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At least 667 records · Page 37Linked to original sources
PubMed2006

Are venous thromboembolic events associated with subsequent breast and colorectal carcinoma diagnoses in the elderly? A case-control study of Medicare beneficiaries.

BACKGROUND: Multiple epidemiologic studies have reported associations between venous thromboembolic events and subsequent cancer diagnoses, but the published results have not suggested clear cancer screening approaches. METHODS: Using data from the National Cancer Institute's Surveillance, Epidemiology, and End Results-Medicare Program, the authors identified patients who were diagnosed with breast and colorectal carcinoma (n = 7166 patients) and compared them with a noncancer control group (n = 126,668 patients) according to their history of hospitalization for deep vein thrombosis (DVT) or pulmonary embolism (PE) in Medicare claims files over the previous 24 months. Using logistic regression analysis, the authors calculated the odds of receiving a diagnosis of breast carcinoma or colorectal carcinoma in the 24 months after admission for DVT or PE. RESULTS: Patients who were hospitalized for DVT or PE had nearly 3.0 times the odds of being diagnosed with colorectal carcinoma (odds ratio [OR], 2.83; 95% confidence interval [95% CI], 1.92-4.17) and > 1.5 times the odds of being diagnosed with breast carcinoma (OR, 1.78; 95% CI, 1.05-3.02) in the subsequent 24 months. CONCLUSIONS: Because hospitalization for DVT or PE is associated with an increased risk of a breast or colorectal carcinoma diagnosis in the subsequent 2 years, physicians should be vigilant in assessing the cancer screening status of patients with new DVT and/or PE to be certain that they are up to date with recommended breast and colorectal screening guidelines.

Aged↗
PubMed2006

In search of the perfect comorbidity measure for use with administrative claims data: does it exist?

BACKGROUND: Numerous measures of comorbidity have been developed for health services research with administrative claims. OBJECTIVE: We sought to compare the performance of 4 claims-based comorbidity measures. RESEARCH DESIGN AND SUBJECTS: We undertook a retrospective cohort study of 5777 Medicare beneficiaries ages 66 and older with stage III colon cancer reported to the Surveillance, Epidemiology, and End Results Program between January 1, 1992 and December 31, 1996. MEASURES: Comorbidity measures included Elixhauser's set of 30 condition indicators, Klabunde's outpatient and inpatient indices weighted for colorectal cancer patients, Diagnostic Cost Groups, and the Adjusted Clinical Group (ACG) System. Outcomes included receipt of adjuvant chemotherapy and 2 year noncancer mortality. RESULTS: For all measures, greater comorbidity significantly predicted lower receipt of chemotherapy and higher noncancer death. Nested logistic regression modeling suggests that using more claims sources to measure comorbidity generally improves the prediction of chemotherapy receipt and noncancer death, but depends on the measure type and outcome studied. All 4 comorbidity measures significantly improved the fit of baseline regression models for both chemotherapy receipt (baseline c-statistic 0.776; ranging from 0.779 after adding ACGs and Klabunde to 0.789 after Elixhauser) and noncancer death (baseline c-statistic 0.687; ranging from 0.717 after adding ACGs to 0.744 after Elixhauser). CONCLUSIONS: Although some comorbidity measures demonstrate minor advantages over others, each is fairly robust in predicting both chemotherapy receipt and noncancer death. Investigators should choose among these measures based on their availability, comfort with the methodology, and outcomes of interest.

Aged↗
PubMed2004

[Federal Cancer Reporting Unit. Surveillance program for cancer registration in Germany].

