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Background Starting in 2018, national death certificates included a new racial classification system that accounts for multiple-race decedents and separates Native Hawaiian and Pacific Islander (NHPI) individuals from Asian individuals. We estimated cancer death rates across updated racial and ethnic categories, sex, and age. Methods Age-standardized US cancer mortality rates and rate ratios from 2018 to 2020 among individuals aged 20 years and older were estimated with national death certificate data by race and ethnicity, sex, age, and cancer site. Results In 2018, there were approximately 597 000 cancer deaths, 598 000 in 2019, and 601 000 in 2020. Among men, cancer death rates were highest in Black men (298.2 per 100 000; n = 105 632), followed by White (250.8; n = 736 319), American Indian/Alaska Native (AI/AN; 249.2; n = 3376), NHPI (205.6; n = 1080), Latino (177.2; n = 66 167), and Asian (147.9; n = 26 591) men. Among women, Black women had the highest cancer death rates (206.5 per 100 000; n = 104 437), followed by NHPI (192.1; n = 1141), AI/AN (189.9; n = 3239), White (183.0; n = 646 865), Latina (128.4; n = 61 579), and Asian (111.4; n = 26 396) women. The highest death rates by age group occurred among NHPI individuals aged 20-49 years and Black individuals aged 50-69 and 70 years and older. Asian individuals had the lowest cancer death rates across age groups. Compared with Asian individuals, total cancer death rates were 39% higher in NHPI men and 73% higher in NHPI women. Conclusions There were striking racial and ethnic disparities in cancer death rates during 2018-2020. Separating NHPI and Asian individuals revealed large differences in cancer mortality between 2 groups that were previously combined in vital statistics data.

Background: Hepatocellular carcinoma (HCC) is the primary histological subtype of liver cancer, comprising up to 75% of such cases in the U.S. People living with HIV (PLWH) have a higher risk of HCC than the general population. A higher proportion of PLWH are coinfected with hepatitis B (HBV) or hepatitis C virus (HCV) due to shared transmission modalities such as injection drug use. Highly active antiretroviral therapy has improved survival from HIV infection, creating increased opportunities to develop liver cancer due to prolonged hepatic inflammation caused by chronic infection with HBV or HCV. Methods: We used data from the HIV/AIDS Cancer Match (HACM), a population-based HIV and cancer registry linkage in the U.S. We compared HCC risk in PLWH to the general population using standardized incidence ratios (SIRs), standardized by race/ethnicity, age group, HIV transmission risk group, calendar period, and registry. SIRs were estimated by race/ethnicity, age group, HIV transmission risk group, and calendar period. Poisson regression was used to estimate incidence rate ratios (RRs) among PLWH by race/ethnicity, age group, HIV transmission risk group and calendar period. In addition, data from Symphony Health, a Texas based health aggregator of medical claims determined the prevalence of HBV and/or HCV infection among people with HCC. Adjusted odds ratios identified predictors of HBV and HCV infection in PLWH with HCC. Results: There were 1,530 incident HCC cases from 2001–2016 in PLWH during over 4 million person-years of follow up. Compared to the general population, the overall SIR was 2.92 (95% CI 2.75-3.09). The risk of HCC was strongly elevated across all racial/ethnic and age groups. Rates were highest among NH-White PLWH (SIR 3.86; 95% CI 3.48-4.27) PLWH aged 40-49 (SIR 4.81; 95% CI 4.31-5.35) or aged 20-39 (SIR 4.15; 95% CI 2.82-5.89). Among PLWH, HCC risk was similar across racial/ethnic groups but increased with age. Compared to men who had sex with men (MSM), men who injected drugs had almost 4 times the risk of HCC (RR 3.93; 95% CI 3.38-4.55) while female PWID had a 60% increased risk (RR 1.61; 95% CI 1.28-2.01), and men with other or unknown HIV transmission had a 50% increased risk (RR 1.48; 95% CI 1.27-1.73). Between 2001-2004 and 2013-2016, rates of HCC declined 16% (RR 0.84; 95% CI 0.69-1.03). Using Symphony Health data, there were a total of 146 HCC cases, 38 coinfected with HBV, 84 with HCV, and 16 triply infected cases. Compared to MSMs, persons who inject drugs (PWID) had 85% decreased odds of HBV infection (aOR 0.15; 95% CI 0.05-0.50) and 8 times the odds of HCV infection (aOR 8.03; 95% CI 2.61-24.7). Conclusions: Utilizing recently updated population-based linked-surveillance data, we found risk of HCC has declined over time among PLWH, though rates remain significantly elevated compared to the general population, with particularly high risk among people who inject drugs. Prevention and treatment of HBV and HCV are needed to reduce HCC risk in this population. Citation Format: Jennifer K. McGee-Avila, Ilona Argirion, Thomas R. O’Brien, Eric Engels, Marie-Josèphe Horner, Qianlai Luo, Meredith Shiels. Risk of hepatocellular carcinoma among people living with HIV in the United States [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C106.

