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Cancer statistics, trends, and multiple primary cancer analyses from the Surveillance, Epidemiology, and End Results (SEER) Program.

An overview of cancer statistics and trends for selected cancers and all sites combined are given based on data from the Surveillance, Epidemiology, and End Results Program. Median age at diagnosis for all sites combined shows a 2-year increase from 1974 through 1978 to 1999 through 2003. Changes in cancer incidence rates from 1975 through 2003 are summarized by annual percent change for time periods determined by joinpoint regression analysis. After initial stability (1975-1979), incidence rates in women for all cancer sites combined increased from 1979 through 2003, although the rate of increase has recently slowed. For men, initial increases in all cancer sites combined (1975-1992) are followed by decreasing incidence rates (1992-1995) and stable trends from 1995 through 2003. Female thyroid cancer shows continued increasing incidence rates from 1981 through 2003. Blacks have the highest incidence and mortality rates for men and women for all cancer sites combined. Based on 2001 through 2003 data, the likelihood of developing cancer during one's lifetime is approximately one in two for men and one in three for women. Five-year relative survival for all stages combined (1996-2002) ranges from 16% for lung to 100% for prostate cancer patients. Cancer survival varies by stage of disease and race, with lower survival in blacks compared with whites. The risk of developing subsequent multiple primary cancers varies from 1% for an initial liver primary diagnosis to 16% for initial bladder cancer primaries. The impact on the future U.S. cancer burden is estimated based on the growing and aging U.S. population. The number of new cancer patients is expected to more than double from 1.36 million in 2000 to almost 3.0 million in 2050.

Female↗

Survival of children with brain tumors: SEER Program, 1973-1980.

Eight hundred eighty-seven children with brain tumors were identified by the SEER registries (1973-1980). Twenty-five percent were low-grade supratentorial astrocytomas, medulloblastomas were 23%, cerebellar astrocytomas 12%, high-grade supratentorial astrocytomas 11%, brainstem gliomas 9%, and ependymomas 8%. The worst survivals were in children less than 2 years of age, and the best were in those aged 10 to 14 years. Five-year survivals of children with cerebellar astrocytomas were 91%, low-grade supratentorial astrocytomas 71%, high-grade supratentorial astrocytomas 35%, medulloblastomas 39%, ependymomas 28%, and brainstem gliomas 18%.

Adolescent↗

Study of completeness of the surveillance, epidemiology and end results (SEER) program case ascertainment by hospital size and casefinding source.

Factors that may enter into the completeness/incompleteness of reporting include: 1. The competence and diligence of staff. 2. Familiarity with the record systems used within each hospital department. This limited review suggested that hospitals employing their own staff for case ascertainment achieved somewhat higher completeness of reporting rates compared with institutions that relied on central registry circuit riders to pick up cases. 3. Where cases are identified through computer listings by diagnosis, errors in the coding of some cases may result in the exclusion of these cases. 4. The use of ambiguous diagnostic terms may contribute to missing cases.

Female↗

Overall and disease-specific survival after radical prostatectomy: geographic uniformity.

OBJECTIVES: To examine whether the survival (both overall and disease-specific) of patients who underwent radical prostatectomy varies from region to region in the United States. Previous reports have documented a geographic variation in the use of radical prostatectomy. METHODS: This study was based on the data from nine geographic regions of the Surveillance, Epidemiology, and End Results Program (SEER) for 1983 through 1992. Patients with localized prostate cancer who underwent radical prostatectomy were included in the analysis. A proportional hazards model was used to investigate whether geographic variation is associated with both overall and disease-specific survival. RESULTS: From 1983 through 1992, the SEER Program collected information from nine geographic regions on 66,293 patients with localized prostate cancer (mean age 71.8 +/- 8.4 years), who had SEER grade codes of 1, 2, or 3. Of these patients, 11,429 (mean age 65.3 +/- 6.5 years) underwent radical prostatectomy and lymph node dissection. Cox's proportional hazards analyses revealed that the impact of geographic location on both overall and disease-specific survival in patients who underwent radical prostatectomy was not statistically significant. CONCLUSIONS: The results of this study indicate that the survival (both overall and disease-specific) of patients with localized prostate cancer who underwent radical prostatectomy is not influenced by geographic location, suggesting that their survival is relatively uniform across the geographic regions in the United States.

Aged↗

Head and neck in situ carcinoma: incidence, trends, and survival.

