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PubMed2006

Additional surgical intervention after radical prostatectomy, radiation therapy, androgen-deprivation therapy, or watchful waiting.

OBJECTIVES: The amount of additional surgical procedures that cancer patients undergo following their initial treatment is one means of measuring the impact that cancer and cancer treatment has on their quality of life. In this study we looked for treatment-related differences in the need for additional surgical intervention among men with nonmetastatic prostate cancer within 66 mo of their initial treatment. METHODS: Data for this study were from the National Cancer Institutes Surveillance, Epidemiology, and End Results (SEER) program and from the Medicare claims database. We searched the claims database for procedure codes indicating artificial urinary sphincter procedures, cystoscopy, urethral dilation, transurethral resection of the prostate (TURP) and bladder-neck incision, bladder irrigation/cystotomy, or nephrostomy. RESULTS: Of the 12,711 patients in our study, 3940 (31.0%) were initially treated by radical prostatectomy (RP), 3950 (31.1%) by radiation therapy (RT), 1209 (9.5%) by androgen-deprivation therapy (ADT), and 3612 (28.4%) by watchful waiting (WW). The percentage of patients who underwent cystoscopy 6-66 mo after their initial treatment ranged narrowly from 22% to 24% among members of the four treatment groups. In the RP group, 5.2% had artificial urinary sphincter procedures; 6.8% of the RT group, 8.2% of the ADT group, and 10.1% of the WW group had TURP/bladder-neck procedures compared with 3.7% of the RP group; and 12.5-16.2% of members in the four groups had urethral dilation procedures. CONCLUSIONS: Over one third of prostate cancer patients needed surgical intervention within 66 mo of their initial treatment despite the type of initial treatment.

Aged↗
PubMed2006

Secondary cancers after a lung carcinoid primary: a population-based analysis.

Carcinoid tumors of the lung were first described in 1937, yet little is known about their etiology. The aim of the present investigation was to determine if there was excess risk of secondary cancers in a population-based sample after a lung carcinoid tumor diagnosis which may provide insight to the etiology. Subjects were 1882 cases diagnosed with carcinoid tumors of the lung between 1988 and 2000 whose information was obtained from the Surveillance, Epidemiology and End Results (SEER) Program database. Standardized incidence ratios were calculated by dividing the observed number of second primary cancers by the expected number of cancers. Excess risk of breast cancer was seen following diagnosis of a carcinoid tumor (SIR=1.80 95% CI 1.22-2.55). When stratified by time after diagnosis, excess risk of breast cancers in women was seen in the first 5 years after carcinoid diagnosis (SIR=1.68 95% CI 1.08-2.50) but fewer than expected breast cancers were diagnosed greater than 5 years after carcinoid diagnosis (SIR=0.29 95% CI 0.09-0.68). Prostate cancers also occurred 2.8 times more often than expected (95% CI 1.66-4.43), with risk being elevated only in the first 5 years post-carcinoid diagnosis. Development of lung carcinoids may be the result of genetic predisposition or environmental exposures, particularly those that are hormonally related. The role of genetics and sex hormones in lung carcinoid development, as well as the identification of other risk factors, should be explored.

Breast Neoplasms↗
PubMed2006

Combinations of cytochrome P-450 genotypes and risk of early-onset lung cancer in Caucasians and African Americans: a population-based study.

