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Cancer statistics, 2000.

The Surveillance Research Program of the American Cancer Society's Department of Epidemiology and Surveillance Research reports its annual compilation of estimated cancer incidence, mortality, and survival data for the United States in the year 2000. After 70 years of increases, the recorded number of total cancer deaths among men in the US declined for the first time from 1996 to 1997. This decrease in overall male mortality is the result of recent down-turns in lung and bronchus cancer deaths, prostate cancer deaths, and colon and rectum cancer deaths. Despite decreasing numbers of deaths from female breast cancer and colon and rectum cancer, mortality associated with lung and bronchus cancer among women continues to increase. Lung cancer is expected to account for 25% of all female cancer deaths in 2000. This report also includes a summary of global cancer mortality rates using data from the World Health Organization.

Adult↗
PubMed2000

Trends in mortality rates in patients with prostate cancer during the era of prostate specific antigen screening.

PURPOSE: We assess the influence of prostate specific antigen screening on trends in mortality rates in patients with prostate cancer. MATERIALS AND METHODS: The incidence based mortality method was applied to prostate cancer data from the Surveillance, Epidemiology, and End Results Program. This method links data on patients diagnosed with cancer to vital status and cause of death, such that mortality can be evaluated by factors associated with disease at diagnosis. Prostate and nonprostate cancer mortality rates were evaluated according to patient age at death, disease stage and grade at diagnosis, race and whether additional cancers involving other sites were present. RESULTS: Mortality due to prostate cancer decreased from 37% in 1988 to 30% in 1995 largely as a result of a sharp increase in nonprostate cancer mortality rates. The overall trend in prostate cancer mortality rates increased from 1988 through 1992 and then decreased. The increase and decrease in rates occurred across categories of age, race, grade and number of cancer primaries. However, the increase in rates did not occur in distant staged cases, nor did the subsequent decrease in rates occur in nondistant staged cases. CONCLUSIONS: Prostate specific antigen screening influenced the increase and decrease in prostate cancer mortality rates.

Aged↗
PubMed2006

Comparison of age distribution patterns for different histopathologic types of breast carcinoma.

BACKGROUND: Historically, female breast carcinoma has been viewed as an etiologically homogeneous disease associated with rapidly increasing incidence rates until age 50 years, followed by a slower rate of increase among older women. More recent studies, however, have shown distinct age incidence patterns for female breast cancer when stratified by estrogen receptor (ER) expression and/or histopathologic subtypes, suggesting etiologic heterogeneity. MATERIALS AND METHODS: To determine if different age incidence patterns reflect etiologic heterogeneity (more than one breast cancer type within the general breast carcinoma), we applied "smoothed" age histograms at diagnosis (density plots) and a two-component statistical mixture model to all breast carcinoma cases (n = 270,124) in the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute. These overall patterns were then reevaluated according to histopathologic type, race, and ER expression. RESULTS: A bimodal age distribution at diagnosis provided a better fit to the data than a single density for all breast carcinoma populations, except for medullary carcinoma. Medullary carcinomas showed a single age distribution at diagnosis irrespective of race and/or ER expression. CONCLUSIONS: Distinct age-specific incidence patterns reflected bimodal breast cancer populations for breast carcinoma overall as well as for histopathologic subtypes, race, and ER expression. The one exception was medullary carcinoma. Of note, medullary carcinomas are rare tumors, which are associated with germ-line mutations in the BRCA1 gene. These descriptive and model-based results support emerging molecular data, suggesting two main types of breast carcinoma in the overall breast cancer population.

Adenocarcinoma↗
PubMed2001

The influence of hospital volume on survival after resection for lung cancer.

