Patterns of leukemia incidence in the United States by subtype and demographic characteristics, 1997–2002

Objective Efforts to prevent leukemia have been hampered by an inability to identify significant risk factors. Exploring incidence patterns of leukemia subtypes by sex and race/ethnic group may generate new etiologic hypotheses and identify high-risk groups for further study. Methods Data from the North American Association of Central Cancer Registries for 1997–2002 were used to assess patterns of leukemia incidence by subtype, sex, age, race and ethnicity. Results A total of 144,559 leukemia cases were identified, including 66,067 (46%) acute and 71,860 (50%) chronic leukemias. The highest rates of acute myeloid leukemia with and without maturation were observed in Asian-Pacific Islanders (API). Hispanics had a higher incidence of acute lymphocytic leukemia, particularly in childhood, and promyelocytic leukemia than did non-Hispanics. African–Americans had the highest rates of HTLV-1 positive adult T-cell leukemia/lymphoma. A sharp increase in the incidence of chronic myeloid leukemia was observed for both APIs and Hispanics, 85 years and older. Conclusion Known risk factors are unlikely to explain the observed disparities in leukemia incidence. Further studies of differences in environmental and genetic risk factors in these populations by specific leukemia subtype may provide clues to the etiologies of these malignancies.     

Is preventive resection of the extrahepatic bile duct necessary in cases of pancreaticobiliary maljunction without dilatation of the bile duct?

BACKGROUND: No consensus has been reached on whether preventive resection of the extrahepatic bile duct is necessary in cases of pancreaticobiliary maljunction (PBM) without dilatation of the extrahepatic bile duct (undilated type). METHODS: Sixty-eight patients with PBM underwent corrective surgery and several clinical characteristics and pathological findings including K-ras point mutation were evaluated. RESULTS: Unlike dilated bile duct, none of the patients with undilated type duct had clinical symptoms in early childhood. In patients with either cystic or spindle type duct, amylase levels in the bile duct were >10(4) U/l, whereas those in patients with undilated type duct were <10(4) U/l. Postoperative scintigraphy of the biliary system of undilated type revealed no evidence of cholestasis. After surgery, eight patients with undilated type duct, in whom the bile duct had been preserved, had no further clinical symptoms and no evidence of malignancy. Bile duct tissue specimens revealed no hyperplasia, dysplasia or cancerous lesions and they had no K-ras mutation in undilated type. CONCLUSION: The results showed that there was little bile stasis, injury to the mucosa was mild and less genetic changes could be seen in patients with undilated type duct. Therefore, in patients without dilatation of bile duct and advanced cancer, cholecystectomy alone is sufficient.     

Patterns of inpatient surgeries for the top four cancers in the United States, National Hospital Discharge Survey, 1988–95

Background: At a time when the population is aging and medical practices are rapidly changing, ongoing surveillance of surgical treatments for cancer is valuable for health services planning. Methods: We used data from the National Hospital Discharge Survey for patients with discharge diagnoses of lung, prostate, female breast, and colorectal cancer during 1988–95 to estimate population-based rates and numbers of inpatient surgical procedures. Results: In 1988–91, rates of lobectomy for lung cancer were significantly higher in males than females. By 1994–95, the male/female differences had largely disappeared due to increasing trends among females and decreasing trends among males. During 1988–95, surgeries on the large intestine for colorectal cancer, including right hemicolectomy and sigmoidectomy, decreased significantly, as did abdominoperineal resections of the rectum. Anterior resections of the rectum increased significantly. Radical prostatectomies for prostate cancer increased from 34,000 in 1988–89 to 104,000 in 1992–93 and then decreased to 87,000 in 1994–95; rates followed a similar pattern. Finally, the number and rates of inpatient mastectomies for female breast cancer decreased over the study period (from 219,000 to 180,000 and from 78.8 to 61.5 per 100,000, respectively). Conclusion: These trends in inpatient surgeries for the major cancers in the US probably reflect changes in disease occurrence and modified treatment recommendations.     

What proportion of breast cancers are detected by mammography in the United States?

BACKGROUND: None of the recent national studies has ascertained how women's breast cancer was detected in the United States. To rectify this gap, questions were added to the leading national health survey. Mammography was of special interest because it is widely used in the US and has evidence of a mortality benefit. METHODS: We used the 2003 National Health Interview Survey (NHIS), to ascertain the self-reported modalities used to detect breast cancer in the non-institutionalized US population. The study included 345 women 40-84 years of age who, in 2003, reported a personal history of breast cancer. We examined the frequency of self-reported characteristics and tested for association with mammography-detected breast cancer using logistic regression. RESULTS: Among the survivors in 2003, the percentage of breast cancers detected by mammography was much higher after 2001 (59%) than before 1993 (29%). Breast cancer survivors with less than high school education or less than US$ 20,000 household income were less likely to report detection by mammography. CONCLUSIONS: Women reported mammography-detected breast cancer at a slightly higher rate than published studies of mammography sensitivity and use would suggest. Lower rates of mammography-detected breast cancers among survivors with low income or low education raise the question whether mammography is underutilized as a diagnostic tool, especially for underserved women.     

