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PubMed2001

The development of breast carcinoma in women with thyroid carcinoma.

BACKGROUND: Breast carcinoma and thyroid carcinoma are two malignancies that occur most commonly in women. An association between the incidence rates of thyroid and breast carcinoma in women after a diagnosis of the other malignancy has been suggested in a retrospective analysis of a single institution's tumor registry. In that study, an increased incidence of breast carcinoma in premenopausal women previously treated for thyroid carcinoma was observed. METHODS: The purpose of this study was to investigate further this relation utilizing a large database, the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) database. The SEER database is maintained by the National Cancer Institute, and it represents 11 population-based cancer registries covering approximately 14% of the United States population. The study was a population-based retrospective cohort analysis using external comparisons. From 1973 to 1994, 365 women in the SEER database were identified as having both thyroid and breast carcinomas. The SEER database from 1973 to 1994 was utilized to calculate age specific and calendar year specific incidence rates for each year for thyroid and breast carcinomas. The expected number of second cancers for each age group, calendar year, and follow-up period were determined by multiplying these incidence rates by the age specific and calendar year specific number of person-years at risk. The risk ratio (RR) was calculated by dividing the observed by the expected number of second cancers. Statistical significance was determined by the Poisson test. RESULTS: A total of 1,333,115 person-years were available for analysis. One hundred thirteen thyroid carcinoma cases were diagnosed after breast carcinoma cases (RR, 0.99; P = 0.576). Two hundred fifty-two breast carcinoma cases were diagnosed after thyroid carcinoma cases (RR, 1.18; P = 0.007). Premenopausal women (age 20-49 years) with an index thyroid carcinoma have a significantly increased risk of developing subsequent breast carcinoma (RR, 1.42; P = 0.001). Black premenopausal women with an index thyroid carcinoma do not have an increased risk of developing breast carcinoma, but the statistical power is lower due to low numbers. No women with index breast carcinoma have an increased risk of developing thyroid carcinoma. CONCLUSIONS: Women with a history of thyroid carcinoma have a greater than expected risk of developing breast carcinoma. This risk is most pronounced in premenopausal white women. The implications of this observation with respect to breast carcinoma screening guidelines and thyroid carcinoma treatment guidelines deserve further investigation.

Adult↗
PubMed2001

Increase of chemotherapy use in older women with breast carcinoma from 1991 to 1996.

BACKGROUND: There is little population-based information available on the actual use of chemotherapy and how closely this use mirrors consensus recommendations. The authors hypothesized that given the relative stability of consensus conference recommendations on chemotherapy use during the period 1991-1996 the patterns of use would more closely approximate consensus recommendation over time. METHODS: The authors studied women who received a diagnosis of Stage I-IV (American Joint Committee on Cancer staging) breast carcinoma at age 65 years and older from 1991 through 1996, using the SEER cancer registry cases linked with Medicare claims. RESULTS: Overall, women whose disease was diagnosed in 1996 had a 30% higher chance of receiving chemotherapy than those in 1991, after controlling for changes in tumor size, stage, and other factors. The use of chemotherapy was strongly influenced by age, with women age 65-69 years more than twice as likely to receive it as were women 70 years and older. The increase over time in chemotherapy depended on both tumor stage and patient age. For Stage I tumor, there was no increase in chemotherapy for any age. For Stage II, the increase was limited to younger women, whereas for Stage III and IV it was observed in women age 70 years and older. CONCLUSIONS: There was a significant increase of chemotherapy use over time from 1991 to 1996 in women age 65 years and older with breast carcinoma. The increase was limited to younger women and those with advanced stage at diagnosis. Thus, consensus recommendations and community practice seemed to mirror each other over time.

Aged↗
PubMed2001

Conditional median survival of patients with advanced carcinoma: surveillance, epidemiology, and end results data.

