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PubMed2003

Management and outcome differences in supraglottic cancer between Ontario, Canada, and the Surveillance, Epidemiology, and End Results areas of the United States.

PURPOSE: We compared the management and outcome of supraglottic cancer in Ontario, Canada, with that in the Surveillance, Epidemiology, and End Results (SEER) Program areas in the United States. METHODS: Electronic, clinical, and hospital data were linked to cancer registry data and supplemented by chart review where necessary. Stage-stratified analyses compared initial treatment and survival in the SEER areas (n = 1,643) with a random sample from Ontario (n = 265). We also compared laryngectomy rates at 3 years in those patients 65 years and older at diagnosis. RESULTS: Radical surgery was more commonly used in SEER, with absolute differences increasing with increasing stage: I/II, 17%; III, 36%; and IV, 45%. The 5-year survival rates were 74% in Ontario and 56% in SEER for stage I/II disease (P =.01), 55.7% in Ontario and 46.8% in SEER for stage III disease (P =.40), and 28.5% in Ontario and 29.1% in SEER for stage IV disease (P =.28). Cancer-specific survival results mirrored the overall survival results with the exception of stage IV disease, for which 34.6% of Ontario patients survived their cancer compared with 38.1% in SEER (P =.10). This stage IV difference was more pronounced when we further controlled for possible cause of death errors by restricting the comparison to patients with a single primary cancer (P =.01). Three-year actuarial laryngectomy rates differed. In stage I/II, these rates were 3% in Ontario compared with 35% in SEER (P < 10(-3)). In stage III disease, the rates were 30% and 54%, respectively (P =.03), and in stage IV disease they were 33% and 64% (P =.002). CONCLUSION: There are large differences in the management of supraglottic cancer between the SEER areas of the United States and Ontario. Long-term larynx retention was higher in Ontario, where radiotherapy is widely regarded as the treatment of choice and surgery is reserved for salvage. In stages I to III, survival was similar in the two regions despite the differences in treatment policy. In stage IV, there may be a small survival advantage in the U.S. SEER areas related to the higher use of primary surgery.

Aged↗
PubMed2003

Cancer rates among American Indians and Alaska Natives: is there a national perspective.

BACKGROUND: Two important goals of cancer surveillance are to provide milestones in the effort to reduce the cancer burden and to generate observations that form the basis for cancer research and intervention for cancer prevention and control. Determination of the cancer burden among American Indians and Alaska Natives (AIAN) has been difficult largely due to lack of data collection efforts in many areas of the country and misclassification of racial data that results in undercounting of Native Americans. There is a revitalized commitment to improve data collection among the national agencies and organizations. METHODS: Data on cancer trends from 12 areas covered by the Surveillance, Epidemiology and End Results (SEER) Program were reviewed for incidence and death rates for 1992-2000. AIAN trends were examined and compared with trends among other racial/ethnic population groups. Reference was made to studies of disease-specific survival for nine of the SEER areas for 1988-1997. RESULTS: In SEER areas, cancer incidence rates for AIAN populations appeared to be decreasing significantly for lung and breast cancers among women and for prostate cancer among men. However, death rates rose, although not significantly, over the same period, except for a significant decrease in prostate cancer. Among the cancers with rising death rates were lung cancer (AIAN women) and colorectal cancer (AIAN men). In addition, survival often was lower for AIAN populations. CONCLUSIONS: Although the incidence was stable or decreased among AIAN populations, increased death rates and lower survival rates indicate the need for intensified application of cancer prevention and control measures, including screening and treatment. Difficulties in interpretation of data include small population size and substantial interregional differences in rates.

Alaska↗
PubMed1997

Regional differences in known risk factors and the higher incidence of breast cancer in San Francisco.

