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PubMedDate not supplied

FIGO stage, histology, histologic grade, age and race as prognostic factors in determining survival for cancers of the female gynecological system: an analysis of 1973-87 SEER cases of cancers of the endometrium, cervix, ovary, vulva, and vagina.

The prognostic impact of FIGO stage, histology, histologic grade, age and race in survival for cancers of the female gynecological (cervix, endometrium, ovary, vulva, vagina) were examined using cases obtained from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program that were diagnosed between 1973 and 1987. Utilizing Cox proportional hazards modeling and relative survival rates analysis of 17,119 cases of cervical cancer indicated that the International Federation of Gynecology and Obstetrics (FIGO) stage, histology, histological grade, lymph node status, and age at diagnosis were all independently prognostic. No evidence was found of survival differences between squamous cell carcinoma and adenocarcinoma. Younger women were not found to have a poorer prognosis, survival declined with increased age. Analysis of 41,120 cases of endometrial cancer indicated that FIGO stage, histology, histologic grade, lymph node status, age at diagnostic, and race were all prognostic factors. Clear cell adenocarcinoma, leiomyosarcoma, and mixed mullerian tumors were all found to have poorer prognosis. Analysis of 21,240 cases of ovarian cancer indicated that FIGO stage, histology, histologic grade, lymph node status, age at diagnosis, presence of ascites, and race were all prognostically significant. Analysis of 2,575 cases of vulvar cancer indicated that FIGO stage, histology, histologic grade, age, and race were all prognostically significant. Analysis of 916 cases of vaginal cancer indicated that FIGO stage, histologic grade, lymph node status, and age are all prognostically significant. Additional analysis of the data by combinations of independent prognostic factors indicates that the interaction of factors may be more predictive of outcome than any one factor separately.

Adenocarcinoma↗
PubMed1993

Melanoma: linked temporal and latitude changes in the United States.

The rise in the incidence and mortality from melanoma of the skin is slowing down in younger age groups in the United States. In many White populations, including that of the US, melanoma incidence and mortality rates increase according to proximity of residence to the Equator. Variations with age in this gradient do not seem to have been examined. We examined how the influence of latitude on melanoma rates varied with age. Estimates of age-specific trends by time and by latitude for natural logarithm (Ln) melanoma incidence-rates from the Surveillance, Epidemiology and End Results (SEER) programs, and Ln melanoma mortality rates from the US Vital Statistics were derived from fitted regression equations. Unexpectedly, a decline from old age to youth in the influence of latitude was found for both incidence and mortality from melanoma of the skin in males, and for mortality in females. Further, these changes in the relationship to latitude with age correlated with the changes in time trends with age. The link with exposure suggests that the time trends in melanoma are driven by variations in damage to melanocytes in early life that increases sensitivity to sunlight. This has implications for the general understanding of melanoma etiology and for health education.

Adolescent↗
PubMed1995

Are increases in mammographic screening still a valid explanation for trends in breast cancer incidence in the United States?

A number of studies have attributed much of the sharp increase in breast cancer incidence in the United States during the 1980s to the increased detection through mammography. The most recent breast cancer data from the US National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program show that the incidence trend has slowed, while results from the National Health Interview Survey (NHIS) of 1987 and 1990 indicate that the percentage of women receiving mammograms continues to increase. This phenomenon suggested the need to reassess the relationship between increasingly early detection of breast cancer and overall incidence trends. A polynomial age-cohort model was used to establish the secular trend in incidence rates excluding the impact of recent increases in detection due to the rising use of mammography. Based on the model, the incidence trend in the youngest age group (40 to 49 years) would peak and then begin to decline in the early 1980s. This pattern would manifest itself later in successively older age groups as these younger cohorts age. Breast cancer trends are seen to be generally consistent with the impact of the increased use of mammography when its effect is superimposed upon the background of declining or slowing secular trends. These results support previous reports linking incidence rates with the increase in screening-mammography.

Adult↗
PubMed1991

The increasing incidence of breast cancer since 1982: relevance of early detection.

