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At least 991 records · Page 55Linked to original sources
PubMed2006

Socioeconomic status and cervical cancer survival among older women: findings from the SEER-Medicare linked data cohorts.

OBJECTIVES: Tumor stage, age, and cell type are well-characterized predictors for cervical cancer survival; socioeconomic factors may also play an important role. The purpose of this study is to estimate cervical cancer survival by socioeconomic indicators and race/ethnicity among elderly women diagnosed with cervical cancer. METHODS: We studied 1251 women with cervical cancer aged 65 or older, identified between 1992 and 1999 from the Surveillance, Epidemiology, and End Results [SEER]-Medicare linked data. All women had similar access to care through Medicare fee-for-services insurance. A composite measure of socioeconomic status was created using census tract level data for poverty, education, and income. Cox proportional hazard modeling was used for all-cause and cervical cancer-specific survival analysis. RESULTS: Increased age (P < 0.0001) and advanced tumor stage (<0.0001) were associated with poorer all-cause and cervical cancer-specific survival. After adjustment for age, stage, and treatment, increased co-morbidity scores and having non-squamous cervical cancer were associated with poorer all-cause survival (P < 0.001). After adjusting for confounders, women receiving hysterectomy vs. no surgery or any treatment had significantly better all-cause and cervical cancer-specific survival. Socioeconomic factors were not associated with either all-cause (P for trend = 0.79) or cervical cancer-specific (P for trend = 0.81) survival. No racial/ethnic differences in all-cause or cervical cancer-specific survival were observed after adjusting for socioeconomic factors. CONCLUSION: Among women with similar access to care, neither minority race/ethnicity nor poorer socioeconomic status were associated with poorer survival in this large sample of older women diagnosed with invasive cervical cancer. Presence of co-morbid conditions and treatment were important predictors of cervical cancer survival.

Aged↗
PubMed2006

Progestin and estrogen potency of combination oral contraceptives and endometrial cancer risk.

OBJECTIVE: Using data from a case-control study of endometrial cancer, we investigated the relationship between the progestin and estrogen potency in combination oral contraceptives (OCs) and the risk of developing endometrial cancer. METHODS: Subjects included 434 endometrial cancer cases and 2,557 controls identified from the Cancer and Steroid Hormone (CASH) study. OCs were classified into four categories according to the individual potencies of each hormonal constituent (high versus low estrogen or progestin potency). Logistic regression was used to evaluate associations between endometrial cancer risk and combination OC formulations. RESULTS: With non-users as the referent group, use of OCs with either high potency progestin [odds ratio for endometrial cancer (OR)=0.21, 95% confidence interval (CI)=0.10 to 0.43] or with low potency progestin (OR=0.39, 95% CI=0.25 to 0.60) were both associated with a decreased risk of endometrial cancer. Overall high progestin potency OCs did not confer significantly more protection than low progestin potency OCs (OR=0.52, 95% CI=0.24 to 1.14). However, among women with a body mass index of 22.1 kg/m2 or higher, those who used high progestin potency oral contraceptives had a lower risk of endometrial cancer than those who used low progestin potency oral contraceptives (OR=0.31, 95% CI=0.11 to 0.92) while those with a BMI below 22.1 kg/m2 did not (OR=1.36, 95% CI=0.39 to 4.70). CONCLUSION: The potency of the progestin in most OCs appears adequate to provide a protective effect against endometrial cancer. Higher progestin-potency OCs may be more protective than lower progestin potency OCs among women with a larger body habitus.

Adult↗
PubMed2006

Tobacco smoke overload and ethnic, state, gender, and temporal cancer mortality disparities in Asian-Americans and Pacific Islander-Americans.

