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PubMed1998

Cancer of the corpus uteri in white and black women in Michigan, 1985-1994: an analysis of trends in incidence and mortality and their relation to histologic subtype and stage.

BACKGROUND: Cancer of the corpus uteri occurs more commonly among white women in the U.S., yet survival is poorer for black women. This study examined whether this trend has changed and also examined the relation of age and histologic subtype to differences in stage. METHODS: This retrospective cohort study assessed incidence trends, mortality trends, and the relation of age and histologic subtype to stage for 12,079 incident cases and 2325 deaths registered between 1985 and 1994 in Michigan. Rate ratios compared incidence and mortality. Odds ratios quantified the contribution of age and histologic subtype to differences in risk for advanced stage, using Mantel-Haenszel univariate techniques and multivariate logistic regression. RESULTS: The overall incidence rate was 21.99 per 100,000, and the overall mortality rate was 3.82 per 100,000. Black women had a 40% lower risk (rate ratio [RR] =0.60) of developing cancer of the corpus uteri but had a 54% greater risk (RR=1.54) of dying from cancer of the corpus uteri. Black women were at greater risk of being diagnosed with either sarcoma or more aggressive adenocarcinoma. However, after adjustment for age and histologic subtype, black women still had an increased risk for advanced stage disease (2.63, 95% confidence interval=2.19-3.16). CONCLUSIONS: The disparity between white and black women persists in incidence and mortality trends for cancer of the corpus uteri. The greater frequency of more aggressive histologic subtypes experienced by black women accounts for only 10% of their excess risk for more advanced stage disease.

Adenocarcinoma↗
PubMed1999

Trends in incidence and treatment for ductal carcinoma in situ in Hispanic, American Indian, and non-Hispanic white women in New Mexico, 1973-1994.

BACKGROUND: Incidence rates of ductal carcinoma in situ (DCIS) breast carcinoma and the use of breast-conserving surgery (BCS) for its treatment show substantial geographic and ethnic variations nationwide. To the authors' knowledge, few studies have investigated incidence rates and treatment patterns in Hispanics and American Indians. METHODS: The authors used data from the population-based New Mexico Tumor Registry to describe trends in DCIS incidence rates between 1973-1994 and investigate patient and physician characteristics related to BCS in a multiethnic population between 1985-1994. Multiple logistic regression was used to evaluate patient and physician factors related to receiving BCS. RESULTS: Incidence rates for DCIS in Hispanics were approximately 50% lower compared with non-Hispanic whites. American Indians had the lowest incidence rate. Beginning in 1985, incidence rates for Hispanics and non-Hispanic whites showed a 21% annual increase. Between 1990-1994, incidence rates in American Indians increased more than twofold. BCS increased 5.8% per year between 1985-1994, with 50% of Hispanic and non-Hispanic white patients treated with BCS in 1994. The strongest factor associated with receiving BCS was geographic location of treatment (P < 0.001). The odds of receiving BCS were 5.8 times higher in the northern third of the state compared with the southern third. No significant variation in BCS was found by ethnicity, rural/urban residency, socioeconomic status, or physician characteristics. CONCLUSIONS: Incidence rates for DCIS increased substantially in all three ethnic groups. The use of BCS was associated most strongly with the location of treatment, most likely reflecting differences in physician practices and treatment recommendations. Further research is needed to investigate the increasing incidence rates of DCIS and the determinants of BCS for the treatment of DCIS.

Adolescent↗
PubMed2000

Adenocarcinoma of the lung in young patients: the M. D. Anderson experience.

