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PubMed1994

U.S. childhood cancer survival, 1973-1987.

The surveillance, epidemiology, and end-results (SEER) data on 5-year relative survival rates (1973-1987) for the most common pediatric tumors (ages 0-14) were analyzed. The SEER data are population based, so the observed progress in survival from childhood cancer represents the real impact that development in cancer treatment had on the population followed by the registry. The greatest increase in survival rate from 1973 until 1987 has been achieved in hematopoietic tumors such as acute lymphocytic leukemia (ALL), in which survival increased from 47.6% (1973-1977) to 60.8% (1983-1987), and Burkitt's lymphoma in which survival increased from 27.6% (1973-1977) to 68.7% (1983-1987). Solid tumors showed a less steep, but steady increase in survival rates. Flattening in the survival rates since 1978-1982 has been observed for acute leukemia, astrocytoma, medulloblastoma, and osteosarcoma. Females have better survival rates for most pediatric tumors, except Hodgkin's disease. Analysis of race of childhood leukemia confirmed that black children have worse survival than white. When solid tumors were analyzed by stage at presentation, there was no indication that diagnosis in earlier stages of disease accounted for the improved survival. Observed flattening in the survival rates since 1978-1982 of leukemia and some solid tumors warrants further follow-up.

Acute Disease↗
PubMed2006

An analysis of SEER data of increasing risk of secondary malignant neoplasms among long-term survivors of childhood brain tumors.

BACKGROUND: Advances made in treatment of a childhood brain cancer have extended the lives of many children and adolescents. Treatment success, however, brings the opportunity to assess late effects; most worrying among these are secondary malignant neoplasms (SMN). Even though the cumulative incidence is quite small, long-term follow-up is required because treatment-induced cancers can occur years after initial treatment. PROCEDURE: The purpose of this project was to determine what treatments and what host characteristics of children treated for a primary brain cancer are associated with an increase in the risk of a SMN in long-term survivors. Data were analyzed from 2,056 5-year survivors, of primary brain cancer in the surveillance, epidemiology, and end results (SEER) database between 1973 and 1998. Thirty-nine patients developed a SMN. Cox regression models were used to evaluate the independent contribution of a number of risk factors. RESULTS: The most important risk factor for developing a SMN in 5-year survivors was the era in which the primary cancer was treated. Compared to treatment prior to 1979, patients treated between 1979 and 1984 had a 4.7-fold increase in risk (P = 0.001), while those treated after 1985 had a 6.7-fold increase in risk. (P = 0.002). Patients treated most recently carry the greatest risk of SMN development even after controlling for radiotherapy. This could be due to the increase in intensive treatment compared to earlier years. CONCLUSION: Although the absolute excess risk of SMN remains quite low, continued surveillance is needed to evaluate long-term effects of new therapies for primary brain tumors.

Adolescent↗
PubMed2007

Neuroblastoma in adults: Incidence and survival analysis based on SEER data.

PURPOSE: Clinical data on survival outcomes of adult patients (defined as 20 years of age and older) with neuroblastoma are scarce due to the rarity of the disease. Small single institution reports have described worse outcomes for adults than pediatric patients. MATERIALS/METHODS: Data from the public access Surveillance Epidemiology and End Results database were reviewed for a 30-year period between 1973 and 2002 for the diagnosis of neuroblastoma. Analyses compared frequency and survival rates of neuroblastoma among children and adults with particular focus on the incidence, case characteristics, and long-term survival of the adult patients. RESULTS: The observed 3- and 5-year survival rates were lowest among adult patients (45.9% and 36.3%, respectively), whereas infants fared best with 86.0% 3-year and 84.6% 5-year overall survival. There was a steady decline in the incidence of adult neuroblastoma from 0.47 cases per million per year in 1973-1977 to 0.12 cases per million per year in 1998-2002. When the long-term adult neuroblastoma survival was examined in detail for 1-, 3-, 5-, 7-, and 10-year follow-up periods, there was continuous decrease in survival during the first 7 years after the diagnosis with subsequent stabilization for both observed (OS) and relative survival (RS) rates. There was a notable trend towards improved outcome over the past three decades. CONCLUSIONS: Adults with neuroblastoma have significantly worse outcome than children. This may be due to tumor biology, more virulent clinical course, or possibly due to the fact that adults are less sensitive or have poor tolerance to pediatric chemotherapy regimens.

Adolescent↗
PubMed2006

Body image and sexual problems in young women with breast cancer.