BACKGROUND: Asians and Pacific Islanders (APIs) are important populations nationally and globally. So we assessed cumulative tobacco smoke overexposure (smoke overload)/cancer mortality associations across states, ethnicities, years, and genders among API-Americans. METHODS: Death rates were adjusted to the 2000 United States age standard, lung cancer death rates used as a smoke overload bio-index, and lung/non-lung cancer death rate linear regressions run. Cancer death rate smoking-attributable fractions (SAFs) are equal to 1--estimated unexposed rate/observed rate. RESULTS: The two lowest smoke overload and non-lung cancer death rates were in South Asian (Indo)-Californian females and males. The highest were in Korean-Californian males. Non-lung cancer death rates were tightly and steeply associated with smoke overload across ethnicity, state, year, or gender. Cancer death rate smoking-attributable fractions ranged from 0 in female and 6% in male Indo-Californians, to 39% in female and 57% in male API-Americans in 2002, to 71% in Korean-Californian and 69% in API Hawaiian males. DISCUSSION: Many API American cancer death rate disparities across genders, ethnicities, states, or years can be explained by smoke overload disparities. Tobacco control may greatly reduce cancer death rates and disparities among API-Americans and, likely, others.

Asian↗
PubMed1996

Second primary cancers after vulvar and vaginal cancers.

OBJECTIVE: Our objective was to examine the occurrence of second primary cancers after vaginal and vulvar cancers. STUDY DESIGN: Women in whom cancers of the vagina (in situ, n=461; invasive, n=888) and vulva (in situ, n=2898; invasive, n=2685) were diagnosed between 1973 and 1988 were identified from nine population-based cancer registries. Subjects were followed through 1989 for the development of a subsequent primary cancer. RESULTS: We found increased risks of all second cancers combined among women with cancer of the vulva (observed/expected in situ = 1.5; observed/expected invasive = 1.3) and vagina observed/expected invasive = 1.2). Most of the excess second cancers were smoking related (e.g., cancers of the lung, buccal cavity and pharynx, esophagus, nasal cavity and larynx) or related to infection with human papillomavirus (e.g., cervix, vulva, vagina, and anus). CONCLUSION: These associations indicate that the follow-up care of women with cancers of the vulva and vagina should involve efforts to promote smoking cessation. The data are also consistent with a common sexually related cause for cancers of the cervix, vulva, vagina, and anus.

Cohort Studies↗
PubMed1999

Young age as a prognostic factor in cervical cancer: results of a population-based study.

OBJECTIVE: Our goal was to use population-based data to determine the difference in 5-year survival in women diagnosed with cervical cancer between those aged 18-34 years and those aged 40-60 years. STUDY DESIGN: The SEER (Surveillance, Epidemiology, and End Results) public-use database, 1973-1994, was used for this investigation. Only subjects with cervical carcinoma diagnosed between 1988 and 1990 were included. Subjects were stratified on age at diagnosis (<35 years or 40-60 years), clinical stage, histologic type, race-ethnicity, and grade. RESULTS: Two thousand cases of invasive cervical cancer were identified. The younger subgroup of patients was diagnosed with earlier-stage disease more frequently than the older group (P =.0001). When adjustments were made for non-cervical cancer causes of death, there was no difference in 5-year survival between the 2 cohorts. African American women had a poorer 5-year survival (P =.02) CONCLUSION: There was no overall difference in survival between the 2 cohorts when appropriate adjustments were made for cause of death and for stage, histologic type, and grade of disease.

Adenocarcinoma↗
PubMed1997

Langerhans cell histiocytosis with orbital involvement.

