Annual report to the nation on the status of cancer, 1975–2003, featuring cancer among U.S. Hispanic/Latino populations

Bayesian Calibration of Microsimulation Models

Microsimulation models that describe disease processes synthesize information from multiple sources and can be used to estimate the effects of screening and treatment on cancer incidence and mortality at a population level. These models are characterized by simulation of individual event histories for an idealized population of interest. Microsimulation models are complex and invariably include parameters that are not well informed by existing data. Therefore, a key component of model development is the choice of parameter values. Microsimulation model parameter values are selected to reproduce expected or known results though the process of model calibration. Calibration may be done by perturbing model parameters one at a time or by using a search algorithm. As an alternative, we propose a Bayesian method to calibrate microsimulation models that uses Markov chain Monte Carlo. We show that this approach converges to the target distribution and use a simulation study to demonstrate its finite-sample performance. Although computationally intensive, this approach has several advantages over previously proposed methods, including the use of statistical criteria to select parameter values, simultaneous calibration of multiple parameters to multiple data sources, incorporation of information via prior distributions, description of parameter identifiability, and the ability to obtain interval estimates of model parameters. We develop a microsimulation model for colorectal cancer and use our proposed method to calibrate model parameters. The microsimulation model provides a good fit to the calibration data. We find evidence that some parameters are identified primarily through prior distributions. Our results underscore the need to incorporate multiple sources of variability (i.e., due to calibration data, unknown parameters, and estimated parameters and predicted values) when calibrating and applying microsimulation models.

Repeat curative intent liver surgery is safe and effective for recurrent colorectal liver metastasis: results from an international multi-institutional analysis

INTRODUCTION

Although 5-year survival approaches 55% following resection of colorectal liver metastasis, most patients develop recurrent disease that is often isolated to the liver. Although repeat curative intent surgery (CIS) is increasingly performed for recurrent colorectal liver metastasis, only small series have been reported. We sought to determine safety and efficacy of repeat CIS for recurrent colorectal liver metastasis as well as determine factors predictive of survival in a large multicenter cohort of patients.

METHODS

Between 1982 and 2008, 1,706 patients who underwent CIS--defined as curative intent hepatic resection/radiofrequency ablation (RFA)--for colorectal liver metastasis were identified from an international multi-institutional database. Two hundred forty-six (14.4%) patients underwent 301 repeat CIS. Data on clinico-pathologic factors, morbidity, and mortality were collected and analyzed.

RESULTS

Following initial CIS, 645 (37.8%) patients had recurrence within the liver. Of these, 246 patients underwent repeat CIS for recurrent disease. The majority had hepatic resection alone as initial therapy (n = 219; 89.0%). A subset of patients underwent third (n = 46) or fourth (n = 9) repeat CIS. Mean interval between surgeries was similar (first --> second, 19.1 months; second --> third, 21.5 months; third --> fourth, 11.3 months; P = 0.20). Extent of hepatic resection decreased with subsequent CIS (>or=hemihepatectomy: first CIS, 30.9% versus second CIS, 21.1% versus third/fourth CIS, 16.4%; P = 0.004). RFA was utilized in one quarter of patients undergoing repeat CIS (second CIS, 21.1% versus third/fourth CIS, 25.5%). Mortality and morbidity were similar following second, third, and fourth CIS, respectively (all P > 0.05). Five-year survival was 47.1%, 32.6%, and 23.8% following the first, second, and third CIS, respectively. Presence of extra-hepatic disease was predictive of worse survival (HR = 2.26, P = 0.01).

CONCLUSION

Repeat CIS for recurrent colorectal liver metastasis can be performed with low morbidity and near-zero mortality. Patients with no extra-hepatic disease are best candidates for repeat CIS. In these patients, repeat CIS can offer the chance of long-term survival.

Presentation and outcome following radical cystectomy in Hispanics with bladder cancer

OBJECTIVE

Significant racial and ethnic differences in the epidemiology of bladder cancer (BC) exist. Studies have shown African Americans to have lower incidence of bladder cancer than Caucasians, but higher incidence of invasive BC. Hispanics are the largest minority group in the United States. However, no reported studies on bladder cancer among Hispanics are available to date. As our center is in a unique position to study BC in Hispanic patients we were prompted to assess presentation and outcome of patients undergoing radical cystectomy (RC) for BC.

MATERIALS AND METHODS

Between January 1992 and May 2006, 448 RC were performed. All relevant data were collected and entered into a database. Patients were categorized by ethnicity as Hispanic and non-Hispanic White. African-American and other minority groups were excluded because of the small number. Comparative analysis of Hispanic and non-Hispanic White patients was performed.

RESULTS

67 (17%) patients were Hispanic. Mean follow-up period was 41 (SD +/- 40) months. Clinical and pathological data between these two groups were compared. Pre-cystectomy T stage was not significantly different between both groups. However, after RC incidence of < or = T1 disease in Hispanics was lower (22%) than Caucasians (37%). This difference, statistically significant (P = 0.024) indicates that Hispanics who undergo RC present with higher stage disease. Kaplan-Meier log rank test indicated a difference in disease free survival and disease specific survival between the two groups but however it did not reach statistical significance (Log Rank P = 0.082, P = 0.063). No significant difference in overall survival was observed (P = 0.465).

CONCLUSIONS

Hispanic patients managed with RC for bladder carcinoma present with higher stage disease.

Serum insulin-like growth factor (IGF)-1 and IGF binding protein-3 in relation to breast cancer among Hispanic and white, non-Hispanic women in the US Southwest

Insulin-like growth factor 1 (IGF-1) and IGF binding protein 3 (IGFBP-3) have been positively associated with breast cancer, especially among premenopausal women. Hispanic women have lower levels of IGF-1 and IGFBP-3 than non-Hispanic white (NHW) women, although no studies have adequately assessed the relationship among IGF-1, IGFBP-3, and breast cancer in Hispanic women. We investigated the association among IGF-1, IGFBP-3, and breast cancer within a subset of participants (n = 184 cases, 522 controls) of a population-based case-control study of women living in the U.S. Southwest. Serum levels of IGF-1 and IGFBP-3 were measured in fasting blood samples, and associations among IGF-1, IGFBP-3, and breast cancer were calculated using logistic regression, adjusting for age, study center, ethnicity, education, recent hormone exposure, body mass index, parity, total energy expenditure, total calories, and cholesterol. Both IGF-1 and IGFBP-3 were statistically significantly associated with breast cancer overall (highest vs. lowest quartile (Q4 vs. Q1) for IGF-1: odds ratio (OR) = 1.92, 95% confidence interval (CI) = 1.07-3.43); for IGFBP-3: OR = 3.04, 95% CI = 1.63-5.67). Positive associations were observed for both premenopausal breast cancer and postmenopausal breast cancer. IGF-1 was associated with breast cancer in NHW women (Q4 vs. Q1: OR = 2.82, 95% CI = 1.36-5.83), but not in Hispanic women (Q4 vs. Q1: OR = 0.81, 95% CI = 0.29-2.27). IGFBP-3 was associated with breast cancer in both ethnic groups (Q4 vs. Q1 for NHW: OR = 3.32, 95% CI = 1.45-7.60; Q4 vs. Q1 for Hispanics: OR = 2.15, 95% CI = 0.76-6.04). In conclusion, the association between IGF-1 and breast cancer differed by ethnicity, while no ethnic differences were observed in IGFBP-3-associated breast cancer.