This analysis describes the epidemiology of in situ head and neck carcinomas (anatomic sites of lip, oral cavity, pharynx, larynx) about which there is limited knowledge. Data were derived from nine population-based cancer registries participating in the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) Program. SEER annual age-adjusted incidence rates for in situ head and neck carcinomas increased from 6.33/1,000,000 person-years (PY) in 1976 to 8.04/1,000,000 PY in 1995 [percent change (PC)=35%, P<0. 001]. From 1976 to 1995 age-adjusted changes in incidence by anatomic site ranged from 53% PC (larynx) to -11% PC (lip) (both P<0. 005). Incidence and survival associated with in situ head and neck carcinomas varied by anatomic site, age, sex, and race and did so in a pattern similar to that seen for invasive carcinomas of this region. However, the climbing incidence of in situ carcinoma, which may be related to increased surveillance, contrasts sharply with the declining incidence of invasive carcinoma.

Age Distribution↗

Hormonal therapy for male breast cancer: A different approach for a different disease.

Male breast cancer (MBC) is on the rise in the United States [Surveillance, Epidemiology, and End Results (SEER) Program () SEER Stat Database: Incidence-SEER 9 Regs Public-Use; November 2004 submission (1973-2002), National Cancer Institute, DCPPS, Surveillance Research Program, Cancer Statistics Branch, released April 2005, based on the November 2004 submission]; however mortality due to MBC has not changed unlike in its female counterpart [American Cancer Society: Cancer facts and figures 2005. Atlanta (GA): American Cancer Society; 2005]. The rarity of MBC has precluded major progress in the understanding and treatment of this disease. Treatment has often been extrapolated from female breast cancer (FBC) despite distinct clinicopathologic features between the two entities, especially with regards to the role of male hormones and estrogens in this disease. Also, it is uncertain if hormone receptor positive tumors carry the same prognostic implication in MBC as in the female disease. Hormonal therapy has been the mainstay of treatment in MBC with tamoxifen the front-line drug. The role of the newer generation aromatase inhibitors has not been well defined but they are being used in clinical practice for the treatment of MBC, based on accepted data for women with the disease. This commentary focuses on the major hormonal differences between male and female breast cancer that would suggest the need to explore different treatment strategies if significant advances are to be made in the understanding and treatment of this distinct disease.

Antineoplastic Agents, Hormonal↗

Multiple imputation methods for modelling relative survival data.

In population-based cancer survival studies, the cause-specific survival measures the net survival (excess mortality) due to cancer when the cause of death information is available and reliable. In contrast, when the cause of death is uncertain or unavailable, relative survival, the ratio of the survival rate due to all causes to the expected survival rate, is more appropriate. There is a large body of work on the modelling and hypothesis testing of cause-specific survival, but many of these methods are not directly applicable to relative survival. In this paper, we extend the multiple imputation (MI) methods (Stat. Methods Med. Res. 1999; 8:3-15) to the case of relative survival data. The MI methodology is combined with relative survival to estimate the net survival by changing relative survival data to cause-specific data. This facilitates the direct application to statistical methods developed for the cause-specific survival to the special situation of relative survival. The parameter estimates and the log-rank statistics are obtained by combining the results from multiple imputed cause-specific data. The likelihood-based methods for modelling relative survival data have been implemented by a Windows application called CANSURV (Comput. Meth. Prog. Biomed 2005). Although these methods produce accurate parameter estimates, the choice for models and diagnostic tools is limited. The MI method is presented as a simpler alternative. The relative survival data for the colorectal cancer patients from Surveillance, Epidemiology, and End Results (SEER) program (SEER Cancer Statistics Review, 1973-1999. National Cancer Institute: Bethesda, 2002) is used as an illustration. The results are compared with those obtained from the likelihood-based relative survival analysis methods. A sample SAS macro for the MI method is provided.

Black People↗

The modeling of breast cancer deaths in Vermont.

Methodologic issues in modeling breast cancer deaths were investigated through modeling the number of breast cancer deaths in Vermont for the period 1975 to 1988. Age-specific incidence rates, case fatality rates, and secular trends of these rates were necessary to represent the observed trend in breast cancer deaths over this time period. Additional information, such as mortality from other causes, stage distribution, or screening history, was not necessary. Incidence and survival information were obtained from a statewide population-based breast cancer registry in Vermont and the Surveillance, Epidemiology and End Results (SEER) program. SEER incidence rates overestimated the actual number of deaths for long-term survival rates. Case fatality rates and secular trends in incidence and survival reported by SEER were appropriate. These results can be applied to the planning of community intervention studies by providing the essential expected numbers of deaths in control communities.

Adult↗

Cancer. Introduction.