Polymorphisms in CYP1A1 and CYP1B1 genes in humans are associated with reduction of enzymatic activity towards several substrates, including those found in tobacco smoke. To investigate the potential role these polymorphisms have as modulators of early-onset lung cancer risk, a population-based case-control study involving early-onset lung cancer cases was performed. Biological samples were available for 383 individuals diagnosed prior to 50 years of age identified from the metropolitan Detroit Surveillance, Epidemiology and End Results (SEER) program and 449 age, race and sex-matched controls ascertained through random digit dialing. Genotype frequencies varied significantly by race for CYP1A1 Ile(462)Val and CYP1B1 Leu(432)Val genotypes, so all analyses were stratified by race. No association was seen between lung cancer risk and polymorphisms in CYP1A1 Msp1 or CYP1B1 Leu(432)Val for Caucasians or African Americans, after adjusting for age at diagnosis, sex, pack years of smoking and family history of lung cancer. In Caucasians, those with the IIe/Val genotype at CYP1A1 Ile(462)Val locus were at decreased risk of having lung cancer compared to those with the lle/lle genotype, after adjusting for age at diagnosis, sex, pack years of smoking and family history of cancer (OR=0.41 95% Cl 0.19-0.90). These results were not replicated among the African American population, nor were they modified by amount of smoking.

Adenocarcinoma↗
PubMed2005

Untreated cervical cancer in the United States.

OBJECTIVE: To evaluate treatment patterns, including lack of treatment, among women diagnosed with cervical cancer in the United States. METHODS: Using the National Cancer Institute's (NCI's) Surveillance, Epidemiology, and End Results (SEER) program, we identified 13,715 women diagnosed with invasive cervical cancer between 1992 and 1999 and eligible for inclusion in the study. RESULTS: Nearly 9% of women diagnosed with invasive cervical cancer received no therapy for their disease. Lack of therapy was associated with a later stage of disease at diagnosis, older age, and unmarried status. More than 16% of women aged 65 and older with stage IIB/IV cervical cancer received no therapy for their disease. CONCLUSION: We must educate women diagnosed with cervical cancer and their families about the importance of treatment for potential cure and control of symptoms. We must identify and overcome obstacles that may prevent adherence to treatment recommendations. These may include comorbidity, access to cancer treatment, inability to pay for treatment, and inadequate social support.

Adult↗
PubMed2003

Older Asian Americans and Pacific Islanders dying of cancer use hospice less frequently than older white patients.

PURPOSE: Cancer is the leading cause of death among Asian Americans, yet little is known about their use of hospice care. We examined hospice use by Asian patients compared with white patients, and assessed whether utilization differs among those born in the United States or abroad. METHODS: We studied Asian and white Medicare beneficiaries registered in the Surveillance, Epidemiology, and End Results (SEER) Program who died of primary lung, colorectal, prostate, breast, gastric, or liver cancer between 1988 and 1998. We used logistic regression to determine the effects of race/ethnicity and birthplace on hospice use, adjusting for demographic characteristics, managed care insurance, year of diagnosis, tumor stage at diagnosis, and tumor registry. RESULTS: Of the 184,081 patients, 5% (n = 8614) were Asian Americans, of whom 45% (n = 3847) were foreign born. Compared with whites, Asian Americans were more likely to be male, married, and enrolled in managed care. Compared with U.S.-born Asian Americans, foreign-born Asian Americans were more likely to reside in low-income areas. After adjustment, patients who were Asian American (odds ratio [OR] = 0.67; 95% confidence interval [CI]: 0.62 to 0.73) and born abroad (OR = 0.90; 95% CI: 0.86 to 0.94) were less likely to use hospice care than were white patients. These results were consistent across the six cancer diagnoses that were examined. CONCLUSION: Older Asian Americans dying of cancer, especially those who are born abroad, are less likely than white patients to use hospice care at the end of life. Additional research is needed to understand the reasons for these differences and to eliminate potential barriers to hospice care.

Age Factors↗
PubMed1996

Concurrent hysterectomy at bilateral salpingo-oophorectomy: benefits, risks, and costs.

