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PubMed2001

Radiation therapy in non-surgically-treated nonmetastatic prostate cancer: geographic and demographic variation.

OBJECTIVES: To examine the geographic variation in the use of radiation to treat nonmetastatic prostate cancer and to identify factors that explain the variation in the United States. METHODS: This study was based on data from the nine geographic regions of the Surveillance, Epidemiology, and End Results Program for 1983 through 1996. Patients with localized or regional prostate cancer who did not undergo surgical treatment were included in the analysis. Logistic regression analysis was used to investigate the influence of geographic and demographic factors on the use of radiation. The squared multiple correlation coefficient R(2) was used to measure the proportion of variation in the selection of radiation explained by each factor of interest. RESULTS: Compared with San Francisco, the adjusted odds ratios for 6 of the 8 geographic areas had highly significant P values, suggesting the use of radiation therapy varies from region to region. However, geographic location only explained less than 3% of the total variation in the use of radiation. The geographic location explained a much higher proportion of variation in the youngest (younger than 55 years) and the oldest (80 years old or older) groups. Overall, age was the most important factor that influenced the use of radiation. CONCLUSIONS: The finding that geographic location explains a significant proportion of the variation in the use of radiation in the youngest and oldest age groups demonstrates the outcome of longstanding controversies in the nonsurgical treatment of prostate cancer. Documenting the impact of the interaction of age and geographic location on the treatment approaches provides for better understanding of the impact of patients and physicians making clinical decisions in the management of nonmetastatic prostate cancer.

Black or African American↗
PubMed2026

Cancer statistics for Asian American, Native Hawaiian, and Pacific Islander people, 2026.

BACKGROUND: Cancer statistics for Asian American and Native Hawaiian and Pacific Islander (NHPI) people are usually aggregated, masking substantial variation within this heterogeneous population. Herein, the American Cancer Society reports cancer incidence and survival for 8 Asian American and 3 NHPI ethnic groups. METHODS: The authors used population-based cancer registry data from the National Cancer Institute's Surveillance, Epidemiology, and End Results program, for Asian American and NHPI ethnic groups from 2000 through 2022. RESULTS: During 2018-2022, overall cancer incidence ranged from 218.3 per 100,000 Kampuchean people to 474.5 per 100,000 Native Hawaiian people, which was 1.5 times higher than the rate for the aggregated Asian American and NHPI population (307.3 per 100,000). High incidence among Native Hawaiian people is largely driven by the highest rates of female breast, colorectal, and prostate cancers, whereas infection-related cancers were highest among Asian American ethnic groups. For example, liver and stomach cancer incidence is highest among Vietnamese (22.2 per 100,000) and Korean people (17.8 per 100,000), respectively, both of which were nearly twice that in Native Hawaiian people (12.9 and 9.6 per 100,000, respectively). Native Hawaiian and Samoan women are twice and 3 times as likely, respectively, to be diagnosed with uterine corpus cancer as aggregated Asian American and NHPI women or White women. Five-year relative survival ranges from 42% in Laotians to 74% in Asian Indians/Pakistanis, with largest differences for colorectal (43% in Laotians to 72% in Asian Indians/Pakistanis) and prostate (63% in Kampucheans to 97% in Japanese) cancers. CONCLUSIONS: Wide variation in cancer risk within the Asian American and NHPI population highlights the critical need for disaggregated data to effectively target cancer prevention and control interventions.

Adolescent↗
PubMed2002

Racial/ethnic differences in survival rates in a population-based series of men with breast carcinoma.

