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PubMed2004

Cervical adenocarcinoma and squamous cell carcinoma incidence trends among white women and black women in the United States for 1976-2000.

BACKGROUND: Although cervical carcinoma incidence and mortality rates have declined in the U.S. greatly since the introduction of the Papanicolaou smear, this decline has not been uniform for all histologic subtypes. Therefore, the authors assessed the differential incidence rates of squamous cell carcinoma (SCC) and adenocarcinoma (AC) of the cervix by race and disease stage for the past 25 years. METHODS: Data from nine population-based cancer registries participating in the U.S. Surveillance, Epidemiology, and End Results (SEER) Program were used to compute incidence rates for cervical carcinoma diagnosed during 1976-2000 by histologic subtype (SCC and AC), race (black and white), age, and disease stage (in situ, localized, regional, or distant). RESULTS: In black women and white women, the overall incidence of invasive SCC declined over time, and the majority of tumors that are detected currently are in situ and localized carcinomas in young women. The incidence of in situ SCC increased sharply in the early 1990s. AC in situ (AIS) incidence rates increased, especially among young women. In black women, invasive AC incidence rose linearly with age. CONCLUSIONS: Changes in screening, endocervical sampling, nomenclature, and improvements in treatment likely explain the increased in situ cervical SCC incidence in white women and black women. Increasing AIS incidence over the past 20 years in white women has not yet translated into a decrease in invasive AC incidence. Etiologic factors may explain the rising invasive cervical AC incidence in young white women; rising cervical AC incidence with age in black women may reflect either lack of effective screening or a differential disease etiology.

Adenocarcinoma↗
PubMed1995

Association of malignant brain tumors and cancers of other sites.

PURPOSE: We conducted an exploratory study of brain tumors that occurred as a second primary malignancy to identify potential risk factors for brain tumors. METHODS: Using data from the Surveillance, Epidemiology, and End Results (SEER) Program, we calculated the sex-specific standardized incidence ratio (SIR), adjusted to age and time period, as an estimate of the relative risk (RR) of developing a second primary brain tumor following other cancers. RESULTS: We found an elevated RR of brain tumors after bladder cancer in both men (RR, 1.7; 95% confidence interval [CI], 1.2 to 2.3) and women (RR, 1.7; 95% CI, 0.8 to 3.2); this effect was present for both astrocytoma and glioblastoma multiforme. Elevated RRs of brain tumors were also found after sarcoma (RR, 4.4; 95% CI, 1.8 to 9.0) and leukemia (RR, 2.9; 95% CI, 1.6 to 4.8) in men, and after colorectal cancer (RR, 1.8; 95% CI, 1.3 to 2.4) and endometrial cancer (RR, 1.4; 95% CI, 1.0 to 1.9) in women. The highest RR observed in this study was for CNS lymphoma following any first primary malignancy in men (RR, 7.9; 95% CI, 5.5 to 11.0). CONCLUSION: The associations of brain tumors with bladder, colorectal, and endometrial cancers in women, and an increased occurrence of CNS lymphoma as a second malignancy in men, are new findings that have not been described previously.

Adult↗
PubMed2003

Incidence of uveal melanoma in the United States: 1973-1997.

PURPOSE: To determine the incidence of 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 the Surveillance, Epidemiology, and End Results (SEER) program database in the United States from 1973 to 1997. METHODS: The significance of trend in age-adjusted incidence rate was determined using chi-square test, and 95% confidence intervals were calculated. MAIN OUTCOME MEASURES: The age-adjusted incidence rate. RESULTS: There was a total of 2493 cases of uveal melanoma, representing 2.9% of all recorded cases of melanoma. Almost all cases (99.4%) were reported by the hospitals, and histopathologic confirmation was available in 81.3% of cases. The mean age-adjusted incidence of uveal melanoma in the United States was 4.3 per million (4.1-4.5; 95% confidence interval [CI]). Most cases (97.8%) occurred in the white population. There was significant variation of incidence between genders (males, 4.9 [4.6-5.2] 95% CI interval; females, 3.7 [3.5-3.9] 95% CI interval). There was no significant variation of incidence by the geographic location of the registry and over the entire period of observation (chi-square test). CONCLUSIONS: The mean age-adjusted incidence of uveal melanoma (4.3 per million) in the United States is similar to that reported from European countries. The age-adjusted incidence rate of uveal melanoma has remained stable for the past 25 years.