BACKGROUND: Surveillance, Epidemiology, and End Results (SEER) data for the years 1973-1992 documented that patients age < 50 years presented with more advanced disease. Because of the increase in the incidence rate of lung adenocarcinoma in the past few decades and the presentation of more advanced disease in young patients, this study was performed to determine whether differences in survival exist between younger and older patients with this disease. METHODS: The authors reviewed the experience of the University of Texas M. D. Anderson Cancer Center between 1985-1994, encompassing 157 patients age < 40 years of 4097 patients registered with adenocarcinoma of the lung. For comparison, 157 patients age > 50 years with lung adenocarcinoma were selected; these patients were matched for gender, stage of disease at presentation, and definitive therapy modality to assess survival differences more accurately. Data regarding exposure to second-hand smoke were not collected secondary to lack of documentation in the charts reviewed. RESULTS: There were no significant differences between the 2 groups with regard to the overall survival rate (P = 0.34) or time to progression (P = 0.43). Smoking status (current vs. former vs. never-smoker) was not found to be predictive of survival in either the younger group (P = 0.51) or the older group (P = 0.92). CONCLUSIONS: The data from the current study indicate that overall survival and disease free survival rates were not significantly different in these two groups. Thus, the younger patient population should be treated similarly to the older patient population. However, a surprisingly high percentage of younger patients were female (45%) and had never smoked (27%), suggesting that risk factors other than active smoking may be involved in lung carcinogenesis in these patients.

Adenocarcinoma↗
PubMed2000

International trends and patterns of prostate cancer incidence and mortality.

Prostate cancer is the most commonly diagnosed cancer in western men, and incidence is rising rapidly in most countries, including low-risk populations. Age-adjusted incidence and mortality rates from 15 and 13 countries between 1973-77 and 1988-92, respectively, were compared to provide leads for future analytic studies. Large increases in both incidence and mortality rates of prostate cancer were seen for all countries. For incidence, increases were more pronounced in the United States, Canada, Australia, France and the Asian countries, while the increases in medium-risk countries were moderate. Increases in incidence ranged from 25%-114%, 24%-55% and 15%-104% in high-, medium- and low-risk countries, respectively. Mortality rates rose more rapidly in Asian countries than in high-risk countries. Substantial differences in incidence and mortality across countries were evident, with U.S. blacks having rates that were 50-60 times higher than the rates in Shanghai, China. Increasing incidence rates in the United States and Canada are likely to be due in part to the widespread use of transurethral resection of the prostate and prostate-specific antigen testing, while increases in the Asian countries are probably related to westernization in these low-risk populations. The large disparities in incidence between high- and low-risk countries may be due to a combination of genetic and environmental factors. Future studies are needed to examine gene-gene and gene-environment interactions in various countries concurrently to shed light on the etiology of prostate cancer and to help elucidate reasons for the large differences in risk between populations.

Age Distribution↗
PubMedDate not supplied

A hypothesis about Spiegel et al.'s 1989 paper on Psychosocial intervention and breast cancer survival.

In a randomized prospective study of 86 metastatic breast cancer patients by Spiegel et al. in 1989, the 50 who took part in a group psychosocial intervention survived on average 18 months longer than the 36 controls who did not. Because the control survival curve looked unusually steep, lacking an expected right-skewed tail, both curves were compared with that of a population from the same region having metastatic breast cancer. When transformed to life-table format, the curves of the control sample and the regional population, neither group having had an intervention, were almost identical for a year, and differed strikingly after 20 months. This led to the hypothesis that the 12 control patients surviving for more than 20 months were an extremely aberrant sample, being subject to the strong biasing influence of possible confounders, of which a considerable number are known, but not including those accounted for in the study. Corollaries to the hypothesis are that the intervention had no effect; that the intervention curve was in fact equivalent to a control curve with mild sampling departure from that of the regional population; and that, therefore, the repetition of the study now under way would not yield confirmation of the 1989 study, but rather, would support the hypothesis and the first two corollaries.

Breast Neoplasms↗
PubMed1995

Gastrointestinal cancer.

