2026 ACRLP Proceedings: Rising Tide of Infection-Related Cancers

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This content is from UT Health San Antonio’s book, “Advancing Cancer Research for Latinos and All Populations: 2026 Conference Proceedings,” which highlights results of the same-named conference in February 2026.

Advancing the Prevention of HPV and Cervical Cancer

Dr. Ana Patricia Ortiz is lead investigator and interim director of the Division of Cancer Control and Population Sciences, and associate director of the Office of Cancer Research Training and Education Coordination at the University of Puerto Rico Comprehensive Cancer Center.

HPV and cervical cancer

Dr. Ortiz began the presentation by explaining that human papillomavirus (HPV) is the most common sexually transmitted infection worldwide, and persistent infection with certain types of HPV is established as a necessary cause for several cancers, including cervical cancer. There are approximately 600,000 new cases of cervical cancer each year, making it the fourth most common cancer worldwide. Furthermore, cervical cancer causes around 350,000 deaths annually, with approximately 90% of those deaths occurring in low- and middle-income countries.

Cervical cancer rates based on race and location

Differences in cervical cancer incidence between high-income and low- and middle-income countries are not attributable to differences in HPV infections. Instead, countries with the highest cervical cancer incidence and mortality lack high-quality cervical cancer screening, timely treatment, healthcare access, and HPV vaccine programs. Women with HIV are also 6 times more likely to develop cervical cancer compared to those who are HIV negative. In order to eliminate cervical cancer, the World Health Organization (WHO) has a goal of fully vaccinating 90% of girls with the HPV vaccine by the age of 15, screening 70% of women using a high-performance test by the age of 35 (and again by the age of 45), treating 90% of women with pre-cancer, and treating 90% of women with invasive cancer.

U.S. cervical cancer incidence rates from 2017-2021 were 9.6 per 100,000 for Hispanic individuals and 7.0 per 100,000 for non-Hispanic White individuals. Additionally, late-stage incidence rates were 4.7 per 100,000 among Hispanic individuals and 3.3 per 100,000 among non-Hispanic White individuals. Cervical cancer mortality rates per 100,000 were 2.4 and 2.1 respectively.

Factors that may be contributing to the differences in cervical cancer incidence and mortality between Hispanic and non-Hispanic White US populations include individual, sociocultural, and system-level factors. Individual factors may include a lack of awareness, certain behaviors, health practices, low-income, low levels of acculturation, low educational attainment, and immigration status. Sociocultural factors may include cultural beliefs and social norms. System-level factors may include a lack of access to health services, being uninsured, limited transportation and childcare, and restrictive work policies to attend health appointments.

Tools for cervical cancer prevention

The primary tool for cervical cancer prevention is the HPV vaccine. In the US, only 5 states or territories have HPV vaccination school entry requirements, including Puerto Rico. In 2024, only approximately 60% of adolescents received the recommended doses of HPV vaccine, well short of the 90% WHO goal.

Secondary prevention of cervical cancer involves screening. In 2020, 74.7% of US Hispanic women between the ages of 21 and 65 had received a pap test within the 3 previous years, compared with 77.6% of non-Hispanic White women. Some barriers to screening include lower income and education, job concerns, a lack of transportation, limited childcare, morbid obesity, and risky sexual behaviors.

HPV self-sampling for screening may help overcome these barriers. Several studies have shown concordance between HPV testing in the clinic and self-sampling. In 2024, the US Food and Drug Administration (FDA) approved self-sampling to be used in health settings, and in 2025, the FDA approved the first at-home self-collection device for cervical cancer screening.

Follow-up care

After screening, however, follow-up care is needed. Hispanic women face certain barriers to follow-up care after an abnormal cervical cancer screening result. In a study of Hispanic individuals in Texas who received an abnormal cervical cancer screening result, only 65.6% received follow-up care within an optimal diagnostic interval. A qualitative study among Latina women reported personal and systemic barriers to follow-up care, including anxiety and fear of a diagnosis, scheduling of appointments interfering with work and/or child care, and inadequate communication about appointments. In a clinic-based study in Puerto Rico, only 52.5% of women achieved guideline-compliant colposcopy after an abnormal cervical cancer screening.

