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PubMed2006

Computed tomography screening for lung cancer in Hodgkin's lymphoma survivors: decision analysis and cost-effectiveness analysis.

BACKGROUND: Hodgkin's lymphoma patients have an elevated risk of developing lung cancer and may be targeted for lung cancer screening. We used a decision-analytic model to estimate the potential clinical benefits and cost-effectiveness of computed tomography (CT) screening for lung cancer in Hodgkin's lymphoma survivors. MATERIALS AND METHODS: We developed a Markov decision-analytic model to compare annual low-dose CT screening versus no screening in a hypothetical cohort of patients diagnosed with stage IA-IIB Hodgkin's lymphoma at age 25, with screening starting 5 years after initial diagnosis. We derived model parameters from published studies and the Surveillance, Epidemiology and End Results (SEER) Program, and assumed that stage-shift produces a survival benefit. RESULTS: Annual CT screening increased survival by 0.64 years for smokers and 0.16 years for non-smokers. The corresponding benefits in quality-adjusted survival were 0.58 quality-adjusted life-years (QALYs) for smokers and 0.14 QALYs for non-smokers. The incremental cost-effectiveness ratios for annual CT screening compared with no screening were $34 100/QALY for smokers and $125 400/QALY for non-smokers. CONCLUSIONS: Our analysis suggests that if early promising results for lung cancer screening hold, CT screening for lung cancer may increase survival and quality-adjusted survival among Hodgkin's lymphoma survivors, with a benefit and incremental cost-effectiveness ratio for smokers comparable to that of other recommended cancer screening strategies.

Aged↗
PubMed1995

Brain, other central nervous system, and eye cancer.

BACKGROUND: The Surveillance, Epidemiology, and End Results (SEER) Program provides population-based data for the descriptive epidemiology of cancer incidence and survival rates by age, sex, race, and time period according to site and various histologic categories. METHODS: Relative frequencies, incidence rates, median age at diagnosis, and 5-year relative survival rates were analyzed by histologic type for microscopically confirmed primary malignant tumors of the brain, central nervous system (CNS) (except lymphomas), and eye, as well as olfactory neuroblastomas. RESULTS: Age-specific incidence rates for astrocytoma and glioblastoma, along with those for malignant meningioma, rose with increasing age up to 70-74 years, whereas rates for ependymoma and medulloblastoma (but not oligodendroglioma) showed a peak at age 0-4 years. Age-adjusted incidence rates for astrocytomas and glioblastomas were lower for blacks compared with whites, but there was little difference for rare types of brain/CNS cancers. Age-adjusted incidence rates increased slightly from 1973-1977 to 1983-1987 for astrocytoma, with little change for other histologic types. For cases diagnosed in 1983-1987, 5-year relative survival rates varied by histologic type and were low for astrocytoma, not otherwise specified (32%), and especially low for glioblastoma (4%); there was no evidence for improvement in survival rates for these two types from 1973-1977 to 1983-1987. Age-specific rates for eye melanoma rose with increasing age (especially for males), and age-adjusted rates were higher for whites than for blacks and declined from 1973-1977 to 1983-1987 in whites. Among cases diagnosed in 1983-1987, 5-year relative survival rates were high for melanoma of the eye (79%) and retinoblastoma (96%); only for retinoblastoma was there evidence of improvement in survival rates between 1973-1977 and 1983-1987. CONCLUSIONS: The SEER data are useful in examining the descriptive epidemiologic features, including time trends in incidence and survival rates, for primary cancers of the brain, CNS and eye. The lack of improvement in the low survival rates for some of these cancers emphasizes the remaining therapeutic challenges.

Adolescent↗
PubMed1996

Determinants of survival following the diagnosis of esophageal adenocarcinoma (United States).

