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PubMed1999

Risk factors in wound infections after laparotomy in obstetrics and gynaecology.

BACKGROUND: The objectives of the study are to obtain risk factors for and rates in postoperative wound infections in order to develop an infection surveillance program. METHODS: A retrospective, case-controlled three-year study of wound infections in Caesarean sections and gynaecological laparotomies with 15 predictive variables. For each patient and variable, the likelihood ratio of having infection was calculated. The prior odds of infection were iteratively combined by a set of predictive variables to establish the posterior probability of being infected. A patient was classified as pathological if the posterior probability was above 0.5 and as normal if the posterior probability was below 0.5. The squared risk of misclassification was used as indicator of the goodness of classification. RESULTS: Ruptured membranes prior to Caesarean section classified 88% of the patients correctly. For gynaecological laparotomies body mass index classified 76% of the patients correctly. The remaining predictive variables added little to improve the classification. CONCLUSIONS: Infection surveillance programs may reduce wound infection rates and have been recommended because they offer increased service quality, safer guidance for the implemantation of preventive measures, and better patient information. We have demonstrated that the number of predictive variables necessary in registering Caesarean sections can be limited to one or two, and in gynaecological laparotomies to one to three.

Case-Control Studies↗
PubMed2003

Reported family history of cancer in the prostate, lung, colorectal, and ovarian cancer screening trial.

The authors analyzed data from almost 150,000 subjects aged 55-74 years enrolled in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial who completed a self-administered baseline questionnaire (1993-2001) that included items about family history of cancer. Male respondents reported significantly less family history of cancer than females. The relative underreporting by male respondents relative to females was greater for female family members (28% lower for sisters and 21% lower for mothers) than for male family members (13% lower for brothers and 9% lower for fathers). Black, Hispanic, and Asian respondents reported significantly less family history of cancer than Whites. Reported family history prevalences for parents decreased with respondents' age, while those for siblings increased with respondents' age. The four most commonly reported cancers in families were breast (11.8%), lung (10.1%), colorectal (9.4%), and prostate (7.3%) cancer. Expected prevalences in family members of history of cancer overall and history of specific types of cancer were calculated using incidence rates and life table data obtained from the Surveillance, Epidemiology, and End Results Program. Overall, the ratio of reported cancer rates to expected cancer rates in family members was approximately 0.7. Liver, bone, stomach, and brain cancer had greater-than-average reported:expected ratios, while lymphoma, bladder cancer, melanoma, and testicular cancer had lower-than-average ratios.

Aged↗
PubMed2006

Descriptive epidemiology of dermatofibrosarcoma protuberans in the United States, 1973 to 2002.

BACKGROUND: The epidemiology of dermatofibrosarcoma protuberans (DFSP) has not been studied in detail. OBJECTIVE: We sought to describe patterns of DFSP incidence and survival in the United States. METHODS: Data were obtained from 9 population-based cancer registries of the Surveillance, Epidemiology, and End Results Program for 1973 to 2002. RESULTS: DFSP overall annual incidence was 4.2 per million. Incidence increased by 43% (3.1-4.4 per million per year) during the study period, but this increase was restricted to whites. Annual incidence among blacks (6.5 per million) was almost double the incidence among whites (3.9 per million; P < .005, 95% confidence interval of difference 2.02-3.22). Women had higher rates of incidence than men (4.4 vs 4.2 per million per year; P = .052, 95% confidence interval of difference -0.002 to 0.60), except among the elderly. Relative 5-year survival was 99.2% (95% confidence interval 98.3-100%). LIMITATIONS: The Surveillance, Epidemiology, and End Results Program lacks independent verification of diagnoses and case detail. CONCLUSIONS: The racial differences in the incidence of DFSP are significant, and the cause is unknown. Previous literature had suggested that men were more frequently affected, which was not true in our data. The tumor rarely results in death. Epidemiologic investigation using population-based data is important to better understand this disorder.

Adolescent↗
PubMed1997

Has there been a real drop in the number of expected cancer cases in the United States?