BACKGROUND: A rare occurrence, about 1500 men in the United States develop breast carcinoma each year. Little is known about survival patterns at the population level, particularly about racial/ethnic variation. METHODS: Using data from the Surveillance, Epidemiology, and End Results Program, we examined survival rates in 1979 men diagnosed with primary invasive breast carcinoma between 1973 and 1997. Race was defined as non-Hispanic white, non-Hispanic black, and other race/ethnicity (predominantly Asian/Pacific Islander and Hispanic). The two outcomes were all-cause and breast carcinoma- specific mortality. Survival curves were drawn using Kaplan-Meier estimates and Cox regression was used to estimate the risk of death with hazard ratios and 95% confidence intervals. For both outcomes, the racial/ethnic survival curves differed significantly when the log rank test was used. Therefore, separate models were run for each racial/ethnic group. Covariates included age, stage, histology, surgery, radiation therapy, and year of diagnosis. Estrogen and progesterone receptor status were available for 616 men. RESULTS: Survival rates differed significantly by race/ethnicity. Overall, 5-year survival rates were 66% for whites, 57% for blacks, and 75% for men of other race/ethnicity. Blacks presented with more advanced disease. By stage, whites and blacks had worse survival rates compared with men of other race/ethnicity. The effects of prognostic factors such as age, surgery type, and radiation were similar, but not always significant, for all groups. Diagnosis year and estrogen receptor status did not affect survival. CONCLUSIONS: Survival following male breast carcinoma differed by race/ethnicity, whereas the prognostic factors associated with survival were similar.

Adenocarcinoma, Mucinous↗
PubMed2006

A population-based study of renal cell carcinoma and prostate cancer in the same patients.

OBJECTIVE: To investigate the incidence of prostate cancer in men with renal cell carcinoma (RCC) and the incidence of RCC in men with prostate cancer. METHODS: We evaluated the database of the Surveillance, Epidemiology and End Results Program of the National Cancer Institute from 1973 to 1996, to calculate the incidence of RCC in men with prostate cancer and the incidence of prostate cancer in men with RCC. The standardized incidence ratio (SIR, observed/expected) was calculated for each of the scenarios of interest, as well as for RCC and prostate cancer in men with other common malignancies. Lung/bronchus cancer, colon/rectal cancer, and non-Hodgkin lymphoma were selected for the control scenarios because they are the most common non-urological cancers among men in the USA. RESULTS: There was a higher incidence of RCC in men with prostate cancer (SIR 1.25, P < 0.01). RCC incidence was also higher in men with each of the other malignancies. Prostate cancer incidence was higher in men with RCC (SIR 1.42, P < 0.001), but was not significantly elevated for any of the control scenarios. CONCLUSIONS: The incidence of RCC is higher in men with each of the index cancers, whereas that for prostate cancer was higher only in men with RCC. A common aetiological factor is possible. However, it is also possible that detection bias explains these findings. Serial imaging might increase the detection of RCC among patients with a variety of index malignancies. Patients with RCC who are followed by a urologist might be screened more rigorously for prostate cancer than patients with other primary malignancies, leading to increased detection in these men.

Adolescent↗
PubMed1996

Marital status in relation to Kaposi's sarcoma, non-Hodgkin's lymphoma, and anal cancer in the pre-AIDS era.

Persons with human immunodeficiency virus/AIDS are at high risk of Kaposi's sarcoma (KS), non-Hodgkin lymphoma (NHL), and possibly anal cancers. To examine whether this risk preceded the AIDS epidemic, we used pre-AIDS era data from the Surveillance, Epidemiology, and End Results program (excluding Connecticut) from 1973 to 1976, and the Connecticut Tumor Registry from 1940 to 1976. We compared risk of being single (a surrogate to identify men who might be homosexual) to those ever married, using a case control matching study with up to 10 controls per case. Overall, no excess risk was observed for KS (risk ratio for men 20-59 years old: 1.00; 95% confidence interval 0.218-3.61), but there was a suggestion of higher risk (4.00; 0.54-29.48) in 1973-1976, the period just before the AIDS epidemic. The NHL risk (0.85; 0.74-0.99) was slightly low, but for anal cancer the risk ratio of being single was significantly high both in men 20-59 years old (5.68) and older men (2.78) long before the AIDS epidemic. If the excess risk was solely due to being homosexual, the actual relative risk in the subset who were homosexual must have been much higher, given that only a fraction of the single men would have been homosexual. As comparison groups to verify the methodology, we used colon (no association with marital status) and prostatic cancer (decreased in single men), with findings as reported in other studies. Thus, single men may have been at an excess risk of KS (but a slightly low risk of NHL) just before the AIDS epidemic and have been at excess risk of anal cancer for many years before the AIDS epidemic.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Prostate-specific antigen testing in black and white men: an analysis of medicare claims from 1991-1998.