For 20 years the Federal Cancer Reporting Unit has been processing and analyzing the comprehensive data of the population-based cancer registries in the Federal Republic of Germany. For this purpose the registries transfer their epidemiological records that have been made anonymous to the Federal Cancer Reporting Unit in the Robert Koch Institute once a year. An essential task of the Federal Cancer Reporting Unit is to check the data coherence and especially the completeness of cancer registration. The completeness of registration is estimated by site- and register-specific log-linear models. Based on data from sufficiently complete registries, national incidence rates and their time trends are estimated. Cancer survival rates, lifetime, and age-conditional probability of developing cancer and risk of dying from cancer are calculated and interpreted. The results are published regularly. With increasing completeness of registration, multiple notification of cases in different registries and their exclusion by matching procedures becomes more important. With increasing completeness of registration, further problems can be addressed such as the incidence of rare cancer sites or the analysis of regional patterns of cancer incidence and their underlying causes. Given the different legal requirements of cancer registration in the federal states of Germany, a national institution such as the Federal Cancer Reporting Unit in the Robert Koch Institute, which is not directly involved in cancer registration, can perform these activities best.

Adolescent↗
PubMed1994

Seasonal variation in frequency of diagnosis of cutaneous malignant melanoma.

Incident cases of in situ and invasive cutaneous malignant melanoma diagnosed during 1975-90 were identified through the National Cancer Institute's Surveillance, Epidemiology, and End Results program. We studied the 32,868 white subjects diagnosed with melanoma, who were living in nine cancer registry areas covering approximately 10% of the population of the USA. The summer-to-winter ratio, defined as the ratio of the number of melanomas diagnosed during June to August (summer), to the number of melanomas diagnosed during December to February (winter), was determined according to gender, stage, histologic type and anatomic site. Summer-to-winter ratios were 1.47 (95% confidence interval (CI) 1.37-1.58) for in situ; 1.43 (95% CI 1.38-1.48) for local stage; 1.24 (95% CI 1.12-1.38) for regional stage; and 0.95 (95% CI 0.82-1.11) for distant stage melanoma. For the melanomas staged as local at diagnosis (86% of the invasive melanomas staged), a July peak was observed. For each of the major histological types of local stage melanoma, summer-to-winter ratios were significantly elevated in men (range 1.24-1.41) and women (range 1.44-1.90). For the major anatomic sites (including the head and neck, which are exposed throughout the year) of local stage melanoma, summer-to-winter ratios were elevated for men (range 1.28-1.45) and for women (range 1.31-1.75).(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1995

Upper aerodigestive tract cancers.

BACKGROUND: Cancers of the upper aerodigestive tract constitute approximately 4% of all malignancies. These include cancer of the lip, tongue, major salivary glands, gums and adjacent oral cavity tissues, floor of the mouth, tonsils, oropharynx, nasopharynx, hypopharynx and other oral regions, nasal cavity, accessory sinuses, middle ear, and larynx. METHODS: The histologically diagnosed cancers of the upper aerodigestive tract reported to the Surveillance, Epidemiology, and End Results program of the National Cancer Institute in 1973-1987 were tabulated by histologic type, sex, age, and racial group, and according to quinquennium (1973-1977, 1978-1982, 1983-1987). Frequencies, age-specific incidence rates, median age, and extent of spread at diagnosis, stage, and survival were examined. RESULTS: Cancer of the upper aerodigestive tract represented 3.5% of all microscopically proven malignant neoplasms. Except for salivary glands, gums, nasopharynx, and nasal cavity and accessory sinuses, epidermoid carcinomas accounted for greater than 95% of the cancers. For all aerodigestive sites combined, there was a 2-to-1 male-to-female ratio (greater for laryngeal cancer, which was approximately 5 to 1). Incidence in black males was often twice the levels recorded in white males, whereas rates for black and white females tended to be close. The 5-year relative survival was approximately 50% (90% for lip and 65% for larynx), was somewhat better for whites than for blacks, and did not improve significantly over the 15 years studied. Salivary gland adenocarcinoma carried a survival of approximately 80%. CONCLUSIONS: Because many of the cancers of the upper aerodigestive tract are caused by alcohol and tobacco use, the potential for prevention is considerable.

Adolescent↗
PubMed2005

Clinical characteristics of different histologic types of breast cancer.