BACKGROUND: The age-adjusted incidence of breast cancer in the San Francisco Bay Area has consistently been higher than that in other regions of the United States. The distribution of established risk factors for breast cancer (i.e., parity, age at first full-term pregnancy, breast-feeding, age at menarche, and age at menopause) and probable risk factors (e.g., alcohol consumption) also differs across geographic regions. PURPOSE: A study was planned to explore the extent to which differences in the regional distribution of established and probable risk factors could explain the increased incidence of breast cancer in the San Francisco Bay Area. METHODS: Age-adjusted breast cancer incidence rates for January 1978 through December 1982 were obtained for the San Francisco Bay Area and other regions from the Surveillance, Epidemiology, and End Results (SEER) Program. Risk factor data from January 1980 through December 1982 were computed from the Cancer and Steroid Hormone Study, a population-based, case-control study of women 22-55 years of age who resided in eight SEER regions. Two different statistical methods were used to compute the relative risk (RR) of breast cancer associated with residence in the San Francisco Bay Area versus other regions, after adjusting for regional differences in known risk factors. RESULTS: Substantial differences in the distribution of breast cancer risk factors were found between the San Francisco Bay Area and other regions. Nearly all of these differences would be expected to lead to an elevated incidence of breast cancer in the San Francisco Bay Area. With the use of incidence rates adjusted only for age, the RR for San Francisco Bay Area residence from January 1978 through December 1982 compared with residence in seven other SEER areas was 1.14 for white women and 1.10 for black women. Depending on the statistical method used, the RR was reduced to approximately 0.96-0.99 for white women and 0.75-0.83 for black women, after further adjusting for established and probable risk factors (parity, age at first full-term pregnancy, breast-feeding, age at menarche, age at menopause, and alcohol consumption). Without adjustment for alcohol consumption, the corresponding results were 0.97-1.02 for white women and 0.77-0.88 for black women. CONCLUSIONS: Among both white women and black women, the elevated breast cancer incidence rate in the San Francisco Bay Area can be completely accounted for by regional differences in known risk factors.

Adult↗
PubMed2005

Cancer incidence in Kentucky, Pennsylvania, and West Virginia: disparities in Appalachia.

CONTEXT: Composed of all or a portion of 13 states, Appalachia is a heterogeneous, economically disadvantaged region of the eastern United States. While mortality from cancer in Appalachia has previously been reported to be elevated, rates of cancer incidence in Appalachia remain unreported. PURPOSE: To estimate Appalachian cancer incidence by stage and site and to determine if incidence was greater than that in the United States. METHODS: Using 1994--1998 data from the central registries of Kentucky, Pennsylvania, and West Virginia, age-adjusted incidence rates were calculated for the rural and nonrural regions of Appalachia. These state rates were compared to rates from the Surveillance, Epidemiology, and End Results (SEER) program for the same years by calculating the adjusted rate ratio (RR) and a 95% confidence interval (CI). FINDINGS: Both the entire and rural Appalachian regions had an adjusted incidence rate for all cancer sites similar to the SEER rate (RR = 1.00 [95% CI, 1.00-1.01] and RR = 0.99 [95% CI, 0.99-1.00], respectively). However, incidence of cancer of the lung/ bronchus, colon, rectum, and cervix in Appalachia was significantly elevated (RR = 1.22 [95% CI, 1.20-1.23], 1.13 [95% CI, 1.11-1.14], 1.19 [95% CI, 1.16-1.22], and 1.12 [95% CI, 1.07-1.17], respectively). Incidence of cancer of the lung/bronchus and cervix in rural Appalachia was even more elevated (RR = 1.34 [95% CI, 1.31-1.36] and 1.29 [95% CI, 1.21-1.38], respectively). Incidence of unstaged disease for all cancer sites in Appalachia (RR = 1.06 [95% CI, 1.05-1.08]), particularly rural Appalachia (RR = 1.28 [95%CI, 1.25-1.301), was elevated. CONCLUSIONS: Cancer incidence in Appalachia was not found to be elevated. However, incidence of cancer of the lung/bronchus, colon, rectum, and cervix was elevated in Appalachia. The rates of unstaged cancer of every examined site were elevated in rural Appalachia, suggesting a lack of access to cancer health care.

Confidence Intervals↗
PubMed2006

Excess risk of subsequent primary cancers among colorectal carcinoma survivors, 1975-2001.