Breast cancer incidence in the United States has been rising dramatically since 1982, as shown in data collected by the Surveillance, Epidemiology, and End Results (SEER) Program. In women aged 50 and older, incidence rates for in situ and localized invasive tumors have increased over the period 1982-86, while rates for regional and distant tumors have remained stable. The incidence of localized tumors less than 1.0 cm, 1.0-1.9 cm, and 2.0-2.9 cm in size has increased more rapidly than that of tumors 3.0 cm or more in size among women over age 50. Survival rates also have improved among cases diagnosed over this time period. These data suggest that early detection may be playing a role in the recent increase in female breast cancer incidence, though other factors cannot be ruled out. Conclusions regarding improved cancer control await confirmation by reduced breast cancer mortality.

Breast Neoplasms↗
PubMed1993

Recent cohort trends in malignant melanoma by anatomic site in the United States.

The incidence of malignant melanoma has been increasing steadily in the United States. The increase may be due to lifestyle changes in subsequent generations or birth cohorts. The nine population-based tumor registries in the Surveillance, Epidemiology, and End Results program (SEER) have been in existence for a sufficient time to begin to investigate cohort trends for the US population. Cases were the 18,787 Caucasians aged 20 to 84 years, who reported to SEER registries with a diagnosis of melanoma in 1974-86. Among men born between 1890 and 1919, each subsequent five-year birth cohort experienced 45 to 57 percent increases in age-adjusted melanoma incidence of the arm and trunk, and 14 to 20 percent increases were experienced across each site (arm, leg, head, and trunk) for the 1920-44 cohorts of men. Among women born between 1890 and 1919, 24 to 29 percent increases were seen for melanoma of the trunk, arms, and legs for each subsequent five-year birth-cohort, followed by six to 29 percent increases in the 1920-44 cohorts. Recent birth cohorts, 1945-64, have shown stabilizing rates, even after an attempt to adjust for the increasing tendency for diagnoses to be made in doctors' offices. Thus, the dramatic birth-cohort effects appear to have ended beginning with those born in 1945. However, melanoma rates will continue to rise until those born after 1945 represent the majority of the population. Furthermore, for the most recent cohorts, the trunk has become the most common site (per square meter of body surface) for men and the second most common site for women.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Possible immunological implications of an association between the stages of first and second independent breast cancers.

Concepts regarding cell-mediated immunity and breast cancer are reviewed. Patients having in situ breast cancers have been found by in vivo and in vitro measurements to have cell-mediated immunity to autologous and homologous in situ breast cancer tissue which may last for some time after diagnosis. These observations suggest that antigenically similar cancers arising subsequently in the contralateral breast should be less likely to progress beyond the in situ stage and, if they do become invasive, should exhibit prognostically favorable signs of cell-mediated immunity, e.g. sinus histiocytosis in the lymph nodes and/or lymphoid infiltrate and perivenous lymphoid infiltrate associated with the primary tumor. Cell-mediated immunity has also been shown to be negatively associated with the stage of disease at diagnosis for invasive cancers, i.e. the proportion of patients exhibiting cell-mediated immunity decreases as the stage at diagnosis increases. These observations suggest that the stages of independent breast cancers occurring in the same woman should be positively correlated. Data from the SEER Program of the National Cancer Institute were examined in this regard and a strong positive association between the stage of first and second independent primary breast cancers was found with the effect on the stage of a second breast cancer following a the first invasive breast cancer appearing to decrease with time subsequent to diagnosis. These observations are consistent with the immunogenicity of breast cancer.

Age Factors↗
PubMed1999

Estimation of the target stem-cell population size in chronic myeloid leukemogenesis.