Breast cancer is a heterogeneous disease, though little is known about some of its rarer forms, including certain histologic types. Using Surveillance, Epidemiology, and End Results Program data on 135 157 invasive breast cancer cases diagnosed from 1992 to 2001, relationships between nine histologic types of breast cancer and various tumour characteristics were assessed. Among women aged 50-89 years at diagnosis, lobular and ductal/lobular carcinoma cases were more likely to be diagnosed with stage III/IV, > or =5.0 cm, and node-positive tumours compared to ductal carcinoma cases. Mucinous, comedo, tubular, and medullary carcinomas were less likely to present at an advanced stage. Lobular, ductal/lobular, mucinous, tubular, and papillary carcinomas were less likely, and comedo, medullary, and inflammatory carcinomas were more likely to be oestrogen receptor (ER) negative/progesterone receptor (PR) negative and high grade (notably, 68.2% of medullary carcinomas were ER-/PR- vs 19.3% of ductal carcinomas). In general, similar differences were observed among women diagnosed at age 30-49 years. Inflammatory carcinomas are associated with more aggressive tumour phenotypes, and mucinous, tubular, and papillary tumours are associated with less aggressive phenotypes. The histologic types of breast cancer studied here differ greatly in their clinical presentations, and the differences in their hormone receptor profiles and grades point to their likely different aetiologies.

Adenocarcinoma↗
PubMed1999

Cancer surveillance series: interpreting trends in prostate cancer--part I: Evidence of the effects of screening in recent prostate cancer incidence, mortality, and survival rates.

BACKGROUND: The prostate-specific antigen test was approved by the U.S. Food and Drug Administration in 1986 to monitor the disease status in patients with prostate cancer and, in 1994, to aid in prostate cancer detection. However, after 1986, the test was performed on many men who had not been previously diagnosed with prostate cancer, apparently resulting in the diagnosis of a substantial number of early tumors. Our purpose is to provide insight into the effect of screening on prostate cancer rates. Detailed data are presented for whites because the size of the population allows for calculating statistically reliable rates; however, similar overall trends are seen for African-Americans and other races. METHODS: Prostate cancer incidence data from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program and mortality data from the National Center for Health Statistics were analyzed. RESULTS/CONCLUSIONS: The following findings are consistent with a screening effect: 1) the recent decrease since 1991 in the incidence of distant stage disease, after not having been perturbed by screening; 2) the decline in the incidence of earlier stage disease beginning the following year (i.e., 1992); 3) the recent increases and decreases in prostate cancer incidence and mortality by age that appear to indicate a calendar period effect; and 4) trends in the incidence of distant stage disease by tumor grade and trends in the survival of patients with distant stage disease by calendar year that provide suggestive evidence of the tendency of screening to detect slower growing tumors. IMPLICATIONS: The decline in the incidence of distant stage disease holds the promise that testing for prostate-specific antigen may lead to a sustained decline in prostate cancer mortality. However, population data are complex, and it is difficult to confidently attribute relatively small changes in mortality to any one cause.

Black or African American↗
PubMed2005

The effect of race on invasive staging and surgery in non-small-cell lung cancer.

PURPOSE: Black patients with early-stage non-small-cell lung cancer (NSCLC) have worse overall survival than white patients. Decreased likelihood of resection has been implicated. To isolate the effect of decision making from access to care, we used receipt of surgical staging as a proxy for access and willingness to undergo invasive procedures, and examined treatments and outcomes by race. PATIENTS AND METHODS: We examined registry and claims data of Medicare-eligible patients with nonmetastatic NSCLC in areas monitored by the Surveillance, Epidemiology, and End Results program from 1991 to 2001. Patients who obtained invasive staging, defined as bronchoscopy, mediastinoscopy, or thoracoscopy, were included. Logistic regression and Cox modeling calculated the odds of having staging and surgery, and survival outcomes. RESULTS: A total of 14,224 patients underwent staging, and 6,972 had surgery for lung cancer. Black patients were less likely to undergo staging (odds ratio [OR] = 0.75; 95% CI, 0.67 to 0.83), and once staged, were still less likely to have surgery than whites (OR = 0.55; 95% CI, 0.47 to 0.64). Survival for blacks and whites was equivalent after resection (hazard ratio = 1.02; P = .06). Staged black patients were less likely to receive a recommendation for surgery when it was not clearly contraindicated (67.0% v 71.4%; P < .05), and were more likely to decline surgery (3.4% v 2.0%; P < .05). CONCLUSION: Black patients obtain surgery for lung cancer less often than whites, even after access to care has been demonstrated. They are more likely not to have surgery recommended, and more likely to refuse surgery. Additional research should focus on the physician-patient encounter as a potential source of racial disparities.