Dr. Ortiz closed by emphasizing the preventability of cervical cancer, and the need for continued strengthening of cervical cancer prevention strategies, as well as research and education to achieve cervical cancer elimination goals in all US states and territories. Although HPV vaccination rates among Hispanic women are similar to the general population, lower cervical cancer screening rates have been reported. Continued research and public health interventions among Hispanic populations is essential for the development of evidence-based targeted cervical cancer prevention and control strategies for this high-risk population.

Rising Tide of Infection-Related Cancer in Latino Communities: A Focus on Gastric Cancer

Dr. Luis G Carvajal-Carmona is Associate Vice Chancellor and Professor of Biochemistry and Molecular Medicine at the University of California, Davis.

Gastric cancer among Latinos

Dr. Carvajal-Carmona began by highlighting the leading cancer sites for cases and deaths among Latinos in the US. Certain cancer sites, such as liver and intrahepatic bile duct, stomach, kidney and renal pelvis, ovary, and uterine cervix, rank much higher in Latino populations than in White populations. The incidence ratio of Latino patients to White patients for liver cancer is 1.71 for men and 1.31 for women. The mortality ratio for stomach cancer is 2.03 for men and 2.53 for women. These sites of higher incidence and mortality tend to be associated with an infection.

Gastric cancer risk factors vary by location, with cardia cancer more common among White individuals, those with gastroesophageal reflux disease (GERD), and male individuals. Non-cardia tumors are more common in minority populations and in those with Helicobacter pylori (H. pylori). Non-cardia tumors are also associated with socioeconomic factors, occurring more frequently in lower socioeconomic populations. In a study of gastric cancer in California, a higher proportion of Latino patients were diagnosed at an early age (<50), had diffuse tumors, and were diagnosed with an advanced stage of cancer compared with White patients.

Genetic variation in Latino gastric tumors

Although approximately 10% of gastric cancer cases exhibit familial clustering, only 1-3% are attributable to a known hereditary syndrome. Recent findings from Dr. Carvajal-Carmona and colleagues have shown that a significant proportion of gastric cancer patients harbor pathogenic variants in susceptibility genes such as PALB2, BRCA1, BRCA2, and RAD51c. A family history of cancer was associated with higher mutation prevalence, suggesting that multi-organ cancer predisposition genes should be included in germline testing panels for patients with gastric cancer.

In another study analyzing multiple biopsies from 36 Latino patients in Mexico and Colombia found high intratumor heterogeneity in gastric cancer. Determining whether mutations are clonal (present in all tumor cells) or subclonal (present in only a subset of tumor cells) is important for understanding tumor evolution and guiding treatment strategies. However, only about 40% of tumors in Latino patients harbor a druggable target. Tumors with clonal mutations associated with microsatellite instability (MSI) are often responsive to immunotherapy. In contrast, genomically stable tumors are more difficult to treat and are closely associated with diffuse histology, which is more common in this population. These tumors are typically immunologically “cold,” meaning they are less likely to respond to immunotherapy, and they also tend to respond poorly to conventional chemotherapy.

In an unpublished study of about 200 tumors from Latino patients, Dr. Carvajal-Carmona and colleagues used low-pass whole-genome analysis, revealing that 57.8% had the genomic stability subtype. New gastric cancer drivers were also identified in Latino patients. When comparing these data with those from The Cancer Genome Atlas (TCGA), which represents largely White and Asian populations, significant differences in driver frequency were observed, a finding that could impact therapeutic decisions. Many mutations in Latino gastric tumors are not druggable.

Ancestry and gastric cancer

Among Latino gastric cancer patients, Dr. Carvajal-Carmona and colleagues found that those with higher Indigenous American ancestry had a higher prevalence of diffuse, genomically stable tumors and a higher frequency of CDH1 mutations, the most important driver of these tumors (Carvajal-Carmona, unpublished).

Dr. Carvajal-Carmona concluded the presentation by emphasizing the importance of studying the Latino population to understand the genetic selectivity of gastric cancer and to identify new genetic drivers. Gastric tumors from Latino patients exhibit extensive genetic variation, with important implications for therapy. More work is needed to understand why Latino gastric tumors are enriched for aggressive molecular subtypes and to further elucidate the influence of American Indian ancestry on somatic genetics in the population.

Multilevel Determinants that Contribute to Barriers to HCC Screening and Disparities in Outcomes

Dr. Patricia D. Jones is Associate Professor of Clinical Medicine, Associate Chief of Clinical Affairs in the Division of Digestive Health and Liver Diseases, and Population Science Lead at the Sylvester Comprehensive Cancer Center and University of Miami Miller School of Medicine.