BACKGROUND: There are great differences in incidence and prognosis of cancer among the component sites of the digestive tract. Furthermore, a number of the histologic types of tumors at these sites differ in their incidence and prognosis. METHODS: The SEER data from 1973 to 1987 on frequency, incidence, staging, and survival for the various histologic types of 194,452 cancers of the esophagus, stomach, and intestines were studied. RESULTS: There was an increased incidence of adenocarcinomas of esophagus, gastric cardia, small intestine, and colon; incidence rates for rectal adenocarcinoma and esophageal squamous cell carcinoma remained stable; and rates for gastric adenocarcinoma decreased. Blacks had higher incidence rates than whites for gastric adenocarcinoma; squamous cell carcinoma of the esophagus; carcinoids of the small intestine, colon, and rectum; and gastric sarcomas. Whites, especially males, had higher incidence rates for adenocarcinomas of the esophagus and gastric cardia than did blacks. Blacks had lower rates for rectal adenocarcinomas than did whites, but slightly higher rates than whites for rectal mucinous carcinomas and colonic adenocarcinomas. Data on race, sex, survival, and time trends indicate that mucinous colorectal carcinomas are biologically different from other adenocarcinomas. Males had poorer overall survival than did females for most histologic types of digestive tract tumors. Appendiceal mucinous adenocarcinomas with distant metastases were associated with a high (50%) 5-year survival. The poor prognosis of cases diagnosed as colonic carcinoid raises the possibility that some of these actually may be carcinomas. CONCLUSION: Studies of digestive tract cancer require analysis by histologic type for adequate assessment.

Adolescent↗
PubMed1995

Sarcomas and other malignancies of soft tissue, retroperitoneum, peritoneum, pleura, heart, mediastinum, and spleen.

BACKGROUND: Malignant neoplasms of the structural tissues, consisting mostly of soft tissue sarcomas, are morphologically diverse and rarely treated for epidemiologic purposes as individual entities. Our understanding to date of the pattern of occurrence of sarcomas is based largely on reports of limited individual clinic experience or case-control studies, each driven by a single hypothesis, and there have been virtually no descriptions according to specific morphologic type. METHODS: The accumulated coverage of the SEER populations offers an opportunity to correct this deficit. Each of the diagnoses has been reported and coded using a single set of rules and described in relation to the population at risk in terms of age, sex, race, calendar period, anatomic location, and outcome. In addition, each morphologic type has been compared with each of the others with respect to the pattern of occurrence and survival. RESULTS: For most of the individual morphologic entities, the pattern of occurrence is specific and unlike other patterns. Differences according to anatomic site, age, sex, race, and period-specific survival were found. Partly because of changes in diagnostic criteria over the years, differences in secular trend, other than that for Kaposi's sarcoma, could not be verified. Although some types of sarcoma may have important genetic determinants, there is evidence of environmental causation in others; for some varieties both genetic and environmental factors may operate. There is no evidence of improvements in survival. CONCLUSIONS: The most likely basis for the observed patterns are morphology-specific differences in etiology and growth phase. Each of the entities should be considered etiologically distinct and should be studied individually whenever possible.

Adolescent↗
PubMed1995

Skin cancer. Melanoma and other specific nonmelanoma skin cancers.

BACKGROUND: Malignant melanoma accounts for most of the growing mortality from skin cancer. However, survival rates are increasing for individual cases, probably because of earlier diagnoses. METHODS: Skin cancers collected by the SEER population-based data base between 1973 and 1987 are described in terms of their histologic classification and their distribution by sex, race, anatomical location, geographic locality, and time period of occurrence. RESULTS: There were 30,519 invasive skin cancers in the 15-year reporting period. Because the common basal cell and squamous cell cancers are not reportable to SEER, most of the cancers (28,206) were melanomas. In addition, 4386 in situ melanomas were reported. The rate of melanoma was 13-fold higher in whites than in blacks and 29% higher in white males than in white females. There was a 52% increase in the age-adjusted incidence rate for invasive melanoma and a 600% increase in the incidence rate of in situ melanoma over the 15-year period for whites and a 12% decrease in the incidence rate of invasive melanoma in blacks. The incidence of melanoma in the ear and trunk predominated in males, whereas melanoma of the lower limb predominated in females. Incidence rates and rate of increase of incidence of melanoma varied by anatomical subsite, sex, and geographic location within the United States. CONCLUSIONS: The variations among incidence rates of melanoma by sex, subsite, race, geographic location, and time period support prevailing theories of a solar cause for most but not all cases of this disease. Although melanoma rates are rising overall, the disproportionate rise in the rate of diagnosis of in situ compared with invasive melanoma suggests that melanomas are being diagnosed earlier.