Adult↗
PubMed1997

Analysis of current trends in United States mesothelioma incidence.

Mesothelioma incidence often is interpreted as an index of past exposure to airborne asbestos. The mesothelioma rate for US males exhibits an increasing trend throughout the 1970s and early 1980s. The trend has been attributed to occupational exposure in the shipbuilding industry during World War II, in manufacturing, and in building construction. Incidence data (1973-1992) from the Surveillance, Epidemiology, and End Results Program were used to investigate current trends in age-adjusted and age-specific mesothelioma rates. An age and birth-cohort model was used to project both lifetime probabilities of mesothelioma by cohort and the annual number of cases expected over the next 70 years. The current trend in female rates is flat (age-adjusted rate = 0.30 per 100,000). The estimated lifetime risk for females is 2.5 x 10(-4), independent of birth cohort. The projected average annual number of female cases is 500. For males, the age-adjusted mesothelioma rate is increasing solely due to the age group 75 years and over, albeit at a declining growth rate. Lifetime risk for males peaks at 2 x 10(-3) for the 1925-1929 birth cohort, then decreases to 5 x 10(-4) for the 1955-1959 birth cohort. The pattern of rates reflected in the age and birth-cohort model suggests a peak in the annual number of mesothelioma cases for males at 2,300 before the year 2000. The number of male cases then will drop during the next 50-60 years toward 500. These trends mirror the US trend in raw asbestos consumption and a reduction in workplace airborne asbestos levels.

Aged↗
PubMed2005

Modeling the effect of tumor size in early breast cancer.

SUMMARY BACKGROUND DATA: The purpose of this study was to determine the type of relationship between tumor size and mortality in early breast carcinoma. METHODS: The data was abstracted from 83,686 cases registered in the Surveillance, Epidemiology, and End Results Program of women diagnosed with primary breast carcinoma between 1988 and 1997 presenting with a T1-T2 lesion and no metastasis in whom axillary node dissection was performed: 58,070 women were node-negative (N0) and 25,616 were node-positive (N+). End point was death from any cause. Tumor size was modeled as a continuous variable by proportional hazards using a generalized additive models procedure. RESULTS: Functionally, a Gompertzian expression exp(-exp(-(size-15)/10)) provided a good fit to the effect of tumor size (in millimeters) on mortality, irrespective of nodal status. Quantitatively, for tumor size between 3 and 50 mm, the increase of crude cumulative death rate (number of observed deaths divided by the number of patients at risk) increased with size from 10% to 25% for N0 and from 20% to 40% for N+. CONCLUSIONS: The functional relationship of tumor size with mortality is concordant with current knowledge of tumor growth. However, its qualitative and quantitative independence of nodal status is in contradiction with the prevailing concept of sequential disease progression from primary tumor to regional nodes. This argues against the perception that nodal metastases are caused by the primary tumor.

Breast Neoplasms↗
PubMed2003

Differences in breast cancer stage, treatment, and survival by race and ethnicity.