BACKGROUND: Conditional survival is clinically useful, particularly for patients with malignant disease who have a poor prognosis. However, there are no published data on the conditional median survival of patients with advanced carcinoma on a population basis. METHODS: Data on 217,573 patients with breast, colorectal, lung, or prostate carcinoma who were newly diagnosed with distant disease between 1973 and 1995 and who were followed through the end of 1997 were extracted from the Surveillance, Epidemiology, and End Results (SEER) data base of the National Cancer Institute. The Kaplan-Meier method was employed to estimate conditional median survival and 95% confidence intervals at 0-5 years after the initial diagnosis. RESULTS: The conditional median survival increased as time elapsed after the initial diagnosis. The increase was slowest and almost leveled off among patients with prostate carcinoma. The median survival of patients with breast carcinoma increased relatively linearly with time, i.e., 5-6 months per year. Conversely, there was a rapid increase in the conditional median survival according to the amount of time since diagnosis for patients with lung and colorectal carcinoma. The trend was most pronounced for patients with colorectal carcinoma. At 5 years after the initial diagnosis, the remaining median survival was longest for patients with colorectal carcinoma, almost 6 years (71.5 months), followed by patients with lung carcinoma (52.5 months), breast carcinoma (42.5 months), and prostate carcinoma (34.5 months). Although race was a correlate with initial survival, gender and age had more impact on late conditional survival. CONCLUSIONS: The conditional median survival provides useful and encouraging information for patients who survive with advanced disease and for healthcare professionals who treat these patients. However, the information should be used carefully, taking the limitations of these data into account.

Adult↗
PubMed2001

Trends in the utilization of androgen-deprivation therapy for patients with prostate carcinoma suggest an effect on mortality.

BACKGROUND: After a surge in the incidence of prostate carcinoma in the early 1990s, diminishing rates of mortality became apparent in 1993. This decrease in mortality is unlikely to be explained entirely by treatment with curative intent alone following screen-detected cases, because the time frame between detection and mortality remains relatively brief. METHODS: This study used incidence and initial treatment data from the Detroit area SEER registry between 1973 and 1998 in addition to mortality data covering the Metropolitan Detroit area obtained from the Michigan Department of Community Health. Data for Caucasian and African-American men were analyzed. The use of androgen-deprivation therapy, which evolved during the study period, was evaluated in conjunction with mortality and incidence trend data for consideration of etiologic contributions. RESULTS: The incidence of prostate carcinoma, as noted previously in national data, increased sharply in 1988, peaking in 1992 in Southeast Michigan, whereas mortality rates began to decrease in approximately 1993, with a sustained decrease to the latest recorded data in 1998. These trends were identical in Caucasians and African Americans. A sharp increase in the use of androgen-deprivation therapy began in 1990. This use of androgen-deprivation therapy is high and sustained for patients with early-stage disease, increases for several years, and then diminishes for patients with regional disease. The use also diminished through the 1990s for patients with late-stage disease, paralleling the decrease in the incidence rate for late-stage disease. CONCLUSIONS: The pattern of androgen-deprivation therapy usage was consistent with that for hormonal monotherapy and adjuvant and neoadjuvant therapy. These findings suggest that androgen-deprivation therapy may contribute, along with advances in diagnostic techniques and curative therapy with radiation or surgery, toward decreasing prostate carcinoma mortality rates in Southeast Michigan.

Adult↗
PubMed2004

Cancer incidence rates among Lawrence Livermore National Laboratory (LLNL) employees: 1974-1997.