PURPOSE: To review three cases of Langerhans cell histiocytosis with orbital involvement that represent a significantly excessive incidence of this rare disease in one community. Current diagnostic criteria and therapeutic modalities related to Langerhans cell histiocytosis are reviewed. METHODS: Case reports. We present clinical, radiologic, histopathologic, and epidemiologic information on three patients with Langerhans cell histiocytosis. RESULTS: All three children, born within 18 months of one another, manifested rapidly progressive unilateral proptosis at age 2 years. By computed tomography, all had moderately enhancing lesions with involvement of the sphenoid bone and lateral orbit as well as the temporal lobe of the brain. All patients were treated with a combination of vincristine and prednisone, with variable resolution of their lesions. The occurrence of three cases in children born in Nogales, Arizona/ Mexico, suggests an incidence rate of 40 per million, which is approximately 26 times the expected rate (P = .0001). CONCLUSIONS: The extraordinarily high incidence and the concentration of cases in both time and space of this cluster implies that Langerhans cell histiocytosis may be a sentinel disease for unusual environmental exposures.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2001

A treatment scale for axillary management in breast cancer.

BACKGROUND: We have investigated a method, the Kaufman axillary treatment scale (KATS), to help assign patients with a clinically negative axilla to one of three current options of axillary management: standard axillary dissection, sentinel node sampling followed by axillary dissection if the sentinel node is positive, or no axillary surgery at all. The KATS score uses preoperative data to guide the choice of axillary treatment. METHODS: The KATS score is calculated by adding the preoperative values of tumor size, patient age, and pathologic grade. Values range from 1 to 4 for size (1 to 9 mm, 10 to 14 mm, 15 to 19 mm, and 20 to 30 mm), 1 to 3 for age (70 years and over, 50 to 69 years, less than 50 years), and 1 to 2 for grade (low or not low) to calculate the score. The KATS score ranges from 3 to 9. We have applied this score against the SEER (Surveillance, Epidemiology, and End Results) tumor registry of 529 patients with invasive breast cancer with known pathologic data. We then validated it by applying it to our own set of 190 patients using preoperative data. The chi-square test and logistic regression analysis were used for P values (all two sided), univariate and multivariate analysis, odds ratio and confidence intervals utilizing SPSS statistics software. RESULTS: In the SEER database using American Joint Committee on Cancer pathologic size alone, no sizable group was identified with a positive node rate neither below 8% (T1a) nor above 48% (T2). KATS scores of 3 and 4 (68 patients, group 1) identify patients with an average node positive rate of 4.4% (P <0.02, group 1 versus 2). Those patients with KATS scores of 5, 6, and 7 (341 patients, group 2) carry an average node positive rate of 22% (P <0.001, group 2 versus 3). KATS scores of 8 and 9 (120 patients, group 3) identify patients with an average node positive rate of 50% (P <0.001, group 3 versus 1). Similar results were found on our own group of 190 patients using preoperative available data. KATS scores of 3 or 4 (11 patients, group 1) had no positive nodes. Group 2 (100 patients, KATS score 5, 6, and 7) had an average 30% node positive rate. Group 3 (79 patients, KATS score 8 and 9) had 61% node positive rate. The KATS score allows the clinician to separate patients into three axillary management groups. Group 1 are those patients who may need no axillary surgery at all. Group 2 are patients who would benefit from sentinel node mapping. Group 3 has a node positive rate (61%) similar to that of clinically palpable nodes (since not all clinically palpable nodes are positive). Group 3 patients may be considered for standard axillary dissection, similar to the palpable node patient. If group 3 patients have sentinel node mapping, more than half of these patients require axillary dissection and the impact of false negative sentinel node procedures may become clinically significant. CONCLUSIONS: An axillary treatment score has been developed to aid in the triage of patients toward reasonable axillary treatment choices for the benefit of the patient. The KATS score is a guideline and not a mandate. The KATS score attempts to use breakpoints that are both clinically practical and validated by scientific data. Like many other attempts to categorize patients, there is a continuum of data points along any variable. The treating physician utilizing the full array of available data on each patient makes the final clinical decision of axillary management.

Age Factors↗
PubMed2003

Do young breast cancer patients have worse outcomes?