The rapidly rising incidence of esophageal adenocarcinomas in the United States and western Europe remains unexplained. Most persons who develop the disease have had long-standing gastroesophageal reflux symptoms with concomitant Barrett's metaplasia. They are, therefore, potentially identifiable for endoscopic screening and cancer surveillance, which should facilitate the early detection of these tumors. We undertook these analyses to determine the extent to which the opportunity for early diagnosis and treatment of esophageal adenocarcinomas has been realized in the US. Specifically, using data from the Surveillance, Epidemiology, and End Results (SEER) program of the US National Cancer Institute, we examined changes in stage of disease at diagnosis and in survival between 1973 and 1991 and investigated patient characteristics as predictors of survival. Improvements in stage at diagnosis and in survival between 1973 and 1991 were minor and clinically insignificant; overall five-year survival never exceeded 10 percent. Stage of disease at diagnosis was the strongest determinant of subsequent survival; five-year survival with patients with in situ tumors was 68.2 percent. This survival advantage persisted up to 15 years after diagnosis and was independent of other prognostic factors. We conclude that the opportunity for reduction in esophageal cancer mortality has been largely unrealized in the US. In light of the increasing incidence of esophageal adenocarcinoma, efforts should be devoted to identifying those at highest risk of developing Barrett's metaplasia and subsequent adenocarcinoma, and to developing cost-effective primary prevention and cancer surveillance methods targetting them.

Adenocarcinoma↗
PubMedDate not supplied

Trends in the use of radical prostatectomy for treatment of prostate cancer.

CONTEXT: The incidence of prostate cancer and rates of radical prostatectomy increased sharply in the Medicare population (men older than 65 years of age) after the introduction of prostate-specific antigen screening in the late 1980s. PRACTICE PATTERN EXAMINED: Trends in age-specific rates of use of radical prostatectomy in U.S. men between 1989 and 1995. DATA SOURCE: The National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program. RESULTS: Overall, rates of radical prostatectomy more than doubled between 1989 and 1992 (from 78 per 100,000 men to 206 per 100,000 men) but decreased by a third between 1992 and 1995 (to 146 per 100,000 men). The pattern in overall radical prostatectomy rates between 1992 and 1995, however, obscures changes that occurred for men in different age groups. Decreases in radical prostatectomy rates were most dramatic in elderly persons, dropping 51% in men 70 to 74 years of age and 71% in men 75 years of age or older. In contrast, rates in younger men continued to increase between 1992 and 1995, rising 42% in men 45 to 49 years of age and 18% in men 50 to 54 years of age. In each age group, trends in surgery rates mirrored trends in cancer detection rates. CONCLUSIONS: Surgical treatment of prostate cancer in older men is decreasing; however, surgery rates are increasing in younger men. These divergent trends reflect the pattern of prostate cancer detection in clinical practice.

Aged↗
PubMed2003

Bilateral synchronous breast cancer: a population-based study of characteristics, method of detection, and survival.

BACKGROUND: The frequency of bilateral synchronous breast cancer (BSBC) is reportedly about 1%-3%, but there is limited information from population-based cancer registries regarding the clinical and prognostic features of these cancers. METHODS: The population-based Connecticut Tumor Registry (CTR), which is part of the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program of registries, was used to identify BSBC (ie, a second cancer diagnosed within 3 months of the first). Information was obtained on the method of detection of BSBC, and clinical characteristics and survival (through 2000) were compared with unilateral cases. RESULTS: Of 15,542 patients reported to the CTR, 300 (1.9%) had BSBC. BSBC was detected most often by mammography of both breasts (35%) or contralateral mammography after a palpable first cancer (18%). Compared to unilateral cases, BSBC patients did not differ in age or stage at diagnosis, but lobular histology was statistically significantly more frequent and use of total mastectomy (vs lesser surgery) was more common. Although length of follow-up was limited, risk of death was statistically, significantly higher among BSBC than unilateral patients. Among BSBC patients, risk of death was higher among those with cancers detected by breast exam/symptoms versus mammography. CONCLUSIONS; While uncommon, BSBCs differ from unilateral cancer in histology and survival, and their study emphasizes the opportunity for detection of contralateral cancers at an early stage.

Adult↗
PubMed2006

Emerging and widening colorectal carcinoma disparities between Blacks and Whites in the United States (1975-2002).

BACKGROUND: Colorectal carcinoma (CRC) is the fourth most common cancer diagnosed and the second most common cause of cancer death in the U.S. Incidence and mortality rates have decreased since the mid-1980s, although more among Whites than Blacks. METHODS: To determine if these racial differences were changing over time, we examined CRC rates in the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program (1975-2002). Rates were stratified by gender, race, anatomic subsite, historic stage, and grade. RESULTS: CRC rates were higher among men than women and higher among Blacks than Whites, with Black men having the highest rates during the latter years. Prior to the mid-1980s, male CRC rates were actually higher among Whites than Blacks; after which there was ethnic crossover with Black rates higher than White rates, and the gaps are widening. Proximal and transverse CRCs were more common and rectal cancers were less common among Blacks than Whites. Over time, rates for localized and regional stages increased among Blacks and decreased among Whites. Rates for distant stages declined for both racial groups, although less among Blacks. Black-to-White rate ratio for distant stage was approximately 1.30. Notably, Blacks compared with Whites had lower grade tumors, despite higher stages and mortality rates. CONCLUSIONS: CRC racial disparities have emerged and widened for three decades. These temporal trends probably reflect complicated racial differences between screening practice patterns and etiologic factors.

