Cancer incidence rates and trends among children and adolescents in the United States, 2001-2009

OBJECTIVES

Cancer continues to be the leading disease-related cause of death among children and adolescents in the United States. More current information is needed to describe recent cancer trends and identify demographic and geographic variations.

METHODS

We analyzed data from the National Program of Cancer Registries and Surveillance, Epidemiology, and End Results statewide registries representing 94.2% of the US population to identify cancers diagnosed among persons aged 0 to 19 years during 2001-2009. Age-adjusted rates and annual percentage change for trends were calculated. Data were stratified by age, gender, race, ethnicity, and geography.

RESULTS

We identified 120,137 childhood and adolescent cancer cases during 2001-2009 with an age-adjusted incidence rate of 171.01 per million. The overall rate of all cancers combined remained stable over time (annual percent change [APC], 0.3%; 95% confidence interval [CI], -0.1 to 0.7). There was an increase in the overall cancer trend among African American children and adolescents (APC, 1.3%; 95% CI, 0.2 to 2.5). An increasing trend for thyroid cancer was observed among both genders (APC, 4.9%; 95% CI, 3.2 to 6.6) and specifically among adolescents and those in the Northeast, South, and West regions of the United States. Renal carcinoma incidence was increasing significantly overall (APC, 5.4%; 95% CI, 2.8 to 8.1). Extracranial and extragonadal germ cell tumors and melanoma were both significantly decreasing.

CONCLUSIONS

This study reports the novel finding that renal carcinoma rates are increasing among children and adolescents. This study confirms that thyroid cancer rates are increasing and further describes rising cancer rates among African Americans.

Indoor tanning among high school students in the United States, 2009 and 2011

IMPORTANCE

Indoor tanning is associated with an increased risk of skin cancer, including melanoma, and is particularly dangerous for younger and more frequent indoor tanners.

OBJECTIVE

To examine the prevalence of indoor tanning and frequent indoor tanning (≥10 times during the 12 months before each survey) and their association with health-related behaviors.

DESIGN, SETTING, AND PARTICIPANTS

A cross-sectional study examined data from the 2009 and 2011 national Youth Risk Behavior Surveys, which used nationally representative samples of US high school students representing approximately 15.5 million students each survey year. The study included 25,861 students who answered the indoor tanning question.

MAIN OUTCOMES AND MEASURES

The prevalence of indoor tanning and frequent indoor tanning were examined as well as their association with demographic characteristics and health-related behaviors using multivariable logistic regression modeling.

RESULTS

The prevalence of indoor tanning was greater among female, older, and non-Hispanic white students. Indoor tanning was highest among female students aged 18 years or older, with 31.5% engaging in indoor tanning in 2011, and among non-Hispanic white female students, with 29.3% engaging in indoor tanning in 2011. Among female students, the adjusted prevalence of indoor tanning decreased from 26.4% in 2009 to 20.7% in 2011. Among female and male students, indoor tanning was associated with other risk-taking behaviors, such as binge drinking (P < .001 and P = .006, respectively), unhealthy weight control practices (P < .001, for both), and having sexual intercourse (P < .001, for both). Additionally, indoor tanning among female students was associated with using illegal drugs (P < .001) and having sexual intercourse with 4 or more persons (P = .03); use among male students was associated with taking steroids without a physician's prescription (P < .001), smoking cigarettes daily (P = .03), and attempting suicide (P = .006). More than half of respondents engaging in indoor tanning reported frequent use of the devices.

CONCLUSIONS AND RELEVANCE

Indoor tanning is common among high school students. Public health efforts are needed to change social norms regarding tanned skin and to increase awareness, knowledge, and behaviors related to indoor tanning. The clustering of risky behaviors suggests a need for coordinated, multifaceted approaches, including primary care physician counseling, to address such behaviors among adolescents.

Clinical trial enrollment among adolescents with cancer: supplement overview

BACKGROUND

Survival rates for children with cancer have significantly increased over the past 35 years. However, adolescents with cancer aged 15 to 19 years have had less progress in survival prolongation compared with younger children, which may be due to lower clinical trial enrollment among adolescents with cancer. To help address this issue, the Centers for Disease Control and Prevention (CDC) convened a series of webinars to identify salient issues and measures to address this problem. This supplement is intended to raise awareness about the unique challenges of clinical trial enrollment among adolescents with cancer.