BACKGROUND: In the mid-1970's an excess of malignant melanoma of the skin was noted among employees at the Lawrence Livermore National Laboratory (LLNL). A 1984 cancer incidence study showed a non-significant excess of total cancers among female employees with significant excesses for melanoma, rectum and anus, and salivary gland cancers. For male employees, there was a non-significant deficit of total cancer with significant excesses in melanoma and non-brain nervous system cancers. This paper reports the results of a surveillance effort to update our understanding of the patterns of cancer incidence in this population. METHODS: We used California Cancer Registry (CCR) data to ascertain employees who had worked for six or more consecutive months at LLNL during the 24-year period of 1974 through 1997 who were diagnosed weith cancer during that time frame. We used the Standardized Incidence Ratio (SIR) in our analyses. RESULTS: There were 17,785 employees who provided 186,558 person-years of observation: 145,203 were from males and 41,355 were from females. The CCR, through its linkage techniques, identified 541 individuals with invasive cancer and 96 with in situ cancer. A total of 404 males had invasive cancer and 33 had in situ cancer whereas there were 137 females with invasive cancer and 63 with in situ cancer. The SIR for invasive cancer in males was 69 (95% CI 62-76). The overall cancer SIR for males was unaffected by calendar time. There were only two invasive cancer sites with significant excess: melanoma and cancer of the testes. For eight categories or cancer sites, we found a statistical deficit in cancer incidence. The most striking deficit occurred in cancer of the lungs and bronchus with a SIR of 36 (95% CI 26-50). The SIR for invasive cancer in females was 80 (95% CI 67-94). The overall cancer SIR for females decreased over calendar time. There was a statistically significant deficit for cancers of the female genital organs. There were 84 cases of invasive and in situ melanoma in both genders. Time-trend analyses for melanoma showed a significant excess during the years 1974-1985 but a reduction to community rates from 1986 through 1997. There were 21 individuals with testicular cancer with a SIR of 207 (95% CI 129-317). There were no differences in age at diagnosis or cell type with the comparison population. We analyzed the data using the same radiosensitive cancer categories used in the 1984 study. There were no increases in SIRs in any of these categories. CONCLUSIONS: We found that the LLNL employees had less cancer than expected with males having relatively fewer cancers than females. The lung cancer rate for males was remarkably low. Since 1986 the melanoma rates resemble the community rates. Testicular cancer rates are modestly elevated and appear to have been so for the past 20 years. Lifestyle patterns, including smoking, and cancer screening activities are probably important contributors to the observed low cancer rates.

Adult↗
PubMed2004

Lymphoma in rheumatoid arthritis: the effect of methotrexate and anti-tumor necrosis factor therapy in 18,572 patients.

OBJECTIVE: The risk of lymphoma is increased in patients with rheumatoid arthritis (RA), and spontaneous reporting suggests that methotrexate (MTX) and anti-tumor necrosis factor (anti-TNF) therapy might be associated independently with an increased risk of lymphoma. However, data from clinical trials and clinical practice do not provide sufficient evidence concerning these issues because of small sample sizes and selected study populations. The objective of this study was to determine the rate of and standardized incidence ratio (SIR) for lymphoma in patients with RA and in RA patient subsets by treatment group. Additionally, we sought to determine predictors of lymphoma in RA. METHODS: We prospectively studied 18,572 patients with RA who were enrolled in the National Data Bank for Rheumatic Diseases (NDB). Patients were surveyed biannually, and potential lymphoma cases received detailed followup. The SEER (Survey, Epidemiology, and End Results) cancer data resource was used to derive the expected number of cases of lymphoma in a cohort that was comparable in age and sex with the RA cohort. RESULTS: The overall SIR for lymphoma was 1.9 (95% confidence interval [95% CI] 1.3-2.7). The SIR for biologic use was 2.9 (95% CI 1.7-4.9) and for the use of infliximab (with or without etanercept) was 2.6 (95% CI 1.4-4.5). For etanercept, with or without infliximab, the SIR was 3.8 (95% CI 1.9-7.5). The SIR for MTX was 1.7 (95% CI 0.9-3.2), and was 1.0 (95% CI 0.4-2.5) for those not receiving MTX or biologics. Lymphoma was associated with increasing age, male sex, and education. CONCLUSION: Lymphomas are increased in RA. Although the SIR is greatest for anti-TNF therapies, differences between therapies are slight, and confidence intervals for treatment groups overlap. The increased lymphoma rates observed with anti-TNF therapy may reflect channeling bias, whereby patients with the highest risk of lymphoma preferentially receive anti-TNF therapy. Current data are insufficient to establish a causal relationship between RA treatments and the development of lymphoma.

Adult↗
PubMed2002

Childhood cancer survival in Europe and the United States.