Adult↗
PubMed2003

Malignant carcinoids in the USA, SEER 1992-1999. An epidemiological study with 6830 cases.

Most of our knowledge on the epidemiology of carcinoid tumours in the USA relies on studies updated during the 1980s. The aim of this study was to describe USA population-based case-series incidence in the period 1992-1999. Data were retrieved from a Surveillance Epidemiology and End Results (SEER) Program public-use file. Incidence rates, male-to-female standardized ratios, estimated annual percentage changes and 5-year relative survival rates were computed, and 6830 malignant carcinoid incident during 1992-1999 were analysed. The overall age-adjusted incidence rates were 1.9 per 100 000 for men and women. There was an excess in women for lung and stomach carcinoids, while rates were higher among men for carcinoids of the small intestine and rectum. From 1992 to 1999, incidence rates showed a 3% estimated annual increase. Thirteen per cent of the cases had metastasis at diagnosis. In the present series, 24% of carcinoid patients had more than one tumour. The overall 5-year relative survival rate was 82%. In conclusion, improvements in diagnostic techniques seem to have influenced the epidemiology of carcinoid tumours, leading to a slightly different site distribution and a better stage distribution at diagnosis. Increasing incidence and improving survival rates were shown.

Adolescent↗
PubMed2005

Incidence of small bowel cancer in the United States and worldwide: geographic, temporal, and racial differences.

OBJECTIVE: To examine the demographic and geographic patterns of small bowel cancer incidence in the United States and worldwide. METHODS: Incidence data from the Surveillance, Epidemiology, and End Results (SEER) program between 1973 to 2000 were used to analyze the four histologic types of small bowel cancer, adenocarcinomas, carcinoid tumors, lymphomas, and sarcomas. International comparisons were made using data from Cancer Incidence in Five Continents (CIVIII). Geographic correlations between small bowel and both large bowel and stomach cancer incidence, were performed. RESULTS: Men had higher rates than women for all types of small bowel cancer. Blacks had almost double the incidence of carcinomas and carcinoid tumors compared to whites (10.6 vs. 5.6 per million people; 9.2 vs. 5.4 per million people, respectively). Small bowel cancer incidence has risen, with the greatest increase for carcinoid tumors (21%) and black men (120%). A geographic correlation between small and large bowel cancer incidence, but not small bowel and stomach cancer, were observed. CONCLUSIONS: Small bowel cancer incidence in the U.S. is higher in blacks compared to whites, particularly for carcinomas and carcinoid tumors. Small bowel cancer incidence is rising, particularly in black men. The geographic correlation between large and small bowel cancer suggests shared etiologies.

Adenocarcinoma↗
PubMed1995

Trends in incidence of primary malignant brain tumors in USA, 1981-1990.

BACKGROUND: There has been considerable controversy regarding whether a recent observed rise in brain tumor incidence is real and so suggestive of increasing exposure to environmental carcinogens, or whether it is largely explainable by changes in diagnostic technology, particularly the introduction of computerized axial tomography (CT) scans in the 1970s. We analysed data from the US Surveillance, Epidemiology, and End Results (SEER) Program to investigate whether there was a rise of brain tumor incidence during 1981-1990, the period after CT scans became extensively available, and if so, the rates of which specific histologic subtypes have risen. METHODS: Age- and sex-specific, as well as age-adjusted incidence rates were calculated for each brain tumor histologic subtype. Regression analysis was used to estimate age-adjusted incidence rate ratios (RR) for different periods and to examine time trends. RESULTS: For all histologic subtypes, the incidence rates increased with age. Regarding time trends, lymphomas in men increased in all age groups during the study period with the age-adjusted rate ratio reaching 5.6 (95% CI: 3.7-8.3) for 1989-1990 as compared to 1981-1982. Lymphoma in women and glioblastoma multiforme in both sexes also appear to have increased, particularly in the elderly. Other histologies did not show any time trends in the age-specific or age-adjusted analyses. CONCLUSION: Our histology-specific analysis is not suggestive of any significant increase in the incidence of brain tumors during 1980-1990, except for lymphomas in men.