BACKGROUND: In the United States, black and Hispanic white women with breast cancer present with more advanced stages and have poorer survival rates than non-Hispanic whites, whereas Asians and Pacific Islanders do not. However, Asians and Pacific Islanders and Hispanic whites are heterogeneous populations, and few studies have evaluated breast cancer stage, treatments, and mortality rates for subgroups of these populations. METHODS: Using data from 11 population-based tumor registries that participate in the Surveillance, Epidemiology, and End Results Program, we conducted a retrospective cohort study to evaluate the relationship between race and ethnicity and breast cancer stage, treatments, and mortality rates. The cohort of 124,934 women diagnosed as having a first primary invasive breast carcinoma between January 1, 1992, and December 31, 1998, included 97,999 non-Hispanic whites, 10,560 blacks, 322 American Indians, 8834 Asians and Pacific Islanders, and 7219 Hispanic whites. RESULTS: Relative to non-Hispanic whites, blacks, American Indians, Hawaiians, Indians and Pakistanis, Mexicans, South and Central Americans, and Puerto Ricans had 1.4- to 3.6-fold greater risks of presenting with stage IV breast cancer. Blacks, Mexicans, and Puerto Ricans were 20% to 50% more likely to receive or elect a first course of surgical and radiation treatment not meeting the 2000 National Comprehensive Cancer Network standards. In addition, blacks, American Indians, Hawaiians, Vietnamese, Mexicans, South and Central Americans, and Puerto Ricans had 20% to 200% greater risks of mortality after a breast cancer diagnosis. CONCLUSIONS: Differences in breast cancer stage, treatments, and mortality rates are present by race and ethnicity. Breast cancer survival may be improved by targeting factors, particularly socioeconomic factors, that underlie these differences.

Adult↗
PubMed2006

Suicide and cancer: a gender-comparative study.

BACKGROUND: Persons with cancer commit suicide more frequently than those without, and males generally commit suicide more frequently than females. A population-based analysis of cancer patients was carried out here, comparing suicide risk between the genders, to elucidate the features specific to each gender. PATIENTS AND METHODS: A total of 1.3 million cancer cases from the Surveillance, Epidemiology, and End Results program were analyzed. Cox proportional hazards models were fitted to personal, tumor-related, and social variates. RESULTS: A total of 265 female and 1307 male suicides were enumerated, reflecting 0.04% and 0.19% from each gender, and providing an overall hazard ratio for male suicide of 6.2 [95% confidence interval (CI) 5.4-7.1]. Females with colorectal (P = 0.01) and cervical (P < 0.0001) cancers showed decreased suicide rates. Males with head and neck cancers (P < 0.0001) and myeloma (P = 0.02) had increased rates, whereas rates were decreased in males with lung cancer (P = 0.01), liver (P = 0.01), brain tumors (P = 0.04), and leukemia (P = 0.007). The hazard ratio associated for male suicide with distant metastasis was 2.84 (95% CI 2.49-3.24); for married status, 0.46 (95% CI 0.39-0.54); and for African-American ancestry, 0.24 (95% CI 0.17-0.34)-comparable ratios were seen here for female suicides. In head and neck cancers, with both genders analyzed together, the suicide hazard was increased if surgery was contraindicated (3.0, 95% CI 1.3-6.8), but not if refused. CONCLUSIONS: The high-risk patient was male, with head and neck cancer or myeloma, advanced disease, little social or cultural support, and limited treatment options. Oncologists and allied health professionals should be aware of the potential for suicide in cancer patients and their associated risk factors.

Female↗
PubMed2002

Treatment and survival for women with Fallopian tube carcinoma: a population-based study.

OBJECTIVE: The objective of this study was to evaluate treatment and survival for women with fallopian tube carcinoma in a population-based data set. METHODS: Using the National Cancer Institute's Surveillance, Epidemiology, and End Results program, we identified 416 women with fallopian tube carcinoma diagnosed between 1990 and 1997. We analyzed treatment and 5-year relative survival. We also compared survival to that of 9032 women with epithelial ovarian cancer diagnosed between 1991 and 1997. RESULTS: Almost half of those diagnosed with stage I/II disease did not undergo surgical evaluation of lymph nodes. Most women with stage I/II disease were treated with surgery alone, while most women with stage III/IV disease were treated with surgery and chemotherapy. Five-year relative survival by FIGO stage was as follows: stage I (N = 102), 95%; stage II (N = 29), 75%; stage III (N = 52), 69%; stage IV (N = 151), 45%. CONCLUSIONS: We observed better survival, stage by stage, for women with fallopian tube carcinoma than for women with epithelial ovarian cancer in this population-based data set. It is possible that some patients with advanced, bulky carcinoma arising in the fallopian tube may have been classified as having ovarian or primary peritoneal cancer. Women with fallopian tube cancer should be treated in accordance with the same guidelines for surgical staging, debulking, and adjuvant chemotherapy as for women with epithelial ovarian cancer. Further studies, both laboratory and clinical, are needed to delineate the differences between fallopian and ovarian cancers.