INTRODUCTION: Previous studies have suggested that young breast cancer patients have poorer survival as compared with their older counterparts. Most of this research reflects single institution experiences that may not be representative of the population. This study was designed to determine whether young breast cancer patients have poorer survival as compared with an older cohort using a national population-based cancer registry and, more specifically, to determine whether differences in survival are caused by more advanced tumor stage, more aggressive disease, or patient-specific characteristics. MATERIALS AND METHODS: Using the Surveillance, Epidemiology, and End Results cancer database (1992-1998), data for all patients with a diagnosis of invasive breast cancer were extracted. Two age categories were analyzed: young group (<or=35 years old, n = 4616) and older group (50-55 years old, n = 20319). Patient demographics, 5-year survival rates, tumor characteristics (stage, grade, and receptor status), surgical treatment, and use of radiation were compared between the groups. RESULTS: Overall, young patients had worse 5-year survival when compared with the older group (74.3% vs. 85.1%). Stage for stage, the young patients also had poorer survival (except for stage IV). They present with more advanced stage disease and have more aggressive tumor characteristics, that is, higher grade tumors and more estrogen- and progesterone receptor-negative tumors. Even after controlling for patient characteristics, tumor factors, and receipt of treatment, a multivariate regression showed that young age was an independent risk factor for death (HR = 1.095). CONCLUSIONS: Young breast cancer patients have poorer outcomes, which are in part attributed to later stage disease, more aggressive tumors, and less favorable receptor status. There still appears to be other important factors, not included in our study, that are contributing to the worse outcomes for these young patients, such as socioeconomic status. Physicians need to have heightened awareness when evaluating this population, and increasingly efficacious adjuvant therapies need to be developed.

Adult↗
PubMed2006

Partial nephrectomy for small renal masses: an emerging quality of care concern?

PURPOSE: The recent popularization of laparoscopic radical nephrectomy may beget underuse of partial nephrectomy. To evaluate this concern we used the SEER registry to characterize national practice patterns for the surgical management of small renal masses. MATERIALS AND METHODS: Between 1988 and 2001, 14,647 patients with primary tumor size 7 cm or less were treated surgically for locoregional kidney cancer. The proportion of patients treated with PN was determined and stratified by year of diagnosis and tumor size. Multivariate models were developed to identify independent determinants of PN use and overall survival following surgical treatment of kidney cancer. RESULTS: Overall 1,401 patients (9.6%) were treated with PN vs 13,246 (90.4%) who underwent total nephrectomy. For tumors 7 cm or less, the use of PN increased progressively between 1988 (4.6%) and 2001 (17.6%, p < 0.001). Despite this trend PN remained fairly uncommon even for the smallest renal masses. Among patients with tumors less than 2 cm, 14% underwent PN in 1988 to 1989 vs 42% in 2000 to 2001. For tumors 2 to 4 cm the corresponding proportions were 5% and 20%, respectively (p < 0.001). Younger patient age, smaller tumor size and more recent diagnostic year were independent determinants of PN use (all p values < 0.05). All cause mortality was similar for patients treated with PN vs TN (HR 0.9, 95% CI 0.8-1.1). CONCLUSIONS: Despite more frequent application during the last 2 decades, nationwide use of PN remains relatively uncommon, even for the smallest renal masses. Recognizing the favorable outcomes associated with preservation of renal parenchyma, our findings identify a possible quality of care concern that should be addressed by the urological community.

Aged↗
PubMed2002

Epidemiology and prevention of colorectal cancer.

CRC, the second-leading cause of cancer death in the United States, is a highly preventable disease. Ironically, available and effective screening technologies are not consistently applied, even as new ones are developed. This discordance between preventive opportunity and practice conveys a sobering message regarding nontechnologic issues that must be addressed if the promise of CRC prevention is to be realized. Our response to this message will determine the public health impact of cancer prevention. In the 1980s, cancer chemoprevention was regarded as scientific speculation. Within the last decade, however, cancer has been recognized as a late, nonobligate stage of carcinogenesis, a chronic process that provides time and targets for preventive intervention. Further advances are emerging out of rigorous clinical testing, which remains the limiting factor in transforming ingenious concepts into useful tools for the prevention of CRC. The challenges and rewards of participation in chemoprevention research--both as patients and health care providers-have never been greater.

