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PubMed2003

The prevalence of patients with colorectal carcinoma under care in the U.S.

BACKGROUND: Prevalence usually is defined as the proportion of individuals alive who previously had a diagnosis of the disease, regardless of whether the individuals still are receiving treatment or are cured. The objective of this study was to estimate the proportion of elderly patients with colorectal carcinoma (CRC) in the U.S. that actually were receiving care for their disease as a better quantification of the burden of CRC. METHODS: The authors used data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program linked to Medicare claims. Four phases of CRC care were defined: initial diagnosis and treatment, postdiagnostic monitoring, treatment for recurrent/metastatic disease, and terminal care. CRC care prevalence measures by phase were extrapolated to the U.S. population age 65 years and older. RESULTS: For all patients with CRC who were diagnosed between 1975 and 1996, 62% received at least 1 service related to their CRC in 1996, and patients received an average of 2.1 months per person of CRC care. Among the U.S. population age 65 years and older, 1.81% had 1 diagnosis of CRC, and (1.81% x 0.62%) = 1.12% received at least 1 service related to their CRC. This translated to 380,783 individuals who received care and 1,210,121 person months of care during 1996. CONCLUSIONS: To the authors' knowledge, this is the first report in which care prevalence has been estimated directly. The classification of CRC care by phases of care provides a very detailed picture of the amount of care delivered in the U.S. population. Person-month estimates can be used to estimate the cost of CRC.

Aged↗
PubMed2004

Anal cancer incidence and survival: the surveillance, epidemiology, and end results experience, 1973-2000.

BACKGROUND: Anal cancer is a rare malignancy of the anogenital tract that historically has affected women at a greater rate than men. METHODS: The authors analyzed changing trends in incidence rates and 5-year relative survival percentages for patients with anal cancer. The publicly available data used in the current study were obtained from the Surveillance, Epidemiology, and End Results (SEER) Program, a system of population-based tumor registries in the United States. RESULTS: The incidence of anal cancer was similar for men and women between 1994 and 2000 (2.04 per 100,000 and 2.06 per 100,000, respectively), the most recent period for which data were available, whereas men had lower rates than did women between 1973 and 1979 (1.06 per 100,000, compared with 1.39 per 100,000), the earliest period for which data were available. In addition, recently, black men had higher incidence rates than did other race-specific and gender-specific groups (2.71 per 100,000). From the earliest period for which data were available to the most recent period, relative 5-year survival improved from 59% to 73% among women, was unchanged among men ( approximately 60%), and decreased from 45% to 27% among black men. Eighteen percent of patients who had distant disease were alive at 5 years, compared with 78% of patients who had localized disease. CONCLUSIONS: The incidence of anal cancer in the United States increased between 1973 and 2000, particularly among men. There were higher incidence rates and lower survival rates for black men compared with other race-specific and gender-specific groups. Later disease stage was inversely associated with the survival rate, indicating that earlier detection may improve the survival of patients with anal cancer.

Adult↗
PubMed2006

Variations in reconstruction after radical cystectomy.

BACKGROUND: Most urologists specializing in the management of patients with bladder cancer consider continent urinary diversion the reconstructive technique that affords the best quality of life after radical cystectomy. The authors sought to evaluate factors that predict reconstructive technique after radical cystectomy. METHODS: Using linked data from Medicare and the National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results (SEER) program, 3611 subjects were identified who underwent radical cystectomy for bladder cancer between 1992 and 2000. Multivariate logistic regression was used to identify factors independently associated with utilization of continent reconstruction after radical cystectomy, incorporating patient and provider variables. RESULTS: In multivariate analysis, the likelihood of continent diversion was inversely associated with older age (odds ratio [OR] < or = 0.68, P <.002), African American race (OR 0.43, P = .003), and higher comorbidity index (OR 0.71, P = .03), and directly associated with male sex (OR 1.45, P = .002), higher education level (OR 1.54, P = .03), and year of surgery (OR > or = 1.56, P < .001 for all year categories vs. 1992-1994). Treatment at academic (OR 1.43, P = .003) and NCI-designated cancer centers (OR 5.50, P <.001) and by high-volume providers (OR 1.49, P <.001) was independently associated with continent reconstruction. CONCLUSIONS: Disparities in the utilization of continent urinary diversion after radical cystectomy suggest that demographic, socioeconomic, provider-based, and clinical variables predict the likelihood that those undergoing radical cystectomy will receive continent reconstruction. Regionalization of bladder cancer care may ameliorate many of the disparities noted but must be balanced against the risk imposed by a delay in care.

