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PubMed1992

Death rates of malignant melanoma among white men--United States, 1973-1988.

Since 1973, death rates for malignant melanoma (International Classification of Diseases, Ninth Revision, codes 172.0-172.9) have increased in the United States and other countries; this increase has occurred disproportionately among white men. To develop hypotheses on the etiology of this increase, the Boston University Schools of Medicine and Public Health and CDC reviewed data from the Surveillance, Epidemiology, and End Results (SEER) Program for the National Cancer Institute and other existing databases. This report summarizes patterns of malignant melanoma among whites in the United States from 1973 through 1988 and suggests possible causes for these patterns.

Adult↗
PubMedDate not supplied

Estimating cancer mortality rates from SEER incidence and survival data.

A method to estimate site-specific cancer mortality rates using Surveillance, Epidemiology, and End Results (SEER) Program incidence and survival data is proposed, calculated, and validated. This measure, the life table-derived mortality rate (LTM), is the sum of the product of the probability of being alive at the beginning of an interval times the probability of dying of the cancer of interest during the interval times the annual age-adjusted incidence rate for each year that data have been collected. When the LTM is compared to death certificate mortality rates (DCM) for organ sites with no known misclassification problems, the LTM was within 10 percent of the death certificate rates for 13 of 14 organ sites. In the sites that have problems with the death certificate rates, there were major disagreements between the LTM and DCM. The LTM was systematically lower than the DCM for sites if there was overreporting on the death certificates, and the LTM was higher than the DCM for sites if there was underreporting. The limitations and applications of the LTM are detailed.

Cause of Death↗
PubMed1986

Cumulative incidence rates for Hodgkin's disease and other hematologic malignancies, with special reference to age-related carcinogenesis.

The cumulative incidence rate throughout the life span was analyzed for 4,865 Hodgkin's disease cases, in comparison with 16,015 malignant lymphomas (ML), 1,694 acute lymphocytic leukemias (ALL), 3,967 acute myeloid leukemias (AML), 2,109 chronic myeloid leukemias (CML), and 4,752 chronic lymphoid leukemias (CLL) in US white reported in the SEER program during 1973-1981. A log-linear increase was observed in ML, AML, CML, and CLL throughout the life-span, but only in childhood in ALL. Hodgkin's disease showed a steep increase until age 20-24, and then the increase became much more gradual. The cumulative incidence rates for males and females were parallel for ML and leukemias, but diverged for Hodgkin's disease (the rate for females had a lower slope than that for males after age 20-24). This difference was mainly caused by a lower frequency in females of mixed cellularity and lymphocyte predominance subtypes. The incidence curve of Hodgkin's disease was consistent with the two-stage model of carcinogenesis; it is likely that the proliferation of progenitor cells peaks at a young age and that the death rate of so-called intermediate cells is a primary influence during the subclinical stage. The cytogenesis of Hodgkin's disease and the histologic variation with special reference to the T-zone histiocytes suggest that a strong host defense mechanism against neoplastic change is involved, rather than different etiologic influences.

Adolescent↗
PubMed1986

Ethnic patterns of Hodgkin's disease incidence among children and adolescents in the United States, 1973-82.

The descriptive epidemiologic findings were summarized on 1,109 patients (white, black, and Hispanic) under 20 years of age who were diagnosed with Hodgkin's disease as reported to the Surveillance, Epidemiology, and End Results ("SEER") Program of the National Cancer Institute from 1973 to 1982. Across all ethnic strata, incidence rates increased with advancing age at diagnosis, with white adolescents 15-19 years old exhibiting the highest rates (male, 3.67; female, 4.18). Gender difference among children 0-14 years of age was most evident in blacks (male:female ratio: 4.0 for blacks, 1.0 for whites). Highest adolescent:childhood ratios of incidence rates were noted for females (5.81 for whites and 8.29 for New Mexico Hispanics) and lowest, for Hispanic males (1.25, New Mexico; 2.15, Puerto Rico). Whites exhibited the highest percentage of the nodular sclerosis histologic subtype (65%) and Hispanics, the lowest (45%). Conversely, Hispanics had higher rates of histologic types associated with a poorer prognosis (mixed cellularity and lymphocyte depletion). These differing age and histologic patterns were consistent with previously described international patterns of disease occurrence. Analysis of secular trends for whites from 1969 to 1982 revealed relatively stable rates for youngest ages and male adolescents. Rates increased over time for white female adolescents, but the trend was not statistically significant.