BACKGROUND: Among patients who have undergone high-risk operations for cancer, postoperative mortality rates are often lower at hospitals where more of these procedures are performed. We undertook a population-based study to estimate the extent to which the number of procedures performed at a hospital (hospital volume) is associated with survival after resection for lung cancer. METHODS: We studied patients 65 years old or older who received a diagnosis of stage I, II, or IIIA non-small-cell lung cancer between 1985 and 1996, resided in 1 of the 10 study areas covered by the Surveillance, Epidemiology, and End Results Program, and underwent surgery at a hospital that participates in the Nationwide Inpatient Sample (2118 patients and 76 hospitals). RESULTS: The volume of procedures at the hospital was positively associated with the survival of patients (P<0.001). Five years after surgery, 44 percent of patients who underwent operations at the hospitals with the highest volume were alive, as compared with 33 percent of those who underwent operations at the hospitals with the lowest volume. Patients at the highest-volume hospitals also had lower rates of postoperative complications (20 percent vs. 44 percent) and lower 30-day mortality (3 percent vs. 6 percent) than those at the lowest-volume hospitals. CONCLUSIONS: Patients who undergo resection for lung cancer at hospitals that perform large numbers of such procedures are likely to survive longer than patients who have such surgery at hospitals with a low volume of lung-resection procedures.

Aged↗
PubMed2000

Association of surface ultraviolet B radiation levels with melanoma and nonmelanoma skin cancer in United States blacks.

Ultraviolet B (UVB) radiation exposure increases the risk of skin cancer in whites. Motivated by indications that United States geographic variation of relative skin cancer risk in blacks approaches that in whites, we used Poisson regression to estimate the risk of skin cancer in blacks as a function of average annual surface-levels of UVB radiation, measured by Robertson-Berger meters. United States data were used on deaths in 506 state economic areas, 1970-1994, and on incident cases in the nine areas of the Surveillance, Epidemiology, and End Results Program, 1973-1994. For black males, the age-adjusted relative risk of mortality for a 50% increase in UVB radiation was significantly above one for malignant melanoma, 1970-1994 (1.16; 95% confidence interval, 1.02-1.32) and nearly so for nonmelanoma skin cancer, 1970-1981 (1.18; 95% confidence interval, 1.00-1.39), for which the time period was chosen to avoid AIDS-related deaths from Kaposi's sarcoma. However, for black females, the relative risk of mortality was not significantly elevated for either skin cancer, and, for both black males and females, the relative risk of incidence was not significantly elevated for melanoma in the period 1973-1994. Incidence data on nonmelanoma skin cancer were not available. Although the public health implication is uncertain because of the much lower absolute risk of skin cancer in blacks compared with whites, the findings suggest that sunlight exposure increases skin cancer risk in blacks.

Adolescent↗
PubMed2005

Survival of mycosis fungoides in patients in the Southeast of England.

BACKGROUND: Mycosis fungoides (MF) is the most common skin lymphoma. The aetiology of MF remains unknown, and no therapy has to date significantly altered patient survival. OBJECTIVE: The present study examines trends in survival of MF patients in a well-defined population-based disease group, namely patients registered over a 40-year period at the Thames Cancer Registry, Southeast England. METHODS: The Thames Cancer Registry is a population-based registry, covering a population of approximately 14 million people. Data were taken from the Surveillance, Epidemiology and End Results cancer registry programme and the National Centre for Health Statistics. The database was used to identify cases of MF diagnosed between 1961 and 2000. A total of 985 records were identified, 821 (83%) of which had complete information on age, sex, year of diagnosis and area of residence. The observed and relative survivals of patients diagnosed during the periods 1971-1975, 1981-1985 and 1991-1995 were examined over a 5-year period of follow-up, using the relsurv Stata program to perform Cox proportional hazard analysis. RESULTS: A total of 821 MF eligible patients were available with a median follow-up of 4.3 years and a maximum follow-up of 30 years. The overall 5-year relative survival rate was 80%, and there was marked improvement between 1971 and 1981. The prognostic factors leading to a significantly poorer survival were high age, male sex, the presence of the Sézary syndrome, the use of hormone treatment and radiotherapy. CONCLUSIONS: A statistically significantly better survival over the last 20 years was found. The prognosis is generally good for most patients but not all. The best survival was seen for the female patients under 45 years of age without the presence of the Sézary syndrome. This difference in survival may be partly due to a difference in the disease stage or different treatment, or to both.

Age Factors↗
PubMed1998

Race, prostate cancer survival, and membership in a large health maintenance organization.