PURPOSE: The purpose of this study was to determine the frequency of body image and sexual problems in the first months after treatment among women diagnosed with breast cancer at age 50 or younger. BACKGROUND: Breast cancer treatment may have severe effects on the bodies of younger women. Surgical treatment may be disfiguring, chemotherapy may cause abrupt menopause, and hormone replacement is not recommended. METHODS: A multi-ethnic population-based sample of 549 women aged 22-50 who were married or in a stable unmarried relationship were interviewed within seven months of diagnosis with in situ, local, or regional breast cancer. RESULTS: Body image and sexual problems were experienced by a substantial proportion of women in the early months after diagnosis. Half of the 546 women experienced two or more body image problems some of the time (33%), or at least one problem much of the time (17%). Among sexually active women, greater body image problems were associated with mastectomy and possible reconstruction, hair loss from chemotherapy, concern with weight gain or loss, poorer mental health, lower self-esteem, and partner's difficulty understanding one's feelings. Among the 360 sexually active women, half (52%) reported having a little problem in two or more areas of sexual functioning (24%), or a definite or serious problem in at least one area (28%). Greater sexual problems were associated with vaginal dryness, poorer mental health, being married, partner's difficulty understanding one's feelings, and more body image problems, and there were significant ethnic differences in reported severity. CONCLUSIONS: Difficulties related to sexuality and sexual functioning were common and occurred soon after surgical and adjuvant treatment. Addressing these problems is essential to improve the quality of life of young women with breast cancer.

Adult↗
PubMed2005

Obesity and the risk of prostate cancer.

BACKGROUND: Prostate cancer and obesity are common diseases among men in the United States. A link between obesity and prostate cancer risk has potential implications in understanding prostate cancer genesis and screening strategies. METHODS: We conducted a population-based case-control study examining the relationship between body mass index (BMI) and prostate cancer risk. Incident cases of prostate cancer were identified in King County, Washington, using the Surveillance, Epidemiology, and End Results (SEER) cancer registry. Interviews were completed with 753 men ages 40-64 that were diagnosed with prostate cancer between 1993 and 1996. Interviews were also completed with 703 age-matched controls identified from the same population through random digit dialing. Logistic regression was performed to generate odds ratios and 95% confidence intervals while controlling for age, race, education, smoking, family history, prostate cancer screening, dietary fat, and caloric intake. RESULTS: BMI was inversely related to prostate cancer risk (P for trend=0.04). Men with a BMI > 29 kg/m2 had the lowest risk of prostate cancer (odds ratio=0.77; 95% confidence interval=0.56, 1.06). Weight was also inversely associated with prostate cancer risk (P for trend=0.03), however, height was not. CONCLUSIONS: The results of this study support the hypothesis that obesity is inversely associated with prostate cancer risk in middle-aged men.

Adult↗
PubMed2002

Estimation and projections of cancer prevalence from cancer registry data.

A method, PIAMOD (Prevalence, Incidence, Analysis MODel), which allows the estimation and projection of cancer prevalence patterns by using cancer registry incidence and survival data is presented. As a first step the method involves the fit of incidence data by an age, period and cohort model to derive incidence projections. Prevalence is then estimated from modelled incidence and survival estimates. Cancer mortality is derived as a third step from modelled incidence, prevalence and survival. An application to female breast cancer is given for the Connecticut State by using data from the Connecticut Tumor Registry (CTR), 1973-1993. The age, period and cohort model fitted incidence quite well and allowed us to derive long-term projections up to 2030. Patients' survival was also projected to future years according to a scenario approach based on two extreme hypotheses: steady, that is, no more improvements after 1993 (conservative), and continuously improving at the same rate as during the observation period. Age-standardized estimated incidence shows a changing trend around the year 2005, when it starts decreasing. Age-standardized prevalence is expected to increase and change trend at a later date. Breast cancer mortality is projected as decreasing, as the combined result of no further increase in incidence and improving cancer patients' survival. An easy-to-use PIAMOD software package, on which work is in progress, will be made available to individual cancer registries and/or health planning institutions or authorities once it is developed. The use of the PIAMOD method for cancer registries will allow them to provide results of paramount importance for the whole community involved in the assessment of future disease burden scenarios in an evolving society.

Adult↗
PubMed2003

Age-conditional probabilities of developing cancer.