Adult↗
PubMed2006

Lymph node-based prognostics: limitations with individualized cancer treatment.

OBJECTIVES: Clinicians will commonly individualize adjuvant cancer therapy, on the basis of the number of involved lymph nodes and other clinicopathological factors, under the assumption that despite the expected statistical variability of such data one can nonetheless garner useful information for the individual case. Here the scientific basis of this assumption will be examined. METHODS: Survival data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program for 19,107 breast, 4,234 gastric, and 4,058 rectal cancers were studied with Kaplan-Meier estimates and Cox proportionate hazard models. The minimal sample size required to discriminate between high and low-risk groups was determined from the hazard ratios between various comparative groups, and their respective frequencies. RESULTS: The number of involved nodes was the strongest prognostic factor for all 3 cancers, followed by tumor diameter and grade. Discrimination between high and low-risk nodal prognostic groups required samples of 30 to 200 cases, depending on the prognostics used and the specific tumor, to attain a two-sided alpha of 0.05% with 90% power. At the individual level such prognostications therefore were uninformative. CONCLUSIONS: Clinicopathological prognostics based upon the number of involved lymph nodes are subject to population heterogeneity that limits their application to large samples. At the individual level, these prognostics appear more spurious than useful. The use of such prognostics to tailor cancer treatment to individuals should be considered a specious practice; instead a more categorical approach, based on the results of randomized trials, should be used.

Breast Neoplasms↗
PubMed1999

Factors contributing to the poorer survival of black Americans diagnosed with oral cancer (United States).

OBJECTIVE: The purpose of this study was to identify factors that contribute to the poorer survival of blacks in the United States diagnosed with oral cancer. METHODS: Data for 6,338 whites and 1,165 blacks diagnosed from 1988 to 1993 with squamous cell carcinoma of the oral cavity and pharynx were obtained from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) program 1973-1993 Public-Use Database. The covariables were sex, age, geographic area, marital status, socioeconomic status (five census-tract measures), stage, anatomic site, grade, lymph node involvement, tumor size, and treatment. Hazard ratios were estimated with Cox regression. RESULTS: Adjusted for age and geographic area, the hazard of death from oral cancer was 1.7 (95% confidence interval: 1.5-1.9) times greater among blacks than whites. The addition of the socioeconomic status (SES) variables to the model reduced the hazard ratio for race to 1.3 (1.0-1.7). Further adjustment by stage and treatment reduced the hazard ratio for race to 1.1 (0.9-1.4). In a model containing all covariables (except lymph node involvement and tumor size), the hazard ratio for race remained 1.1 (0.9-1.4). Analyses with the outcome death from any cause gave similar results. CONCLUSIONS: Lower SES, more advanced stage, and differences in treatment accounted for 86% of the excess hazard of death from oral cancer among blacks.

Adolescent↗
PubMedDate not supplied

Factors associated with no surgery or radiation therapy for invasive cervical cancer in Black and White women.

This paper identifies the proportion of invasive cervical cancer cases that do not receive cancer-directed surgery or radiation; assesses the influence of race, stage, age, grade, nodal status, histology, and co-morbid cancer primaries on receipt of treatment; and considers reasons why cancer-directed therapy is not received. We analyzed data for 8,119 patients with invasive cervical cancer from eleven population-based tumor registries in the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute, 1992-96. Approximately 8.03% of Whites and 11.64% of Blacks did not receive surgery or radiation therapy (no therapy). The percentage of cases receiving no therapy were greatest for unstaged cases, and for cases with unknown grade or unknown lymph node status. Adjusted odds of no therapy significantly increased with distant and unstaged disease (vs local stage) and older age (vs 0-39) at diagnosis; unknown grade (vs well differentiated); or unknown lymph node (vs no lymph node) status. Black cases were more likely to be unstaged and unstaged cases are more likely to not receive therapy. Blacks were more likely than Whites not to receive surgery because it was not recommended, contraindicated due to other conditions, or refused. Of cases refusing radiation, 53.85% of Whites and 83.33% of Blacks refused surgery, and of women refusing surgery, 22.58% of Whites and 50% of Blacks refused radiation. Stage, age, grade, and lymph node status directly influence receipt of treatment. Race influences receipt of treatment indirectly through stage. Reasons why therapy was not received (eg, not recommended, refused) differ according to race and stage at diagnosis.

