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Howlader N, Bhattacharya M, Scoppa S, Miller D, Noone AM, Negoita S, Cronin K, Mariotto A. Cancer and COVID-19: US cancer incidence rates during the first year of the pandemic. J Natl Cancer Inst 2024; 116:208-215. [PMID: 37796818 PMCID: PMC10852612 DOI: 10.1093/jnci/djad205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 08/10/2023] [Accepted: 09/15/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has had a profound global impact on health-care systems and patient outcomes. However, the specific effects of the pandemic on cancer incidence rates in the United States during its initial year remain unknown. METHODS In this study, we analyzed data from the Surveillance, Epidemiology, and End Results-22 registries, which encompass approximately 50% of the US population. We investigated changes in monthly incidence rates stratified by various factors, including cancer type, stage, age group, sex, race and ethnicity, socioeconomic status, rural-urban status, and registry locations. We compared the incidence rates observed during the pandemic with those from the previous year. RESULTS Our findings revealed a decline in incidence rates for all cancer sites combined starting in March 2020, coinciding with the implementation of stay-at-home orders. This decline reached its lowest point in April 2020 and persisted at a lower level until May 2020. Notably, compared with April 2019, the incidence rates in April 2020 dropped by 48.1% and did not consistently return to prepandemic levels. The reduction in cancer rates was more pronounced in urban and affluent counties. Across all cancer types, there was a statistically significant decrease in incidence rates during the pandemic, with the largest declines observed in thyroid (71.2%), prostate (57.9%), breast (54.9%), and colon and rectum cancers (54.1%). Furthermore, these decreases were primarily observed in early stage rather than late-stage disease. CONCLUSIONS The COVID-19 pandemic had a statistically significant impact on cancer outcomes. Monitoring long-term consequences of the pandemic on cancer incidence, stage at diagnosis, and mortality trends will be crucial.
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Affiliation(s)
- Nadia Howlader
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Manami Bhattacharya
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Steve Scoppa
- Information Management Services, Calverton, MD, USA
| | | | - Anne-Michelle Noone
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Serban Negoita
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Kathy Cronin
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Angela Mariotto
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
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Abstract
OBJECTIVES We estimated years of life lost (YLLs) to all causes of death and YLL lost to cancer among persons with HIV (PWH) in the United States. DESIGN Linked HIV and cancer registry data from the HIV/AIDS Cancer Match Study were used to identify incident cancers and deaths among PWH in 11 regions of the United States during 2006-2015. METHODS Mean YLL (MYLL) to all causes of death and MYLL to cancer during 2006-2015 were derived from the restricted mean survival estimated from Cox proportional hazards regression models. MYLLs were then upweighted to the national population of PWH to obtain all-cause total YLL (TYLL) and cancer-related TYLL in the United Staets during 2006-2015. RESULTS Among 466 234 PWH in the study population, 25 772 (5.5%) developed cancer during 2006-2015. Nationally, an estimated 134 986 years of life were lost to cancer of all types during 2006-2015 among PWH, representing 9.6% of TYLL to all causes. Non-Hodgkin lymphoma (NHL), Kaposi sarcoma, anal cancer, and lung cancer were the four largest cancer contributors (45% of TYLL to cancer). The largest fraction of TYLL occurred among back PWH, MSM, and PWH aged 40-59 years old. CONCLUSION PWH have higher mortality rates after developing cancer. NHL, Kaposi sarcoma and anal and lung cancers were large contributors to YLL to cancer in the United States population of PWH, highlighting opportunities to reduce cancer mortality through improved access to antiretroviral treatment, prevention, and screening.
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Affiliation(s)
| | - Ruth M Pfeiffer
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics
| | - Anne-Michelle Noone
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland, USA
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Warren JL, Noone AM, Stevens J, Wu XC, Hseih MC, Mumphrey B, Schmidt R, Coyle L, Shields R, Mariotto AB. The Utility of Pathology Reports to Identify Persons With Cancer Recurrence. Med Care 2022; 60:44-49. [PMID: 34812787 PMCID: PMC8720471 DOI: 10.1097/mlr.0000000000001669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Cancer recurrence is an important measure of the impact of cancer treatment. However, no population-based data on recurrence are available. Pathology reports could potentially identify cancer recurrences. Their utility to capture recurrences is unknown. OBJECTIVE This analysis assesses the sensitivity of pathology reports to identify patients with cancer recurrence and the stage at recurrence. SUBJECTS The study includes patients with recurrent breast (n=214) or colorectal (n=203) cancers. RESEARCH DESIGN This retrospective analysis included patients from a population-based cancer registry who were part of the Patient-Centered Outcomes Research (PCOR) Study, a project that followed cancer patients in-depth for 5 years after diagnosis to identify recurrences. MEASURES Information abstracted from pathology reports for patients with recurrence was compared with their PCOR data (gold standard) to determine what percent had a pathology report at the time of recurrence, the sensitivity of text in the report to identify recurrence, and if the stage at recurrence could be determined from the pathology report. RESULTS One half of cancer patients had a pathology report near the time of recurrence. For patients with a pathology report, the report's sensitivity to identify recurrence was 98.1% for breast cancer cases and 95.7% for colorectal cancer cases. The specific stage at recurrence from the pathology report had a moderate agreement with gold-standard data. CONCLUSIONS Pathology reports alone cannot measure population-based recurrence of solid cancers but can identify specific cohorts of recurrent cancer patients. As electronic submission of pathology reports increases, these reports may identify specific recurrent patients in near real-time.
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Affiliation(s)
- Joan L. Warren
- National Cancer Institute/Division of Cancer Control and Population Science, Bethesda, Maryland 20892
| | - Anne-Michelle Noone
- National Cancer Institute/Division of Cancer Control and Population Science, Bethesda, Maryland 20892
| | | | - Xiao-Cheng Wu
- Louisiana Tumor Registry, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana 70112
| | - Mei-chin Hseih
- Louisiana Tumor Registry, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana 70112
| | - Brent Mumphrey
- Louisiana Tumor Registry, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana 70112
| | | | - Linda Coyle
- Information Management Services, Calverton, Maryland 20705
| | - Rusty Shields
- Information Management Services, Calverton, Maryland 20705
| | - Angela B. Mariotto
- National Cancer Institute/Division of Cancer Control and Population Science, Bethesda, Maryland 20892
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Noone AM, Pfeiffer RM, Schaubel DE, Dorgan JF, Magder LS, Bromberg JS, Lynch CF, Morris CR, Pawlish KS, Engels EA. Life-years lost due to cancer among solid organ transplant recipients in the United States, 1987 to 2014. Cancer 2021; 128:150-159. [PMID: 34541673 DOI: 10.1002/cncr.33877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/14/2021] [Accepted: 07/21/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Solid organ transplant recipients have an elevated risk of cancer. Quantifying the life-years lost (LYL) due to cancer provides a complementary view of the burden of cancer distinct from other metrics and may identify subgroups of transplant recipients who are most affected. METHODS Linked transplant and cancer registry data were used to identify incident cancers and deaths among solid organ transplant recipients in the United States (1987-2014). Data on LYL due to cancer within 10 years posttransplant were derived using mean survival estimates from Cox models. RESULTS Among 221,962 transplant recipients, 13,074 (5.9%) developed cancer within 10 years of transplantation. During this period, the mean LYL due to cancer were 0.16 years per transplant recipient and 2.7 years per cancer case. Cancer was responsible for a loss of 1.9% of the total life-years expected in the absence of cancer in this population. Lung recipients had the highest proportion of total LYL due to cancer (0.45%) followed by heart recipients (0.29%). LYL due to cancer increased with age, from 0.5% among those aged birth to 34 years at transplant to 3.2% among those aged 50 years and older. Among recipients overall, lung cancer was the largest contributor, accounting for 24% of all LYL due to cancer, and non-Hodgkin lymphoma had the next highest contribution (15%). CONCLUSIONS Transplant recipients have a shortened lifespan after developing cancer. Lung cancer and non-Hodgkin lymphoma contribute strongly to LYL due to cancer within the first 10 years after transplant, highlighting opportunities to reduce cancer mortality through prevention and screening.
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Affiliation(s)
- Anne-Michelle Noone
- Divison of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Ruth M Pfeiffer
- Divison of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Douglas E Schaubel
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joanne F Dorgan
- Department of Epidemiology and Public Health, University of Maryland Baltimore, Baltimore, Maryland
| | - Laurence S Magder
- Department of Epidemiology and Public Health, University of Maryland Baltimore, Baltimore, Maryland
| | - Jonathan S Bromberg
- Department of Surgery, University of Maryland Baltimore, Baltimore, Maryland
| | - Charles F Lynch
- Department of Epidemiology, University of Iowa, Iowa City, Iowa
| | - Cyllene R Morris
- Institute for Population Health Improvement, UC Davis Health System, Sacramento, California
| | - Karen S Pawlish
- New Jersey Department of Health, Cancer Epidemiology Services, Trenton, New Jersey
| | - Eric A Engels
- Divison of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
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Noone AM, Lam CJK, Smith AB, Nielsen ME, Boyd E, Mariotto AB, Banerjee M. Machine Learning Methods to Identify Missed Cases of Bladder Cancer in Population-Based Registries. JCO Clin Cancer Inform 2021; 5:641-653. [PMID: 34097440 PMCID: PMC8462616 DOI: 10.1200/cci.20.00170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Population-based cancer incidence rates of bladder cancer may be underestimated. Accurate estimates are needed for understanding the burden of bladder cancer in the United States. We developed and evaluated the feasibility of a machine learning–based classifier to identify bladder cancer cases missed by cancer registries, and estimated the rate of bladder cancer cases potentially missed. METHODS Data were from population-based cohort of 37,940 bladder cancer cases 65 years of age and older in the SEER cancer registries linked with Medicare claims (2007-2013). Cases with other urologic cancers, abdominal cancers, and unrelated cancers were included as control groups. A cohort of cancer-free controls was also selected using the Medicare 5% random sample. We used five supervised machine learning methods: classification and regression trees, random forest, logic regression, support vector machines, and logistic regression, for predicting bladder cancer. RESULTS Registry linkages yielded 37,940 bladder cancer cases and 766,303 cancer-free controls. Using health insurance claims, classification and regression trees distinguished bladder cancer cases from noncancer controls with very high accuracy (95%). Bacille Calmette-Guerin, cystectomy, and mitomycin were the most important predictors for identifying bladder cancer. From 2007 to 2013, we estimated that up to 3,300 bladder cancer cases in the United States may have been missed by the SEER registries. This would result in an average of 3.5% increase in the reported incidence rate. CONCLUSION SEER cancer registries may potentially miss bladder cancer cases during routine reporting. These missed cases can be identified leveraging Medicare claims and data analytics, leading to more accurate estimates of bladder cancer incidence.
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Affiliation(s)
- Anne-Michelle Noone
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Clara J K Lam
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Angela B Smith
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC.,Biostatistics and Clinical Data Management Core, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Matthew E Nielsen
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC.,Biostatistics and Clinical Data Management Core, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Eric Boyd
- Information Management Services Inc, Calverton, MD
| | - Angela B Mariotto
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
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Forjaz G, Bastos J, Castro C, Mayer A, Noone AM, Chen HS, Mariotto AB. Regional differences in tobacco smoking and lung cancer in Portugal in 2018: a population-based analysis using nationwide incidence and mortality data. BMJ Open 2020; 10:e038937. [PMID: 33099497 PMCID: PMC7590355 DOI: 10.1136/bmjopen-2020-038937] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES This study aims to estimate the proportion of lung cancer cases and deaths attributable to tobacco smoking in Portugal in 2018, complemented by trends in incidence and mortality, by sex and region. DESIGN Cancer cases for 1998-2011 and cancer deaths for 1991-2018 were obtained from population-based registries and Statistics Portugal, respectively. We projected cases for 2018 and used reported deaths for the same year to estimate, using Peto's method, the number and proportion of lung cancer cases and deaths caused by tobacco smoking in 2018. We calculated the age-adjusted incidence and mortality rates in each year of diagnosis and death. We fitted a joinpoint regression to the observed data to estimate the annual percentage change (APC) in the rates. SETTING Portugal. RESULTS In 2018, an estimated 3859 cases and 3192 deaths from lung cancer were attributable to tobacco smoking in Portugal, with men presenting a population attributable fraction (PAF) of 82.6% (n=3064) for incidence and 84.1% (n=2749) for mortality, while in women those values were 51.0% (n=795) and 42.7% (n=443), respectively. In both sexes and metrics, the Azores were the region with the highest PAF and the Centre with the lowest. During 1998-2011, the APC for incidence ranged from 0.6% to 3.0% in men and 3.6% to 7.9% in women, depending on region, with mortality presenting a similar pattern between sexes. CONCLUSION Exposure to tobacco smoking has accounted for most of the lung cancer cases and deaths estimated in Portugal in 2018. Differential patterns of tobacco consumption across the country, varying implementation of primary prevention programmes and differences in personal cancer awareness may have contributed to the disparities observed. Primary prevention of lung cancer remains a public health priority, particularly among women.