Adolescent↗
PubMed1985

Screening geographic areas for unusual survival experience or stage at diagnosis with application to breast and colon cancer.

An approach was devised for the problem of detecting geographic areas with poor survival for cancer patients. Methods were proposed to deal with the two major sources of variability in summary survival measures for geographic areas: the distribution of prognostic factors for individuals within an area and random variation. In addition, small geographic areas often had to be combined so that a sufficient number of cases could be obtained in each area for calculation of survival statistics, and a procedure for doing so was developed. Then stage-specific and overall 5-year survival estimates for each geographic area were converted to standardized normal deviates so that outlying observations could be detected using the theory of normal-order statistics. A similar approach was used to determine which geographic areas had unusually high proportions of advanced disease at diagnosis. Our outlier detection procedure was designed for screening available data for geographic areas possibly deserving further study rather than for concluding that survival or staging was substandard in those areas. Methods were applied to data from the Surveillance, Epidemiology, and End Results (SEER) Program for breast and colon cancer. For each cancer site, some geographic areas were identified with unusual survival or stage distributions.

Breast Neoplasms↗
PubMed1995

The role of Hispanic race/ethnicity and poverty in breast cancer survival.

The association of Hispanic race/ethnicity and poverty with general survival time and breast cancer survival time was examined for a total of 14,896 breast cancer patients (14,035 White and 861 Hispanic) included in the National Cancer Institute Surveillance Epidemiology and End Results (NCI SEER) program in New Mexico and San Francisco between 1975 and 1984. Variables examined included: age, marital status, stage at diagnosis, tumor histology, delay, treatment, period of diagnosis (1975-79 vs. 1980-84), and poverty. Univariate analysis of 14,896 patients indicated that a greater proportion of Hispanics (vs. Whites) with breast cancer were: younger than age 50, married, diagnosed at a later stage, diagnosed in New Mexico, lived in greater poverty, were diagnosed between 1980-84, and died from breast cancer. Univariate Cox Proportion Hazards analysis indicated that poverty was a significant predictor for reduced general survival time. Being diagnosed in the 1980-84 period was a predictor for improved general survival time. Poverty and Hispanic race/ethnicity were significant predictors of reduced breast cancer survival time. Multivariate Cox Proportional Hazards models indicated that Hispanic race/ethnicity was a significant risk factor for breast cancer survival time for women aged 50 and older. For White women: state, marital status, poverty, surgery, radiation/hormonal treatments, and histology were significant risk factors for breast cancer survival time. For Hispanic women: stage, surgery, hormonal treatment and period of diagnosis were significant risk factors for breast cancer survival time. For White breast cancer patients, period of diagnosis was not a significant risk factor for reduced breast cancer survival time; but for Hispanics, it was a significant risk factor. In the age and race/ethnicity-stratified models of breast cancer survival time, similar risk factors emerged for both Whites and Hispanics. For both younger and older Hispanics, being diagnosed in the early 1980's (vs. the late 1970's) was associated with reduced breast cancer survival time--vs. Whites, who experienced no significant change in breast cancer survival time in the same time period. Poverty was not a predictor for Hispanic survival time in any of the models; however, it was a predictor for younger Whites for breast cancer survival time. These results fueled discussion in three areas targeting breast cancer in underserved women: the development of racial/ethnic-specific cancer control guidelines, the development of a breast cancer integrated delivery system, and population management.