BACKGROUND: Studies of persons with colorectal cancer have reported increased risk of subsequent primary cancers. Results have not been consistent, however, and there is little information about such risk in specific races and ethnic populations. METHODS: Using 1975-2001 data from the Surveillance, Epidemiology, and End Results (SEER) Program, we assembled 262,600 index cases of colorectal carcinoma to assess the occurrence of subsequent primary cancers in 13 noncolonic sites. Observed (O) subsequent cancers were compared with those expected (E) based on age-/sex-/race-/year-/site-specific rates in the SEER population. The standardized incidence ratio (SIR) and the absolute excess risk (AER) represent 'O / E' and 'O - E,' respectively. RESULTS: Colorectal carcinoma patients had significantly elevated SIRs for small gut, stomach (males), kidney, and corpus uteri cancers, ranging from 1.13 for stomach cancer in males to 3.45 for small gut cancer in females. Elevated SIRs for additional sites were seen in certain population subgroups: pancreas and ovary in persons aged <50 years, and prostate in black males. The excess burden, as assessed by AER, was notable for prostate cancer in black males and for corpus uteri cancer in females aged <50 years (26.5 and 9.5 cancers per 10,000 person-years, respectively), and it persisted beyond 5 years of follow-up. CONCLUSIONS: Although significantly elevated SIRs were found for several cancers, the excess burden was notable only for cancer of the prostate in black males and of the corpus uteri in females under age 50.

Aged↗
PubMed2005

A population-based study of racial and ethnic differences in survival among women with invasive cervical cancer: analysis of Surveillance, Epidemiology, and End Results data.

OBJECTIVE: The incidence of cervical cancer is higher in Hispanic than in non-Hispanic or African American women in the United States, but few studies have examined differences in survival between these groups. The objective of this study was to examine racial/ethnic differences in survival after diagnosis with invasive cervical cancer in a population-based sample of patients while adjusting for patient and tumor characteristics and treatment types. METHODS: We identified 7267 women (4431 non-Hispanic Caucasians, 1830 Hispanic Caucasians, and 1006 non-Hispanic African Americans) diagnosed with primary invasive cervical cancer from 1992 to 1996 (with follow-up through 2000) from the Surveillance, Epidemiology and End Results (SEER) Program. Kaplan-Meier and Cox proportional hazards survival methods were used to assess differences in survival by race/ethnicity. RESULTS: After adjusting for age at diagnosis, histology, stage, first course of cancer-directed treatment (surgery and radiation therapy), and SEER registry, Hispanic Caucasian women were at 26% decreased risk of death from any cause (hazard ratio (HR) = 0.74, 95% confidence interval (CI): 0.66-0.83) and non-Hispanic African American women were at 19% increased risk of death (HR = 1.19, 95% CI: 1.06-1.33) compared to non-Hispanic Caucasian women over the follow-up period. CONCLUSION: Analysis of population-based SEER data indicates significant survival differences by race/ethnicity for women with invasive cervical cancer. Hispanic Caucasian women in SEER had improved survival compared to non-Hispanic Caucasian or non-Hispanic African American women.

Adult↗
PubMed2004

Probabilities of death from breast cancer and other causes among female breast cancer patients.

BACKGROUND: Among cancer patients, probabilities of death from that cancer and other causes in the presence of competing risks are optimal measures of prognosis and of mortality across demographic groups. We used data on breast cancer patients from the Surveillance, Epidemiology, and End Results (SEER) Program in a competing-risk analysis. METHODS: We determined vital status and cause of death for 395,251 white and 35,259 black female patients with breast cancer diagnosed from January 1, 1973, through December 31, 2000, by use of SEER data. We calculated probabilities of death from breast cancer and other causes according to stage, race, and age at diagnosis; for cases diagnosed from January 1, 1990, to December 31, 2000, we also calculated some such probabilities according to tumor size and estrogen receptor (ER) status. All statistical tests were two-sided. RESULTS: The probability of death from breast cancer after nearly 28 years of follow-up ranged from 0.03 to 0.10 for patients with in situ disease to 0.70 to 0.85 for patients with distant disease, depending on race and age. The probability of death from breast cancer at the end of the follow-up period generally declined with age at diagnosis; the probability among the oldest (> or =70 years) compared with the youngest (<50 years) patients was 33% lower for white and 46% lower for black patients with localized disease and 14% lower for white patients and 13% lower for black patients with distant disease. The probability of death from breast cancer exceeded that from all other causes for patients diagnosed with localized disease before age 50 years, with regional disease before age 60 years, and with distant disease at any age. The probability of death from breast cancer for patients diagnosed with localized or regional disease was statistically significantly greater in black patients than in white patients (all six P values < or =.01 for age groups 30-49 to 60-69 years; two P values < or =.04 for ages > or =70 years). Among patients with localized or regional disease and known ER status, the probability of death from breast cancer after nearly 11 years of follow-up ranged from 0.04 to 0.11 for patients with localized ER-positive tumors of 2 cm or less to 0.37 to 0.53 for patients with regional ER-negative tumors. CONCLUSIONS: The probability of death from breast cancer versus other causes varied substantially according to stage, tumor size, ER status, and age at diagnosis in both white and black patients.