Estimation of the number of hematopoietic stem cells capable of causing chronic myeloid leukemia (CML) is relevant to the development of biologically based risk models of radiation-induced CML. Through a comparison of the age structure of CML incidence data from the Surveillance, Epidemiology, and End Results (SEER) Program and the age structure of chromosomal translocations found in healthy subjects, the number of CML target stem cells is estimated for individuals above 20 years of age. The estimation involves three steps. First, CML incidence among adults is fit to an exponentially increasing function of age. Next, assuming a relatively short waiting time distribution between BCR-ABL induction and the appearance of CML, an exponential age function with rate constants fixed to the values found for CML is fitted to the translocation data. Finally, assuming that translocations are equally likely to occur between any two points in the genome, the parameter estimates found in the first two steps are used to estimate the number of target stem cells for CML. The population-averaged estimates of this number are found to be 1.86x10(8) for men and 1.21x10(8) for women; the 95% confidence intervals of these estimates are (1.34x10(8), 2. 50x10(8)) and (0.84x10(8), 1.83x10(8)), respectively.

Adolescent↗
PubMed2005

Smoking-adjusted lung cancer incidence among Asian-Americans (United States).

OBJECTIVE: Chinese women residing in Asia and Hawaii have low consumption of tobacco but a high incidence of lung cancer. To explore this question further, we conducted a study of lung cancer among Chinese women residing in mainland US. METHODS: Using data from NCI's SEER program, we identified residents of Los Angeles County, the San Francisco Metropolitan Area, and the Seattle-Puget Sound Area who were 50 years or older, diagnosed with cancer of the lung or bronchus in 1999-2001, with race specified as non-Hispanic white (n = 18,493), Chinese (n = 853), Filipino (n = 615), or Japanese (n = 282). The sex-specific observed number of lung cancer cases among each Asian sub-group was compared to the expected number of lung cancer cases for each Asian sub-group. The expected number was determined by multiplying the age-, sex-, and geographic area-adjusted incidence rates for non-Hispanic whites by the age- and sex-specific ratio of percentage of current smokers in each Asian sub-group to whites in 1990, and then by the size of the respective Asian populations. RESULTS: Chinese women had a four-fold increased risk of lung cancer, and Filipino women a two-fold increased risk, compared to that expected based on rates in US non-Hispanic whites with a similar proportion of cigarette smokers. Lung cancer among Chinese, Filipino, and Japanese males, as well as Japanese females, did not deviate from expected risk. Among Chinese women, the increased risk was largely restricted to adenocarcinoma and large cell undifferentiated carcinoma. CONCLUSIONS: Chinese female residents of the western US mainland have a much higher risk of lung cancer than would be predicted from their tobacco use patterns, just as they do in Asia.

Adult↗
PubMed2006

Incidences and trends of second cancers in female breast cancer patients: a fixed inception cohort-based analysis (United States).

OBJECTIVE: To determine incidences and time trends of second cancers among female breast cancer patients. METHODS: Using data of the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program, we designed three inception cohorts: 1975-1977 (n=25,920), 1983-1985 (n=32,722) and 1991-1993 (n=40,819), and analyzed their incidences of second cancers during the first 8 years after initial breast cancer diagnosis. RESULTS: Between the 1970s and the 1990s, the incidence rate of malignant second cancer significantly increased among female breast cancer patients, of which second non-Hodgkin's lymphoma and kidney cancer increased by about 150%, while second cancers of the thyroid, uterine corpus and skin melanoma increased 80%, and cancer of the lung increased 50%. The patterns of trend of second cancers were somewhat similar to those of the general population except for second endometrial cancer at all ages and second leukemia and skin melanoma among young patients aged 20-49. In the 1990s, the risk ratios (RR) of all sites cancer were found to be 5.5 (95% CI=5.0-6.1) for age 20-49, 1.3 (1.3-1.4) for age 50-64, and 1.2 (1.1-1.2) for age 65 and over, comparing breast cancer patients to general population. Additionally, radiotherapy slightly increased the risks of second leukemia (RR=1.8, 1.2-2.8), and second endometrial (RR=1.3, 1.0-1.6) and breast (RR=1.2, 1.1-1.3) cancers. CONCLUSIONS: The fixed inception cohort method is valid for analyzing cancer registry-based second cancer data. By this method, we found that the incidence of second cancer has substantially increased among female breast cancer patients over the past 25 years. Observed changes in incidence may partially reflect the effect of treatments. Because the absolute number of affected patients is small, however, the breast cancer treatments have remained safe for most patients.