Adult↗
PubMed1995

Benefits and costs of screening and treatment for early breast cancer. Development of a basic benefit package.

OBJECTIVE: To develop a basic benefit package for detection and treatment of early breast cancer by evaluating the effectiveness and costs for screening mammography, primary surgery, adjuvant therapy, and follow-up care. DATA SOURCES: Published articles were retrieved through MEDLINE; additional articles were obtained through searches of their bibliographies. Cancer statistics were taken from Surveillance, Epidemiology, and End Results (SEER) Program data, population statistics were taken from US Census data, and charges from 1993 Southern California Medicare fees were used to represent costs. STUDY SELECTION: Studies were selected on the basis of their design. Preference, in decreasing order, was given to meta-analyses of randomized trials, individual randomized clinical trials, prospective cohort studies, retrospective cohort studies, and case series. DATA EXTRACTION: Studies were examined for the effect of the intervention on overall survival, disease-free survival, and health-related quality of life. We evaluated effects on survival in terms of number of lives saved at 10 years and average years of life saved. Costs were related to the benefits observed and modeled onto a hypothetical health care organization of 500,000 lives. RESULTS: Based on this analysis, we recommend a basic benefit plan for the detection and treatment of early breast cancer that would include the following: (1) screening mammography only for women aged 50 to 69 years; (2) choice of mastectomy or breast-conserving surgery with radiation therapy for all women with early breast cancer; (3) adjuvant therapy for all women at risk of recurrence; and (4) only clinical follow-up without routine testing for metastatic disease. CONCLUSIONS: By choosing which services they provide to specific groups of patients, providers can substantially reduce their expenses and still provide quality health benefits.

Adult↗
PubMed1994

Trends in breast cancer in younger women in contrast to older women.

Using data from the Surveillance, Epidemiology, and End Results (SEER) Program and the National Center for Health Statistics, trends in female breast cancer rates were examined for the time period 1973-1989 for the age group 20-39 and contrasted with those for older ages. Only about 7% of breast cancers occur by the age of 40; the risk of developing breast cancer prior to the age of 40 is less than 1%. The incidence trends for women in the 20-39 age group have been essentially stable, whereas for women 40 and older the rates increased steeply during the 1980s (at a faster rate than anticipated based on historical trends) and then leveled off beginning in 1987. Breast cancer mortality has been much more stable over time than incidence. Up to age 40, blacks have a higher incidence than whites. Over age 40, white rates exceed those for blacks, and the absolute and relative differences in incidence increase with advancing age. For whites, 5-year relative survival rates improved with advancing age up to age 50. Blacks under the age of 30 had survival rates similar to whites, whereas, in the older age groups, whites had somewhat better survival rates overall and by stage. The occurrence of second cancers was also analyzed in women with a first invasive breast cancer. Cancers found to occur at higher than expected rates included leukemia and cancers of the breast, ovary, and lung.

Adult↗
PubMed1994

Deaths from breast cancer--United States, 1991.

Breast cancer is the most commonly diagnosed cancer and the second leading cause of cancer death among women in the United States. For 1990, the National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results Program (SEER) reported that the incidence of breast cancer was approximately 109 per 100,000 women. The annual incidence of breast cancer among women increased approximately 52% during 1950-1990, while the death rate increased 4% during the same period. This report summarizes epidemiologic information about deaths from breast cancer in 1991 and describes mortality trends during 1980-1991.

Adult↗
PubMed1994

[Trends of lung cancer incidence and its prognosis in Osaka, Japan].

