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PubMed1995

Leukemias, myeloma, and other lymphoreticular neoplasms.

BACKGROUND: The purpose of this study was to assess the occurrence of various morphologic types of leukemia and myeloma within patient demographic groups and to correlate findings with data-reporting periods and other variables, such as 5-year relative survival. METHODS: Data from 31,850 cases of multiple subgroups of acute and chronic leukemia, 12,237 cases of myeloma, and 321 cases of "other" lymphoreticular neoplasms were collected by the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program. The data were examined by age, sex, race, age-specific and age-adjusted incidence rate, and patient 5-year relative survival during three reporting periods: 1973-1977, 1978-1982, and 1983-1987. RESULTS: The age-adjusted incidence rate for all categories of leukemia combined has been constant, but there has been an increase in the relative frequency (percentage) of acute lymphoid leukemia (ALL) in the general population and a rising incidence rate of myeloid leukemia in the black population. The increase of ALL is offset by a decline of acute myeloid leukemias (AMLs) and acute leukemia, not otherwise specified. The age-adjusted rate of ALL in whites, 1.5 per 100,000 per year, is twice that of blacks, 0.8. The rates for each of the major categories of leukemia are considerably higher in males than in females. Five-year survival rates changed very little for leukemias over the 15 years of the study except for ALL, in which there was a marked improvement between the first (1973-1977) (39.1%) and second (1978-1982) (51.3%) reporting period. The SEER data confirm that multiple myeloma is predominantly a disease of late adulthood and occurs more frequently in blacks and males. The incidence rate of multiple myeloma has not changed during the 15 years surveyed. The 5-year relative survival rate has remained nearly constant for multiple myeloma. There is a marked difference in 5-year relative survival rates for patients with plasmacytoma of bone marrow (45.7%), multiple myeloma (25.9%), and plasma cell leukemia (13.0%). CONCLUSIONS: Shifts in the relative frequencies of leukemia types may have been affected by changes in classification criteria, changes in the use of histologic terms over time, and the expanded use of immunophenotyping and other technology to characterize acute leukemias. Incidence rates and 5-year relative survival rates for myeloma have remained stable.

Adolescent↗
PubMed2005

Population characteristics in cervical cancer trials: search for external validity.

OBJECTIVE: The purpose of this study was to compare the characteristics of patients with cervical cancer who were enrolled in cooperative group trials with characteristics of the cervical cancer population of the United States and to determine the generalizability of the results of those trials to the disease population in the United States. STUDY DESIGN: Phase III trials in cervical cancer that were conducted by cooperative groups in the United States from 1981 through 1997 were identified. These groups were placed into 4 categories on the basis of disease stage and primary treatment modality: Stage IB, negative pelvic nodes that were treated with radical hysterectomy (n = 277 patients); Stage IB-IIA, positive pelvic nodes that were treated with radical hysterectomy (n = 239 patients); Stage IB 2 , negative pelvic and para-aortic nodes that were treated with radiation therapy (n = 369 patients); and Stage IIB-IVA, negative para-aortic nodes that were treated with radiation therapy (n = 1190 patients). For each category, comparable patients from the Surveillance, Epidemiology, and End Results (SEER) database were identified. The age and ethnic distributions of each study population and the distributions of the SEER program were compared. RESULTS: The age distributions were equivalent, except for patients with IB 2 disease that was treated with radiation therapy where cooperative group subjects were more likely to be younger than 50 years, (odds ratio, 0.17; 95% CI, 0.11-0.26). A statistically significant higher proportion of black and Hispanic women enrolled in cooperative group studies in comparison with surveillance, epidemiology, and end results. CONCLUSION: Hispanic and black women were recruited proportionately to cooperative group randomized cervical cancer trials in comparison to the United States population. The age distribution of the clinical trial population is also comparable to that of the general population.

Adult↗
PubMed2002

Oral cavity and pharynx cancer incidence rates in the United States, 1975-1998.