This supplement presents the study of various histologic types of cancers diagnosed in the populations covered by the Surveillance, Epidemiology, and End Results (SEER) Program. It describes the SEER program and the coding of histologic type by the International Classification of Diseases for Oncology. Each of the 19 articles deals with the histologic types of cancer found in major sites or with specific histologic types, such as lymphomas or melanomas. Histologic types have been grouped based on those developed by Dr. John Berg. Data presented in this supplement are based on more than one million microscopically proven invasive cancers and 98,000 in situ cancers diagnosed during the period 1973-1987 in areas covered by the SEER Program.

Adolescent↗

Incidence of and treatment for ductal carcinoma in situ of the breast.

OBJECTIVE: To describe trends in incidence and treatment for ductal carcinoma in situ (DCIS) of the breast in the United States between 1973 and 1992 and to estimate total numbers of in situ cases diagnosed and numbers treated by mastectomy since 1983, when screening mammography for breast cancer began to become widespread. DESIGN: Analysis of population-based breast cancer incidence data collected by the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program since 1973 and treatment data collected by the SEER program since 1983. STUDY POPULATION: All women in the geographic areas af the United States included in the SEER program. MAIN OUTCOME MEASURES: Annual age-adjusted and age-specific incidence rates for DCIS; time trends in distribution of cases by type of treatment; percentage of cases treated by mastectomy by geographic area; and estimated numbers for the entire United States of DCIS cases, mastectomies for DCIS, and cases attributable to mammography. RESULTS: There was a marked increase in DCIS incidence beginning in the early 1980s. Average annual increases in rates between 1973 and 1983 and between 1983 and 1992 changed from 0.3% to 12.0% among women aged 30 to 39 years, from 0.4% to 17.4% among women aged 40 to 49, and from 5.2% to 18.1% among women aged 50 years or older. The total estimated number of DCIS cases in the United States in 1992 (23,368) was 200% higher than expected based on 1983 rates and trends between 1973 and 1983. Between 1983 and 1992, there was a marked decline in the proportion of DCIS cases treated by mastectomy (from 71% to 43.8%) and an increase in those treated by lumpectomy (from 25.6% to 53.3%). In 1992, 23.3% of cases were treated by lumpectomy and radiation, 30.2% by lumpectomy alone, and 2.6% with no surgery. Treatment patterns varied substantially by geographic area, with 57.7% of cases in New Mexico treated by mastectomy in 1992 compared with 28.8% in Connecticut. Despite the decline in the proportion of cases treated by mastectomy, the increased DCIS incidence rates resulted in an increase in the absolute number of cases treated by mastectomy until 1990 (n=10,657); in 1992, there were an estimated 10,242 DCIS cases treated by mastectomy. CONCLUSIONS: Incidence rates of DCIS of the breast have increased dramatically since 1983. This increase correlates with the widespread adoption of modern mammographic screening. While early detection of invasive breast cancer is beneficial, the value of DCIS detection is currently unknown. There is cause for concern about the large number of DCIS cases that are being diagnosed as a consequence of screening mammography, most of which are treated by some form of surgery. In addition, the proportion of cases treated by mastectomy may be inappropriately high, particularly in some areas of the United States.

Adult↗

Second lymphomas and other malignant neoplasms in patients with mycosis fungoides and Sezary syndrome: evidence from population-based and clinical cohorts.

OBJECTIVE: To assess risks for developing second malignancies in patients with mycosis fungoides or Sézary syndrome. DESIGN: Retrospective study of 2 cohorts. SETTING: Nine population-based US cancer registries that constitute the Surveillance, Epidemiology, and End Results Program (SEER-9), and Stanford University referral center cohort of patients with cutaneous lymphoma. Patients with mycosis fungoides or Sézary syndrome from the SEER-9 registry diagnosed and followed up from 1984 through 2001 and from the Stanford University cohort diagnosed and followed up from 1973 through 2001. MAIN OUTCOME MEASURES: Relative risk was estimated using the standardized incidence ratio (SIR). The expected cancer incidence for both cohorts was calculated using age-, sex-, race-, and calendar year-specific SEER-9 incidence rates for the general population. Nonmelanoma skin cancers were excluded because these cancers are not routinely reported by the SEER database. RESULTS: In the SEER-9 cohort (n = 1798), there were 197 second instances of cancer (SIR = 1.32; 95% confidence interval [CI], 1.15-1.52) at all sites. Significantly elevated risk (P<.01) was observed for Hodgkin disease (6 cases; SIR = 17.14; 95% CI, 6.25-37.26) and non-Hodgkin lymphoma (27 cases; SIR = 5.08; 95% CI, 3.34-7.38). Elevated risk (P<.05) was also observed for melanoma (10 cases; SIR = 2.60; 95% CI, 1.25-4.79), and urinary cancer (21 cases; SIR = 1.74; 95% CI, 1.08-2.66). In the Stanford University cohort (n = 429), there were 37 second instances of cancer (SIR = 1.04; 95% CI, 0.76-1.44). Elevated risk (P<.01) was observed for Hodgkin disease (3 cases; SIR = 27.27; 95% CI, 5.35-77.54). Elevated risk (P<.05) was also observed for biliary cancer (2 cases; SIR = 11.76; 95% CI, 1.51-42.02). CONCLUSION: Updated SEER (population based) and Stanford (clinic based) data confirm the generalizability of earlier findings of increased risk of lymphoma in patients with mycosis fungoides or Sézary syndrome.