Adolescent↗
PubMed1995

Lung cancer.

BACKGROUND: Lung cancer is the most common cause of cancer death in the United States, and its incidence has been rising for at least 50 years. Shifts in histologic type and differences in sex and race distribution have accompanied the increased incidence of lung malignancies. METHODS: Population-based data regarding lung cancer reported to the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program for the 15-year period 1973-1987 were analyzed. RESULTS: Results indicate that from 1973-1977 to 1983-1987, the age-adjusted rates of lung cancer increased by 30%, with the gain markedly greater in women (70%) than in men (17%). The largest percentage increases in age-adjusted rates were observed for small cell carcinoma and adenocarcinoma (approximately 60% each), with a more modest change for squamous cell carcinoma (+ 14%). For squamous cell carcinoma, the age-adjusted rates increased substantially for black (65%) and white (70%) women and only slightly for black men (10%), whereas it decreased slightly in recent years for white men. CONCLUSIONS: In recent years, adenocarcinoma has replaced squamous cell carcinoma as the most frequent histologic subtype for all sexes and races combined. These shifts in histologic types by sex and race may be related to differences in exposure to tobacco products, dietary factors, environmental or occupational carcinogens, and host characteristics. Increased use of transbronchial and needle biopsy may have also influenced these trends to some extent. Over the study period, 5-year relative survival rate did not change appreciably for lung cancer, suggesting that therapeutic advances have had little effect.

Adolescent↗
PubMed2002

Hormone receptors in breast cancer: racial differences in distribution and survival.

The purpose of this study was to describe hormone receptor status and analyze the effect of receptors on survival from breast cancer. Comparisons were made between African-American and Caucasian racial categories. Breast cancer data from 1990 through 1997 collected by the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program were analyzed. Subjects were 993 Caucasian men, 12,303 African-American women, and 141,045 Caucasian women. The number of African-American men was too small to analyze separately (n = 93). In addition to analysis of estrogen and progesterone receptor status by sex and race, tumor and patient characteristics included age, stage at time of diagnosis, and tumor histology. The proportion of Caucasian men with hormone receptor positive tumors remained relatively high and stable for all ages. In women, the proportion of hormone receptor positive tumors increased with age, with African-American women having the highest proportion of hormone receptor negative tumors. Caucasian men had highest proportions of hormone receptor positive tumors in all histology and stage groups, while African-American women had lowest proportions of hormone receptor positive tumors in all stage and histologic categories. Survival for African-American women was significantly worse for each hormone receptor category. In multivariate analyses, race was a significant independent predictor of survival, but sex was not. Although reasons for differences in hormone receptor status by sex and race are unknown, several hypotheses are discussed with respect to differences in tumor histopathology and risk factors.

Adult↗
PubMed2001

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

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

Adolescent↗
PubMedDate not supplied

Infant cancer in the U.S.: histology-specific incidence and trends, 1973 to 1992.

