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PubMed1988

Increasing incidence of primary brain lymphoma in the US.

There have been a number of clinical reports suggesting an increasing incidence of primary brain lymphoma unrelated to acquired immune deficiency syndrome (AIDS) and organ transplantation. To investigate this issue, the US incidence of this rare lymphoma was assessed using data from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) program (1973 through 1984). Never-married men, a relatively high risk group for AIDS, were excluded from the analyses. Brain lymphoma incidence increased from 2.7 in 1973 through 1975 to 7.5 cases per ten million population in 1982 through 1984 (chi-square trend, 15.25; P less than 0.001), and it increased among both men (chi-square trend, 6.74; P = 0.009) and women (chi-square trend, 10.48; P = 0.001). Increases in incidence also were observed among persons younger than 60 years of age (chi-square trend, 4.10; P = 0.04) and persons 60 years of age and older (chi-square trend, 9.16; P = 0.002). This increased incidence of brain lymphoma appears to be real: It antedates the AIDS epidemic and does not appear to be related to organ transplantation, another cause of increased risk of brain lymphoma. Although part of the increase may be an artifact of improvements in diagnostic technology and practice, most of the observed increase antedates the widespread use of such technologies. Finally, the increase in incidence of brain lymphoma does not appear to be related to overall trends in the incidence of brain tumors and non-Hodgkin's lymphoma, and it is not related to time trends in nosology.

Age Factors↗
PubMed1989

Relation of tumor size, lymph node status, and survival in 24,740 breast cancer cases.

Two of the most important prognostic indicators for breast cancer are tumor size and extent of axillary lymph node involvement. Data on 24,740 cases recorded in the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute were used to evaluate the breast cancer survival experience in a representative sample of women from the United States. Actuarial (life table) methods were used to investigate the 5-year relative survival rates in cases with known operative/pathologic axillary lymph node status and primary tumor diameter. Survival rates varied from 45.5% for tumor diameters equal to or greater than 5 cm with positive axillary nodes to 96.3% for tumors less than 2 cm and with no involved nodes. The relation between tumor size and lymph node status was investigated in detail. Tumor diameter and lymph node status were found to act as independent but additive prognostic indicators. As tumor size increased, survival decreased regardless of lymph node status; and as lymph node involvement increased, survival status also decreased regardless of tumor size. A linear relation was found between tumor diameter and the percent of cases with positive lymph node involvement. The results of our analyses suggest that disease progression to distant sites does not occur exclusively via the axillary lymph nodes, but rather that lymph node status serves as an indicator of the tumor's ability to spread.

Breast Neoplasms↗
PubMed1989

Contribution of socioeconomic status to black/white differences in cancer incidence.

Blacks and Whites have very different cancer incidence rates for many sites, but this may largely be due to the racial differences in socioeconomic status (SES). The authors tested this hypothesis by determining the effect of adjustment for SES on the black/white incidence ratios for 12 cancer sites. Race-specific census tract-level SES variables (median family income, percent below poverty level, and years of education) were obtained from the 1980 US census and applied to approximately 20,000 black and 88,000 white cancer cases from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program for the years 1978 to 1982. For each cancer site (with each sex considered separately), Poisson regression was used to produce age-adjusted black/white incidence ratios, with and without adjustment for SES. The SES variable with the strongest adjusting power was percent below poverty level. For many sites (breast, in situ and invasive cervix, esophagus, male lung, pancreas, stomach) poverty accounted for much or all of the racial differences. For several sites (bladder, multiple myeloma, prostate, uterine corpus), large racial differences persisted after adjustment for poverty, and these findings suggest directions for investigating the etiology of these cancers.

Adult↗
PubMed1989

Risk of second malignancy after cutaneous T-cell lymphoma.

Risk of second primary malignancy was assessed in a population-based follow-up survey of all persons who developed cutaneous T-cell lymphoma (CTCL) in nine geographic areas of the United States covered by the Surveillance, Epidemiology and End Results (SEER) program of the National Cancer Institute during the period 1973 to 1983. Among 544 patients with a first primary tumor reported as CTCL, a second cancer developed in 35 (6%), yielding a significantly elevated relative risk (RR) of 1.7, which reflects excesses for cancers of the lung and colon and non-Hodgkin's lymphoma. Although the excess of lymphoma may be related to the evolution of CTCL to less differentiated T-cell lymphoma, additional studies are needed to clarify the immunologic, genetic, viral, and environmental factors that may contribute to the development of second cancers.

