Surveillance of screening-detected cancers (colon and rectum, breast, and cervix) - United States, 2004-2006

PROBLEM/CONDITION

Population-based screening is conducted to detect diseases or other conditions in persons before symptoms appear; effective screening leads to early detection and treatment, thereby reducing disease-associated morbidity and mortality. Based on systematic reviews of the evidence of the benefits and harms and assessments of the net benefit of screening, the U.S. Preventive Services Task Force (USPSTF) recommends population-based screening for colon and rectum cancer, female breast cancer, and uterine cervix cancer. Few publications have used national data to examine the stage at diagnosis of these screening-amenable cancers.

REPORTING PERIOD COVERED

2004-2006.

DESCRIPTION OF SYSTEMS

Data were obtained from cancer registries affiliated with CDC's National Program of Cancer Registries (NPCR) and the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program. Combined data from the NPCR and SEER programs provide the best source of information on national population-based cancer incidence. Data on cancer screening were obtained from the Behavioral Risk Factor Surveillance System. This report provides stage-specific cancer incidence rates and screening prevalence by demographic characteristics and U.S. state.

RESULTS

Approximately half of colorectal and cervical cancer cases and one third of breast cancer cases were diagnosed at a late stage of disease. Incidence rates of late-stage cancer differed by age, race/ethnicity, and state. Incidence rates of late-stage colorectal cancer increased with age and were highest among black men and women. Incidence rates of late-stage breast cancer were highest among women aged 60-79 years and black women. Incidence rates of late-stage cervical cancer were highest among women aged 50-79 years and Hispanic women. The percentage of persons who received recommended screening differed by age, race/ethnicity, and state.

INTERPRETATION

Differences in late-stage cancer incidence rates might be explained partially by differences in screening use.

PUBLIC HEALTH ACTION

The findings in this report emphasize the need for ongoing population-based surveillance and reporting to monitor late-stage cancer incidence trends. Screening can identify colorectal, cervical, and breast cancers in earlier and more treatable stages of disease. Multiple factors, including individual characteristics and health behaviors as well as provider and clinical systems factors, might account for why certain populations are underscreened. Cancer control planners, including comprehensive cancer-control programs, can use late-stage cancer incidence and screening prevalence data to identify populations that would benefit from interventions to increase screening utilization and to monitor performance of early detection programs.

Colorectal cancer incidence in the United States, 1999-2004 : an updated analysis of data from the National Program of Cancer Registries and the Surveillance, Epidemiology, and End Results Program

BACKGROUND

: By using recent national cancer surveillance data, the authors investigated colorectal cancer (CRC) incidence by subpopulation to inform the discussion of demographic-based CRC guidelines.

METHODS

: Data included CRC incidence (1999-2004) from the combined National Program of Cancer Registries and Surveillance, Epidemiology, and End Results Program databases. Incidence rates (age-specific and age-adjusted to the 2000 US standard population) were reported among individuals ages 40 to 44 years, 45 to 49 years, 50 to 64 years, and > or =65 years by sex, subsite, disease stage, race, and ethnicity. Rate ratios (RR) and rate differences (RD) were calculated to compare CRC rates in different subpopulations.

RESULTS

: Incidence rates were greater among men compared with women and among blacks compared with whites and other races. Incidence rates among Asians/Pacific Islanders (APIs), American Indians/Alaska Natives (AI/ANs), and Hispanics consistently were lower than among whites and non-Hispanics. Sex disparities were greatest in the population aged > or =65 years, whereas racial disparities were more pronounced in the population aged <65 years. Although the RD between blacks and whites diminished at older ages, the RD between APIs and whites, between AI/ANs and whites, and between non-Hispanics and Hispanics increased with increasing age. By subsite, blacks had the highest incidence rates compared with whites and other races in the proximal and distal colon; the reverse was true in the rectum. By stage, whites had higher incidence rates than blacks and other races for localized and regional disease; for distant and unstaged disease, blacks had higher incidence rates than whites.