Adult↗
PubMed2003

Trends in leukemia incidence and survival in the United States (1973-1998).

BACKGROUND: It is estimated that each year, approximately 30,800 individuals will be diagnosed with leukemia in the United States and 21,700 individuals will die of the disease. Although the overall incidence of leukemia has been declining in the United States, recent reports suggest that incidence rates may be increasing for certain age and racial groups. METHODS: Leukemia incidence (including acute lymphoblastic leukemia [ALL], acute myeloid leukemia [AML], chronic myeloid leukemia [CML], and chronic lymphoblastic leukemia [CLL]) and 5-year survival rates were obtained from the Surveillance, Epidemiology, and End Results (SEER) program. Specific rates for age (birth-19, 20-44, 45-64, and 65 + years), gender, and race (black, white) were also examined. RESULTS: A total of 66,404 cases of leukemia were identified for the period 1973-1998 in the nine reporting SEER sites. For children younger than 20 years old, the overall incidence rate of leukemia increased significantly (estimated annual percent change [EAPC] = 0.5%, 95% confidence interval [CI] = 0.1-0.9), whereas the rate decreased significantly among the group 65 years and older (EAPC = - 0.3, 95% CI = - 0.5 to - 0.1). Incidence rates for CLL and CML decreased significantly during this time period, whereas incidence rates for AML remained stable. Children younger than 20 years old experienced a 15% increase in the 5-year survival rates for both ALL and AML when comparing the two 10-year periods of 1974-1983 and 1984-1993. In contrast, there was little overall improvement in survival for adults 45 years and older. In particular, there was a notable decrease in the overall 5-year survival for blacks older than 65 years and for black males older than 44 years. CONCLUSIONS: Although the current study confirmed some of the results noted in other populations, the observed overall decline in leukemia survival for blacks is surprising and warrants further investigation.

Adolescent↗
PubMed2006

Diagnostic, treatment, and demographic factors influencing survival in a population-based study of adult glioma patients in the San Francisco Bay Area.

We compare survival estimates for population-based glioma cases by using two diagnostic coding schemes, (1) the International Classification of Diseases, Oncology, second edition (ICD-O-2) as reported by the Surveillance, Epidemiology, and End Results (SEER) program and (2) central neuropathology review diagnosis based on the World Health Organization II classification. In addition, among review categories, we estimate survival in relation to several patient demographic and treatment factors. Eligible cases included adults residing in the San Francisco Bay SEER Area with newly diagnosed, histologically confirmed glioma during the years 1991-1994 and 1997-1999. The study group included participating subjects for whom subsequent central neuropathology review confirmed glioma. We determined treatments, vital status, and other factors by using registry, interview, medical record, and active follow-up data. Survival differences between anaplastic astrocytoma (AA) and astrocytoma were apparent from review diagnoses (median months of survival for AA, 13.0 [95% CI, 9.9-19.5], and astrocytoma, 101.3 [95% CI lower limit, 42.1; upper limit not yet reached]), but not with ICD-O-2 diagnoses reported by SEER (median months of survival for AA, 16.6 [95% CI, 12.0-20.7], and astrocytoma, not otherwise specified, 17.2 [95% CI, 10.6-71.6]). This finding emphasizes the need for improvements in coding for nonglioblastoma astrocytomas to provide better population survival estimates. When review diagnosis was used, younger age and resection (vs. biopsy) were statistically significant for all histology groups analyzed by multivariable Cox proportional hazard models. Additional statistically significant variables were as follows: among 517 glioblastoma patients, radiation treatment and being married; among 105 AA patients, inclusion of chemotherapy in the initial treatment; and among 106 patients with nonanaplastic oligodendroglial tumors, college education. Further consideration of impact of marital status, education, and other social factors in glioma survival may be warranted.

Adult↗
PubMed2000

Non-Hodgkin's lymphoma: an analysis of the Metropolitan Detroit SEER database.