Chordoma: incidence and survival patterns in the United States, 1973–1995

Background: Chordoma, a rare tumor arising from notochordal remnants, has been described to date only by single-institution case series or small population-based surveys. Methods: We used data from the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute, 1973–1995, to calculate age-adjusted incidence and survival rates for 400 cases of microscopically confirmed chordoma and to derive information regarding case distribution and risk of second cancer. Results: The age-adjusted chordoma incidence rate (IR) of 0.08 per 100,000 was age-dependent, more common in males (IR 0.10) than females (IR 0.06) and rare among patients aged <40 years and blacks. Within the axial skeleton 32% of cases were cranial, 32.8% spinal and 29.2% sacral. Young age (<26 years; p = 0.0001) and female sex (p = 0.037) were associated with greater likelihood of cranial presentation. There was no overall increased risk for second primary cancers after chordoma. Median survival was 6.29 years; 5- and 10-year relative survival rates were 67.6% and 39.9%, respectively. Comparison with other bone sarcomas revealed racial disparities in incidence for the two developmental tumors, chordoma and Ewing's sarcoma. Conclusions: This study provides new data regarding incidence and survival patterns of chordoma in the US. Additional epidemiologic studies are required to elucidate the genetic and environmental determinants underlying this rare, distinctive neoplasm.     

Pediatric neurological cancer incidence and trends in the United States, 2000–2018

Cancer Causes & Control - To characterize the epidemiological trends and sociodemographic variation of pediatric and adolescent neurological cancers by histological subtypes over time in the...     

A case–control study of reproductive factors and renal cell carcinoma among black and white women in the United States

Objective  

Renal cell carcinoma (RCC) incidence is higher among blacks than whites in the United States and has been associated with the frequency and timing of childbirth among women in some epidemiologic studies. We investigated whether reproductive factors are associated with RCC, overall and by race, within a population-based case–control study.     

Selected cancers with increasing mortality rates by educational attainment in 26 states in the United States, 1993–2007

Background

Mortality rates continue to increase for liver, esophagus, and pancreatic cancers in non-Hispanic whites and for liver cancer in non-Hispanic blacks. However, the extent to which trends vary by socioeconomic status (SES) is unknown.

Methods

We calculated age-standardized death rates for liver, esophagus, and pancreas cancers for non-Hispanic whites and non-Hispanic blacks aged 25–64 years by sex and level of education (≤12, 13–15, and ≥16 years, as a SES proxy) during 1993–2007 using mortality data from 26 states with consistent education information on death certificates. Temporal trends were evaluated using log-linear regression, and rate ratios (RRs) with 95 % confidence intervals (CIs) compared death rates in persons with ≤12 versus ≥16 years of education.

Results

Generally, death rates increased for cancers of the liver, esophagus, and pancreas in non-Hispanic whites and non-Hispanic blacks (liver cancer only) with ≤12 and 13–15 years of education, with steeper increases in the least educated group. In contrast, rates remained stable in persons with ≥16 years of education. During 1993–2007, the RR (rates in ≤12 versus ≥16 years of education) increased for all three cancers, particularly for liver cancer among men which increased from 1.76 (95 % CI, 1.38–2.25) to 3.23 (95 % CI, 2.78–3.75) in non-Hispanic whites and from 1.28 (95 % CI, 0.71–2.30) to 3.64 (95 % CI, 2.44–5.44) in non-Hispanic blacks.

Conclusions

The recent increase in mortality rates for liver, esophagus, and pancreatic cancers in non-Hispanic whites and for liver cancer in non-Hispanic blacks reflects increases among those with lower education levels.     

A birth cohort analysis of the incidence of ascending and descending colon cancer in the United States, 1973–2008

Objectives

There is evidence indicating that the trends in colorectal cancer (CRC) incidence rates in the United States differ according to CRC subsites, including for ascending cancer which has shown a different pattern from the overall trends. We investigated the time trends for ascending and descending colon cancer in the United States by race and gender to identify the specific components that may account for the incidence trends.

Methods

Using data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results program for 1973–2008, we conducted age–period–cohort modeling to evaluate birth cohort patterns and evaluate age–period–cohort effects on incidence trends of colon cancer over time.

Results

A clear birth cohort pattern was observed for both ascending and descending colon cancer, and the incidence rates of ascending colon cancer in the more recent birth cohorts were higher compared to earlier cohorts particularly for black males and females. This increase was most obvious in the younger age groups and appeared to accelerate, especially for black females. For descending colon cancer, the study suggested an increase in the birth cohort slope in the later birth cohorts for all gender and race groups, after a period of decline in earlier birth cohorts.