Lung cancer incidence figures in Japan were estimated as 30,000 for males and 11,000 for females for 1989 and represented the second and the fifth leading site of cancer, respectively, according to the Research Group for Population-based Cancer Registration in Japan. It is also estimated that lung cancer will steadily increase in the future. In relative frequencies of the major histological types, squamous cell carcinoma showed a decreasing trend, while small as well as large cell carcinomas showed an increasing trend in Osaka. In the distribution of clinical staging, the proportion of localized cases accounted for only 20% of the lung cancers in 1990. Five-year relative survival rates for lung cancer were 11.3% for all patients and 43.0% for localized cases in Osaka in 1984-1986. The rates were reported as 13.5% and 36.6% for total patients and localized cases, respectively, among caucasians from the SEER Program, a NCI project including 10 population-based cancer registries in the US. No noticeable difference was observed between Japan and the US. To control lung cancer in Japan it is considered vitally important and urgent to develop (1) new examination methods for diagnosing lung cancer in the earlier stage, (2) an efficient and effective cessation campaign for cigarettes smoking and (3) non-smoking based education.

Carcinoma, Squamous Cell↗
PubMed1996

Cancer incidence in United States Air Force aircrew, 1975-89.

UNLABELLED: We compared the cancer incidence of male United States Air Force (USAF) aircrew (342 cancers, 532,980.97 man-years) with non-flying Air Force officers (827 cancers, 1,084,370.08 man-years) between 1975-89. METHODS: Incident cancer cases for both aviators and non-flying officers were obtained from USAF hospitalization records. Age-adjusted standardized incidence ratios (SIR's) were calculated for aircrew using data from the National Cancer Institute's Surveillance Epidemiology and End Results (SEER) program. Aviator age-adjusted cancer rate ratios were also obtained using non-flying officers as an internal comparison group. RESULTS: We observed statistically significant excesses of aircrew cancers for all sites, testis, and urinary bladder. All other aviator cancer classifications were not significantly different from the comparison cohort; most notably, cancers of the colon and rectum, skin (both malignant melanoma and non-epithelial), brain and nervous system, Hodgkin's Disease and leukemias. CONCLUSION: Previous studies of commercial pilots that demonstrated excesses of these cancers may have been biased by the use of external comparison groups. We used an internal comparison population to reduce selection bias, information bias and confounding. From these data we detected notable excess aircrew cancer risk for cancers of the testis, urinary bladder, and all sites combined.

Adult↗
PubMedDate not supplied

Probability of developing or dying of cancer United States, 1991.

Since the mid-1960s, the proportion of deaths from the leading cause of U.S. mortality, heart disease, has decreased fairly steadily. The proportion of cancer deaths has risen over the same period, however, from 16.3 percent in 1965 to 23.7 in 1991. Public awareness of this increase has resulted in questions being raised about the probability of developing or dying of cancer. Analyses of published data in the 1973-1991 Surveillance, Epidemiology and End Results (SEER) program of the National Cancer Institute estimated a person's lifetime risk of developing or dying of cancer. The lifetime risk of developing cancer is 44.8 percent for men and 39.3 percent for women. For both sexes, the risk of dying of lung cancer is higher than for any other cancer.

Adolescent↗
PubMedDate not supplied

Monitoring health care in the United States--a challenging task.

Surveys have provided magnificent information about the health of the American people, but they rarely contribute to our understanding of how medical services affect people's health. The authors explore the opportunity to harness the medical services system to provide information that clarifies the relationship between people's health and the services they receive. They also note the risk posed by managed care-that competition and cost-cutting may pit the health industry against access to and standardization of health services data--but see hope in recent legislation.

Aged↗
PubMed1998

Changing patterns in the incidence of esophageal and gastric carcinoma in the United States.