OBJECTIVE: To evaluate the medical and economic consequences of concurrent hysterectomy at the time of bilateral salpingo-oophorectomy (BSO) for benign ovarian disease in peri- and postmenopausal women. METHODS: Decision analysis was used to compare the health outcomes and economic costs of performing BSO with concurrent hysterectomy versus BSO alone in theoretic cohorts of 10,000 women undergoing surgery for benign adnexal disease. A model was constructed incorporating probabilities of possible outcomes from the National Hospital Discharge Database, the National Cancer Institute SEER Program, and the literature. Data on associated costs were obtained from the California State Discharge Database, Medicare, and the literature. RESULTS: Performing concurrent hysterectomy in a cohort of 10,000 45-year-old women would prevent approximately 71 future deaths from gynecologic disease at a cost of five immediate deaths from the surgery. However, short-term complications are much more frequent in women undergoing hysterectomy. On average, hysterectomy at age 45 adds approximately 0.071 years of life expectancy; at age 55, it adds 0.026 years. The procedure results in cost savings of approximately $1913 per patient at age 45 and $1112 at age 55. CONCLUSION: Concurrent hysterectomy causes short-term morbidity, but appears to increase average life expectancy slightly among perimenopausal women and is cost-saving. Medical outcomes and economic consequences only marginally favor the procedure. Patient preferences for the potential outcomes should play a key role in determining the appropriateness of its use.

Cohort Studies↗
PubMed1999

Radiation therapy and patient age in the survival from early-stage breast cancer.

PURPOSE: To analyze the use of radiation therapy following local excision of invasive localized breast cancer and subsequent survival by 5-year age category. METHODS: Data for 27, 399 women diagnosed with localized stage of breast cancer and treated with local excision surgery from 1983 through 1992 were collected and provided by the national Surveillance, Epidemiology, and End Results (SEER) program. Use of radiation therapy was analyzed by race, ethnic background, geographic location, and age at diagnosis. Survival for women treated with local excision plus radiation therapy was compared to that of women treated with local excision alone for each 5-year age category. RESULTS: Subjects in older age groups were significantly less likely (p < 0.001) to receive radiation following local excision compared to younger age groups. Statistically significant survival advantages were conferred on women receiving radiation therapy in each 5-year age category from age 35 to 84 years (ranging from p = 0.02 to p < 0.0001). CONCLUSION: While the use of radiation therapy following local excision of early-stage breast tumors drops significantly in older age groups, women aged 35-84 years receiving radiation therapy had significant reductions in mortality. These results did not appear to be influenced by the presence of mortal comorbid conditions. These results strongly suggest the need to consider carefully patient characteristics other than age in deciding the course of treatment for early-stage breast cancer.

Adult↗
PubMed1999

Validation of the Brief Pain Inventory in a Taiwanese population.

Assessment of pain in cancer patients is very important to all health care professionals. This paper describes the development of a Taiwanese version of the Brief Pain Inventory (BPI-T) and discusses its psychometric properties in Taiwan. The BPI-T was developed from the original BPI using back-translation and committee review. A total of 534 cytologically or pathologically diagnosed cancer patients in three medical centers in Taiwan were interviewed between July 1992 and October 1997. The intraclass correlation coefficient for the test-retest reliability was 0.79 for the pain severity scale and 0.81 for the pain interference scale. The explained variance for the within-scale factor analyses was larger than 60% in both scales. The coefficient alpha for the internal reliability was 0.81 for the severity scale and 0.89 for the interference scale. Confirmatory factor analysis of the BPI-T clearly identified the same two scales (severity and interference scales) in the 299 adult patients (age between 20-64) with high education (education years > 9) or patients at an early stage of disease. However, in the 235 nonadult patients with distant metastasis or low education patients with distant metastasis, the "most severe pain" item loaded more to the interference scale than the severity scale. Convergent validity of the pain severity was demonstrated by significant correlations with stage of disease (National Cancer Institute's Surveillance, Epidemiology, and End Results Program [SEER]), performance status (Eastern Cooperative Oncology Group [ECOG]), and pain interference. In conclusion, interviewer-administered BPI-T was a reliable instrument for cancer pain severity and its interference in Taiwan. Additionally, it was a valid instrument on adult cancer patients with high education or patients at an early stage of disease.

Adolescent↗
PubMed2000

Measuring the projected public health impact of lung cancer through lifetime and age-conditional risk estimates.