METHODS

The CDC convened a workgroup of researchers and health care providers in the field of adolescent and young adult oncology and cancer survivorship to examine the barriers and challenges limiting the participation of adolescents in clinical trials and to define ways to improve on these concerns.

RESULTS

The workgroup identified 3 distinct issues affecting clinical trial enrollment among adolescents with cancer: (1) many adolescents with cancer are not referred to institutions where clinical trials are offered, (2) there are limited numbers of clinical trials for adolescents with cancer, and (3) psychosocial barriers impede adolescents with cancer from enrolling in clinical trials.

CONCLUSIONS

Adolescents with cancer have the smallest proportion and least number of patients enrolled in clinical trials in pediatric oncology. Successfully addressing this challenge requires improving referral to existing clinical trials, addressing regulatory barriers to clinical trial enrollment, increasing the number of clinical trials for adolescents, and addressing unique psychosocial barriers to clinical trial enrollment.

Psychosocial barriers and facilitators to clinical trial enrollment and adherence for adolescents with cancer

Adolescents (aged 15-19 years) have not experienced the same survival gains as children and older adults diagnosed with cancer. Poor clinical trial enrollment and adherence rates among adolescents may account for some of this disparity. Although biological, regulatory, systemic, and practice-related challenges to clinical trial enrollment and adherence have been examined, studies of psychosocial factors, which can serve as barriers or facilitators to enrollment and adherence, are limited. To bring attention to these psychological factors, we reviewed existing literature on psychosocial barriers and facilitators that can affect an adolescent's decision to enroll and adhere to a clinical trial. We also provide potential strategies to address psychosocial factors affecting clinical trial accrual and adherence.

Treatment setting, clinical trial enrollment, and subsequent outcomes among adolescents with cancer: a literature review

BACKGROUND

There has been an overall improvement in survival rates for persons with cancer over the past 35 years. However, these gains are less prevalent among adolescents with cancer aged 15 to 19 years, which may be due to lower clinical trial enrollment among adolescents with cancer.

METHODS

We conducted a literature review to assess current research regarding clinical trial enrollment and subsequent outcomes among adolescents with cancer. The search included English-language publications that reported original data from January 1985 to October 2011.

RESULTS

The search identified 539 records. Of these 539 records, there were 30 relevant original research articles. Multiple studies reported that adolescents with cancer are enrolled in clinical trials at lower rates compared with younger children and older adults. Treatment setting, physician type, and institution type may all be factors in the low enrollment rate among adolescents. Few data focused solely on adolescents, with many studies combining adolescents with young adults. The number of available studies related to this topic was limited, with significant variability in study design, methods, and outcomes.

CONCLUSIONS

This literature review suggests that adolescents with cancer are not treated at optimal settings and are enrolled in clinical trials at low rates. This may lead to inferior treatment and poor subsequent medical and psychosocial outcomes. The scarcity in data further validates the need for additional research focusing on this population.

Understanding and addressing the lack of clinical trial enrollment among adolescents with cancer

Despite overall improvement in survival, morbidity, and quality of life of US patients with cancer, this progress is less prevalent in the population of adolescent and young adult patients with cancer, including those between the ages of 15 and 19 years. Evidence suggests that participation in clinical trials is associated with better survival outcomes among children and adolescents with cancer; however, adolescents have lower clinical trial participation rates compared with younger age cohorts. To better understand the unique concerns among adolescent patients with cancer, the Division of Cancer Prevention and Control at the Centers for Disease Control and Prevention convened a workgroup of researchers and health care providers in the field of adolescent and young adult oncology and cancer survivorship to examine the barriers and challenges limiting the participation of adolescents in clinical trials and to define ways to improve upon these concerns. This article summarizes the activities of the workgroup and their suggestions for enhanced accrual.