Adolescent↗
PubMed1995

Endocrine gland cancer.

BACKGROUND: Incidence and prognosis of cancers of the endocrine glands vary greatly by histologic type. METHODS: Population-based data from SEER registries, 1973-1987, were analyzed. RESULTS: Thyroid cancer accounts for most (92%) of the cancers of the endocrine glands. The four major histologic types of thyroid cancer display distinct patterns, reflecting different biologic entities. Papillary carcinoma, the most common type, occurs more frequently in women than in men and in whites than in blacks and has an early onset. Follicular carcinoma, the second most common type, shows a steady increase in incidence with age and a female preponderance but no racial disparity. Medullary carcinoma, the rare differentiated thyroid tumor, has a female excess in whites only and a slow increase in incidence with age. Anaplastic carcinoma shows few racial or sex variations and reaches a substantial level only after age 50. The prognosis also varies greatly by histologic type. The overall 5-year relative survival rate is greater than 90% for papillary and follicular carcinomas, 82% for medullary carcinoma, and less than 10% for anaplastic carcinoma. Carcinomas of the suprarenal gland and thymus are rare, accounting for about 3% of endocrine cancers each. These tumors, unlike the differentiated thyroid cancer, show no female preponderance, have a higher incidence rate in blacks, and have a poorer survival rate. CONCLUSIONS: The marked predominance of papillary carcinoma and the continued increase in its relative frequency characterize the postgoiter era and an increased use of scintigraphy and fine needle aspiration. Underdiagnosis of small tumors may explain the observed lower incidence of papillary carcinoma in blacks.

Adolescent↗
PubMed1995

Cancer of unknown primary site.

BACKGROUND: About 2% of more than 1 million cases of cancer diagnosed in residents of SEER areas for the 15-year period 1973-1987 were designated as being cancers of unknown primary site. METHODS: The 26,050 histologically diagnosed cancers of unknown primary site were studied. The small groups of other and ill-defined sites within the respiratory and intrathoracic systems and other ill-defined sites (546 total) were included in this total. RESULTS: Over the 15-year period, there has been a decrease in the number of these cancers for each race-sex group. There has been very little change over time in the distribution by histologic type. The most frequent diagnosis was adenocarcinoma (around 55%), with approximately equal numbers of epidermoid carcinoma and carcinoma, not otherwise specified (about 14%). Changes in the frequency of mucinous, small cell, and large cell carcinoma have been observed. Carcinoid tumors of unknown primary site increased substantially. CONCLUSION: The decline in the numbers of cancers assigned to unknown primary site is to be welcomed.

Adolescent↗
PubMed1995

Non-Hodgkin's lymphoma.

BACKGROUND: Significant advances in the understanding of non-Hodgkin's lymphoma (NHL) have occurred in the past two decades, resulting in changes in terminology and classification practices, which may affect the analysis of the Surveillance, Epidemiology, and End Results (SEER) data. METHODS: The incidence rates for each subgroup of NHL in the Working Formulation were reviewed from the National Cancer Institute's SEER data during three time periods: 1973-1977, 1978-1982, and 1983-1987. RESULTS: NHL has significantly increased by 50% from 1973 to 1988. The most frequently occurring NHL is diffuse large cell lymphoma, constituting nearly 30% of all lymphomas. Increased incidence rates for large cell immunoblastic and small noncleaved cell NHL observed during the 1980s are attributable largely to the acquired immunodeficiency syndrome epidemic. Exposure to environmental agents such as herbicides and hair coloring dyes have recently been identified as factors that increase the risk of NHL, but the overall contribution of these factors remains to be identified. The increase in extranodal lymphomas is in part a consequence of the application of modern immunophenotypic and genotypic methods, which lead to the reclassification of pseudolymphomas as monoclonal B-cell neoplasms. The apparent dramatic decline in the incidence of diffuse small cleaved NHL appears to be artifactual, as well, secondary to changes in classification of NHL. CONCLUSIONS: With the enhanced ability of pathologists to delineate new clinicopathologic entities by immunophenotypic and molecular biologic studies, future modifications to the collection of SEER data may be appropriate. Such an approach will address the limitations of the Working Formulation and lead to a more accurate data base for the evaluation of epidemiologic trends.