To identify subgroups of oral cavity and pharynx (OCP) cancers that may be etiologically distinct, we evaluated age-adjusted incidence rates by histologic type, anatomical site, race, and sex using cases diagnosed during 1975-1998 in nine US Surveillance, Epidemiology, and End Results (SEER) program registries. Male/female rate ratios were about one for adenocarcinoma (AC), three or more for squamous cell carcinoma (SCC), and undetermined for Kaposi's sarcoma (KS). Among males, black/white rate ratios exceeded two for cancers of the palate, tonsil, oropharynx, and pyriform sinus, and were less than one only for lip and salivary gland cancers. Among females, rates by race were similar for all oral sites except lip, but rates for each of the pharynx subsites were higher among blacks. Findings suggest that OCP cancers may be separated into SCC of the lip, SCC of the oral cavity, SCC of the pharynx, AC, and KS.

Adenocarcinoma↗
PubMed1998

Asymptomatic incidence and duration of prostate cancer.

Prostate cancer is known as a disease with an extremely high prevalence relative to its clinical incidence in the population. The combination of preclinical incidence and duration that could yield this phenomenon is of tremendous interest to researchers trying to understand the natural history of the disease and to develop efficient screening strategies. In this article, the authors present estimates of the age-specific asymptomatic incidence and average preclinical duration of prostate cancer. The methodological approach is to first estimate the age-specific incidence of new (stage AI) prostate cancers using preclinical prevalence data from autopsy studies performed between 1941 and 1964 and clinical incidence data for the years 1960-1986 from the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute. Then, the preclinical prevalence estimates are divided by the derived preclinical incidence estimates to yield estimates of the average duration of asymptomatic disease. The estimated mean duration among white men is between 11 and 12 years and appears to be approximately 1 year shorter for blacks than for whites. Comparison of the lifetime risks of preclinical and clinical disease suggests that approximately 75% of prostate cancers will never become diagnosed if clinical incidence remains at levels observed in 1984-1986, prior to the introduction of prostate-specific antigen (PSA) screening in the population.

Adult↗
PubMed1997

An analysis of 8305 cases of carcinoid tumors.

BACKGROUND: Carcinoid tumors are unusual and most reports are anecdotal or limited in number. A series of 2837 cases was published in 1975. No recent large series is available. METHODS: The authors evaluated 5468 cases identified by the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute (NCI) from 1973 to 1991 together with 2837 carcinoid cases previously registered by 2 earlier NCI programs. To the authors' knowledge, the 8305 carcinoid tumors analyzed represent the largest current epidemiology series to date. RESULTS: The most frequent sites for carcinoids were the gastrointestinal (GI) tract (73.7%) and the bronchopulmonary system (25.1%). Within the GI tract, most occurred in the small bowel (28.7%), appendix (18.9%), and rectum (12.6%). For all sites, age-adjusted incidence rates were highest in African American males (2.12 per 100,000 population per year). Associated noncarcinoid tumors were frequent in conjunction with small intestinal (16.6%), appendiceal (14.6%), and colonic carcinoids (13.1%). The highest percentage of nonlocalized lesions were noted for pancreatic (76.1%), colonic (71.2%), and small intestinal carcinoids (70.7%) and this corresponded to their poor 5-year survival rates (34.1%, 41.6%, and 55.4%, respectively). The best 5-year survival rates were recorded for appendiceal (85.9%), bronchopulmonary (76.6%), and rectal carcinoids (72.2%). These exhibited invasive growth or metastatic spread in only 35.4%, 27.2%, and 14.2% of cases, respectively. CONCLUSIONS: Carcinoids appear to have increased in incidence in the past 20 years. In part, this may be due to different surgical rules of the various registries, improved diagnostic technology, and increased awareness. A cumulative analysis of all types of carcinoid tumors in the SEER group indicates that in 45.3% metastases are already evident at the time of diagnosis. The overall 5-year survival rate of all carcinoid tumors regardless of site was 50.4% +/- 6.4%.