Measuring colorectal cancer care quality for the publicly insured in New York State

The extent to which concordance with colorectal cancer treatment quality metrics varies by patient characteristics in the publicly insured is not well understood. Our objective was to evaluate the quality of colorectal cancer care for publicly insured residents of New York State (NYS). NYS cancer registry data were linked to Medicaid and Medicare claims and hospital discharge data. We identified colorectal cancer cases diagnosed from 2004 through 2006 and evaluated three treatment quality measures: adjuvant chemotherapy within 4 months of diagnosis for American Joint Cancer Committee (AJCC) stage III colon cancer, adjuvant radiation within 6 months of diagnosis for AJCC stage IIB or III rectal cancer, and adjuvant chemotherapy within 9 months of diagnosis for AJCC stage II-III rectal cancer. Concordance with guidelines was evaluated separately for Medicaid-enrollees under age 65 years and Medicare-enrollees aged 65-79 years. For adjuvant chemotherapy for colon cancer, 79.4% (274/345) of the Medicaid cohort and 71.8% (585/815) of the Medicare cohort were guideline concordant. For adjuvant radiation for rectal cancer, 72.3% (125/173) of the Medicaid cohort and 66.9% (206/308) of the Medicare cohort were concordant. For adjuvant chemotherapy for rectal cancer, 89.5% (238/266) of the Medicaid cohort and 76.0% (392/516) of the Medicare cohort were concordant. Younger age was associated with higher adjusted odds of concordance for all three measures in the Medicare cohort. Racial differences were not evident in either cohort. There is room for improvement in concordance with accepted metrics of cancer care quality. Feedback about performance may assist in targeting efforts to improve care.

Persistent cigarette smoking and other tobacco use after a tobacco-related cancer diagnosis

INTRODUCTION

People who continue to smoke after a cancer diagnosis have an increased risk for recurrences or development of new malignancies. These risks may be even higher among tobacco-related cancer survivors (TRCS). We describe tobacco use behaviors among TRCS, other cancer survivors, and people without a history of cancer.

METHODS

We used 2009 Behavioral Risk Factor Surveillance System data to describe demographic characteristics, smoking history, current smoking prevalence, and smokeless tobacco use among TRCS, other cancer survivors, and people without a history of cancer (cigarette smoking and smokeless tobacco use were calculated after adjusting for age, sex, race, and insurance status). Tobacco-related cancers were defined as lung/bronchial, pharyngeal, laryngeal, esophageal, stomach, pancreatic, kidney/renal, urinary bladder, cervical, and acute myeloid leukemia.

RESULTS

A total of 20 % of all cancer survivors were TRCS. TRCS were primarily female (68 %) and white (78 %). Smoking prevalence was higher among TRCS (27 %) compared with other cancer survivors (16 %) and respondents without a history of cancer (18 %). Smokeless tobacco use was higher among respondents without a history of cancer (4 %) compared with TRCS (3 %) and other cancer survivors (3 %).

CONCLUSIONS

The self-reported smoking prevalence among TRCS is higher than among other cancer survivors and people without a history of cancer. Targeted smoking prevention and cessation interventions are needed for cancer survivors, especially those diagnosed with a tobacco-related cancer.

IMPLICATIONS FOR CANCER SURVIVORS

We recommend all cancer survivors be made aware of the health risks associated with smoking after a cancer diagnosis, and smoking cessation services be offered to those who currently smoke. We provide the first population-based report on demographic characteristics and tobacco use behaviors among self-reported tobacco-related cancer survivors.

Cervical cancer survivors at increased risk of subsequent tobacco-related malignancies, United States 1992-2008

PURPOSE

Persistent smoking among cancer survivors may increase their risk of subsequent malignancies, including tobacco-related malignancies. Despite these risks, nearly 40 % of women diagnosed with cervical cancer continue to smoke after diagnosis. This study describes the relative risk of developing any subsequent and tobacco-related malignancy among cervical cancer survivors.

METHODS

We examined data from the year 1992 to 2008 in 13 Surveillance, Epidemiology and End Results registries. We calculated the standardized incidence ratio (SIR) and 95 % confidence limits (CLs) for all subsequent and tobacco-related malignancies among cervical cancer survivors. Tobacco-related malignancies were defined according to the 2004 Surgeon General's Report on the Health Consequences of Smoking. For comparison with cervical cancer survivors, SIRs for subsequent malignancies were also calculated for female survivors of breast or colorectal cancers.

