Upper tract urothelial neoplasms: incidence and survival during the last 2 decades

PURPOSE: Upper tract urothelial cancer is rare but studies in the 1970s showed that its incidence was increasing. We evaluated national trends of the incidence and survival of upper tract urothelial neoplasms from 1973 to 1996. MATERIAL AND METHODS: We obtained information on upper tract urothelial neoplasms from 1973 to 1996 from the National Cancer Institute Surveillance, Epidemiology and End Results program. To provide a time comparison we evaluated upper tract urothelial cancer from 1973 to 1984 and 1985 to 1996. We also calculated overall disease specific survival stratified by cancer stage, patient race and gender for the study period overall. RESULTS: A total of 9,072 cases of upper tract urothelial cancer were identified in the Surveillance, Epidemiology and End Results program from 1973 to 1996, including 5,379 of the renal pelvis and 3,678 of the ureter. Comparing age adjusted annual incidence rates revealed an increase in ureteral neoplasms from 0.69 to 0.73/100,000 person-years but no change in the incidence of renal pelvic tumors, while the rate of in situ neoplasms increased from 7. 2% to 23.1%. Overall disease specific 5-year survival was significantly different in regard to tumor stage (95.1% in situ, 88. 9% localized, 62.6% regional and 16.5% distant lesions). Disease specific annual mortality was greater in black than in white individuals and in women than in men (7.4% versus 4.9% and 6.1% versus 4.4%, respectively). CONCLUSIONS: There appears to have been a slight increase in the national incidence of ureteral tumors in the last 23 years. Fortunately we also detected a slight improvement in the overall disease specific survival of patients with upper tract neoplasms.     

Incidence trends in primary malignant penile cancer

OBJECTIVE: To examine trends in the incidence of primary, malignant penile cancer in the United States. METHODS AND MATERIALS: A total of 1,817 men with primary, malignant penile cancer diagnosed between 1973 and 2002 from the Surveillance, Epidemiology and End Results Program Public-use data were used for analysis. Incidence rates were calculated by clinical and demographic variables of interest and decade of diagnosis (1973-1982, 1983-1992, and 1993-2002) using Surveillance, Epidemiology and End Results-Stat 6.1, and trends were examined using the annual percent change statistic. Additional incidence calculations were performed to examine further racial/ethnic differences. RESULTS: The overall incidence of primary, malignant penile cancer from 1973 to 2002 was 0.69 per 100,000. Incidence decreased significantly over time: 0.84 per 100,000 in 1973-1982 to 0.69 per 100,000 in 1982-1992 to 0.58 per 100,000 in 1993-2002. Incidence increased with increasing age at diagnosis. The majority of cases had squamous cell carcinomas, graded as I or II, and originated at the glans penis. Incidence of unknown grade primary, malignant penile cancer decreased significantly over the last 30 years, as did incidence of primary site penis, not otherwise specified primary, malignant penile cancer. The incidence of regional stage disease also increased over time. From 1993 to 2002, White Hispanics had the highest incidence rates (1.01 per 100,000) followed by Alaska Native/American Indians (0.77 per 100,000) and Blacks (0.62 per 100,000). CONCLUSIONS: The overall incidence of primary, malignant penile cancer in the United States has decreased, and these rates varied by race/ethnicity. Incidence rates increased with increasing age at diagnosis, and the incidence of regional stage disease increased over time, while incidence of unknown grade primary, malignant penile cancer decreased over the last 30 years.     

Analysis of recent trends in prostate cancer incidence and mortality

BACKGROUND: There is debate over whether the recent increases seen in prostate cancer are due to lead-time bias from screening, or identification of clinically insignificant lesions. METHODS: Population-based incidence rates for 1973-1996 were calculated, based on the Surveillance, Epidemiology, and End Results Program (SEER) tumor registries. Relative incidence rates for prostate cancer by stage, fatal incidence, and lymph nodes were calculated, adjusted for age. RESULTS: Localized and regional stage prostate cancer increased through 1992 and then dropped. The rate of distant-stage disease was relatively stable from 1973-1991, with a decrease in distant stage starting in 1992. The 2-year mortality rates were constant for 1973-1989. A decline in the 2-year mortality among cases (fatal incidence) also began in 1992. CONCLUSIONS: These data show large increases in early disease, followed by a drop and leveling off along with a decrease in advanced disease (distant stage, 2-year mortality, positive lymph nodes). This indicates that the increasing incidence rates for prostate cancer are largely due to lead-time bias from increased early detection and treatment of prostate cancer. However, since incidence rates have not declined to rates seen in the 1970s, the additional cases may also reflect length bias from insignificant lesions or a true increase in incidence over time.     