Black or African American↗
PubMed2004

Childhood leukaemia incidence and the population mixing hypothesis in US SEER data.

We evaluated the infectious aetiology hypothesis of childhood leukaemia that rapid population influx into rural areas is associated with increased risk. Using data from the US SEER program, we found that in changes in rural county population sizes from 1980 to 1989 were associated with incidence rates for childhood acute lymphocytic leukaemia (ALL). The observed associations were strongest among children 0-4 years of age, born in the same state as diagnosis, in extremely rural counties, and when counties adjacent to nonrural counties were excluded. Similar analyses for brain and central nervous system (CNS) cancer in children, a disease less linked to this infectious hypothesis, provide evidence against methodologic bias. Similar evaluations for other decades were not meaningful due to limited sample sizes and, perhaps, increased population mobility.

Adolescent↗
PubMed2005

Tongue and tonsil carcinoma: increasing trends in the U.S. population ages 20-44 years.

BACKGROUND: An increasing incidence of oral carcinoma among young adults has been reported in the U.S. and Europe. Although the association between human papillomavirus infection and tonsillar carcinoma is now well established, to the authors' knowledge little is known about incidence trends in tonsillar carcinoma among younger adults. The objective of the current study was to explore the trends in both oral cavity and pharyngeal squamous cell carcinoma (SCC) in younger U.S. populations, in particular tongue and tonsillar SCC. METHODS: Using the 1973-2001 Surveillance, Epidemiology and End Results (SEER) database, we computed age, race, and site-specific trends of oral and pharyngeal (excluding nasopharynx) carcinoma incidence rates. The percent change (PC) and annual percent change (APC) were computed to explore trends in incidence rates over time. RESULTS: There were 2262 SCC of the oral cavity and 1251 SCC of the pharynx reported to the SEER program from 1973 to 2001 in adults aged 20-44 years. There was a statistically significant increase in the incidence of oral tongue SCC (APC = +2.1; P < 0.001), base of tongue SCC (APC = +1.7; P = 0.04), and palatine tonsil SCC (APC = +3.9; P < 0.001) among younger white individuals, whereas the incidence of SCC in all other oral and pharyngeal sites decreased or remained constant. CONCLUSIONS: The increase in tonsil SCC incidence from 1973 to 2001 paralleled the increase in tongue SCC, whereas SCC in all other oral and pharyngeal sites remained constant or decreased. This may suggest similar etiologic factors for SCC affecting the palatine tonsils and tongue in younger populations.

Adult↗
PubMed1996

The impact of stage and histology on the long-term clinical course of 163,808 patients with breast carcinoma.

BACKGROUND: Stage and histologic type have a significant impact on the long term clinical course of breast carcinoma. Clinical course is governed by two components: likelihood of cure and medial tumor-related survival time among uncured patients. Estimates of these components can be derived only by using survival models that incorporate cured fraction as a specific parameter. METHODS: The prognostic value of stage and histologic type was determined for 163,808 patients with breast carcinoma using the log normal and log logit cure-based survival models. Follow-up ranged from 1 month to 19 years and was obtained from the SEER Program. RESULTS: In approximate terms, ductal carcinoma was diagnosed in 70% of the patients, with estimate cured fractions of 2/3 and 1/3 for local and regional disease, respectively. Estimates of medial survival times for uncured patients were 10 and 5 years. Findings were similar for patients with tumor of miscellaneous histologic types. For patients with medullary carcinoma were 82% and 50%, with median survival times of 6 and 4 years. For patients with mucinous, lobular, and ductolobular carcinomas, parametric analysis gave inconsistent estimates of cured fraction, but findings suggested unusually long tumor-related survival times. CONCLUSIONS: Cured-based parametric survival models offer valuable insight into the impact of stage and histology on the clinical course of breast cancer.