RESULTS

The SIR of developing a subsequent tobacco-related malignancy was higher among cervical cancer survivors (SIR = 2.2, 95 % CL = 2.0-2.4). Female breast (SIR = 1.1, 95 % CL = 1.0-1.1) and colorectal cancer survivors (1.1, 1.1-1.2) also had an elevated risk. The increased risk of a subsequent tobacco-related malignancy among cervical cancer survivors was greatest in the first 5 years after the initial diagnosis and decreased as time since diagnosis elapsed.

CONCLUSION

Women with cervical cancer have a two-fold increased risk of subsequent tobacco-related malignancies, compared with breast and colorectal cancer survivors. In an effort to decrease their risk of subsequent tobacco-related malignancies, cancer survivors should be targeted for tobacco prevention and cessation services. Special attention should be given to cervical cancer survivors whose risk is almost twice that of breast or colorectal cancer survivors.

Health status of adolescent and young adult cancer survivors

BACKGROUND

Adolescents and young adults (AYA) ages 15 to 29 years who are diagnosed with cancer are at risk for long-term morbidity and mortality associated with treatment of their cancer and the cancer itself. In this article, the authors describe the self-reported health status of AYA cancer survivors.

METHODS

The authors examined 2009 data from the Behavioral Risk Factor Surveillance System, including demographic characteristics, risk behaviors, chronic conditions, health status, and health care access, among AYA cancer survivors compared with respondents who had no history of cancer.

RESULTS

The authors identified 4054 AYA cancer survivors and 345,592 respondents who had no history of cancer. AYA cancer survivors, compared with respondents who had no history of cancer, reported a significantly higher prevalence of current smoking (26% vs 18%); obesity (31% vs 27%); chronic conditions, including cardiovascular disease (14% vs 7%), hypertension (35% vs 29%), asthma (15% vs 8%), disability (36% vs 18%), and poor mental health (20% vs 10%) and physical health (24% vs 10%); and not receiving medical care because of cost (24% vs 15%).

CONCLUSIONS

AYA cancer survivors commonly reported adverse behavioral, medical, and health care access characteristics that may lead to poor long-term medical and psychosocial outcomes. Increased adherence to established follow-up guidelines may lead to improved health among AYA cancer survivors.

Racial and regional disparities in lung cancer incidence

BACKGROUND

Lung cancer is the second most commonly diagnosed cancer and the leading cause of cancer-related death in the United States (US). We examined data from 2004 to 2006 for lung cancer incidence rates by demographics, including race and geographic region, to identify potential health disparities.

METHODS

Data from cancer registries affiliated with the Centers for Disease Control and Prevention's (CDC) National Program of Cancer Registries (NPCR), and the National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results Program (SEER) were used for this study; representing 100% of the US population. Age-adjusted incidence rates and 95% confidence intervals for demographic (age, sex, race, ethnicity, and US Census region), and tumor (stage, grade, and histology) characteristics were calculated.

RESULTS

During 2004 to 2006, 623,388 people (overall rate of 68.9 per 100,000) were diagnosed with lung cancer in the US. Lung cancer incidence rates were highest among men (86.2), Blacks (73.0), persons aged 70 to 79 years (431.1), and those living in the South (74.7). Among Whites, the highest lung cancer incidence rate was in the South (75.6); the highest rates among Blacks (88.9) and American Indians/Alaska Natives (65.4) in the Midwest, Asians/Pacific Islanders in the West (40.0), and Hispanics in the Northeast (40.3).

CONCLUSIONS

Our findings of racial, ethnic, and regional disparities in lung cancer incidence suggest a need for the development and implementation of more effective culturally specific preventive and treatment strategies that will ultimately reduce the disproportionate burden of lung cancer in the US.

Surveillance of demographic characteristics and health behaviors among adult cancer survivors--Behavioral Risk Factor Surveillance System, United States, 2009

PROBLEM/CONDITION

Approximately 12 million people are living with cancer in the United States. Limited information is available on national and state assessments of health behaviors among cancer survivors. Using data from the Behavioral Risk Factor Surveillance System (BRFSS), this report provides a descriptive state-level assessment of demographic characteristics and health behaviors among cancer survivors aged ≥18 years.