In 1993, after more than 20 years of increases, there was an observed decrease in the number of new cancer cases reported and in the overall cancer incidence rate in areas covered by the Surveillance, Epidemiology, and End Results Program based at the National Cancer Institute. Most of the decrease is attributed to a reduction in the number of prostate cancers diagnosed in 1993, a result of the introduction of a new screening tool for prostate cancer in the late 1980s. The article examines a number of possible reasons for the decrease in both overall cancer rates and prostate cancer rates and discusses whether the decrease is real or a statistical anomaly.

Adult↗
PubMed2000

Minorities, women, and clinical cancer research: the charge, promise, and challenge.

Significant progress has been made since the war against cancer was launched. Discoveries in molecular medicine, genetics, and epidemiology have led to the recognition that certain cancers are potentially preventable and that elements of lifestyle, along with genetic, hormonal, and metabolic factors can be altered to reduce cancer risk. Advances in medical technology have led to the development of new imaging methods and computer technologies that can aid in efforts to detect, diagnosis, and treat cancer. Since the offensive against cancer was initiated, cancer treatments have become more powerful, more precise, less drastic, and safer. As a result, cancer incidence and mortality have begun to decline. Yet, while the nation boasts of the progress being achieved relative to cancer incidence and mortality, and federal research agencies retort that research applies to all populations, it is apparent that the declines do not translate to all populations in the United States. Clinical research is essential to cancer prevention and control. Within the oncology community, clinical cancer research trials are viewed as an efficient and economical way for patients to secure state-of-the-science medical care. Recognizing the need to improve access to state-of-the-science cancer treatment and control programs, minority and female participation in clinical cancer research trials has been encouraged. This recommendation is based on the belief that increased participation in well-designed clinical cancer research trials adhering to strict protocols and quality controls will, not only help validate the application of research findings to minority and female populations, but also result in better patient outcomes. Born out of a commitment to social equity, justice, beneficence, and the desire to ensure that data relevant to cancer prevention and control are both valid and generalizable to populations across the United States, several programs of research aimed toward increasing the representation of women and minorities in clinical cancer research have been pursued by the National Cancer Institute. This issue of the Annals of Epidemiology Minorities, Women, and Clinical Cancer Research presents issues and challenges that face the research community and descriptions of effective models, strategies, and practices that may be used to increase the participation of minorities and women in clinical cancer research trials and facilitate the conduct of research directed toward reducing the cancer burden within the United States.

Cost of Illness↗
PubMed2003

Cancer in women.

Incidence, mortality and survival trends for the most frequent cancers affecting women are presented on a worldwide basis. Data sources are represented by several different cancer databases, as no single world cancer database covers these epidemiological measures. Monitoring cancer incidence, mortality and survival are fundamental indicators which allow estimates and predictions of geographical and temporal changes of these diseases, enabling the design and set-up of adequate cancer control activities and national health programs. The observed differences in cancer incidence, mortality and survival in more developed countries compared with less developed countries (as defined by WHO) are mainly due to different individual and social risk factors between the two geo-political areas. For some cancers, advancements in screening, diagnosis and treatment in the more developed areas were the most effective factors in reducing incidence and mortality as well as prolonging survival. These effects were not detected in the less developed areas because of the limited access to primary and specialist care.

Breast Neoplasms↗
PubMed2004

Occupational asbestos exposure and the incidence of non-Hodgkin lymphoma of the gastrointestinal tract: an ecologic study.

PURPOSE: A previous case-control study observed a strong association between occupational exposure to asbestos and the incidence of non-Hodgkin lymphoma of the gastrointestinal tract (GINHL). To test this hypothesis, we sought to determine whether the geographic pattern of the incidence of GINHL in the US has paralleled that of mesothelioma. METHODS: Using data obtained from the nine US regions participating in the National Cancer Institute's Surveillance, Epidemiology and End Results program, we examined the incidence of malignancies among men ages 50 to 84 years between 1973 and 1984. RESULTS: The rates of mesothelioma, but not of GINHL, were about two times higher in the areas of Seattle and San Francisco, than in the other regions. Overall, there was no correlation between the rates of mesothelioma and of GIHNL (Pearson correlation coefficient-0.12, p = 0.77). CONCLUSIONS: This ecologic study finds no support for the hypothesis that occupational asbestos exposure is related to the subsequent incidence of GINHL.