BACKGROUND: Survival rates for most major adult cancers are higher in the United States compared with the survival rates in Europe. The objective of this study was to determine whether transatlantic differences in survival also are present in childhood cancers. METHODS: The authors analyzed 16,148 European patients and 3476 patients in the United States who were diagnosed with malignant disease at age < 15 years during 1985-1989. The patients were obtained from 34 EUROCARE cancer registries in 17 countries and from 9 SEER registries in the United States. The authors considered the major 14 diagnostic categories of the International Classification of Childhood Cancers. To increase the power of comparisons, they also considered all childhood cancers together. Observed survival was calculated by actuarial methods. RESULTS: For all cancers combined, northern Europe had the highest 5-year survival rate at 75% (95% confidence interval [95%CI], 72-78%), and Eastern Europe had the lowest survival rate at 55% (95%CI, 52-58%). The survival rate in the United States was roughly comparable to the survival rates in Italy and other Western European countries at 70%. Northern Europe also had highest survival rate for patients with lymphoid leukemias (83%; 95%CI, 78-88%); whereas Germany, Italy, and the other Western European countries had survival rates similar to the average survival rate for patients in the United States (77%; 95%CI, 74-80%). The survival rate was 7-9% lower in Europe compared with the survival rate in United States for patients with neuroblastoma and Wilms tumors and 8% higher for patients with retinoblastoma (all significant). Small, nonsignificant differences were found for patients with osteosarcoma, ependymoma, and medulloblastoma (with a higher survival rate in the United States) and for patients with acute nonlymphocytic leukemia (with a higher survival rate in Europe). Very similar survival rates among the two populations were found for the other cancers. CONCLUSIONS: Unlike the survival of adults with cancer, the survival of children with cancer in Europe (except Eastern Europe) is very similar to that in the United States. Childhood cancers are generally more responsive to therapy than adult cancers, but these results also may reflect wide accessibility of these treatments for most patients. These results are relevant to the interpretation of differences in adult cancer survival.

Adolescent↗
PubMed2002

Twenty-five years of clinical research for patients with limited-stage small cell lung carcinoma in North America.

BACKGROUND: To determine the changes in clinical trials and outcomes of patients with limited-stage small cell lung carcinoma (SCLC) treated on Phase III randomized trials initiated in North America between 1972 and 1992. METHODS: Phase III trials from 1972 to 1992 for patients with limited-stage SCLC were identified. Patients with limited-stage SCLC treated during a similar time interval were also evaluated in the Surveillance, Epidemiology, and End Results (SEER) database. Trends were tested in the number of trials, in the number and gender of patients entered on trial, and in survival duration over time. RESULTS: Thirty trials involving 6564 patients were eligible for analyses. Nineteen trials (61%) involving 3626 patients were initiated within the first half of this time period (1972-1981). The median of median survival times of all patients treated on the control arms of the Phase III trials initiated between 1972 and 1981 and between 1982 and 1992 were 12.0 months (range, 10-16 months) and 17.0 months (range, 11-20 months), respectively (P < 0.001). Of 26 studies available for survival analysis, 5 (19%) showed a statistically significant survival prolongation in the experimental arm compared with the control arm with a median prolongation of 3.4 months (range, 1-5.2 months). All five evaluated some aspect of thoracic radiation therapy. Over a similar time period, there was a 6.4-month increase in the median survival of limited-stage SCLC patients listed in the SEER database (P < 0.0001) and a more than doubling of the 5-year survival from 5.2% to 12.1% (P = 0.0001). CONCLUSIONS: Analyses of the patients with limited-stage SCLC treated on Phase III trials in North America initiated between 1972 and 1992 and those listed in the SEER database show significant improvements in median survivals. Furthermore, the 5-year survival of patients with limited-stage SCLC listed in the SEER database has more than doubled over the last 25 years. Further research will be needed to determine the relative contribution of improved therapy, supportive care, and stage migration to this prolongation in survival.

Adult↗
PubMed2002

The continuing increase in the incidence of primary central nervous system non-Hodgkin lymphoma: a surveillance, epidemiology, and end results analysis.