We evaluated incidence and survival trends of non-Hodgkin's lymphoma (NHL) in a large population-based cancer registry. Data regarding demographics, histology, incidence, and survival were obtained on all patients with NHL registered in the Metropolitan Detroit Cancer Surveillance System, a participant in the Surveillance Epidemiology and End Results (SEER) Program of the National Cancer Institute. Incidence and survival trends from 1973 through 1995 were evaluated and stratified based on age at diagnosis, sex, race, and tumor grade. There were 11,978 patients diagnosed with NHL and recorded in the Metropolitan Detroit SEER registry from 1973 to 1995. The age-adjusted incidence rate increased from 8.6 to 15.8 per 100,000, leading to an overall increase in incidence of 83% and an average annual increase of 3.2% per year. Incidence increased significantly (p < 0.05) over time in all age groups except the youngest (ages 0-19) and in all demographic groups studied. Incidence was highest in white men and lowest in black women. The incidence of both low-grade and intermediate/high-grade NHL increased significantly for each age group (p < 0.05) except the youngest (ages 0-19). In the oldest patients (70+ years), the incidence of intermediate/high-grade NHL was almost double that of low-grade NHL. Five-year relative survival increased from 64% (1973-1983) to 68% (1984-1991) for patients with low-grade NHL and from 40% to 44% for those with intermediate/high-grade NHL. The increase in relative survival was only seen in whites, however, with 5-year relative survival in blacks decreased from 53% (1973-1983) to 45% (1984-1991). In metropolitan Detroit, the current NHL epidemic affects all age groups except the very young (ages 0-19), both sexes, and both whites and blacks and is due to increases in the incidence of both low-grade and intermediate/high-grade NHL. Five-year survival rates have increased for whites but not for blacks.

Adolescent↗
PubMed2003

Trends in incidence rates of invasive lobular and ductal breast carcinoma.

CONTEXT: Research has suggested that use of combined estrogen and progestin hormone replacement therapy (CHRT) increases breast cancer risk and that CHRT use is more strongly associated with the risk of invasive lobular breast carcinoma than that of invasive ductal carcinoma. Lobular carcinoma is less common than ductal carcinoma but can be more difficult to diagnose because of its subtle elusive infiltrative pattern. OBJECTIVE: To evaluate trends in invasive lobular and ductal carcinoma incidence rates from 1987 through 1999, during which time use of CHRT increased in the United States. DESIGN: Descriptive epidemiologic study. SETTING: Nine cancer registries that participate in the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute and that cover Atlanta, Ga; Detroit, Mich; San Francisco-Oakland, Calif; Seattle, Wash; and Connecticut, Hawaii, Iowa, New Mexico, and Utah. POPULATION: Women 30 years of age and older residing in the areas covered by the 9 SEER registries. MAIN OUTCOME MEASURES: Proportional changes in incidence rates of invasive lobular and ductal carcinoma among women with no prior history of breast cancer. RESULTS: A total of 190 458 women were included in this analysis who were identified through the registries as having invasive breast cancer; 7682 of the 198 140 potentially eligible women (ie, those identified as not having in situ breast cancer) were excluded from this analysis because stage of cancer was unknown. Invasive breast cancer incidence rates adjusted for age and for SEER historic stage increased 1.04-fold (95% confidence interval [CI], 1.004-1.07) from 1987-1999 (206.7/100 000 to 214.1/100 000, age-adjusted). However, incidence rates of tumors classified as lobular increased 1.52-fold (95% CI, 1.42-1.63), and those classified as mixed ductal-lobular increased 1.96-fold (95% CI, 1.80-2.14); rates of these types combined increased 1.65-fold (95% CI, 1.55-1.78) (19.8/100 000 to 33.4/100 000, age-adjusted). In contrast, ductal carcinoma rates remained largely constant (153.8/100 000 to 155.3/100 000, age-adjusted; proportional change, 1.03 [95% CI, 0.99-1.06]). The proportion of breast cancers with a lobular component increased from 9.5% in 1987 to 15.6% in 1999. CONCLUSIONS: Ductal carcinoma incidence rates remained essentially constant from 1987-1999 while lobular carcinoma rates increased steadily. This increase presents a clinical challenge given that lobular carcinoma is more difficult to detect than ductal carcinoma by both physical examination and mammography.