Aged↗
PubMed2006

Identifying individuals at high risk of melanoma: a practical predictor of absolute risk.

PURPOSE: We developed a model to estimate the 5-year absolute risk of melanoma to efficiently identify individuals at increased risk of melanoma for potential interventions. PATIENTS AND METHODS: We used data from a case-control study with 718 non-Hispanic white patients with invasive cutaneous melanoma from melanoma clinics in Philadelphia, PA and San Francisco, CA; matched controls were 945 patients from outpatient clinics with similar catchment areas. All participants underwent extensive interviews and skin examinations. We selected easily obtained clinical characteristics and responses to simple questions for study in order to develop sex-specific relative risk models. These models were combined with incidence and mortality rates by United States geographic areas to develop estimates of the absolute risk of developing melanoma within 5 years. RESULTS: Relative risk models yielded an attributable risk of 86% for men and 89% for women, using at most seven variables. Attributable risks did not vary by age, ultraviolet B flux or hours outdoors. The absolute individual risks varied widely, depending on age, other host characteristics, and geographic area. Individual absolute risk can be estimated using a program available online. CONCLUSION: Our procedures allow for estimating the absolute risk of developing melanoma to assist in the identification of patients at high risk. Such high-risk individuals could undergo interventions including a complete skin examination, counseling to avoid sun exposures, regular self and professional surveillance, or participation in prevention trials. It is important to emphasize that these projections are not intended to identify current melanoma cases.

Adult↗
PubMed2006

Differences in cancer incidence among Indians in Alaska and New Mexico and U.S. Whites, 1993-2002.

Cancer incidence for American Indians and Alaska Natives is typically reported as a single rate for all U.S. indigenous populations combined. Previously reported combined rates suggest that American Indians and Alaska Natives have lower cancer incidence rates compared with the U.S. population. Alaska Native people comprise three major ethnic groups: Eskimo, Indian, and Aleut people. We examined cancer incidence from only Alaska Indians and compared incidence rates with an American Indian population living in New Mexico. These data indicate striking differences in cancer patterns between two American Indian populations. Cancer data for the years 1993 to 2002 for American Indians of New Mexico and U.S. Whites are from the National Cancer Institute Surveillance, Epidemiology, and End Results Program Public-use data set. Data for Alaska Indians are from the Alaska Native Tumor Registry, which is also a Surveillance Epidemiology and End Results Program participant. Overall, cancer incidence rates for all sites combined in New Mexico Indian men and women were lower than U.S. White rates, whereas Alaska Indian men and women exceeded U.S. rates. In comparing Alaska and New Mexico Indians, we observed a 2.5-fold higher incidence of cancer among Alaska Indians. The largest differences between the two Indian populations were noted primarily in cancers associated with tobacco use, including cancers of the oral cavity/pharynx, esophagus (only in men), colon and rectum, pancreas, larynx (men), lung, prostate, and urinary bladder (men). Lung cancer rates in Alaska Indian men and women were 7 and 10 times those of New Mexico Indian men and women.

Alaska↗
PubMed1996

A computer program to assist in making breast cancer adjuvant therapy decisions.

This report describes a computer program designed to assist health care professionals in making projections of the average benefit of systemic adjuvant therapy for individual breast cancer patients. It requires as input patient age (used to make projections of natural mortality), an estimate of breast cancer-related mortality at 5 years (used to make projections of breast cancer-specific mortality), and the proportional risk reduction for breast cancer mortality expected for the adjuvant therapy (with included tables from the Early Breast Cancer Trialist's 1992 meta-analysis). The program uses life table analytical techniques to make projections of outcome in three scenarios: that the breast cancer never occurred, that the breast cancer patient received definitive local therapy but no adjuvant systemic therapy, and that the patient received adjuvant therapy. The outcome projections are given for total, natural (non-breast cancer-related), and breast cancer-related mortality at several time points and also of total remaining life expectancy. These estimates are currently widely made by clinicians by nonnumerical techniques. Computer-based tools can serve as valuable aids in physician and patient education and in the process of informed decision making.

Adult↗
PubMed2006

The number distribution for involved lymph nodes in cancer.