Rates and patterns of recurrence following curative intent surgery for colorectal liver metastasis: an international multi-institutional analysis of 1669 patients

OBJECTIVE(S)

To investigate rates and patterns of recurrence in patients following curative intent surgery for colorectal liver metastasis.

BACKGROUND

Outcomes following surgical management of colorectal liver metastasis have largely focused on overall survival. Contemporary data on rates and patterns of recurrence following surgery for colorectal liver metastasis are limited.

METHODS

One thousand six hundred sixty-nine patients treated with surgery (resection +/- radiofrequency ablation [RFA]) for colorectal liver metastasis between 1982 and 2008 were identified from an international multi-institutional database. Clinicopathologic data, recurrence patterns, and recurrence-free survival (RFS) were analyzed.

RESULTS

At the time of the initial liver-directed surgery, surgical treatment was resection only (90.2%), resection plus RFA (8.0%), or RFA alone (1.8%). While 5-year overall survival was 47.3%, 947 (56.7%) patients recurred with a median RFS time of 16.3 months. First recurrence site was intrahepatic only (43.2%), extrahepatic only (35.8%), intra- and extrahepatic (21.0%). There was no difference in RFS based on site of recurrence (intrahepatic: 16.9 months; extrahepatic: 16.6 months; intra- and extrahepatic: 16.2 month; P > 0.05). Receipt of adjuvant chemotherapy was associated with overall recurrence risk (hazard ratio [HR] = 0.56), while history of RFA (HR = 2.39, P = 0.001) and R1 margin status (HR = 1.36) were predictive of intrahepatic recurrence. Pattern of recurrence and RFS remained similar following repeat surgery for recurrent disease.

CONCLUSIONS

While 5-year survival following surgery for colorectal liver metastasis approaches 50%, over one-half of patients develop recurrence within 2 years. The pattern of failure is distributed relatively equally among intrahepatic, extrahepatic, and intra- plus extrahepatic sites. Patients undergoing repeat surgery for recurrent metastasis have similar patterns of recurrence and RFS time.

Racial disparities in lung cancer mortality in U.S. congressional districts, 1990-2001

The objective of this study was to detect statistically significant racial disparities in lung cancer mortality at the U.S. congressional district level. We applied absolute disparity statistics to mortality data from the National Center for Health Statistics (NCHS) for 1990-2001, mapped significant lung cancer mortality disparities by race and gender within U.S. congressional districts, and uncovered previously unreported disparities. The disparity statistics comparing black and white females revealed higher mortality rates for black females in the Midwestern U.S., and higher mortality rates for white females in the South-eastern U.S. Our methodology provides a spatial tool for guiding public health cancer control practices to monitor, target and reduce disparities.

Incidence of first primary central nervous system tumors in California, 2001-2005

We examined the incidence of first primary central nervous system tumors (PCNST) in California from 2001-2005. This study period represents the first five years of data collection of benign PCNST by the California Cancer Registry. California's age-adjusted incidence rates (AAIR) for malignant and benign PCNST (5.5 and 8.5 per 100,000, respectively). Malignant PCNST were highest among non-Hispanic white males (7.8 per 100,000). Benign PCNST were highest among African American females (10.5 per 100,000). Hispanics, those with the lowest socioeconomic status, and those who lived in rural California were found to be significantly younger at diagnosis. Glioblastoma was the most frequent malignant histology, while meningioma had the highest incidence among benign histologies (2.6 and 4.5 per 100,000, respectively). This study is the first in the US to compare malignant to benign PCNST using a population-based data source. It illustrates the importance of PCNST surveillance in California and in diverse communities.

The effect of race on the incidence of retinoblastoma

PURPOSE

To examine the incidence of retinoblastoma for regional variations by race.

METHODS

Age-adjusted incidence rates, rate ratios, and 95% confidence intervals were determined in 109 regions from 1993 to 1997 using compiled data from the International Agency for Research on Cancer.

RESULTS

The rate ratio was 1.12 (range: 0.35 to 4.15) between white populations in the United States and Europe/Australia, 0.98 (range: 0.37 to 2.65) between Hispanic populations in Spain and the United States, and 1.44 (range: 0.29 to 1.79) between Hispanic populations in Uruguay and the United States. The rate ratio between Hispanic and white populations within the United States was 0.94 (range: 0.33 to 2.56). No differences were significant.

CONCLUSIONS

Because retinoblastoma is a genetic disease, its incidence is similar among varied populations.

Cancer incidence in first generation U.S. Hispanics: Cubans, Mexicans, Puerto Ricans, and new Latinos

BACKGROUND

The diversity among Hispanics/Latinos, defined by geographic origin (e.g., Mexico, Puerto Rico, Cuba), has been neglected when assessing cancer morbidity. For the first time in the United States, we estimated cancer rates for Cubans, Mexicans, Puerto Ricans, and other Latinos, and analyzed changes in cancer risk between Hispanics in their countries of origin, U.S. Hispanics in Florida, and non-Hispanic Whites in Florida.

METHODS

Florida cancer registry (1999-2001) and the 2000 U.S. Census population data were used. The Hispanic Origin Identification Algorithm was applied to establish Hispanic ethnicity and subpopulation.

RESULTS

The cancer rate of 537/100,000 person-years (95% confidence interval, 522.5-552.5) for Hispanic males in Florida was lower than Whites (601; 595.4-606.9). Among women, these rates were 376 (365.6-387.1) and 460 (455.6-465.4), respectively. Among Florida Hispanics, Puerto Ricans had the highest rates, followed by Cubans. Mexicans had the lowest rates. Rates for Hispanics in Florida were at least 40% higher than Hispanics in their countries of origin, as reported by the IARC.

CONCLUSION

Substantial variability in cancer rates occurs among Hispanic subpopulations. Cubans, unlike other Hispanics, were comparable with Whites, especially for low rates of cervical and stomach cancers. Despite being overwhelmingly first generation in the U.S. mainland, Puerto Ricans and Cubans in Florida showed rates of colorectal, endometrial, and prostate cancers similar to Whites in Florida. Because rates are markedly lower in their countries of origin, the increased risk for cancer among Cubans, Mexicans, and Puerto Ricans who move to the United States should be further studied.

Looking under the Hispanic umbrella: cancer mortality among Cubans, Mexicans, Puerto Ricans and other Hispanics in Florida

Cancer is the second leading cause of death among Hispanics. Most of the cancer statistics available both at the state and national levels report cancer statistics for all Hispanics as an aggregate group. The goal of this paper is to provide a population-based overview of cancer mortality among Hispanics (Cubans, Mexicans, Puerto Ricans and other Hispanics) in Florida from 1990 to 2000 and to explore the demographic diversity of this growing ethnic group. The study population consisted of Hispanics and White non-Hispanics who died from cancer. Cancer mortality rates and proportion of cancer deaths by type and age at death for the selected racial/ethnic groups were calculated. Our findings indicate that the cancer death rates of the Hispanic subgroups compared favorably with those of White non-Hispanics and that cancer rates often presented for all Hispanics mask important differences between the different ethnic subgroups that fall under the Hispanic umbrella.