Breast Neoplasms↗
PubMedDate not supplied

Equal participation of minority patients in U.S. national pediatric cancer clinical trials.

PURPOSE: To determine the ethnic/racial distribution of patients entered in national pediatric cancer clinical trials relative to the patient population served. METHODS: The ethnic/racial distribution of 29,134 patients < 20 years of age entered in clinical trials conducted by the Children's Cancer Group (CCG) and Pediatric Oncology Group (POG) between January 1, 1991 and June 30, 1994 were compared with the expected distribution of patients of the same age in the United States. The latter was predicted from the 1989 to 1991 crude incidence data of the National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER) program applied to the 1990 United States census. RESULTS: Of the patients on CCG and POG trials, 11.6% were reported to be Hispanic, 10.4% were African-American, and 4.7% were other racial groups. The expected values were 9.1%, 10.7% and 4.3%, respectively. Representation of minority patients was equal or greater than expected for 24 of 27 subgroups analyzed. CONCLUSIONS: In the United States, minority children with cancer are proportionately represented on clinical trials of the two national pediatric cancer cooperative groups. They and their families are provided with an equal opportunity to access clinical cancer trials and the potential benefits of cancer research.

Child↗
PubMed2005

Histologic subtypes and laterality of primary epithelial ovarian tumors.

OBJECTIVES: To determine if the likelihood of bilateral primary ovarian tumors differs by histologic subtype. METHODS: Using data collected by the Surveillance Epidemiology and End Results (SEER) program, the analysis included 22,328 women 25-84 years of age who were diagnosed with a borderline or malignant epithelial ovarian tumor during 1992-2000, categorized as to laterality and histologic subtype. RESULTS: Malignant serous tumors were bilateral in 57.5% of cases. Corresponding figures for mucinous, clear cell, endometrioid and other epithelial tumors were 21.3%, 13.3%, 26.8%, and 35.6%, respectively. Borderline serous tumors were bilateral in 29.8% of the cases compared to only 7.0% of mucinous tumors. The tendency for serous tumors to present as bilateral was consistent across all categories of race, age, and stage. CONCLUSIONS: Serous tumors of the ovary are more commonly bilateral than ovarian tumors of other histologic subtypes. The reasons for this tendency remain to be determined.

Adult↗
PubMed2002

Black-white differences in tumor grade (aggressiveness) at diagnosis of prostate cancer, 1992-1998.

OBJECTIVES: To compare recent temporal trends in the proportion of high-grade (less differentiated, or more "aggressive") prostate cancers for Blacks (African Americans) and Whites. Reports of Black-White differences have generated speculation that genetic factors could be involved. METHODS: The study included all 126,889 non-Hispanic White and 20,247 Black patients with prostate cancer diagnosed in 1992-1998 and reported to the US National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) Program of population-based cancer registries. RESULTS: Overall and stage-specific Black-White differences in proportion of high-grade cancers were not large and declined over time (especially among elderly patients). By 1998, the adjusted odds ratio for high (vs other known) grade was not statistically significant for Black vs White elderly patients when age and stage at diagnosis were included in a multiple logistic regression model. CONCLUSIONS: These data provide little justification for speculation about a genetic basis for a higher proportion of aggressive prostate cancer among Black patients. Trends in Black-White differences in the frequency of high-grade cancer suggest Black-White differences in trends in prostate cancer screening rates (especially in the elderly), which require further investigation.

Black or African American↗
PubMed2006

Epidemiology of head and neck cancer in the United States.