BACKGROUND: Population-based cancer registry data have shown that black men with prostate cancer have poorer stage-specific survival than white men, while studies in equal-access health care systems have not found racial differences in stage-specific survival. This study was designed to test the hypothesis that black men and white men with prostate cancer have equal stage-specific survival in equal-access health care systems. METHODS: We conducted a cohort study using cancer registry data from all incident cases of prostate cancer occurring in a five-county San Francisco Bay Area region. Incident cases occurred among members (5263 cases, from January 1973 through June 1995) and nonmembers (16,019 cases, from January 1973 through December 1992) of the Kaiser Permanente Medical Care Program, a large health maintenance organization. Death rate ratios (DRRs, black men versus white men) for Kaiser members and nonmembers were computed for all stages combined (adjusting for age and stage) and for each stage (adjusting for age). RESULTS: Among Kaiser members, adjusted DRRs comparing black men with white men were as follows: all stages combined, 1.28 (95% confidence interval [CI] = 1.14-1.44); local stage, 1.23 (95% CI = 1.01-1.51); regional stage, 1.30 (95% CI = 0.97-1.75); and distant stage, 1.27 (95% CI = 1.07-1.50). Corresponding DRRs for nonmembers were as follows: all stages combined, 1.22 (95% CI = 1.14-1.30); local stage, 1.24 (95% CI = 1.09-1.41); regional stage, 1.48 (95% CI = 1.29-1.68); and distant stage, 1.01 (95% CI = 0.91-1.12). CONCLUSIONS: These results show poorer prostate cancer survival for black men compared with white men in an equal-access medical care setting. The findings are most consistent with the hypothesis of increased tumor virulence in blacks.

Black or African American↗
PubMed2005

Continuity of care and early diagnosis of head and neck cancer.

This study investigated whether receiving continuous regular care with the same primary care provider had an independent association with stage at diagnosis for head and neck cancers (HNCA) in a Medicare population. The study database (N = 10,662) linked files from the Surveillance, Epidemiology, and End Results Program 1991-2000 for patients with cancers of the oral cavity, pharynx, and larynx with their files from the Center for Medicare and Medicaid Services Program. Continuity of care displayed a statistically significant independent association and dose-response pattern with stage at diagnosis when the provider was an internist but not a general or family physician. An independent statistically significant association between continuity of care with an internist and stage at diagnosis was found for oral cavity tumors (adjusted odds ratio [AOR] = 0.85; 95%CI = 0.73-0.99), but not pharyngeal tumors (AOR = 1.02; 95%CI = 0.74-1.41). Laryngeal tumors were borderline statistically significant at p-value = 0.07 (AOR = 0.84; 95%CI = 0.69-1.02). Regular continuous care from the same primary care provider displayed an independent association with early diagnosis of HNCA when the anatomic site was the oral cavity and the provider was an internist, but not when the provider was a general or family physician. Primary care physicians including general/family physicians may represent a relevant group for encouraging increased opportunistic HNCA screening efforts among their patients.

Aged↗
PubMed2006

Prognosis of metachronous contralateral breast cancer according to stage at diagnosis: the importance of early detection.

Detection of metachronous contralateral breast cancer (MCBC) is an important aspect of follow-up among the many women previously diagnosed with first primary breast cancer (FPBC). While randomized studies have demonstrated the efficacy of early detection of FPBC, such findings cannot be generalized to women previously diagnosed with breast cancer since they were specifically excluded from participation. In this study, we determined if detection of MCBC at stage 0-I improves prognosis among women diagnosed with stage 0-III FPBC. Using data from the 1990-2000 Surveillance, Epidemiology, and End Results program, we defined MCBC as contralateral breast cancer that occurred at least 6 months after stage 0-III FPBC diagnosis. Women who developed a MCBC were categorized as having stage 0-I versus stage II-IV. To avoid lead-time bias, survival of MCBC was measured from the date of FPBC. Among 170,453 women who had been diagnosed with stage 0-III FPBC, 2904 were subsequently diagnosed with MCBC. Of these 2904 women, 329 died from breast cancer and 194 died from other causes. Seventy percent of women were diagnosed with stage 0-I MCBC. An 81% survival benefit existed for stage 0-I MCBC relative to those with stage II-IV MCBC in multivariable analysis (adjusted hazard ratio: 0.19; 95% confidence interval: 0.15-0.25). The findings are robust for various subpopulations. Unmeasured confounding was unlikely to explain the observed results in sensitivity analysis. For women with stage 0-III FPBC, diagnosis of stage 0-I MCBC is associated with an 81% reduction in risk of breast cancer death.