Indirect method to estimate specific Hispanic group cancer rates

INTRODUCTION

Several states with large Hispanic populations have historically served as the source for US Hispanic cancer incidence rates, with aggregation of data across all states limited by different methodologies to identify Hispanic persons. Now with data available for more than 85% of the US Hispanic population, state rates suggest regional diversity in their Hispanic cancer profiles.

METHOD

We tested an approach of using a surrogate indicator of county residential homogeneity for Hispanic groups based on the 2000 US Census. The indicator used the counts of specific Hispanic residents compared to the total Hispanic population in the county to define counties with homogenous Hispanic populations. From these data, we aggregated counties into homogeneity categories for each Hispanic group and defined thresholds and rules for allocating Hispanic persons to a specific Hispanic group.

RESULTS

We found that it was possible to use county demographic data in many counties to meaningfully attribute a specific Hispanic ethnicity to incident cancer cases based on homogeneity thresholds. Cancer rates for the US Hispanic population describe a profile of high rates of cancers of the liver, gallbladder, cervix (in female), stomach, and lower rates of the cancers of the lung, female breast, and prostate compared with the non-Hispanic white population. In general, rates among US Mexicans are lower than the US Hispanic rates, while rates for Puerto Ricans and Cubans are higher than the US Hispanic rates. Additional variations among the three Hispanic groups were also evident.

CONCLUSION

The approach yielded reasonable and useful information to explore etiologic differences among the populations, as well as to develop relevant cancer control interventions. However, direct identification of specific Hispanic ethnicity in medical records and annual Census estimates of these populations would be preferable if they ever became available.

Breast cancer in the Middle Eastern population of California, 1988-2004

This report presents the patterns of incidence, survival, and mortality of breast cancer in the Middle Eastern (ME) population of California. Cases were identified through surname recognition and population estimates were obtained from census public use files. Rates, trends, and survival in this ethnic group were compared with the non-Hispanic White (NHW) of California, as well as natives in the Middle East. Age-adjusted incidence rates for the insitu (22.8), invasive (126.2), and mortality (23.2) in ME women were significantly lower than similar rates of 26.0, 146.9, and 30.6 in the NHW women. Incidence rate in ME women in California was higher than rates in women in the Middle East. Lower rates for early stage and higher rates for late stage diagnoses in this ethnic population suggest lack of optimal access to preventive healthcare. Relative survival in the two groups is negatively associated with stage at diagnosis and is slightly higher in ME women, probably due to large numbers of lost to follow-up in ME women suggesting the presence of salmon bias. Positive association with socioeconomic standing was detected only in the NHW women. Incidence of breast cancer in ME men was significantly higher than that of NHW men.

Subcutaneous interleukin-4 (IL-4) for relapsed and resistant non-Hodgkin lymphoma: A phase II trial in the North Central Cancer Treatment Group, NCCTG 91-78-51

Interleukin-4 (IL-4), a pleiotropic cytokine, has in vitro activity against non-Hodgkin lymphoma (NHL). This phase II study was conducted to learn the efficacy and toxicity of IL-4 in patients with NHL. Patients with relapsed or refractory indolent or aggressive NHL were eligible to receive 2.5 or 5.0 mcg/kg of subcutaneous IL-4 for 28 days of a 42-day cycle. Patients with response and acceptable toxicity after two cycles were eligible to continue treatment for six cycles. The target overall response rate (ORR) was 20%. Forty-one patients were enrolled and assessable for toxicity; two were ineligible after histology review. The ORR was 13% (5/39) with one complete and four partial responses. All responders were treated with 5.0 mcg/kg; the median time to progression was 84 days, the median duration of response for responders was 8.3 months. The most common toxicities of any grade in all patients were edema (66%), malaise (56%), and elevated liver function tests (56%). Grade 3 and 4 toxicities were more common at 5.0 mcg/kg, leading to a reduction in the starting dose. Although the study observed anti-tumor activity with IL-4, the ORR goal of the study was not achieved. Agents that target the IL-4 receptor can potentially benefit patients with NHL; however, alternative schedules using IL-4 in shorter duration and in combination with other agents would be required to overcome toxicities observed in this study.

Socioeconomic status and prostate cancer incidence and mortality rates among the diverse population of California

Background

The racial/ethnic disparities in prostate cancer rates are well documented, with the highest incidence and mortality rates observed among African-Americans followed by non-Hispanic Whites, Hispanics, and Asian/Pacific Islanders. Whether socioeconomic status (SES) can account for these differences in risk has been investigated in previous studies, but with conflicting results. Furthermore, previous studies have focused primarily on the differences between African-Americans and non-Hispanic Whites, and little is known for Hispanics and Asian/Pacific Islanders.

Objective

To further investigate the relationship between SES and prostate cancer among African-Americans, non-Hispanic Whites, Hispanics, and Asian/Pacific Islanders, we conducted a large population-based cross-sectional study of 98,484 incident prostate cancer cases and 8,997 prostate cancer deaths from California.

Methods

Data were abstracted from the California Cancer Registry, a population-based surveillance, epidemiology, and end results (SEER) registry. Each prostate cancer case and death was assigned a multidimensional neighborhood-SES index using the 2000 US Census data. SES quintile-specific prostate cancer incidence and mortality rates and rate ratios were estimated using SEER*Stat for each race/ethnicity categorized into 10-year age groups.

Results

For prostate cancer incidence, we observed higher levels of SES to be significantly associated with increased risk of disease [SES Q1 vs. Q5: relative risk (RR) = 1.28; 95% confidence interval (CI): 1.25–1.30]. Among younger men (45–64 years), African-Americans had the highest incidence rates followed by non-Hispanic Whites, Hispanics, and Asian/Pacific Islanders for all SES levels. Yet, among older men (75–84 years) Hispanics, following African-Americans, displayed the second highest incidence rates of prostate cancer. For prostate cancer deaths, higher levels of SES were associated with lower mortality rates of prostate cancer deaths (SES Q1 vs. Q5: RR = 0.88; 95% CI: 0.92–0.94). African-Americans had a twofold to fivefold increased risk of prostate cancer deaths in comparison to non-Hispanic Whites across all levels of SES.

Conclusions

Our findings suggest that SES alone cannot account for the greater burden of prostate cancer among African-American men. In addition, incidence and mortality rates of prostate cancer display different age and racial/ethnic patterns across gradients of SES.

Electronic supplementary material

The online version of this article (doi:10.1007/s10552-009-9369-0) contains supplementary material, which is available to authorized users.

Racial and ethnic variations in the incidence of cancers of the uterine corpus, United States, 2001-2003

OBJECTIVE

We examined racial/ethnic variations in uterine corpus cancer incidence.