REPORTING PERIOD COVERED

2009

DESCRIPTION OF SYSTEM

BRFSS is an ongoing, state-based, random-digit-dialed telephone survey of the noninstitutionalized U.S. population aged ≥18 years. BRFSS collects information on health risk behaviors and use of preventive health services related to leading causes of death and morbidity. In 2009, BRFSS added questions about previous cancer diagnoses to the core module. The 2009 BRFSS also included an optional cancer survivorship module that assessed cancer treatment history and health insurance coverage for cancer survivors. In 2009, all 50 states, the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands administered the core cancer survivorship questions, and 10 states administered the optional supplemental cancer survivorship module. Five states added questions on mammography and Papanicolaou (Pap) test use, eight states included questions on colorectal screening, and five states included questions on prostate cancer screening.

RESULTS

An estimated 7.2% of the U.S. general population aged ≥18 years reported having received a previous cancer diagnosis (excluding nonmelanoma skin cancer). A total of 78.8% of cancer survivors were aged ≥50 years, and 39.2% had received a diagnosis of cancer >10 years previously. A total of 57.8% reported receiving an influenza vaccination during the previous year, and 48.3% reported ever receiving a pneumococcal vaccination. At the time of the interview, 6.8% of cancer survivors had no health insurance, and 12% had been denied health insurance, life insurance, or both because of their cancer diagnosis. The prevalence of cardiovascular disease was higher among male cancer survivors (23.4%) than female cancer survivors (14.3%), as was the prevalence of diabetes (19.6% and 14.7%, respectively). Overall, approximately 15.1% of cancer survivors were current cigarette smokers, 27.5% were obese, and 31.5% had not engaged in any leisure-time physical activity during the past 30 days. Demographic characteristics and health behaviors among cancer survivors varied substantially by state.

INTERPRETATION

Health behaviors and preventive health care practices among cancer survivors vary by state and demographic characteristics. A large proportion of cancer survivors have comorbid conditions, currently smoke, do not participate in any leisure-time physical activity, and are obese. In addition, many are not receiving recommended preventive care, including cancer screening and influenza and pneumococcal vaccinations.

PUBLIC HEALTH ACTION

Health-care providers and patients should be aware of the importance of preventive care, smoking cessation, regular physical activity, and maintaining a healthy weight for cancer survivors. The findings in this report can help public health practitioners, researchers, and comprehensive cancer control programs evaluate the effectiveness of program activities for cancer survivors, assess the needs of cancer survivors at the state level, and allocate appropriate resources to address those needs.

Testicular cancer: a narrative review of the role of socioeconomic position from risk to survivorship

BACKGROUND

Testicular cancer (TC) is one of the most curable cancers. Given survival rates of close to 100% with appropriate therapy, ensuring proper treatment is essential. We reviewed and summarized the literature on the association of socioeconomic position (SEP) along the cancer control spectrum from risk factors to survivorship.

METHODS

We searched PubMed from 1966 to 2011 using the following terms: testicular cancer, testicular neoplasm, poverty, and socioeconomic factors, retrieving 119 papers. After excluding papers for the non-English (10) language and non-relevance (46), we reviewed 63 papers. We abstracted information on socioeconomic position (SEP), including occupation, education, income, and combinations of the 3. Five areas were examined: risk factors, diagnosis, treatment, survival, and survivorship.

RESULTS

Most studies examined area-based measures, not individual measures of SEP. The majority of studies found an increased risk of developing TC with high SEP though recent papers have indicated increased risk in low-income populations. Regarding diagnosis, recent papers have indicated that lower levels of education and SEP are risk factors for later-stage TC diagnosis and hence higher TC mortality. For treatment, 1 study that examined the use of radiation therapy (RT) in stage I seminoma reported that living in a county with lower educational attainment led to lower use of RT. For survival (mortality), several studies found that men living in lower SEP geographic areas experience lower survival and higher mortality.

CONCLUSION

The strongest evidence for SEP impact on testicular germ cell tumor (TGCT) was found for the risk of developing cancer as well as survival. The association of SEP with TGCT risk appears to have changed over the last decade. Given the highly curable nature of TGCT, more research is needed to understand how SEP impacts diagnosis and treatment for TGCT and to design interventions to address disparities in TGCT outcomes and SEP.

Recent trends in prostate cancer testing and incidence among men under age of 50

BACKGROUND

Information on prostate cancer testing and incidence among men under age 50 is scant. This study aims to describe trends of prostate cancer testing and incidence by demographic and clinical characteristics and identify potential correlations between prostate cancer testing and incidence.

