In the Caribbean, cancer accounts for one-fifth of all deaths and its incidence is increasing [1]. People diagnosed with cancer in this region face unique challenges in prevention and control efforts [2]. Puerto Rico, a territory of the United States (USA). In the Caribbean Sea, it has a history of environmental and social neglect and a disproportionate impact of extreme weather events driven by climate change [3]. It is home to nearly 3.2 million Hispanics/Latinos [4]. From 2000 to 2022, 320,076 cases of cancer were diagnosed: in men, the age-adjusted incidence rate increased from 348.3 to 377.6 per 100,000; in women, from 252.9 to 314.5 per 100,000 [5]. Although overall cancer mortality in Puerto Rico decreased from 2016 to 2020, its incidence has increased annually [6].

Among women, significant increases were observed in the incidence of breast cancer (Annual Percentage Change [APC] = 1.7%), body and uterus (APC = 4.6%), thyroid (APC = 9.0%), non-Hodgkin lymphoma (APC = 2.1%), pancreas (APC = 3.1%), leukemia (APC = 2.7%) and ovary (APC = 0.8%). Among men, significant increases were seen in prostate (CPA = 1.7%), non-Hodgkin lymphoma (CPA = 1.8%), liver and bile ducts (CPA = 1.9%), kidney and renal pelvis (CPA = 4.3%), leukemia (CPA = 2.2%) and pancreas (CPA = 2.2%). Municipalities in the southern, northern and central regions of Puerto Rico have the highest cancer incidence rates [6].

Although cancer risk is influenced by multiple factors, including genetics, environment, medical history, and lifestyle [7], previous studies have highlighted a disproportionate burden of environmental pollution on black and Hispanic/Latino populations [8—12]. Therefore, identifying environmental risk factors in Puerto Rico is a public health priority, as they have been associated with genitourinary, digestive, gastrointestinal, gynecological, hematological/blood and breast cancers.

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