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Affiliation(s)
- Gonçalo Forjaz
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland, USA
- Azores Oncological Centre, Azores, Portugal
| | - Joana Bastos
- Centre Region Cancer Registry, Francisco Gentil Portuguese Institute for Oncology of Coimbra, Coimbra, Portugal
| | - Clara Castro
- Northern Region Cancer Registry, Francisco Gentil Portuguese Institute for Oncology of Porto, Porto, Portugal
- EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal
| | - Alexandra Mayer
- Southern Region Cancer Registry, Francisco Gentil Portuguese Institute for Oncology of Lisbon, Lisboa, Portugal
| | - Anne-Michelle Noone
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland, USA
| | - Huann-Sheng Chen
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland, USA
| | - Angela B Mariotto
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland, USA
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Noone AM, Pfeiffer RM, Dorgan JF, Magder LS, Bromberg JS, Lynch CF, Morris C, Pawlish K, Engels EA. Cancer-attributable mortality among solid organ transplant recipients in the United States: 1987 through 2014. Cancer 2019; 125:2647-2655. [PMID: 31034602 PMCID: PMC6625902 DOI: 10.1002/cncr.32136] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/08/2019] [Accepted: 03/18/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Solid organ transplant recipients have an elevated risk of cancer. Quantifying deaths attributable to cancer can inform priorities to reduce cancer burden. METHODS Linked transplantation and cancer registry data were used to identify incident cancers and deaths among solid organ transplant recipients in the United States (1987-2014). Population-attributable fractions (PAFs) of deaths due to cancer and corresponding cancer-attributable mortality rates were estimated using Cox models. RESULTS Among 221,962 solid organ transplant recipients, 15,012 developed cancer. Approximately 13% of deaths (PAF, 13.2%) were attributable to cancer, corresponding to a cancer-attributable mortality rate of 516 per 100,000 person-years. Lung cancer was the largest contributor to mortality (PAF, 3.1%), followed by non-Hodgkin lymphoma (NHL; PAF, 1.9%), colorectal cancer (PAF, 0.7%), and kidney cancer (PAF, 0.5%). Cancer-attributable mortality rates increased with age at transplantation, reaching 1229 per 100,000 person-years among recipients aged ≥65 years. NHL was the largest contributor among children (PAF, 4.1%) and lung cancer was the largest contributor among recipients aged ≥50 years (PAFs, 3.7%-4.3%). Heart recipients had the highest PAF (16.4%), but lung recipients had the highest cancer-attributable mortality rate (1241 per 100,000 person-years). Overall, mortality attributable to cancer increased steadily with longer time since transplantation, reaching 15.7% of deaths (810 per 100,000 person-years) at ≥10 years after transplantation. Comparison of cancer-attributable mortality rates with specified causes of death indicated that some deaths recorded as other causes might instead be caused by cancer or its treatment. CONCLUSIONS Cancer is a substantial cause of mortality among solid organ transplant recipients, with major contributions reported from lung cancer and NHL. Cancer-attributable mortality increases with age and time since transplantation, and therefore cancer deaths will become an increasing burden as recipients live longer.
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Affiliation(s)
- Anne-Michelle Noone
- Divison of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Ruth M. Pfeiffer
- Divison of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Joanne F. Dorgan
- Department of Epidemiology and Preventative Medicine, University of Maryland Baltimore, Baltimore, MD
| | - Laurence S. Magder
- Department of Epidemiology and Preventative Medicine, University of Maryland Baltimore, Baltimore, MD
| | | | | | - Cyllene Morris
- Institute for Population Health Improvement, UCD Health System, Sacramento, CA
| | - Karen Pawlish
- New Jersey Department of Health, Cancer Epidemiology Services, Trenton, NJ
| | - Eric A. Engels
- Divison of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
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Cronin KA, Lake AJ, Scott S, Sherman RL, Noone AM, Howlader N, Henley SJ, Anderson RN, Firth AU, Ma J, Kohler BA, Jemal A. Annual Report to the Nation on the Status of Cancer, part I: National cancer statistics. Cancer 2018; 124:2785-2800. [PMID: 29786848 PMCID: PMC6033186 DOI: 10.1002/cncr.31551] [Citation(s) in RCA: 756] [Impact Index Per Article: 126.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 04/23/2018] [Accepted: 04/26/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND The American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR) collaborate to provide annual updates on cancer occurrence and trends in the United States. METHODS Incidence data were obtained from the CDC-funded and NCI-funded population-based cancer registry programs and compiled by NAACCR. Data on cancer deaths were obtained from the National Center for Health Statistics National Vital Statistics System. Trends in age-standardized incidence and death rates for all cancers combined and for the leading cancer types by sex, race, and ethnicity were estimated by joinpoint analysis and expressed as the annual percent change. Stage distribution and 5-year survival by stage at diagnosis were calculated for breast cancer, colon and rectum (colorectal) cancer, lung and bronchus cancer, and melanoma of the skin. RESULTS Overall cancer incidence rates from 2008 to 2014 decreased by 2.2% per year among men but were stable among women. Overall cancer death rates from 1999 to 2015 decreased by 1.8% per year among men and by 1.4% per year among women. Among men, incidence rates during the most recent 5-year period (2010-2014) decreased for 7 of the 17 most common cancer types, and death rates (2011-2015) decreased for 11 of the 18 most common types. Among women, incidence rates declined for 7 of the 18 most common cancers, and death rates declined for 14 of the 20 most common cancers. Death rates decreased for cancer sites, including lung and bronchus (men and women), colorectal (men and women), female breast, and prostate. Death rates increased for cancers of the liver (men and women); pancreas (men and women); brain and other nervous system (men and women); oral cavity and pharynx (men only); soft tissue, including heart (men only); nonmelanoma skin (men only); and uterus. Incidence and death rates were higher among men than among women for all racial and ethnic groups. For all cancer sites combined, black men and white women had the highest incidence rates compared with other racial groups, and black men and black women had the highest death rates compared with other racial groups. Non-Hispanic men and women had higher incidence and mortality rates than those of Hispanic ethnicity. Five-year survival for cases diagnosed from 2007 through 2013 ranged from 100% (stage I) to 26.5% (stage IV) for female breast cancer, from 88.1% (stage I) to 12.6% (stage IV) for colorectal cancer, from 55.1% (stage I) to 4.2% (stage IV) for lung and bronchus cancer, and from 99.5% (stage I) to 16% (stage IV) for melanoma of the skin. Among children, overall cancer incidence rates increased by 0.8% per year from 2010 to 2014, and overall cancer death rates decreased by 1.5% per year from 2011 to 2015. CONCLUSIONS For all cancer sites combined, cancer incidence rates decreased among men but were stable among women. Overall, there continue to be significant declines in cancer death rates among both men and women. Differences in rates and trends by race and ethnic group remain. Progress in reducing cancer mortality has not occurred for all sites. Examining stage distribution and 5-year survival by stage highlights the potential benefits associated with early detection and treatment. Cancer 2018;124:2785-2800. © 2018 American Cancer Society.
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Affiliation(s)
- Kathleen A Cronin
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Andrew J Lake
- Information Management Services, Inc., Rockville, Maryland
| | - Susan Scott
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Recinda L Sherman
- North American Association of Central Cancer Registries, Springfield, Illinois
| | - Anne-Michelle Noone
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Nadia Howlader
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - S Jane Henley
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robert N Anderson
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
| | - Albert U Firth
- Information Management Services, Inc., Rockville, Maryland
| | - Jiemin Ma
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Betsy A Kohler
- North American Association of Central Cancer Registries, Springfield, Illinois
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
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Noone AM, Negoita S, Schussler N, Adamo M, Cronin KA, Groves C, Liu B, Ward K, Penberthy L. Medical Record-Documented TNM Categories and Stage Group: Feasibility of Use for Cancer Surveillance. J Registry Manag 2017; 44:46-53. [PMID: 29595945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND OBJECTIVES: In 2016, with the discontinuation of the Collaborative Staging system, the cancer surveillance community planned to rely on physician-assigned TNM stage documented in the medical record. The objectives of this study were to describe how often physician-assigned staging components were documented in the medical records accessible to the registrar and to assess the agreement of these physician-assigned components with registrar-assigned values. METHODS: Medical record documents for 282 routine cases from 5 cancer sites were selected from the Surveillance, Epidemiology, and End Results registries. First, the documents were evaluated to determine how often they contained the TNM staging components. Next, the available components were compared with values assigned by a panel of experienced cancer registrars. The agreement for each type of source document was estimated among 100 cases. RESULTS: Overall, the physician-assigned TNM components and stage groups were not often found in the medical record. Pathologic T and N were found most frequently (65% and 64%, respectively). Agreement between physician-assigned and registrar-assigned TNM components varied (cT = 57%, cN = 72%, pT = 83%, pN = 89%). For stage group, agreement was better when the stage group was documented more than once (clinical, 71%; pathologic, 67%). Path reports included valid pT and pN in 79% and 89% of cases, respectively. Oncology consultation notes provided valid cT for 83% of cases. Validity was lower for other document sources. CONCLUSIONS: The physician-assigned TNM components will rarely be documented in the medical record and available to the registrar. Collection of accurate stage information for cancer surveillance requires cancer registrars to review the full medical record and assign the TNM components required for stage.
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Noone AM, Cronin KA, Altekruse SF, Howlader N, Lewis DR, Petkov VI, Penberthy L. Cancer Incidence and Survival Trends by Subtype Using Data from the Surveillance Epidemiology and End Results Program, 1992-2013. Cancer Epidemiol Biomarkers Prev 2016; 26:632-641. [PMID: 27956436 DOI: 10.1158/1055-9965.epi-16-0520] [Citation(s) in RCA: 256] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 11/18/2016] [Accepted: 11/22/2016] [Indexed: 12/12/2022] Open
Abstract
Background: Cancers are heterogeneous, comprising distinct tumor subtypes. Therefore, presenting the burden of cancer in the population and trends over time by these tumor subtypes is important to identify patterns and differences in the occurrence of these subtypes, especially to generalize findings to the U.S. general population.Methods: Using SEER Cancer Registry Data, we present incidence rates according to subtypes for diagnosis years (1992-2013) among men and women for five major cancer sites: breast (female only), esophagus, kidney and renal pelvis, lung and bronchus, and thyroid. We also describe estimates of 5-year relative survival according to subtypes and diagnosis year (1992-2008). We used Joinpoint models to identify years when incidence rate trends changed slope. Finally, recent 5-year age-adjusted incidence rates (2009-2013) are presented for each subtype by race and age.Results: Hormone receptor-positive and HER2-negative was the most common subtype (about 74%) of breast cancers. Adenocarcinoma made up about 69% of esophagus cases among men. Adenocarcinoma also is the most common lung subtype (43% in men and 52% in women). Ninety percent of thyroid subtypes were papillary. Distinct incidence and survival patterns emerged by these subtypes over time among men and women.Conclusions: Histologic or molecular subtype revealed different incidence and/or survival trends that are masked when cancer is considered as a single disease on the basis of anatomic site.Impact: Presenting incidence and survival trends by subtype, whenever possible, is critical to provide more detailed and meaningful data to patients, providers, and the public. Cancer Epidemiol Biomarkers Prev; 26(4); 632-41. ©2016 AACR.