Incidence Pattern and Survival for Gallbladder Cancer Over Three Decades—An Analysis of 10301 Patients

BACKGROUND: Little is known about the trends in the incidence, survival, and treatment patterns of gallbladder cancer over the last decade. METHODS: Data of patients in the Surveillance, Epidemiology and End Results Program of the National Cancer Institute (SEER 13) with a diagnosis of primary gallbladder cancer from 1973-2002 were examined. The effect of surgery and radiotherapy on survival was examined. Incidence of disease, survival, use of surgery, and radiotherapy for patients diagnosed between 1993 and 2002 (Group B) were compared to the others (Group A). RESULTS: Median age of the 10301 included patients was 73. 72.4% were female and median survival was 4 months. SEER histologic stage was classified as localized (23.7%), regional (37.4%), and distant (38.9%) patients. Median survival for these stages was 20 months, 5 months, and 2 months, respectively. 81.5% patients underwent surgery and 13.3% radiotherapy. Median survival of patients undergoing surgery was significantly longer (8 versus 2 months, P < 0.0001). Radiotherapy in addition to surgery was associated with prolonged survival for patients with regional and distant stages but not localized stage. Over the 3 decades, the incidence of gallbladder cancer gradually decreased in patients older than 50 years, but increased in younger patients. Significantly fewer Group B patients underwent surgery compared with Group A (74.6% versus 89.9%, P < .001). However, the use of radiotherapy was higher in Group B (14.5% versus 12.4%, P < 0.01). CONCLUSIONS: Over the last decade, the incidence of gallbladder cancer has reduced in patients older than 50 years with an increased incidence in younger patients. Survival of patients has also improved over the last decade. The number of patients undergoing surgery has reduced with an increase in the use of radiotherapy.     

Pancreatic cancer in the general population: Improvements in survival over the last decade

Background: It is unknown whether the improved survival seen at high-volume centers has been translated to all patients with pancreatic cancer. Objective: To use the Surveillance, Epidemiology, and End Results (SEER) database to evaluate population-based trends in surgical resection and survival. Methods: All patients diagnosed with pancreatic cancer from 1988–1999 were identified. The survival and proportion of patients undergoing surgical resection were compared for each of three equal time periods. Results: There were 24,016 patients with pancreatic cancer. 19,533 had stage data available. 9% had localized, 29% had regional, and 62% had distant disease. Resection rates increased for patients with localized and regional disease over the three time periods. Survival increased for patients with regional and distant disease. For regional pancreatic cancer patients, 2-year survival increased from 9.5% to 13.5% (p<0.0001) and from 21.5% to 28.9% following surgical resection (p=0.002). For resected local/regional pancreatic cancer, the year of diagnosis was and independent predictor of improved survival (p=0.0001). Conclusions: SEER patients with regional and distant pancreatic cancer have improved survival over the past decade in both unadjusted and adjusted models. The improvement is most striking for patients with regional disease and reflects increased resection rates and improved resection techniques over time. Presented at the Forty-Seventh Annual Meeting of The Society for Surgery of the Alimentary Tract, Los Angeles, California, May 20–24, 2006 (oral presentation). Work supported in part by the American Cancer Society-Institutional Research Grant, IRG-96-152-07.     

Disease specific death after external beam radiation of prostate cancer

Our purpose in this paper was to examine the association of age, race, stage, grade, and calendar period with and generate estimates of disease-specific mortality after external beam radiation for prostate cancer. Using data from the Surveillance Epidemiology and End Results Program, we fit proportional hazards models and used life table analyses to estimate survival distribution. High grade and stage, black race, and early calendar period were individually associated with disease-specific mortality. Disease-specific survival ranged from 43% for poorly differentiated regional cancer diagnosed in 1978-1982 to 88% for well differentiated localized cancer diagnosed in 1983-1987. Estimates of disease-specific mortality varied by grade, stage and calendar period of diagnosis. These estimates may be considered in evaluating future treatments.     