OBJECTIVES: To describe the trends in prostate-specific antigen (PSA) use and associated cancer detection among black and white Medicare beneficiaries older than 65 years during the calendar period from January 1991 through December 1998. METHODS: Medicare claims data were linked with cancer registry data from the Surveillance, Epidemiology and End Results program of the National Cancer Institute. Data from a 5% random sample of men without a diagnosis of prostate cancer were combined with data from prostate cancer cases diagnosed during the calendar period from 1991 to 1998. PSA tests conducted after a diagnosis of prostate cancer were excluded. RESULTS: PSA use has stabilized among white men, reaching an annual rate of 38% by 1995 and remaining at this level through 1998. The annual rate of use among black men reached 31% by 1998, but was still increasing at that time. By 1996, at least 80% of tests in both blacks and whites were second or later tests. By the end of 1996, 35% of white men and 25% of black men were undergoing testing at least biannually or more frequently. In 1996, 83% of diagnoses in whites and 77% in blacks were preceded by a PSA test. CONCLUSIONS: Older black men lag slightly behind older white men in their use of the PSA test; however, annual testing rates in blacks have yet to stabilize. In both race groups, an overwhelming majority of diagnoses are associated with a PSA test, whether for screening or diagnostic purposes. Regular screening rates in blacks are substantially lower than in whites, but the regular screening rates are relatively low in both race groups. Should PSA screening prove efficacious, efforts to promote regular use among both black and white men will likely be needed.

Black or African American↗
PubMed2002

Rapidly rising breast cancer incidence rates among Asian-American women.

In recent years, breast cancer incidence rates have fluctuated over relatively short time spans; examination of these patterns can provide etiologic clues and direction for prevention programs. Asian-American women are generally considered to be at lower risk of breast cancer than other ethnic groups. However, their rates are typically based on an aggregation of ethnic Asian populations, which may obscure important ethnic differences in risk. Detailed analyses of the trends in ethnic-specific incidence rates will provide more information than when ethnicities are combined. Los Angeles County, California, the most populous and probably the most ethnically diverse county in the United States, has a large multi-ethnic Asian-American population. Trends in invasive female breast cancer incidence were examined using data from the Los Angeles Cancer Surveillance Program, the population-based cancer registry covering the County. Although overall breast cancer incidence rates remained stable in the late 1980s and early 1990s, data for the most recent 5-year period suggest that incidence may again be increasing for Asian-American and non-Hispanic white women over age 50 (estimated annual percent change = 6.3%, p < 0.05 and 1.5%, p < 0.05, respectively), although little change has occurred among black and Hispanic women. Invasive breast cancer incidence rates for Asian-American ethnic groups are heterogeneous and, for most, are increasing. In Los Angeles County, rates for Japanese-American women have increased rapidly since 1988 and are now approaching rates for non-Hispanic white women. Rates among Filipinas, who have historically had higher rates than their other Asian-American counterparts, are not increasing as rapidly as rates for Japanese women, but remain relatively high. Breast cancer risk among women of Japanese and Filipino ancestry is twice that of Chinese and Korean women. Asian women, who commonly have low breast cancer rates in their native countries, typically experience increasing breast cancer incidence after immigrating to the United States. Ethnic-specific incidence rates show that Japanese-Americans, the first Asian population to immigrate to Los Angeles County in large numbers and the most acculturated, have experienced a rapid increase in breast cancer incidence. Japanese-American rates in Los Angeles County may have already surpassed those of non-Hispanic whites if recent trends have continued unabated.

Asian↗
PubMed2006

Outcomes of women with metachronous breast and ovarian carcinomas.