Adult↗
PubMed2006

Hypothesis: hair cover can protect against invasive melanoma on the head and neck (Australia).

The anatomic distribution of cutaneous melanoma reflects people's levels and patterns of sun exposure. While examining trends of incident invasive melanomas by site in recent decades in Australia we noted significant increases in incidence on the ears but not the face or any other site in women younger than 40 years, by 6% (95% confidence interval [CI] 2-10%) per year, and 40-59 years by 7% (95% CI 4-10%) per year. Men of the same age showed no corresponding changes in ear melanoma. However incidence rates of ear melanoma in general were fourfold higher in males than females in Australia. Further, using data from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) Program, rates of invasive melanoma on the ear were found to be sevenfold higher in males than females in the US population in the same period. Higher rates of scalp and neck melanomas were also seen in men and women in both populations. We therefore speculated that the isolated rises of ear melanoma in younger women in Australia, and the higher overall rates of ear, scalp and neck melanoma in men compared with women, reflect differences in hair coverage. We tested the specific hypothesis that hair cover reduces sun exposure of the ears using experimental manikins and found that hair cover of the ear reduced solar ultraviolet-B exposure by 81% [SE +/-8] compared with uncovered ears. We conclude that hair cover can protect against invasive melanoma on the ear and may similarly protect on the scalp and neck. When discretionary, hair may be an important additional factor to be considered for melanoma prevention.

Adult↗
PubMed2006

Projecting the number of patients with colorectal carcinoma by phases of care in the US: 2000-2020.

OBJECTIVE: This study provides projections of colorectal cancer prevalence by phases of care (initial, monitoring, and last year of life) to the year 2020 and describes the estimation method. METHODS: Cancer prevalence by phase of care was estimated from colorectal cancer incidence and survival from the Surveillance, Epidemiology, and End Results (SEER) Program data, population estimates and projections from the US Census Bureau, and all cause mortality data from the Human Mortality Life Tables. Assumptions of constant incidence and survival were used for projections from 2000 to 2020. Modeled and directly observed patient months by phase of care were compared for 1996 -1998 to provide validation of estimates. RESULTS: Prevalence of colorectal cancer is estimated to increase from 1,002,786 (0.36%) patients to 1,522,348 (0.46%) patients between 2000 and 2020. The estimated number of person-months in the initial and last year of life phases of care will increase 43%, while the monitoring phase of care will increase 54%. Modeled person-months by phase of care were consistent with directly observed measures of person months by phase of care in 1996-1998. CONCLUSIONS: Under assumptions of current cancer control strategies we project that colorectal cancer prevalence will increase more rapidly than the US population, largely due to the aging of the US population. This suggests that considerable resources will be needed in the future for initial, continuing and last year of life treatment of colorectal cancer patients unless notable breakthroughs in primary prevention occur in the future years.

Age Distribution↗
PubMed2004

Trends in colorectal cancer incidence and mortality in the Israeli Jewish ethnic populations.

BACKGROUND: Ashkenazi Jews, as compared to non-European Jews and non-Jews, are at increased risk for colorectal cancer (CRC), this is attributed to genetic susceptibility and/or lifestyle. AIMS: To follow Israeli long-term trends in CRC incidence and mortality and their associations with ethnicity. METHODS: All Israeli CRC data accumulated 1970-2001 was used, age standardized rates (adjusted to world standard population) was computed by cancer site, US Surveillance, Epidemiology and End Results Program (SEER) Stage and ethnic group (continent of birth: Europe-America, Asia, Africa, Israel). RESULTS: From 1970, CRC incidence increased 190% in males and 140% in females; mainly colon cancer (270% and 185% respectively) (P < 0.01), while rectal cancer incidence decreased and is now stable. Stage 3 CRC increased while stage 4 decreased significantly (P < 0.01 for both). In 2001, CRC incidence per 100,000 in European-American-born males was 48.3, Asian and African born 35.5 and Israeli born 32.7 (relative risk (RR) 1.36, P = 0.03), while European-American female rates were 35 and all the others 26 (RR 1.35, P < 0.01). Overall survival increased 9% over 30 years (P < 0.01), 5 years survival since 1988-1996 for European-American born was 43.1%, Asian 46.7%, African 47.5% and Israeli 55.8%. Stage-2 CRC 5 years survivals for 1970-1996 (most had no post surgical treatment) for European-American born were 41.7%, Asian and African 44.8% and Israeli 53.4% (P < 0.05). Stage-3 CRC survivals (most received adjuvant therapy in addition to surgery) for European-American born was 38.8%, Asian and African 43.3% and Israeli 45.1% (P < 0.01). CONCLUSIONS: Colon cancer has increased in Israel, mainly in males and European-American born. Israeli-born Jews (of 20 to 60% mixed ethnicity and lifestyle habits) have the lowest incidence and best survival data for stages-2 and -3 CRC. There is evidence of ethnic survival advantage and possibly in response to adjuvant oncological therapy.