BACKGROUND: Primary central nervous system lymphoma (PCNSL) is an extranodal form of non-Hodgkin lymphoma arising in the craniospinal axis. The incidence of PCNSL appears to be increasing. METHODS: PCNSL incidence data from 1973-1997 were obtained from the nine Surveillance, Epidemiology and End Results (SEER) registries. To limit the influence of the human immunodeficiency virus on incidence rates, data of never-married males and females and persons of unknown marital status were excluded. As a surrogate for new technology, SEER data were reviewed by dates of diagnosis (surrogate for imaging) and compared with glioma incidence (surrogate for stereotactic neurosurgery and improved diagnostic neuropathology). Age-adjusted incidence rates were estimated and compared for the period prior to computed tomography (CT) (1973-1984) and the magnetic resonance imaging (MRI) period (1985-1997). The estimated annual percent change was calculated based on linear regression analyses using SEER*STAT. RESULTS: The incidence of PCNSL appears to be increasing in all SEER registries examined. All age groups demonstrated an increase over time. This increase was observed both in the CT era as well as in the MRI era. PCNSL age-adjusted incidence (0.15 to 0.48, a 3-fold increase) outpaced that of systemic lymphoma (14.1 to 18.5, a 33% increase) for the same registries over the same time periods. The rate of increase has begun to slow since 1985; the estimated annual percent change for PCNSL was three-fold higher during the period 1973-1985 compared with 1986-1997. CONCLUSION: The incidence rate of PCNSL continues to rise. The increase is evident in all age groups and in both genders. Data from the current study suggest that improved diagnostic tools, such as CT or MRI, cannot explain this increase.

Adult↗
PubMed2002

Marked regional variation in adenocarcinomas of the esophagus and the gastric cardia in the United States.

BACKGROUND: Adenocarcinomas of the esophagus and the gastric cardia recently have experienced rapidly increasing incidence rates. Although these sites frequently are combined, they may have different risk factors. METHODS: The authors compared regional incidence rates of esophageal adenocarcinoma, gastric cardia adenocarcinoma, and esophageal squamous cell carcinoma within the U.S. Surveillance, Epidemiology, and End Results (SEER) cancer registry for the years 1973-1998. RESULTS: Regional incidence rates varied considerably. The Seattle-Puget Sound registry's recent average esophageal adenocarcinoma rates were over twice as high as those of the Utah registry (5.3 vs. 2.4 per 100,000 persons per year; P < 0.01); gastric cardia rates also differed (4.0 vs. 2.8 per 100,000 persons per year; P < 0.01). The incidence rate increase also varied markedly between regions. Since 1974, white male esophageal adenocarcinoma rates increased by 800% in Seattle compared with an increase of only 300% in Utah. In contrast, white male cardia adenocarcinoma rates increased by only 16% in Seattle (from 3.1 per 100,000 persons per year in 1974 to 3.6 per 100,000 persons per year in 1998) compared with 300% in Utah (from 0.7 to 2.2 per 100,000 persons per year). Both types of adenocarcinoma were more common in males and in the white population in all regions, but recent esophageal adenocarcinoma rates for black males in Connecticut were significantly higher than the U.S. black male average (3.1 vs. 0.8 per 100,000 persons per year; P < 0.01) and equaled the rates for the white population in some areas. Esophageal adenocarcinoma rates continued rising for white males through 1998, whereas cardia adenocarcinoma rates stabilized after 1988. CONCLUSIONS: There are substantial regional, temporal, and ethnic differences between esophageal adenocarcinoma incidence rates and gastric cardia adenocarcinoma incidence rates within a single cancer registry system. Thus, these malignancies may differ in important ways and should not be combined routinely in research studies. Individual-level studies are needed to explain these substantial regional and ethnic differences.

Adenocarcinoma↗
PubMed2002

Factors influencing mortality among young women with second primary breast carcinoma.

BACKGROUND: Tumor characteristics are strong predictors of survival among women with breast carcinoma, yet the variability in prognosis among women presenting with similar stages suggests other factors may also play an important role. We examine the prognostic significance of etiologic risk factors for breast carcinoma to determine whether factors that influence the development of breast carcinoma also affect the course of the disease among a prospective cohort of young women with bilateral breast carcinoma. METHODS: The 369 U.S. women included in this study were from the Cancer and Steroid Hormone Study who were diagnosed with an invasive first primary breast carcinoma between 1980 and 1982 and a second primary breast carcinoma before 1999. Cox proportional hazards models were used to evaluate factors known and suspected to be associated with breast carcinoma and with survival, based on reporting at the time of the first primary. RESULTS: One hundred sixty women died during the 16-18-year follow-up period. The adjusted 1, 5, 10, and 15-year survival rates following diagnosis of second primary breast carcinoma were 94%, 70%, 55%, and 49%, respectively. Survival rates werepoorest among the youngest women, those diagnosed with a second primary within 5 years of their first, poor African American women, women with either primary diagnosed at a later stage, those with less than 12 years of school, single women, and those with major weight gain between age 18 and adulthood. CONCLUSIONS: This study provided little evidence that important etiologic factors for breast carcinoma predict mortality following diagnosis of a second primary breast carcinoma.

