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Cancer patient survival: Surveillance, Epidemiology, and End Results Program, 1973-79.

Data from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute were used in the evaluation of cancer patient survival experience for almost 10% of the U.S. population. This first report contains actuarial (life table) survival analysis on 368,263 patients with first primary cancer diagnosed in 1973-79 from nine SEER areas: the entire States of Connecticut, Iowa, New Mexico, Utah, and Hawaii and the metropolitan areas of Atlanta, Detroit, San Francisco, and Seattle. Both observed and relative survival rates were shown for whites and blacks, sex, age, primary site, and time period (each yr, 1973-78). The largest racial difference in survival was for cancer of the corpus uteri: 87% 5-year relative survival rate for white females versus only 54% for black females. Survival rates varied considerably by primary site. For most sites, as age increased the relative and observed survival rates decreased. Analysis of relative survival rates by ech year of diagnosis, 1973-78, and for each year following diagnosis suggested increasing rates for cancers of the colon, lung, and prostate gland, whereas there were no definite increases for cancers of the female breast and corpus uteri. A dramatic increase in survival from acute lymphocytic leukemia was found for children under 15 years of age, with the 4-year relative survival rate increasing from 51% among those diagnosed in 1973-75 to 65% for those diagnosed in 1976-78.

Adolescent↗

The fall in incidence of prostate carcinoma. On the down side of a prostate specific antigen induced peak in incidence--data from the Utah Cancer Registry.

BACKGROUND: In the 1980s, prostate specific antigen (PSA) came into wide use as a prostate carcinoma screening and detection method in the United States. Following the introduction of PSA, the age-adjusted incidence of prostate carcinoma reported by the Surveillance, Epidemiology, and End Results (SEER) program in the United States rose rapidly (from 84.4/100,000 in 1984 to 163/100,000 in 1991). When an increase in incidence is observed following the introduction of a screening method, a subsequent decrease in incidence may be expected as prevalent cases are removed from the population (a cull effect). Incidence rates may also fall due to factors such as decreased intensity of screening. The Utah Cancer Registry data were examined for a decrease in prostate cancer incidence. METHODS: We tracked age-adjusted prostate carcinoma incidence trends from the population-based Utah Cancer Registry and compared them with rates from the SEER national registry. RESULTS: A rapid and highly correlated rise in prostate carcinoma incidence has been observed in both SEER and Utah incidence rates between 1988 and 1991, the last year for which SEER data are available. In 1992, Utah incidence rates peaked at 236.2 per 100,000. In 1993 and 1994, Utah incidence rates fell to 195.0, and an estimated 164.0 per 100,000, respectively. CONCLUSIONS: Population-based data from the Utah Cancer Registry indicates that the incidence of prostate carcinoma is decreasing rapidly after a similarly rapid increase.

Age Factors↗

Patterns of care for women with ovarian cancer in the United States.

PURPOSE: To characterize treatments for ovarian cancer, to determine if recommended staging and treatment were provided, and to determine factors that influence receipt of recommended staging and treatment. METHODS: A total of 785 women diagnosed with ovarian cancer in 1991 were selected from the National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER) program. Type and receipt of recommended staging and treatment were examined using data on surgery and physician-verified chemotherapy. RESULTS: Most women with presumptive stage I and II ovarian cancer were treated with surgery alone (58%), while women with stage III or IV disease were treated with surgery plus platinum-based chemotherapy (75% stage III, 56% stage IV). Approximately 10% of women with presumptive stage I and II, 71% with stage III, and 53% with stage IV disease received recommended staging and treatment. The absence of lymphadenectomy and assignment of histologic grade were the primary reasons women with presumptive stage I and II cancer did not receive recommended staging and treatment, whereas for stages III and IV, it was due to older women not receiving surgery plus platinum-based adjuvant chemotherapy. Age, stage, comorbidity, "other" race/ethnicity, and treatment at a facility with an approved residency training program were associated with whether recommended staging and therapy were received. CONCLUSION: Older women with late-stage disease did not receive recommended treatment. The majority of women with early-stage disease did not receive recommended staging and treatment.

Adolescent↗

Thyroid cancer: is the incidence still increasing?