Population-Based Study of Islet Cell Carcinoma

Background We examine the epidemiology, natural history, and prognostic factors that affect the duration of survival for islet cell carcinoma by using population-based registries. Methods The Surveillance, Epidemiology, and End Results (SEER) Program database (1973–2003 release, April 2006) was used to identify cases of islet cell carcinoma by histology codes and tumor site. Results A total of 1310 (619 women and 691 men) cases with a median age of 59 years were identified. The annual age-adjusted incidence in the periods covered by SEER 9 (1973–1991), SEER 13 (1992–1999), and SEER 17 (2000–2003) were .16, .14, and .12 per 100,000, respectively. The estimated 28-year limited duration prevalence on January 1, 2003, in the United States was 2705 cases. Classified by SEER stage, localized, regional, and distant stages corresponded to 14%, 23%, and 54% of cases. The median survival was 38 months. By stage, median survival for patients with localized, regional, and distant disease were 124 (95% CI, 80–168) months, 70 (95% CI, 54–86) months, and 23 (95% CI, 20–26) months, respectively. By multivariate Cox proportional modeling, stage (P < .001), primary tumor location (P = .04), and age at diagnosis (P < .001) were found to be significant predictors of survival. Conclusions Islet cell carcinomas account for approximately 1.3% of cancers arising in the pancreas. Most patients have advanced disease at the time of diagnosis. Despite the disease’s reputation of being indolent, survival of patients with advanced disease remains only 2 years. Development of novel therapeutic approaches is needed.     

Population-based analysis of factors associated with survival in patients undergoing cytoreductive nephrectomy in the targeted therapy era

ObjectivesDespite level 1 evidence demonstrating a survival benefit of cytoreductive nephrectomy (CN) in well-selected patients with metastatic renal cell carcinoma (mRCC) in the cytokine era, its role in the contemporary period of targeted therapy remains understudied. To help facilitate improved patient selection for CN and clinical trial design in the targeted therapy era, this study sought to identify factors associated with RCC-specific survival in patients diagnosed with mRCC and undergoing CN between 2005 and 2010 using a large population-based cohort.Materials and methodsPatients diagnosed with mRCC and undergoing CN between 2005 and 2010 were identified from the Surveillance Epidemiology and End Results cancer database. Kaplan-Meier methods were used to calculate disease-specific survival. Stepwise multivariable Cox proportional hazards regression analysis was used to identify factors independently associated with risk of RCC-specific death.ResultsA total of 2,478 patients were identified who were eligible for analysis with a median disease-specific survival of 21 months (95% CI: 19, 22). Factors independently associated with an increased risk of RCC-specific death included age at diagnosis≥60 years, African American race, higher American Joint Committee on Cancer T stage (≥T₃), high Fuhrman nuclear grade (3 or 4), primary tumor size≥7 cm, regional lymphadenopathy, both distant lymph node and visceral metastases, and sarcomatoid histology. A higher number of adverse factors correlated with an increased risk of RCC-specific death (P<0.001).ConclusionsFactors associated with RCC-specific survival identified in this large population-based study can be used to better stratify patients suitable for CN and to help with future clinical trial design and interpretation.     

Secular trends in the incidence of female breast cancer in the United States, 1973-1998

Statistical modeling suggests a causal association between the rapid increase in the incidence of female breast cancer (FBC) in the United States and the widespread use of screening mammography. Additional support for this suggestion is a shift in the stage at diagnosis that consists of an increase in early stage diagnosis followed by a decrease in late-stage diagnosis. This has not been reported in the United States. The objective of this study was to examine the secular trends in the incidence of FBC in search of empirical support for this shift. FBC cases in the Surveillance, Epidemiology, and End Results (SEER) database from 1973 through 1998 were dichotomized into early and late detection based. Early detection included all the in situ and invasive cases with local spread. Late detection included cases with regional spread and distant metastasis. Joinpoint segmented regression modeling was used for trend analysis. Early detection in white and black women followed a similar pattern of significant increase in the early 1980s that continued through 1998 with slight modification in 1987. The expected shift in stage was noticed only for white women when the incidence of late detection in them began to decline in 1987. The incidence of late detection in black women has remained stable. These results provide further support for the previously implied causal association between the use of screening mammography and the increased incidence of FBC in the United States. It also shows that the expected stage shift appeared in white women 50-69 years of age after an estimated detection lead time (DLT) of about 5 years. This is the first estimate of DLT in the United States that is based on actual data. The subsequent increase in late detection in white women since 1993 may be due to changes in case management and the increased use of sentinel lymph node biopsy (SLNB) rather than changes in the etiology or biology of FBC.     