Adult↗
PubMed1987

Black/white differences in bladder cancer patient survival.

Black bladder cancer patients have been found to have a substantially poorer survival experience than white patients; the 5-year relative survival rates are 71% for whites and 54% for blacks. To explore this difference in survival, data were analyzed on 4289 white and 380 black bladder cancer patients diagnosed during the period 1977-80 in three geographic areas covered by the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute. The orientation of the analysis was to identify variables, using multivariable procedures, that were not only prognostic but which also were important in regard to explaining black/white differences in patient survival. Such variables are referred to as explanatory variables. Three variables were analyzed in regard to their importance as explanatory variables, i.e. histologic type, stage, and histologic grade, and all were found to be of roughly equal importance. The effects of other factors on black/white differences in survival are also discussed including the possible importance of lead-time bias and the possible lack of diagnosis of the more benign forms of bladder cancer in blacks.

Black or African American↗
PubMed1991

High-risk populations as targets for breast cancer prevention trials.

Breast cancer risk factors include age; a family history of the disease in first-degree relatives (particularly if premenopausal with bilateral disease); proliferative benign breast disease with or without atypia; mammographic parenchymal pattern showing glandular, dense, dysplastic, or Wolfe P2 changes; and obesity. Women in these risk groups have annual breast cancer incidence rates 2 to 10 times higher than baseline. Using data from the National Cancer Institute SEER Program, the U.S. 1987 census estimates, and published prevalence and incidence estimates for breast cancer risk factors, estimates were made for the number of women in the white female population who are at increased risk for breast cancer and who might serve as suitable subjects for an antiestrogen chemoprevention intervention trial. More than 30 million white women are older than 50 years. Two million women older than 50 years have at least one first-degree relative with breast cancer. Six million women over age 50 have undergone breast biopsy for benign disease; one-fourth of these women have proliferative changes, and 11% also have a family history of breast cancer. More than 8 million women older than 50 years are obese, and at least a million older women have high-risk mammographic parenchymal patterns. Thus, there are at least 12 million women at increased risk for breast cancer in the United States, and each year 200,000 additional women enter the high-risk pool. These data indicate that sufficient numbers of women at increased risk for breast cancer are present in the population to justify a chemoprevention trial. The optimal recruitment strategy is yet to be identified.

Adult↗
PubMed1994

Racial and marital status influences on 10 year survival from breast cancer.

The association of race and marital status with survival during a 10 year period after a breast cancer diagnosis is described. The data for this study were obtained from the Metropolitan Detroit Cancer Surveillance System, a participant in the National Cancer Institute's SEER program. The study sample was 10,778 women (85.6% white and 14.4% black) diagnosed with incident invasive breast cancer between 1973 and 1978. Marital status was significantly associated with race, but had only a weak relationship with length of survival in a multivariate model predicting 10 year survival. However, race was strongly related to survival. African American women were significantly more likely than white women to die from breast cancer after controlling for age at diagnosis, marital status, tumor stage, histologic type, treatment status, and the interaction of age with stage. Ten years after being diagnosed with breast cancer, 38.2% of whites, compared with 33.3% of blacks were still living. These data confirm a body of literature which finds that blacks experience a shorter survival period following a cancer diagnosis than do whites. However, the relationship of marital status to cancer survival is still unclear and needs further study.