BACKGROUND: Incidence rates for esophageal adenocarcinoma previously were reported to be increasing rapidly, especially among white males. Rates for gastric cardia adenocarcinoma also were observed to be rising, although less rapidly. In this article, the authors update the incidence trends through 1994 and further consider the trends by age group. METHODS: Surveillance, Epidemiology, and End Results (SEER) program data were used to calculate age-adjusted incidence rates for esophageal carcinoma by histologic type and gastric adenocarcinoma by anatomic subsite. RESULTS: Among white males, the incidence of adenocarcinoma of the esophagus rose > 350% since the mid-1970s, surpassing squamous cell carcinoma around 1990. Rates also rose among black males, but remained at much lower levels. To a lesser extent, there were continuing increases in gastric cardia adenocarcinoma among white and black males, which nearly equaled the rates for noncardia tumors of the stomach in white men. The upward trend for both tumors was much greater among older than younger men. Although the incidence also rose among females, rates remained much lower than among males. CONCLUSIONS: Previously reported increases of esophageal adenocarcinoma are continuing, most notably among white males. Cigarette smoking may contribute to the trend through an early stage carcinogenic effect, along with obesity, which may increase intraabdominal pressure and predispose to gastroesophageal reflux disease. Further research into esophageal and gastric cardia adenocarcinoma is needed to clarify the risk factors and mechanisms responsible for the upward trends as well as the racial and gender disparities in incidence.

Adenocarcinoma↗
PubMed1999

Cancer surveillance series: interpreting trends in prostate cancer--part II: Cause of death misclassification and the recent rise and fall in prostate cancer mortality.

BACKGROUND: The rise and fall of prostate cancer mortality correspond closely to the rise and fall of newly diagnosed cases. To understand this phenomenon, we explored the role that screening, treatment, iatrogenic (i.e., treatment-induced) deaths, and attribution bias (incorrect labeling of death from other causes as death from prostate cancer) have played in recent mortality trends. METHODS: Join point regression is utilized to assess the recent rise and fall in mortality and the relationship of total U.S. trends to those areas served by the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Cancer Registry Program. Incidence-based mortality (IBM) is estimated with the use of prostate cancer data from the SEER Program to partition (from overall prostate cancer mortality trends) the contribution of cases diagnosed since the widespread use of prostate-specific antigen (PSA) testing starting in 1987. IBM is also used to examine the contribution of stage at diagnosis to the recent prostate cancer mortality trends. RESULTS: IBM for cases diagnosed since 1987 rose above the pre-1987 secular (i.e., background) trend, peaked in the early 1990s, and almost returned to the secular trend by 1994. This rise and fall of IBM track with the pool of prevalent cases diagnosed within the prior 2 years. IBM for cases diagnosed with metastatic disease fell starting in 1991, while IBM for those diagnosed with localized/regional disease was relatively flat. CONCLUSIONS: The rise and fall in prostate cancer mortality observed since the introduction of PSA testing in the general population are consistent with a hypothesis that a fixed percent of the rising and falling pool of recently diagnosed patients who die of other causes may be mislabeled as dying of prostate cancer. The decline in IBM for distant stage disease and flat IBM trends for localized/regional disease provide some evidence of improved prognosis for screen-detected cases, although alternative interpretations are possible.

Age Distribution↗
PubMed2003

Favorable cardiac risk among elderly breast carcinoma survivors.

BACKGROUND: There are two reasons why women who survive breast carcinoma may be at a lower risk of developing coronary heart disease (CHD) compared with women without a history of breast carcinoma. First, estrogens may be etiologic in the development of breast carcinoma and protective of CHD. Second, a common therapy for breast carcinoma (tamoxifen) may be associated with cardiac protection. METHODS: In this population-level cohort study, the authors analyzed data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER)-Medicare program to study the cardiac risk of elderly female Medicare beneficiaries with and without a history of breast carcinoma. Using the SEER file, the authors identified elderly women survivors of Stage 0, I, or II breast carcinoma (n = 5980) diagnosed between the ages of 55 and 64. Using the Medicare 5% noncancer file, the authors also identified elderly women without a history of cancer (n = 23,165). They followed women from age 67 for up to 5 years for hospitalization for acute myocardial infarction (AMI) through a review of Medicare claims. The authors controlled the analyses for race, socioeconomic status, geographic location, cohort entry year, and medical comorbidity. RESULTS: The hazard of hospitalization for AMI for breast carcinoma survivors relative to comparison patients was 0.66 (95% confidence interval, 0.49-0.88). This apparent cardioprotective effect of breast carcinoma survivorship was stronger in breast carcinoma survivors with documented cardiac risk factors. CONCLUSIONS: Survivors of early-stage postmenopausal breast carcinoma are at a significantly lower risk of hospitalization for AMI than women who do not have a history of breast carcinoma. That survivors' risk varies with previous cardiac risk factors may be consistent with effects of selective estrogen receptor modulators. This phenomenon should be evaluated further with individual-level data containing information on patient cardiac risk factors and tamoxifen use to help clarify the mechanism behind the risk reduction.