BACKGROUND: Many cancers in infants demonstrate unique epidemiologic, clinical, and genetic characteristics compared with cancers in older children. Few epidemiologic reports, however, have focused on this important age group. METHODS: Population-based data from the Surveillance, Epidemiology, and End Results (SEER) program were used to estimate relative frequency, incidence rates, and average annual percentage change of rates among children in their first year of life (infants) who were diagnosed with a malignant neoplasm from 1973 to 1992 (N = 1461). RESULTS: The greatest proportion of cases (12%) was diagnosed during the first month of life, with extracranial neuroblastoma accounting for 35% of this total. Overall, the average annual incidence rate was 223/1,000,000 infants. Extracranial neuroblastoma was the most common infant malignancy (58/1,000,000 infants per year), followed by leukemias (37/1,000,000), brain and central nervous system (CNS) tumors (34/1,000,000), and retinoblastoma (27/1,000,000). White infants had a 32% higher incidence rate than black infants. The average annual percentage increase in rates for all cancer from 1973 to 1992 was 2.9% (95% CI: 1.9%, 3.8%). For neoplasms with at least 100 cases, increasing trends were greatest for retinoblastoma (4.6%), CNS (4.1%), and extracranial neuroblastoma (3.4%). CONCLUSIONS: Incidence rates increased notably over the study period. Future studies should consider the unique presentation of infants with cancer when developing new hypotheses related to cancer etiology and gene-environment interactions.

Black or African American↗
PubMed2006

Disparities in oral and pharyngeal cancer incidence, mortality and survival among black and white Americans.

BACKGROUND: The authors present statistics and long-term trends in oral and pharyngeal cancer (OPC) incidence, mortality and survival among U.S. blacks and whites. METHODS: The authors obtained incidence, mortality and five-year relative survival rates via the Surveillance, Epidemiology and End Results (SEER) Program Web site. Current rates and time trends for 1975 through 2002 are presented. RESULTS: From 1975 through 2002, age-adjusted incidence rates (AAIRs) and mortality rates (AAMRs) were higher among males than among females and highest for black males. By the mid-1980s, incidence and mortality rates were declining for black and white males and females; however, disparities persisted. During the period 1998-2002, AAIRs were more than 20 percent higher for black males compared with white males, while the difference in rates for black and white females was small. AAMRs were 82 percent higher for black males compared with white males, but rates were similar for black and white females. Five-year relative survival rates for patients diagnosed during the period 1995-2001 were higher for whites than for blacks and lowest for black males. CONCLUSIONS: Despite recent declines in OPC incidence and mortality rates, disparities persist. Disparities in survival also exist. Black males bear the brunt of these disparities. PRACTICE IMPLICATIONS: Dentists can aid in reducing OPC incidence and mortality by assisting patients in the prevention and cessation of tobacco use and alcohol abuse. Five-year relative survival may be improved through early detection.

Adult↗
PubMedDate not supplied

Cancer statistics for Hispanics, 2003.

In this article, the American Cancer Society (ACS) provides estimates on the number of new cancer cases and deaths, and compiles health statistics on the US Hispanic population. The compiled statistics include cancer incidence, mortality, and behaviors relevant to cancer using the most recent data on incidence from the National Cancer Institute's (NCI) Surveillance, Epidemiolgy, and End Results (SEER) Program, mortality data from the National Center for Health Statistics, and behavioral information from the Behavior Risk Factor Surveillance System (Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System [BRFSS], Youth Risk Behavior Surveillance System [YRBSS], and National Health Interview Survey [NHIS].) An estimated 67,400 new cases of cancer and 22,100 cancer deaths will occur among Hispanics in 2003. Hispanics have lower incidence and death rates from all cancers combined and from the four most common cancers (breast, prostate, lung and bronchus, and colon and rectum) than non-Hispanic whites. However, Hispanics have higher incidence and mortality rates from cancers of the stomach, liver, uterine cervix, and gallbladder, reflecting in part greater exposure to specific infectious agents and lower rates of screening for cervical cancer, as well as dietary patterns and possible genetic factors. Strategies for reducing cancer risk among Hispanics include further development of effective interventions to increase screening and physical activity, reductions in tobacco use and obesity, and the development and application of effective vaccines.

Adolescent↗
PubMed2004

Impact of preoperative staging and chemoradiation versus postoperative chemoradiation on outcome in patients with rectal cancer: a decision analysis.