Adult↗
PubMed2003

A population-based analysis of risk factors for a second primary cutaneous melanoma among melanoma survivors.

BACKGROUND: The results of several studies have provided evidence that patients diagnosed with cutaneous melanoma (CM) are at a higher risk of developing a second primary CM than the general population. In this study, the authors examined how the risk of a second primary tumor varied with time from diagnosis of CM and examined the patient-specific factors that modify a CM patient's risk of developing a second primary tumor. METHODS: Survival curves for time from first CM to second CM were calculated using the Kaplan-Meier method. The Cox proportional hazards model was used to determine which demographic- and disease-related factors influence the risk of a second CM. RESULTS: Approximately 0.5% of Surveillance, Epidemiology, and End Results (SEER) CM patients were found to have synchronous second primaries. The estimated cumulative probability of having a second primary CM was 0.99% at 1 year after initial CM diagnosis, 2.06% at 5 years, 3.17% at 10 years, and 5.34% at 20 years. Risk was significantly greater for males; older patients; patients with first CM on the face, neck, or trunk; those from the Atlanta, Hawaii, or Connecticut registries; and more recently diagnosed patients. Risk was lower for patients from the Utah registry and those with Stage IV disease. CONCLUSIONS: The elevated risk for CM among CM survivors appears to be greatest in the first few months, and then subsequently declines. However, the risk for a second CM among CM survivors was found to remain substantially higher than the risk for a first CM in the general population throughout the observation period (> 20 years). Demographic- and disease-related factors substantially modify the risk of a second primary CM.

Female↗
PubMed2003

Population-based patterns of human immunodeficiency virus-related Hodgkin lymphoma in the Greater San Francisco Bay Area, 1988-1998.

BACKGROUND: Epidemiologic characteristics of human immunodeficiency virus (HIV)-related Hodgkin lymphoma (HL) have not been examined in the Greater San Francisco Bay Area, a center of the HIV/acquired immunodeficiency syndrome (AIDS) epidemic, for a decade, despite changes in AIDS-associated diseases after the availability of highly active antiretroviral therapies (HAART). METHODS: With population-based cancer registry data for 1988-1998, the authors examined risk factors, Epstein-Barr virus (EBV) association, incidence rates, and survival probabilities for 1752 patients with HL who were classified as HIV-positive or HIV-negative by a cancer registry-based method. RESULTS: One hundred twenty-eight patients with HL (7%) were classified with HIV/AIDS; 95% were male. Among males, multivariate analysis (n=514 patients) found that HIV-related HL was associated strongly at diagnosis with ages 30-49 years, San Francisco residence, late-stage disease, lymphocyte depletion and unspecified histologic subtypes, and tumor cell EBV but not with other clinical features or mixed cellularity histology. Survival among patients with HIV-related HL, although it was poor, did not differ by race/ethnicity but was worse for patients with the nonnodular sclerosis histologic subtypes. Patients who were HIV-positive with HAART era (1996-1998) diagnoses were slightly older, were less likely to live in San Francisco, and were much more likely to be Hispanic compared with HIV-positive patients who were diagnosed before the HAART era; they had somewhat less aggressive disease and better survival. Incidence rates were higher for patients with HL overall compared with patients who had HIV-unrelated HL by 11% for white patients, 22% for black patients, and by 14% for Hispanic patients; excesses were greater in young adults. CONCLUSIONS: Among males in the San Francisco Bay Area, HIV-related HL had distinctive demographic features, more aggressive clinical characteristics, stronger EBV association, and poorer survival and contributed to elevated regional HL incidence rates, particularly in young adults. Patients with HIV-related HL who were diagnosed after HAART was introduced appeared to have less aggressive disease and better survival.