INTRODUCTION: Women with a history of breast cancer have a significantly increased risk of developing a second primary ovarian cancer and vice versa. We proposed to determine the characteristics and outcomes of women diagnosed with metachronous breast and ovarian cancer. METHODS: Patients were identified from the Surveillance, Epidemiology, and End Results program database between 1988 and 2001. Kaplan-Meier and Cox proportional hazards regression tests were used to determine survival outcomes. RESULTS: Of 704 women, 526 developed breast cancer then ovarian cancer (B-O) and 178 developed ovarian cancer then breast cancer (O-B). The mean age at diagnosis of the first cancer in the B-O versus O-B group was 60.3 versus 58.9 years, respectively (P = 0.23). Twenty-five percent of women in the B-O group had stage I-II ovarian cancer versus 63% in the O-B group (P < 0.001). The percentage of those with stage I-II breast cancer was 94% and 91% in the B-O versus O-B group, respectively (P = 0.13). Women in the B-O group had more high grade of ovarian cancer compared to those in the O-B group (P < 0.001). The mean time interval between diagnoses of breast then ovarian versus ovarian then breast cancer was 58 versus 56 months, respectively (P = 0.42). CONCLUSIONS: In the largest series to date, we found that women diagnosed with ovarian cancer first had significantly more early stage and lower grade ovarian cancers with better survival compared to those with breast cancer followed by ovarian cancer. Since half of the women had their second cancer beyond 5 years, continued surveillance of these high risk patients is recommended.

Aged↗
PubMed2006

Uterine papillary serous and clear cell carcinomas predict for poorer survival compared to grade 3 endometrioid corpus cancers.

To compare the survival of women with uterine papillary serous carcinoma (UPSC) and clear cell carcinoma (CC) to those with grade 3 endometrioid uterine carcinoma (G3EC). Demographic, pathologic, treatment, and survival information were obtained from the Surveillance, Epidemiology, and End Results Program from 1988 to 2001. Data were analysed using Kaplan-Meier and Cox proportional hazards regression methods. Of 4180 women, 1473 had UPSC, 391 had CC, and 2316 had G3EC cancers. Uterine papillary serous carcinoma and CC patients were older (median age: 70 years and 68 vs 66 years, respectively; P<0.0001) and more likely to be black compared to G3EC (15 and 12% vs 7%; P<0.0001). A higher proportion of UPSC and CC patients had stage III-IV disease compared to G3EC patients (52 and 36% vs 29%; P<0.0001). Uterine papillary serous carcinoma, CC and G3EC patients represent 10, 3, and 15% of endometrial cancers but account for 39, 8, and 27% of cancer deaths, respectively. The 5-year disease-specific survivals for women with UPSC, CC and G3EC were 55, 68, and 77%, respectively (P<0.0001). The survival differences between UPSC, CC and G3EC persist after controlling for stage I-II (74, 82, and 86%; P<0.0001) and stage III-IV disease (33, 40, and 54; P<0.0001). On multivariate analysis, more favourable histology (G3EC), younger age, and earlier stage were independent predictors of improved survival. Women with UPSC and CC of the uterus have a significantly poorer prognosis compared to those with G3EC. These findings should be considered in the counselling, treating and designing of future trials for these high-risk patients.

Adenocarcinoma, Clear Cell↗
PubMed2003

Is there a true "shift" to the right colon in the incidence of colorectal cancer?

OBJECTIVE: Previous studies have reported a migration in the occurrence of colorectal cancer (CRC) toward a proximal colonic location. To assess the potential impact of this, we evaluated recent temporal trends in the United States. METHODS: Using the nine population-based cancer registries that constitute the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute, we identified primary CRCs diagnosed between 1978 and 1998. Temporal changes were evaluated for 3-yr time periods. Age-adjusted incidence rates and the proportions of new diagnoses of CRC were calculated by site and by race. RESULTS: We identified 243,861 individuals with CRC during 1978-1998, 51.1% of whom were men. In whites and in blacks, the proportions of new diagnoses of right CRC rose significantly, from 34% and 37% to 40% and 44%, respectively. In contrast, the proportions of left CRC (in whites and blacks) and of rectosigmoid CRC (in whites) decreased significantly over time. For whites and blacks, the age-adjusted incidence rates for right CRC remained unchanged (in whites) or showed a small increase (in blacks), whereas the age-adjusted incidence rates for left CRC (in whites and blacks) and for rectosigmoid CRC (in whites) declined. During 1996-1998, right CRC was the most common site in the oldest age groups (70-79, 80 yr, and older) in whites and in blacks. CONCLUSIONS: The proximal migration of CRC over time is not attributed to a true increase in the incidence of right CRC. It is explained by a decrease in the incidence of distal CRC coupled with the aging of the population. Older individuals, in whom the burden of CRC is greatest, and in whom right CRC is the most common site, would be the most adversely affected from CRC screening methods that do not assess the total colon.