BACKGROUND: Although radical resection and postoperative chemoradiation have been the standard therapy for patients with rectal cancer, preoperative staging by local imaging and chemoradiation are widely used. We used a decision analysis to compare the two strategies for rectal cancer management. METHODS: We developed a decision model to compare survival outcomes after postoperative chemoradiation versus preoperative staging and chemoradiation in patients aged 70 years with resectable rectal cancer. In the postoperative chemoradiation strategy, patients undergo radical resection and receive postoperative chemoradiation. In the preoperative staging and chemoradiation strategy, patients with locally advanced cancer receive preoperative chemoradiation and radical resection, whereas those with amenable localized tumors undergo local excision. The cohorts of patients were entered into a Markov model incorporating age-adjusted and disease-specific mortality. Outcomes were evaluated by modeling 5-year disease-specific survival for preoperative chemoradiation as less than, equal to, or greater than that of postoperative chemoradiation. Base-case probabilities were derived from published data; the Surveillance, Epidemiology, and End Results (SEER) Program database; and U.S. Life Tables. One-way and two-way sensitivity analyses were performed. The outcome measures were life expectancy and quality-adjusted life expectancy. RESULTS: Life expectancy and quality-adjusted life expectancy were 9.72 and 8.72 years, respectively, in the postoperative chemoradiation strategy. In the preoperative staging and chemoradiation strategy, life expectancy was 9.36, 9.72, and 10.09 years and quality-adjusted life expectancy was 8.71, 9.04, and 9.37 years when 5-year disease-specific survival was less than, equal to, or greater than that of postoperative chemoradiation, respectively. The decision model was sensitive to differences in the long-term toxicity of pre- and postoperative chemoradiation. When the 5-year disease-specific survival for patients after pre- or postoperative chemoradiation was equal, the decision model was sensitive to surgical mortality and to the probability of residual lymph node disease after local excision. CONCLUSION: If efficacy and toxicity after preoperative chemoradiation are equal to or better than that after postoperative chemoradiation in patients with locally advanced rectal cancer, then preoperative staging to select patients appropriate for preoperative chemoradiation is beneficial.

Adult↗
PubMed1996

Temporal and regional variability in the surgical treatment of cancer among older people.

OBJECTIVES: Numerous studies have documented that older individuals with cancer have been treated less aggressively than younger individuals. We utilized data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program to assess geographic variation in the effects of age on the surgical treatment of cancer and to examine temporal trends in the treatment of older people between 1973 and 1991. DESIGN: Ecological analyses comparing time trends of treatment in nine regions over a 19-year period. SETTING: Population-based data for nine geographic areas of the United States. PARTICIPANTS: Persons with incident cancer of the breast, colon, rectum, lung, ovary, uterus, pancreas, and stomach residing in these regions during the selected years. RESULTS: After age 64, the percentage of patients treated surgically decreased with increasing age for every cancer site studied. Between 1973 and 1991, the likelihood of receiving surgery for cancers of the uterus, colon, rectum, ovary, and breast increased more rapidly among patients ages 65 years and older than among those under age 65. This relative increase occurred consistently across most geographic areas studied. For cancers of the lung, stomach, and pancreas, the effect of age on the likelihood of receiving surgery did not diminish through the period under study.: CONCLUSIONS: Although older people remain less likely to receive surgical therapy than younger persons, for some important cancer sites the gap between the treatment of older and younger individuals narrowed from 1973 through 1991.

Age Factors↗
PubMed1995

Hodgkin's disease.