CONCLUSIONS

: The current findings suggested differences that can be considered in formulating targeted screening and other public health strategies to reduce disparities in CRC incidence in the United States. Cancer 2009. Published 2009 by the American Cancer Society.

Burden of invasive squamous cell carcinoma of the penis in the United States, 1998-2003

BACKGROUND

Invasive squamous cell carcinoma (SCC) of the penis is rare in the United States. Although human papillomavirus (HPV) infection is an established etiologic agent in at least 40% of penile SCCs, relatively little is known about the epidemiology of this malignancy.

METHODS

Population-based data from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) program, the Centers for Disease Control and Prevention's National Program for Cancer Registries, and the National Center for Health Statistics were used to examine invasive penile SCC incidence and mortality in the United States. SEER data were used to examine treatment of penile SCC.

RESULTS

From 1998 to 2003, 4967 men were diagnosed with histologically confirmed invasive penile SCC in the United States, representing less than 1% of new cancers in men. The annual, average age-adjusted incidence rate was 0.81 cases per 100,000 men, and rates increased steadily with age. Overall, penile SCC incidence was comparable in whites and blacks, but approximately 2-fold lower in Asians/Pacific Islanders. Rates among Hispanics were 72% higher compared with non-Hispanics. Blacks compared with whites and Asians/Pacific Islanders and Hispanics compared with non-Hispanics were diagnosed at significantly younger ages. Higher rates of mortality were also observed among blacks compared with whites and Hispanics compared with non-Hispanics. Penile SCC incidence and mortality were elevated in Southern states and in regions of low socioeconomic status (SES). Some histologic and anatomic site differences were observed by race and ethnicity. Treatment of penile SCC varied with age, stage, and other tumor characteristics.

CONCLUSIONS

There are considerable disparities in invasive penile cancer incidence and mortality in the United States. Key risk factors for excess incidence include Hispanic ethnicity and residence in the South and in low SES regions. Risks for excess mortality include these factors in addition to black race. Decreases in penile cancer incidence and mortality in the United States may be realized in the future as the indirect result of prophylactic HPV vaccination of females. Further research is needed to better understand the epidemiology of penile cancer including the role of HPV.

Descriptive epidemiology of vaginal cancer incidence and survival by race, ethnicity, and age in the United States

BACKGROUND

Vaginal cancer is a rare malignancy. It has many of the same risk factors as cervical cancer, including a strong association with persistent human papillomavirus infection. Descriptive studies of the epidemiology of vaginal cancer are scarce in the literature.

METHODS

The 1998 through 2003 incidence data from 39 population-based cancer registries were used, covering up to 83% of the US population. The 1996 through 2003 data from 17 cancer registries were used for survival analysis. Incidence rates, disease stage, and 5-year relative survival rates were calculated by race, ethnicity, and age group. Data analysis focused mainly on squamous cell carcinoma (SCC).

RESULTS

Incidence rates for all vaginal cancers combined were 0.18 per 100,000 female population for in situ cases and 0.69 for invasive cases. The median age of invasive cases was older than that of in situ cases (aged 68 years vs 58 years). SCC was the most common histologic type (71% of in situ cases and 66% of invasive cases). Compared with the rate for white women, the age-adjusted incidence rate of invasive SCC was 72% higher (P < .05) among black women, whereas the rate among Asian/Pacific Islander (API) women was 34% lower (P < .05). Hispanic women had a 38% higher rate than non-Hispanic women (P < .05) of invasive SCC. The rates for in situ SCC peaked at age 70 years and then declined, whereas the rates of invasive SCC increased continuously with advancing age. Black, API, and Hispanic women as well as older women were more likely to be diagnosed with late-stage disease, and these groups had lower 5-year relative survival rates than their white, non-Hispanic, and younger counterparts.

CONCLUSIONS

Incidence rates of vaginal SCC varied significantly by race, ethnicity, and age group. Black, API, and Hispanic women as well as older women had a high proportion of late-stage disease and a low 5-year survival rate.