The number of involved lymph nodes exhibits considerable heterogeneity within populations. Here, the implications of population heterogeneity are explored with respect to the kinematics of nodal metastases. Data from the National Cancer Institute's Surveillance, Epidemiology, and End Results program for 224656 breast, 12404 gastric, 18015 rectal, 4117 cervical and 2443 laryngeal cancers as well as 9118 melanomas were used to construct frequency distributions for the number of involved nodes which were then fitted to the negative binomial distribution. The negative binomial distribution described the heterogeneity in nodal involvement well. The patterns of nodal involvement can be explained by either of two models: one where involved nodes could seed further nodal metastases, the other where the number of nodal metastases in any individual was randomly distributed, with the deviations between patients accounted for by population heterogeneity. Since the number of sampled nodes similarly approximated a negative binomial distribution, random involvement with superimposed population heterogeneity would more credibly explain both sets of observations.

Binomial Distribution↗
PubMed1997

Survival rates for four forms of cancer in the United States and Ontario.

OBJECTIVES: In this study, cancer survival rates for patients diagnosed in Ontario and selected areas within the United States were compared. METHODS: Relative survival rates were computed for patients aged 15 through 84 years diagnosed with any of four forms of cancer (breast, colon, lung, and Hodgkin's disease). The cohorts represented those diagnosed over the years 1978 through 1986 in the Canadian province of Ontario and in nine regions covered by the US National Cancer Institute's Surveillance Epidemiology and End Results program. Patients were followed through the end of 1990. RESULTS: The cumulative relative survival rates were similar for American and Canadian patients. The largest difference was observed for breast cancer, where patients in the United States enjoyed a survival advantage throughout the follow-up period. CONCLUSIONS: Patients in the United States and Ontario with the diseases studied, except for breast cancer, experience very similar survival. The greater use of mammographic screening in the United States could account for that country's higher breast cancer survival rate by promoting earlier and therefore more efficacious treatment, by introducing bias, or by a combination of both treatment and bias factors.

Adolescent↗
PubMed1999

Twenty-year trends in the reported incidence of mycosis fungoides and associated mortality.

OBJECTIVES: Patterns of mycosis fungoides incidence and associated mortality in the United States were evaluated. METHODS: Data were taken from the Surveillance, Epidemiology, and End Results cancer registry program and the National Center for Health Statistics. RESULTS: The incidence rate from 1973 through 1992 was 0.36/10(5) person-years. The age-adjusted incidence rate ratio of Blacks to Whites was 1.7; that of Asians to Whites was 0.6. There was no evidence of increasing incidence rates during the period 1983 through 1992. Mortality rates declined steadily from 1979 to 1991 and were less heterogeneous geographically than incidence rates. Mortality rate patterns with age, sex, and race were similar to the corresponding incidence patterns. CONCLUSIONS: The incidence rate of mycosis fungoides has stabilized and the mortality rate has declined. For unknown reasons, the disorder varies greatly among demographic and geographic subgroups.

Adolescent↗
PubMed1994

Improved survival after colorectal cancer in patients complying with a postoperative endoscopic surveillance program.

This study investigates whether compliance with a postoperative surveillance program in patients with surgically treated colorectal cancer leads to prolongation of life. The clinical course of 212 patients who had undergone curative resections for colorectal cancer was monitored for at least five years. Eighty-eight patients adhered strictly to a rigid endoscopic surveillance program, and 124 did not. Tumor recurrences occurred in 10% of compliant and 14% of noncompliant patients. Patients with asymptomatic tumor recurrences survived significantly longer (p < 0.05; five-year actuarial survival: 42%) than those who were symptomatic (five-year actuarial survival: 8%). The overall survival rate was significantly higher (p < 0.0002) in compliant patients (five-year actuarial survival: 80%) than in noncompliant patients (five-year actuarial survival: 59%). Noncompliance increased the risk of early death by a factor of 2.5 (95% CI = 1.5; 4.2). It is concluded that postoperative endoscopic surveillance leads to early tumor detection, and is associated with an improvement in survival in patients with colorectal cancer.

Aged↗
PubMed2004

Small-area incidence trends in breast cancer.