Adult↗
PubMed2003

Barriers to hospice care among older patients dying with lung and colorectal cancer.

PURPOSE: To identify factors associated with hospice enrollment and length of stay in hospice among patients dying with lung or colorectal cancer. METHODS: We used the Linked Medicare-Tumor Registry Database to conduct a retrospective analysis of the last year of life among Medicare beneficiaries diagnosed with lung or colorectal cancer at age > or = 66 years between January 1, 1973, and December 31, 1996, in the Surveillance, Epidemiology, and End Results Program who died between January 1, 1988, and December 31, 1998. Our outcomes of interest were time from cancer diagnosis to hospice enrollment and length of stay in hospice care. We used Cox proportional hazards regression to adjust for demographic and clinical information. RESULTS: We studied elderly patients dying with lung cancer (n = 62,117) or colorectal cancer (n = 57,260). Overall, 27% of patients (n = 16,750) with lung cancer and 20% of patients (n = 11,332) with colorectal cancer received hospice care before death. Median length of stay for hospice patients with lung and colorectal cancer was 25 and 28 days, respectively. Overall, 20% of patients entered hospice within 1 week of death, whereas 6% entered more than 6 months before death. Factors associated with later hospice enrollment include being male; being of nonwhite, nonblack race; having fee-for-service insurance; and residing in a rural community. Many of these factors also were associated with shorter stays in hospice. CONCLUSION: Although use of hospice care has increased dramatically over time, specific patient groups, including men, patients residing in rural communities, and patients with fee-for-service insurance continue to experience delays in hospice enrollment.

Aged↗
PubMed2006

The evolving presentation of renal carcinoma in the United States: trends from the Surveillance, Epidemiology, and End Results program.

PURPOSE: The incidence of renal cancer is increasing, while cases series suggest that tumor size is decreasing. This has important implications for treatment planning. We evaluated national trends in renal cancer size and observed survival in patients diagnosed in the 3 periods 1988 to 1992, 1993 to 1997 and 1998 to 2002. MATERIALS AND METHODS: From the Surveillance, Epidemiology, and End Results database we identified 29,053 patients diagnosed with primary renal cancer. Patients were stratified into size categories and 5-year time cohorts. Size distribution was compared across cohorts. Kaplan-Meier survival curves and Cox proportional hazards modeling were used to examine trends in overall and stage specific survival. RESULTS: From 1988 through 2002 renal tumor size decreased from 66.8 to 58.6 mm, while the age adjusted incidence of renal cancer increased from 8.6 to 11.2 cases per 100,000 individuals. Kaplan-Meier analysis showed steadily deteriorating survival with increased cancer size above 4 cm with a median survival of 105 months for 4 to 7 cm vs 46 months for more than 7 cm. Cox modeling demonstrated significantly improved survival in patients diagnosed in the latter cohorts. With adjustment for size the latter cohorts remained significantly improved compared to the earliest cohort, although the 1998 to 2002 cohort was no longer significantly different than the 1993 to 1997 cohort. CONCLUSIONS: Nationally renal tumor size at presentation has steadily and consistently decreased. Patients more recently diagnosed had improved survival, which could be attributable to decreased tumor size in the latter cohorts. Patients more recently diagnosed also demonstrated a relative survival advantage independent of size compared to the earliest patients studied.

Female↗
PubMed2003

Analysis of racial differences in incidence, survival, and mortality for malignant tumors of the uterine corpus.