Biomarkers, Tumor↗
PubMed2002

Difference in stage and morphology-adjusted survival between young and elderly patients with a testicular germ cell tumor.

OBJECTIVES: To compare the relative survival in men younger and older than 50 years with a testicular germ cell tumor. METHODS: Data on patients with testicular cancer diagnosed between 1973 and 1997 and registered by one of the nine population-based Surveillance, Epidemiology, and End Results (SEER) cancer registries in the United States were obtained from the National Cancer Institute public domain SEER*Stat 3.0 package. Survival rates adjusted for mortality owing to other causes (ie, relative survival) were calculated for men within each category of the American Joint Committee on Cancer staging system. RESULTS: Patients who developed a germ cell tumor before the age of 50 years had better 10-year relative survival (90.8%, 95% confidence interval 90.6% to 91.0%) than those who developed one after the age of 50 years (84.0%, 95% confidence interval 81.9% to 86.1%). This difference remained after stratification by histologic type and stage, except for patients with localized seminomatous disease (97.9% versus 98.0% for men younger and older than 50 years, respectively). The largest difference in 10-year relative survival was found in men with metastasized disease: seminomatous disease, 89.7% versus 69.6%, and nonseminomatous disease, 76.9% versus 57.0%, for men younger and older than 50 years, respectively. CONCLUSIONS: Lower stage and morphology-adjusted relative survival rate was observed among patients older than 50 years of age with testicular cancer. This difference was more evident in metastasized disease. Whether the worse prognosis in testicular cancer can be explained by a lower tolerance to chemotherapy and/or to suboptimal treatment in the elderly has to be established.

Adult↗
PubMed1999

Lack of association between renal cell carcinoma and non-Hodgkin's lymphoma.

OBJECTIVES: To determine the incidence of non-Hodgkin's lymphoma (NHL) and renal cell carcinoma (RCC) after a diagnosis of the other malignancy. METHODS: The 1973 to 1994 Surveillance, Epidemiology, and End Results (SEER) data base was used to determine the age-, sex-, race-, and calendar year-specific incidence rates for each year for RCC and NHL. The expected number of second cancers for each sex, race, and follow-up period (less than 1, 1 to 5, 5 to 10, and 10 or more years) was obtained by multiplying these incidence rates by the age-, sex-, race-, and calendar year-specific number of person-years at risk, with these products summed over the different age groups and calendar years. The standardized incidence ratio (SIR) was calculated (observed/expected number of second cancers), with statistical significance determined using the Poisson test. RESULTS: From 1973 to 1994, 32,293 individuals in the SEER data base were diagnosed with RCC and 63,997 with NHL. NHL was diagnosed after RCC in 67 cases versus 59.8 expected (SIR 1.12, P = 0.19) and RCC after NHL in 96 cases versus 56.1 expected (SIR 1.71, P <0.0001). Only white males and females had a significantly increased risk of RCC after NHL, which was limited to the first year of follow-up. Excluding the first year of follow-up, NHL was diagnosed after RCC in 54 cases versus 49.3 expected (SIR 1.10, P = 0.27) and RCC after NHL in 54 cases versus 45.1 expected (SIR 1.20, P = 0.11). CONCLUSIONS: When the first year of follow-up is excluded, there is no increased risk of NHL after RCC or vice versa.

Adolescent↗
PubMed2002

Prostate cancer trends in the era of prostate-specific antigen. An update of incidence, mortality, and clinical factors from the SEER database.