Adolescent↗
PubMed1995

Basal cell and squamous cell carcinomas are important risk factors for cutaneous malignant melanoma. Screening implications.

BACKGROUND: This study was designed to determine the risk of developing malignant melanoma (MM) in patients with a history of basal cell and/or squamous cell skin cancer (BCC/SCC) and to determine whether surveillance efforts can be directed toward these patients for the detection of early MMs. METHODS: The study cohort was followed by annual total cutaneous examination (TCE). Controls consisted of individuals from the United States population matched for age, sex, and length of follow-up. The anatomic locations of the study cohorts' newly diagnosed MMs were plotted on an anatomic chart. The setting was a private dermatology practice. Two hundred, ninety consecutive white patients with a history of BCC/SCC but with no personal or family history of MM were followed by annual TCEs. The main outcome measures were the relative risk of developing MM and their prognosis. RESULTS: Ten of the 290 patients developed an MM within an average of 109 months of follow-up (range, 3-17 years). All MMs were less than 0.70 mm in Breslow thickness and 80% occurred on usually clothed cutaneous sites. The expected number of MMs in the control population was 0.59 (P = 0.006), resulting in a relative risk of 17. CONCLUSION: Patients with BCC/SCC skin cancer are at substantial increased risk for developing MM. Regular and life-long surveillance TCE is an inexpensive and effective method for detecting curable MMs in such patients.

Adult↗
PubMed1995

Increased risk of second malignant neoplasms outside radiation fields in patients with cervical carcinoma.

BACKGROUND: The relative risk of second primary cancers was evaluated in 125 women with International Federation of Gynecology and Obstetrics (FIGO) Stages I and II cervical carcinoma treated radically with radiation therapy between January 1980 and December 1990. METHODS: Medical records of patients were reviewed to evaluate the incidence of second malignant neoplasms. Only tumors histologically proven were scored. The annual 5-year age-specific cancer incidence data per 100,000 white women in the years 1981-1985 were obtained from the National Cancer Institute's Surveillance, Epidemiology and End Results database. The relative risks were calculated as the ratio of observed-to-expected numbers of second cancers, using person-years at risk accumulated for each individual in the study. RESULTS: During the follow-up time (through December 1992), 10 women whose median age was 65.5 years at the time cervical cancer was diagnosed were found to have 11 second primary cancers. Nine of these cancers were metachronous with regard to cervical cancer and included breast (4), lung (2), myeloma (1), non-Hodgkin's lymphoma (1) and vulva(1). The metachronous tumors were diagnosed at a median age of 74 years and at median follow-up time of 34 months. Two of the cancers were synchronous with cervical cancer and included bladder (1) and thyroid (1). All of the second tumors were located outside radiation fields. None of the patients with second tumors received chemotherapy during treatment for cervical carcinoma. The relative risk of developing a second cancer of any type was 2.31 (95% confidence interval [CI] = 1.15-4.13), whereas the relative risk of developing a metachronous breast cancer was 2.64 (95% CI = 0.72-6.75). CONCLUSIONS: An increased risk of second primary cancers developing was observed among 125 patients with FIGO Stages I and II cervical carcinoma, which may suggest an abnormal genetic background and/or a common etiology for the initial and second tumors. The increased risk of breast cancer occurring as a second primary is in contrast with previously published studies reporting a decreased risk of breast cancer in survivors of cervical cancer.

Adult↗
PubMed1995

Second primary cancer after treatment for cervical cancer. An international cancer registries study.