Conclusion

The increase in incidence rates of both ascending and descending colon cancer in more recent birth cohorts for blacks suggests the need for targeted public health strategies to increase CRC screening. Further, additional etiological studies are warranted to evaluate factors responsible for the observed trends in more recent birth cohorts, including differences by subsites, race, and/or gender.     

Epidemiology of Lymphedema-related admissions in the United States: 2012–2017

BackgroundLymphedema is a debilitating chronic condition with no definitive curative treatment. There is a paucity of data on prevalence, mortality and burden of care in the United States. This study aimed to describe hospitalizations due to lymphedema and identify factors associated with poor outcomes.Study designWe performed a retrospective analysis of the Healthcare Cost and Utilization Project National Inpatient Sample for lymphedema-related hospitalizations from 2012 to 2017. All adults admitted with a primary diagnosis of lymphedema or a primary diagnosis of extremity cellulitis and secondary diagnosis of lymphedema were included. Weights were used to obtain national estimates and complex sampling structure was accounted for using survey methods. Chi-squared tests were performed to assess the association between patient demographics, hospital characteristics, and inpatient mortality.ResultsBetween 2012 and 2017, there were an estimated 165,055 lymphedema admissions in the United States. The vast majority of hospitalizations were for cellulitis (92%), lower extremity disease (88%), and were admitted through the emergency room (77%). Median length of stay was 3.61 days (IQR 2.24–5.77) and inpatient mortality was 0.03% (n = 505). Age >80yrs (OR 3.83, 95% CI 1.72, 8.52) and Charlson comorbidity index ≥3 (OR 4.13, 95% CI 2.19, 7.79) were associated with increased risk of inpatient mortality.ConclusionAlthough mortality is low, lymphedema-related hospitalizations are a significant burden to the US healthcare system. Counseling older lymphedema patients with comorbidities on early symptoms and signs of infection and prompt treatment of same may reduce mortality.     

Estimating the annual frequency of synchronous brain metastasis in the United States 2010–2013: a population-based study

In this retrospective, IRB-exempt study, we analyzed data from 68 patients diagnosed with glioblastoma (GBM) in two institutions and investigated the relationship between tumor shape, quantified using algorithmic analysis of magnetic resonance images, and survival. Each patient’s Fluid Attenuated Inversion Recovery (FLAIR) abnormality and enhancing tumor were manually delineated, and tumor shape was analyzed by automatic computer algorithms. Five features were automatically extracted from the images to quantify the extent of irregularity in tumor shape in two and three dimensions. Univariate Cox proportional hazard regression analysis was performed to determine how prognostic each feature was of survival. Kaplan Meier analysis was performed to illustrate the prognostic value of each feature. To determine whether the proposed quantitative shape features have additional prognostic value compared with standard clinical features, we controlled for tumor volume, patient age, and Karnofsky Performance Score (KPS). The FLAIR-based bounding ellipsoid volume ratio (BEVR), a 3D complexity measure, was strongly prognostic of survival, with a hazard ratio of 0.36 (95% CI 0.20–0.65), and remained significant in regression analysis after controlling for other clinical factors (P?=?0.0061). Three enhancing-tumor based shape features were prognostic of survival independently of clinical factors: BEVR (P?=?0.0008), margin fluctuation (P?=?0.0013), and angular standard deviation (P?=?0.0078). Algorithmically assessed tumor shape is statistically significantly prognostic of survival for patients with GBM independently of patient age, KPS, and tumor volume. This shows promise for extending the utility of MR imaging in treatment of GBM patients.     

Trends in breast cancer mortality rates by region of the United States, 1950–1999

Introduction: Limited information is available on trends in breast cancer mortality by region of the country. Methods: Rates for broad age groups were calculated from 1950 to 1999 for whites and 1970–1999 for blacks for four census regions and 508 state economic areas of the United States. Results: For white women ages 50–64years, the mortality relative risk [RR] for the Northeast compared to the South was 1.48 in 1950–1959 and 1.15 in 1990–1999. Rates increased in all regions from the 1950s to 1960s but more substantially in the South, increased slightly in the 1970s in all regions, declined slightly in the Northeast, Midwest and West but not in the South in the 1980s, and declined more in the Northeast, Midwest and West than in the South in the 1990s. Among similarly aged black women, the RRs for the Northeast compared to the South were 1.13 and 1.0 in 1970–1979 and 1990-1999, respectively. Among these women, rates increased in all regions in the 1980s; in the 1990s rates declined in the Northeast, Midwest and West but continued to increase in the South. Conclusion: The historically lower breast cancer mortality rates in the South have been eroded because of relatively less favorable trends in the South.     