Aged↗
PubMed2003

Low risk of hip fracture among elderly breast cancer survivors.

PURPOSE: Prior research has shown that women with either osteoporotic fracture or low bone density are at a decreased risk of breast cancer. Little prior work has evaluated whether women with breast cancer are at a decreased risk of osteoporotic fracture. METHODS: We used data from the National Cancer Institute's Surveillance Epidemiology and End Results (SEER)-Medicare program to study the risk of hip fracture among elderly female Medicare beneficiaries with and without histories of breast cancer. Using the SEER file, we identified elderly women survivors of stage 0, I, or II breast cancer (N=5980) diagnosed between the ages of 55 and 64 years; using the Medicare 5% file, we identified elderly women without histories of cancer (N=23,165) from SEER regions. Using Medicare claims from 1993 through 1998, we followed women for hospitalization for hip fracture or death until December 31, 1998. RESULTS: We found the rate ratio of hospitalization for hip fracture for breast cancer survivors relative to comparison patients was 0.63 (95% CI: 0.43-0.94) after adjusting for age, race, socioeconomic status, geographic location, cohort entry year, and medical comorbidity. CONCLUSIONS: We conclude that survivors of early stage post-menopausal breast cancer are at significantly lower risk of hip fracture than women who do not have histories of breast cancer.

Aged↗
PubMed2005

Long-term all-sites cancer mortality time trends in Ohio, USA, 1970-2001: differences by race, gender and age.

BACKGROUND: There were significant changes in cancer mortality in the USA over the last several decades, in the whole country and in particular states. However, no in depth analysis has been published so far, dealing with changes in mortality time trends in the state of Ohio. Since the state of Ohio belongs to the states of relatively high level of all-sites mortality in both males and females, it is of interest to analyze recent changes in mortality rates, as well as to compare them with the situation in the rest of the USA. The main aim of this study was to analyze, describe and interpret all-sites cancer mortality time trends in the population of the State of Ohio. METHODS: Cancer mortality data by age, sex, race and year for the period 1970-2001 were obtained from the Surveillance Research Program of the National Cancer Institute SEER*Stat software. A joinpoint regression methodology was used to provide estimated annual percentage changes (EAPCs) and to detect points in time where significant changes in the trends occurred. RESULTS: In both, males and females mortality rates were higher in blacks compared with whites. The difference was bigger in males (39.9%) than in women (23.3%). Mortality rates in Ohio are generally higher than average USA rates--an overall difference was 7.5% in men in 1997-2001, and 6.1% in women. All-sites mortality trends in Ohio and in the whole USA are similar. However, in general, mortality rates in Ohio remained elevated compared with the USA rates throughout the entire analyzed period. The exceptions are the rates in young and middle-aged African Americans. CONCLUSION: Although direction of time trends in Ohio are similar in Ohio and the whole US, Ohio still have cancer mortality rates higher than the US average. In addition, there is a significant discrepancy between white and black population of Ohio in all-sites mortality level, with disadvantage for Blacks. To diminish disparities in cancer mortality between African Americans and white inhabitants of Ohio efforts should be focused on increasing knowledge of black people regarding healthy lifestyle and behavioral risk factors, but also on diminishing socioeconomic differences, and last but not least, on better access to medical care.

Adult↗