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Affiliation(s)
- Anne-Michelle Noone
- Division of Cancer Control and Population Sciences, Surveillance Research Program, National Cancer Institute, Bethesda, Maryland.
| | - Kathleen A Cronin
- Division of Cancer Control and Population Sciences, Surveillance Research Program, National Cancer Institute, Bethesda, Maryland
| | - Sean F Altekruse
- Division of Cancer Control and Population Sciences, Surveillance Research Program, National Cancer Institute, Bethesda, Maryland
| | - Nadia Howlader
- Division of Cancer Control and Population Sciences, Surveillance Research Program, National Cancer Institute, Bethesda, Maryland
| | - Denise R Lewis
- Division of Cancer Control and Population Sciences, Surveillance Research Program, National Cancer Institute, Bethesda, Maryland
| | - Valentina I Petkov
- Division of Cancer Control and Population Sciences, Surveillance Research Program, National Cancer Institute, Bethesda, Maryland
| | - Lynne Penberthy
- Division of Cancer Control and Population Sciences, Surveillance Research Program, National Cancer Institute, Bethesda, Maryland
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Andridge R, Noone AM, Howlader N. Imputing estrogen receptor (ER) status in a population-based cancer registry: a sensitivity analysis. Stat Med 2016; 36:1014-1028. [PMID: 27921315 DOI: 10.1002/sim.7193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 11/07/2016] [Accepted: 11/14/2016] [Indexed: 01/02/2023]
Abstract
Breast cancers are clinically heterogeneous based on tumor markers. The National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program provides baseline data on these tumor markers for reporting cancer burden and trends over time in the US general population. These tumor markers, however, are often prone to missing observations. In particular, estrogen receptor (ER) status, a key biomarker in the study of breast cancer, has been collected since 1992 but historically was not well-reported, with missingness rates as high as 25% in early years. Previous methods used to correct estimates of breast cancer incidence or ER-related odds or prevalence ratios for unknown ER status have relied on a missing-at-random (MAR) assumption. In this paper, we explore the sensitivity of these key estimates to departures from MAR. We develop a predictive mean matching procedure that can be used to multiply impute missing ER status under either an MAR or a missing not at random assumption and apply it to the SEER breast cancer data (1992-2012). The imputation procedure uses the predictive power of the rich set of covariates available in the SEER registry while also allowing us to investigate the impact of departures from MAR. We find some differences in inference under the two assumptions, although the magnitude of differences tends to be small. For the types of analyses typically of primary interest, we recommend imputing SEER breast cancer biomarkers under an MAR assumption, given the small apparent differences under MAR and missing not at random assumptions. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Rebecca Andridge
- The Ohio State University College of Public Health, Columbus, 43210, OH, U.S.A
| | - Anne-Michelle Noone
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, 20892, MD, U.S.A
| | - Nadia Howlader
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, 20892, MD, U.S.A
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Abstract
BACKGROUND The population-based Surveillance, Epidemiology, and End Results (SEER) registries collect information on first-course treatment, including surgery, chemotherapy, radiation therapy, and hormone therapy. However, the SEER program does not release data on chemotherapy or hormone therapy due to uncertainties regarding data completeness. Activities are ongoing to investigate the opportunity to supplement SEER treatment data with other data sources. METHODS Using the linked SEER-Medicare data, we examined the validity of the SEER data to identify receipt of chemotherapy and radiation therapy among those aged 65 and older diagnosed from 2000 to 2006 with bladder, female breast, colorectal, lung, ovarian, pancreas, or prostate cancer and hormone therapy among men diagnosed with prostate cancer at age 65 or older. Treatment collected by SEER was compared with treatment as determined by Medicare claims, using Medicare claims as the gold standard. The κ, sensitivity, specificity, positive predictive values, and negative predictive values were calculated for the receipt of each treatment modality. RESULTS The overall sensitivity of SEER data to identify chemotherapy, radiation, and hormone therapy receipt was moderate (68%, 80%, and 69%, respectively) and varied by cancer site, stage, and patient characteristics. The overall positive predictive value was high (>85%) for all treatment types and cancer sites except chemotherapy for prostate cancer. CONCLUSIONS SEER data should not generally be used for comparisons of treated and untreated individuals or to estimate the proportion of treated individuals in the population. Augmenting SEER data with other data sources will provide the most accurate treatment information.
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Affiliation(s)
- Anne-Michelle Noone
- Division of Cancer Control and Population Sciences, Surveillance Research Program, National Cancer Institute, Bethesda, MD
| | - Jennifer L. Lund
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Angela Mariotto
- Division of Cancer Control and Population Sciences, Surveillance Research Program, National Cancer Institute, Bethesda, MD
| | - Kathleen Cronin
- Division of Cancer Control and Population Sciences, Surveillance Research Program, National Cancer Institute, Bethesda, MD
| | | | - Dennis Deapen
- Los Angeles Cancer Surveillance Program, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Joan L. Warren
- Division of Cancer Control and Population Sciences, Applied Research Program, National Cancer Institute, Bethesda, MD
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Ryerson AB, Eheman CR, Altekruse SF, Ward JW, Jemal A, Sherman RL, Henley SJ, Holtzman D, Lake A, Noone AM, Anderson RN, Ma J, Ly KN, Cronin KA, Penberthy L, Kohler BA. Annual Report to the Nation on the Status of Cancer, 1975-2012, featuring the increasing incidence of liver cancer. Cancer 2016; 122:1312-37. [PMID: 26959385 PMCID: PMC4840031 DOI: 10.1002/cncr.29936] [Citation(s) in RCA: 650] [Impact Index Per Article: 81.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 01/21/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Annual updates on cancer occurrence and trends in the United States are provided through an ongoing collaboration among the American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR). This annual report highlights the increasing burden of liver and intrahepatic bile duct (liver) cancers. METHODS Cancer incidence data were obtained from the CDC, NCI, and NAACCR; data about cancer deaths were obtained from the CDC's National Center for Health Statistics (NCHS). Annual percent changes in incidence and death rates (age-adjusted to the 2000 US Standard Population) for all cancers combined and for the leading cancers among men and women were estimated by joinpoint analysis of long-term trends (incidence for 1992-2012 and mortality for 1975-2012) and short-term trends (2008-2012). In-depth analysis of liver cancer incidence included an age-period-cohort analysis and an incidence-based estimation of person-years of life lost because of the disease. By using NCHS multiple causes of death data, hepatitis C virus (HCV) and liver cancer-associated death rates were examined from 1999 through 2013. RESULTS Among men and women of all major racial and ethnic groups, death rates continued to decline for all cancers combined and for most cancer sites; the overall cancer death rate (for both sexes combined) decreased by 1.5% per year from 2003 to 2012. Overall, incidence rates decreased among men and remained stable among women from 2003 to 2012. Among both men and women, deaths from liver cancer increased at the highest rate of all cancer sites, and liver cancer incidence rates increased sharply, second only to thyroid cancer. Men had more than twice the incidence rate of liver cancer than women, and rates increased with age for both sexes. Among non-Hispanic (NH) white, NH black, and Hispanic men and women, liver cancer incidence rates were higher for persons born after the 1938 to 1947 birth cohort. In contrast, there was a minimal birth cohort effect for NH Asian and Pacific Islanders (APIs). NH black men and Hispanic men had the lowest median age at death (60 and 62 years, respectively) and the highest average person-years of life lost per death (21 and 20 years, respectively) from liver cancer. HCV and liver cancer-associated death rates were highest among decedents who were born during 1945 through 1965. CONCLUSIONS Overall, cancer incidence and mortality declined among men; and, although cancer incidence was stable among women, mortality declined. The burden of liver cancer is growing and is not equally distributed throughout the population. Efforts to vaccinate populations that are vulnerable to hepatitis B virus (HBV) infection and to identify and treat those living with HCV or HBV infection, metabolic conditions, alcoholic liver disease, or other causes of cirrhosis can be effective in reducing the incidence and mortality of liver cancer. Cancer 2016;122:1312-1337. © 2016 American Cancer Society.
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Affiliation(s)
- A. Blythe Ryerson
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christie R. Eheman
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sean F. Altekruse
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - John W. Ward
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ahmedin Jemal
- Surveillance Research Program, American Cancer Society, Atlanta, Georgia
| | - Recinda L. Sherman
- North American Association of Central Cancer Registries, Springfield, Illinois
| | - S. Jane Henley
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Deborah Holtzman
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Andrew Lake
- Information Management Services, Inc., Rockville, Maryland
| | - Anne-Michelle Noone
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Robert N. Anderson
- Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
| | - Jiemin Ma
- Surveillance Research Program, American Cancer Society, Atlanta, Georgia
| | - Kathleen N. Ly
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kathleen A. Cronin
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Lynne Penberthy
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Betsy A. Kohler
- North American Association of Central Cancer Registries, Springfield, Illinois
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Temkin SM, Minasian L, Noone AM. The End of the Hysterectomy Epidemic and Endometrial Cancer Incidence: What Are the Unintended Consequences of Declining Hysterectomy Rates? Front Oncol 2016; 6:89. [PMID: 27148481 PMCID: PMC4830827 DOI: 10.3389/fonc.2016.00089] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 03/29/2016] [Indexed: 12/12/2022] Open
Abstract
Population-level cancer incidence rates are one measure to estimate the cancer burden. The goal is to provide information on trends to measure progress against cancer at the population level and identify emerging patterns signifying increased risk for additional research and intervention. Endometrial cancer is the most common of the gynecologic malignancies but capturing the incidence of disease among women at risk (i.e., women with a uterus) is challenging and not routinely published. Decreasing rates of hysterectomy increase the number of women at risk for disease, which should be reflected in the denominator of the incidence rate calculation. Furthermore, hysterectomy rates vary within the United States by multiple factors including geographic location, race, and ethnicity. Changing rates of hysterectomy are important to consider when looking at endometrial cancer trends. By correcting for hysterectomy when calculating incidence rates of cancers of the uterine corpus, many of the disparities that have been assumed for this disease are diminished.
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Affiliation(s)
- Sarah M Temkin
- Division of Cancer Prevention, National Cancer Institute , Bethesda, MD , USA
| | - Lori Minasian
- Division of Cancer Prevention, National Cancer Institute , Bethesda, MD , USA
| | - Anne-Michelle Noone
- Division of Cancer Control and Population Sciences, National Cancer Institute , Bethesda, MD , USA
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15
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Kohler BA, Sherman RL, Howlader N, Jemal A, Ryerson AB, Henry KA, Boscoe FP, Cronin KA, Lake A, Noone AM, Henley SJ, Eheman CR, Anderson RN, Penberthy L. Annual Report to the Nation on the Status of Cancer, 1975-2011, Featuring Incidence of Breast Cancer Subtypes by Race/Ethnicity, Poverty, and State. J Natl Cancer Inst 2015; 107:djv048. [PMID: 25825511 PMCID: PMC4603551 DOI: 10.1093/jnci/djv048] [Citation(s) in RCA: 608] [Impact Index Per Article: 67.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 01/21/2015] [Accepted: 02/10/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The American Cancer Society (ACS), Centers for Disease Control and Prevention (CDC), National Cancer Institute (NCI), and North American Association of Central Cancer Registries (NAACCR) collaborate annually to produce updated, national cancer statistics. This Annual Report includes a focus on breast cancer incidence by subtype using new, national-level data. METHODS Population-based cancer trends and breast cancer incidence by molecular subtype were calculated. Breast cancer subtypes were classified using tumor biomarkers for hormone receptor (HR) and human growth factor-neu receptor (HER2) expression. RESULTS Overall cancer incidence decreased for men by 1.8% annually from 2007 to 2011 [corrected]. Rates for women were stable from 1998 to 2011. Within these trends there was racial/ethnic variation, and some sites have increasing rates. Among children, incidence rates continued to increase by 0.8% per year over the past decade while, like adults, mortality declined. HR+/HER2- breast cancers, the subtype with the best prognosis, were the most common for all races/ethnicities with highest rates among non-Hispanic white women, local stage cases, and low poverty areas (92.7, 63.51, and 98.69 per 100000 non-Hispanic white women, respectively). HR+/HER2- breast cancer incidence rates were strongly, positively correlated with mammography use, particularly for non-Hispanic white women (Pearson 0.57, two-sided P < .001). Triple-negative breast cancers, the subtype with the worst prognosis, were highest among non-Hispanic black women (27.2 per 100000 non-Hispanic black women), which is reflected in high rates in southeastern states. CONCLUSIONS Progress continues in reducing the burden of cancer in the United States. There are unique racial/ethnic-specific incidence patterns for breast cancer subtypes; likely because of both biologic and social risk factors, including variation in mammography use. Breast cancer subtype analysis confirms the capacity of cancer registries to adjust national collection standards to produce clinically relevant data based on evolving medical knowledge.