We propose an estimator of the probability of developing a disease in a given age range, conditional on never having developed the disease prior to the beginning of the age range. Our estimator improves the one described by Wun, Merrill and Feuer ( Lifetime Data Analysis 1998; 4, 169-186) that is currently used by the U.S. National Cancer Institute for the SEER Cancer Statistics Review. Both estimators use cross-sectional disease rates and provide an interpretation of these rates in terms of the age-conditional probability of developing disease in a hypothetical cohort. The difficulty of this problem is that rates are not available per person-years alive and disease free, but only per person-years alive. Wun et al. used ad hoc methods to handle this problem which did not properly account for competing risks, did not provide a measure of variability, and only allowed age ranges using prespecified 5-year age intervals. Here we solve the problem under a unified competing risks framework, which allows the calculation of the age-conditional probabilities for any age range. We generalize gamma confidence intervals to apply to our new statistic. Although our new method provides estimates which are numerically similar to that of Wun et al., this paper provides a comprehensive theoretical basis for estimation and inference about the age-conditional probability of developing a disease.

Age of Onset↗
PubMed2004

Modelling relative survival using transformation methods.

Patient survival is often assessed as a measure of effectiveness of treatment in cancer clinical trials. The relative survival rate is a measure of patient survival corrected for the effect of other causes of death. We incorporate an additive hazards model for the overall force of mortality focusing attention on the form of the underlying disease process. Transformation models for the cause-specific hazard rate describing the disease process are considered. We demonstrate a method for estimating the transformation parameter providing insight into the appropriate choice of model structure. The models include the additive and multiplicative structures as special cases. We write the models in the generalized linear model framework and demonstrate ease of fitting via existing statistical software. The methodology is applied to a Hodgkin's disease data set to assess the effect of clinical trial results on population survival. Our analysis concludes that the multiplicative structure provides a more appropriate description of the data as compared to the additive structure.

Clinical Trials as Topic↗
PubMed2006

A population model of prostate cancer incidence.

Introduction of screening for prostate cancer using the prostate-specific antigen (PSA) marker of the disease led to remarkable dynamics of the incidence of the disease observed in the last two decades. A statistical model is used to provide a link between dissemination of PSA and the observed transient population responses. The model is used to estimate lead time, overdiagnosis and other relevant characteristics of prostate cancer screening.

Age of Onset↗
PubMed2007

A natural history model of stage progression applied to breast cancer.

Invasive breast cancer is commonly staged as local, regional or distant disease. We present a stochastic model of the natural history of invasive breast cancer that quantifies (1) the relative rate that the disease transitions from the local, regional to distant stages, (2) the tumour volume at the stage transitions and (3) the impact of symptom-prompted detection on the tumour size and stage of invasive breast cancer in a population not screened by mammography. By symptom-prompted detection, we refer to tumour detection that results when symptoms appear that prompt the patient to seek clinical care. The model assumes exponential tumour growth and volume-dependent hazard functions for the times to symptomatic detection and stage transitions. Maximum likelihood parameter estimates are obtained based on SEER data on the tumour size and stage of invasive breast cancer from patients who were symptomatically detected in the absence of screening mammography. Our results indicate that the rate of symptom-prompted detection is similar to the rate of transition from the local to regional stage and an order of magnitude larger than the rate of transition from the regional to distant stage. We demonstrate that, in the even absence of screening mammography, symptom-prompted detection has a large effect on reducing the occurrence of distant staged disease at initial diagnosis.

Adult↗
PubMed1994

Projection of incidence rates to a larger population using ecologic variables.

There is wide acceptance of direct standardization of vital rates to adjust for differing age distributions according to the representation within age categories of some referent population. One can use a similar process to standardize, and subsequently project vital rates with respect to continuous, or ratio scale ecologic variables. We obtained from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) programme, a 10 per cent subset of the total U.S. population, country-level breast cancer incidence during 1987-1989 for white women aged 50 and over. We applied regression coefficients that relate ecologic factors to SEER incidence to the full national complement of county-level information to produce an age and ecologic factor adjusted rate that may be more representative of the U.S. than the simple age-adjusted SEER incidence. We conducted a validation study using breast cancer mortality data available for the entire U.S. and which supports the appropriateness of this method for projecting rates.

Age Factors↗
PubMedDate not supplied

The development of the series of U.S. cancer atlases: implications for future epidemiologic research.

An historic perspective on the development of the National Cancer Institute's series of cancer atlases is provided. Emphasis is placed on the role which emergent questions concerning environmental determinants of cancer played in the acquisition and utilization of data resources. Studies which were fielded as a consequence of the atlases are highlighted. The legacy of the collective effort of many persons who worked on the development of the cancer atlases-the facilitation of many current epidemiologic investigations-is discussed.

Atlases as Topic↗
PubMed1997

Age at onset of ovarian cancer in women with a strong family history of ovarian cancer.