Adult↗
PubMed1997

The results of prostate carcinoma screening in the U.S. as reflected in the surveillance, epidemiology, and end results program.

BACKGROUND: The rapid escalation in the incidence of prostate carcinoma between the years 1988 and 1992 has been attributed to prostate specific antigen screening. There have been concerns regarding the possible diagnosis and treatment of insignificant tumors in the absence of randomized, controlled trial evidence of a decrease in mortality. Descriptive studies suggest that serial screening decreases the detection of advanced disease. In November 1996, the National Center for Health Statistics recorded a decrease in prostate carcinoma mortality. METHODS: The basis of this analysis is 208,234 prostate carcinoma cases diagnosed between 1973 and 1993 in population-based Surveillance, Epidemiology, and End Results registries. The general staging system was used rather than that of the American Joint Committee on Cancer to permit observation of long term trends. Grade incorporating Gleason scores was used as an indication of the significance of the prostate carcinoma. Age-adjusted survival rates were used to separate prostate carcinoma deaths from deaths due to other causes. RESULTS: The increase in the incidence of prostate carcinoma has been greater than for any other malignancy. The increase was largely in Grade 2 significant tumors and not in Grade 1 (15%) insignificant tumors. There was a decrease in the detection of advanced disease. After the peak incidence in 1992, a progressive decrease to near baseline levels occurred. Approximately 38% of all deaths were from prostate carcinoma. Deaths from other causes increased with age. When corrected for death from other causes, men age > 69 years had a greater rate of death from prostate carcinoma than men age 50-69 years. Approximately 61% of all deaths from prostate carcinoma occurred within 5 years of diagnosis and 88% within 10 years. The 10-year survival rate for patients treated by radical prostatectomy was 100%, 78% for patients treated by radiation, and 33% for patients treated with other (noncomparable modalities). CONCLUSIONS: The indirect evidence suggested that prostate carcinoma screening of men ages >50 years decreased the incidence of distant disease, which influences the mortality rate.

Aged↗
PubMed2005

CYP1A1 and CYP1B1 polymorphisms and risk of lung cancer among never smokers: a population-based study.

The cytochrome P450 (CYP) superfamily of enzymes catalyse one of the first steps in the metabolism of carcinogens such as polycyclic aromatic hydrocarbons, nitroaromatics and arylamines. Polymorphisms within the CYP1A1 gene have been shown to be associated with lung cancer risk, predominantly among Asian populations. Despite functional evidence of a possible role of CYP1B1 in lung cancer susceptibility, only a few studies have evaluated polymorphisms in this gene in relation to lung cancer susceptibility. This population-based study evaluates polymorphisms in both of these CYP genes within never smokers, most of whom had environmental tobacco smoke (ETS) exposure. Cases (n = 160) were identified through the metropolitan Detroit Surveillance, Epidemiology and End Results program, and age, sex and race-matched population-based controls (n = 181) were identified using random digit dialing. Neither CYP1A1 MspI nor CYP1A1 Ile(462)Val was associated with lung cancer susceptibility among Caucasians or African-Americans. Among Caucasians, however, CYP1B1 Leu(432)Val was significantly associated with lung cancer susceptibility odds ratio (OR) for at least one valine allele = 2.87 [95% confidence interval (CI) 1.63-5.07]. Combinations of this Phase I enzyme polymorphism along with selected Phase II enzyme polymorphisms (GSTM1 null, GSTP1 Ile(105)Val and NQO1 C(609)T) were evaluated. The combination of CYP1B1 Leu(432)Val and NQO1 C(609)T appeared to be associated with the highest risk of lung cancer (OR = 4.14, 95% CI 1.60-10.74), although no combinations differed significantly from the risk associated with CYP1B1 Leu(432)Val alone. When individuals were stratified by household ETS exposure (yes/no), CYP1B1 Leu(432)Val alone and in combination with Phase II enzyme polymorphisms was more strongly associated with increased lung cancer susceptibility among those with at least some household ETS exposure. Additional studies will be required to further validate these findings among never smokers and to evaluate the effects of this polymorphism among smoking populations as well.