Aged↗
PubMed2006

Differences in survival among patients with urachal and nonurachal adenocarcinomas of the bladder.

BACKGROUND: Primary adenocarcinomas of the bladder and urachus are rare malignancies, and knowledge of the patient demographics, pathologic characteristics, and survival associated with these tumors is poor. The current study compares disease-specific characteristics and survival associated with urachal and nonurachal primary bladder adenocarcinomas. METHODS: Incident cases of urachal and nonurachal primary adenocarcinomas of the bladder were identified from the Surveillance, Epidemiology, and End Results (SEER) Program. Demographic and pathologic characteristics at the time of diagnosis were compared. Risks of mortality among urachal and nonurachal primary adenocarcinomas of the bladder were compared using multivariate Cox regression. RESULTS: A total of 151 urachal and 1374 nonurachal adenocarcinomas of the bladder patients were identified. Compared to those with nonurachal tumors, patients with urachal adenocarcinoma were more likely to be younger (median age, 56 vs. 69 years, P <.0001) and female (45% vs. 36%, P = .02). Urachal lesions were less likely to be high grade (35% vs. 66%, P < .001), but more likely to involve distant metastases (30% vs. 15%, P < .001). Partial cystectomy was more common in urachal tumors (66% vs. 16%, P <.001). In multivariate analysis, subjects with urachal tumors had a lower risk of all cause (hazard ratio [HR] = 0.56, 95% confidence interval [CI]: 0.38-0.83) and disease-specific (HR = 0.59, 95% CI: 0.35-0.98) mortality compared with patients with nonurachal tumors. CONCLUSIONS. Urachal adenocarcinomas represent 10% of all primary adenocarcinomas of the bladder. Overall and disease-specific mortality risks are improved in patients with urachal lesions, even after controlling for numerous patient and tumor characteristics.

Adenocarcinoma↗
PubMed2006

Survival of men with clinically localized prostate cancer treated with prostatectomy, brachytherapy, or no definitive treatment: impact of age at diagnosis.

BACKGROUND: The optimal treatment for men with early stage prostate cancer remains undefined. Survival of such patients after surgery, brachytherapy, or no definitive therapy was investigated specifically to determine the impact of age at diagnosis. METHODS: In all, 60,290 men diagnosed with organ-confined, low and moderate grade prostate cancer between 1988 and 2002 were retrospectively identified from centers participating in the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program. Prostate cancer-specific mortality (PCSM) and any-cause mortality (ACM) were determined. Outcomes for patients treated by brachytherapy, surgery, or receiving no definitive treatment were compared using the Wilcoxon test, stratified by T-stage and grade, and using multivariate analysis. RESULTS: The median follow-up time was 46 months (range, 0-189 months). For men under age 60 at diagnosis, PCSM at 10 years was 1.3%, 0.5%, and 3.7% for surgery, brachytherapy, and no definitive therapy, respectively. For men age 60 and older the PCSM was 3.8%, 5.3%, and 8.4%, respectively. On univariate and multivariate analysis, surgery and brachytherapy resulted in statistically equivalent PCSM and ACM, and both had a significantly lower PCSM and ACM versus no definitive therapy. CONCLUSIONS: A better survival was observed in men treated with a definitive therapy. The magnitude of the benefit on PCSM or ACM was similar for both definitive therapies irrespective of age.

Adenocarcinoma↗
PubMedDate not supplied

Association between malignancies of the upper aerodigestive tract and uterine cervix.