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Affiliation(s)
- Betsy A Kohler
- North American Association of Central Cancer Registries, Springfield, IL (BAK, RLS, KAH, FPB); National Cancer Institute, Bethesda, MD (NH, KAC, AMN, LP); American Cancer Society, Atlanta, GA (AJ); Centers for Disease Control and Prevention, Atlanta, GA (ABR, SJH, CRE); Temple University Department of Geography, Philadelphia, PA (KAH); New York State Cancer Registry, NY (FPB); Information Management Services, Inc., Rockville, MD (AL); National Center for Health Statistics, Hyattsville, MD (RNA).
| | - Recinda L Sherman
- North American Association of Central Cancer Registries, Springfield, IL (BAK, RLS, KAH, FPB); National Cancer Institute, Bethesda, MD (NH, KAC, AMN, LP); American Cancer Society, Atlanta, GA (AJ); Centers for Disease Control and Prevention, Atlanta, GA (ABR, SJH, CRE); Temple University Department of Geography, Philadelphia, PA (KAH); New York State Cancer Registry, NY (FPB); Information Management Services, Inc., Rockville, MD (AL); National Center for Health Statistics, Hyattsville, MD (RNA)
| | - Nadia Howlader
- North American Association of Central Cancer Registries, Springfield, IL (BAK, RLS, KAH, FPB); National Cancer Institute, Bethesda, MD (NH, KAC, AMN, LP); American Cancer Society, Atlanta, GA (AJ); Centers for Disease Control and Prevention, Atlanta, GA (ABR, SJH, CRE); Temple University Department of Geography, Philadelphia, PA (KAH); New York State Cancer Registry, NY (FPB); Information Management Services, Inc., Rockville, MD (AL); National Center for Health Statistics, Hyattsville, MD (RNA)
| | - Ahmedin Jemal
- North American Association of Central Cancer Registries, Springfield, IL (BAK, RLS, KAH, FPB); National Cancer Institute, Bethesda, MD (NH, KAC, AMN, LP); American Cancer Society, Atlanta, GA (AJ); Centers for Disease Control and Prevention, Atlanta, GA (ABR, SJH, CRE); Temple University Department of Geography, Philadelphia, PA (KAH); New York State Cancer Registry, NY (FPB); Information Management Services, Inc., Rockville, MD (AL); National Center for Health Statistics, Hyattsville, MD (RNA)
| | - A Blythe Ryerson
- North American Association of Central Cancer Registries, Springfield, IL (BAK, RLS, KAH, FPB); National Cancer Institute, Bethesda, MD (NH, KAC, AMN, LP); American Cancer Society, Atlanta, GA (AJ); Centers for Disease Control and Prevention, Atlanta, GA (ABR, SJH, CRE); Temple University Department of Geography, Philadelphia, PA (KAH); New York State Cancer Registry, NY (FPB); Information Management Services, Inc., Rockville, MD (AL); National Center for Health Statistics, Hyattsville, MD (RNA)
| | - Kevin A Henry
- North American Association of Central Cancer Registries, Springfield, IL (BAK, RLS, KAH, FPB); National Cancer Institute, Bethesda, MD (NH, KAC, AMN, LP); American Cancer Society, Atlanta, GA (AJ); Centers for Disease Control and Prevention, Atlanta, GA (ABR, SJH, CRE); Temple University Department of Geography, Philadelphia, PA (KAH); New York State Cancer Registry, NY (FPB); Information Management Services, Inc., Rockville, MD (AL); National Center for Health Statistics, Hyattsville, MD (RNA)
| | - Francis P Boscoe
- North American Association of Central Cancer Registries, Springfield, IL (BAK, RLS, KAH, FPB); National Cancer Institute, Bethesda, MD (NH, KAC, AMN, LP); American Cancer Society, Atlanta, GA (AJ); Centers for Disease Control and Prevention, Atlanta, GA (ABR, SJH, CRE); Temple University Department of Geography, Philadelphia, PA (KAH); New York State Cancer Registry, NY (FPB); Information Management Services, Inc., Rockville, MD (AL); National Center for Health Statistics, Hyattsville, MD (RNA)
| | - Kathleen A Cronin
- North American Association of Central Cancer Registries, Springfield, IL (BAK, RLS, KAH, FPB); National Cancer Institute, Bethesda, MD (NH, KAC, AMN, LP); American Cancer Society, Atlanta, GA (AJ); Centers for Disease Control and Prevention, Atlanta, GA (ABR, SJH, CRE); Temple University Department of Geography, Philadelphia, PA (KAH); New York State Cancer Registry, NY (FPB); Information Management Services, Inc., Rockville, MD (AL); National Center for Health Statistics, Hyattsville, MD (RNA)
| | - Andrew Lake
- North American Association of Central Cancer Registries, Springfield, IL (BAK, RLS, KAH, FPB); National Cancer Institute, Bethesda, MD (NH, KAC, AMN, LP); American Cancer Society, Atlanta, GA (AJ); Centers for Disease Control and Prevention, Atlanta, GA (ABR, SJH, CRE); Temple University Department of Geography, Philadelphia, PA (KAH); New York State Cancer Registry, NY (FPB); Information Management Services, Inc., Rockville, MD (AL); National Center for Health Statistics, Hyattsville, MD (RNA)
| | - Anne-Michelle Noone
- North American Association of Central Cancer Registries, Springfield, IL (BAK, RLS, KAH, FPB); National Cancer Institute, Bethesda, MD (NH, KAC, AMN, LP); American Cancer Society, Atlanta, GA (AJ); Centers for Disease Control and Prevention, Atlanta, GA (ABR, SJH, CRE); Temple University Department of Geography, Philadelphia, PA (KAH); New York State Cancer Registry, NY (FPB); Information Management Services, Inc., Rockville, MD (AL); National Center for Health Statistics, Hyattsville, MD (RNA)
| | - S Jane Henley
- North American Association of Central Cancer Registries, Springfield, IL (BAK, RLS, KAH, FPB); National Cancer Institute, Bethesda, MD (NH, KAC, AMN, LP); American Cancer Society, Atlanta, GA (AJ); Centers for Disease Control and Prevention, Atlanta, GA (ABR, SJH, CRE); Temple University Department of Geography, Philadelphia, PA (KAH); New York State Cancer Registry, NY (FPB); Information Management Services, Inc., Rockville, MD (AL); National Center for Health Statistics, Hyattsville, MD (RNA)
| | - Christie R Eheman
- North American Association of Central Cancer Registries, Springfield, IL (BAK, RLS, KAH, FPB); National Cancer Institute, Bethesda, MD (NH, KAC, AMN, LP); American Cancer Society, Atlanta, GA (AJ); Centers for Disease Control and Prevention, Atlanta, GA (ABR, SJH, CRE); Temple University Department of Geography, Philadelphia, PA (KAH); New York State Cancer Registry, NY (FPB); Information Management Services, Inc., Rockville, MD (AL); National Center for Health Statistics, Hyattsville, MD (RNA)
| | - Robert N Anderson
- North American Association of Central Cancer Registries, Springfield, IL (BAK, RLS, KAH, FPB); National Cancer Institute, Bethesda, MD (NH, KAC, AMN, LP); American Cancer Society, Atlanta, GA (AJ); Centers for Disease Control and Prevention, Atlanta, GA (ABR, SJH, CRE); Temple University Department of Geography, Philadelphia, PA (KAH); New York State Cancer Registry, NY (FPB); Information Management Services, Inc., Rockville, MD (AL); National Center for Health Statistics, Hyattsville, MD (RNA)
| | - Lynne Penberthy
- North American Association of Central Cancer Registries, Springfield, IL (BAK, RLS, KAH, FPB); National Cancer Institute, Bethesda, MD (NH, KAC, AMN, LP); American Cancer Society, Atlanta, GA (AJ); Centers for Disease Control and Prevention, Atlanta, GA (ABR, SJH, CRE); Temple University Department of Geography, Philadelphia, PA (KAH); New York State Cancer Registry, NY (FPB); Information Management Services, Inc., Rockville, MD (AL); National Center for Health Statistics, Hyattsville, MD (RNA)
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Jamison PM, Altekruse SF, Chang JT, Zahn J, Lee R, Noone AM, Barroilhet L. Site-specific factors for cancer of the corpus uteri from SEER registries: collaborative stage data collection system, version 1 and version 2. Cancer 2015; 120 Suppl 23:3836-45. [PMID: 25412395 DOI: 10.1002/cncr.29054] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 07/24/2014] [Accepted: 08/05/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND Uterine cancer is the fourth leading cancer among US women. Changes in uterine cancer staging were made from the American Joint Committee on Cancer (AJCC) 6th to 7th edition staging manuals, and 8 site-specific factors (SSFs) and 3 histologic schemas were introduced. Carcinomas account for 95% of cases and are the focus of this report. METHODS Distributions of SSF values were examined for 11,601 cases of malignant cancer of the corpus uteri and uterus, NOS (not otherwise specified) diagnosed in Surveillance, Epidemiology, and End Results (SEER) Program registries during 2010. AJCC 6th and 7th edition staging distributions were compared for 11,176 cases using data in both staging systems. AJCC 6th edition staging distributions during 2004-2010 were examined. AJCC 7th edition SSFs required by SEER were International Federation of Gynecology and Obstetrics stage (SSF1), peritoneal cytology (SSF2), number of positive pelvic lymph nodes (SSF3), number of pelvic lymph nodes examined (SSF4), number of positive para-aortic lymph nodes (SSF5), and number of para-aortic lymph nodes examined (SSF6). RESULTS For SSFs related to lymph nodes, a third of cases were classified as "not applicable," reflecting that lymph node dissection is not indicated for cases with stage1A and stage 4 diagnoses. AJCC 7th edition criteria assigned more cases to stage I (72.9%) than AJCC 6th edition criteria (68.7%). Annual counts significantly increased during 2004-2010, as did counts for AJCC 6th edition stages INOS, IA, IB, IC, IIIA, IIIB, IIIC, and IVB. The proportion of cases diagnosed with stage I cancer was stable, whereas stages II and IV decreased and stage III increased. CONCLUSIONS Five SSFs were suitable for analysis: peritoneal cytology results (SSF2), numbers of positive pelvic lymph nodes (SSF3), pelvic lymph nodes examined (SSF4), positive para-aortic lymph nodes (SSF5), and para-aortic lymph nodes examined (SSF6).
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Affiliation(s)
- Patricia M Jamison
- National Cancer Institute, Division of Cancer Control and Population Sciences, Rockville, Maryland
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Noone AM, Schussler N, Negoita S, Adamo M, Cronin K, Cyr J, Gress D, Grove C, Kosary C, Liu B, Sun L, Ward K, Penberthy L. Availability of TNM Staging Data Elements in the Medical Record and Training Needs Assessment: Results from the 2014 SEER Training Needs Assessment for TNM Study. J Registry Manag 2015; 42:40-47. [PMID: 26360105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND In 2016, the cancer registry community will directly assign T, N and M components of stage. The Surveillance, Epidemiology, and End Results program implemented a field study to determine how often T, N and M were not available in the medical record, requiring the registrar to directly assign clinical or pathologic TNM stage components. The field study also identified specific training needs. METHODS T, N and M status were collected from multiple sources within medical records for a total of 280 cases, 56 each from breast, prostate, colon, lung, and ovarian cancer. TNM data elements were also directly assigned by a series of reviewers and by study participants using the medical records with TNM information redacted. Availability of physician-assigned TNM was estimated from the medical record. Also, participant responses were compared to preferred answers. RESULTS Pathologic T, N and M were available more often in the medical records than were clinical values and varied by site. Pathologic T and N were available for about two-thirds of the cases, but the clinical elements were available for only about 20% of cases. The agreement between participant responses and review panel assignments varied by data element and cancer site. Agreement was modest for most data elements and cancer sites, ranging from 54% for clinical T to 92% for clinical M for all cancer sites combined. CONCLUSIONS The data elements for TNM staging and stage group were often missing from the medical records, so registrars in the field will need to assign TNM frequently. Furthermore, the results of this study strongly suggest that more training is required, even among those who currently assign TNM.
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18
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Warren JL, Butler EN, Stevens J, Lathan CS, Noone AM, Ward KC, Harlan LC. Receipt of chemotherapy among medicare patients with cancer by type of supplemental insurance. J Clin Oncol 2014; 33:312-8. [PMID: 25534387 DOI: 10.1200/jco.2014.55.3107] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Medicare beneficiaries with cancer bear a greater portion of their health care costs, because cancer treatment costs have increased. Beneficiaries have supplemental insurance to reduce out-of-pocket costs; those without supplemental insurance may face barriers to care. This study examines the association between type of supplemental insurance coverage and receipt of chemotherapy among Medicare patients with cancer who, per National Comprehensive Cancer Network treatment guidelines, should generally receive chemotherapy. PATIENTS AND METHODS This retrospective, observational study included 1,200 Medicare patients diagnosed with incident cancer of the breast (stage IIB to III), colon (stage III), rectum (stage II to III), lung (stage II to IV), or ovary (stage II to IV) from 2000 to 2005. Using the National Cancer Institute Patterns of Care Studies and linked SEER-Medicare data, we determined each Medicare patient's supplemental insurance status (private insurance, dual eligible [ie, Medicare with Medicaid], or no supplemental insurance), consultation with an oncologist, and receipt of chemotherapy. Using adjusted logistic regression, we evaluated the association of type of supplemental insurance with oncologist consultation and receipt of chemotherapy. RESULTS Dual-eligible patients were significantly less likely to receive chemotherapy than were Medicare patients with private insurance. Patients with Medicare only who saw an oncologist had comparable rates of chemotherapy compared with Medicare patients with private insurance. CONCLUSION Dual-eligible Medicare beneficiaries received recommended cancer chemotherapy less frequently than other Medicare beneficiaries. With the increasing number of Medicaid patients under the Affordable Care Act, there will be a need for patient navigators and sufficient physician reimbursement so that low-income patients with cancer will have access to oncologists and needed treatment.