Changing patterns of bladder cancer in the USA: evidence of heterogeneous disease

Study Type – Disease prevalence (retrospective cohort) Level of Evidence 2b What’s known on the subject? and What does the study add? The incidence of bladder cancer has shown a slightly decreasing trend during the past several decades. All published epidemiological studies have trended papillary transitional cell carcinoma (PTCC) and non‐papillary transitional cell carcinoma (NPTCC) as one single disease called transitional cell carcinoma (TCC). This study for the first time examined the time trends by PTCC and NPTCC and found that these two histological subtypes presented different temporal trends. The study results support the hypothesis that bladder cancer is a heterogeneous disease and taking disease’s heterogeneity into consideration in future epidemiological studies is essential.

OBJECTIVE

? To test the hypothesis that bladder cancer is a heterogeneous disease.

PATIENTS AND METHODS

? We examined the temporal trends of bladder cancer by histological subtype and by disease stage and grade using the National Cancer Institute’s Surveillance, Epidemiology, and End Results data collected in 1973–2007.

RESULTS

? The age‐adjusted incidence rates of bladder cancer showed a slight decrease from 1973 to 2007 (annual percentage change [APC]=?0.4, P < 0.05). ? Although the age‐adjusted incidence rates of non‐papillary transitional cell carcinoma decreased by about 53% from 7.9 per 100 000 in 1973 to 3.7 per 100 000 in 2007 (APC =?2.2, P < 0.05), the age‐adjusted incidence rates of papillary transitional cell carcinoma increased by about 56% from 6.8 per 100 000 in 1973 to 10.6 per 100 000 in 2007 (APC = 0.5, P < 0.05). ? Among other rare histological subtypes, except for small cell carcinoma which showed a slightly rising trend, squamous cell carcinoma, adenocarcinoma and others all presented a decreasing trend. ? Similar patterns were found for different stages (localized, regional and distant), but a dramatic increasing trend of grade IV was found between 1998 and 2007 when a corresponding decreasing trend was shown for grades I, II and III.

CONCLUSION

? The results support the hypothesis that bladder cancer is a heterogeneous disease and taking disease heterogeneity into consideration in future epidemiological studies is essential.     

Age-adjusted incidence, mortality, and survival rates of stage-specific renal cell carcinoma in North America: a trend analysis

Background

The rising incidence of renal cell carcinoma (RCC) has been largely attributed to the increasing use of imaging procedures.

Objective

Our aim was to examine stage-specific incidence, mortality, and survival trends of RCC in North America.

Design, setting, and participants

We computed age-adjusted incidence, survival, and mortality rates using the Surveillance Epidemiology and End Results database. Between 1988 and 2006, 43 807 patients with histologically confirmed RCC were included.

Measurements

We calculated incidence, mortality, and 5-yr survival rates by year. Reported findings were stratified according to disease stage.

Results and limitations

Age-adjusted incidence rate of RCC rose from 7.6 per 100 000 person-years in 1988 to 11.7 in 2006 (estimated annual percentage change [EAPC]: +2.39%; p < 0.001). Stage-specific age-adjusted incidence rates increased for localized stage: 3.8 in 1988 to 8.2 in 2006 (EAPC: +4.29%; p < 0.001) and decreased during the same period for distant stage: 2.1 to 1.6 (EAPC: −0.57%; p = 0.01). Stage-specific survival rates improved over time for localized stage but remained stable for regional and distant stages. Mortality rates varied significantly over the study period among localized stage, 1.3 in 1988 to 2.4 in 2006 (EAPC: +3.16%; p < 0.001), and distant stage, 1.8 in 1988 to 1.6 in 2006 (EAPC: −0.53%; p = 0.045). Better detailed staging information represents a main limitation of the study.

Conclusions

The incidence rates of localized RCC increased rapidly, whereas those of distant RCC declined. Mortality rates significantly increased for localized stage and decreased for distant stage. Innovation in diagnosis and management of RCC remains necessary.     