BACKGROUND: Cancer rates of the head and neck are traditionally linked to public health issues. OBJECTIVE: To describe the epidemiology of head and neck cancer in the United States. DESIGN AND SETTING: National Cancer Institute's Surveillance Epidemiology and End Results (SEER) program. RESULTS: A total of 75,000 cases of head and neck cancer were diagnosed in 2001. Incidence is rising in thyroid (up 52%), bone (43%) soft tissues (20%), salivary (20%), tongue (16%), tonsil (12%), and nose (12%). Incidence is falling in lip (down 58%), hypopharynx (35%), cervical esophagus (32%), oropharyngeal mucosa (26%), and larynx (26%). There were 30,000 deaths from head and neck cancer in 2001. Mortality has decreased to some degree at all sites except thyroid where it was stable. CONCLUSION: Many head and neck cancers have changing incidence and mortality rates contrary to expected changes given trends in public health issues. Further investigation of risk factors, diagnostic practices, and management strategies is warranted. EBM RATING: 2C.

Bone Neoplasms↗
PubMed2002

Risk of subsequent cancer following breast cancer in men.

The etiology of breast cancer in men is not well understood. We assessed the risk of subsequent cancers among all 1788 men diagnosed with a first primary breast cancer from 1973 through 1996 who were registered with the Surveillance, Epidemiology, and End Results (SEER) Program. Although the overall subsequent cancer risk in men was not increased (standardized incidence ratio [SIR] = 0.99, 95% confidence interval [CI] = 0.86 to 1.1), the risk of contralateral second breast cancer was strongly elevated (12 cases; SIR = 30, 95% CI = 15 to 52). The risk was higher for men diagnosed with their first breast cancer before age 50 years than for older men. There were no major differences in the risk of contralateral breast cancer associated with different treatments received for the first breast cancer. The relative risk of second breast cancer was substantially higher among men than among women with breast cancer, but the absolute excess risk was lower. We conclude that men diagnosed with breast cancer are at high risk of contralateral breast cancer.

Aged↗
PubMed2002

5- and 10-year survival in cancer patients aged 90 and older: a study of 37,318 patients from SEER.

BACKGROUND AND OBJECTIVES: Uncertainty exists about the value of cancer therapy in patients aged 90 years and older. Because of the relative paucity of these patients, as well as the possibility of selection bias in any one institution, the use of a large, total population-based cancer registry was employed. METHODS: The Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute (NCI) offers a large, total population-based cancer registry. It includes more than 2,000,000 cases in the nine registry data from 1973 to 1998; 37,318 of these are 90 or older and are eligible for follow-up studies. A cross-sectional study of relative survival of all these cases, along with younger age groups for comparison, was carried out. RESULTS: After the first year after diagnosis, the annual relative survival is not affected by a patient's age for up to 10 years. CONCLUSIONS: Age alone is not a contraindication to cancer treatment in the most elderly and, other than in the first year, one can expect the same relative survival in these oldest patients as one does for younger patients.

Aged↗
PubMed2005

Recent trends in incidence rates for selected alcohol-related cancers in the United States.

AIMS: To examine recent trends in incidence rates for cancer types most strongly associated with alcohol use, using data from US cancer registries. METHODS: Age-standardized annual incidence rates (ASIRs) for squamous cell carcinomas of the oral cavity and pharynx, esophagus and larynx diagnosed in the most recent 10-year period (1992-2001) were examined for geographic areas included in the US National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) program of high-quality cancer registries. RESULTS: For all geographic areas combined, ASIRs for these cancers declined over time, with no evidence for a recent plateau or upturn. This also held true for ASIRs in younger adults (age 20-54 years at diagnosis). For white males, declines in ASIRs occurred in each of the 11 geographic areas, and were statistically significant in nine areas. The declines in ASIRs were consistent with temporal declines in apparent alcohol consumption by state, although the prevalence of binge and heavy drinking in adults increased in some states. CONCLUSIONS: Although there was no evidence for a recent plateau in ASIRs, continued surveillance is needed, in view of recent increases in the prevalence of binge and heavy drinking among US adults.

Adult↗
PubMed2003

Survival rates with uveal melanoma in the United States: 1973-1997.