PURPOSE: Lifetime and age-conditional probability (risk) estimates of developing lung cancer in the United States are presented by age, race, and gender. Effects on the risk estimates of an aging population and changing tobacco use are identified. METHODS: Risk estimates were derived by applying cross-sectional, population-based incidence rates of malignant lung cancer and mortality rates from other causes to a hypothetical cohort. The cohort was aged through a double-decrement life table to determine the expected proportion of the population that would develop the disease across age intervals. Incidence and mortality data were obtained from the Surveillance, Epidemiology, and End Results (SEER) Program and the National Centers for Health Statistics, respectively. RESULTS: Among all cancers, risk estimates of developing lung cancer within 10 years, conditioned on being free of the disease at age 50, 60, or 70, ranked second to prostate cancer for men and second to breast cancer for women. For men, despite higher incidence rates of lung cancer for blacks than whites across most age groups, the risk of developing this disease over the life-span becomes similar, because white men are more likely to live to older ages where lung cancer is common. For women, lung cancer incidence rates are similar between Whites and Blacks, but an older age distribution among white women explains their greater lifetime risk of being diagnosed with the disease. Changes in the age distribution between the mid 1970s and the mid 1990s had little impact on the short-term risk estimates of developing lung cancer for younger ages but had a large influence on long-term risk estimates, particularly for the older age groups. CONCLUSIONS: Declining lung cancer among younger age groups may be attributed to declining tobacco use among the cohorts, but several more years may be required before the trends begin to fall in older age groups, particularly in women. In the meantime, an aging population is contributing to more people being diagnosed with lung cancer. Consequently, the projected risk of developing lung cancer will remain high for several years to come.

Adult↗
PubMed1999

Tamoxifen and risk of large bowel cancer in women with breast cancer.

BACKGROUND: The increasingly consistent association between estrogen replacement therapy and colorectal cancer suggests that the anti-estrogen tamoxifen may also be associated with large bowel cancer incidence. METHODS: Women with new diagnoses of breast cancer were identified from the Surveillance Epidemiology and End Results (SEER) Program, a set of geographically defined, population based cancer registries representing approximately ten percent of the U.S. population. Of 85,411 women with local or regional breast cancer diagnosed from 1983-90, 14,984 women were reported to have received hormonal therapy and 70,427 were not known to have received hormonal therapy. Subsequent cancer diagnoses were identified in this cohort beginning 6 months after initial breast cancer diagnosis until death, or December 31, 1994. Multivariate Cox proportional hazards models were used to estimate the risk of developing colorectal cancer and other second cancers according to hormonal therapy use. RESULTS: Over the follow-up period 793 colorectal, 2,648 contralateral breast, 506 endometrial, 250 ovarian, 98 gastric, and 1,765 other cancers were identified in the study cohort. While overall there was no association between hormonal therapy use and colorectal cancer (relative risk (RR) 1.09, 95% confidence interval (CI) 0.88-1.35), in the period five or more years after diagnosis, risk was increased significantly by about 50% (95% CI 1.00-2.15). As expected, based upon clinical trials data, cancers of the contralateral breast were significantly decreased, and cancers of the uterine endometrium were significantly increased. No other meaningful associations were observed. When women were excluded for whom hormonal therapy might represent therapy other than tamoxifen (premenopausal women and those who received chemotherapy), this did not meaningfully alter these estimates. CONCLUSIONS: The results of this large population based cohort study suggest that tamoxifen therapy may modestly increase risk of large bowel cancer in women, but only after 5 years following initiation of breast cancer therapy.

Age Factors↗
PubMed2000

Breast cancer following augmentation mammoplasty (United States).