BACKGROUND: Over three time periods, 1973-1977, 1978-1982, and 1983-1987, the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute collected all cases of Hodgkin's disease in designated geographic regions representative of the United States as a whole. METHODS: The authors reviewed the data pertaining to 9418 microscopically confirmed cases of Hodgkin's disease and focused on trends that emerged over the time intervals of this study. RESULTS: Hodgkin's disease had a bimodal distribution of age-specific incidence rates with two peaks in the age groups of 15-34 years and older than 55 years. Since 1973, the incidence of Hodgkin's disease in the younger age group increased progressively as a result of a marked increase in the incidence of the nodular sclerosis subtype. From the period 1973-1977 to 1983-1987, the age-adjusted incidence rate of nodular sclerosis rose from 1.1 to 1.6 per 100,000. In 1983-1987, nodular sclerosis represented 57.7% of Hodgkin's disease and occurred most often in whites, with an equal sex ratio. In females, this increase in incidence over time was most dramatic in young adult women. The overall incidence of the mixed cellularity subtype, 23.4% of Hodgkin's disease, remained stable although the age-specific incidence rate increased progressively in black males older than age 40 years. The incidence of the lymphocytic predominance subtype, 6.0% of Hodgkin's disease, remained stable over time, with a slight increase in adults older than age 50 years. The lymphocytic depletion subtype, 3.8% of Hodgkin's disease, occurred predominantly in the elderly; its incidence decreased, most likely the result of changes in diagnostic criteria, with many cases being reclassified as non-Hodgkin's lymphoma (NHL). Similarly, unclassifiable cases of Hodgkin's disease designated as miscellaneous, 9.1% of Hodgkin's disease, decreased over time, probably the result of improved classification. Nevertheless, a subset of cases of Hodgkin's disease remained difficult to subclassify. The human immunodeficiency virus (HIV) epidemic appears to be associated with an increased incidence of Hodgkin's disease in San Francisco County in adult males age 30-49 years, a population known to have a high prevalence of HIV infection. CONCLUSION: The SEER data suggest that Hodgkin's disease is a heterogeneous entity composed of at least two different diseases--nodular sclerosis and mixed cellularity. Over the time course of this study, the incidence of nodular sclerosis increased dramatically, particularly in adolescents and young adults, whereas mixed cellularity remained stable. The incidence of Hodgkin's disease in the elderly decreased, most likely the result of our improved ability to diagnose both Hodgkin's disease and NHL and the realization that many cases of NHL had been misclassified as Hodgkin's disease. This decrease in Hodgkin's disease occurred predominantly in the lymphocytic depletion and miscellaneous groups.

Adolescent↗
PubMed1996

Childhood cancer in the United States. A geographical analysis of cases from the Pediatric Cooperative Clinical Trials groups.

BACKGROUND: After injuries, cancer is the leading cause of death in children younger than 15 years in the United States. Despite dramatic increases in 5-year survival rates, more than 100,000 person-years of life are lost to childhood cancer each year. The exact proportion of pediatric cancer patients who receive care at centers that utilize up-to-date therapeutic protocols [such as those affiliated with the Childrens Cancer Group (CCG) or the Pediatric Oncology Group (POG)] remains unknown. The purpose of this study was to estimate the proportion and geographic distribution of childhood cancer patients in the United States who are seen at participating centers of the CCG and the POG. METHODS: Patients included 21,026 incident pediatric cancer cases diagnosed from January 1, 1989 through December 31, 1991. Observed numbers of pediatric cancer cases were compared with expected numbers of cases calculated from incidence rates obtained from the Surveillance, Epidemiology, and End Results (SEER) Program and population counts obtained from the 1990 U.S. Census Bureau. RESULTS: Approximately 94% of children younger than 15 years diagnosed with cancer are seen at an institution that is a member of either POG or CCG. Comparisons of the observed-to-expected numbers of incident cases in the age groups (birth-4 years, 5-9 years, 10-14 years, and 15-19 years) demonstrated ascertainment rates of 100, 93, 84, and 21%, respectively. In some regions within the United States the observed number of cases was significantly less than that expected number, including areas of Idaho, Oklahoma, and Virginia. In addition, there were areas in which the observed number of childhood cancer cases was substantially greater than that expected, including areas in California and Florida. CONCLUSIONS: The membership of the cooperative clinical trials groups (the POG and CCG) ascertain and provide access to state-of-the-art treatment protocols for the vast majority of pediatric cancer patients in the country. For the younger age groups, the CCG and POG may represent a mechanism of case ascertainment that approximates a population-based series for the continental United States. Those areas that have large enough discrepancies in observed-to-expected numbers may warrant further investigation.