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Affiliation(s)
- Joan L Warren
- Joan L. Warren, Anne-Michelle Noone, and Linda C. Harlan, National Cancer Institute, Bethesda; Jennifer Stevens, Information Management Services, Beltsville, MD; Eboneé N. Butler, University of North Carolina, Chapel Hill, NC; Christopher S. Lathan, Dana-Farber Cancer Institute, Boston, MA; and Kevin Ward, Emory University, Atlanta, GA.
| | - Eboneé N Butler
- Joan L. Warren, Anne-Michelle Noone, and Linda C. Harlan, National Cancer Institute, Bethesda; Jennifer Stevens, Information Management Services, Beltsville, MD; Eboneé N. Butler, University of North Carolina, Chapel Hill, NC; Christopher S. Lathan, Dana-Farber Cancer Institute, Boston, MA; and Kevin Ward, Emory University, Atlanta, GA
| | - Jennifer Stevens
- Joan L. Warren, Anne-Michelle Noone, and Linda C. Harlan, National Cancer Institute, Bethesda; Jennifer Stevens, Information Management Services, Beltsville, MD; Eboneé N. Butler, University of North Carolina, Chapel Hill, NC; Christopher S. Lathan, Dana-Farber Cancer Institute, Boston, MA; and Kevin Ward, Emory University, Atlanta, GA
| | - Christopher S Lathan
- Joan L. Warren, Anne-Michelle Noone, and Linda C. Harlan, National Cancer Institute, Bethesda; Jennifer Stevens, Information Management Services, Beltsville, MD; Eboneé N. Butler, University of North Carolina, Chapel Hill, NC; Christopher S. Lathan, Dana-Farber Cancer Institute, Boston, MA; and Kevin Ward, Emory University, Atlanta, GA
| | - Anne-Michelle Noone
- Joan L. Warren, Anne-Michelle Noone, and Linda C. Harlan, National Cancer Institute, Bethesda; Jennifer Stevens, Information Management Services, Beltsville, MD; Eboneé N. Butler, University of North Carolina, Chapel Hill, NC; Christopher S. Lathan, Dana-Farber Cancer Institute, Boston, MA; and Kevin Ward, Emory University, Atlanta, GA
| | - Kevin C Ward
- Joan L. Warren, Anne-Michelle Noone, and Linda C. Harlan, National Cancer Institute, Bethesda; Jennifer Stevens, Information Management Services, Beltsville, MD; Eboneé N. Butler, University of North Carolina, Chapel Hill, NC; Christopher S. Lathan, Dana-Farber Cancer Institute, Boston, MA; and Kevin Ward, Emory University, Atlanta, GA
| | - Linda C Harlan
- Joan L. Warren, Anne-Michelle Noone, and Linda C. Harlan, National Cancer Institute, Bethesda; Jennifer Stevens, Information Management Services, Beltsville, MD; Eboneé N. Butler, University of North Carolina, Chapel Hill, NC; Christopher S. Lathan, Dana-Farber Cancer Institute, Boston, MA; and Kevin Ward, Emory University, Atlanta, GA
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Mariotto AB, Noone AM, Howlader N, Cho H, Keel GE, Garshell J, Woloshin S, Schwartz LM. Cancer survival: an overview of measures, uses, and interpretation. J Natl Cancer Inst Monogr 2014; 2014:145-86. [PMID: 25417231 PMCID: PMC4829054 DOI: 10.1093/jncimonographs/lgu024] [Citation(s) in RCA: 163] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Survival statistics are of great interest to patients, clinicians, researchers, and policy makers. Although seemingly simple, survival can be confusing: there are many different survival measures with a plethora of names and statistical methods developed to answer different questions. This paper aims to describe and disseminate different survival measures and their interpretation in less technical language. In addition, we introduce templates to summarize cancer survival statistic organized by their specific purpose: research and policy versus prognosis and clinical decision making.
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Affiliation(s)
- Angela B Mariotto
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (AM, AN, NH, HC); Division of Cancer Registration and Surveillance, National Cancer Center, Goyang-si Gyeonggi-do, Korea (HC); Information Management Services, Inc., Calverton MD (GEK, JG); Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH, Geisel School of Medicine at Dartmouth, Hanover, NH, Department of Veterans Affairs Medical Center, Veterans Affairs Outcomes Group, White River Junction, VT (SW, LMS).
| | - Anne-Michelle Noone
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (AM, AN, NH, HC); Division of Cancer Registration and Surveillance, National Cancer Center, Goyang-si Gyeonggi-do, Korea (HC); Information Management Services, Inc., Calverton MD (GEK, JG); Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH, Geisel School of Medicine at Dartmouth, Hanover, NH, Department of Veterans Affairs Medical Center, Veterans Affairs Outcomes Group, White River Junction, VT (SW, LMS)
| | - Nadia Howlader
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (AM, AN, NH, HC); Division of Cancer Registration and Surveillance, National Cancer Center, Goyang-si Gyeonggi-do, Korea (HC); Information Management Services, Inc., Calverton MD (GEK, JG); Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH, Geisel School of Medicine at Dartmouth, Hanover, NH, Department of Veterans Affairs Medical Center, Veterans Affairs Outcomes Group, White River Junction, VT (SW, LMS)
| | - Hyunsoon Cho
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (AM, AN, NH, HC); Division of Cancer Registration and Surveillance, National Cancer Center, Goyang-si Gyeonggi-do, Korea (HC); Information Management Services, Inc., Calverton MD (GEK, JG); Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH, Geisel School of Medicine at Dartmouth, Hanover, NH, Department of Veterans Affairs Medical Center, Veterans Affairs Outcomes Group, White River Junction, VT (SW, LMS)
| | - Gretchen E Keel
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (AM, AN, NH, HC); Division of Cancer Registration and Surveillance, National Cancer Center, Goyang-si Gyeonggi-do, Korea (HC); Information Management Services, Inc., Calverton MD (GEK, JG); Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH, Geisel School of Medicine at Dartmouth, Hanover, NH, Department of Veterans Affairs Medical Center, Veterans Affairs Outcomes Group, White River Junction, VT (SW, LMS)
| | - Jessica Garshell
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (AM, AN, NH, HC); Division of Cancer Registration and Surveillance, National Cancer Center, Goyang-si Gyeonggi-do, Korea (HC); Information Management Services, Inc., Calverton MD (GEK, JG); Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH, Geisel School of Medicine at Dartmouth, Hanover, NH, Department of Veterans Affairs Medical Center, Veterans Affairs Outcomes Group, White River Junction, VT (SW, LMS)
| | - Steven Woloshin
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (AM, AN, NH, HC); Division of Cancer Registration and Surveillance, National Cancer Center, Goyang-si Gyeonggi-do, Korea (HC); Information Management Services, Inc., Calverton MD (GEK, JG); Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH, Geisel School of Medicine at Dartmouth, Hanover, NH, Department of Veterans Affairs Medical Center, Veterans Affairs Outcomes Group, White River Junction, VT (SW, LMS)
| | - Lisa M Schwartz
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (AM, AN, NH, HC); Division of Cancer Registration and Surveillance, National Cancer Center, Goyang-si Gyeonggi-do, Korea (HC); Information Management Services, Inc., Calverton MD (GEK, JG); Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH, Geisel School of Medicine at Dartmouth, Hanover, NH, Department of Veterans Affairs Medical Center, Veterans Affairs Outcomes Group, White River Junction, VT (SW, LMS)
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Cheng I, Le GM, Noone AM, Gali K, Patel M, Haile RW, Wakelee HA, Gomez SL. Lung cancer incidence trends by histology type among Asian American, Native Hawaiian, and Pacific Islander populations in the United States, 1990-2010. Cancer Epidemiol Biomarkers Prev 2014; 23:2250-65. [PMID: 25368400 PMCID: PMC5738466 DOI: 10.1158/1055-9965.epi-14-0493] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Lung cancer is one of the leading cancer sites diagnosed among Asian Americans, Pacific Islanders, and Native Hawaiians (AANHPI). To better understand the patterns of lung cancer incidence among AANHPIs, we examined the incidence trends of five histologic cell types of lung cancer across ten AANHPI populations in comparison with non-Hispanic Whites. METHODS Lung cancer incidence data from 1990 through 2010 were obtained from 13 U.S. population-based cancer registries. Age-adjusted histologic cell-type-specific incidence rates and 95% confidence intervals were calculated. Joinpoint regression models and annual percentage change (APC) statistics were used to characterize the magnitude and direction of trends. RESULTS From 1990 through 2010, incidence rates of adenocarcinoma increased significantly for Filipino and Korean women with a 2.6% and 3.0% annual percentage increase, respectively. More recently, a significant rise in the incidence of adenocarcinoma was observed for Chinese men (1996-2010; APC = 1.3%). Squamous cell carcinoma (SCC) increased 2.4% per year among Japanese women. For SCC, small cell lung carcinoma, large cell and other specified carcinoma, and unspecified types, stable or decreasing trends were observed in most AANHPI groups and non-Hispanic Whites. CONCLUSIONS AANHPIs demonstrate a range in the burden of lung cancer across histologies and specific populations. IMPACT These findings illustrate the importance of disaggregating AANHPIs into their specific populations. The rise in incidence of adenocarcinoma and SCC among certain AANHPIs demonstrates the need for research into non-tobacco associated risk factors for these populations and targeted efforts for tobacco prevention.
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Affiliation(s)
- Iona Cheng
- Cancer Prevention Institute of California, Fremont, California. Stanford Cancer Institute, Stanford, California.
| | - Gem M Le
- Cancer Prevention Institute of California, Fremont, California. Stanford Cancer Institute, Stanford, California. Division of Epidemiology, Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
| | - Anne-Michelle Noone
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Kathleen Gali
- Social Cognitive Sciences Graduate Group, School of Social Sciences Humanities and Arts, University of California, Merced, California
| | - Manali Patel
- Division of Epidemiology, Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California. Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Robert W Haile
- Stanford Cancer Institute, Stanford, California. Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Heather A Wakelee
- Stanford Cancer Institute, Stanford, California. Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Scarlett L Gomez
- Cancer Prevention Institute of California, Fremont, California. Stanford Cancer Institute, Stanford, California. Division of Epidemiology, Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
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Abstract
The goal of health equity requires the collection and reporting of disaggregated data in underrepresented populations such as Asian American (AA) and Native Hawaiian and Other Pacific Islander (NHOPI) communities. A recent Department of Health and Human Services report outlines the necessity for disaggregated data, which would offer communities, providers, and planners better tools to address health problems. In a recent collaboration, the National Cancer Institute (NCI) and several registries published a series of articles tracking cancer incidence data on AA and NHOPI communities using data from the NCI's Surveillance, Epidemiology, and End Results (SEER) program. The findings indicate a need for concentrated focus and planning for the next stages of cancer prevention and control for AA and NHOPI subpopulations. In this article, we provide (i) the context for the perpetuation of the model minority myth as well as historical and sociocultural factors that have shaped health and disease for AA and NHOPI subgroups; (ii) potential strategies for research and public health policy for AA and NHOPI groups using subpopulation-based approaches while addressing challenges and limitations; and (iii) a portfolio analysis of currently funded projects within the NCI/DCCPS to identify gaps and areas of potential research.