Purpose: HIV infection and cervical cancer disproportionately impact low-income and racial/ethnic minorities in urban areas. Few studies have examined factors associated with HIV testing during cancer diagnosis in vulnerable populations. Current National Comprehensive Cancer Network (NCCN) guidelines recommend an HIV test during initial invasive cervical cancer (ICC) workup. We examine factors associated with patterns of HIV testing among Medicaid enrollees diagnosed with ICC in New Jersey. Methods: Using linked data from the New Jersey State Cancer Registry and New Jersey Medicaid claims and enrollment files, we examined patterns of HIV and other STI testing (chlamydia, gonorrhea and syphilis) among nonelderly (ages 21-64) ICC cases diagnosed between 2012 and 2014. We evaluated two HIV testing time periods: at any point during our study period (2011-2014; pre- or post-cancer diagnosis) and during the cancer workup (6 months pre/post ICC diagnosis). Bivariate and multivariable logistic regression models were used to identify sociodemographic, clinical tumor, and area-level factors associated with patterns of HIV testing. Results: A total of 248 ICC Medicaid enrollees were included in the analytic sample, of whom 83 (33%) received an HIV test at any time. A little over a quarter (26.6%) received STI testing at any time, including 21% for chlamydia and gonorrhea testing. Of those who received any HIV testing, almost half (46%) received their HIV testing during the cancer workup. In the adjusted model, women who lacked any STI testing had higher odds of also not receiving an HIV test during initial cancer workup compared with at least one STI test pre/post cancer diagnosis (OR: 4.2; 95% CI: 1.98-8.98). Similarly, women enrolled for less than a full year prediagnosis also had higher odds of not receiving an HIV test compared to those with full-year enrollment (OR: 2.6; 95% CI: 1.02-6.94). The odds of nonreceipt of HIV testing during the cancer workup were lower among Hispanic/NH-API/Other women compared with White women (OR: 0.38; 95% CI: 0.16-0.88) and higher for those with no primary care visits post-diagnosis compared to ≥ 3 PCP visits (OR: 2.6; 95% CI: 1.07-6.53) Area-level factors (median household income and population density) were not associated with nonreceipt of HIV testing. Conclusions: Although ICC is considered an AIDS-defining cancer, more than two-thirds of women diagnosed with ICC in our study population did not receive any HIV test during the study period. Strategies to address missed opportunities for HIV testing at ICC diagnosis for vulnerable populations warrant further exploration. Additional validation of claims and patterns of testing should also be explored. Citation Format: Jennifer K. McGee-Avila, Michelle Doose, Jose Nova, Rizie Kumar, Antoinette M. Stroup, Jennifer Tsui. Patterns of HIV testing among New Jersey Medicaid enrollees diagnosed with invasive cervical cancer [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B083.