Cohort Studies↗
PubMed1990

Occupational and non-occupational risk factors in relation to an excess of primary liver cancer observed among residents of Brooklyn, New York.

The incidence and mortality rates of primary liver cancer (PLC) among residents of Brooklyn, New York, were studied for 1976 through 1983. Standardized race and sex-specific incidence and mortality rates and rate ratios were computed and compared with overall US rates as reported by the Surveillance, Epidemiology, and End Results (SEER) program. The results indicate a significant excess of PLC among all race and sex groupings. A comparison of the degree of agreement between incidence and mortality data for Brooklyn residents showed excellent agreement among male patients with PLC and adequate agreement among female patients with PLC. Next, the effect of occupation on PLC mortality among Brooklyn residents was assessed. Specific occupations found to be at excess risk for PLC are private household workers (ratio of observed to expected cases [O/E] = 4.34; P less than 0.0001), non-domestic cleaning and food and beverage service workers (O/E = 2.59; P less than 0.0001), protective service workers (O/E = 1.78; P = 0.035), and transport equipment operatives (O/E = 1.52; P = 0.027). Since the distribution of Brooklyn workers employed in these occupations was found to be similar to the distribution of all US workers employed in these occupations, it is unlikely that these occupational risk factors can explain the observed excess of PLC among Brooklyn residents. The effects of non-occupational risk factors for PLC were then assessed using multiple regression analysis. The only non-occupational risk factor found to be associated with PLC among Brooklyn residents was cirrhosis of the liver (P = 0.0072). It is interesting that of the four occupations found to be at excess risk for PLC in this study, three have been previously shown to be at excess risk for cirrhosis mortality. Moreover, Brooklyn residents have cirrhosis mortality rates that are approximately two times higher than US rates. These facts, coupled with the findings of this study, support the hypothesis that the excess of PLC observed among Brooklyn residents might be related to an excess of cirrhosis of the liver in the same population, and thus provide support for an etiologic role of cirrhosis in the pathogenesis of PLC.

Female↗
PubMed1987

End results, interhospital differences, and trends in patterns of care for gynecologic cancer.

Survival rates represent one measure of population-wide progress in cancer control. Data from the Surveillance, Epidemiology and End Results (SEER program of the National Cancer Institute (NCI) document that, during the 1970s, survival rates for several cancers improved. For the major gynecologic cancers and breast cancer, improvements are evident for some sites but, areas of decline also are observed. Black women in the US have a poorer survival rate than white women and the trend in recent years suggest that this gap may be widening. Comparisons of survival rates from comprehensive cancer centers and population-based rates indicate differences in outcomes associated with the treatment setting. Data from the American College of Surgeons (ACS) patterns of care surveys suggest substantial interhospital variability in cancer survival which is largely explained by characteristics of the patient populations served. Recent studies of patterns of care document major shifts in treatment practices in the US and provide insight concerning the rate at which treatment changes are adopted at the community level.

Female↗
PubMed1992

Carcinoma of the gallbladder. Histologic types, stage of disease, grade, and survival rates.

Data on patients with gallbladder cancer listed in the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute were reviewed. Between 1977 and 1986, 3038 patients were recorded in the Program. Histologic grade, histologic type, stage of disease, and vascular invasion were correlated with outcome. Compared with all other histologic types of cancer, papillary carcinomas had the most favorable prognosis. The 2-year survival rate for patients with papillary carcinoma was 47%. A correlation with survival existed between grade, stage of disease, and vascular invasion. The study confirmed that cancers of the gallbladder occur more often in older age groups and are more common in women. Almost 40% of cases are found at an advanced stage. For patients whose enolase tumor was limited to the gallbladder at the time of surgery, the 2-year survival rate was 45% and the 5-year rate was 32%.