HCC by the numbers

Dr. Jones’s presentation discussed the barriers to hepatocellular carcinoma (HCC) screening, and variances in HCC outcomes. Primary liver cancer is the sixth most frequently occurring cancer worldwide, and the third most common cause of cancer mortality. Primary liver cancer includes HCC and cancer of the intrahepatic bile duct, with HCC representing approximately 85% of the 41,000 to 42,000 new cases of primary liver cancer cases diagnosed each year in the US. The 5-year relative survival rate for cancer of the liver and intrahepatic bile ducts is only 22%.

Causes of liver cancer

Most individuals who develop liver cancer have some form of liver disease, which has multiple causes: alcohol-related liver disease, steatotic liver disease, viral hepatitis, autoimmune liver disease, and genetic liver disease. Liver disease patients are at risk for developing cirrhosis, the strongest risk factor for HCC. In fact, 85-95% of patients with HCC have cirrhosis.

From 1999 to 2021, the percentage of liver cancer cases caused by hepatitis B decreased, while the percentages of cases caused by hepatitis C and alcohol related liver cancer increased, and the percentage of cases caused by steatotic liver disease nearly doubled. The incidence of liver cancer varies by race, with American Indian/Alaska Native individuals having the highest risk, followed by Hispanic individuals. The risk in all minority groups is higher than the risk in non-Hispanic White individuals.

The most common cause of HCC also varies by race and nation of origin. Among Black individuals, hepatitis C is the leading cause of HCC for both men and women, however, among black men born in Haiti, the leading cause is hepatitis B. Fatty liver is the most common cause for individuals from Central and South America, but Cuban and US-born Mexican men or Puerto Rican men and women experience hepatitis C as a leading cause.

Dr. Jones and colleagues have received funding to establish the Genetic and Environmental Risk of Non-Alcoholic Fatty Liver Disease (NAFLD)-related HCC in All Latinos (GENIAL). In general, Latinos have not been represented adequately in genome-wide association studies (GWAS). GENIAL seeks to assess the interplay between genetic factors, NAFLD phenotype, demographic factors, clinical factors, non-medical drivers of health, cultural factors, and environmental factors, and how they contribute to HCC.

HCC screening

Patients with liver disease or cirrhosis should receive a straightforward screening for HCC every 6 months; the screening involves an ultrasound of the liver and a blood-based biomarker test called alpha fetoprotein (AFP). However, only between 6% and 25% of HCC patients have received screening and diagnosis. The largest barrier to screening is undiagnosed liver disease. Screening rates are lower in black individuals, those who are uninsured, and residents of neighborhoods with higher levels of poverty.

One recently studied intervention to try to improve HCC screening involved mailed outreach and patient navigation. HCC surveillance was performed in 23.3% of outreach + navigation patients, 17.8% of mailed outreach‐alone patients, and 7.3% of usual care patients. However, even these improved surveillance rates are very low.

Stage at diagnosis

The global HCC BRIDGE study, a longitudinal cohort study of 18,031 patients, found that Barcelona Clinic Liver Cancer (BCLC) C (advanced) stage at diagnosis was the most common stage in North America, Europe, China, and South Korea with 42%, 51%, 55%, and 53% of patients presenting at that stage, respectively. BCLC C stage indicates that a patient has metastatic disease, either distant or with involvement of some of the large veins leaving the liver. Japan and Taiwan, however, each have national surveillance programs; 70% of patients from Taiwan and 73% of patients from Japan are diagnosed with very early stage disease.

Only 30.4% of Black patients are diagnosed at an early stage, compared to 54.4% of White patients and 46.8% of Hispanic patients. Black race is also significantly associated with treatment delays compared to White race. Compared to urban residents, rural and suburban residents are 12% and 8% less likely to receive treatment, respectively.

Dr. Jones closed by quoting Angela Davis, who said, “I am no longer accepting the things I cannot change. I am changing the things I cannot accept.” The factors that contribute to variable outcomes in HCC must be addressed, including insurance status, education attainment, socioeconomic status, transportation, access, and other factors. Patient navigation programs and coordination of care can help with these barriers, building relationships between the navigator, the patient, and the caregiver.

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