METHODS

Data are from state cancer registries meeting quality criteria in the National Program of Cancer Registries (NPCR) and Surveillance, Epidemiology, and End Results (SEER) programs, 2001-2003. We included females with microscopically confirmed invasive uterine corpus cancer (n = 97,098). We calculated age-adjusted incidence rates per 100,000, stratified by race and ethnicity.

RESULTS

Cancers were most common among women who were 50-64 years old, white and non-Hispanic. Epithelial cancer rates were lower for Asian/Pacific Islanders (API) than whites (12.8 vs. 21.7, p < 0.0001), including serous adenocarcinoma (0.5 vs. 0.9, p < 0.0001). Epithelial cancer rates were also lower for American Indian/Alaska Natives (AIAN) vs. whites (11.5 vs. 21.7, p < 0.0001) and Hispanics vs. non-Hispanics (16.0 vs. 21.3, p < 0.0001). Among all race groups, blacks had the highest rates of mesenchymal (0.9) and mixed cancers (2.0) and of serous adenocarcinoma (2.0), clear cell adenocarcinoma (0.5), and carcinosarcoma (1.9). Blacks also had the lowest rates of low-grade and localized stage epithelial cancer and the highest rates of high-grade and distant stage disease.

CONCLUSIONS

Uterine corpus cancer rates are generally lower for API and AIAN than for whites or blacks and for Hispanics vs. non-Hispanics. Further research is needed to understand reasons for the differences in incidence.

Predisposing and enabling factors associated with mammography use among Hispanic and non-Hispanic white women living in a rural area

CONTEXT

Women who do not receive regular mammograms are more likely than others to have breast cancer diagnosed at an advanced stage.

PURPOSE

To examine predisposing and enabling factors associated with mammography use among Hispanic and non-Hispanic White women.

METHODS

Baseline data were used from a larger study on cancer prevention in rural Washington state. In a sample of 20 communities, 537 women formed the sample for this study. The main outcomes were ever having had a mammogram and having had a mammogram within the past 2 years.

FINDINGS

Reporting ever having had a mammogram was inversely associated with lack of health insurance (OR = 0.37, 95% CI: 0.16-0.84), ages under 50 years (OR = 0.23, 95% CI: 0.12-0.45), high cost of exams (OR = 0.48, 95% CI: 0.27-0.87), and lack of mammography knowledge (OR = 0.16, 95% CI: 0.07-0.37), while increasing education levels were positively associated (OR = 1.72, 95% CI: 1.09-2.70). Reporting mammography use within the past 2 years was inversely associated with ages under 50 years (OR = 0.49, 95% CI: 0.27-0.88) and over 70 years (OR = 0.47, 95% CI: 0.24-0.94), lack of health insurance (OR = 0.23, 95% CI: 0.10-0.50), and high cost of exams (OR = 0.55, 95% CI: 0.35-0.87).

CONCLUSIONS

Continued resources and programs for cancer screening are needed to improve mammography participation among women without health insurance or low levels of education.

Outcome of esophageal carcinoma in the veteran affairs population: a comparative analysis from the Veteran Affairs Central Cancer Registry

OBJECTIVE

Reports indicate that esophageal carcinoma is changing with a shift from squamous cell carcinoma (SCC) to adenocarcinoma (AC) along with worse survival in black patients. However, data on esophageal carcinoma in the Veteran Affairs (VA) population is lacking. We set to describe site-specific and histology-specific characteristics of esophageal cancer in the VA population over the past decades.

METHODS

We queried the VA Central Cancer Registry database for esophageal cancer cases between 1995 and 2005. Patient characteristics and treatment methods were obtained and overall survival was estimated using the Kaplan-Meier method.

RESULTS

There were 7929 patients included in the study. The median survival in the period 1995 to 1999 was 7.53 months and 2000 to 2005 was 8.33 months. The median survival in AC was 8.93 months; SCC was 7.30 months. Cox-regression multivariate model revealed that location, age, histology, stage, and treatment were independent predictors of survival. Blacks were less likely to undergo surgery and more likely to undergo radiation.

CONCLUSIONS

In nonmetastatic esophageal cancer at the VA, SCC has worse outcome as compared with AC. Blacks with AC have worse outcome than whites. Despite equal access to health care blacks are less likely to undergo surgery, which may contribute to their worse outcome. We recommend further studies to determine factors leading to selection of treatment modalities in minority patients.

Osteoblastic and osteolytic human osteosarcomas can be studied with a new xenograft mouse model producing spontaneous metastases

There is no animal model that reflects the histological and radiographical heterogeneity of osteosarcoma. We assessed seven osteosarcoma cell lines for their potential to develop orthotopic tumors and lung metastasis in SCID mice. Whereas radiologically, 143B developed osteolytic tumors, SaOS-LM7 developed osteoblastic primary tumors. The mineralization status was confirmed by assessing the alkaline phosphatase activity and the microarray expression profile. We herein report a xenograft orthotopic osteosarcoma mouse model to assess osteoblastic and osteolytic lesions, which may contribute in the search for new diagnostic and therapeutic approaches.

Acral lentiginous melanoma: incidence and survival patterns in the United States, 1986-2005

OBJECTIVE

To examine incidence and survival patterns of acral lentiginous melanoma (ALM) in the United States.

DESIGN

Population-based registry study. We used the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute to evaluate data from 17 population-based cancer registries from 1986 to 2005.

PARTICIPANTS

A total 1413 subjects with histologically confirmed cases of ALM. Main Outcome Measure Incidence and survival patterns of patients with ALM.

RESULTS

The age-adjusted incidence rate of ALM overall was 1.8 per million person-years. The proportion of ALM among all melanoma subtypes was greatest in blacks (36%). Acral lentiginous melanoma had 5- and 10-year melanoma-specific survival rates of 80.3% and 67.5%, respectively, which were less than those for all cutaneous malignant melanomas overall (91.3% and 87.5%, respectively; P < .001). The ALM 5- and 10-year melanoma-specific survival rates were highest in non-Hispanic whites (82.6% and 69.4%), intermediate in blacks (77.2% and 71.5%), and lowest in Hispanic whites (72.8% and 57.3%) and Asian/Pacific Islanders (70.2% and 54.1%). Acral lentiginous melanoma thickness and stage correlated with survival according to sex and in the different racial groups.

CONCLUSIONS

Population-based data showed that ALM is a rare melanoma subtype, although its proportion among all melanomas is higher in people of color. It is associated with a worse prognosis than cutaneous malignant melanoma overall. Hispanic whites and Asian/Pacific Islanders have worse survival rates than other groups, and factors such as increased tumor thickness and more advanced stage at presentation are the most likely explanations.