Adenocarcinoma↗
PubMed2006

Merkel cell carcinoma and multiple primary cancers.

Merkel cell carcinoma (MCC) is an aggressive neuroendocrine tumor of the skin for which causative factors remain largely unknown. The site-specific risks of multiple primary cancers associated with MCC, which may provide insight into etiologic influences, have not been quantified in large population-based studies. We estimated the long-term risk of subsequent primary tumors after a first primary MCC (1,306 patients) and the risk of second primary MCC following other first primary cancers (2,048,739 patients) within 11 population-based cancer registries which report to the National Cancer Institute's Surveillance, Epidemiology, and End Results Program (1986-2002). Patients with first primary MCC were at significantly increased risk of developing a subsequent cancer [standardized incidence ratio (SIR), 1.22; 95% confidence intervals (95% CI), 1.01-1.45; observed (O = 122)], with significant excesses restricted to the first year after diagnosis (SIR, 1.71; 95% CI, 1.21-2.33; O = 39). Significantly elevated site-specific risks were observed for cancers of salivary gland (SIR, 11.55; 95% CI, 2.32-33.76; O = 3), biliary sites other than liver and gallbladder (SIR, 7.24; 95% CI, 1.46-21.16; O = 3), and non-Hodgkin lymphoma (SIR, 2.56; 95% CI, 1.23-4.71; O = 10). Nonsignificantly increased risks of 2-fold or higher were seen for chronic lymphocytic leukemia, and cancers of the small intestine and brain. A significantly increased 1.36-fold risk (95% CI, 1.19-1.55; O = 221) of MCC as a second primary malignancy was observed among patients with all other first primary cancers taken together. In particular, significant 3- to 7-fold excesses of MCC followed multiple myeloma (SIR, 3.70; 95% CI, 1.01-9.47; O = 4), chronic lymphocytic leukemia (SIR, 6.89; 95% CI, 3.77-11.57; O = 14), non-Hodgkin lymphoma (SIR, 3.37; 95% CI, 1.93-5.47; O = 16), and malignant melanoma (SIR, 3.05; 95% CI, 1.74-4.95; O = 16). Although enhanced medical surveillance may play a role, increased reciprocal risks suggest that MCC may share etiologic influences with other malignancies. Heightened awareness of the associations of lymphohematopoietic malignancies with MCC may facilitate early clinical recognition.

Aged↗
PubMed2000

Racial differences in breast carcinoma survival.

BACKGROUND: Survival after breast carcinoma diagnosis is significantly worse among African American women for reasons unknown. The purpose of this study was to update reports on the National Surveillance, Epidemiology, and End Results Program and to examine the effect of race on breast carcinoma survival. METHODS: Subjects were 135,424 women diagnosed with primary breast carcinoma between 1988-1995. Patient age, tumor stage at the time of diagnosis, hormone receptor status, tumor histology, menopausal status, and survival were compared by race category. RESULTS: African American women diagnosed with breast carcinoma (n = 11,159) had a significantly increased risk of death from breast carcinoma and from all cancers compared with white women (n = 124,265), independent of the effects of other predictor variables. African American women were significantly younger at the time of diagnosis, with approximately 33% of the population age </= 50 years, compared with slightly <25% of the white women belonging to that younger age group. African American women were significantly more likely to present with advanced stages of breast carcinoma and, within each stage category, had significantly poorer survival compared with white women. African American women were significantly less likely to have tumors positive for estrogen or progesterone receptors, as well as histologically confirmed lobular and tubular carcinomas, whereas they were more likely to have inflammatory, medullary, and papillary histology compared with white women. CONCLUSIONS: The results of the current study show that race is an independent predictor of survival from breast carcinoma. These findings are consistent with other large, population-based studies of racial differences in breast carcinoma survival and have been comported by studies of racial differences in the molecular biology of breast carcinoma, thus providing support for the epidemiologic credibility of the independence of the association.