BACKGROUND: The objective of this study was to define the epidemiology of thyroid cancer in our regional population and compare results with Surveillance, Epidemiology, and End RESULTS (SEER) Program cancer registry trends. METHODS: Thyroid cancer cases diagnosed between 1990 and 2000 were identified in the Florida Cancer Data System (FCDS). Overall, gender-specific, age-specific, and stage-specific incidence rates were calculated. All rates are per 100,000 and age-adjusted to the 2000 U.S. standard population. Estimated Annual Percent Change (EAPC) was calculated with a linear least-squares model. RESULTS: Patients with thyroid cancer (n = 8603) were identified in the FCDS registry. Age-adjusted incidence rates increased from 4.2 per 100,000 to 7 per 100,000 in 2000. The EAPC for this period was 5.5% (P < .001). The SEER incidence rates increased from 7.9 to 10.2 per 100,000, and the EAPC was 3.7% (P < .05). Analysis of gender-specific incidence rates showed increases from 6 and 2.2 per 100,000 in 1990 to 10.1 and 3.8 per 100,000 in 2000 among females and males, respectively, with EAPCs of 5.9% (females) and 4.5% (males) (P < .001). With stratification by age group, the highest incidence rates were 9 per 100,000 in the group aged 65 to 84 years and 8.4 per 100,000 in the group aged 45 to 64 years. CONCLUSIONS: Thyroid cancer incidence rates in Florida almost doubled over the 1990-2000 period and are concordant with SEER trends. Etiologic studies addressing temporal changes in reproductive factors, more intensive diagnostic activities, and changes in histological criteria are warranted.

Adolescent↗

Incidence of testicular cancer in the United States: has the epidemic begun to abate?

In response to a report that testicular cancer incidence in non-Hispanic White males in Los Angeles county had fallen in the 1990s, particularly in young men, the authors analyzed data collected by the Surveillance, Epidemiology, and End Results (SEER) program from 1973 to 1995. While the incidence rate of testicular cancer in US White males ages 15-64 years did stabilize in the first half of the 1990s, after a number of years of a steady increase, there was no indication of an actual decline.

Adolescent↗

Increasing incidence of thyroid cancer in the United States, 1973-2002.

CONTEXT: Increasing cancer incidence is typically interpreted as an increase in the true occurrence of disease but may also reflect changing pathological criteria or increased diagnostic scrutiny. Changes in the diagnostic approach to thyroid nodules may have resulted in an increase in the apparent incidence of thyroid cancer. OBJECTIVE: To examine trends in thyroid cancer incidence, histology, size distribution, and mortality in the United States. METHODS: Retrospective cohort evaluation of patients with thyroid cancer, 1973-2002, using the Surveillance, Epidemiology, and End Results (SEER) program and data on thyroid cancer mortality from the National Vital Statistics System. MAIN OUTCOME MEASURES: Thyroid cancer incidence, histology, size distribution, and mortality. RESULTS: The incidence of thyroid cancer increased from 3.6 per 100,000 in 1973 to 8.7 per 100,000 in 2002-a 2.4-fold increase (95% confidence interval [CI], 2.2-2.6; P<.001 for trend). There was no significant change in the incidence of the less common histological types: follicular, medullary, and anaplastic (P>.20 for trend). Virtually the entire increase is attributable to an increase in incidence of papillary thyroid cancer, which increased from 2.7 to 7.7 per 100,000-a 2.9-fold increase (95% CI, 2.6-3.2; P<.001 for trend). Between 1988 (the first year SEER collected data on tumor size) and 2002, 49% (95% CI, 47%-51%) of the increase consisted of cancers measuring 1 cm or smaller; 87% (95% CI, 85%-89%) consisted of cancers measuring 2 cm or smaller. Mortality from thyroid cancer was stable between 1973 and 2002 (approximately 0.5 deaths per 100,000). CONCLUSIONS: The increasing incidence of thyroid cancer in the United States is predominantly due to the increased detection of small papillary cancers. These trends, combined with the known existence of a substantial reservoir of subclinical cancer and stable overall mortality, suggest that increasing incidence reflects increased detection of subclinical disease, not an increase in the true occurrence of thyroid cancer.

Adenocarcinoma, Follicular↗

Cumulative cause-specific mortality for cancer patients in the presence of other causes: a crude analogue of relative survival.