Celebremos la Salud: a community-based intervention for Hispanic and non-Hispanic white women living in a rural area

The evaluation for Celebremos La Salud, a community randomized trial of Hispanic cancer prevention found no differences in mammography screening rates between intervention and control communities. The goal of the present study was to determine reasons for the intervention's lack of effectiveness. In the first aim, we assessed reach of the intervention. In the second, we assessed which intervention activities were associated with mammography use. In the third, we examined whether factors related to health care access, education level, or age modified the effect of the intervention. Data were used from a post-intervention survey of 20 rural communities in Washington State. Hispanic (N = 202) and non-Hispanic White (N = 389) women, over age 40 formed the sample. Reporting having awareness of or having participated in intervention activities was positively associated with Hispanic ethnicity and intervention group and negatively associated with lack of health insurance and having a lower education level. Only one intervention activity was associated with screening use. Having participated in presentations at organizations was positively associated with having had a mammogram in the previous 2 years for Hispanic women. No individual level modifiers influenced the intervention's effectiveness. Heavily targeting the intervention to Hispanic women and not reaching as many White women may have contributed to the lack of intervention effect. Increasing mammography screening rates among women living in a rural area may require improved access to health care and reaching women with lower education levels and lack of health insurance.

Effectiveness of Cultivando la Salud: a breast and cervical cancer screening promotion program for low-income Hispanic women

OBJECTIVES

We tested the effectiveness of a lay health worker intervention to increase breast and cervical cancer screening among low-income Hispanic women.

METHODS

Participants were women 50 years and older who were nonadherent to mammography (n = 464) or Papanicolaou (Pap) test (n = 243) screening guidelines. After the collection of baseline data, lay health workers implemented the Cultivando la Salud (CLS; Cultivating Health) intervention. Data collectors then interviewed the participants 6 months later.

RESULTS

At follow-up, screening completion was higher among women in the intervention group than in the control group for both mammography (40.8% vs 29.9%; P < .05) and Pap test (39.5% vs 23.6%; P < .05) screening. In an intent-to-treat analysis, these differences remained but were not significant. The intervention increased mammography self-efficacy, perceived susceptibility, perceived survivability, perceived benefits of mammography, subjective norms, and processes of change. The intervention also significantly increased Pap test self-efficacy, perceived benefits of having a Pap test, subjective norms, and perceived survivability of cancer. It did not change Pap test knowledge, perceived susceptibility, or perceptions about negative aspects of Pap test screening.

CONCLUSIONS

Our results add to the evidence concerning the effectiveness of lay health worker interventions for increasing Pap test screening and mammography. Future research should explore the effectiveness of CLS in other Hispanic groups, the mechanisms through which interpersonal communication influences decisions about screening, and how effective interventions such as CLS can best be adopted and implemented in community-based organizations or other settings.

Trends in area-socioeconomic and race-ethnic disparities in breast cancer incidence, stage at diagnosis, screening, mortality, and survival among women ages 50 years and over (1987-2005)

BACKGROUND

Breast cancer is the most commonly diagnosed cancer and the second leading cause of cancer death among women in the United States and varies systematically by race-ethnicity and socioeconomic status. Previous research has often focused on disparities between particular groups, but few studies have summarized disparities across multiple subgroups defined by race-ethnic and socioeconomic position.

METHODS

Data on breast cancer incidence, stage, mortality, and 5-year cause-specific probability of death (100 - survival) were obtained from the Surveillance, Epidemiology, and End Results program and data on mammography screening from the National Health Interview Survey from 1987 to 2005. We used four area-socioeconomic groups based on the percentage of poverty in the county of residence (<10, 10-15, 15-20, +20%) and five race-ethnic groups (White, Black, Asian, American Indian, and Hispanic). We used summary measures of disparity based on both rate differences and rate ratios.

RESULTS

From 1987 to 2004, area-socioeconomic disparities declined by 20% to 30% for incidence, stage at diagnosis, and 5-year cause-specific probability of death, and by roughly 100% for mortality, whether measured on the absolute or relative scale. In contrast, relative area-socioeconomic disparities in mammography use increased by 161%. Absolute race-ethnic disparities declined across all outcomes, with the largest reduction for mammography (56% decline). Relative race-ethnic disparities for mortality and 5-year cause-specific probability of death increased by 24% and 17%, respectively.

CONCLUSIONS

Our analysis suggests progress towards race-ethnic and area-socioeconomic disparity goals for breast cancer, especially when measured on the absolute scale. However, greater progress is needed to address increasing relative socioeconomic disparities in mammography and race-ethnic disparities in mortality and 5-year cause-specific probability of death.

Incidence trends of invasive cervical cancer in the United States by combined race and ethnicity

OBJECTIVE

To better understand national patterns of invasive cervical cancer (ICC) incidence by race and ethnicity in order to develop appropriate ICC prevention policies.

METHODS

Age-adjusted and age-specific ICC incidence rates were calculated by combined race/ethnicity, making distinct the Hispanic/all races category from three other Non-Hispanic (White, Black and other) racial categories.

RESULTS

There was a significant downward trend in ICC incidence during both time periods for every combination of race/ethnicity (p-value <0.05) except Hispanic/all races during 1995-1999. Non-Hispanic/Black and Hispanic/all races women had significantly higher incidence rates of ICC compared to Non-Hispanic/White women. ICC incidence peaked much earlier for Non-Hispanic/White women (35-44 years of age) compared to any other racial/ethnic group. Non-Hispanic (White, Black and other) women had lower rates of adenocarcinoma and squamous cell carcinoma compared to Hispanic/all races women. Non-Hispanic/Black and Hispanic/all races women were more likely to be diagnosed at late stage or unstaged at diagnosis than Non-Hispanic/White women.

CONCLUSION

Although ICC incidence decreased significantly over the last 10 years, Black or Hispanic US populations continue to have the highest ICC incidence compared to Non-Hispanic/Whites, highlighting the need for improved health literacy and social support to ensure their equal access to ICC screening and HPV prevention including HPV vaccination.

County-level poverty and distant stage cancer in the United States

OBJECTIVE

Late stage cancer at diagnosis increases the likelihood of cancer death. We evaluated the relation of county-level poverty with late stage cancer for 18 anatomic sites using data from the North American Association of Central Cancer Registries.

METHODS

Stratified analysis and logistic regression were applied to 2 million incident cancers (1997-2000) from 32 states representing 57% of the United States.

RESULTS

For 12 sites, higher county poverty significantly increased the odds of late stage, [adjusted odds ratio (95% confidence interval) comparing highest to lowest county poverty: larynx 2.4 (1.8-3.2), oral cavity 2.2 (1.8-2.7), melanoma 2.0 (1.5-2.8), female breast 1.9 (1.7-2.2), prostate 1.7 (1.5-1.9), corpus uteri 1.6 (1.3-1.9), cervix 1.6 (1.3-2.1), bladder 1.6 (1.2-2.1), colorectum 1.4 (1.3-1.5), esophagus 1.3 (1.1-1.7), stomach 1.3 (1.1-1.5), and kidney 1.3 (1.1-1.5)]. With some exceptions, county poverty associations with stage were comparable across gender and race, but stronger among metropolitan cases. A few differences by age may reflect screening patterns.

