Environmental PFAS exposure as an understudied social determinant of health for endometrial cancer disparities: A geospatial study in Florida.

Abstract

10564 Background: Endometrial cancer (EC) is the most common gynecological malignancy in the U.S. Although overall survival rate for EC in the US is 81%, non-Hispanic Black (NHB) women die from EC at higher rates than non-Hispanic White (NHW) women. Currently, population-based research on social determinants of health associated with EC disparities is limited. PFAS exposure has been linked to increased risk for EC, but the potential impacts of environmental PFAS exposure on EC disparities are largely understudied. This research examined how EC incidence rates and mortality odds by census tracts vary with respect to proximity to industrial PFAS facilities as well as drinking water PFAS contamination in Florida. Methods: Florida cancer registry data from 2011 to 2020 was used to calculate age-adjusted incidence rates and mortality odds (number of mortalities divided by number of cases diagnosed) of both Type I and Type II EC by race/ethnicity for all census tracts in Florida. Data on the locations of industrial facilities handling PFAS as well as ZIP codes with public drinking water tested positive for PFAS were obtained from US EPA. A geographic information system was used to calculate indicators of proximity to PFAS facilities within 5 km of a census tract. Statistical tests including two-way ANOVA and two-sample t-test were used to compare mean incidence rates and mortality odds for three levels of PFAS proximity and drinking water PFAS status. Results: A total of 11,796 cases (8,931 in NHW, 1,821 in Hispanics, and 1,044 in NHB) of Type I EC and 9,715 cases (6,088 in NHWs, 1,450 in Hispanics, and 2,177 in NHB) of Type II EC were diagnosed and geocoded to 3,095 census tracts in Florida from 2011 to 2020. ANOVA showed that higher proximity to PFAS facilities is associated with higher rates of poverty as well as higher likelihood of drinking water PFAS contamination. Census tracts with higher proximity to PFAS show higher age-adjusted incidence and mortality odds for both Types I and II EC in NHW. NHB living in areas with higher PFAS proximity show higher mortality odds, while no statistically significant associations were found for Hispanic. T-tests showed that positive drinking water PFAS status is associated with higher aged-adjusted incidence and mortality odds for Type I EC in NHW as well as higher type II EC mortality odds in NHB and Hispanic. Conclusions: Results of this study demonstrate environmental PFAS exposure as a critical yet underexplored social determinant of health for EC epidemiology. Further research is needed to unearth the effect mechanism and to firmly establish PFAS exposure as a risk factor for EC disparities in the population. Such efforts can help develop public health policies to protect vulnerable populations from PFAS exposure and subsequent EC development as well as to accelerate the regulation process for environmental PFAS contamination.