Incidence of in situ and invasive vulvar cancer in the US, 1998-2003

BACKGROUND

The human papillomavirus (HPV) vaccine has been shown to prevent precancerous lesions of the vulva with the potential to prevent a percentage of vulvar cancers. To provide a baseline picture before HPV vaccine implementation, the authors described vulvar cancer epidemiology by age, race, ethnicity, and histology in the US.

METHODS

The authors examined incidence data from 39 population-based cancer registries that met high-quality data standards from 1998 to 2003, covering approximately 83% of the US population. They limited their analysis to in situ and invasive vulvar squamous cell carcinomas (SCCs). In situ vulvar cancers did not include vulvar intraepithelial neoplasia type 3 (VIN 3).

RESULTS

SCC accounted for 77% of in situ cases and 75% of invasive vulvar cancers, an annual burden of 1498 in situ and 2266 invasive SCC vulvar cancers. Greater than 75% of the in situ and invasive SCCs had no specific histology identified. White women had the highest rates of vulvar cancer; the incidence rates of invasive vulvar SCC among black women and Hispanic women were approximately one-third lower than for their counterparts (white women and non-Hispanic women, respectively). For women aged <50 years, the age-specific rates of invasive SCC were approximately the same among whites and blacks. Increases in rates after age 50 years, however, were noted to be more rapid among white than among black women.

CONCLUSIONS

Distinct age-specific incidence rate patterns of invasive vulvar SCC by race and ethnicity and the higher incidence rates observed among white women compared with women of other races and ethnicities were opposite to patterns noted for cervical cancer. Underestimations of the burden of in situ vulvar cancers were a result of the inability to examine VIN 3 in the authors' data. Encouragement of cancer registries to report and submit VIN 3 data and more research on data quality will allow a thorough assessment of the impact of HPV vaccine by providing a basis for examining the true burden and quality of these precancerous vulvar tumors. Increased documentation of histologic subtypes in pathology reports and in cancer registry data can help differentiate the burden ofHPV-associated types from non-HPV-associated types of vulvar cancers.

Number of Repetitions to Maximum in Hop Tests in Patients with Anterior Cruciate Ligament Injury

The unilateral horizontal, triple cross-over and vertical hops are commonly used as outcome measures after knee injury but there is little knowledge of the number of repetitions needed to reach maximum performance. Seventy subjects who had either an anterior cruciate ligament deficient or reconstructed knee participated in this study. Unilateral vertical, horizontal, and triple cross-over hop testing was applied to each leg until two consecutive decrements in performance occurred. The number of repetitions to reach maximum during these tests were calculated. Fifteen repetitions of the horizontal and vertical hops, and 10 repetitions of the triple-crossover hop enable distances to be achieved that are acceptably close to maximal levels in these knee-injured patients. In order to increase the likelihood of finding a patient's maximum hop performance after knee injury, more repetitions are suggested than has been reported in the literature.

Cancer mortality surveillance--United States, 1990-2000

PROBLEM/CONDITION

Cancer is the second leading cause of death in the United States and is expected to become the leading cause of death within the next decade. Considerable variation exists in cancer mortality between the sexes and among different racial/ethnic populations and geographic locations. The description of mortality data by state, sex, and race/ethnicity is essential for cancer-control researchers to target areas of need and develop programs that reduce the burden of cancer.

REPORTING PERIOD COVERED

1990-2000.

DESCRIPTION OF SYSTEM

Mortality data from CDC were used to calculate death rates and trends, categorized by state, sex, and race/ethnicity. Trend analyses for 1990-2000 are presented for all cancer sites combined and for the four leading cancers causing death (lung/bronchus, colorectal, prostate, and breast) categorized by state, sex, and race/ethnicity. Death rates per 100,000 population for the 10 primary cancer sites with the highest age-adjusted rates are also presented for each state and the District of Columbia by sex. For males, the 10 primary sites include lung/bronchus, prostate, colon/rectum, pancreas, leukemia, non-Hodgkin lymphoma, liver/intrahepatic bile duct, esophagus, stomach, and urinary bladder. For females, the 10 primary sites include lung/bronchus, breast, colon/rectum, pancreas, ovary, non-Hodgkin lymphoma, leukemia, brain/other nervous system, uterine corpus, and myeloma.