Adult↗
PubMed1992

Carcinoma of the extrahepatic bile ducts. Histologic types, stage of disease, grade, and survival rates.

Data on patients with extrahepatic bile duct carcinomas recorded in the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute were reviewed. We analyzed the records of 1766 patients reported during a 10-year period (1977-1986). These tumors occurred primarily in older age groups and were slightly more common in males. Histologic grade, histologic types, and stage of disease are useful prognostic indicators. The 5-year survival rate for patients with Stage I disease was 11%. Although carcinomas of the extrahepatic bile ducts are better differentiated than carcinomas arising in the gallbladder, they have a less favorable prognosis.

Adult↗
PubMed1994

Trends in cervical cancer incidence among young black and white women in metropolitan Detroit.

BACKGROUND: Although the overall incidence of invasive cervical cancer in the United States has declined over the past several decades, recent studies suggest that rates for both invasive and in situ cervical cancer are rising among younger women. METHODS: Trends in cervical cancer incidence among females between the ages of 15 and 39 years were evaluated using data from the Metropolitan Detroit Cancer Surveillance System, a population-based registry and founding participant in the SEER Program of the National Cancer Institute. Age-adjusted and age-specific rates for all black and white women in this age group were evaluated as well as rates for married and single women for the period 1973-1991. RESULTS: Incidence trends vary by race and marital status. A nonlinear increasing trend was evident (P < 0.01), for in situ cervical cancer among white women, with rates for single white women exhibiting the largest increase. Rates among black women for in situ cervical cancer exhibited a nonlinear decreasing trend (P < 0.01), with rates for married black women declining by 75%. Among single white women, invasive cervical cancer exhibited an increasing linear trend (P < 0.01), although the number of cases was small. CONCLUSIONS: Differences in trends among black and white women may reflect a combination of greater exposure to risk factors associated with cervical carcinoma as well as differential access to diagnostic and treatment services. Appropriate groups should be targeted for educational, screening, and follow-up services.

Adolescent↗
PubMed1995

Conditional survival of 56,268 patients with breast cancer.

BACKGROUND: Survival rates calculated from the date of diagnosis may not be predictive of future outcome for patients who have already survived several years after diagnosis. Conditional survival rates are more informative clinically because they take into account survival after diagnosis. METHODS: Conditional relative survival rates were calculated by the life-table method using data from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute. RESULTS: Survival rates up to 8 years for patients having survived 1, 2, 3, 4 or 5 years after diagnosis are presented by stage of disease for 56,268 women who were diagnosed as having invasive breast cancer from 1983 to 1987. CONCLUSIONS: Women with Stage IV breast cancer had a better survival as they moved further in time from their diagnosis. Survival rates did not improve for those with Stage I and II disease regardless of the number of years they survived after diagnosis.

Adult↗
PubMed1995

Pancreas cancer as a second primary malignancy. A population-based study.

BACKGROUND: The study of second primary malignancies may give clues to the etiology of various cancers. Little is known about risk factors for pancreatic carcinoma; therefore, its occurrence as a second primary malignancy was investigated. METHODS: Data from the Surveillance, Epidemiology, and End-Results (SEER) program were used for the period from January 1, 1973 through December 31, 1990. Person-years of follow-up for various cancer sites were calculated, excluding the initial 6 months after diagnosis, and were multiplied times the age- and sex-specific incidence rates for pancreas cancer to calculate the expected number of second primary pancreas cancer cases. The observed number of cases was divided by the expected number to estimate the relative risk (RR) of pancreas cancer as a second primary cancer, and 95% confidence limits were calculated. RESULTS: The risk of second primary cancer was elevated after lung cancer for men (RR 1.3, 95% CI 1.0-1.6) and women (RR 2.5, 95% CI 1.9-3.2). An elevation in risk also was found after head and neck cancer in women (RR 1.8, 95% CI 1.2-2.5) and bladder cancer in women (RR 1.5, 95% CI 1.1-2.0), but not in men. Other significant elevations were found after prostate cancer (RR 1.2, 95% CI 1.1-1.3), and a decreased risk was found after lymphoma in men (RR 0.2, 95% CI 0.0-0.8). CONCLUSIONS: Second primary pancreas cancer is increased after tobacco-related malignancies, particularly in females, supporting the role of cigarette smoking as a risk factor for pancreas cancer and suggesting a stronger effect of cigarette smoking for women. The elevation in risk after prostate cancer and the decreased risk after lymphoma in males need to be confirmed in other data sets.