Primary central nervous system tumor treatment and survival in the United States, 2004–2015

Journal of Neuro-Oncology - Brain tumor treatment and survival information is generally limited in large-scale cancer datasets. We provide a clinical investigation of current patterns of care and...     

Impact of screening on cervical cancer incidence: A population-based case–control study in the United States

Cervical cancer is widely preventable through screening, but little is known about the duration of protection offered by a negative screen in North America. A case–control study was conducted with records from population-based registries in New Mexico. Cases were women diagnosed with cervical cancer in 2006–2016, obtained from the Tumor Registry. Five controls per case from the New Mexico HPV Pap Registry were matched to cases by sex, age and place of residence. Dates and results of all cervical screening and diagnostic tests since 2006 were identified from the pap registry. We estimated the odds ratio of nonlocalized (Stage II+) and localized (Stage I) cervical cancer associated with attending screening in the 3 years prior to case-diagnosis compared to women not screened in 5 years. Of 876 cases, 527 were aged 25–64 years with ≥3 years of potential screening data. Only 38% of cases and 61% of controls attended screening in a 3-year period. Women screened in the 3 years prior to diagnosis had 83% lower risk of nonlocalized cancer (odds ratio [OR] = 0.17, 95% CI: 0.12–0.24) and 48% lower odds of localized cancer (OR = 0.52, 95% CI: 0.38–0.72), compared to women not screened in the 5 years prior to diagnosis. Women remained at low risk of nonlocalized cancer for 3.5–5 years after a negative screen compared to women with no negative screens in the 5 years prior to diagnosis. Routine cervical screening is effective at preventing localized and nonlocalized cervical cancers; 3 yearly screening prevents 83% of nonlocalized cancers, with no additional benefit of more frequent screening. Increasing screening coverage remains essential to further reduce cervical cancer incidence.     

Incidence of intracranial germ cell tumors by race in the United States, 1992–2010

Little is known about the etiology of intracranial germ cell tumors (iGCTs), although international incidence data suggest that the highest incidence rates occur in Asian countries. In this analysis, we used 1992–2010 data from the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) Program to determine whether rates of iGCT were also high in Asian/Pacific Islanders living in the United States. Frequencies, incidence rates and survival rates were evaluated for the entire cohort and for demographic subgroups based on sex, age category (0–9 and 10–29 years), race (white, black, and Asian/Pacific Islander), and tumor location (pineal gland vs. other) as sample size permitted. Analyses were conducted using SEER*Stat 8.1.2. We observed a significantly higher incidence rate of iGCT in Asian/Pacific Islanders compared with whites (RR = 2.05, 95 % CI 1.57–2.64, RR = 3.04, 95 % CI 1.75–5.12 for males and females, respectively) in the 10–29 year age group. This difference was observed for tumors located both in the pineal gland and for tumors in other locations. Five-year relative survival differed by demographic and tumor characteristics, although these differences were not observed in comparisons limited to cases treated with radiation. Increased incidence rates of iGCT in individuals of Asian descent in the SEER registry are in agreement with data from the International Agency for Research on Cancer, where Japan and Singapore were among the countries with highest incidence. The increased incidence in individuals of Asian ancestry in the United States suggests that underlying genetic susceptibility may play a role in the etiology of iGCT.     

The Care and Outcomes of Older Persons with Lung Cancer in England and the United States, 2008–2012

Introduction

Although prior research has demonstrated lower lung cancer survival in England than in the United States, more detailed comparisons are needed. We conducted a population-based analysis to compare diagnostic, treatment, and survival patterns.

Psychosocial stress and cigarette smoking persistence, cessation, and relapse over 9–10 years: a prospective study of middle-aged adults in the United States

Purpose

Year-to-year decreases in smoking in the US have been observed only sporadically in recent years, which suggest a need for intensified efforts to identify those at risk for persistent smoking. To address this need, we examined the association between a variety of psychosocial stressors and smoking persistence, cessation, and relapse over 9–10 years among adults in the United States (n = 4,938, ages 25–74).

Methods

Using information provided at baseline and follow-up, participants were categorized as non-smokers, persistent smokers, ex-smokers, and relapsed smokers. Stressors related to relationships, finances, work–family conflict, perceived inequality, neighborhood, discrimination, and past-year family problems were assessed at baseline and follow-up.

Results

High stress at both assessments was associated with greater odds of persistent smoking for stressors related to relationships, finances, work, perceived inequality, past-year family problems, and a summary score. Among respondents who were smokers at baseline, high stress at both time points for relationship stress, perceived inequality, and past-year family problems was associated with nearly double the odds of failure to quit.

Conclusions

Interventions to address psychosocial stress may be important components within smoking cessation efforts.