OBJECTIVE: Although clinical reports have raised concern that breast implants may either increase the risk of breast cancer or delay its diagnosis, epidemiologic studies have generally shown implant recipients to be at a reduced risk of subsequent breast cancer. A large retrospective cohort study was undertaken to clarify effects of cosmetic breast implantation. METHODS: Medical records of 13,488 women receiving cosmetic implants at 18 plastic surgery practices and a group of 3936 patients who received other types of plastic surgery at the same practices were reviewed and information abstracted. Questionnaires were sent to all subjects located as alive, with 71% being completed. Attempts were made to obtain medical verification for all reported cancers and to obtain death certificates for deceased subjects. RESULTS: A total of 136 breast cancers were observed among the breast implant patients. External analyses, using general population rates from the Surveillance, Epidemiology and End Results (SEER) program, resulted in 152.2 cases expected and a standardized incidence ratio (SIR) of 0.9 (95% CI 0.8-1.1). A comparable SIR was found for the other plastic surgery patients (SIR =1.0, 95% CI 0.7-1.2). Internal analyses, directly comparing the implant patients with the other plastic surgery patients, showed a RR of 0.8 (95% CI 0.6-1.1). In neither the external nor internal analyses was there any systematic variation in risk by age or calendar year of initial implant. Risk also did not vary by years of follow-up or by type of implant. Risk was not affected by exclusion of patients who received their implants following surgery for benign breast disease. Although breast tumors tended to be detected at a somewhat later stage among the breast implant than the comparison patients, the difference was not statistically significant, nor was there any significant difference in breast cancer mortality between the two groups. CONCLUSIONS: Breast implants do not appear to alter the risk of subsequent breast cancer.

Adult↗
PubMed2000

Colorectal cancer incidence in Asian migrants to the United States and their descendants.

OBJECTIVES: To examine the incidence of colorectal cancer among Asian residents of the United States according to country of birth. METHODS: We determined the incidence of colorectal cancer during 1973-1986 among Asian residents in three areas of the western United States (Hawaii, San Francisco/Oakland SMSA, and western Washington state) in relation to country of birth. Numerators for the rates were obtained from the Surveillance, Epidemiology and End Results (SEER) program; a special tabulation of the 1980 US Census was used to estimate the size and composition of the population at risk. RESULTS: US-born Japanese men experienced incidence rates of colorectal cancer twice as high as foreign-born Japanese men and about 60% higher than those of US-born white men. Incidence among US-born Japanese women was about 40% higher than that among Japanese women born in Japan or US-born white women. Foreign-born Chinese men had about the same incidence of colorectal cancer as US-born white men, while US-born Chinese men experienced slightly reduced rates. Chinese women had rates that were generally 30-40% lower than that of US-born white women, regardless of place of birth. Incidence rates for both US-born and foreign-born Filipinos were 20-50% those of US-born whites. CONCLUSIONS: These findings suggest that one or more exposures or characteristics that differ between Japanese migrants and their descendants affect the development of colorectal cancer.

Adult↗
PubMed1998

Estimating lifetime and age-conditional probabilities of developing cancer.

Lifetime and age-conditional risk estimates of developing cancer provide a useful summary to the public of the current cancer risk and how this risk compares with earlier periods and among select subgroups of society. These reported estimates, commonly quoted in the popular press, have the potential to promote early detection efforts, to increase cancer awareness, and to serve as an aid in study planning. However, they can also be easily misunderstood and frightening to the general public. The Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute and the American Cancer Society have recently begun including in annual reports lifetime and age-conditional risk estimates of developing cancer. These risk estimates are based on incidence rates that reflect new cases of the cancer in a population free of the cancer. To compute these estimates involves a cancer prevalence adjustment that is computed cross-sectionally from current incidence and mortality data derived within a multiple decrement life table. This paper presents a detailed description of the methodology for deriving lifetime and age-conditional risk estimates of developing cancer. In addition, an extension is made which, using a triple decrement life table, adjusts for a surgical procedure that removes individuals from the risk of developing a given cancer. Two important results which provide insights into the basic methodology are included in the discussion. First, the lifetime risk estimate does not depend on the cancer prevalence adjustment, although this is not the case for age-conditional risk estimates. Second, the lifetime risk estimate is always smaller when it is corrected for a surgical procedure that takes people out of the risk pool to develop the cancer. The methodology is applied to corpus and uterus NOS cancers, with a correction made for hysterectomy prevalence. The interpretation and limitations of risk estimates are also discussed.