Concurrent with the successful life-saving efforts in terms of prostate cancer diagnosis and treatment, some men who do not need treatment are receiving it. These are men destined to die of causes other than prostate cancer. Unfortunately, at diagnosis, men needing treatment for prostate cancer cannot be differentiated from men who do not. To make such decisions correctly for individual patients would require extremely precise measures of the time to death from prostate cancer versus when the patient would die from a competing cause. Predictive tools with this level of accuracy will never be available given the inherent uncertainty of life. At the time of prostate cancer diagnosis, the date and the cause of death for the patient are matters of weak statistical speculation. Unless the date of death from prostate cancer and the date of death from non-prostate cancer causes can be precisely determined for each patient, some men will always be overtreated or undertreated. Conservative strategies result in the undertreatment of some patients who would benefit from treatment while sparing other patients unneeded treatment. Aggressive strategies result in the overtreatment of patients who do not need therapy while curing other men of prostate cancer. Both strategies are correct, but only some of the time. Better methods of determining the length of life and cause of death may improve this situation, but not by much. [figure: see text] Dramatic shifts in the incidence, grade, stage, and age of men with prostate cancer have been observed with the advent of widespread PSA-based cancer detection in the United States. Grade and stage trends suggest that more biologically relevant (the shift from well-differentiated to moderately differentiated tumors) and yet therapeutically amenable (earlier stage) tumors have been identified in large numbers of patients during the PSA era. Clearly many men have been diagnosed and treated who will not benefit from such treatment. The relative mix of these two groups of men is not known. Given the long delay between treatment and mortality that is inherent in prostate cancer (Fig. 14), the full effects of treatment on prostate cancer mortality are probably not yet seen in prostate cancer mortality data.

Age Factors↗
PubMed2000

Relation between appropriateness of primary therapy for early-stage breast carcinoma and increased use of breast-conserving surgery.

BACKGROUND: Breast-conserving surgery is a more complex treatment than mastectomy, because a separate incision is needed for axillary lymph-node dissection, and postoperative radiotherapy is necessary. We postulated that adoption of this therapy into clinical practice might have led to discrepancies between the care recommended and that received. METHODS: We used records of the US national Surveillance, Epidemiology, and End Results tumour registry to study 144,759 women aged 30 years and older who underwent surgery for early-stage breast cancer between 1983 and 1995. We calculated the proportion undergoing at least the minimum appropriate primary treatment (defined, in accordance with the recommendations of a National Institutes of Health Consensus Conference in 1990, as total mastectomy with axillary node dissection or breast-conserving surgery with axillary node dissection and radiotherapy) during each 3-month period. FINDINGS: The proportion of women receiving appropriate primary therapy fell from 88% in 1983-89 to 78% by the end of 1995. This decline was observed in all subgroups of age, race, stage, and population density. Of all women in the cohort, the proportion undergoing an inappropriate form of mastectomy remained stable at about 2.7% throughout the study period. The proportion undergoing an inappropriate form of breast-conserving surgery (omission of radiotherapy, axillary node dissection, or both) increased from 10% in 1989 to 19% at the end of 1995. INTERPRETATION: Although most women undergo appropriate care, the appropriateness of care for early-stage breast cancer in the USA declined from 1990 to 1995. Because the proportion of all women who were treated by breast-conserving surgery increased, and because this approach was more likely than was mastectomy to be applied inappropriately, the proportion of all women having inappropriate care increased.

Adult↗
PubMed2002

Merkel cell carcinoma and HIV infection.

Merkel cell carcinoma (MCC) is a rare skin cancer that occurs more frequently after organ transplantation or B-cell malignancy, conditions of suppressed or disordered immunity. To assess further whether immune suppression increases MCC risk, we studied its occurrence in a cohort of 309365 individuals with acquired immunodeficiency syndrome (AIDS) by using linked AIDS and cancer registries. We identified six cases of MCC, corresponding to a relative risk of 13.4 (95% CI 4.9-29.1) compared with the general population. These results suggest that immune suppression induced by the human immunodeficiency virus increases MCC risk.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Prostate cancer.

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Biopsy↗