Databases, Factual↗
PubMed2001

Increased risk of soft tissue sarcoma after radiotherapy in women with breast carcinoma.

BACKGROUND: Numerous studies to date have suggested an association between radiation exposure and the development of soft tissue sarcoma. The current study was performed to quantify the risk of soft tissue sarcoma in the vicinity of previously irradiated anatomic regions in women with breast carcinoma. METHODS: In this population-based, retrospective cohort study, 194,798 women who were diagnosed with invasive breast carcinoma (exclusive of those with distant metastasis) between 1973--1995 were identified, and subsequent soft tissue sarcoma cases utilizing the data from the Surveillance, Epidemiology, and End Results Program (SEER) were ascertained. Poisson regression analysis was used to calculate age standardized incidence ratios (SIR) and to model the influence of radiotherapy (RT) on the relative risk (RR) between the RT and non-RT cohorts. RESULTS: A total of 54 women in the RT cohort and 81 women in the non-RT cohort subsequently developed soft tissue sarcoma. In the RT cohort, the SIR was 26.2 (95% confidence interval [95% CI], 16.5--41.4) for angiosarcoma and was 2.5 (95% CI, 1.8--3.5) for other sarcomas; in the non-RT cohort, the SIRs were 2.1 (95% CI, 1.0--4.4) and 1.3 (95% CI, 1.0--1.7), respectively. The RT cohort demonstrated a higher risk of developing both angiosarcoma (RR: 15.9; 95% CI, 6.6--38.1) and other sarcomas (RR: 2.2; 95% CI, 1.4--3.3) compared with the non-RT cohort, and the largest increase was observed in the chest wall/breast. The elevated RR was significant even within 5 years of RT, but it reached a maximum between 5--10 years. CONCLUSIONS: The risk of soft tissue sarcoma, especially angiosarcoma, was elevated after RT in women with breast carcinoma.

Adult↗
PubMed2001

Risk of thyroid carcinoma in a female population after radiotherapy for breast carcinoma.

BACKGROUND: There is increasing concern regarding the risk of developing a second primary tumor in adjacent organs as a result of scattered radiation among patients who have undergone radiotherapy (RT) for breast carcinoma. Previous studies have focused mainly on the possible increase in the incidence of contralateral breast carcinoma. To the authors' knowledge, the risk of thyroid carcinoma among these women has not been explored to date. METHODS: In this population-based, retrospective cohort study, the authors identified 194,798 women who were diagnosed with invasive breast carcinoma (exclusive of those with distant metastasis) between 1973 and 1993, and ascertained subsequent cases of thyroid carcinoma utilizing data from the Surveillance, Epidemiology, and End Results (SEER) program of the U.S. National Cancer Institute. Poisson regression was used to calculate the age-standardized incidence ratio (SIR) of thyroid carcinoma and to model the influence of RT on the relative risk (RR) between the RT cohort (48,495 women) and the non-RT cohort (146,303 women). RESULTS: A total of 28 women in the RT cohort and 112 women in the non-RT cohort subsequently developed thyroid carcinoma. The distribution of thyroid carcinoma histologies in both the RT cohort and the non-RT cohort was similar to that in the female general population. Overall, there was no significant increase in the risk of thyroid carcinoma in either the RT cohort or the non-RT cohort compared with the general population; the SIR was 1.1 (95% confidence interval [95% CI], 0.8-1.6) for the RT cohort and 1.2 (95% CI, 1.0-1.4) for the non-RT cohort. When the RT cohort was compared with the non-RT cohort, the RR of thyroid carcinoma was 1.0 (95%CI, 0.7-1.5). CONCLUSIONS: The risk of radiation-associated thyroid carcinoma after initial RT for breast carcinoma was so low as to be undetectable in the current large population-based study. Continued monitoring of these women will be required to document that these findings are maintained with even longer follow-up periods. However, with 10,895 women having been followed for > 10 years at the time of last follow-up in the current study, these findings should be reassuring to women considering RT for their breast carcinoma. Therefore, women who have received RT for breast carcinoma require no special surveillance for their thyroid gland. Furthermore, previous breast radiation need not be a factor in determining the optimal management of thyroid nodules arising in women who received RT for breast carcinoma.