Adult↗
PubMed1998

Inflammatory breast carcinoma incidence and survival: the surveillance, epidemiology, and end results program of the National Cancer Institute, 1975-1992.

BACKGROUND: Little is known about the cause of inflammatory breast carcinoma (IBC), the most aggressive form of breast cancer. To the authors' knowledge, no studies have investigated whether IBC risk factors are different from those for breast carcinoma overall, and there has been only one report of IBC incidence and survival patterns. METHODS: The authors used data from the Surveillance, Epidemiology, and End Results program of the National Cancer Institute for the period 1975-1992 to calculate age-adjusted incidence and survival rates for 913 white and 121 African American women with IBC involving dermal invasion of lymphatic ducts and 166,375 white and 13,674 African American women with other types of breast carcinoma (non-IBC). RESULTS: Between 1975-1977 and 1990-1992, IBC incidence doubled, increasing among whites from 0.3 to 0.7 cases per 100,000 person-years and among African Americans from 0.6 to 1.1 cases. However, rates for African Americans varied due to the small numbers of IBC cases. The twofold increase in IBC incidence was higher than that observed for non-IBC during the same period (27% for African Americans and 25% for whites). IBC patients were significantly younger at diagnosis than non-IBC patients; and among both IBC and non-IBC patients, African Americans were younger than whites. Overall survival was significantly worse for IBC patients than for non-IBC patients and for African Americans than for whites. Among whites, 3-year survival improved more for IBC patients than for non-IBC patients between 1975-1979 and 1988-1992, increasing from 32% to 42% for IBC patients (P=0.0001) and from 80% to 85% for non-IBC patients (P=0.0001). CONCLUSIONS: The disparities observed in incidence trends and age at diagnosis, particularly according to race, highlight the need for further investigation of the differences between IBC and non-IBC incidence.

Adenocarcinoma↗
PubMed2007

Long-term outcome after operative intervention for rectal cancer in patients aged over 80 years: analysis of 9,501 patients.

INTRODUCTION: Perceptions of poor outcome may detract caregivers from offering standard therapies to patients over 80 years who have been diagnosed with rectal cancer. We evaluate the effect of operative intervention on their survival. METHODS: Demographics, tumor characteristics, treatment, and survival for patients over 80 years with rectal and rectosigmoid cancer from 1993 to 2002 in the Surveillance, Epidemiology and End Results Program of the National Cancer Institute were examined. Survival was determined by using the Kaplan-Meier method. Patients who underwent operation (Group A) were compared with those who did not undergo surgery (Group B). Fisher's exact, chi-squared, analysis of variance, and log-rank tests were used as appropriate, and P < 0.05 was considered statistically significant. RESULTS: A total of 9,501 patients (19 percent) were aged older than 80 years. Mean age was 85 years, and median survival was 24 months. Stage of disease was unknown for 2,915 patients. Median survival was 58, 53, 39, 27, and 5 months for Stages 0 (n=163), I (n=1,878), II (n=1,796), III (n=1,536), and IV (n=1,213), respectively. A total of 6,900 patients (81 percent) underwent surgery. Median survival for operated patients was significantly longer for all stages (36 vs. 5 months, P < 0.00001), Stage 0 (60 vs. 7 months, P < 0.01), Stage I (55 vs. 11 months, P < 0.0001), Stage II (41 vs. 13 months, P < 0.0001), Stage III (28 vs. 14 months, P < 0.05), and Stage IV (8 vs. 3 months, P < 0.0001). For patients with rectal cancer, local therapy also significantly improved median survival compared with nonoperated patients (P < 0.0001). CONCLUSIONS: Operative intervention provides sustained benefit in terms of survival to patients aged >80 years with rectal cancer at all stages who are assessed to be a good operative risk. Age older than 80 years should not detract surgeons from offering optimal therapy to good-risk patients.