A common population-based cancer progress measure for net survival (survival in the absence of other causes) of cancer patients is relative survival. Relative survival is defined as the ratio of a population of observed survivors in a cohort of cancer patients to the proportion of expected survivors in a comparable set of cancer-free individuals in the general public, thus giving a measure of excess mortality due to cancer. Relative survival was originally designed to address the question of whether or not there is evidence that patients have been cured. It has proven to be a useful survival measure in several areas, including the evaluation of cancer control efforts and the application of cure models. However, it is not representative of the actual survival patterns observed in a cohort of cancer patients. This paper suggests a measure for cumulative crude (in the presence of other causes) cause-specific probability of death for a population diagnosed with cancer. The measure does not use cause of death information which can be unreliable for population cancer registries. Point estimates and variances are derived for crude cause-specific probability of death using relative survival instead of cause of death information. Examples are given for men diagnosed with localized prostate cancer over the age of 70 and women diagnosed with regional breast cancer using Surveillance, Epidemiology and End Results (SEER) Program data. The examples emphasize the differences in crude and net mortality measures and suggest areas where a crude measure is more informative. Estimates of this type are especially important for older patients as new screening modalities detect cancers earlier and choice of treatment or even 'watchful waiting' become viable options. Published in 2000 by John Wiley & Sons, Ltd.

Aged↗

Breast cancer stage at time of detection in women with systemic lupus erythematosus.

Mounting evidence suggests an increased cancer risk in several autoimmune diseases, including systemic lupus erythematosus (SLE). However, greater scrutiny for cancer in subjects with chronic disease (compared to the general population) might explain this apparent association. If so, one would expect cancers in SLE to be diagnosed at earlier stages than in the general population. This might be particularly evident in cancers where screening is available, such as breast cancer. We linked the University of Pittsburgh lupus cohort with the Pennsylvania Cancer Registry to determine the frequency distribution for stage at diagnosis of invasive breast cancers in the SLE subjects. Data on staging of cancers occurring in the general population of Pennsylvania were obtained from The US Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute. A lower percentage of women with SLE presented with localized breast cancer (nine of the 16, 56.2%) compared to the general population of women (63.5%). Although not definitive, this evidence suggests that cancers in SLE are not necessarily diagnosed at earlier stages than in the general population.

Adult↗

Bone cancers.

BACKGROUND: Frequency distribution data for primary bone sarcomas have long been used to provide clues to the diagnosis of bone cancers after their identification in radiographs. Age and skeletal site are often helpful, in addition to specific radiographic features, in narrowing down the probable histologic categories of bone neoplasms before biopsy. METHODS: Data on 2627 histologically confirmed primary malignant tumors of bone, as collected by the SEER program during the period 1973-1987, were analyzed by age, sex, race, and anatomical site. RESULTS: Osteosarcoma was the most frequently diagnosed primary sarcoma of bone (35.1%), followed by chondrosarcoma (25.8%), Ewing's sarcoma (16.0%), chordoma (8.4%), and malignant fibrous histiocytoma, including fibrosarcoma (5.6%). The most frequently diagnosed sarcoma of bone in persons younger than age 20 was osteosarcoma, followed by Ewing's sarcoma. Chondrosarcoma was the most frequently diagnosed bone tumor in the population older than age 50. The overall 5-year relative survival rates were as follows: osteosarcoma, 41.0%; chondrosarcoma, 72.7%; Ewing's sarcoma, 41.2%; chordoma, 63.8%; and malignant fibrous histiocytoma, 42.9%. There was an improvement in the survival rates during the period 1973-1987 for patients with chordoma and for white female patients with Ewing's sarcoma. Ewing's sarcoma and chordoma occurred almost exclusively in the white population. CONCLUSIONS: SEER data provide a unique opportunity to evaluate the incidence and survival rates of bone sarcomas, which are uncommon but highly lethal tumors. The findings from this analysis provide information useful in the diagnosis of these cancers.

Adolescent↗

Alaska Native cancer update: incidence rates 1989-1993.

Five-year average annual age-adjusted cancer incidence rates for Alaska Natives (Eskimos, Indians, and Aleuts) for the most recent period (1989-1993) are compared to rates of 20 years earlier. Rates for all cancers combined increased 28 and 25% in men and women, respectively, during the 25-year interval. Increases were seen in men in cancers of the lung, prostate, and colon and in women for cancers of the lung, breast, and corpus uteri. Rates are also compared to data from the the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program for United States whites. Rates for all cancers combined in Alaska Native women are now similar to those of United States whites, whereas rates in Alaska Native men are lower than the United States, but only 10% lower. Significant site-specific differences previously reported between Alaska Natives and United States whites persist.

Alaska↗

Merkel cell carcinoma and melanoma: etiological similarities and differences.