BACKGROUND: The pattern of second cancers after treatment for cervical cancer provides important information on the risk of radiation-induced malignancies. Large numbers of women survive many years and can be studied for late effects. METHODS: Incident second cancers in 86,193 patients with cervical cancer reported to 13 population-based cancer registries in 5 countries were evaluated to estimate the risk of second cancer among very long term survivors. RESULTS: Overall, 7543 second cancers were observed versus 6015 cancers expected based on population rates (observed/expected = 1.2). Lung cancer accounted for nearly half of the excess cancers. Among the 49,828 women treated with radiation, 3750 survived 30 or more years and a two-fold risk of cancers of heavily irradiated organs was seen. Most of the excess cancers were of the rectum, vagina, vulva, ovary, and bladder. Patterns of risk over time since treatment were consistent with a radiation etiology. Significant increases of nonchronic lymphocytic leukemia and cancers of the bone and kidney were also linked to radiotherapy. Women treated surgically were also at significant risk of second cancers, in all likelihood related to cigarette smoking and risk factors similar to those of cervical cancer. CONCLUSIONS: Curative therapy for cervical cancer results in large numbers of long term survivors who develop second cancers very late in life. Radiation is an important cause of this increase and there is no evidence that risk returns to normal levels.

Europe↗
PubMed1995

Cervical cancer survival in a high risk urban population.

BACKGROUND: Cervical cancer remains an important public health problem, particularly for the urban minority population. To the authors' knowledge, determinants of cervical cancer survival have not been studied in this high risk population. METHODS: This study included all 158 women diagnosed and treated for invasive cervical cancer from January 1, 1986, through December 31, 1992, at the Grady Memorial Hospital and Clinics (Atlanta, GA). Medical records were abstracted to determine age at diagnosis, race, International Federation of Gynecology and Obstetrics (FIGO) clinical stage, treatment, and survival. Pathologic material was reviewed to confirm the diagnosis. RESULTS: Most patients (80%) were African American, and the stage distribution was similar for African American and white patients. Sixty-six (42%) had FIGO Stage I disease; 50%, Stage II or III; and 8%, Stage IV. Four-year actuarial survival differed significantly according to clinical stage (Ia = 94%, Ib = 79%, II = 39%, III = 26%, IV = 0%). Overall survival was lower for patients with glandular carcinomas than for those with squamous cell carcinomas (26% vs. 55%, P = 0.09). This difference was almost entirely due to increased mortality in patients with Stage Ib adenocarcinomas (53% vs. 88% for squamous cell carcinoma, Stage Ib, P = 0.03). CONCLUSIONS: The major prognostic markers for cervical cancer survival in this high risk patient population were clinical stage and histology, factors identical to those identified for other populations.

Black or African American↗
PubMed2001

Expert review of the diagnosis and histologic classification of Hodgkin disease in a population-based cancer registry: interobserver reliability and impact on incidence and survival rates.

BACKGROUND: The reliability of Hodgkin disease (HD) diagnosis and histologic classification is an ongoing concern but has not been evaluated in a population-based case series in 20 years. Yet, diagnostic error in cancer registry data used in surveying HD occurrence may produce statistics that misrepresent incidence, mortality, or survival. METHODS: Uniform pathology review was attempted for all 395 women ages 19--79 years with incident HD reported to a population-based cancer registry in 1988--94. Agreement between original registry and review diagnoses was measured with positive predictive values and kappa statistics. Incidence rates and survival probabilities were computed based on registry and review diagnoses. RESULTS: Registry and review diagnosis agreed for 245 of the 362 reviewed cases. Positive predictive values varied by histologic subtype (nodular sclerosis, 95%; lymphocyte predominance, 69%; mixed cellularity, 58%; lymphocyte depletion, 0%; not otherwise specified, 40%), but agreement was good overall (kappa, 0.66, 95% confidence interval, 0.56--0.76). Eleven patients were determined not to have HD; all were older than age 44 years. Hodgkin disease incidence rates differed for original and review diagnoses only in older women, for whom registry rates slightly overestimated incidence. Five-year survival rates did not differ for registry and review data overall or by age group. CONCLUSIONS: For most adult women patients, the diagnosis of HD was confirmed on review, reflecting the very good agreement between registry and review diagnoses for nodular sclerosis, the most common subtype. Thus, cancer registry statistics for this time period can provide accurate estimates of disease patterns for HD overall and for the nodular sclerosis variant. For other histologic subtypes, rates may be unreliable, and HD occurrence overall may be less dependable in populations with larger proportions of these subtypes.

Adult↗