Adolescent↗
PubMed2002

The greater impact of menopause on ER- than ER+ breast cancer incidence: a possible explanation (United States).

OBJECTIVE: Analysis of 3359 Danish breast cancer cases indicated that menopause exerted a greater protective effect on estrogen-receptor negative (ER-) breast cancer than on estrogen-receptor positive (ER+) breast cancer. We examined US age-specific breast cancer rates by hormone receptor status in white and black women and men to investigate this unexpected result. METHODS: Age-specific breast cancer incidence rates from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute were analyzed by joint estrogen receptor and progesterone receptor (ER/PR) status of 101,140 white female and 8870 black female cases and by ER status in 706 white male and black male cases diagnosed from 1992 to 1998. Changes in the rate of increase in rates with age were identified using Poisson regression analyses. RESULTS: For both white women and black women the age-specific rates of ER- breast cancer cease increasing after 50 years of age, but age-specific rates of ER+ breast cancer continue to increase after 50 years of age. For men the incidence of ER- cancers may increase at a slower rate than incidence of ER+ cancers in older ages. In women the black rates of ER+ cancers are greater than white rates only until age 35, but black rates of ER- cancers are greater than white rates for all ages. CONCLUSIONS: Differences in age-specific breast cancer incidence patterns by hormone receptor status are similar for black women and white women. The incidence pattern for ER- cancers is consistent with a paracrine model for hormone-stimulated growth in normal breast tissue. The continued increase in ER+ cancers after menopause may be explained by both the paracrine growth model and an increase in the proliferation rate of ER+ cells with age.

Age Distribution↗
PubMed2002

Changing incidence of lobular carcinoma in situ of the breast.

Estimating the incidence of lobular carcinoma in situ (LCIS) of the breast is challenging because it lacks both clinical and mammographic signs and is usually an incidental finding in breast biopsies performed for other reasons. In general, population-based studies are believed to provide the most accurate measures, but few documenting changes in LCIS incidence rates over time have been reported. Age-adjusted age-specific LCIS incidence rates among women with no prior history of in situ or invasive breast carcinoma from 1978 to 1998 were obtained from nine population-based cancer registries that participate in the Surveillance, Epidemiology, and End Results (SEER) Program. Linear trends were evaluated using negative binomial regression. Overall, LCIS incidence rates increased fourfold (95% confidence interval, 2.9-5.6) over the study period. Specifically, they rose from 0.90/100,000 person-years in 1978-80 to 2.83/100,000 person-years in 1987-89, but then increased only modestly up to 1996-98 where the incidence rate was 3.19/100,000 person-years. However, among women 50-79 years of age, LCIS incidence rates increased continuously over the study's duration. In 1996-98, 50-59 year-olds had the highest incidence rate (11.47/100,000 person-years) and experienced the greatest absolute increase in incidence over the study period (9.48/100,000 person-years). LCIS incidence rates have steadily increased from 1978 to 1998 only among postmenopausal women. Further research is required to assess what factors are contributing to these trends.

Adult↗
PubMed2005

Cancer survival in Kampala, Uganda.