Adult↗
PubMed2003

Histologic grade, stage, and survival in breast carcinoma: comparison of African American and Caucasian women.

BACKGROUND: African American women have lower breast carcinoma survival rates than do Caucasian women. African American women often present with advanced-stage disease and more aggressive tumors as shown by histologic and laboratory-based prognostic factors. Aggressive tumor behavior may be responsible, at least in part, for the advanced stage and reduced survival rates. METHODS: The authors investigated the correlation between survival and histologic grade, stage of disease, and tumor size for both African American and Caucasian women who were younger than age 50 years and age 50 years and older. The authors also investigated the distribution of grade within each stage group and the distribution of grade by tumor size. African American and Caucasian women were matched by stage, tumor size, and histologic grade. Survival was represented by 6-year breast carcinoma-specific survival rates. RESULTS: Compared with Caucasian women, African American women, regardless of age, had proportionally more Grade III tumors and fewer Grade I and II tumors for all stages combined and for each individual stage group. Similarly, matched for tumor size, African American women had more Grade III tumors and fewer Grade I and II tumors compared with Caucasian women, except for tumors smaller than 1.0 cm. For nearly all combinations of stage and grade regardless of age, the 6-year breast carcinoma-specific survival rate was lower for African American women than for Caucasian women, although it did not always reach statistical significance. CONCLUSIONS: Compared with Caucasian women, African American women, regardless of age, presented with proportionally more aggressive tumors for each stage of disease and for each tumor size above 1.0 cm as revealed by the histologic grade. Higher histologic grade may be a significant contributing factor to survival disadvantage for African American women.

Adult↗
PubMed2004

Access to multidisciplinary cancer care: is it linked to the use of breast-conserving surgery with radiation for early-stage breast carcinoma?

BACKGROUND: Breast-conserving surgery (BCS) with radiation (BCSR) requires a multidisciplinary care approach between surgeons and radiation oncologists. METHODS: This retrospective cohort study examined the use of preoperative radiation oncology consultation and whether use of or distance to this care was associated with treatment choice among 1188 women age > or = 65 years who were diagnosed with local or regional breast carcinoma in Washington State in 1994 and 1995. Study outcomes included rates of BCSR; BCS alone; and mastectomy; and radiation therapy among women who underwent BCS. RESULTS: Only 29% of patients in the current study consulted with a radiation oncologist preoperatively, and less than half of the patients (46.6%) consulted with either a medical oncologist or a radiation oncologist. Among women who underwent either BCSR or mastectomy, the odds of undergoing BCSR among women who had a preoperative radiation oncology consultation were 6.7 times the odds of women who did not have the consultation (P < or = 0.001). Similarly, the odds of receiving radiation therapy among women who underwent BCS and had a preoperative radiation oncology consultation were 5 times the odds of women who did not have the consultation (P < 0.001). The 3.4% of women who lived > 50 miles from the radiation therapy center had the lowest BCSR rate (15.8%) and had the lowest radiation therapy rate among women who underwent BCS (54.5%), although these findings were not statistically significant in adjusted analyses. CONCLUSIONS: A preoperative visit with a radiation oncologist was associated strongly with BCSR use. More should be done to evaluate the role of multidisciplinary consultation in the decision to use BCSR.

Aged↗
PubMed2004

Annual report to the nation on the status of cancer, 1975-2001, with a special feature regarding survival.