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Affiliation(s)
- Anh Bao Nguyen
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland.
| | - Neetu Chawla
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Anne-Michelle Noone
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Shobha Srinivasan
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
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Edwards BK, Noone AM, Mariotto AB, Simard EP, Boscoe FP, Henley SJ, Jemal A, Cho H, Anderson RN, Kohler BA, Eheman CR, Ward EM. Annual Report to the Nation on the status of cancer, 1975-2010, featuring prevalence of comorbidity and impact on survival among persons with lung, colorectal, breast, or prostate cancer. Cancer 2014; 120:1290-314. [PMID: 24343171 PMCID: PMC3999205 DOI: 10.1002/cncr.28509] [Citation(s) in RCA: 862] [Impact Index Per Article: 86.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 11/19/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND The American Cancer Society (ACS), 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 updates on cancer incidence and death rates and trends in these outcomes for the United States. This year's report includes the prevalence of comorbidity at the time of first cancer diagnosis among patients with lung, colorectal, breast, or prostate cancer and survival among cancer patients based on comorbidity level. METHODS Data on cancer incidence were obtained from the NCI, the CDC, and the NAACCR; and data on mortality were obtained from the CDC. Long-term (1975/1992-2010) and short-term (2001-2010) trends in age-adjusted incidence and death rates for all cancers combined and for the leading cancers among men and women were examined by joinpoint analysis. Through linkage with Medicare claims, the prevalence of comorbidity among cancer patients who were diagnosed between 1992 through 2005 residing in 11 Surveillance, Epidemiology, and End Results (SEER) areas were estimated and compared with the prevalence in a 5% random sample of cancer-free Medicare beneficiaries. Among cancer patients, survival and the probabilities of dying of their cancer and of other causes by comorbidity level, age, and stage were calculated. RESULTS Death rates continued to decline for all cancers combined for men and women of all major racial and ethnic groups and for most major cancer sites; rates for both sexes combined decreased by 1.5% per year from 2001 through 2010. Overall incidence rates decreased in men and stabilized in women. The prevalence of comorbidity was similar among cancer-free Medicare beneficiaries (31.8%), breast cancer patients (32.2%), and prostate cancer patients (30.5%); highest among lung cancer patients (52.9%); and intermediate among colorectal cancer patients (40.7%). Among all cancer patients and especially for patients diagnosed with local and regional disease, age and comorbidity level were important influences on the probability of dying of other causes and, consequently, on overall survival. For patients diagnosed with distant disease, the probability of dying of cancer was much higher than the probability of dying of other causes, and age and comorbidity had a smaller effect on overall survival. CONCLUSIONS Cancer death rates in the United States continue to decline. Estimates of survival that include the probability of dying of cancer and other causes stratified by comorbidity level, age, and stage can provide important information to facilitate treatment decisions.
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Affiliation(s)
- Brenda K Edwards
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
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Liu L, Noone AM, Gomez SL, Scoppa S, Gibson JT, Lichtensztajn D, Fish K, Wilkens LR, Goodman MT, Morris C, Kwong S, Deapen D, Miller BA. Cancer incidence trends among native Hawaiians and other Pacific Islanders in the United States, 1990-2008. J Natl Cancer Inst 2013; 105:1086-95. [PMID: 23878354 PMCID: PMC3735461 DOI: 10.1093/jnci/djt156] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Lack of annual population estimates for disaggregated Native Hawaiian and Other Pacific Islander (NHOPI) populations limits the ability to examine cancer incidence rates and trends to understand the cancer burdens among NHOPIs. METHODS Utilizing 1990 and 2000 population census data, we estimated the annual populations by age and sex for Native Hawaiians, Samoans, and Guamanians/Chamorros for 1990-2008 in regions covered by 13 of the National Cancer Institute's SEER registries. Cancer diagnoses during 1990-2008 from these registries were used to calculate the age-adjusted (2000 US Standard) incidence rates by sex, calendar year/period, and cancer type for each population. The annual percentage change (APC) in incidence rates was estimated with the 95% confidence intervals (95% CIs) calculated for both the rate and APC estimates. RESULTS Statistically significant declining trends were found in Native Hawaiians, in men for lung and stomach cancers (APC = -2.3%; 95% CI = -3.3 to -1.3; and APC = -3.8%; 95% CI = -6.0 to -1.6, respectively), and in women for breast cancer (APC = -4.1%; 95% CI = -5.7 to -2.5) since 1998 and lung cancer (APC = -6.4%; 95% CI = -10.7 to -1.8) since 2001. Rising incidence trends were experienced by Samoans, especially by Samoan women for breast (APC = 2.7%; 95% CI = 0.9 to 4.5) and uterus (APC = 7.3%; 95% CI = 6.2 to 8.4) cancers. With limited data, Guamanians/Chamorros demonstrated lower, but increasing, incidence rates than other NHOPIs. CONCLUSIONS Population-based cancer incidence rates for disaggregated NHOPI populations help identify disparities in cancer burden and provide valuable information to improve cancer control efforts among NHOPIs.
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Affiliation(s)
- Lihua Liu
- Los Angeles Cancer Surveillance Program, University of Southern California, Los Angeles, CA 90089-9238, USA.
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Gomez SL, Noone AM, Lichtensztajn DY, Scoppa S, Gibson JT, Liu L, Morris C, Kwong S, Fish K, Wilkens LR, Goodman MT, Deapen D, Miller BA. Cancer incidence trends among Asian American populations in the United States, 1990-2008. J Natl Cancer Inst 2013; 105:1096-110. [PMID: 23878350 DOI: 10.1093/jnci/djt157] [Citation(s) in RCA: 209] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND National cancer incidence trends are presented for eight Asian American groups: Asian Indians/Pakistanis, Chinese, Filipinos, Japanese, Kampucheans, Koreans, Laotians, and Vietnamese. METHODS Cancer incidence data from 1990 through 2008 were obtained from 13 Surveillance, Epidemiology, End Results (SEER) registries. Incidence rates from 1990 through 2008 and average percentage change were computed using SEER*Stat and Joinpoint software. The annual percentage change (APC) in incidence rates was estimated with 95% confidence intervals (95% CIs) calculated for both the rate and APC estimates. Rates for non-Hispanic whites are presented for comparison. RESULTS Prostate cancer was the most common malignancy among most groups, followed by lung, colorectal, liver, and stomach cancers. Breast cancer was generally the most common cancer in women, followed by colorectal and lung cancers; liver, cervix, thyroid, and stomach cancers also ranked highly. Among men, increasing trends were observed for prostate (Asian Indians and Pakistanis: APC 1990-2003 = 2.2, 95% CI = 0.3 to 4.1; Filipinos: APC 1990-1994 = 19.0, 95% CI = 4.5 to 35.4; Koreans: APC 1990-2008 = 2.9, 95% CI = 1.8 to 4.0), colorectal (Koreans: APC 1990-2008 = 2.2, 95% CI = 0.9 to 3.5), and liver cancers (Filipinos: APC 1990-2008 = 1.6, 95% CI = 0.4 to 2.7; Koreans: APC 1990-2006 = 2.1, 95% CI = 0.4 to 3.7; Vietnamese: APC 1990-2008 = 1.6, 95% CI = 0.3 to 2.8), whereas lung and stomach cancers generally remained stable or decreased. Among women, increases were observed for uterine cancer (Asian Indians: APC 1990-2008 = 3.0, 95% CI = 0.3 to 5.8; Chinese: APC 2004-2008 = 7.0, 95% CI = 1.4 to 12.9; Filipina: APC 1990-2008 = 3.0, 95% CI = 2.4 to 3.7; Japanese: APC 1990-2008 = 1.1, 95% CI = 0.1 to 2.0), colorectal cancer (Koreans: APC 1990-2008 = 2.8, 95% CI = 1.7 to 3.9; Laotians: APC: 1990-2008 = 5.9, 95% CI = 4.0 to 7.7), lung cancer (Filipinas: APC 1990-2008 = 2.1, 95% CI = 1.4 to 2.8; Koreans: APC 1990-2008 = 2.1, 95% CI = 0.6 to 3.6), thyroid cancer (Filipinas: APC 1990-2008 = 2.5, 95% CI = 1.7 to 3.3), and breast cancer in most groups (APC 1990-2008 from 1.2 among Vietnamese and Chinese to 4.7 among Koreans). Decreases were observed for stomach (Chinese and Japanese), colorectal (Chinese), and cervical cancers (Laotians and Vietnamese). CONCLUSIONS These data fill a critical knowledge gap concerning the cancer experience of Asian American groups and highlight where increased preventive, screening, and surveillance efforts are needed-in particular, lung cancer among Filipina and Korean women and Asian Indian/Pakistani men, breast cancer among all women, and liver cancer among Vietnamese, Laotian, and Kampuchean women and Filipino, Kampuchean, and Vietnamese men.
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Cheung WY, Aziz N, Noone AM, Rowland JH, Potosky AL, Ayanian JZ, Virgo KS, Ganz PA, Stefanek M, Earle CC. Physician preferences and attitudes regarding different models of cancer survivorship care: a comparison of primary care providers and oncologists. J Cancer Surviv 2013; 7:343-54. [PMID: 23526165 DOI: 10.1007/s11764-013-0281-y] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 03/08/2013] [Indexed: 01/08/2023]
Abstract
PURPOSE New strategies for delivering cancer follow-up care are needed. We surveyed primary care providers (PCPs) and oncologists to assess how physician attitudes toward and self-efficacy with cancer follow-up affect preferences for different cancer survivorship models. METHODS The survey of physician attitudes regarding the care of cancer survivors was mailed to a randomly selected national sample of PCPs and oncologists to evaluate their perspectives regarding physician roles, knowledge about survivorship care processes, and views on cancer surveillance. Multinomial logistic regression models were constructed to examine how physician attitudes towards, and self-efficacy with, their own skills affected preferences for different cancer survivorship care models. RESULTS Of 3,434 physicians identified, a total of 2,026 participants provided eligible responses: 938 PCPs and 1,088 oncologists. Most PCPs (51 %) supported a PCP/shared care model; whereas, the majority of specialists (59 %) strongly endorsed an oncologist-based model (p < 0.001). Less than a quarter of PCPs and oncologists preferred specialized survivor clinics. A significant proportion of oncologists (87 %) did not feel that PCPs should take on the primary role of cancer follow-up. Most PCPs believed that they were better able to perform breast and colorectal cancer follow-up (57 %), detect recurrent cancers (74 %), and offer psychosocial support (50 %), but only a minority (32 %) was willing to assume primary responsibility. PCPs already involved with cancer surveillance (43 %) were more likely to prefer a PCP/shared care than oncologist-based survivorship model (OR, 2.08; 95 % CI, 1.34-3.23). CONCLUSIONS AND IMPLICATIONS FOR CANCER SURVIVORS PCPs and oncologists have different preferences for models of cancer survivorship care. Prior involvement with cancer surveillance was one of the strongest predictors of PCPs' willingness to assume this responsibility.
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Affiliation(s)
- Winson Y Cheung
- Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
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Jemal A, Simard EP, Dorell C, Noone AM, Markowitz LE, Kohler B, Eheman C, Saraiya M, Bandi P, Saslow D, Cronin KA, Watson M, Schiffman M, Henley SJ, Schymura MJ, Anderson RN, Yankey D, Edwards BK. Annual Report to the Nation on the Status of Cancer, 1975-2009, featuring the burden and trends in human papillomavirus(HPV)-associated cancers and HPV vaccination coverage levels. J Natl Cancer Inst 2013; 105:175-201. [PMID: 23297039 PMCID: PMC3565628 DOI: 10.1093/jnci/djs491] [Citation(s) in RCA: 749] [Impact Index Per Article: 68.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background The American Cancer Society (ACS), 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 updates on cancer incidence and death rates and trends in these outcomes for the United States. This year’s report includes incidence trends for human papillomavirus (HPV)–associated cancers and HPV vaccination (recommended for adolescents aged 11–12 years). Methods Data on cancer incidence were obtained from the CDC, NCI, and NAACCR, and data on mortality were obtained from the CDC. Long- (1975/1992–2009) and short-term (2000–2009) trends in age-standardized incidence and death rates for all cancers combined and for the leading cancers among men and among women were examined by joinpoint analysis. Prevalence of HPV vaccination coverage during 2008 and 2010 and of Papanicolaou (Pap) testing during 2010 were obtained from national surveys. Results Death rates continued to decline for all cancers combined for men and women of all major racial and ethnic groups and for most major cancer sites; rates for both sexes combined decreased by 1.5% per year from 2000 to 2009. Overall incidence rates decreased in men but stabilized in women. Incidence rates increased for two HPV-associated cancers (oropharynx, anus) and some cancers not associated with HPV (eg, liver, kidney, thyroid). Nationally, 32.0% (95% confidence interval [CI] = 30.3% to 33.6%) of girls aged 13 to 17 years in 2010 had received three doses of the HPV vaccine, and coverage was statistically significantly lower among the uninsured (14.1%, 95% CI = 9.4% to 20.6%) and in some Southern states (eg, 20.0% in Alabama [95% CI = 13.9% to 27.9%] and Mississippi [95% CI = 13.8% to 28.2%]), where cervical cancer rates were highest and recent Pap testing prevalence was the lowest. Conclusions The overall trends in declining cancer death rates continue. However, increases in incidence rates for some HPV-associated cancers and low vaccination coverage among adolescents underscore the need for additional prevention efforts for HPV-associated cancers, including efforts to increase vaccination coverage.