An Up-to-date Assessment of US Prostate Cancer Incidence Rates by Stage and Race: A Novel Approach Combining Multiple Imputation with Age and Delay Adjustment

BackgroundIn the USA, it is unknown whether metastatic prostate cancer incidence has continued to increase and whether racial differences have persisted.ObjectiveCombining multiple imputation with age and delay adjustment, we provide an up-to-date, comprehensive assessment of US prostate cancer incidence trends by stage and race.Design, setting, and participantsFrom Surveillance Epidemiology and End Results (SEER)-18, 774 240 prostate cancer cases were diagnosed during 2004–2017.Outcome measurements and statistical analysisMultiple imputation assigned prostate cancer stage to the 4.7% of cases with missing stage, which varied by year and race-ethnicity. SEER delay factors adjusted case counts to anticipated future data corrections. Twenty datasets were imputed, and Rubin’s rules were used for summary estimation. Overall and stage-specific rates were estimated and stratified by race and age group. Joinpoint software identified significant temporal changes and estimated annual percentage changes. We compared these estimates without multiple imputation and delay adjustment.Results and limitationsMetastatic prostate cancer incidence increased during 2011–2017, with an annual percentage change of 5.5. This was followed by increases in localized and regional disease since 2014. Non-Hispanic black men continued to have the highest incidence, especially for metastatic disease. The increasing rate of metastatic prostate cancer in non-Hispanic white men aged 50–74 yr accelerated recently, and the incidence was 56% higher in 2017 than in 2004. Rates without multiple imputation and delay adjustment were quantitatively and qualitatively different. This observational study is unable to assign causes to observed changes in prostate cancer incidence.ConclusionsMultiple imputation and delay adjustment are essential for portraying accurately stage- and race-specific prostate cancer incidence as clinical practice evolves.Patient summaryIn the USA, diagnosis of prostate cancer that has spread to distant sites (metastatic disease) continues to increase. Black men continue to have higher risks of being diagnosed with metastatic prostate cancer than other race-ethnicities.     

Trends in mortality rates in patients with prostate cancer during the era of prostate specific antigen screening

PURPOSE: We assess the influence of prostate specific antigen screening on trends in mortality rates in patients with prostate cancer. MATERIALS AND METHODS: The incidence based mortality method was applied to prostate cancer data from the Surveillance, Epidemiology, and End Results Program. This method links data on patients diagnosed with cancer to vital status and cause of death, such that mortality can be evaluated by factors associated with disease at diagnosis. Prostate and nonprostate cancer mortality rates were evaluated according to patient age at death, disease stage and grade at diagnosis, race and whether additional cancers involving other sites were present. RESULTS: Mortality due to prostate cancer decreased from 37% in 1988 to 30% in 1995 largely as a result of a sharp increase in nonprostate cancer mortality rates. The overall trend in prostate cancer mortality rates increased from 1988 through 1992 and then decreased. The increase and decrease in rates occurred across categories of age, race, grade and number of cancer primaries. However, the increase in rates did not occur in distant staged cases, nor did the subsequent decrease in rates occur in nondistant staged cases. CONCLUSIONS: Prostate specific antigen screening influenced the increase and decrease in prostate cancer mortality rates.     

Incidence and survival of patients with carcinoma of the ureter and renal pelvis in the USA, 1973–2005

Study Type – Prognosis (retrospective cohort)
Level of Evidence 2b What’s known on the subject? and What does the study add? Upper‐tract urothelial carcinoma (UTUC) is a relatively uncommon urological malignancy with survival and outcomes data largely determined from single‐centre series which can be limited by relatively small case numbers. Through review of a large population based cohort, this study provides valuable information regarding epidemiological and survival patterns for over 13,000 patients with UTUC diagnosed over the past three decades.

OBJECTIVE

? To evaluate epidemiological and survival patterns of upper‐tract urothelial carcinoma (UTUC) over the past 30 years through a review of a large, population‐based database.

PATIENTS AND METHODS

? Data from the Surveillance, Epidemiology and End Results (SEER) database from 1973 to 2005 were reviewed in 10‐year increments to evaluate disease trends. ? Univariate and multivariate survival analyses identified prognostic variables for outcomes.