METHODS

We examined prostate cancer testing and incidence rates among American men under age of 50 using data from the Behavioral Risk Factor Surveillance System (2002, 2004, 2006, and 2008) and data from the National Program of Cancer Registries and Surveillance, Epidemiology, and End Results programs (2001-2006). We conducted descriptive, logistic regression, and trend analyses using SUDAAN and SEER*Stat.

RESULTS

The prostate cancer incidence rate among black men was more than 2-fold that of white men. The overall prostate cancer incidence rate slightly increased from 2001 to 2006; however, the prevalence of prostate cancer testing declined over time. There was a borderline significant increase in prostate cancer incidence rate (APC=3.5, 95% CI=0.0, 7.0) for men aged 40-44. Well-differentiated prostate cancer incidence decreased significantly (APC=-24.7; 95% confidence interval (CI)=-34.9, -12.8) over time.

CONCLUSIONS

We observed a large difference in prostate cancer incidence between blacks and whites under age 50. Similar patterns in prostate cancer testing and cancer incidence by race and ethnicity suggested prostate cancer testing might have influenced incidence to some extent in this young population. The different temporal patterns for prostate cancer testing and incidence, especially for men aged 40-44 years, suggested screening alone could not fully accounted for the increasing prostate cancer incidence rates. Decreasing trend of well-differentiated prostate cancer may be partially due to "Grade Inflation".

Use of indoor tanning devices by high school students in the United States, 2009

The objectives of this study were to provide estimates of indoor tanning device use among US high school students and provide baseline data before implementation of a 10% excise tax on indoor tanning device use mandated by recent federal health care reform legislation. We examined the frequency of indoor tanning device use by using data from the 2009 national Youth Risk Behavior Survey. Overall, 15.6% of students used an indoor tanning device during the 12 months before the survey; almost half of those students used an indoor tanning device 10 or more times. Reported use and frequency of use varied by age, sex, and race/ethnicity. Given the high prevalence of indoor tanning device use among US high school students and the associated risk of melanoma, strategies to reduce exposure must be examined.

Prostate cancer screening and incidence among men younger than age 50

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Background: Prostate cancer has long been considered as a disease of older men. However, age at diagnosis with prostate cancer has continued to decline. Since the introduction of prostate-specific antigen (PSA) test in 1986, the prostate cancer incidence rate has steadily and dramatically increased in men under age 50. This study aims to better understand demographic variations in prostate cancer screening and incidence, and clinical characteristics of prostate cancers in men under age 50.

Methods: We examined prostate cancer testing data from the Behavioral Risk Factor Surveillance System (2002, 2004, 2006, and 2008) and prostate cancer incidence data from the CDC's National Program of Cancer Registries and the NCI's Surveillance, Epidemiology, and End Results programs (2001-2006). We estimated the weighted percentage of self-reported cancer testing using SUDAAN and age-adjusted cancer incidence rates and trends using SEER-STAT. Statistical significance for trends was determined by the annual percentage change (APC) differing form zero.

Results: A total of 29,176 prostate cancer cases were identified from 2001-2006 among men under age 50. Of these, 551 (1.9%) were among men under age 40. Incidence rates remained stable from 2001-2006; however the incidence of well-differentiated tumors decreased significantly (APC=−24.7) during this time period. About 44% of men aged 40-49 years old reported having a prostate cancer test in the past two years. Prostate cancer testing and incidence rates were highest among men who were black, non-Hispanic, or lived in the northeast. Black men had more than a 2-fold increase in cancer incidence than white men.

Conclusions: The magnitude of prostate cancer testing and incidence in men under age 50 reveals significant health/public health problems in this younger population. This study demonstrates substantial regional differences in prostate cancer testing and incidence in men under age 50. It also confirms that prostate cancer testing and incidence varies by race and ethnicity. We observed a large disparity in prostate cancer incidence between blacks and whites. The incidence rate remained stable over time; the dramatic decrease occurred in well-differentiated cancers.

No significant financial relationships to disclose.

Abstract B90: Smoking prevalence among tobacco-related cancer survivors in the United States, BRFSS 2009

Introduction: Cancer survivors who continue to smoke are at increased risk for primary cancer recurrences or development of new malignancies. Risks may be even higher among Tobacco Related Cancer Survivors (TRCS). We provide a national report on smoking behavior among TRCS.