Merkel cell carcinoma (MCC) of the skin and cutaneous malignant melanoma can now be compared epidemiologically through the use of population-based data not previously available for MCC. The results may provide new clues to etiology. In this study, United States data covered by the Surveillance, Epidemiology, and End Results (SEER) Program were from nine areas of the United States (approximately 10% of the population). In 1986-1994, 425 cases of MCC were registered. The annual age-adjusted incidence per 100,000 of MCC was 0.23 for whites and 0.01 for blacks; among whites, the ratio of melanoma to MCC was approximately 65 to 1. Only 5% of MCC occurred before age 50, unlike the lifelong risk of nodular and superficial spreading melanoma. Regional incidence rates of both cancers increased similarly with increasing sun exposure as measured by the UVB solar index. The most sun-exposed anatomical site, the face, was the location of 36% of MCC but only 14% of melanoma. Both cancers increased in frequency and aggressiveness after immunosuppression and organ transplantation (36 cases from the Cincinnati Transplant Tumor registry and 12 from published case reports) and after B-cell neoplasia (5 cases in this study; 13 from case series in the literature). The SEER data contained reports of six patients with both types of cancer; 5 melanomas before the diagnosis of MCC and 1 after diagnosis. MCC and melanoma are similarly related to sun exposure and immunosuppression, but they differ markedly from one another in their distributions by age, race, and anatomical site, especially the face.

Age Factors↗

Partitioned prostate cancer prevalence estimates: an informative measure of the disease burden.

STUDY OBJECTIVES: Public health burden of disease is often measured using prevalence statistics. Prevalence of invasive prostate cancer in the United States is presented according to age at diagnosis, time from diagnosis, geographical area, and two races (white and black). DESIGN: Invasive prostate cancer data from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute is used for obtaining prevalence estimates. MAIN RESULTS: Despite falling prostate cancer incidence rates, the prevalence of this disease continues to rise for both white and black men. Black men diagnosed at ages 60 years and older experience lower levels of prevalence of prostate cancer than white men because of poorer survival and a smaller proportion of black men living to older ages where the disease becomes common. Black men require fewer years of follow up than white men to capture over 99% of prevalent cases (that is, 14 years versus 16 years, respectively). Prevalence estimates in the United States are traditionally based on Connecticut data. On 1 January 1997, United States prostate cancer prevalence estimates based on Connecticut are overestimated for white men and underestimated for black men. CONCLUSIONS: Partitioned prevalence estimates may provide a more meaningful and informative measure of the disease burden than conventional prevalence estimates. Prostate cancer prevalence estimates based on SEER rather than Connecticut data are better representative of the United States.

Adolescent↗

Community-based use of chemotherapy and hormonal therapy for early-stage breast cancer: 1987-2000.

PURPOSE: We describe trends in the use of chemotherapy and hormonal therapy by nodal and estrogen receptor (ER) status in women with early-stage breast cancer. METHODS: Cases were randomly sampled from the population-based Surveillance, Epidemiology and End Results (SEER) program and physician verified treatment was examined. A total of 9,481 women, aged 20 years and older, diagnosed with early-stage breast cancer in 1987 to 1991, 1995, and 2000 were included in the study. RESULTS: The use of chemotherapy plus tamoxifen increased between 1995 and 2000 for women with node-negative, ER-positive breast cancer > or = 1 cm (8% to 21%). Nearly 23% of women with node-negative and ER-positive tumors > or = 1 cm received no adjuvant therapy. The use of chemotherapy alone increased to nearly 60% in women with node-negative, ER-negative tumors > or = 1 cm (48% to 59%). However, in 2000, 16% of women with node-positive and ER-negative tumors received no adjuvant therapy and an additional 6% received tamoxifen alone. The influence of age can clearly be seen. Chemotherapy is given much less often in women 70 years or older. CONCLUSION: The results from SEER areas across the United States suggest that physicians quickly responded to publications and guidelines regarding breast cancer therapy. The lack of definitive findings from clinical trials on the use of adjuvant therapy in women 70 years and older may explain the lower use in this group of women.

Adult↗

Evaluation of African-American and white racial classification in a surveillance, epidemiology, and end results cancer registry.