Cancers of the cervix and buccal cavity share histologic, epidemiologic, and exposure characteristics. In particular, cigarette smoking and human papillomavirus (HPV) have been cited as etiologic cofactors of both malignancies. Using incidence data from the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute for the years 1973 through 1984, we evaluated the incidence of second cancers of the buccal cavity following an initial cervical cancer. Standardized incidence ratios (SIR) were uniformly elevated for both white (SIR = 2.0), and black (SIR = 3.5) women. There were also elevated risks for the development of cervical cancer following an initial buccal cavity cancer (SIRs = 3.3 and 2.5, respectively). A similar pattern was evident for laryngeal cancer among white women. HPV transmission could account in part for the paired occurrence of these two anatomically distinct cancer sites. Cigarette smoking could act as a synergistic cofactor in the malignant transformation of viral genome-harboring tissue.

Adult↗
PubMed2004

Is fibrolamellar carcinoma different from hepatocellular carcinoma? A US population-based study.

There have been no population-based studies of the epidemiology and prognosis of patients with fibrolamellar carcinoma (FLC). We conducted a retrospective cohort study using information collected by population-based registries of the Surveillance, Epidemiology, and End Results (SEER) program. The demographic features, stage at diagnosis, and type of therapy, as well as age-adjusted incidence rates and observed and relative survival rates were compared between persons with FLC and those with hepatocellular carcinoma (HCC) diagnosed between 1986 and 1999. A multivariate Cox proportional hazards model was constructed to examine the effect of histology (FLC vs. HCC) on the risk of mortality. There were 68 microscopically confirmed cases of FLC and 7,896 cases of HCC. FLC constituted 0.85% of all cases of primary liver cancer and 13.4% of all cases below the age of 40. Compared to HCC, patients with FLC were more likely to be younger (mean age 39 vs. 65), female (51.5% vs. 26.3%), and white (85.3% vs. 56.9%). A greater proportion of case with FLC had localized disease (41.2% vs. 30.9%), or received potentially curative therapy (resection, transplantation), compared to cases with HCC. The age-adjusted incidence rate for FLC was 0.02 per 100,000; No significant differences in age-adjusted incidence rates were observed by gender or race. The 1- and 5-year observed and relative survival rates were significantly longer in patients with FLC than HCC. The 5-year relative survival rate was 31.8% (95% CI, 20.5%-43.1%) for FLC, compared with 6.8% (95% CI, 6.3 %-7.4 %) for HCC. Adjusting for differences in age, gender, race, stage of disease, receipt of resection or transplantation, and time of diagnosis, FLC was independently associated with a 46% reduction in risk of mortality within 5 years compared with HCC. In conclusion, in a population-based study, we observed remarkable differences in the epidemiology and prognosis of FLC compared to HCC.

Adult↗
PubMed1999

Incidence of cancer in primary biliary cirrhosis: the Mayo experience.

Patients with primary biliary cirrhosis (PBC) may be at increased risk for malignancies. Several studies have addressed the risk of specific malignancies; however, there is little information about overall incidences of malignancies in these patients. We hypothesize that these patients may be at an increased risk for cancer. We performed a retrospective chart review evaluating patients with the diagnosis of PBC and malignancies. We reviewed records of patients with PBC presenting to the Mayo Clinic between 1976 and 1985. The diagnosis of PBC was made using evidence of cholestasis, positive antimitochondrial antibody titers and liver biopsy findings consistent with PBC. The incidence of malignancies were then compared with published data by the Surveillance, Epidemiology and End Results (SEER) program of the National Cancer Institute. Of the 1,692 patients with PBC in the Mayo Clinic data base, 114 patients were identified with primary cancer. The number of malignancies was higher than would be anticipated by chance alone; with 93 observed versus 62.4 expected events (P <.001). Hepatobiliary malignancies had a relative risk of 46 (P <.0001) for women and 55 (P <.0001) in men. There was a dramatic increased risk for development of hepatobiliary malignancies. PBC patients might benefit from more aggressive surveillance for hepatobiliary malignancies during their lifetime.