Black or African American↗
PubMedDate not supplied

Effect of the number of uninvolved nodes on survival in early breast cancer.

A high number of uninvolved axillary nodes was found by some authors to be associated with poor survival in node-negative breast cancer. We searched for confirmation and extend the investigation to node-positive cases, using population data from the SEER Program. Patients selected were women aged 40-69 years, diagnosed 1988-1997, T1-T2 breast cancer, undergoing axillary dissection with 4-35 nodes examined. Survivals were estimated by the product-limit method and were computed on pooled data. Results in node-negative patients (n=37,519) showed a 5-year overall survival from 92% (95% confidence interval: 88-95%) with 4 uninvolved nodes, to 93% (87-98%) with 34 uninvolved nodes. In node-positive patients (n=16,978), the 5-year survival increased from 50% (44-56%) with 0 uninvolved nodes, to 91% (82-100%) with 30 uninvolved nodes. Survival graphs indicated an improvement or a plateau with higher number of uninvolved nodes. The graphs also suggested that the ratio of involved and uninvolved nodes might be correlated with survival. We conclude that there was no evidence of poor outcome associated with a high number of uninvolved nodes. The incidental finding that ratio-based characterization of node involvement might be a prognostic factor will be further investigated.

Adult↗
PubMed2003

Conjunctival melanoma: is it increasing in the United States?

PURPOSE: While the incidence of cutaneous melanoma has been found to have increased over time, the evidence for conjunctival melanoma is not as clear. We applied a large cancer registry database to determine whether any changes had occurred in the incidence of conjunctival melanoma. DESIGN: Descriptive epidemiologic analysis. METHOD: Using population-based registry data from the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute (NCI), we identified 206 newly diagnosed patients with conjunctival melanoma from 1973 to 1999. For analysis purposes, we calculated age-adjusted incidence rates and described temporal changes, using joinpoint regression model. RESULTS: Overall estimated biannual percent change (EBAPC) was 5.5 (95% confidence interval [CI] = 2.3, 8.8; P <.001). The significant elevated trend was observed for white men (EBAPC = 11.2; 95% CI = 6.3, 16.3; P <.001) but not for white women (EBAPC = 0.3; 95% CI = -4.1, 4.9; P >.05). In white men, the incidence rate increased 295% within the 27 years. Our analysis also showed a significant upward trend in the age group aged 60 years or more (EBAPC = 7.6; 95% CI = 3.9, 11.3; P <.001). Incidence tended to rise in the group aged 40 to 59 years, but it was not statistically significant (EBAPC = 4.4; 95% CI = -2.3, 11.6; P =.1536). CONCLUSIONS: Substantial temporal changes in the incidence of conjunctival melanoma have occurred in the United States in recent years. The changing incidence patterns coincide with those seen in cutaneous melanoma, suggesting a possible link to a sunlight-related etiology.

Adult↗
PubMed2004

Under use of necessary care among cancer survivors.

Comorbid conditions are the major threat to life for many cancer survivors, yet little is known about the quality of the noncancer-related health care they receive. The authors analyzed the Medicare claims of 14,884 Medicare-eligible, 5-year colorectal carcinoma survivors who were diagnosed initially while they lived in a region monitored by the Surveillance, Epidemiology, and End Results (SEER) Program and compared them with matched controls who had no history of cancer drawn from the Medicare 5% sample. In both univariable and multivariable analyses, cancer survivorship was associated with an increased likelihood of not receiving recommended care across a broad range of chronic medical conditions (odds ratio, 1.19, 95% confidence interval, 1.12-1.27). For example, colorectal carcinoma survivors were less likely than controls to receive appropriate follow-up for heart failure, necessary diabetic care, or recommended preventive services. Having both primary care physicians and oncologists involved in follow-up appeared to ameliorate this effect significantly. African-American, poor, and elderly patients were less likely to receive necessary care in both groups. Whether it was due to patient factors, physician factors, or both, cancer survivors appear to be a vulnerable patient population, because their cancer diagnosis may shift attention away from important noncancer problems and providers. In addition, there may be lack of clarity around the relative roles primary care and specialist physicians will play in a survivor's care. Special attention and education are needed to ensure that survivors receive optimal medical services.