Adult↗
PubMed2002

Reduced risk of synovial sarcoma in females: X-chromosome inactivation?

Synovial sarcoma shows a characteristic t(X;18) translocation but not the expected female predominance in incidence. We speculate that, among females, one X-chromosome is inactivated and that only the translocation to an active X-chromosome leads to development of synovial sarcoma. Population-based cancer registry data from the SEER program support this hypothesis.

Adolescent↗
PubMed2004

Lung cancer incidence trends in black and white young adults by gender (United States).

OBJECTIVE: This study analyzed temporal trends in lung cancer incidence rates for young adults, as an indicator of the recent and potential future impact of risk factor trends, by gender for blacks (African Americans) and whites in US geographic areas with high-quality cancer registries. The areas also varied in a tobacco control index (TCI) for 1992-1993. METHODS: Age-standardized incidence rates (ASIRs) were analyzed for lung cancer diagnosed at age 20-44 years from 1973-1976 to 1997-2000 for blacks and whites by gender, using data from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) Program. Recent trends (1989-1992 to 1997-2000) also were analyzed for each SEER area, which differed in the TCI. RESULTS: ASIRs declined for black and white men from 1973-1976 to 1997-2000, but not for black or white women after 1985-1988; the gender ratio (men/women) declined to reach 1.0 in whites and 1.4 in blacks. ASIRs decline from 1989-1992 to 1997-2000 for men in all but one of the SEER areas examined, but declines for women were largely limited to SEER areas in California, a state with a high (but not the highest) TCI. Black-white disparities in ASIRs persisted for all SEER areas combined and in each of the areas examined, and increased for women in the Detroit area. CONCLUSIONS: Continued surveillance of ASIRs in young adults is needed, but these data emphasize the need for tobacco control programs to include targeting women and blacks.

Adult↗
PubMed2000

Declines in lung cancer rates--California, 1988-1997.

Cigarette smoking is the leading cause of lung and bronchus cancer (1). During 1988-1997, per capita cigarette smoking in California declined more than twice as rapidly compared with the rest of the country (2). To characterize lung cancer incidence in California, data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program were compared with data from the population-based California Cancer Registry (CCR). This report summarizes the results of that analysis, which indicated that during 1988-1997, age-adjusted lung cancer incidence rates in California declined significantly compared with stable incidence rates for the combined SEER area of five states and three metropolitan areas.

California↗
PubMed1999

Cancer of the colon and rectum in Louisiana.

Cancer of the colon and rectum ranks fourth for incidence and second for mortality among Louisiana residents. Incidence rates calculated from Louisiana Tumor Registry data for 1991-95 show that whites in Louisiana were diagnosed with colon cancer at approximately the same rates as those in the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program, but rates for African Americans were significantly lower in Louisiana than nationally. For rectal cancer, Louisiana incidence rates approximate the national rates for all but African-American males, whose rate was significantly lower. Mortality rates for colon and rectal cancer in Louisiana were comparable to the SEER rates, suggesting Louisiana blacks, once diagnosed, have a poorer survival than their national counterparts. Risk factors for colorectal cancer and guidelines for screening are discussed, as is an upcoming study of patient care for colon cancer.

Adult↗
PubMed1997

Will primary central nervous system lymphoma be the most frequent brain tumor diagnosed in the year 2000?