Adult↗
PubMed2001

Demographics and occurrence of oral and pharyngeal cancers. The outcomes, the trends, the challenge.

OVERVIEW: This article summarizes current trends in the occurrence of, mortality rates associated with and rates of survival of oral and pharyngeal cancer. METHODS: The author reviewed relevant data and literature on these aspects of oral and pharyngeal cancer, including data from the National Cancer Institute's Surveillance, Epidemiology and End Results program collected from 1973 to 1998. RESULTS: The occurrence of oral and pharyngeal cancer in the United States remains constant, at about 30,000 new cases diagnosed each year. There has been no marked improvement in the five-year survival rates, which remain at about 50 percent, despite advances in surgery and radiation. Detection of early, localized lesions has not improved significantly during the past three decades. There is a minor trend toward a younger age at diagnosis and a slight increase among women. CONCLUSIONS: On the basis of epidemiologic data, it appears that the most important approach to decreasing morbidity and mortality associated with oral cancer is increasing early detection of localized lesions combined with appropriate treatment. Concomitantly, aggressive counseling is vital to prevent use and encourage cessation of tobacco and alcohol use. CLINICAL IMPLICATIONS: Professional and public education about oral and pharyngeal cancer needs to be improved, and clinicians must emphasize the need for and perform routine oral cancer examinations to promote early diagnosis and treatment.

Adult↗
PubMed2002

Prevalence-corrected prostate cancer incidence rates and trends.

A correction is made of prostate cancer incidence rates based on data from the Surveillance, Epidemiology, and End Results Program of the United States National Cancer Institute. Unlike conventional incidence rates reported by the Program, corrected rates remove from the population the estimated number already diagnosed with the disease. The corrected rates reflect the average prostate cancer risk for men in the at-risk population. Because of the high incidence of and relatively good survival for prostate cancer, the prevalence of this disease is high. Corrected prostate cancer incidence rates were higher in magnitude, particularly in older age groups and among Black men. For example, in 1997 for Whites, the corrected rates were 3.8 percent higher in cases aged 60-69 years, 9.3 percent higher in cases aged 70-79, and 13.1 percent higher in cases aged 80 or more. Corresponding percentages for Blacks were 5.9, 18.9, and 16.9 percent, respectively. Percent changes over calendar time were very similar between corrected and uncorrected prostate cancer incidence rates according to age and race (White and Black). Failure to account for high levels of prostate cancer prevalence in conventional incidence rates of the disease results in underestimation of the rates but little temporal difference in the trends.

Black or African American↗
PubMed2005

Pre-operative imaging, surgery and adjuvant therapy for women diagnosed with cancer of the corpus uteri in community practice in the United States.

INTRODUCTION: Non-Hispanic black women are less often diagnosed with endometrial cancer than are non-Hispanic white women, but are more likely to die of their disease. Reasons for this disparity in outcome are not well understood. METHODS: The Surveillance, Epidemiology, and End-Results Program data were used to sample women newly diagnosed in 1998 with cancer of the corpus uteri. A total of 711 women with no previous diagnosis of cancer were selected. Women with sarcoma were not eligible for the study. We then sought to verify the therapy provided each woman with her treating physician. RESULTS: Non-Hispanic black women were diagnosed with higher stage, grade, poor histologic subtype, and greater extension of the tumor than were non-Hispanic white women. Hispanic women were diagnosed with more favorable tumor characteristics than non-Hispanic black women, but less favorable than non-Hispanic white women. The use of radiation and chemotherapy increased with stage. CONCLUSIONS: Our study did not show any difference in recommended therapy for women with uterine adenocarcinoma among NH black women, NH white women, and Hispanic women. We must look for other factors, therefore, to explain the disparities in cancer outcome observed among NH black women with endometrial cancer.

Adenocarcinoma↗
PubMed2005

Impact of hysterectomy on endometrial carcinoma rates in the United States.