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Affiliation(s)
- Ahmedin Jemal
- Surveillance Research Program, American Cancer Society, 250 Williams St NW, Atlanta, GA 30303, USA.
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Selsky C, Luta G, Noone AM, Huerta EE, Mandelblatt JS. Internet access and online cancer information seeking among Latino immigrants from safety net clinics. J Health Commun 2013; 18:58-70. [PMID: 23066874 PMCID: PMC3555511 DOI: 10.1080/10810730.2012.688248] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Internet use is widespread, but little is known about Internet use for cancer information among Latinos, especially those who rely on safety net clinics. The authors investigated access to and intended use of the Internet for cancer information among low income, immigrant Latinos predominately from Central and South America. A cross-sectional study of 1,273 Latinos 21 years and older attending safety net clinics or health fairs was conducted from June 2007 to November 2008. The authors used logistic regression models to evaluate associations of age, acculturation, psychosocial factors and other covariates with Internet access and intended use of the Internet for cancer information among those with access. Of the sample, 44% reported Internet access. Higher information self-efficacy and greater trust in the Internet were independently associated with Internet access (p = .05 and p < .001, respectively). Among those with access, 53.8% reported they intended to seek cancer help online if they needed information. Those with younger age and higher acculturation, education and self-efficacy had higher odds of intended Internet use for cancer information, considering covariates. In addition, those with high (vs. low) perceived risk of cancer (OR = 1.76; 95% CI [1.14, 2.73]; p = .01) and higher levels of trust in online health information (OR = 1.47 per one-point increase; 95% [CI 1.19, 1.82]; p = .0004) were more likely to intend to seek cancer information online. These findings that Internet access is fairly high in the immigrant Latino population and that the Internet is a trusted source of cancer information suggest that the Internet may be a channel for cancer control interventions.
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Affiliation(s)
- Claire Selsky
- Cancer Control Program, Lombardi Cancer Center and Department of Oncology, Georgetown University Medical Center, Washington DC 20007, USA
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Jamison PM, Noone AM, Ries LA, Lee NC, Edwards BK. Trends in Endometrial Cancer Incidence by Race and Histology with a Correction for the Prevalence of Hysterectomy, SEER 1992 to 2008. Cancer Epidemiol Biomarkers Prev 2012; 22:233-41. [DOI: 10.1158/1055-9965.epi-12-0996] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Howlader N, Noone AM, Yu M, Cronin KA. Use of imputed population-based cancer registry data as a method of accounting for missing information: application to estrogen receptor status for breast cancer. Am J Epidemiol 2012; 176:347-56. [PMID: 22842721 DOI: 10.1093/aje/kwr512] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program provides a rich source of data stratified according to tumor biomarkers that play an important role in cancer surveillance research. These data are useful for analyzing trends in cancer incidence and survival. These tumor markers, however, are often prone to missing observations. To address the problem of missing data, the authors employed sequential regression multivariate imputation for breast cancer variables, with a particular focus on estrogen receptor status, using data from 13 SEER registries covering the period 1992-2007. In this paper, they present an approach to accounting for missing information through the creation of imputed data sets that can be analyzed using existing software (e.g., SEER*Stat) developed for analyzing cancer registry data. Bias in age-adjusted trends in female breast cancer incidence is shown graphically before and after imputation of estrogen receptor status, stratified by age and race. The imputed data set will be made available in SEER*Stat (http://seer.cancer.gov/analysis/index.html) to facilitate accurate estimation of breast cancer incidence trends. To ensure that the imputed data set is used correctly, the authors provide detailed, step-by-step instructions for conducting analyses. This is the first time that a nationally representative, population-based cancer registry data set has been imputed and made available to researchers for conducting a variety of analyses of breast cancer incidence trends.
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Affiliation(s)
- Nadia Howlader
- Data Analysis and Interpretation Branch, Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20892, USA.
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Lopez-Class M, Luta G, Noone AM, Canar J, Selksy C, Huerta E, Mandelblatt J. Patient and provider factors associated with colorectal cancer screening in safety net clinics serving low-income, urban immigrant Latinos. J Health Care Poor Underserved 2012; 23:1011-9. [PMID: 24212154 PMCID: PMC3824152 DOI: 10.1353/hpu.2012.0109] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Latinos have lower colorectal cancer screening rates than Whites. METHODS We reviewed a random sample of charts between July 2009 and February 2010 of safety-net clinic of 840 immigrants (50 years and older) from Central and South America receiving care. Logistic regression evaluated associations of ever vs. never screening, patient and physician factors. RESULTS Ever screening rates were 24.5%, and only 17% of charts noted a physician screening recommendation. However, the odds of screening were 9.89 times higher (95% CI: 6.25-15.64, p<.001) among patients with a physician recommendation vs. those without, considering covariates. The odds of screening were 0.61 times lower (95% CI: 0.40-0.92, p=.02) in patients with a body mass index ≥ 30 vs. <30. CONCLUSIONS While rates were low, determinants of screening were similar in this Latino subgroup to those reported in other Latino and non-Latino populations. Low rates of documented physician screening recommendations may indicate a potential missed opportunity for cancer control in safety-net clinics.
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Wallington SF, Luta G, Noone AM, Caicedo L, Lopez-Class M, Sheppard V, Spencer C, Mandelblatt J. Assessing the awareness of and willingness to participate in cancer clinical trials among immigrant Latinos. J Community Health 2012; 37:335-43. [PMID: 21805372 DOI: 10.1007/s10900-011-9450-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Clinical trials are considered the gold standard of evidence about the efficacy of cancer prevention, early detection, and treatment interventions. A paucity of data exists on determinants of clinical trial participation in the growing US Latino population despite poor cancer outcomes in this group. This study seeks to describe correlates of awareness of and willingness to participate in clinical trials among largely Central, North, and South American Latinos using safety-net clinics. Between June 2007 and November 2008, we conducted an interviewer-administered, Spanish-language cross-sectional survey (n = 944). Logistic regression was used to assess effects of health information sources and psychosocial variables on awareness of and intention to participate in clinical trials. Analyses were completed in spring 2010. While only 48% knew what a clinical trial was, when explained, 65% indicated a willingness to participate. Providers were the most common source of health information. Use of Internet for health information, trust in health information, and higher education each independently increased the odds of clinical trial awareness, but obtaining information from providers did not. Contacting the Cancer Information Service and psychosocial factors were each independently associated with intent to join a clinical trial, while demographic factors were not. Information channels such as the Internet may be effective in conveying clinical trial information to Latinos. Providers being cited as the most common source of health information but not being associated with knowledge about or intent to participate in trials suggests a missed opportunity for communication to this population.
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Affiliation(s)
- Sherrie Flynt Wallington
- Lombardi Comprehensive Cancer Center, Georgetown University School of Medicine, Research Building, W326A, 3970 Reservoir Rd, NW, Washington, DC 20057, USA.
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Eheman C, Henley SJ, Ballard-Barbash R, Jacobs EJ, Schymura MJ, Noone AM, Pan L, Anderson RN, Fulton JE, Kohler BA, Jemal A, Ward E, Plescia M, Ries LAG, Edwards BK. Annual Report to the Nation on the status of cancer, 1975-2008, featuring cancers associated with excess weight and lack of sufficient physical activity. Cancer 2012. [PMID: 22460733 DOI: 10.1002/cncr.27514;+10.1002/cncr.27514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Annual updates on cancer occurrence and trends in the United States are provided through collaboration between the American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR). This year's report highlights the increased cancer risk associated with excess weight (overweight or obesity) and lack of sufficient physical activity (<150 minutes of physical activity per week). METHODS Data on cancer incidence were obtained from the CDC, NCI, and NAACCR; data on cancer deaths were obtained from the CDC's National Center for Health Statistics. Annual percent changes in incidence and death rates (age-standardized to the 2000 US population) for all cancers combined and for the leading cancers among men and among women were estimated by joinpoint analysis of long-term trends (incidence for 1992-2008 and mortality for 1975-2008) and short-term trends (1999-2008). Information was obtained from national surveys about the proportion of US children, adolescents, and adults who are overweight, obese, insufficiently physically active, or physically inactive. RESULTS Death rates from all cancers combined decreased from 1999 to 2008, continuing a decline that began in the early 1990s, among men and among women in most racial and ethnic groups. Death rates decreased from 1999 to 2008 for most cancer sites, including the 4 most common cancers (lung, colorectum, breast, and prostate). The incidence of prostate and colorectal cancers also decreased from 1999 to 2008. Lung cancer incidence declined from 1999 to 2008 among men and from 2004 to 2008 among women. Breast cancer incidence decreased from 1999 to 2004 but was stable from 2004 to 2008. Incidence increased for several cancers, including pancreas, kidney, and adenocarcinoma of the esophagus, which are associated with excess weight. CONCLUSIONS Although improvements are reported in the US cancer burden, excess weight and lack of sufficient physical activity contribute to the increased incidence of many cancers, adversely affect quality of life for cancer survivors, and may worsen prognosis for several cancers. The current report highlights the importance of efforts to promote healthy weight and sufficient physical activity in reducing the cancer burden in the United States.
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Affiliation(s)
- Christie Eheman
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
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Eheman C, Henley SJ, Ballard-Barbash R, Jacobs EJ, Schymura MJ, Noone AM, Pan L, Anderson RN, Fulton JE, Kohler BA, Jemal A, Ward E, Plescia M, Ries LAG, Edwards BK. Annual Report to the Nation on the status of cancer, 1975-2008, featuring cancers associated with excess weight and lack of sufficient physical activity. Cancer 2012; 118:2338-66. [PMID: 22460733 PMCID: PMC4586174 DOI: 10.1002/cncr.27514] [Citation(s) in RCA: 329] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 02/03/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Annual updates on cancer occurrence and trends in the United States are provided through collaboration between the American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR). This year's report highlights the increased cancer risk associated with excess weight (overweight or obesity) and lack of sufficient physical activity (<150 minutes of physical activity per week). METHODS Data on cancer incidence were obtained from the CDC, NCI, and NAACCR; data on cancer deaths were obtained from the CDC's National Center for Health Statistics. Annual percent changes in incidence and death rates (age-standardized to the 2000 US population) for all cancers combined and for the leading cancers among men and among women were estimated by joinpoint analysis of long-term trends (incidence for 1992-2008 and mortality for 1975-2008) and short-term trends (1999-2008). Information was obtained from national surveys about the proportion of US children, adolescents, and adults who are overweight, obese, insufficiently physically active, or physically inactive. RESULTS Death rates from all cancers combined decreased from 1999 to 2008, continuing a decline that began in the early 1990s, among men and among women in most racial and ethnic groups. Death rates decreased from 1999 to 2008 for most cancer sites, including the 4 most common cancers (lung, colorectum, breast, and prostate). The incidence of prostate and colorectal cancers also decreased from 1999 to 2008. Lung cancer incidence declined from 1999 to 2008 among men and from 2004 to 2008 among women. Breast cancer incidence decreased from 1999 to 2004 but was stable from 2004 to 2008. Incidence increased for several cancers, including pancreas, kidney, and adenocarcinoma of the esophagus, which are associated with excess weight. CONCLUSIONS Although improvements are reported in the US cancer burden, excess weight and lack of sufficient physical activity contribute to the increased incidence of many cancers, adversely affect quality of life for cancer survivors, and may worsen prognosis for several cancers. The current report highlights the importance of efforts to promote healthy weight and sufficient physical activity in reducing the cancer burden in the United States.
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Affiliation(s)
- Christie Eheman
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
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Eheman C, Henley SJ, Ballard-Barbash R, Jacobs EJ, Schymura MJ, Noone AM, Pan L, Anderson RN, Fulton JE, Kohler BA, Jemal A, Ward E, Plescia M, Ries LAG, Edwards BK. Annual Report to the Nation on the status of cancer, 1975-2008, featuring cancers associated with excess weight and lack of sufficient physical activity. Cancer 2012. [PMID: 22460733 DOI: 10.1002/cncr.27514; 10.1002/cncr.27514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Annual updates on cancer occurrence and trends in the United States are provided through collaboration between the American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR). This year's report highlights the increased cancer risk associated with excess weight (overweight or obesity) and lack of sufficient physical activity (<150 minutes of physical activity per week). METHODS Data on cancer incidence were obtained from the CDC, NCI, and NAACCR; data on cancer deaths were obtained from the CDC's National Center for Health Statistics. Annual percent changes in incidence and death rates (age-standardized to the 2000 US population) for all cancers combined and for the leading cancers among men and among women were estimated by joinpoint analysis of long-term trends (incidence for 1992-2008 and mortality for 1975-2008) and short-term trends (1999-2008). Information was obtained from national surveys about the proportion of US children, adolescents, and adults who are overweight, obese, insufficiently physically active, or physically inactive. RESULTS Death rates from all cancers combined decreased from 1999 to 2008, continuing a decline that began in the early 1990s, among men and among women in most racial and ethnic groups. Death rates decreased from 1999 to 2008 for most cancer sites, including the 4 most common cancers (lung, colorectum, breast, and prostate). The incidence of prostate and colorectal cancers also decreased from 1999 to 2008. Lung cancer incidence declined from 1999 to 2008 among men and from 2004 to 2008 among women. Breast cancer incidence decreased from 1999 to 2004 but was stable from 2004 to 2008. Incidence increased for several cancers, including pancreas, kidney, and adenocarcinoma of the esophagus, which are associated with excess weight. CONCLUSIONS Although improvements are reported in the US cancer burden, excess weight and lack of sufficient physical activity contribute to the increased incidence of many cancers, adversely affect quality of life for cancer survivors, and may worsen prognosis for several cancers. The current report highlights the importance of efforts to promote healthy weight and sufficient physical activity in reducing the cancer burden in the United States.