CONCLUSIONS

In this large population-based study, higher county poverty independently predicted distant stage cancer. This held for several non-screenable cancers, suggesting improved area economic deprivation, including access to and utilization of good medical care might facilitate earlier diagnosis and longer survival even for cancers without practical screening approaches.

Barriers and facilitators related to mammography use among lower educated Mexican women in the USA

This study explores barriers to and facilitators of breast cancer screening and how people in a woman's social network influence these screening behaviors. A total of 40 semi-structured qualitative interviews were conducted in rural Washington State (USA) among Mexican women aged 50 and over. Eligible women reported either having had a mammogram within the last two years, over two years ago, or never. We found that lack of health insurance, the perception that the mammogram is painful, and fear of finding cancer were cited as barriers to participation in mammography screening. Women who had lived in the US for a shorter period were more likely to report never having had a mammogram than women who had lived in the US for a longer period. Women often cited daughters and female friends as those from whom they received advice or encouragement to receive a mammogram. Few differences were found related to network size and mammography use among the groups. These findings may be useful in designing interventions to promote mammography use. Including daughters in intervention activities may help facilitate mammography use among Mexican women.

The inclusion of women and minorities in smoking cessation clinical trials: a systematic review

This study assesses the impact of the 1993 NIH Revitalization Act on the inclusion and subgroup analysis of women and minorities in trials of FDA-approved smoking cessation pharmacotherapy. Female representation, while commensurate with population levels, declined significantly for trials that began recruitment after 1993(M = 47.2% vs. M = 53.9%), and fewer than half reported analyses by gender. Minorities continued to be under-represented in later trials; however, significant improvement in representation (M = 16.1% vs. M = 10%) and analysis by race occurred. Industry-sponsored studies had lower minority representation than NIH funded studies. Recommendations are offered to improve subgroup analyses and minority inclusion.

Cancer occurrence

In this chapter, we describe the variability of cancer occurrence by using measures of incidence, mortality, prevalence, and survival, according to demographic characteristics such as age, sex, socioeconomic status, and race/ethnicity, as well as geographic location and time period. We also discuss the variability of cancer occurrence in relation to changes in risk factors, screening rates, and improved treatments. The variation according to risk factors provides strong evidence that much of cancer is caused by environmental factors and is potentially avoidable.

Epidemiology of ovarian cancer

Ovarian cancer represents the sixth most commonly diagnosed cancer among women in the world, and causes more deaths per year than any other cancer of the female reproductive system. Despite the high incidence and mortality rates, the etiology of this disease is poorly understood. Established risk factors for ovarian cancer include age and having a family history of the disease, while protective factors include increasing parity, oral contraceptive use, and oophorectomy. Lactation, incomplete pregnancies, and surgeries such as hysterectomy and tubal ligation may confer a weak protective effect against ovarian cancer. Infertility may contribute to ovarian cancer risk among nulliparous women. Other possible risk factors for ovarian cancer include postmenopausal hormone-replacement therapy and lifestyle factors such as cigarette smoking and alcohol consumption. Many of the causes of ovarian cancer are yet to be identified. Additional research is needed to better understand the etiology of this deadly disease.

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.

A population-based, descriptive analysis of malignant intraductal papillary mucinous neoplasms of the pancreas

BACKGROUND

Intraductal papillary mucinous neoplasms (IPMN) are distinct precursor lesions that can progress to pancreatic adenocarcinoma; thus, it has been of particular interest to cancer prevention researchers. We set out to do a population-based analysis of malignant IPMNs compared with other pancreatic subtypes to better delineate its characteristics and explore implications for prevention and management.

METHODS

We conducted a case-only analysis of California Cancer Registry data (2000-2007), including descriptive analysis of relevant clinical variables. Overall survival univariate analyses were conducted using the Kaplan-Meier method. Multivariate survival analyses were done using Cox proportional hazards ratios.

RESULTS

Overall, 15,296 pancreatic cancer cases were identified, including incident cases of 10,186 adenocarcinomas, 880 mucinous tumors, 568 endocrine tumors, 3,619 carcinoma not otherwise specified tumors, and 43 malignant IPMNs. Thirty-three (80.5%) IPMN cases had localized disease at presentation, eight had regional disease (19.5%), and no IPMNs were identified with distant disease (two were unstaged). Five-year overall survival was better for malignant IPMN cases (65%) compared with pancreatic endocrine tumors (30%), mucinous tumors (5%), carcinoma not otherwise specified (2%), and adenocarcinoma cases (2%). Compared with adenocarcinoma cases, malignant IPMN cases (hazard ratio = 0.19; 95% CI, 0.10-0.35), endocrine tumors (hazard ratio=0.28; 95% CI, 0.25-0.32), and mucinous tumors (hazard ratio=0.84; 95% CI, 0.77-0.90) had higher overall survival in a multivariate survival analysis after adjustment for age, gender, stage, race, socioeconomic status, surgery, chemotherapy, and radiation therapy.

CONCLUSIONS

Pancreatic malignant IPMNs represent an uncommon pancreatic tumor subtype, uniquely characterized by early stage at presentation and better survival.

Annual report to the nation on the status of cancer, 1975-2005, featuring trends in lung cancer, tobacco use, and tobacco control

BACKGROUND

The American Cancer Society, the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR) collaborate annually to provide updated information on cancer occurrence and trends in the United States. This year's report includes trends in lung cancer incidence and death rates, tobacco use, and tobacco control by state of residence.

METHODS

Information on invasive cancers was obtained from the NCI, CDC, and NAACCR and information on mortality from the CDC's National Center for Health Statistics. Annual percentage changes in the age-standardized incidence and death rates (2000 US population standard) for all cancers combined and for the top 15 cancers were estimated by joinpoint analysis of long-term (1975-2005) trends and by least squares linear regression of short-term (1996-2005) trends. All statistical tests were two-sided.

RESULTS

Both incidence and death rates from all cancers combined decreased statistically significantly (P < .05) in men and women overall and in most racial and ethnic populations. These decreases were driven largely by declines in both incidence and death rates for the three most common cancers in men (lung, colorectum, and prostate) and for two of the three leading cancers in women (breast and colorectum), combined with a leveling off of lung cancer death rates in women. Although the national trend in female lung cancer death rates has stabilized since 2003, after increasing for several decades, there is prominent state and regional variation. Lung cancer incidence and/or death rates among women increased in 18 states, 16 of them in the South or Midwest, where, on average, the prevalence of smoking was higher and the annual percentage decrease in current smoking among adult women was lower than in the West and Northeast. California was the only state with decreasing lung cancer incidence and death rates in women.

CONCLUSIONS

Although the decrease in overall cancer incidence and death rates is encouraging, large state and regional differences in lung cancer trends among women underscore the need to maintain and strengthen many state tobacco control programs.

Accuracy of self-reported smoking and secondhand smoke exposure in the US workforce: the National Health and Nutrition Examination Surveys

OBJECTIVES

Occupational health studies often rely on self-reported secondhand smoke (SHS) exposure. This study examines the accuracy of self-reported tobacco use and SHS exposure.