BACKGROUND: In the United States, incidence rates for malignant tumors of the uterine corpus are lower among blacks than among whites, whereas mortality rates are higher among blacks. Reasons for the higher level of mortality among blacks have been debated. METHODS: Using data from the Surveillance, Epidemiology, and End Results program, the authors compared incidence rates by histopathologic type for malignant tumors of the uterine corpus (including uterus, not otherwise specified) during the period 1992-1998 among white Hispanic, black, and white non-Hispanic patients. The authors also compared cumulative relative survival rates for blacks and whites by histopathologic type and by other factors, and they calculated estimated type-specific mortality rates. RESULTS: Overall incidence (per 100,000 woman-years) of corpus malignancy was significantly lower among white Hispanics (14.04; 95% confidence interval [CI], 13.39-14.72) and blacks (15.31; 95% CI, 14.61-16.04) compared with white non-Hispanics (23.43; 95% CI, 23.06-23.81). Compared with white non-Hispanics, blacks had significantly higher incidence rates of serous/clear cell carcinoma (rate ratio, 1.85; 95% CI, 1.61-2.12), carcinosarcoma (rate ratio, 2.33; 95% CI, 1.99-2.72), and sarcoma (rate ratio, 1.56; 95% CI, 1.31-1.86). Survival was worse for blacks than for whites in every histopathologic category and in 'usual' types of endometrial adenocarcinoma, stratified by stage, grade, and age. Rare aggressive tumor types accounted for 53% of mortality among blacks, compared with 36% among whites. CONCLUSIONS: Less favorable outcomes for usual types of endometrial adenocarcinoma and for rare aggressive tumors contribute equally to the relatively high mortality due to corpus cancer among black women.

Adenocarcinoma↗
PubMed1996

Comorbidity and breast cancer survival: a comparison between black and white women.

The presence of concurrent health conditions (comorbidity) at the time of breast cancer diagnosis has an adverse effect on survival. It is unclear, however, whether the strength of the association between comorbidity and survival varies in different populations of breast cancer patients. It is necessary, therefore, to establish (1) whether a comorbidity index derived from a general population of patients (mostly white) would predict survival in a black population, and (2) whether comorbidity would have the same degree of relationship to mortality in black as in white populations. We studied 1196 breast cancer patients who were members of the Kaiser Permanente Medical Care Program and were diagnosed with local (n = 708), regional (n = 446), or remote (n = 49) stage breast cancer from 1973 to 1986. Mortality follow-up was completed to December 1994. Ten-year survival was studied in relation to the Charlson comorbidity index for black women and for white women, and for both groups of women combined. Compared to women with a Charlson comorbidity score of 0 (no comorbidity), patients with scores of 1, 2, and 3+ had risk ratios for ten-year mortality of 1.23 (P = 0.10), 2.58 (P < 0.001), and 3.44 (P < 0.001), respectively. This pattern of risk associated with comorbidity was similar to that found in the original Charlson study. The pattern of risk ratios for different levels of comorbidity was very similar for black and white patients. The results confirm previous studies indicating that comorbidity (in particular, the Charlson Comorbidity Index) predicts the survival of women with breast cancer, independently of other factors, such as stage of breast cancer at diagnosis. The Charlson index has prognostic significance for both black and white populations. Research is needed to determine whether the Charlson index can be improved by including health conditions that are particularly prevalent or severe in specific subgroups of women.

Aged↗
PubMed2004

Mesothelioma trends in the United States: an update based on Surveillance, Epidemiology, and End Results Program data for 1973 through 2003.

Using 1973-2000 mesothelioma incidence data released by the Surveillance, Epidemiology, and End Results Program in April 2003, the authors estimated the parameters of a birth-cohort and age model to determine whether previously reported patterns of mesothelioma in the United States have changed. Compared with analyses based on data through 1992, a slower decline was found in male cases immediately after a peak in 2000-2004, but no other notable changes in the time pattern were detected. Analysis confirmed that the annual number of male mesothelioma cases, which increased steeply from the 1970s through the mid-1990s, has leveled off in terms of both the age-adjusted rate and the absolute numbers of cases. After a peak of approximately 2,000 cases, a return to background levels is expected by 2055. The total projected number of male mesothelioma cases in 2003-2054 is approximately 71,000. The maximum lifetime risk for males, which occurs for the 1925-1929 birth cohort, is 1.8 x 10(-3). The age-adjusted rate for females is constant, as are the female lifetime mesothelioma risk across birth cohorts (3.6 x 10(-4)) and the annual risk (3.9 x 10(-6)). The time pattern of cases for females supports the existence of a threshold exposure for mesothelioma and a quantifiable background rate.

Adolescent↗