Adenocarcinoma, Follicular↗
PubMed1984

Leukemia incidence by occupation in the Portland-Vancouver metropolitan area.

During a 15-year period in an urban area with over a million inhabitants, we identified 1,678 cases of leukemia among residents aged 16 or older. Case finding was done according to the methods of the National Cancer Institute (NCI) SEER program. Usual occupation was coded by a system based on the U.S. Census Bureau classification. According to age-standardized incidence rates for persons aged 16-67, significant excess leukemia risks were found for 14 male and 8 female occupation categories, with the larger number of male excess risk situations due to nonlymphatic leukemia. Lymphatic leukemia risks were significantly elevated among dentists, school teachers of both sexes, auto mechanics, gas station attendants, female assembly workers, and female laundry and dry cleaning workers. Nonlymphatic leukemia risks were significantly elevated among machinists, other metal tradesmen, heavy equipment operators, textile operatives, meat cutters, cannery workers, construction laborers, freight and stock handlers, policemen, and firemen. Risks of both types of leukemia were significantly elevated among registered and practical nurses and lumber mill workers. This study has not identified specific etiologic agents and exposures, but applied investigations aimed at disease control by prevention of cases are now possible in this community. Nationwide surveillance and control are recommended.

Adolescent↗
PubMed1986

Recent trends in mesothelioma incidence in the United States.

Mesothelioma incidence rates based on data from population-based cancer registries in New York State (exclusive of New York City), Los Angeles County, California, and the SEER Program of the National Cancer Institute were analyzed for trends, using original cancer registry diagnoses. Results indicate a significant increase in incidence during 1973-80 for pleural mesothelioma among white males older than 55 at time of diagnosis but not for other age-race-sex-site subgroups. A histopathologic review of New York State and Los Angeles County cases by two independent pathologists, expert in the diagnosis of mesothelioma, lowered the overall estimates but a significant upward trend remained. The observed trend does not appear to be related to changes in diagnostic practice. The results of a five-member panel of expert pathologists will be published in a separate methodology paper.

Adolescent↗
PubMed2002

Decreasing incidence rates of primary central nervous system lymphoma.

BACKGROUND: Incidence rates of primary central nervous system lymphomas (PCNSL) in the U.S. were reported to have increased dramatically during the 1980s and early 1990s. Recent reports portray a continuation of this trend. With potential etiologic factors related to immunosuppression changing, the authors hypothesized that the incidence of PCNSL would be stabilizing. METHODS: The authors analyzed age specific, gender specific, and race specific PCNSL incidence rates from 1973-1998 using data from the Surveillance, Epidemiology, and End Results (SEER) program. To estimate the impact of the acquired immunodeficiency syndrome (AIDS) and organ transplantation on PCNSL trends, the authors evaluated incidence data from the Centers for Disease Control and Prevention HIV [human immunodeficiency virus]/AIDS Surveillance Report, and the United Network for Organ Sharing. RESULTSPCNSL incidence rates decreased from a peak of 10.2 per 1 million person-years in 1995 to 5.1 per 1 million person-years in 1998, a decrease that was largely attributable to a decrease in the incidence of the disease in males age or= 60 years essentially has remained unchanged since 1994, at approximately 16 per 1 million person-years. Since the early 1980s, regardless of age, PCNSL incidence rates were higher in males than in females, and higher in blacks than in whites. Concordant with PCNSL trends, AIDS rates have decreased since their peak in 1993. However, the rate of solid organ transplantations has increased steadily since 1990. CONCLUSIONS: In contrast to recent reports of a progressively increasing incidence, the authors found that PCNSL rates have been decreasing in the majority of demographic groups in the U.S since the mid-1990s. A notable exception was observed in the highest PCNSL risk group, those age >or= 60 years.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Existing data on breast cancer in African-American women: what we know and what we need to know.

