United States, in which Papanicolaou (Pap) tests have reduced the annual incidence to approximately 11,000 cervical cancers, >60% of cases are reported to occur in medically underserved populations as part of a complex of diseases linked to poverty, race/ethnicity, and/or health disparities. Because carcinogenic human papillomavirus (HPV) infections cause virtually all cervical cancer, 2 new approaches for cervical cancer prevention have emerged: 1) HPV vaccination to prevent infections in younger women (aged 18 years) and 2) carcinogenic HPV detection in older women (aged 30 years). Together, HPV vaccination and testing, if used in an age-appropriate manner, have the potential to transform cervical cancer prevention, particularly among underserved populations. Nevertheless, significant barriers of access, acceptability, and adoption to any cervical cancer prevention strategy remain. Without understanding and addressing these obstacles, these promising new tools for cervical cancer prevention may be futile. In the current study, the delivery of cervical cancer prevention strategies to these US populations that experience a high cervical cancer burden (African-American women in South Carolina, Alabama, and Mississippi; Haitian immigrant women in Miami; Hispanic women in the US-Mexico Border; Sioux/Native American women in the Northern Plains; white women in the Appalachia; and Vietnamese-American women in Pennsylvania and New Jersey) is reviewed. The goal was to inform future research and outreach efforts to reduce the burden of cervical cancer in underserved populations.

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Introduction The quantitative intraracial burden of cancer incidence, survival and mortality within black populations in the US is virtually unknown. Methods We computed cancer mortality rates of US- and Caribbean-born residents of Florida, specifically focusing on black populations (US, Haiti, Jamaica) and compared them using age-adjusted mortality ratios obtained from Poisson regression models. We compared the mortality of Haitians and Jamaicans residing in Florida to populations in their countries of origin using Globocan. Results We analyzed 185,113 cancer deaths from 2008–2012, of which 20,312 occurred in black populations. The overall risk of death from cancer was 2.1 (95% CI: 1.97–2.17) and 1.6 (95% CI: 1.55–1.71) times higher for US-born blacks than black Caribbean men and women, respectively (p<0.001). Conclusions Race alone is not a determinant of cancer mortality. Among all analyzed races and ethnicities, including Whites and Hispanics, US-born blacks had the highest mortality rates while black Caribbeans had the lowest. The biggest intraracial difference was observed for lung cancer, for which US-blacks had nearly 4 times greater mortality risk than black Caribbeans. Migration from the islands of Haiti and Jamaica to Florida resulted in lower cancer mortality for most cancers including cervical, stomach, and prostate, but increased or stable mortality for two obesity-related cancers, colorectal and endometrial cancers. Mortality results in Florida suggest that US-born blacks have the highest incidence rate of “aggressive” prostate cancer in the world, rather than Caribbean men.

Background Firefighters are at increased risk for select cancers. However, many studies are limited by relatively small samples, with virtually no data on the cancer experience of female firefighters. This study examines cancer risk in over 100,000 career Florida firefighters including 5000 + females assessed over a 34‐year period. Methods Florida firefighter employment records (n = 109 009) were linked with Florida Cancer Data System registry data (1981‐2014; ~3.3 million records), identifying 3760 male and 168 female‐linked primary cancers. Gender‐specific age and calendar year‐adjusted odds ratios (aOR) and 95% confidence intervals for firefighters vs non‐firefighters were calculated. Results Male firefighters were at increased risk of melanoma (aOR = 1.56; 1.39‐1.76), prostate (1.36; 1.27‐1.46), testicular (1.66; 1.34‐2.06), thyroid (2.17; 1.78‐2.66) and late‐stage colon cancer (1.19;1.00‐1.41). Female firefighters showed significantly elevated risk of brain (2.54; 1.19‐5.42) and thyroid (2.42; 1.56‐3.74) cancers and an elevated risk of melanoma that approached statistical significance (1.68; 0.97‐2.90). Among male firefighters there was additional evidence of increased cancer risk younger than the age of 50 vs 50 years and older for thyroid (2.55; 1.96‐3.31 vs 1.69; 1.22‐2.34), prostate (1.88; 1.49‐2.36 vs 1.36; 1.26‐1.47), testicular (1.60; 1.28‐2.01 vs 1.47; 0.73‐2.94), and melanoma (1.87; 1.55‐2.26 vs 1.42; 1.22‐1.66) cancers. Conclusion Male career firefighters in Florida are at increased risk for five cancers with typically stronger associations in those diagnosed younger than the age of 50, while there was evidence for increased thyroid and brain cancer, and possibly melanoma risk in female firefighters. Larger cohorts with adequate female representation, along with the collection of well‐characterized exposure histories, are needed to more precisely examine cancer risk in this occupational group.