RESULTS

For 1990-2000, cancer mortality decreased among the majority of racial/ethnic populations and geographic locations in the United States. Statistically significant decreases in mortality among all races combined occurred with lung and bronchus cancer among men (--1.7%/year); colorectal cancer among men and women (--2.0%/year and--1.7%/year, respectively); prostate cancer (--2.6%/year); and female breast cancer (--2.3%/year). For 1990-2000, cancer mortality remained stable among American Indian/Alaska Native populations. Statistically significant increases in lung and bronchus cancer mortality occurred among women of all racial/ethnic backgrounds, except among Asian/Pacific Islanders.

INTERPRETATION

Although cancer remains the second leading cause of death in the United States, the overall declining trend in cancer mortality demonstrates considerable progress in cancer prevention, early detection, and treatment.

PUBLIC HEALTH ACTION

More effective tobacco-cessation programs are necessary to reduce lung and bronchus cancer mortality among women and sustain the decrease in lung and bronchus cancer mortality among men. Additional programs that deter smoking initiation among adolescents are essential to ensure future decreases in lung and bronchus cancer mortality. Continued research in primary prevention, screening methods, and therapeutics is needed to further reduce disparities and improve quality of life and survival among all populations.

Effects of open versus closed kinetic chain training on knee laxity in the early period after anterior cruciate ligament reconstruction

Knee extensor resistance training using open kinetic chain (OKC) exercise for patients recovering from anterior cruciate ligament reconstruction (ACLR) surgery has lost favour mainly because of research indicating that OKC exercise causes greater ACL strain than closed kinetic chain (CKC) exercise. In this prospective, randomized clinical trial the effects of these two regimes on knee laxity were compared in the early period after ACLR surgery. Thirty-six patients recovering from ACLR surgery (29 males, 7 females; age mean = 30) were tested at 2 and 6 weeks after ACLR with knee laxity measured using the Knee Signature System arthrometer. Between tests subjects trained using either OKC or CKC resistance of their knee and hip extensors in formal physical therapy sessions three times per week. Following adjustment for site of treatment, pretraining injured knee laxity, and untreated knee laxity at post-training, the use of OKC exercise, when compared to CKC exercise, was found to lead to a 9% increase in looseness with a 95% confidence interval of -8% to +29%. These results indicate that the great concern about the safety of OKC knee extensor training in the early period after ACLR surgery may not be well founded.

Arthroscopy in sporting and sedentary children and adolescents

We performed arthroscopic procedures on 97 knees in 91 patients younger than 16 years of age. Sixty arthroscopic procedures in 58 patients were for sports-related injuries or symptoms. The most common diagnosis was maltracking of the patella. In 78 cases, an operative procedure was performed at the time of diagnostic arthroscopy. No complications were experienced. The accuracy of diagnosis for suspected meniscal tears was poor. Further pathologies, especially meniscal tears, were commonly associated with anterior cruciate ligament tears. Arthroscopy of the knee in children is safe, has a high diagnostic accuracy, and, in a significant proportion of patients, it can have not only a diagnostic role but allows the management of a wide variety of intra-articular conditions.