BACKGROUND: Much of what is known about breast cancer in African-American (AA) women is based on existing cancer surveillance data. Thus, it is important to consider the accuracy of these resources in describing the impact of breast cancer in AA populations. METHODS: National cancer surveillance data bases are described, their most recent findings are presented, their limitations are outlined, and recommendations are made for improving their utility. RESULTS: Breast cancer characteristics have been studied well in urban (but not in rural) and Southern AA populations. The recent Surveillance, Epidemiology, and End Results (SEER) Program expansion and the continued improvement of state cancer registry operations will provide opportunities to study larger and more diverse AA subpopulations. Recommendations for improving the utility of surveillance data bases include adding new items to better describe correlates of advanced stage at diagnosis and reduced survival of AA women with breast cancer by linking surveillance data bases with other large data bases to provide area-level socioeconomic status, health insurance status, and retrieving new information about patient comorbidities and biomarkers from medical records; improving the completeness and accuracy of treatment and survival information already collected for all patients; working to improve the dissemination of appropriate cancer data to nonresearch consumer communities, including clinicians, patients, advocates, politicians, and health officials; and the development of new training programs for cancer registrars and researchers. CONCLUSIONS: The continued improvement of cancer surveillance systems should be considered important activities in this research agenda, because these data will play a far-reaching role in the prevention and control of breast cancer in AA women.

Black or African American↗
PubMed2003

A 5-decade analysis of 13,715 carcinoid tumors.

BACKGROUND: Carcinoid tumors represent an unusual and complex disease spectrum with protean clinical manifestations. This compilation of several large United States-based databases comprising patients from 1950 to 1999 examines 13,715 carcinoid tumors and provides epidemiologic information regarding the natural history and evolution of the detection and diagnosis of this entity. METHODS: The authors evaluated 10,878 carcinoid tumors that were identified by the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute (NCI) from 1973 to 1999 in addition to 2837 carcinoid tumors that were registered previously by two earlier NCI programs. To the authors' knowledge, this represents the largest current epidemiology series addressing carcinoid tumors to date. RESULTS: Specific trends in incidence for carcinoid tumors of certain sites were identified. Among the most recently collected subset of data, sites that demonstrated the greatest incidence of carcinoids were the gastrointestinal tract (67.5%) and the bronchopulmonary system (25.3%). Within the gastrointestinal tract, most carcinoid tumors occurred in the small intestine (41.8%), rectum (27.4%), and stomach (8.7%). For all sites, age-adjusted incidence rates were highest in black males (4.48 per 100,000 population per year). Associated noncarcinoid tumors were frequent in conjunction with small intestinal (29.0%), gastric (20.5%), colonic (20.0%), and appendiceal (18.2%) carcinoids. The highest percentages of nonlocalized lesions were noted for cecal (81.5-83.2%) and pancreatic (71.9-81.3%) carcinoids, whereas the highest percentage of localized disease was found among rectal (81.7%), gastric (67.5%), and bronchopulmonary (65.4%) carcinoids. The best 5-year survival rates were recorded for patients with rectal (88.3%), bronchopulmonary (73.5%), and appendiceal (71.0%) carcinoids; these tumors exhibited invasive growth or metastatic spread in 3.9%, 27.5%, and 38.8% of patients, respectively. CONCLUSIONS: Carcinoids appear to have increased in overall incidence over the past 30 years; for some sites, this trend has been evident for nearly half a century. Recent marked increases in gastric and rectal carcinoids and a concomitant decrease in appendiceal carcinoid incidence may be due in part to varying rules of registration among the compiled databases examined in this report or to improvements in diagnostic technology; increased awareness of and about carcinoid tumors also may play a significant role. In 12.9% of all patients with carcinoid, distant metastases already were evident at the time of diagnosis; the overall 5-year survival rate for all carcinoid tumors, regardless of site, was 67.2%. These findings bring into question the widely promulgated relative benignity of carcinoid disease. Certain carcinoid tumors, such as those of the rectum, appear to be over-represented among the black and Asian populations within the United States, suggesting the role of genetics in the development of this intriguing disease.

Carcinoid Tumor↗