Adolescent↗

Socioeconomic status and breast carcinoma survival in four racial/ethnic groups: a population-based study.

BACKGROUND: Although overall survival for invasive breast carcinoma remains high, black women experience poorer survival than whites. Less is known about the survival of Hispanics and Asians, who may share clinical and socioeconomic risk factors similar to blacks. To better understand racial/ethnic survival patterns, we investigated the effect of socioeconomic status (SES) and disease stage on racial/ethnic differences in breast carcinoma survival in a large population-based cohort. METHODS: Using data from the Surveillance, Epidemiology, and End Results program (SEER), we identified 10,414 white, 940 black, 1100 Hispanic, and 1180 Asian females diagnosed with breast carcinoma in the Greater San Francisco Bay Area between 1988 and 1992. We used the Kaplan-Meier method to generate survival rates and Cox proportional hazards regression to estimate the risk of death by race/ethnicity, after adjustment for clinical, demographic, and census-derived SES variables. RESULTS: The 10-year unadjusted survival rates were 81% for whites, 69% for blacks, 75% for Hispanics, and 79% for Asians. Adjusting for stage decreased the relative risk of mortality for blacks from 1.81 to 1.29; the stage-adjusted relative risk for Hispanics (1.11) and Asians (1.02) did not differ significantly from whites. Additional adjustment for age, tumor characteristics, and treatment factors did little to alter the relative risk in blacks; adding blue-collar status to the model further decreased the relative risks for blacks to 1.22. Residing in a blue-collar neighborhood was independently associated with a 1.16 increase in risk of death. CONCLUSIONS: After adjustment for multiple factors, blacks continue to have slight but significantly poorer survival after breast carcinoma compared with whites, whereas the survival of Hispanics and Asians did not differ from whites.

Adult↗

Mortality trends for cervical squamous and adenocarcinoma in the United States. Relation to incidence and survival.

BACKGROUND: In the United States, detection of squamous carcinoma in situ (CIS) by screening has led to reduced rates for invasive squamous carcinoma and lower mortality. Adenocarcinoma in situ (AIS) rates also have increased, but invasive cervical adenocarcinoma rates have not declined similarly. To make inferences about the effectiveness of screening, the authors assessed mortality trends for squamous and adenocarcinoma in relation to incidence of these tumors, incidence of their precursors and survival. METHODS: Using data from the Surveillance, Epidemiology, and End Results program (SEER), the authors tabulated incidence per 10(5) woman-years for invasive carcinomas (1976-2000) and for CIS and AIS (1976-1995) by age (< 50 years, > or = 50 years) and race (whites, blacks). Cumulative relative survival rates were tabulated for 1976-1995 and mortality rates were estimated for 1986-2000. RESULTS: Among all groups, CIS rates approximately doubled whereas rates for invasive squamous carcinoma declined. Among younger whites, mortality declined from 1.12 to 0.93, and for older whites, mortality decreased from 5.02 to 3.82. Among younger blacks, mortality for squamous carcinoma decreased from 2.69 to 1.96. Among older blacks, the mortality rates declined from 14.88 to 9.15. Although AIS rates have increased dramatically among whites (all ages) and younger blacks, adenocarcinoma incidence and mortality rates have not changed greatly. Survival for patients did not change greatly within these age-race groups. CONCLUSIONS: The authors concluded that increases in CIS seemed disproportionately large compared with improvements in mortality rates for squamous carcinoma. Despite increased reporting of AIS, declines in mortality for cervical adenocarcinoma have not been demonstrated conclusively. However, future analyses are required to evaluate these trends more completely.

Adenocarcinoma↗

Neighborhood composition and incidence of cancer among Hispanics in the United States.