Aged, 80 and over↗
PubMed2000

Cancer surveillance series: non-Hodgkin's lymphoma incidence by histologic subtype in the United States from 1978 through 1995.

BACKGROUND: Clinical investigations have shown prognostic heterogeneity within the non-Hodgkin's lymphomas (NHLs) according to histology, but few descriptive studies have considered NHLs by subgroup. Our purpose is to assess the demographic patterns and any notable increases in population-based rates of different histologic subgroups of NHL. METHODS: Using data collected by the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute, we calculated incidence rates for the major clinicopathologic categories of NHL by age, race, sex, geographic area, and time period. RESULTS: Among the 60 057 NHL cases diagnosed during the period from 1978 through 1995, total incidence (per 100 000 person-years) was 17.1 and 11.5 among white males and females, respectively, and 12.6 and 7.4 among black males and females, respectively. However, rates for follicular NHLs were two to three times greater among whites than among blacks, with little sex variation. Blacks demonstrated much higher incidence than whites for peripheral T-cell NHL, with the incidence rates higher in males than in females. For other NHL subgroups, the incidence rates for persons less than 60 years of age were generally higher among males than among females, with little racial difference; at older ages, the rates were higher among whites than among blacks, with little sex difference. High-grade NHL was the most rapidly rising subtype, particularly among males. Follicular NHL increased more rapidly in black males than in the other three race/sex groups. Overall, the broad categories of small lymphocytic, follicular, diffuse, high-grade, and peripheral T-cell NHL emerged as distinct entities with specific age, sex, racial, temporal, and geographic variations in rates. CONCLUSIONS: Findings from our large, population-based study reveal differing demographic patterns and incidence trends according to histologic group. Future descriptive and analytic investigations should evaluate NHL risks according to subtype, as defined by histology and new classification criteria.

Adolescent↗
PubMed2005

Risk of contralateral testicular cancer: a population-based study of 29,515 U.S. men.

BACKGROUND: Although risk estimates for synchronous and metachronous contralateral testicular cancers vary widely, many clinicians recommend routine biopsy of the contralateral testis for patients diagnosed with unilateral testicular cancer. We evaluated the risk of contralateral testicular cancer and survival in a large population-based cohort of men diagnosed with testicular cancer before age 55 years. METHODS: For 29 515 testicular cancer cases reported to the National Cancer Institute's Surveillance, Epidemiology and End Results Program from 1973 through 2001, we estimated the prevalence of synchronous contralateral testicular cancer, the observed-to-expected ratio (O/E) and 15-year cumulative risk of metachronous contralateral testicular cancer, and the 10-year overall survival rate of both synchronous and metachronous contralateral testicular cancer, using the Kaplan-Meier method for the two latter assessments. Age-adjusted multivariable analyses were used to examine risk according to histologic type of the original cancer. RESULTS: A total of 175 men presented with synchronous contralateral testicular cancer; 287 men developed metachronous contralateral testicular cancer (O/E = 12.4 [95% confidence interval {CI} = 11.0 to 13.9]; 15-year cumulative risk = 1.9% [95% CI = 1.7% to 2.1%]). In the multivariable analysis, only nonseminomatous histology of the first testicular cancer was associated with a statistically significantly decreased risk of metachronous contralateral testicular cancer (hazard ratio [HR] = 0.60, 95% confidence interval [CI] = 0.46 to 0.79; P<.001). Increasing age at first testicular cancer diagnosis was associated with decreasing risk of nonseminomatous metachronous contralateral testicular cancer (odds ratio = 0.90, 95% CI = 0.86 to 0.94). The 10-year overall survival rate after metachronous contralateral testicular cancer diagnosis was 93% (95% CI = 88% to 96%), and that after synchronous contralateral testicular cancer was 85% (95% CI = 78% to 90%). CONCLUSIONS: The low cumulative risk of metachronous contralateral testicular cancer and favorable overall survival of patients diagnosed with metachronous contralateral testicular cancer is in accordance with the current U.S. approach of not performing a biopsy on the contralateral testis.

Adult↗