Adolescent↗
PubMed2000

Radical prostatectomy: geographic and demographic variation.

OBJECTIVES: Previous reports have documented a geographic variation in the use of radical prostatectomy. We examined whether this phenomenon can be explained by factors other than geography alone. METHODS: This study was based on the data from nine geographic regions of the Surveillance, Epidemiology, and End Results (SEER) program for the years 1983 through 1994. Patients with localized or regional prostate cancer were included in the analysis. Logistic regression analysis was used to investigate the influence of geographic and demographic factors on the use of radical prostatectomy. The squared multiple correlation coefficient R(2) was used to measure the proportion of variation in the selection of radical prostatectomy explained by each factor of interest. RESULTS: As previously reported, the use of radical prostatectomy was significantly associated with geographic location; the degree of geographic variation varied as a function of age and was most dramatic in the youngest (younger than 45 years) and the oldest (75 years or older) groups. Overall, however, geography explained less than 2% of the total variation in the use of radical prostatectomy. Age was the most important factor that influenced the use of radical prostatectomy. CONCLUSIONS: Geography explains only a small proportion of the variation in the use of radical prostatectomy. In fact, of the factors examined, only age appeared to meaningfully explain the variation in the use of radical prostatectomy. Overall, our ability to explain the variation in the use of radical prostatectomy remains meager, and new factors must be identified if we are to better understand how patients and physicians make clinical decisions.

Adult↗
PubMedDate not supplied

Prostate cancer incidence and mortality rates and trends in the United States and Canada.

OBJECTIVE: The purpose of this study was to compare prostate cancer incidence and mortality trends between the United States and Canada over a period of approximately 30 years. METHODS: Prostate cancer incident cases were chosen from the National Cancer Institute's Surveillance Epidemiology and End Results (SEER) Program to estimate rates for the United States white males and from the Canadian Cancer Registry for Canadian men. National vital statistics data were used for prostate cancer mortality rates for both countries, and age-adjusted and age-specific incidence and mortality rates were calculated. Joinpoint analysis was used to identify significant changes in trends over time. RESULTS: Canada and the U.S. experienced 3.0% and 2.5% growth in age-adjusted incidence from 1969-90 and 1973-85, respectively. U.S. rates accelerated in the mid- to late 1980s. Similar patterns occurred in Canada with a one-year lag. Annual age-adjusted mortality rates in Canada were increasing 1.4% per year from 1977-93 then fell 2.7% per year from 1993-99. In the U.S., annual age-adjusted mortality rates for white males increased 0.7% from 1969-1987 and 3.0% from 1987-91, then decreased 1.2% and 4.5% during the 1991-94 and 1994-99 periods, respectively. CONCLUSIONS: Recent incidence patterns observed between the U.S. and Canada suggest a strong relationship to prostate-specific antigen (PSA) test use. Clinical trials are required to determine any effects of PSA test use on prostate cancer and overall mortality.

Age Factors↗
PubMed1999

Conditional survival among patients with carcinoma of the lung.

OBJECTIVE: One- and 5-year probabilities of survival or death change once a patient has already survived > or = 1 year after diagnosis. The current paper reports these probabilities for lung cancer patients according to histologic subtype, stage, and age at diagnosis. METHODS: Cumulative observed survival rates were calculated and compared among 95,283 patients with histologically confirmed lung cancer (diagnosed from 1983 to 1992 and followed through 1995) by the life-table method using population-based tumor registries participating in the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute. On the basis of the cumulative survival estimates, we derived the probability of death in the next year, conditioned on having already survived to the start of the year (annual hazards), and the probability of survival conditioned on having already survived > or = 1 year (conditional survival). These rates were reported according to histologic subtype, stage, and age groups. RESULTS: At the time of diagnosis, annual hazard rates differ greatly among histologic subtypes. However, by 5 years after diagnosis, the rates become similar. Bronchioloalveolar carcinoma displays the lowest annual hazards and small-cell carcinoma displays the highest annual hazards. Stage-age subcategories within histologic subtypes continue to show large differences in annual hazard rates. Five-year conditional survival probabilities are also reported, providing survival information that is consistent to that obtained from the annual hazards. CONCLUSIONS: One- and 5-year prognosis for lung cancer patients is influenced by years already survived and histology, stage, and age at diagnosis. Annual hazards and conditional survival provides useful and more relevant information than conventional survival estimates for patients and their physicians. These statistics can be directly obtained from cumulative survival estimates and should be more widely reported.