BACKGROUND: Hispanics in the United States have a 33% lower age-adjusted incidence of cancer and a 38% lower cancer mortality rate compared with non-Hispanic whites. This may be secondary to health behaviors that vary with residential and economic assimilation. The authors investigated whether cancer incidence among Hispanics increased with residential and economic assimilation into mainstream culture. METHODS: Data from the Surveillance, Epidemiology, and End Results program (SEER) and the U.S. Census Bureau were used to compare cancer incidence rates and rate ratios as a function of percentage of Hispanics and income of Hispanics in a census tract. Type of cancer was identified with a site recode variable in the SEER data set. Cases with in situ prostate and cervical carcinoma were excluded. Hispanic ethnicity in SEER was identified by medical record review and Hispanic surname lists. The study also used income of Hispanics living in the census tract, age at diagnosis, and stratification by gender. RESULTS: The incidence of breast, colorectal, and lung carcinoma among Hispanics increased as the percentage of Hispanics in the census tract decreased and as tract Hispanic income increased. For example, there was a 39% reduction in breast carcinoma and a 38% reduction in male colorectal carcinoma when the Hispanic population in high-density Hispanic neighborhoods in the lowest income quartile was contrasted to Hispanics living in tracts with the lowest total percentage of Hispanics in the highest income quartile. CONCLUSIONS: The lower cancer rates among Hispanics relative to non-Hispanic whites in the United States may dissipate as Hispanics become more assimilated into the mainstream society.

Acculturation↗

Racial differences in clinical progression among Medicare recipients after treatment for localized prostate cancer (United States).

OBJECTIVE: Prostate cancer recurrence impacts patient quality of life and risk of prostate-cancer specific death following definitive treatment. We investigate differences in disease-free survival among white, black, Hispanic, and Asian patients in a large, population-based database. METHODS: Merged Surveillance, Epidemiology, and End Results Program (SEER) and Medicare files provided data on 23,353 white patients, 2,814 black patients, 480 Hispanic patients, and 566 Asian patients diagnosed at age 65-84 years with clinically localized prostate cancer between 1986 and 1996 in five SEER sites. Patients were followed through 1998. Racial differences in disease-free survival were assessed using Kaplan-Meier survival curves and Cox regression models. RESULTS: The 75th percentile disease-free survival time for black patients was 13 months less than that for white patients (95% confidence interval [CI]: 6.2-19.8 months), 29.7 months less than that for Hispanic patients (95% CI: 4.4-55.0 months), and 39.1 months less than that for Asian patients (95% CI: 12.1-66.1 months). In multivariate analysis, black race predicted shorter disease-free survival among surgery patients, but not among radiation patients. CONCLUSIONS: Black patients experienced shorter disease-free survival compared to white, Hispanic, and Asian patients, and the disease-free survival of white, Hispanic, and Asian patients were not statistically different. Earlier recurrence of prostate cancer may help explain black patients' increased risk of mortality from prostate cancer.

Black or African American↗

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

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

Black or African American↗

Cancer of the uterine corpus among Hispanic women living in the United States: patterns of staging, diagnosis, and primary treatment.

OBJECTIVES: To evaluate the demographic characteristics, clinico-pathological features, and patterns of care of uterine cancer among Hispanic women living in the United States. METHODS: The National Cancer Institute (NCI)'s Surveillance, Epidemiology, and End Results Program (SEER), was used to identify 1618 Hispanic, 17,814 non-Hispanic white (NHW), and 1477 non-Hispanic black (NHB) women diagnosed with primary carcinoma of the uterus during 1996-2000. Data derived from hospital registries was analyzed, for differences in case presentation, staging, and primary treatment by race/ethnicity and age. Statistical analysis was performed using the IBM PC packages, Stata, and the SAS system. RESULTS: Hispanic women were statistically significantly more likely to present with uterine cancer at a younger age compared to non-Hispanic groups. Hispanic women with early stage disease (stage I-II) were also statistically significantly more likely to be younger than 55 years at the time of diagnosis (NHW: OR=0.40, 95% CI: 0.35-0.45; P = 0.0000, NHB: OR=0.45, 95% CI: 0.38-0.55; P=0.0000). Hispanics were statistically significant less likely than NHB to present with advanced stage disease, high tumor grade, and receive radiation therapy for uterine cancer. CONCLUSIONS: Hispanic women are more likely to be diagnosed with uterine cancer at a younger age than other ethnic groups. The etiologic factors related to this presentation have yet to be precisely defined. Additional epidemiological and demographic studies, addressing such factors as body mass index and other medical co-morbidities, are needed to identify opportunities for improved cancer prevention and control in this population of women.

Female↗