Adolescent↗
PubMed2002

Relationship of uveal and cutaneous malignant melanoma in persons with multiple primary tumors.

Uveal and cutaneous melanomas differ in tumor biology, immunophenotypes and the demographic correlates of their occurrence. As a means to examine the possibility of some shared etiologic factors, we wished to learn if the 2 cancers occurred in the same individual more often than would be expected by chance. Data from the Surveillance, Epidemiology and End Results (SEER) program from 1973-1998 were utilized for this purpose. The number of persons who went on to develop a second melanoma was compared to that expected based on the incidence of each type of melanoma in the general population, after adjusting for age, sex, calendar year and residence. Given an initial cutaneous melanoma, there was a 10-fold increased risk of developing a second cutaneous melanoma (95% confidence interval [CI] = 9.4-10.6). Persons with uveal melanoma went on to develop cutaneous melanoma 4.6 times (95% CI = 2.9-6.8) more often than the population at large. In contrast, persons with cutaneous melanoma were not subsequently diagnosed with uveal melanoma at an appreciably elevated rate (standardized incidence ratio [SIR] = 1.4; 95% CI = 0.5-3.0). While these data offer some support for the hypothesis that uveal and cutaneous melanomas have 1 or more etiologies in common, the lack of symmetry in the pattern of second uveal and second cutaneous melanomas remains unexplained.

Age Factors↗
PubMed1988

Ethnic patterns of thyroid cancer incidence in the United States, 1973-1981.

Descriptive epidemiological findings for 7,696 patients with newly diagnosed thyroid cancer reported to the Surveillance, Epidemiology, and End Results (SEER) program for the years 1973 through 1981 are summarized. The preponderance of this tumor in women and of the papillary histologic subtype are well documented. The data suggest that previously reported increases in the incidence of thyroid cancer among Whites levelled off in the late 1970s. Differences in the incidence of this cancer according to ethnic group were particularly striking. Compared with White men and women, Puerto Rico Hispanics and Blacks had significantly lower thyroid cancer rates (weighted rate ratios ranged from 0.48 to 0.65). New Mexico Hispanic men and Chinese, Japanese, Hawaiian and Filipino men and women had significantly higher rates (weighted rate ratios ranged from 1.56 to 3.17). Elevated thyroid cancer rates for residents of Hawaii, regardless of ethnic group, were also a noteworthy finding. Variations in thyroid cancer risk according to ethnic group and geographical residence may reflect socio-economic or local environmental influences, including the possibility of a carcinogenic agent in volcanic lava.

Adolescent↗
PubMed1991

Increasing incidence of cancers associated with the human immunodeficiency virus epidemic.

We examined data from San Francisco and other areas participating in the Surveillance, Epidemiology, and End Results (SEER) Program to determine the effect of the human immunodeficiency virus (HIV) epidemic on cancer incidence between 1973 and 1987. In this period, non-Hodgkin's lymphoma incidence has increased over 10-fold and Kaposi's sarcoma incidence has increased over 5000-fold in single San Francisco men 20 to 49 years of age. Increases in non-Hodgkin's lymphoma have been restricted to high-grade and diffuse large-cell (intermediate-grade) histological types. With the exceptions of non-Hodgkin's lymphoma and Kaposi's sarcoma, no other tumor has significantly increased in incidence. During 1987, we estimate that HIV-seropositive men in San Francisco had a 0.47% risk of developing non-Hodgkin's lymphoma and a 1.6% risk of developing Kaposi's sarcoma. The relative risks for non-Hodgkin's lymphoma and Kaposi's sarcoma associated with HIV infection were 104 and 40,000, respectively. For 1987, HIV was associated with 14% of all reported cancers (except non-melanoma skin cancer) in men aged 20 to 49. We expect that 1,890 to 2,730 excess cases of non-Hodgkin's lymphoma and 6,490 to 8,320 excess cases of Kaposi's sarcoma will occur in the United States in 1990.

Adult↗
PubMed1993

Age distribution of histologic types of breast carcinoma.

