Federally qualified health centers (FQHCs) offer primary and preventive healthcare, including cancer screening, for the nation’s most vulnerable population. The purpose of this study was to explore the relationship between access to FQHCs and cancer mortality-to-incidence ratios (MIRs). One-way analysis of variance was conducted to compare the mean MIRs for breast, cervical, prostate, and colorectal cancers for each U.S. county for 2006–2010 by access to FQHCs (direct access, in-county FQHC; indirect access, adjacent-county FQHC; no access, no FQHC either in the county or in adjacent counties). ArcMap 10.1 software was used to map cancer MIRs and FQHC access levels. The mean MIRs for breast, cervical, and prostate cancer differed significantly across FQHC access levels (p < 0.05). In urban and healthcare professional shortage areas, mean MIRs decreased as FQHC access increased. A trend of lower breast and prostate cancer MIRs in direct access to FQHCs was found for all racial groups, but this trend was significant for whites only. States with a large proportion of rural and medically underserved areas had high mean MIRs, with correspondingly more direct FQHC access. Expanding FQHCs to more underserved areas and concentrations of disparity populations may have an important role in reducing cancer morbidity and mortality, as well as racial-ethnic disparities, in the United States.

Background Although much has been done to examine those factors associated with higher mortality among African American women, there is a paucity of literature which examines disparities among rural African Americans in South Carolina. The purpose of this investigation was to examine the association of race and mortality among BrCA patients in a large cohort residing in South Carolina for which treatment regimens are standardized for all patients. Methods Subjects included 1209 women diagnosed with BrCA between 2000–2002 at a large, local hospital containing a comprehensive breast center. Kaplan Meier survival curves were calculated to determine survival rates among AA and EA women, stratified by disease stage or other prognostic characteristics. Adjusting for various characteristics, Cox multivariable survival models were used to estimate the hazard ratio (HR) Results The 5-year overall all-cause mortality survival proportion was ~78% for AA women and ~89% for EA women, p<0.01. In analyses of sub-populations of women with identical disease characteristics, AA women had significantly higher mortality than EA women for the same type of breast cancer disease. In multivariable models, AA women had significantly higher mortality than EA women for both BrCA specific death (HR = 2.41; 1.21–4.79) and all-cause mortality (HR = 1.42; 1.06–1.89). Conclusion AA women residing in rural South Carolina had lower survival for breast cancer even after adjustment for disease-related prognostic characteristics. Impact These findings support health interventions among AA BrCA patients aimed at tertiary prevention strategies or further down-staging of disease at diagnosis.

Chronic hepatitis B infection (HBV) is the major cause of primary liver cancer worldwide and Asians are disproportionately affected. The prevalence of HBV among most Asian American groups has been well documented, except in Hmong immigrants in the United States. The aim of this study was to determine the prevalence of HBV among Hmong immigrants in the San Joaquin Valley of California. A convenient sample of 534 Hmong age ≥18 years was recruited at various locations throughout Fresno County. Blood samples from study participants were collected and tested for hepatitis B surface antigen (HBsAg) by enzyme-immunoassay. Two hundred and eighty-nine females and 245 males of Hmong descent (mean age, 43.93) were screened. Eighty-nine (41 males and 48 females) were positive for HBsAg, which accounts for a prevalence of 16.7% (95% C.I. 13.5–19.9). The majorities of HBsAg positive patients were ≥40 years (64.2%), married (66.7%), born in Laos (87.3%), and had lived in the United States ≥20 years (62.5%). Only 37.5% of the participants reported having a primary care physician. Our study revealed that approximately one out of every six Hmong immigrants screened was infected with HBV. Based on our findings, more than one-third of these infected patients have no primary care physician to provide further treatment, surveillance for liver cancer, or vaccination of their families. This supports the Institute of Medicine’s recent recommendations to the Center for Disease Control to engage in a national Hepatitis B surveillance system.

The South Carolina Cancer Prevention and Control Research Network, in partnership with the South Carolina Primary Health Care Association, and Federally Qualified Health Centers (FQHCs), aims to promote evidence-based cancer interventions in community-based primary care settings. Partnership activities include (1) examining FQHCs’ readiness and capacity for conducting research, (2) developing a cancer-focused data sharing network, and (3) integrating a farmers’ market within an FQHC. These activities identify unique opportunities for public health and primary care collaborations.