OBJECTIVES: This study evaluated the validity of registry-reported race for individuals who participated in research studies conducted since 1980 through the Metropolitan Detroit Cancer Surveillance System (MDCSS), a Surveillance, Epidemiology, and End Results (SEER) Program registry. METHODS: 5329 individuals who self-identified as African American or White and were classified in the MDCSS registry as African American or White were included. Self-identified and registry-reported race were compared, and associations between demographics and racial misclassification were examined. RESULTS: Most self-identified African Americans and Whites were correctly classified (sensitivity=98.5%, specificity=99.7%). Males were two times more likely to be misclassified than females [odds ratio (OR)=2.13, 95% confidence interval (CI): 1.06-4.29]. Individuals diagnosed with cancer after 1990 were two times more likely to be misclassified than those diagnosed before 1990 (OR= 2.17, 95% CI: 1.07-4.42). African Americans were four times more likely to be misclassified than Whites (OR=4.39, 95% CI: 2.24-8.60). CONCLUSIONS: Misclassification in the MDCSS registry of African Americans as Whites, and vice versa, is relatively low. Additional studies should evaluate misclassification of African Americans and Whites as other races and/or ethnicities in the SEER registry.

Black or African American↗

Cancers of the salivary gland: workplace risks among women and men.

PURPOSE: The purpose of this study was to assess the risk of salivary gland cancers associated with diverse occupations and industries. METHODS: A population-based case referent study utilized data obtained from a SEER program cancer registry for cases and by telephone interview for cases and referents to evaluate workplace risks of salivary gland cancer for black and white women and men. RESULTS: Significantly elevated odds ratios were observed among women employed as hairdressers and those working in beauty shops. CONCLUSIONS: The risk of salivary gland cancer is elevated among women employed as hairdressers. Further research should assess dyes, sprays, and other inhaled chemicals that may be acting as carcinogens.

Adult↗

Survival of lymph node-negative breast cancer patients in relation to number of lymph nodes examined.

OBJECTIVE: To assess the relationship between number of lymph nodes examined and survival of patients diagnosed with node-negative localized breast cancer using a large sample of patients from population-based cancer registries in the United States. SUMMARY BACKGROUND DATA: Conflicting results have been reported from studies on the relationship between number of lymph nodes examined and survival of patients diagnosed with node-negative localized breast cancer. METHODS: The study included 69,543 patients diagnosed in 1988-97 with localized invasive node-negative breast cancer reported to nine population-based registries in the U.S. National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) Program of population-based cancer registries. Hazard ratios for groups defined by number of nodes examined were analyzed in Cox proportional hazards regression models that included age, tumor size and grade, race/ethnicity, and other variables. RESULTS: A significantly higher risk of death from breast cancer was found among patients with 0, 1 to 3, or 4 to 10 nodes examined than with 20-plus nodes examined, even among patients with tumors 2 cm or smaller. CONCLUSIONS: Future studies of survival of node-negative patients, by number of nodes examined, should include information on comorbidity and treatment.

Adult↗

Trends in late-stage breast, cervical and colorectal cancers in blacks and whites.

OBJECTIVE: This study examined the black-white disparities in diagnosis of late-stage breast, cervical, and colorectal cancers, which could change over time, especially in view of changes in the health-care system. METHODS: Recent trends (1988-95) in stage distribution were examined by age group (<65 and 65+ years) for the geographic areas covered by the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) Program. RESULTS: Proportions of breast and cervical (but not colorectal) cancers that were late-stage declined in both races and black-white disparities had narrowed by 1995, especially for patients diagnosed at age 65 years or older. The proportion of breast and cervical cancers that were late stage declined for blacks in counties with a black poverty rate of 20% or higher. CONCLUSIONS: Some progress toward black-white equity in stage at diagnosis was evident, consistent with reported trends in use of screening tests, but further surveillance and research are needed.

Adolescent↗

Childhood cancer in Louisiana 1988-1996.

Utilizing data from the Louisiana Tumor Registry, cancer incidence among children younger than 15 years of age is presented by major cancer type, according to the primarily histology-based International Classification of Childhood Cancer scheme. Cases include those diagnosed and/or treated at any hospitals and medical facilities in Louisiana, St. Jude Children's Research Hospital in Memphis, M.D. Anderson in Houston, and from neighboring states. Rates were age-adjusted, presented as rates per million, and were compared to the combined rates of the Surveillance, Epidemiology, and End Results (SEER) Program. The significance of rate differences were assessed at 0.05 level. From 1988-1996, about 125 children were diagnosed with cancer each year. In general, rates are higher in younger than older children, males than females, and white children than African-American children. The five most common childhood cancers are: leukemias (28% of total cases), central nervous system malignancies (22%), lymphomas (13%), renal tumors (8.4%), and soft tissue sarcomas (7.6%). Major findings of these cancers and their associated risk factors are presented.

Adolescent↗