PURPOSE: To determine variations in 5-year relative survival rates with primary uveal melanoma in the United States over a 25-year period from 1973 to 1997. DESIGN: Systematic review of existing databases. PARTICIPANTS: Two thousand four hundred ninety-three patients with primary uveal melanoma, International Classification of Oncology [ICDO-2] codes C69.3 [choroid melanoma] and C69.4 [ciliary body and iris]) derived from Surveillance, Epidemiology, and End Results (SEER) program database in the United States from 1973 to 1997. METHODS: The patients were stratified according to the treatment (surgery or radiotherapy). The relative 5-year survival was calculated for 2054 patients diagnosed between 1973 and 1993 by the life table method using US life expectancy tables. MAIN OUTCOME MEASURES: The relative 5-year survival rate. RESULTS: Surgical treatment was performed in 1476 (72%) cases, and radiotherapy was given in 300 (15%) cases. The proportion of cases treated by radiotherapy increased progressively from 2% to 28% in 20 years. Relative 5-year survival rates ranged from 77% to 84% without a statistically significant variation. CONCLUSIONS: Advances made in the local methods of treatment of primary uveal melanoma have not led to an improvement in survival. Systemic approaches to management of uveal melanoma are warranted.

Adolescent↗
PubMed2003

Rural-urban differences in ductal carcinoma in situ as a proxy for mammography use over time.

CONTEXT: With emphasis on increasing use of mammography, the rate of ductal carcinoma in situ (DCIS) of the breast has increased dramatically in the United States starting in the early 1980s. It is unclear if rural and urban women have experienced similar increases. PURPOSE: To describe differences in incidence of DCIS between rural and urban women 50 to 69 years of age over time. This may be a proxy indicator of mammography use for the early detection of breast cancer. METHODS: The study population consisted of women 50 to 69 years of age who were diagnosed with DCIS during 1973-1997 and resided in Iowa, Utah, or New Mexico. Data from the Surveillance, Epidemiology, and End Results (SEER) programs in these states were used in the analysis. Location of the woman's residence was classified into urban when she lived in a county considered a Metropolitan Statistical Area, while she was considered rural if she resided elsewhere at the time of her diagnosis. FINDINGS: Increases in rates were different between rural (annual percentage change [APC]: 15.1) and urban women (APC: 34.4). During the 1990s among urban women, the rate of DCIS was still increasing (APC: 3.8), while there was no increase among rural women (APC: 0.2). Differences between rural and urban women within these 3 states were also identified. CONCLUSIONS: The data suggest differences in utilization of mammography between both populations; the increase was lower and started later for rural women. Possible reasons for such differences over time are discussed.

Aged↗
PubMed2005

Colorectal cancer among Asians and Pacific Islanders in the U.S.: survival disadvantage for the foreign-born.

BACKGROUND: Asian Americans and Pacific Islanders (AAPI) have better colorectal cancer survival than other racial populations. However, immigrants face challenges that may place them at higher risk for late diagnosis and death. METHODS: To compare survival between the foreign- and U.S.-born, we identified 17,302 AAPI colorectal cancer patients between 1973 and 1998 from the Surveillance, Epidemiology, and End-Results (SEER) Program. Patients were categorized as foreign-born or U.S.-born using multiple imputation methods. RESULTS: Foreign birth was associated with higher risk for death from any cause (hazard ratio [HR] 1.29; 95% CI 1.23-1.36) and with modestly higher risk after adjustment for selected demographic characteristics (HR 1.13; 95% CI 1.05-1.21) and registry site (HR 1.05; 95% CI 0.98-1.14). Although foreign-born AAPI were more likely to present later, additional adjustment for cancer stage reduced but did not eliminate their higher risk of death (HR 1.09; 95% CI 1.01-1.18) CONCLUSIONS: Compared to the U.S.-born, foreign-born AAPI have poorer survival following colorectal cancer diagnosis. Future investigation of the care processes after diagnosis may be important in understanding these differences.

Aged↗