METHODS

Data on serum cotinine, self-reported tobacco use, and SHS exposure for US workers were extracted from three National Health and Nutrition Examination Surveys (n = 17,011). Serum cotinine levels were used to classify workers into SHS exposure categories. The percent agreement between self-reported tobacco use and SHS exposure with the cotinine categories was calculated.

RESULTS

Workers reporting tobacco use were 88% accurate whereas workers reporting work, home, or home+work exposures were 87% to 92% accurate. Workers reporting no SHS exposure were only 28% accurate.

CONCLUSIONS

Workers accurately reported their smoking status and workplace-home SHS exposures, but substantial numbers reporting "no exposures" had detectable levels of cotinine in their blood, indicating exposure to SHS.

Childhood and adolescent cancer survival in the US by race and ethnicity for the diagnostic period 1975-1999

BACKGROUND

Survival trends provide a measure of improvement in detection and treatment over time. In the current study, updated childhood and adolescent cancer survival statistics are presented, overall and among demographic subgroups, including Hispanics, for whom to the authors' knowledge national rates have not been previously reported. These results extend those provided by the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program in their detail and interpretation.

METHODS

Survival trends of primary cancers in children and adolescents (ages birth to 19 years) were evaluated using SEER 9 data. Five-year and 10-year relative survival rates across 5-year (1975-1979, 1985-1989, and 1995-1999) and 10-year (1975-1984 and 1985-1994) cohorts were compared via Z-tests. Annual percent change (APC) in survival was computed via weighted least-squares regression. Rates in Hispanic children and adolescents were compared with those in non-Hispanic whites and blacks (SEER 13, 1995-1999).

RESULTS

Five-year survival rates increased significantly overall (1975-1979: 63% vs 1995-1999: 79%; P< .0001) and for nearly all histologic types examined; increases were greatest for ependymoma (+37%; P< .0001) and non-Hodgkin lymphoma (+34%; P< .0001). Hispanic children and adolescents had somewhat poorer 5-year rates than non-Hispanic whites overall (74% vs 81%; P< .0001) and for Ewing sarcoma, leukemia, central nervous system tumors, and melanoma. Ten-year rates also increased significantly overall (1975-1984: 61% vs 1985-1994: 72%; P< .0001) and for a majority of cancer types. The largest improvements were noted for acute lymphoblastic leukemia (+19%; P< .0001) and non-Hodgkin lymphoma (+19%; P< .0001).

CONCLUSIONS

Observed trends reinforce the need for resources devoted to advancing treatment modalities, reducing disparities among racial/ethnic groups and adolescents, and providing long-term care of survivors.

Recent trends in Black-White disparities in cancer mortality

Despite decreases in overall cancer death rates across all racial and ethnic groups since the early 1990s, racial disparities in cancer mortality persist. We examined temporal trends in Black-White disparities in cancer mortality from all sites combined, smoking-related cancers (lung and a group including oral cavity, pharynx, larynx, esophagus, pancreas, bladder, and kidney), and sites affected, or potentially affected by screening and treatment (breast, prostate, colon/rectum). Death rates, rate differences, and rate ratios comparing Blacks to Whites from 1975 through 2004 were based on mortality data from the National Center for Health Statistics. The Black-White disparity in overall cancer death rates narrowed from the early 1990s through 2004, especially in men. This reduction was driven predominantly by more rapid decreases in mortality from tobacco-related cancers in Black men than White men. In contrast, racial disparities in mortality from cancers potentially affected by screening and treatment increased over most of the interval since 1975. Coordinated efforts to improve early detection and treatment for all segments of the population are essential to eliminate racial disparities in cancer mortality.

Multiple primary cancers of the colon, rectum, and the thyroid gland

The major concern in the case of cancer, whether one or in worse case more than one, is the extent of treatment required and the prognosis. This article reports three cases with two cancers: colorectal cancer and thyroid cancer, in the same patient at the same time. It also discusses the related clinical presentation and management of the cancers, and a review of literature has been presented.

Improvement in the diagnostic evaluation of a positive fecal occult blood test in an integrated health care organization

BACKGROUND

Screening for fecal occult blood can be effective in reducing colorectal cancer mortality only if positive tests are appropriately followed up with complete diagnostic evaluation (ie, colonoscopy or flexible sigmoidoscopy with double contrast barium enema) and treatment.

OBJECTIVES

To examine whether rates of complete diagnostic evaluation after a positive fecal occult blood test (FOBT) have improved over time after the implementation of tracking systems and physician guidelines within a large integrated health care organization.

RESEARCH DESIGN

From 1993 to 2005, 8513 positive FOBTs were identified on 8291 enrollees aged 50-79 of a large health care system. Automated records were used to identify repeat FOBTs, colonoscopy, flexible sigmoidoscopy, and double-contrast barium enema within 1 year after the positive FOBT. National rates of complete diagnostic evaluation were estimated from the 2005 National Health Interview Survey.

RESULTS

In this integrated health care organization, the percentage of positive FOBTs followed by complete diagnostic evaluation within 1 year increased from 57-64% in 1993-1996 to 82-86% from 2000-2005. Use of repeat FOBT after a positive FOBT decreased from 28-31% in 1993-1996 to 6-11% in 2000-2005. Based on the National Health Interview Survey, only 52% of positive FOBTs in 2000-2005 were followed by complete diagnostic evaluation nationally.

CONCLUSIONS

Adherence to recommendations for complete diagnostic evaluation after a positive FOBT has greatly improved over time in an integrated group medical practice. Through the use of tracking systems and screening guidelines, it may be possible to reach levels of follow-up that are comparable to those observed in randomized trials.

Trends in esophageal cancer incidence by histology, United States, 1998-2003

Esophageal adenocarcinoma rates may be increasing, whereas, squamous cell carcinoma rates appear to be decreasing in the United States. Previous population-based research on esophageal cancer has only covered up to 68% of the country. Additional, updated research on a larger percentage of the country is needed to describe racial, ethnic and regional trends in histologic subtypes of esophageal cancer. Invasive esophageal cancer cases diagnosed between 1998 and 2003 (n = 65,926), collected by the National Program of Cancer Registries or the Surveillance, Epidemiology, and End Results program, were included. These data cover 83% of the US population. Esophageal squamous cell carcinoma incidence fell by 3.6%/year, whereas esophageal adenocarcinoma increased by 2.1%/year. Squamous cell carcinoma rates decreased among both sexes in most racial or ethnic groups, whereas adenocarcinoma rates increased primarily among white or non-Hispanic men. Except for white or non-Hispanic men, squamous cell carcinoma rates were similar to, or greater than, adenocarcinoma rates for men and women of all other races and ethnicities. The largest decrease in squamous cell carcinoma rates occurred in the West census region, which also exhibited no increase in adenocarcinoma rates. The rate of regional and distant-staged adenocarcinomas increased, while rates for local-staged adenocarcinoma remained stable. This is the first article to characterize esophageal cancer trends using data covering the majority of the US. Substantial racial, ethnic and regional variation in esophageal cancer is present in the US. Our work may inform interventions related to tobacco and alcohol use, and overweight/obesity prevention, and provide avenues for further research.