The large number of cases in the Surveillance, Epidemiology and End Results (SEER) program of the US National Cancer Institute allowed a detailed analysis of the age distribution of the histologic types of invasive breast carcinoma. Between ages 50 and 85 years in females, the age-specific incidence rate shows little change for medullary, inflammatory and apocrine carcinomas; is about doubled for Paget's disease and for ductal, lobular, tubular and metaplastic carcinomas; and increases to 4 to 8 times the menopausal level for mucinous, papillary and signet-ring-cell carcinomas. The peri-menopausal break on the age-incidence curve is most marked for carcinomas of predominantly lobular origin and virtually absent for carcinomas of predominantly ductal origin. In males, the age distribution of papillary carcinoma is similar to that of all types combined, whereas that of mucinous carcinoma is skewed towards older ages, as in females.

Adult↗
PubMed1995

Clinical characteristics of metachronous colorectal tumors.

A cancer-registry-based study was conducted to investigate the survival patterns associated with metachronous colorectal tumors and to compare the survival of patients with single and metachronous colorectal tumors. The study included all 1,396 White patients with metachronous colorectal tumors diagnosed among 143,283 patients with primary colorectal tumors reported between 1973-1986 to the SEER program. The influence on survival of age at diagnosis, site of tumor and stage was evaluated by means of multivariate survival analysis, using Cox Proportional Hazards Models. Metachronous tumors developed more often following left-colon tumors. Stage distribution of the second tumors was better than that of single 47% of the second tumors were discovered in regionally-advanced or distant-metastatic stages. Survival from the second tumor diagnosed in the rectum was worse than that of a single tumor in the same stage and site. Only the stage of the second tumor was found to influence survival from metachronous tumors. The relatively high rate of diagnosis of advanced second colorectal tumors may reflect either improper follow-up after the diagnosis of the first tumor, or more aggressive biological characteristics of the second tumors.

Aged↗
PubMed1995

Epidemiology of endometrial neoplasia.

Though among U.S. women endometrial cancer is the most common invasive gynecological cancer, it has a relatively favorable prognosis. From 1986-1990, approximately 19% of U.S. Surveillance, Epidemiology and End Results (SEER) Program cases were diagnosed in women less than 55 years of age; however, the age-specific incidence (per 100,000) peaked at 70-74 years (100.7), which was 2.85 times the rate reported at 50-54 years (38.9). The incidence under 50 years was 2.19 times higher in U.S. White compared with U.S. Black women; for uterine corpus cancers diagnosed at 50 years and older, the ratio declined but continued to be elevated in Whites (1.46). In contrast, average annual age-adjusted mortality (per 100,000) from 1986-1990 for uterine corpus cancer (1970 U.S. standard) was almost twice as high in U.S. Black women (6.0) as in U.S. White women (3.3). The determinants of age-specific elevated risks in mortality, in contrast to the lesser age-specific risks in incidence experienced by U.S. Black women compared with U.S. White women, may be explored with respect to socioeconomic and cultural factors that influence the distribution of epidemiologic risk factors such as reproductive history, choice of contraception methods, hormone replacement therapy, obesity, and dietary factors; age-specific prevalence of hysterectomy for other gynecological conditions; quality of medical care and surveillance practices; genetic factors influencing susceptibility; and tumor-associated biological factors. The majority of risk factors and medical conditions associated with endometrial cancer are related directly or indirectly to the levels and metabolic effects of the reproductive hormones, namely estrogens and progestogens. The molecular, genetic and epidemiologic characterization of endometrial cancer is attempting to delineate the multiple steps in the natural history of estrogen-induced or estrogen-responsive neoplasms.

Black or African American↗
PubMed1989

Incidence and anatomic distribution of cutaneous melanoma among United States Hispanics.