Correlates of knee laxity change in early rehabilitation after anterior cruciate ligament reconstruction

Factors other than ligament graft length (knee ROM, knee swelling, initial knee laxity) may need to be accounted for in interpreting changes in knee laxity during rehabilitation following anterior cruciate ligament reconstruction (ACLR) surgery. Twenty-three patients recovering from ACLR surgery (16 M, 7 F, age mean = 30) were tested at 2 and 6 weeks after ACLR with knee laxity measured using th Knee Signature System arthrometer, passive ROM with a standard goniometer and swelling by measuring knee circumference at the mid-patella level using a cloth measuring tape. Spearman correlation coefficients (in parentheses) were calculated using rankings of the change in the injured minus uninjured knee laxity as the dependent variable and the following independent variables: pre-test injured minus uninjured knee laxity (ranked; -0.457; statistically significant two-tailed P < 0.05); change in injured knee maximum extension relative to the uninjured side (ranked; 0.127); change in injured knee maximum flexion relative to the uninjured side (unranked; -0.073); and change in the injured minus uninjured knee girth (unranked; -0.159). These results indicate that consideration should be given to the patient's knee laxity at the start of intervention when using changes in laxity to guide rehabilitation after ACLR.

Surgical decompression of chronic central core lesions of the Achilles tendon

We report the outcome of 14 athletes with chronic recalcitrant achillodynia and central core degeneration of the Achilles tendon. The patients underwent surgery after an average time from onset of symptoms to surgery of 87 months. All patients had undergone conservative management, including physical therapy treatment, orthoses, nonsteroidal antiinflammatory drugs, and steroid injections. At an average follow-up of 35 months (range, 27 to 52), only 5 patients had an excellent or good result, despite reexploration in 6 of the 14 patients. In athletes with long-standing pain and central core degeneration of the Achilles tendon, prognosis is poor, and even reexploration is not successful. If the referral pattern allows, surgery should probably be undertaken earlier.

Surgical management of tendinopathy of the main body of the patellar tendon in athletes

OBJECTIVE

To report the results of surgery for tendinopathy of the main body of the patellar tendon.

DESIGN

Retrospective study.

SETTING

A teaching hospital of the University of London.

PATIENTS

Twenty-eight patients reviewed at an average follow-up of 42 months from surgery for tendinopathy of the main body of the patellar tendon after failed conservative treatment.

INTERVENTION

Exploration of the affected patellar tendon, stripping of the paratenon, excision of pathological areas, and multiple longitudinal tenotomies.

MAIN OUTCOME MEASURES

Postoperative complications, ability to return to sport, and subjective satisfaction, as measured by formal clinical assessment or telephone questionnaire.

RESULTS

At follow-up, 23 patients were completely free of pain and had resumed full sporting activity at the same preoperative level. Three patients were improved enough to have returned to their preoperative sporting level or just below it. In two patients, the initial operation failed. In the patients who resumed sport, the average time from surgery to resuming full sporting activity was 7 months (range 6 weeks to 12 months). The most common early postoperative complications were wound hematoma and superficial infection. The most common late complications were related to the incision, with anterior knee pain on kneeling and skin dysesthesia.

CONCLUSION

Surgical decompression of the patellar tendon with multiple longitudinal tenotomies is an effective treatment for patellar tendinopathy. In the middle term, patients do not seem to relapse once they have recovered, whereas those who do not respond to surgery do not recover at all and may need a new operation.

Exercise induced leg pain-chronic compartment syndrome. Is the increase in intra-compartment pressure exercise specific?

Intra-compartment pressure studies remain the main investigative method in diagnosing chronic compartment syndrome (CCS). Standard exercise protocols have been used to cause the raise in pressure measured in the laboratories. This case suggests that CCS cannot be excluded without the specific sports activity being used to raise the intracompartmental pressure.

ABC of sports medicine. Management of the acutely injured joint

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A prospective, double-blind trial of electrical capacitive coupling in the treatment of non-union of long bones

Twenty-three patients who had an established non-union of a long bone were entered into a prospective, double-blind trial in which electrical capacitive coupling was used for treatment. Twenty-one patients completed the study: ten who were actively managed and eleven who were managed with a placebo unit. The non-union healed in six of the ten patients who had been managed actively but in none of the patients who had been managed with the placebo unit. This difference in the rates of healing between the actively managed and the placebo groups is highly significant (p = 0.004).