Adult↗
PubMed2005

Lifetime implications and cost-effectiveness of using finasteride to prevent prostate cancer.

PURPOSE: We estimate the lifetime implications of daily treatment with finasteride following the results of the Prostate Cancer Prevention Trial (PCPT). In this trial, prostate cancer prevalence was reduced by 25%; however, an increase in the number of high-grade tumors among the treatment group necessitates the long-term projection of the likely benefits and costs. METHODS: We use a Markov decision analysis model with data from the trial, the SEER program, and published literature. The model measures the cost per life-year and cost per quality-adjusted life-year (QALY) gained for a cohort of men age 55 years who initiate preventive treatment with finasteride. RESULTS: Finasteride is associated with a gain of 6 life-years per 1000 men treated at an incremental cost of 1660000 dollars per life-year gained. The quality-adjusted analysis results in 46 QALYs gained per 1000 men treated at an incremental cost of 200000 dollars per QALY gained, due primarily to the favorable effects of finasteride on benign prostatic hyperplasia. Under the assumption that the increase in high-grade tumors observed among finasteride treated men is a pathologic artifact, the incremental costs are 290000 dollars per life-year gained and 130000 dollars per QALY gained. CONCLUSIONS: The cost burden associated with finasteride is substantial, while its survival benefit is small and only realized many years after initiating treatment. To achieve an incremental cost below 100000 dollars per QALY gained, the price of finasteride must be reduced by 50% from its current average wholesale price and finasteride must be shown to prevent high-grade as well as low-grade disease.

Aged↗
PubMed2004

Prostate cancer mortality in Connecticut, Iowa and New Mexico African American men.

We sought to assess trends in prostate cancer incidence, treatment and mortality in African American men by means of analysis of prostate cancer data from three states, Connecticut, Iowa and New Mexico, all participants in the Surveillance, Epidemiology, and End Results (SEER) Program. Compared with levels before prostate specific antigen (PSA) testing, prostate cancer incidence increased in all three states after widespread testing. For men diagnosed with localized or regional prostate cancer, the respective increases in radical prostatectomy in Connecticut, Iowa, and New Mexico were 3.2, 2.3, and 4.9 times pre-test levels. Age-standardized mortality in Connecticut and Iowa increased slightly; in New Mexico the 104.7 deaths per 100,000 in 1979-1986, 62.1 in 1987-1990, dropped to 47.6 in 1991-1998, an amount of decline that was statistically significant. Introduction of PSA testing influenced early detection and treatment of prostate cancer in all three states. Although decline in prostate cancer mortality in New Mexico over time may be linked with use of the PSA test and definitive therapy, the relationship among these factors, and thus the proper treatment for the early stages of this condition, is unclear on the basis of these data.

Black or African American↗
PubMed2004

Standard cancer patient population for age standardising survival ratios.

Standard adult cancer patients populations are derived in this paper as a tool for the calculation of age-standardised cancer survival figures. Previously used standards in survival analysis have been site- and/or study-specific. Here, multivariate methods have been used to define the smallest possible number of general standard cancer patient populations which are simple to use and provide standardised survival values close to the raw ones for the largest possible number of cancer sites. The analysis was based on data for over 1.1 million cancer patients included in the EUROCARE-2 study. The proposed standard populations consist of three age distributions, appropriate for cancers with incidence patterns: (1) increasing with age - the vast majority of cancers; (2) broadly constant with age and (3) mainly affecting young adults. The three standard distributions are presented by both broad and five-year age classes. The latter can be used to determine which of the three standards would be used for sites not included in the cluster analysis because their survival is generally calculated in unusual age groups. Overall, standard 1 is appropriate for over 91% of cases, standard 2 for just over 7%, and standard 3 for less than 2%. The proposed standards were tested on European (EUROCARE-2 and EUROCARE-3) and US (Surveillance, Epidemiology and End Results Program, SEER) relative survival data. There was very good correspondence between the raw (population weighted) and age-standardised survival figures.

Adolescent↗