Using the data base for melanoma incidence compiled by the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute, we compared the incidence and anatomic distribution of primary cutaneous melanomas in Hispanic and non-Hispanic Caucasian populations and in blacks between 1973 and 1981. Cases were divided into United States whites, New Mexico (NM) whites (non-Hispanic Caucasians), NM Hispanics, Puerto Rico (PR) residents by definition Hispanic, and US blacks. Among whites, the highest incidence was 8.0 per 100,000 and was ten times that of US blacks. The incidence among PR and NM Hispanic residents was 1.6 to 3.7 times that of US blacks. The anatomic distribution among NM Hispanics was similar to US and NM whites for both genders. In contrast, among PR residents the anatomic distribution in both genders was most common for the leg, similar to that for blacks. Spaniards who migrated to PR have more admixture with blacks from Africa than Spaniards who migrated to the mainland. This suggests a genetic predilection for the occurrence of melanoma on the lower extremity among PR residents as opposed to NM Hispanics.

Arm↗
PubMed1992

A comparison of the clinical characteristics of second primary and single primary sarcoma: a population based study.

The clinical characteristics of 240 patients with sarcoma as a second metachronous primary neoplasm (SPN) were compared with those of 8,815 patients with sarcoma as a single tumor. The data were obtained from patients registered during the period 1973-1986 in the Surveillance, Epidemiology and End Results (SEER) Program in the United States. Seventy-four of the 240 SPN patients had postirradiation sarcoma (PIS) while the other 153 patients developed the sarcoma as a second tumor in an area which was not exposed to prior radiotherapy (non-PIS). The stage of disease at diagnosis was more advanced in patients with PIS than in those with single sarcomas but the difference did not reach statistical significance. Overall, in comparable clinical stage localized and regional disease there was no statistically significant difference in survival between PIS and non-PIS sarcoma patients after adjusting for age. The survival of patients with localized or regionally advanced sarcoma as a second tumor was significantly worse than of those with single sarcomas with the same stage. There was no difference in survival between first or second sarcomas with metastatic disease.

Adolescent↗
PubMed2003

Familial aggregation of prostate cancer in African-Americans and white Americans.

BACKGROUND: We compared the incidence of prostate cancer in first-degree family members of African-Americans with that in white Americans. METHODS: A historical cohort design was used to enroll 330 incident cases <80 years of age that were diagnosed at the Houston VA Medical Center between June 9, 1993 and June 8, 1996. We compared incidence rates in the probands' families with the incidence rates found in contemporaneous data from the national and regional Surveillance, Epidemiology, and End-Results (SEER) program. RESULTS: Three-hundred five probands (41% African-American) had evaluable first-degree relatives (394 African-American, 527 non-African-American). The standardized incidence ratio was 1.61 overall (95% confidence interval (CI): 1.22-2.13) and did not differ between African-American and non-African-American families: 1.58 (1.05-2.29) and 1.65 (1.06-2.45) in African-Americans and non-African-Americans, respectively. CONCLUSIONS: The similar level of familial aggregation is evidence that the higher incidence of prostate cancer in African-Americans is not attributable to a higher prevalence of germline mutations predisposing to the disease.

Adult↗
PubMedDate not supplied

Influence of extent of disease, histology, and demographic factors on lung cancer survival in the SEER population-based data.

Rates calculated from the Surveillance, Epidemiology, and End Results (SEER) Program are used to show variations in lung cancer survival by prognostic factors with an emphasis on the extent of disease and demographic variables. The analysis is based on 52,755 histologically confirmed cases of invasive lung cancer diagnosed from 1983 through 1987 and 51,377 cases diagnosed from 1977 through 1982. Females survived better than males. In general, white patients survived better than blacks. However, if both race and sex are considered together, black females survived better than white males and white females had the highest rates and black males the lowest. Age, however, proved to be the strongest predictor of survival of the demographic variables. Young females (< 45 years) with non-small cell lung cancer had an 81% 5-year relative survival rate compared to 44% for those 75 years and over. Survival for small cell lung cancer was lower than that for any other histologic type even when stratified on stage of disease (stages I and II, all stages). Survival for stages III and IV did not vary by histologic type. The histologic grade showed prognostic value only for patients assigned stage I. More detailed extent of disease information was used to show how often specific sites of distant metastases are seen at diagnosis. It also demonstrated the inter-relationship of the different extent of disease variables and their effect on outcome.

Adenocarcinoma↗