BACKGROUND: There has been a dramatic increase in the diagnosis of primary lymphoma of the brain during the past decade, prompting speculation that it may become the most frequently diagnosed tumor of the central nervous system by the year 2000. The current analysis drew from the updated Surveillance, Epidemiology, and End Results (SEER) database to establish projections for the incidence of brain lymphoma. The study also attempted to determine whether increased incidence rates are attributable to the increasing incidence of acquired immunodeficiency syndrome (AIDS) and whether there is gender or age dependence. METHODS: Primary brain lymphoma case data and population census data for calculating incidence rates for the period 1973-1992 were obtained from the SEER program. In an attempt to determine the contribution of AIDS to the increasing incidence of the disease, separate analyses were performed with and without the inclusion of never married men (a high risk group for the development of AIDS). Separate analyses were also performed within the San Francisco SEER registry because a higher incidence of AIDS-related cancers has been documented in this geographic region. Finally, a piece-wise linear model (using one regression line until 1982 and another regression line from 1982 onward) was used to predict incidence rates for the year 2000. RESULTS: During the period of study, the incidence rates of brain lymphoma increased more than 10-fold, from 2.5 cases per 10 million population in 1973 to 30 in 1991-1992 (chi-square trend, 17.76: P < 0.0001). These increased incidence rates were independent of age and gender. The incidence rates of primary brain lymphoma did not differ significantly when comparing the San Francisco registry with the remainder of the SEER database for any comparison that excluded never married males. However, when the analysis included never married males, a statistically significantly higher incidence rate of primary central nervous system lymphoma was observed among San Franciscans compared with age-matched controls from the remainder of the SEER database. In the year 2000, the projected incidence rate of brain lymphoma would reach 51.1 per 10 million population and 118.2 per 10 million population, with never married men excluded and included, respectively. These incidence rates would still fall below the corresponding projections for glioma and glioblastoma multiforme. CONCLUSIONS: There continues to be a significantly increasing incidence of brain lymphoma that is independent of age and gender. Indirect evidence implicates the AIDS epidemic as a contributor to this trend. Although the rate of increase in the incidence of non-Hodgkin's lymphoma of the brain is higher than for peripheral non-Hodgkin's lymphoma and other glial tumors, brain lymphoma is not projected to surpass glial tumors as the most frequently diagnosed intracranial malignancy by the year 2000.

Age Factors↗
PubMed2006

Survival differences by race in nasopharyngeal carcinoma.

Incidence rates of nasopharyngeal carcinoma (NPC) are much higher among Chinese than they are among most other racial/ethnic groups around the world. With respect to NPC, results from survival studies are mixed, as some studies have and others have not found differences by race/ethnicity. Using Surveillance, Epidemiology, and End Results (SEER) Program data, the authors used a multivariate Cox proportional hazards regression model to evaluate differences in risk of mortality among NPC patients across Chinese, non-Hispanic White, Black, and Filipino populations in the United States. From 1973 to 2002, 3,952 patients with microscopically confirmed NPC were identified across SEER 9 registries. After controlling for SEER registry, age at diagnosis, year of diagnosis, gender, World Health Organization type of grade histology, stage, and use of radiotherapy, the authors found that Chinese NPC patients had lower risks of overall mortality compared with non-Hispanic White patients (hazard ratio = 0.73, 95 percent confidence interval: 0.64, 0.84). However, no differences in risk of NPC cause-specific mortality were observed by race/ethnicity. Despite having higher incidence rates of NPC compared with other groups, Chinese NPC patients in the United States have better overall survival and the same risks of NPC-related mortality compared with other racial/ethnic groups.

Adult↗
PubMed1997

Axillary lymph node dissection: is it required in T1a breast cancer?

BACKGROUND: Several authors have questioned the need for axillary lymph node dissection in T1a breast cancer (primary tumors 5 mm or less in diameter), although current practice typically includes routine axillary lymph node dissection. STUDY DESIGN: We retrospectively reviewed the records of 2,242 breast cancers in our tumor registries from 1987 to 1994. The incidence of axillary lymph node metastases was determined according to primary breast cancer size. The objective was to determine the need for axillary lymph node dissection in T1a breast cancers, and our data included 74 T1a cancers. Axillary lymph node dissection was performed in 66 of these patients. RESULTS: Axillary lymph node metastases were found in 3 of 66 cases (4.5 percent). We also reviewed several other institutional series of T1a breast cancers and found no statistical difference in the reported axillary lymph node metastases and our data (p < .10). The combined single-institution data included 256 T1a breast cancers and had a 3.9 percent incidence of axillary lymph node metastases. The Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute published data statistically different from ours. From 1977 to 1982, 339 T1a lesions had a 21 percent incidence of axillary lymph node metastases (p < .005), and from 1983 to 1987, 1,491 T1a lesions had an 11 percent metastatic rate (p < .001). We believe that the SEER data is flawed, because SEER results do not require histologic confirmation of axillary lymph node status. CONCLUSIONS: We believe the single-institution rate of 3.9 percent axillary lymph node metastases in T1a breast tumors results from state-of-the-art breast cancer screening and detection of earlier and smaller lesions. Our data support abandoning routine axillary lymph node dissection in T1a breast cancer.

Adult↗