Aged↗
PubMed2000

Changing patterns of tonsillar squamous cell carcinoma in the United States.

OBJECTIVE: Tonsillar squamous cell carcinoma (SCC) may differ etiologically from other oral cancers. The aim of this study was to provide a detailed description of the incidence patterns of tonsillar SCC in the United States. METHODS: Population-based incidence data from the Connecticut Tumor Registry (period 1945-1994) and from the SEER program (period 1973-1995) were used to calculate age-standardized (US 1970) and age-specific incidence rates and confidence intervals (CIs). Linear regression was used to evaluate trends. RESULTS: The incidence of tonsillar SCC increased fourfold among white women in Connecticut during 1945-1994 but remained rather constant in white men. During 1973-1995, incidence rates per million person-years were considerably higher in blacks (31.6; 95% CI: 29.0-34.4 in men, and 9.6; 95% CI: 8.3-10.9 in women) than whites (14.8; 95% CI: 14.3 15.3 in men, and 6.1; 95% CI: 5.8-6.4 in women). Men, but not women, who were younger than 60 years experienced significant annual increases in tonsillar SCC incidence during 1973-1995 (2.7% in blacks and 1.9% in whites). No similar increases occurred for oral SCC at non-tonsillar sites. CONCLUSION: Incidence rates of tonsillar SCC vary considerably by sex, race and time in a way that cannot be explained by changes in tonsillectomy practices alone. Changes in environmental risk factors, including changes in smoking patterns and an increase in oral human papillomavirus infections, may have contributed.

Adult↗
PubMed1996

Outcomes of external-beam radiation therapy for prostate cancer: a study of Medicare beneficiaries in three surveillance, epidemiology, and end results areas.

PURPOSE: This study was designed to obtain representative estimates of the quality of life and probabilities of possible adverse effects among Medicare-age patients treated with external-beam radiation therapy for prostate cancer. METHODS: Patients treated for local or regional prostate cancer with high-energy external-beam radiation between 1989 and 1991 were sampled from a claims data base of the Surveillance, Epidemiology, and End Results (SEER) program from three regions. Patients were surveyed primarily by mail, with telephone follow-up evaluation of non-respondents. There were 621 respondents (83% response rate). The results were compared with data from a previously published national survey of Medicare-age men who had undergone radical prostatectomy. RESULTS: Although they were older at the time of treatment, radiation patients were less likely than surgical patients to wear pads for wetness (7% v 32%) and had a lower rate of impotence (23% v 56% for men < 70 years), while they were more likely to report problems with bowel dysfunction (10% v 4%). Both groups reported generally positive feelings about their treatments. Radiation and surgical patients reported similar rates of additional subsequent treatment (24% v 26% at 3 years after primary treatment). However, radiation patients were less likely to say they were cancer-free, and they reported more worry about cancer than did surgical patients. CONCLUSION: The health-related quality of life of radiation and surgical patients, on average, is similar, but the pattern of experience with adverse consequences of treatment differs by treatment.

Aged↗
PubMed2002

Ethnic differences in survival among women with ovarian carcinoma.

BACKGROUND: Ovarian carcinoma is the leading cause of death among all female reproductive malignancies. There are substantial differences in age-adjusted incidence rates and survival rates between Caucasian women and African-American women. The objective of this study was to examine ethnic differences in survival after ovarian carcinoma in a population-based sample of women. METHODS: Thirteen thousand eighty-three patients (12285 Caucasian women and 798 African-American women) who were diagnosed with primary ovarian carcinoma from the population-based Surveillance, Epidemiology, and End Results (SEER) Program were used for analysis. Odds ratios were used to estimate the association between prognostic variables and ethnicity. Chi-square tests were used to determine the statistical significance of these associations (using two-sided P values). Univariable and multivariable Cox proportional hazards models were used to assess survival differences. RESULTS: African-American women were significantly younger at the time of diagnosis, were more likely to be single, and were less likely to undergo site specific surgery compared with Caucasian women. In addition, the crude median survival for African-American women was nearly 1 year less than for Caucasian women (22 months vs. 32 months, respectively; P < 0.0001). African-American women were at a 30% increased risk of death from any cause when adjusting for all other prognostic variables that differed between the two ethnic groups. CONCLUSIONS: African-American women who are diagnosed with ovarian carcinoma are at a significant increased risk of death from any cause compared with Caucasian women who are diagnosed with ovarian carcinoma.

Adult↗