In the United States, endometrial carcinoma incidence rates, uncorrected for hysterectomy prevalence, are higher among white women than black women. We estimated corrected endometrial carcinoma rates by racial/ethnic groups and age (30-74 years) for 1992-2000 using data from the Surveillance, Epidemiology, and End Results program and the Behavioral Risk Factor Surveillance Survey. Hysterectomy prevalence was higher among black women than among Hispanic and white non-Hispanic women. Correcting for hysterectomy prevalence increased age-adjusted endometrial carcinoma rates per 10(5) woman-years from 29.2 to 48.7 (66.8% increase) overall, from 14.6 to 28.5 (95.3% increase) in blacks, from 18.8 to 29.6 (57.6% increase) in Hispanics, and from 33.2 to 54.9 (65.1%) in white non-Hispanics. This correction reduced the rate ratio for white non-Hispanics compared with blacks from 2.27 to 1.93. Among blacks but not Hispanics or white non-Hispanics, the endometrial carcinoma risk factors of obesity and diabetes were more prevalent among hysterectomized than nonhysterectomized women. Failure to correct for hysterectomy prevalence may lead to underestimates of endometrial carcinoma risk, especially among blacks. The high prevalence of hysterectomy among blacks with strong endometrial cancer risk factors may partly account for lower cancer rates in this group.

Adult↗
PubMed2006

Rising incidence of small renal masses: a need to reassess treatment effect.

The incidence of kidney cancer has been rising over the last two decades, especially in cases where the disease is localized. Although rates of renal surgery parallel this trend, mortality rates have continued to rise. To investigate the basis of this "treatment disconnect" (i.e., increased rates of treatment accompanied by increased mortality rates), we analyzed patient data from nine registries of the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. We assembled a cohort of 34,503 kidney cancer patients and derived incidence, treatment, and mortality trends for kidney cancer, overall and as a function of tumor size. From 1983 to 2002, the overall age-adjusted incidence rate for kidney cancer rose from 7.1 to 10.8 cases per 100,000 US population; tumors < or = 4 cm in size accounted for most of the increase. Adjusted rates of renal surgery increased concurrently, most notably for tumors < or = 4 cm (0.9-3.6 surgeries per 100,000 US population). However, among kidney cancer patients, all-cause mortality per 100,000 US population increased from 1.5 deaths in 1983 to 6.5 deaths in 2002, with the greatest absolute increase noted for patients with lesions > 7 cm. Our results demonstrate that the rising incidence of kidney cancer is largely attributable to an increase in small renal masses that are presumably curable. The fact that increased detection and treatment of small tumors is not reducing mortality argues for a reassessment of the current treatment paradigm.

Aged↗
PubMed1996

Ethnic variation in prostate cancer survival in New Mexico.

Prostate cancer survival varies markedly by ethnicity. American Indians and blacks have the lowest 5-year relative survival among ethnic groups in the U.S. In New Mexico, relative survival for prostate cancer is lower for ethnic minority groups than for non-Hispanic whites. To examine factors underlying ethnic differences in prostate cancer survival in New Mexico, we analyzed Surveillance, Epidemiology, and End Results Program data collected by the New Mexico Tumor Registry from 1983 to 1992. Unadjusted relative risk (RR) of death after prostate cancer diagnosis was greater for Hispanics [RR = 1.1; 95% confidence interval (CI), 1.0, 1.2], American Indians (RR = 1.4; 95% CI, 1.2, 1.5), and blacks (RR = 1.5; 95% CI, 1.2, 1.7) than for non-Hispanic whites. After adjusting for age, stage, histological grade, year of diagnosis, and initial treatment, the risk for Hispanics (RR = 1.0; 95% CI, 0.9, 1.1), American Indians (RR = 1.0; 95% CI, 0.9, 1.1), and non-Hispanic whites was comparable. Although based on small numbers, adjusted risk ratios among blacks remained elevated (RR = 1.2; 95% CI, 0.9, 1.6), due in part to lower survival during the first 12 months after diagnosis (RR = 2.0; 95% CI, 1.2, 3.3) and poorer survival following radical prostatectomy (RR = 4.2; 95% CI, 1.3, 13). These findings suggest that poorer survival for Hispanics and American Indians may be explained by delayed detection and differences in treatment.

Aged↗
PubMed2006

Estimates of long-term survival for newly diagnosed cancer patients: a projection approach.