Epidemiological data on the occurrence of cancer in sub-Saharan Africa are sparse, and population-based cancer survival data are even more difficult to obtain due to various logistic difficulties. The population-based Cancer Registry of Kampala, Uganda, has followed up the vital status of all registered cancer patients with one of the 14 most common forms of cancer, who were diagnosed and registered between 1993 and 1997 in the study area. We report 5-year absolute and relative survival estimates of the Ugandan patients and compare them with those of black American patients diagnosed in the same years and included in the SEER Program of the United States. In general, the prognosis of cancer patients in Uganda was very poor. Differences in survival between the two patient populations were particularly dramatic for those cancer types for which early diagnosis and effective treatment is possible. For example, 5-year relative survival was as low as 8.3% for colorectal cancer and 17.7% for cervical cancer in Uganda, compared with 54.2 and 63.9%, respectively, for black American patients. The collection of good-quality follow-up data was possible in the African environment. The very poor prognosis of Ugandan patients is most likely explained by the lack of access to early diagnosis and treatment options in the country. On the policy level, the results underscore the importance of the consistent application of the national cancer control programme guidelines as outlined by the World Health Organization.

Adolescent↗
PubMed2004

Hepatitis C infection and the increasing incidence of hepatocellular carcinoma: a population-based study.

BACKGROUND AND AIMS: A significant increase in the incidence of hepatocellular carcinoma (HCC) has been reported in the United States. The risk factors underlying this increase remain unclear. METHODS: By using Surveillance, Epidemiology, and End-Results program (SEER)-Medicare-linked data, we conducted a population-based study to examine temporal changes in risk factors for patients 65 years and older diagnosed with HCC between 1993 and 1999. Only patients with continuous Medicare enrollment for 2 years before and up to 2 years after HCC diagnosis were examined. Univariate and multiple logistic regression analyses were used to evaluate changes in risk factors over time (January 1993-June 1996 and July 1996-December 1999). RESULTS: The age-adjusted incidence of HCC among persons 65 years of age and older significantly increased from 14.2 per 100,000 in 1993 to 18.1 per 100,000 in 1999. We identified 2584 patients with continuous Medicare enrollment 2 years before and up to 2 years after HCC diagnosis. The proportion of hepatitis C virus (HCV)-related HCC increased from 11% during January of 1993 to June of 1996 to 21% during July of 1996 to December of 1999, whereas hepatitis B virus (HBV)-related HCC increased from 6% to 11% ( P < .0001). In multiple logistic regression analyses that adjusted for age, sex, race, and geographic region, the risk for HCV-related HCC and HBV-related HCC increased by 226% and 67%, respectively. Idiopathic HCC decreased from 43% to 39%. This decrease did not fully account for the significant increases observed for HCV and HBV. No significant changes over time were observed for alcohol-induced liver disease, nonspecific cirrhosis, or nonspecific hepatitis. CONCLUSIONS: There has been a significant recent increase in HCV- and HBV-related HCC. Increasing rates of HCV-related HCC can explain a substantial proportion of the reported increase in HCC incidence during recent years.

Age Distribution↗
PubMed2001

Increasing incidence and mortality of primary intrahepatic cholangiocarcinoma in the United States.

Clinical observations suggest a recent increase in intrahepatic biliary tract malignancies. Thus, our aim was to determine recent trends in the epidemiology of intrahepatic cholangiocarcinoma in the United States. Reported data from the Surveillance, Epidemiology, and End Results (SEER) program and the United States Vital Statistics databases were analyzed to determine the incidence, mortality, and survival rates of primary intrahepatic cholangiocarcinoma. Between 1973 and 1997, the incidence and mortality rates from intrahepatic cholangiocarcinoma markedly increased, with an estimated annual percent change (EAPC) of 9.11% (95% CI, 7.46 to 10.78) and 9.44% (95%, CI 8.46 to 10.41), respectively. The age-adjusted mortality rate per 100,000 persons for whites increased from 0.14 for the period 1975-1979 to 0.65 for the period 1993-1997, and that for blacks increased from 0.15 to 0.58 over the same period. The increase in mortality was similar across all age groups above age 45. The relative 1- and 2-year survival rates following diagnosis from 1989 to 1996 were 24.5% and 12.8%, respectively. In conclusion, there has been a marked increase in the incidence and mortality from intrahepatic cholangiocarcinoma in the United States in recent years. This tumor continues to be associated with a poor prognosis.

Black or African American↗