OBJECTIVE: To determine whether women with a strong family history of ovarian cancer develop ovarian cancer at a younger age than the general population, and to determine if the age at onset of ovarian cancer in families with multiple cases of ovarian cancer is progressively younger with successive generations. METHODS: Using a large voluntary familial ovarian cancer registry, 90 probands were identified whose grandmothers had developed ovarian cancer and for whom the age at onset was known. The distribution of age at onset of ovarian cancer in the grandmothers was compared to the expected distribution based on data from the Surveillance Epidemiology End Results (SEER) project. In addition, 131 families were identified for whom complete pedigrees were available and in whom 3 or more family members had developed ovarian cancer. Ovarian cancer-free survival curves were constructed for each aggregate generation (using the probands as the reference generation) utilizing the Kaplan-Meier method. RESULTS: Among the 90 grandmothers, 18 from families with 3 or more cases of ovarian cancer had a distribution of age of onset that was younger than expected (P = 0.02). However, the distribution of age at onset among the 72 grandmothers from families with only 2 cases of ovarian cancer was not significantly different from that expected based on the SEER data (P = 0.18). Among the 131 families with 3 or more cases of ovarian cancer, the probands' daughters developed ovarian cancer at a younger age than the probands (P = 0.018), probands developed ovarian cancer at a younger age than their mothers (P = 0.0008), and the probands' mothers developed ovarian cancer at a younger age than the probands' grandmothers (P = 0.0038). CONCLUSIONS: Ovarian cancer patients from families with 3 or more cases of ovarian cancer tend to develop their cancer at a younger than expected age. This is consistent with the phenomenon known as anticipation.

Adult↗
PubMed1999

SEER data, corpus uteri cancer: treatment trends versus survival for FIGO stage II, 1988-1994.

OBJECTIVE: 1998 Surveillance, Epidemiology, and End Results (SEER) data estimate an 83.1% 5-year survival rate for corpus uteri adenocarcinoma FIGO stage II. The SEER data were evaluated to determine whether primary treatment differences using simple hysterectomy or radical hysterectomy, with or without radiation, altered disease survival. MATERIALS AND METHODS: SEER incidence data for FIGO II uterine corpus cancer of adenocarcinoma histology from 1988 to 1994 were stratified by hysterectomy type (simple versus radical) and whether radiation was given. Survival rates were calculated using a relative survival method and are expressed as percentages. Statistical analysis was done using a Z test. RESULTS: The 5-year cumulative survival rate for patients with stage II uterine corpus adenocarcinoma who received surgery alone as primary therapy was 84.36% with simple hysterectomy and 92.96% with radical hysterectomy (P<0.05). Survival for patients who received combination radiation and surgery as primary therapy was 82.77% with simple hysterectomy and 88.02% with radical hysterectomy (P<0.05). Pelvic and para-aortic nodes were negative. There was no significant survival difference for radiation versus no radiation in either surgical group. CONCLUSION: Radical hysterectomy is associated with better survival when compared to simple hysterectomy for FIGO II corpus uteri adenocarcinoma.

Adenocarcinoma↗
PubMed1999

Ethnic differences in patterns of care of stage 1A(1) and stage 1A(2) cervical cancer: a SEER database study.

OBJECTIVE: The aim of this study was to evaluate patterns of care for women with Stage 1A(1) and 1A(2) cervical cancer utilizing the SEER database. METHODS: Review of SEER data from 11 registries from 1990 to 1995 was performed. Data from 2358 women were reviewed and stratified by substage, ethnicity, type of therapy, and age. RESULTS: Three remarkable differences among subgroups were identified. (1) Among women >/=35 years of age, whites were more likely to have Stage 1A(1) cancer than blacks or Hispanics; OR (95% CI) = 1.56 (1. 05, 2.31) and 1.41 (1.04, 1.91), respectively. (2) Patients >/=35 years of age were more likely to undergo hysterectomy than younger patients both for 1A(1) and 1A(2) stages; OR (95% CI) = 2.31 (1.68, 3.19) and 2.78 (2.21, 3.50), respectively, with Mantel-Haenszel test of independence chi(2) = 102.9943, P value < 0.001. (3) Black and Hispanic women >/=35 years of age with 1A(2) disease were less likely to have a hysterectomy than whites. Only 15% of Hispanic patients and 9% of blacks over the age of 35 and with Stage 1A(2) were treated via hysterectomy, compared to 76% of white women. Differences in hysterectomies for <35 years of age, 1A(1) patients approached but did not reach statistical significance: blacks 36% versus Hispanic/whites 59%, P value = 0.07. CONCLUSIONS: Older white women were more likely to have cervical carcinoma diagnosed at an earlier stage (1A(1)) than age-matched blacks or Hispanics. Older patients, across all ethnic groups analyzed, were also more likely to be treated for both Stage 1A(1) and 1A(2) disease via hysterectomy than younger patients. Ethnic differences in the management of women with Stage 1A(2) cervical cancer do exist: older minority women are less likely to have a hysterectomy and more likely to be treated via fertility-sparing, less definitive procedures than whites.