BACKGROUND: The American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR) collaborate annually to provide updated information regarding cancer occurrence and trends in the U.S. This year's report features a special section on cancer survival. METHODS: Information concerning cancer cases was obtained from the NCI, CDC, and NAACCR and information concerning recorded cancer deaths was obtained from the CDC. The authors evaluated trends in age-adjusted cancer incidence and death rates by regression models and described and compared survival rates over time and across racial/ethnic populations. RESULTS: Incidence rates for all cancers combined decreased from 1991 through 2001, but stabilized from 1995 through 2001 when adjusted for delay in reporting. The incidence rates for female lung cancer decreased (although not statistically significant for delay adjusted) and mortality leveled off for the first time after increasing for many decades. Colorectal cancer incidence rates also decreased. Death rates decreased for all cancers combined (1.1% per year since 1993) and for many of the top 15 cancers occurring in men and women. The 5-year relative survival rates improved for all cancers combined and for most, but not all, cancers over 2 diagnostic periods (1975-1979 and 1995-2000). However, cancer-specific survival rates were lower and the risk of dying from cancer, once diagnosed, was higher in most minority populations compared with the white population. The relative risk of death from all cancers combined in each racial and ethnic population compared with non-Hispanic white men and women ranged from 1.16 in Hispanic white men to 1.69 in American Indian/Alaska Native men, with the exception of Asian/Pacific Islander women, whose risk of 1.01 was similar to that of non-Hispanic white women. CONCLUSIONS: The continued measurable declines for overall cancer death rates and for many of the top 15 cancers, along with improved survival rates, reflect progress in the prevention, early detection, and treatment of cancer. However, racial and ethnic disparities in survival and the risk of death from cancer, and geographic variation in stage distributions suggest that not all segments of the U.S. population have benefited equally from such advances.

American Cancer Society↗
PubMed2004

Breast carcinoma in men: a population-based study.

BACKGROUND: Male breast carcinoma is an uncommon disease, and most previous studies have been single-institution series that were limited by extremely small sample sizes. The goals of the current study were to fill in the major gaps in knowledge regarding the incidence, presenting characteristics, prognostic factors, and survival rates of male breast carcinoma and to determine how breast carcinoma differs between men and women. METHODS: Data from the National Cancer Institute Surveillance, Epidemiology, and End Results 1973-1998 database were used. Age-adjusted incidence rates were calculated. Characteristics of the patients and presenting tumors were compared between men and women. Univariate and multivariate analyses were performed to determine the effect of each variable on overall survival. Survival rates by disease stage were compared for men and women. RESULTS: Over the years of the study, the incidence of male breast carcinoma increased significantly from 0.86 to 1.08 per 100,000 population (P < 0.001). Men had a higher median age at diagnosis (P < 0.001) and were more likely to have lymph node involvement (P < 0.001), a more advanced stage at diagnosis (P < 0.001), and tumors that were positive for estrogen receptor (ER) (P < 0.001) and progesterone receptor (PR) (P < 0.001). In multivariate analysis, larger tumor size and lymph node involvement were associated with shortened survival. Tumor grade and ER/PR status did not appear to independently influence survival. Relative survival rates by stage of disease for men and women were similar. CONCLUSIONS: Although it remains a rare disease, the incidence of male breast carcinoma is increasing. Breast carcinoma in men has some epidemiologic and biologic differences from breast carcinoma in women.

Adult↗
PubMed2004

Persistent area socioeconomic disparities in U.S. incidence of cervical cancer, mortality, stage, and survival, 1975-2000.

BACKGROUND: Temporal cervical cancer incidence and mortality patterns and ethnic disparities in patient survival and stage at diagnosis in relation to socioeconomic deprivation measures have not been well studied in the United States. The current article analyzed temporal area socioeconomic inequalities in U.S. cervical cancer incidence, mortality, stage, and survival. METHODS: County and census tract poverty and education variables from the 1990 census were linked to U.S. mortality and Surveillance, Epidemiology, and End Results cancer incidence data from 1975 to 2000. Age-adjusted incidence and mortality rates and 5-year cause-specific survival rates were calculated for each socioeconomic group and differences in rates were tested for statistical significance at the 0.05 level. RESULTS: Substantial area socioeconomic gradients in both incidence and mortality were observed, with inequalities in cervical cancer persisting against a backdrop of declining rates. Cervical cancer incidence and mortality rates increased with increasing poverty and decreasing education levels for the total population as well as for non-Hispanic white, black, American Indian, Asian/Pacific Islander, and Hispanic women. Patients in lower socioeconomic census tracts had significantly higher rates of late-stage cancer diagnosis and lower rates of cancer survival. Even after controlling for stage, significant differences in survival remained. The 5-year survival rate among women diagnosed with distant-stage cervical cancer was approximately 30% lower in low than in high socioeconomic census tracts. CONCLUSIONS: Census-based socioeconomic measures such as area poverty and education levels could serve as important surveillance tools for monitoring temporal trends in cancer-related health inequalities and targeting interventions.

Education↗