Methods: Tobacco-related cancers (lung/bronchial, pharyngeal, esophageal, stomach, pancreatic, kidney/renal, urinary bladder, cervical and leukemia) are defined according to the 2004 report of the Surgeon General on The Health Consequences of Smoking. Data from the 2009 Behavioral Risk Factor Surveillance System (BRFSS) were used to describe demographic characteristics and tobacco use behaviors reported by TRCS, other cancer survivors and the non cancer BRFSS cohort. Self reported prevalence percentages and confidence intervals were calculated using SAS version 9.2 (SAS Institute, Inc, Cary, North Carolina).

Results: Overall, 10% of BRFSS respondents reported being diagnosed with cancer. Approximately 17% of all cancer survivors were diagnosed with a tobacco related cancer. Survivors in this group were primarily white (85.4%) and female (71.9%). Approximately 8.8% of TRCS were Hispanic. TRCS report a substantially higher proportion of current and past tobacco use. Among TRCS, 68% (95%CI 66.0-69.0) reported a history of smoking and 27.1% (95%CI 25.4-28.9) reported currently smoking; among other cancer survivors, 45.7% (95%CI 45.4-45.9) reported a history of smoking and 27.6% (95%CI 27.3-27.9) reported currently smoking.

Conclusion: When compared to other cancer survivors, persons diagnosed with tobacco related cancers have higher past and current smoking rates. Smoking cessation interventions should target TRCS, and increased surveillance of smoking behaviors is needed in this population.

Citation Information: Cancer Prev Res 2010;3(12 Suppl):B90.

Abstract A128: Racial and ethnic disparities in lung cancer incidence, United States 1998–2005

Background: Lung cancer is the second most commonly diagnosed cancer in men and women and the leading cause of cancer related death in the United States. Racial disparities in lung cancer incidence, treatment, mortality and survival have been documented. Advances in cancer surveillance, such as expansions in geographic coverage, allow for a more complete description of lung cancer incidence. This population-based study examines racial and ethnic disparities in incidence of lung cancer for the United States by demographic, geographic, and tumor characteristics.

Methods: We analyzed lung cancer incidence data obtained from cancer registries affiliated with Center for Disease Control's National Program of Cancer Registries and the National Cancer Institute's Surveillance, Epidemiology, and End Results program. The combined data collected on new cases diagnosed during 1998–2005 cover approximately 81% of the U.S. population. We calculated age-adjusted (2000 US standard) incidence rates, rate ratios, and 95% confidence intervals by demographic and tumor characteristics such as age, sex, race, ethnicity, U.S. Census Region, tumor grade, stage and histology.

Results: A total of 1,296,933 lung and bronchial cancer cases were diagnosed in the U.S. from 1998 until 2005. The overall incidence rate was (69.2/100,000 persons). Rates were higher among men (88.5) than women (55.1). Among men, incidence rates were highest for blacks (111.1) followed by whites (87.7), Asian/Pacific Islanders (API) (53.4) and American Indians/Alaska Natives (AI/AN) (53.3). Among women, whites (56.3) had the highest incidence rates followed by blacks (53.1), API (37.4), and AI/AN (27.3). Compared to non-Hispanics (71.8), Hispanics (37.5) had lower lung cancer incidence rates. More blacks were diagnosed at younger ages (40–59 years) compared to all other groups. At time of diagnosis, blacks have a higher percentage of distant disease (17%), and a higher percentage of poorly differentiated tumors (14%) compared to whites. Incidence rates differed amongst U.S. Census regions by race. Among whites, the highest lung cancer incidence rate was in the South (76.8) whereas rates among blacks (88.6), American Indians/Alaska Natives (61.5) & Hispanics (41.1) were highest in the Midwest.

Conclusion: This report updates previous findings from population-based studies describing U.S. disparities in lung cancer incidence. Differences in stage at diagnosis by race were also noted. We describe regional differences in incidence rates for certain racial and ethnic groups. These differences may reflect differences in tobacco use behaviors, early detection, treatment, or other unknown factors. Further investigation into the source of differences is warranted.

Citation Information: Cancer Prev Res 2010;3(1 Suppl):A128.