Adult↗
PubMed2000

National Cancer Data Base/Surveillance Epidemiology and End Results: potential insensitive-measure bias.

OBJECTIVES: Abstraction of data from National Cancer Data Base (NCDB)/Surveillance Epidemiology and End Results (SEER) for reasons other than incidence, mortality, and patterns of care has risen. A potential problem with these data is that insensitive-measure bias can exist because of possible inaccuracies in hospital tumor registry staging. The purpose of this study is to assess the accuracy of tumor registry staging from six community hospitals. METHODS: Staging of 103 consecutive cancers operated on by a gynecologic oncologist (one of the authors) as a surgical consultant to a gynecologist or surgeon was reviewed. Hospital tumor registry staging forms were arbitrarily assigned to be completed by the nongynecologic oncologist versus the gynecologic oncologist by the medical records department. The authors reassessed cancer staging by medical chart review. The tumor registry staging was compared with the actual staging as determined by the authors. Major staging violations were defined as errors that would significantly change stage enough to alter prognosis or change recommended adjuvant treatment. All other violations were defined as minor. RESULTS: Twenty-eight (27%) cancers were staged by the gynecologic oncologist and 75 (73%) by nongynecologic oncologists. Eighty (78%) cancers were endometrial and 14 (13%) ovarian. Eighty-three (81%) tumors were stage I or II. Major staging violations occurred in 0% of cancers staged by the gynecologic oncologist and 22% (16/75) by a nongynecologic oncologist (P = 0.002). Minor staging violations occurred in 14% (4/28) of cancers staged by the gynecologic oncologist and 42% (32/75) by a nongynecologic oncologist (P = 0. 005). Minor violations were due to omission of histologic subtype and/or grade. CONCLUSION: The 22% major staging violation rate represents significant insensitive-measure bias. If additional studies produce similar results, abstraction of data from NCDB/SEER for reasons other than incidence, mortality, and patterns of care cannot be accepted as evidence-based scientific medicine.

Bias↗
PubMed2000

The rising incidence of adenocarcinoma relative to squamous cell carcinoma of the uterine cervix in the United States--a 24-year population-based study.

OBJECTIVE: The aim of this study was to compare the age-adjusted incidence and survival for invasive adenocarcinoma and squamous cell carcinoma of the uterine cervix using population-based data. METHODS: The SEER database was used to identify all cases of cervical cancer registered between 1973 and 1996. Stage was defined as localized, regional, or distant. Age-adjusted incidence rates were analyzed statistically using the Jonchkeere-Terpstra exact test for trends. Relative and observed survival rates, respectively, were compared using z tests and log-rank tests. RESULTS: The age-adjusted incidence rates per 100,000 for all invasive cervical cancers decreased by 36.9% over 24 years [12.35 (1973-1977) vs 7.79 (1993-1996)]. Similarly, the age-adjusted incidence rates for squamous cell carcinoma declined by 41.9% [9.45 (1973-1977) vs 5.49 (1993-1996)]. In contrast, the age-adjusted incidence rates for adenocarcinoma increased by 29.1% [1.34 (1973-1977) vs 1.73 (1993-1996)]. The proportion of adenocarcinoma increased 107.4% relative to all cervical cancer, 95.2% relative to squamous cell carcinoma, and 49.3% relative to the population of women at risk [10. 8% vs 22.4% (P < 0.001), 12.4% vs 24.0% (P < 0.001), and 1.40 vs 2. 09 per 100,000 women (P < 0.001), respectively]. Observed survival rates for adenocarcinoma vs squamous cell carcinoma were poorer for regional (P = 0.04), but not localized or distant disease. CONCLUSIONS: Over the past 24 years, the incidence of all cervical cancer and squamous cell carcinoma has continued to decline. However, the proportion of adenocarcinoma relative to squamous cell carcinoma and to all cervical cancers has doubled, and the rate of adenocarcinoma per population at risk has also increased. These results suggest that current screening practices in the United States are insufficient to detect a significant proportion of adenocarcinoma precursor lesions.

Adenocarcinoma↗