BACKGROUND: Patients with newly diagnosed cancer may request an estimate of their prospects for long-term survival. Unfortunately, standard estimates of survival may be outdated, because they do not reflect recent advances. The authors present a projection method that incorporates trends in survival and provides more up-to-date estimates of long-term survival for newly diagnosed patients. METHODS: The projection method fits a regression model to interval relative survival and includes a parameter associated with a trend on diagnosis year. The cumulative relative survival rate (CRS) in a target year is calculated by multiplying the projected interval survival rates for that year. To investigate the predictive ability of the projection approach and to develop model-selection rules, data from the Surveillance, Epidemiology, and End Results Program and the Connecticut tumor registry were used to recreate data that were available at a particular time in the past, and those data were used to project survival for specified target years. RESULTS: The projection method was better at predicting the survival of recently diagnosed patients than current methods, especially long-term survival for patients who had disease sites with an increasing and stable trend in survival. The authors predicted that the 15-year CRS for patients who were diagnosed in 2003 will be 61% for all cancer sites combined, 57% for colorectal cancer, 82% for female breast cancer, 53% for ovarian cancer, and 97% for prostate cancer. CONCLUSIONS: Although the projection method was more speculative than other methods that are aligned more closely with current observed data, it offered the possibility of providing improved estimates of long-term survival for recently diagnosed patients. Caution should be used when applying these methods for cancer sites where there has been a dramatic uptake of screening, e.g., prostate cancer, for which the projected results may be overly optimistic.

Female↗
PubMed2004

Differences in testis cancer survival by race and ethnicity: a population-based study, 1973-1999 (United States).

OBJECTIVE: We examined the relationship between race/ethnicity and testis cancer survival in a population-based setting. METHODS: We analyzed 16,086 cases of primary testis cancer diagnosed during 1973-1999 and reported to 12 cancer registries participating in the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. We compared testis cancer-specific survival between patients from different racial/ethnic groups by use of the hazard ratio (HR) and 95% confidence intervals (CI) calculated from Cox proportional hazards models, adjusting for stage, histology, and period of diagnosis. RESULTS: Relative to non-Hispanic whites, a greater proportion of African American, Native American, Hawaiian, and Hispanic patients were diagnosed at late stages. There were 886 deaths among 16,086 testis cancer patients and overall 5-year survival was 95%. After adjustment for stage, histology, and period of diagnosis, the risk of dying from testis cancer was increased among African Americans (HR = 2.3; CI: 1.6-3.2), Native Americans (HR = 2.1; CI: 1.1-3.9), Filipinos (HR = 3.6; CI: 1.3-9.5), Hawaiians (HR = 2.4; CI: 1.4-4.1), and Hispanics (HR = 1.4; CI: 1.1-1.8), compared to non-Hispanic whites. CONCLUSION: These findings are consistent with previous reports of race/ethnic disparities in stage at diagnosis and survival in testis cancer patients as well as other cancer patients. Further research is needed to understand the reasons underlying these disparities.

Adolescent↗
PubMed1996

Mortality in prostate cancer.

PURPOSE: We evaluated in patients with prostate cancer whether treatment is associated with in decreased mortality and whether the association of treatment with mortality varies with calendar time. MATERIALS AND METHODS: Using the 146,979 prostate cancer patients from the 1973 to 1990 public use tape of the Surveillance, Epidemiology and End Results program, we performed survival analysis and multivariate proportional hazards modeling to estimate the relative risk of disease specific and overall mortality. RESULTS: In men with prostate cancer, advanced age, black race, high tumor stage and not having treatment were independently associated with disease specific and overall mortality. The relative risk of mortality in treated patients decreased significantly from 1973 to 1990. CONCLUSIONS: The fact that advanced age and black race are associated with disease specific mortality (even when treatment and stage are controlled) is a new observation, which suggests that tumor biology and/or response to treatment is worse in elderly and black men. Overall, the data are consistent with the hypothesis that treatment of prostate cancer is associated with lower disease specific and overall mortality rates. The decreases in relative mortality in treated patients from 1973 to 1990 indirectly support the theory that changes in patterns of care from 1973 to 1990 had a beneficial effect on mortality. This observation implies that future studies should account for calendar time when interpreting outcomes data.

Aged↗