RESULTS

? In total, 13 800 SEER‐registered cases of UTUC were included. The overall incidence of UTUC increased from 1.88 to 2.06 cases per 100 000 person‐years during the period studied, with an associated increase in ureteral disease (0.69 to 0.91) and a decrease in renal pelvic cancers (1.19 to 1.15). ? The proportion of in situ tumours increased from 7.2% to 31.0% (P < 0.001), whereas local tumours declined from 50.4% to 23.6% (P < 0.001). ? There was no change in the proportion of patients presenting with distant disease. ? In multivariate analysis, increasing patient age (P < 0.001), male gender (P < 0.001), black non‐Hispanic race (P < 0.001), bilateral UTUC (P= 0.001) and regional/distant disease (P < 0.001) were all associated with poorer survival outcomes.

CONCLUSIONS

? The incidence of UTUC has slowly risen over the past 30 years. ? Increased use of bladder cancer surveillance regimens and improved abdominal cross‐sectional imaging may contribute to the observed stage migration towards more in situ lesions. ? Although pathological disease characteristics impact cancer outcomes, certain sociodemographic factors also appear to portend worse prognosis.     

Upper-extremity sarcomas in the United States: analysis of the surveillance,epidemiology, and end results database, 1973-1998

PURPOSE: Upper-extremity soft-tissue sarcomas are a rare disease with unclear epidemiology and evolving treatment strategies. Our purpose is to evaluate the incidence of upper-extremity soft-tissue sarcomas and the use of adjuvant radiotherapy in this patient population. METHODS: Using the Surveillance, Epidemiology, and End Results (SEER) database, a national population-based database, we identified all cases of primary upper-extremity sarcoma reported to the 9 national SEER registries in the Untied States from 1973 to 1998. RESULTS: Of the 1,286 upper-extremity soft-tissue sarcomas the average incidence rate is 2.2 cases/million/y, which has not changed significantly from 1973 to 1998. Caucasians' average incidence rate is significantly higher than African Americans' (incidence rate ratio [IRR] = 1.3, p =.02); and men are at a significantly higher risk compared with women (IRR = 1.3, p <.01). The use of adjuvant radiotherapy has increased significantly from 17% in 1973 to 47% in 1998 (p <.01). African-Americans, compared with Caucasians, are significantly less likely to receive adjuvant radiotherapy (odds ratio [OR] =.5, p =.01). CONCLUSIONS: The incidence of upper-extremity sarcomas has not changed significantly over the past 3 decades; however, the disease differentially affects the population with higher rates in Caucasians and men. Based on the results of this study the use of adjuvant radiotherapy is increasing but African Americans are less likely than Caucasians to receive this treatment for upper-extremity sarcoma.     

Trends in testicular germ cell tumours by ethnic group in the United States

The incidence of testicular germ cell tumours (TGCT) has increased in white and black men in the United States. Little is known, however, about trends among men of other racial/ethnic groups. The current study sought to examine TGCT patterns among men of Asian/Pacific Islander/American Indian/ Alaska Native (API/AIAN) and Hispanic ancestries and to determine whether tumours in these groups are diagnosed at comparable stages and sizes to tumours in white and black men. TGCT incidence data and tumour characteristics were drawn from the Surveillance, Epidemiology and End Results registries for two time periods: 1973-2003 and 1992-2003. In 1973-2003, TGCT rates were significantly lower among black (rate ratio = 0.18, p < 0.001) and API/AIAN (rate ratio = 0.37, p < 0.001) men than among white men. Among white and API/AIAN men, rates increased over 60%, mainly prior to 1989-1993. Among black men, rates increased almost 40%, mainly after 1989-1993. Among white and API/AIAN men, increasing proportions of localized disease were diagnosed over time, while the opposite trend was seen among black men. In 1992-2003, TGCT incidence among Hispanic white men (3.46/100 000) was significantly lower than it was among non-Hispanic white men, but rates of both seminoma and non-seminoma increased. While the incidence of TGCT increased among all men, different patterns in the increase were evident. These data suggest that rates are increasing among Hispanic white men and black men, but are stabilizing among white men and API/AIAN men. The peak of the TGCT epidemic may have been reached in these latter groups.     