BACKGROUND: During the past 2 decades, the observed incidence of in situ and early-stage invasive breast cancer has increased substantially as a result of increased use of mammography. Geographic variability in the increase in breast cancer incidence has been observed among large areas. Examining the variability among small areas in the incidence over time will facilitate appropriate geographic allocation of resources aimed at increasing screening. METHODS: We examined county-specific increases in breast cancer incidence over time, specifically the variability and spatial correlation in the increase in breast cancer incidence. The analyses were based on county-level data (1973-1997) from the Iowa Surveillance, Epidemiology, and End Results program. A spatiotemporal hierarchical Bayesian model was used to examine variability in county-specific rates (intercepts, slopes, and spatial correlations) among white women at least 40 years of age. RESULTS: Posterior values indicate there was little variability among counties in the change in breast cancer incidence over time (slope) but substantial variation among intercepts. There was considerable spatial correlation among the county-specific intercepts but a lack of a spatial correlation among the county-specific slopes. There was no correlation between the county-specific intercept and slope. CONCLUSIONS: Breast cancer incidence increased over time, but county-specific rates increased independently relative to their neighboring counties or their initial rate.

Adult↗
PubMed2003

Up-to-date survival curves of children with cancer by period analysis.

Survival rates of children with cancer have strongly improved during the past decades, but much of this improvement has been disclosed with substantial delay by traditional methods of survival analysis, which reflect survival experience of patients diagnosed many years ago. In this paper, the use of a new method of survival analysis, denoted period analysis, for providing more up-to-date estimates of 10-year survival curves of children with cancer is empirically evaluated using data of the Surveillance, Epidemiology, and End Results Program of the United States National Cancer Institute. It is shown that period analysis provides much more up-to-date estimates of survival curves than traditional cohort-based survival analysis indeed, at least as long as there is ongoing improvement in survival rates over time, as it seems to be the case for many forms of childhood cancer. The most recent 10-year period survival estimates indicate that survival rates of children with cancer achieved by the end of the 20th century are substantially higher than previously available survival statistics have suggested. Application of period analysis may be particularly useful in the field of childhood cancer as it may help to prevent patients, their families and clinicians from being burdened by outdated, often too pessimistic survival expectations.

Adolescent↗
PubMed1994

Liver cancer.

The trends in liver cancer incidence and mortality were investigated by gender in Japan, Norway, Singapore, Spain, Sweden, the UK and the USA. Cancer Incidence in Five Continents, Vols I-VI, were the principal source of the analysis of age specific incidence rates by sex; additional incidence information was obtained from the published data of the Connecticut Tumor Registry and the Surveillance, Epidemiology and End Results Program in the USA. Mortality rates were calculated using the World Health Organization database. The trends observed were generally weak. Increasing occurrence of primary liver cancer was noted in Japan and the Nordic countries, although the rates seemed to be stabilizing or even decreasing in the most recent data from Sweden. By contrast, decreasing trends were apparent in Spain and Singapore. Changes in the rates appeared to be more evident or somewhat stronger for males than for females. Some biological explanations were offered to account for these trends. However, the dominant determinants of the apparent changes in the incidence and mortality of primary liver cancer were felt to be related to classification and coding revisions as well as to variations over time in diagnostic and certification practices.

Age Factors↗
PubMed2005

Trends in the incidence rates of nasopharyngeal carcinoma among Chinese Americans living in Los Angeles County and the San Francisco metropolitan area, 1992-2002.

Nasopharyngeal carcinoma is much more common in Asian countries than in Western countries. However, since the 1980s, nasopharyngeal carcinoma incidence has fallen among both men and women in Hong Kong, and recently a similar trend has also been noted in Singapore. Using data from the Surveillance, Epidemiology, and End Results Program and the US Census, the authors evaluated recent trends in the incidence rates of nasopharyngeal carcinoma among Chinese living in Los Angeles County and in the San Francisco-Oakland (California) metropolitan area. From 1992 to 2002, the rates of nasopharyngeal carcinoma in these two populations decreased in men by 37% (95% confidence interval: -54, -12) but in women by just 1% (95% confidence interval: -40, 64). In Chinese men, the overall decline in incidence was limited primarily to a decline in the rate of type I tumors (differentiated squamous tumors with keratin production). While the reasons underlying the observed patterns of incidence remain to be determined, changes in lifestyle and environment are likely to be contributory factors.

Asian↗