Adenocarcinoma↗
PubMed2005

Radiotherapy for oral cancer as a risk factor for second primary cancers.

Radiation exposure, known to cause DNA damage, may be a potential source of field cancerization of the upper aerodigestive tract. Radiotherapy for head and neck cancers has been examined as a possible risk factor for second primary cancers, but the results have been equivocal. We evaluated the impact of therapeutic radiation for oral cancer on the risk of second primary cancers with data from the Surveillance, Epidemiology, and End Results (SEER) program for 1973-1999. Among 30,221 first primary oral squamous cell carcinoma patients, 6163 (20.4%) patients developed a second primary cancer, 5042 of which were metachronous. Patients treated with radiation only (RR=1.64, 95%CI=1.18-2.29) or radiation with surgery (RR=1.49, 95%CI=1.07, 2.06) had elevated risks of developing a second primary tumor, whereas patients treated with surgery only did not appear to be at increased risk (RR=1.28, 95%CI=0.93, 1.76). Consistent with an expected latent period between radiation exposure and tumor occurrence, radiation became a risk factor after 10 years of follow-up for solid cancers of the oral cavity (RR=2.8, 95%CI=1.5, 5.2), pharynx (RR=5.9, 95%CI=1.7, 20.7), esophagus (RR=3.9, 95%CI=1.1, 13.4) and lung (RR=1.5, 95%CI=1.0, 2.4), and after 1-5 years of follow-up for second primary leukemia (RR=2.5, 95%CI=1.0, 6.7). Radiotherapy for oral cancer appears to be a risk factor for second primary tumors. Further studies that account for chemotherapy and examine frequency and duration of radiotherapy would be of interest in confirming the observed association.

Aged↗
PubMed2004

Survival of women diagnosed with malignant, mixed mullerian tumors of the ovary (OMMMT).

OBJECTIVE: To analyze the survival of women with malignant, mixed mullerian tumors of the ovary (OMMMT) compared to women with epithelial ovarian cancer (EOC). METHODS: Data from the Surveillance, Epidemiology and End Results (SEER) Program on 14025 women diagnosed with primary invasive ovarian cancer between 1988 and 1997 were used for this analysis (382 had OMMMT). Differences in distribution of prognostic variables by histological type were compared using a chi-square test. Multivariable survival models were fit using Cox proportional hazards regression analysis to compare risk of death for OMMMT compared to EOC. Analyses were also performed using cases with OMMMT compared to high-grade EOC only. RESULTS: Women with OMMMT were older at diagnosis and were more likely to have primary surgery compared to women with EOC. The majority of women in either histological group had advanced-stage disease at diagnosis. Women with OMMMT had a significant increased risk of death from any cause whether being compared to all women with EOC (HR = 1.69, 95% CI = 1.50,1.90) or to women with high-grade EOC only (HR = 1.58, 95% CI = 1.40,1.79). Women with advanced-stage OMMMT were at a 60% increased risk of death compared to women with advanced-stage, high-grade EOC, after adjustment for other variables of interest (adjusted HR = 1.60, 95% CI = 1.40,1.84). There was no difference in risk of death for these two groups of women with early-stage disease. CONCLUSION: OMMMT is a rare malignancy compared to EOC and had a significantly worse prognosis compared to EOC.

Aged↗