Perceived risk of breast cancer among Latinas attending community clinics: risk comprehension and relationship with mammography adherence

OBJECTIVE

To describe breast cancer risk perceptions, determine risk comprehension, and evaluate mammography adherence among Latinas.

METHODS

Latina women age >or=35, primarily from Central and South America, were recruited from community-based clinics to complete in-person interviews (n = 450). Risk comprehension was calculated as the difference between numeric perceived risk and Gail risk score. Based on recommended guidelines from the year data were collected (2002), mammography adherence was defined as having a mammogram every one to two years for women >or=40 years of age.

RESULTS

Breast cancer risk comprehension was low, as 81% of women overestimated their risk and only 6.9% of women were high risk based on Gail risk scores. Greater cancer worry and younger age were significantly associated with greater perceived risk and risk overestimation. Of women age eligible for mammography (n = 328), 29.0% were non-adherent to screening guidelines. Adherence was associated with older age, (OR = 2.99, 95% CI = 1.76-5.09), having insurance (OR = 1.81, 95% CI = 1.03-3.17), greater acculturation (OR = 1.18, 95% CI = 1.02-1.36), and higher breast cancer knowledge (OR = 2.03, 95% CI = 1.21-3.40).

CONCLUSIONS

While most Latinas over-estimated their breast cancer risk, older age, having insurance, being more acculturated, and having greater knowledge were associated with greater screening adherence in this Latino population. Perceived risk, risk comprehension, and cancer worry were not associated with adherence. In Latinas, screening interventions should emphasize knowledge and target education efforts at younger, uninsured, and less acculturated mammography-eligible women.

The social determinants of cancer: a challenge for transdisciplinary science

To make further significant advances in cancer control research, a transdisciplinary science approach is needed that integrates the study of the biological nature of cancer and its clinical applications with the behavioral and social influences on cancer. More-effective interventions to reduce the burden of cancer can be developed and implemented by the adoption of a transdisciplinary research framework that takes into account the social determinants of cancer and seeks to discover interactions among social, environmental, behavioral, and biological factors in cancer etiology. This paper addresses two critical issues in the science of team science: (1) a cross-disciplinary, multilevel framework for organizing future research, and (2) a perspective that could aid in the translation and dissemination of cancer research findings in health care and public health practice. This conceptual framework is designed to encourage transdisciplinary research that will integrate social determinants into cancer research. The authors' goal is to promote a more complete understanding of the causes of cancer that will lead to the improved translation and implementation of the results of research.

Secular trends in mortality from common cancers in the United States by educational attainment, 1993-2001

Background

Death rates for the four major cancer sites (lung, breast, prostate, and colon and rectum) have declined steadily in the United States among persons aged 25–64 years since the early 1990s. We used national data to examine these trends in relation to educational attainment.

Methods

We calculated age-standardized death rates for each of the four cancers by level of education among 25- to 64-year-old non-Hispanic white and non-Hispanic black men and women for 1993 through 2001 using data on approximately 86% of US deaths from the National Center for Health Statistics, education level as recorded on the death certificate, and population data from the US Bureau of Census Current Population Survey. Annual percent changes in age-adjusted death rates were estimated using weighted log-linear regression models. All statistical tests were two-sided.

Results

Death rates for each cancer decreased statistically significantly from 1993 to 2001 in people with at least 16 years of education in every sex and race stratum except lung cancer in black women, for whom death rates were stable. For example, colorectal cancer death rates among white men, black men, white women, and black women with at least 16 years of education decreased by 2.4% (P < .001), 4.8% (P = .011), 3.0% (P < .001), and 2.6% (P = .030) annually, respectively. By contrast, among people with less than 12 years of education, a statistically significant decrease in death rates from 1993 through 2001 was seen only for breast cancer in white women (1.4% per year; P = .029). Death rates among persons with less than 12 years of education over the same time interval increased for lung cancer in white women (2.4% per year; P < .001) and for colon cancer in black men (2.7% per year; P < .001) and were stable for the remaining race/sex/site strata. Temporal trends generally followed an educational gradient in which the slopes of the decreases in death rate became steeper with higher educational attainment.

Conclusion

The recent declines in death rates from major cancers in the United States mainly reflect declines in more highly educated individuals.

Melanoma in Hispanic and Black Americans

Background

Although age-adjusted incidence rates (per 100,000) for melanoma are lower among Hispanics and blacks (4.5 and 1.0, respectively) compared with white non-Hispanics (21.6), melanomas among minority populations in the United States are more likely to metastasize and have poorer outcomes.

Methods

A review of the literature was conducted on melanomas affecting Hispanic and black Americans.

Results

Because of the low index of suspicion in both the medical community and these ethnic populations, diagnosis is often delayed, resulting in advanced presentation and a poorer prognosis.

Conclusions

More comprehensive medical training, expanded public educational campaigns, and increased awareness among patients of all skin types to perform self skin checks are recommended. Further studies elucidating the etiology and risk factors for melanoma among minority populations are warranted.

The disparity of cervical cancer in diverse populations

Significant disparities in cervical cancer incidence and mortality rates among minority groups have been documented in the United States, despite an overall decline in these rates for the population as a whole. Differences in cervical cancer screening practices have been suggested as an explanation for these disparities, as have differences in treatment among various racial and ethnic groups. A number of factors are attributed to these observed differences. As minority populations continue to grow in size over the next 50 years, persistent disparities will place an ever increasing burden on these populations and on the national healthcare system. Strategies to reduce cervical cancer disparities need to be employed in order to reverse these trends.

Thyroid cancer in the Middle Eastern population of California

OBJECTIVE

To describe and compare the epidemiology of thyroid cancer in the rapidly growing Middle Eastern (ME) population and the non-Hispanic, non-Middle Eastern White (NHNMW) residents of California. Population with ME heritage that is officially not recognized as a distinct ethnicity has rarely been studied in the past.

METHODS

ME cases in the California cancer registry files for 1988-2004 were identified by surname recognition. ME population was estimated by ancestry from census data.

RESULTS

Thyroid cancer in ME group, 869 cases and 56 deaths were compared with 19,182 cases and 1,327 deaths in the NHNMW population. Age-adjusted rate ratio (RR) for incidence was 1.5 (95% CI 1.3-1.7) in men and 1.5 (95% CI 1.4-1.7) in women. RR for mortality was 1.4 (95% CI 0.9-2.4) in men and 2.3 (95% CI 1.4-3.9) in women. Papillary tumors comprised over 80% of all cases and their pattern correlated with the rapid increase in thyroid cancer in recent years. Five-year observed survival in ME men was significantly higher than in NHNMW men, but similar in women.

CONCLUSIONS

Eighty-five percent of ME cases identified in this study were born in the Middle East. The higher incidence of thyroid cancer in this immigrant population may largely reflect a combination of sequels of radiation treatment for fungal diseases of the scalp that was common in the area in early 1950s, benign proliferative thyroid disease that is common in the area due to dietary iodine imbalance, and possibly genetic predisposition.