Rates of colon and rectal cancers are increasing in young adults

Incidence rates for colorectal cancer are decreasing in the United States, possibly due to preventative cancer screening. Because these programs target older patients, their beneficial effects may not apply to young patients. The purpose of this study was to compare incidence rates and tumor characteristics of colon and rectal cancers for young versus older patients using a population-based cancer registry. Colon and rectal cancer patients reported in the Surveillance, Epidemiology, and End Results registry (1973-1999) were separately analyzed. Incidence rates over time, stage, and grade were compared for two age groups: young patients (20-40 years, n = 5383) and older patients (60+ years, n = 256,401). For older patients, colon cancer incidence remained stable while rectal cancer incidence decreased 11 per cent to 72.1/100,000 persons (P < 0.05). For the young, colon cancer incidence increased 17 per cent to 2.1 (P < 0.05), and rectal incidence rose 75 per cent to 1.4 (P < 0.05). Young patients had less localized tumors than older patients: colon (25.8% vs. 35.3%, P < 0.001); rectal (38.4% vs. 41.7%, P = 0.005). Young patients also had more poorly differentiated tumors: colon (22.2% vs. 14.7%, P < 0.001); rectal (16.4% vs. 12.3%, P < 0.001). Incidence rates for colon and rectal cancers in young patients are rising, and they have more advanced disease. Although the overall prevalence is low in this population, the increasing incidence suggests health-care providers should have heightened awareness when caring for this population.     

Ductal carcinoma in situ: trends in geographic, temporal, and demographic patterns of care and survival

While long-term prognosis is excellent, treatment of ductal carcinoma in situ (DCIS) remains controversial and inconsistent. The purpose of this study was to track geographic and temporal patterns of care for women diagnosed with DCIS, and analyze subsequent cancer-specific risk of mortality. Subjects for this study were 41,245 women diagnosed with primary DCIS in the National Surveillance, Epidemiology, and End Results (SEER) program from 1973 through 2000. Variables analyzed included patient age, year of diagnosis, SEER site of residence at the time of diagnosis, treatment (surgery, radiation), race, age, and hormone (estrogen and progesterone) receptor status. The percentage of women diagnosed with DCIS out of the total number of women diagnosed with breast cancer increased steadily between 1973 and 2000, with the largest increase occurring around 1985. Breast conserving surgery (BCS) utilization increased over time for each SEER site to the current proportions, ranging from 49.5% in Utah to 76.9% in Connecticut. Younger women were significantly more likely to receive mastectomy and had significantly lower risk of death. Women receiving BCS who also had radiation therapy (RT) had a significantly lower risk of death, although those receiving mastectomy had the lowest risk of death. Black women and Asian/Pacific island women were significantly more likely to receive BCS, although black women were less likely to receive follow-up RT and had a significantly increased risk of death. Racial and age differences in the treatment of DCIS resulted in significantly disparate rates of survival, which should be considered in public health programming. Mastectomy utilization resulted in improved survival, although additional studies may elucidate the interaction of treatment with patient age.     

Gender and geographic influence on the racial disparity in bladder cancer mortality in the US

BACKGROUND: In 2005, there were an estimated 63,210 new cases of bladder cancer and 13,180 related deaths in the US. African Americans reportedly have a lower incidence of bladder cancer, but a higher mortality. The objective of this study was to evaluate the gender and geographic differences in bladder cancer survival between Caucasians and African Americans to better understand the racial disparity in bladder cancer survival. STUDY DESIGN: Surveillance Epidemiology and End Results Program (SEER) data were used to evaluate racial differences in bladder cancer survival from 1973 to 1999. Bivariate and multivariate Cox proportional hazard models were performed to determine the relationship between race and survival, adjusting for cancer stage and grade, marital status, region of country, treatment received, and the interaction between race and region. RESULTS: African Americans were diagnosed with higher grade (p < 0.001) and higher stage (p < 0.001) tumors, compared with Caucasians. In the multivariable model, African-American race was an independent predictor of poor survival, adjusting for age, marital status, region of the country, stage, grade, treatment received, and interaction between race and region. Surprisingly, African Americans diagnosed in the Atlanta metropolitan area had a substantially worse survival. CONCLUSIONS: African Americans were diagnosed with more aggressive and more advanced tumors. Adjusted multivariable models demonstrated a survival advantage for Caucasians, with African-American race being an independent predictor of poor survival, especially when diagnosed in the Atlanta metropolitan area. Racial disparity continues to exist in bladder cancer presentation and survival in the US.