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Affiliation(s)
- Christie Eheman
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
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Abstract
Tree-based methods have become popular for analyzing complex data structures where the primary goal is risk stratification of patients. Ensemble techniques improve the accuracy in prediction and address the instability in a single tree by growing an ensemble of trees and aggregating. However, in the process, individual trees get lost. In this paper, we propose a methodology for identifying the most representative trees in an ensemble on the basis of several tree distance metrics. Although our focus is on binary outcomes, the methods are applicable to censored data as well. For any two trees, the distance metrics are chosen to (1) measure similarity of the covariates used to split the trees; (2) reflect similar clustering of patients in the terminal nodes of the trees; and (3) measure similarity in predictions from the two trees. Whereas the latter focuses on prediction, the first two metrics focus on the architectural similarity between two trees. The most representative trees in the ensemble are chosen on the basis of the average distance between a tree and all other trees in the ensemble. Out-of-bag estimate of error rate is obtained using neighborhoods of representative trees. Simulations and data examples show gains in predictive accuracy when averaging over such neighborhoods. We illustrate our methods using a dataset of kidney cancer treatment receipt (binary outcome) and a second dataset of breast cancer survival (censored outcome).
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Affiliation(s)
- Mousumi Banerjee
- Department of Biostatistics, University of Michigan, Ann Arbor, MI 48109, U.S.A.
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Maclaughlin BW, Wang D, Noone AM, Liu N, Harazduk N, Lumpkin M, Haramati A, Saunders P, Dutton M, Amri H. Stress biomarkers in medical students participating in a mind body medicine skills program. Evid Based Complement Alternat Med 2011; 2011:950461. [PMID: 21799696 PMCID: PMC3137844 DOI: 10.1093/ecam/neq039] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Accepted: 04/09/2010] [Indexed: 11/12/2022]
Abstract
Georgetown University School of Medicine offers an elective Mind-Body Medicine Skills (MBMS) course to medical students to promote self-care and self-awareness. Participating medical students reported better management of academic stress and well-being than non-participants. In this study, we sought to assess the stress-reducing effects of MBMS by measuring physiological changes in first-year medical students. Saliva samples were collected before (January, time 1 (T1)-pre-intervention) and upon completion of the course (May, time 2 (T2p)-post-intervention), as well as from non-participating medical students (May, time 2 (T2c)-control). The T2p and T2c collections coincided with the period of final examinations. Cortisol, dehydroepiandrosterone-sulfate (DHEA-S), testosterone and secretory immunoglobulin A (sIgA) were measured. The mean morning salivary cortisol at T2p was 97% of the mean at baseline T1 which was significantly lower than for T2c (2.4) (95% confidence interval (CI) 0.57-1.60, P = .001); DHEA-S showed similar pattern as cortisol where the T2p levels were significantly lower than T2c (P < .001) in both morning and evening collections. Testosterone ratio at T2p (0.85) was also lower than T2c (1.6) (95% CI 0.53-1.3, P = .01). sIgA levels were not statistically different. On direct comparison, the T2c and T2p means were significantly different for all cortisol, DHEA-S and testosterone values. Participants maintained their hormonal balance within the normal range throughout the academic semester while the control group showed significantly increased levels, probably exacerbated by the end of the semester exam stress. To our knowledge, this is the first study to assess the physiologic benefits of a MBMS program in medical students.
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Affiliation(s)
- Brian W Maclaughlin
- Department of Physiology and Biophysics, Georgetown University Medical Center, 3900 Reservoir Road, Washington, DC 20007, USA
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Abstract
Cause-specific analyses under a competing risks framework have received considerable attention in the statistical literature. Such analyses are useful for comparing mortality patterns across racial and/or age groups. Earlier work in the statistical literature focused on the situation when the cause of death is known. A challenging twist to the problem arises when the cause of death is not known exactly, but can be narrowed down to a set of potential causes that do not necessarily act independently. This phenomenon, referred to as masking, is often the result of incomplete or partial information on death certificates and/or lack of routine autopsy on every patient. In this article we propose a semiparametric Bayesian approach for analyzing competing risks survival data with masked cause of death. The models proposed do not assume independence among the causes, and are valid for an arbitrary number of causes. Further, the Bayesian approach is flexible in allowing a general pattern of missingness for the cause of death. We illustrate our methodology using breast cancer data from the Detroit Surveillance, Epidemiology, and End Results registry.
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Affiliation(s)
- Ananda Sen
- Department of Statistics and Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, MI, USA
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Wycherly BJ, Berkowitz F, Noone AM, Kim HJ. Computed tomography and otosclerosis: a practical method to correlate the sites affected to hearing loss. Ann Otol Rhinol Laryngol 2011; 119:789-94. [PMID: 21250549 DOI: 10.1177/000348941011901201] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We present a practical method for correlating computed tomography (CT) scans with hearing loss in otosclerosis. METHODS We reviewed the CT scans of 18 patients (34 ears) with clinical otosclerosis who were seen between 2007 and 2008. The scans were reviewed by an otologist in a clinical office setting, followed by a blinded radiologist working at an imaging workstation. The 5 most commonly affected sites in otosclerosis were evaluated for evidence of otospongiosis and then correlated with the degree of air-bone gap and sensorineural hearing loss. RESULTS Positive CT findings were noted in 70.5% of ears, with a 94% concordance between readings. The sites affected included the ante fenestram (21 ears), round window niche (12), cochlear promontory (4), cochlear apex (3), and posterior fenestram (2). The average air-bone gap increased with each additional site of involvement within an otic capsule (p = 0.004). The bone conduction threshold also increased, on average, with each additional affected site (p = 0.047). CONCLUSIONS Most patients with clinical evidence of otosclerosis have evidence of otosclerosis on CT that is readily detected in the office setting. Ears with more affected sites have a significantly greater degree of air-bone gap and sensorineural hearing loss.
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Affiliation(s)
- Benjamin J Wycherly
- Department of Otolaryngology-Head and Neck Surgery, Georgetown University, Washington, DC 20007, USA
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Dyba M, Wang A, Noone AM, Goerlitz D, Shields P, Zheng YL, Rivlin R, Chung FL. Metabolism of isothiocyanates in individuals with positive and null GSTT1 and M1 genotypes after drinking watercress juice. Clin Nutr 2010; 29:813-8. [PMID: 20656381 DOI: 10.1016/j.clnu.2010.06.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Revised: 05/24/2010] [Accepted: 06/26/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND & AIMS Isothiocyanates (ITCs) derived from cruciferous vegetables have been shown to be promising agents against cancer in human cell culture, animal models, and in epidemiological studies. Several epidemiological studies have demonstrated an inverse relationship between intake of dietary isothiocyanates and the risk of cancers, particularly lung, colon, and breast. More importantly, the protective effects of dietary ITCs appear to be influenced by glutathione S-transferase (GST) genotype; specifically, individuals with glutathione S-transferase theta 1 (GSTT1) and glutathione S-transferase Mu 1 (GSTM1) null are better protected than those with GSTT1 and M1 positive. Although the majority of studies, especially those conducted in populations exposed to ITC rich diets, demonstrated such effects, there are a few studies that showed opposite or no association. While evidence for the interactions of dietary ITCs with GST genes is relatively strong, the reasons for the differential effects remain unclear. In this study, we examined one possible mechanism: whether subjects with null genotypes excrete ITCs at a slower rate than those with positive genotypes after drinking watercress juice, a rich source of ITCs. METHODS A total of 48 subjects, 28 GSTT1 and M1 positive and 20 null genotypes were enrolled in the study. The rates of excretion were determined using five urine samples collected over a period of 24 h after drinking watercress juice. RESULTS No statistically significant differences in the rates of isothiocyanate excretion and the time of peak excretion were observed between the two tested groups having positive and null genotypes. CONCLUSIONS GSTT1 and M1 genotypes are not likely to be involved in the rate of excretion of ITCs in watercress. The demonstrated differences in protection among subjects with the two genotypes are not likely due to differences in overall ITC excretion rates, however, excretion rates of ITCs other than PEITC need to be investigated. Other yet to be identified mechanism(s) may underlie the diet and gene interactions between dietary ITCs and GST genotypes in human cancer prevention. Further research is needed to evaluate the protective mechanisms of isothiocyanates against cancer.
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Affiliation(s)
- Marcin Dyba
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia, Washington, DC 20057, USA
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Mandelblatt JS, Sheppard VB, Hurria A, Kimmick G, Isaacs C, Taylor KL, Kornblith AB, Noone AM, Luta G, Tallarico M, Barry WT, Hunegs L, Zon R, Naughton M, Winer E, Hudis C, Edge SB, Cohen HJ, Muss H. Breast cancer adjuvant chemotherapy decisions in older women: the role of patient preference and interactions with physicians. J Clin Oncol 2010; 28:3146-53. [PMID: 20516438 PMCID: PMC2903313 DOI: 10.1200/jco.2009.24.3295] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Accepted: 03/30/2010] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Breast cancer chemotherapy decisions in patients > or = 65 years old (older) are complex because of comorbidity, toxicity, and limited data on patient preference. We examined relationships between preferences and chemotherapy use. METHODS Older women (n = 934) diagnosed with invasive (> or = 1 cm), nonmetastatic breast cancer from 2004 to 2008 were recruited from 53 cooperative group sites. Data were collected from patient interviews (87% complete), physician survey (93% complete), and charts. Logistic regression and multiple imputation methods were used to assess associations between chemotherapy and independent variables. Chemotherapy use was also evaluated according to the following two groups: indicated (estrogen receptor [ER] negative and/or node positive) and possibly indicated (ER positive and node negative). RESULTS Mean patient age was 73 years (range, 65 to 100 years). Unadjusted chemotherapy rates were 69% in the indicated group and 16% in the possibly indicated group. Women who would choose chemotherapy for an increase in survival of < or = 12 months had 3.9 times (95% CI, 2.4 to 6.3 times; P < .001) higher odds of receiving chemotherapy than women with lower preferences, controlling for covariates. Stronger preferences were seen when chemotherapy could be indicated (odds ratio [OR] = 7.7; 95% CI, 3.8 to 16; P < .001) than when treatment might be possibly indicated (OR = 1.9; 95% CI, 1.0 to 3.8; P = .06). Higher patient rating of provider communication was also related to chemotherapy use in the possibly indicated group (OR = 1.9 per 5-point increase in communication score; 95% CI, 1.4 to 2.8; P < .001) but not in the indicated group (P = .15). CONCLUSION Older women's preferences and communication with providers are important correlates of chemotherapy use, especially when benefits are more equivocal.
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Affiliation(s)
- Jeanne S Mandelblatt
- Georgetown University School of Medicine and Lombardi Comprehensive Cancer Center, Washington, DC, USA.
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Broustas CG, Ross JS, Yang Q, Sheehan CE, Riggins R, Noone AM, Haddad BR, Seillier-Moiseiwitsch F, Kallakury BV, Haffty BG, Clarke R, Kasid UN. The Proapoptotic Molecule BLID Interacts with Bcl-XL and Its Downregulation in Breast Cancer Correlates with Poor Disease-Free and Overall Survival. Clin Cancer Res 2010; 16:2939-48. [DOI: 10.1158/1078-0432.ccr-09-2351] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ryanne Wu R, Lindenberg PA, Slack R, Noone AM, Marshall JL, He AR. Evaluation of hypertension as a marker of bevacizumab efficacy. J Gastrointest Cancer 2010; 40:101-8. [PMID: 19921473 DOI: 10.1007/s12029-009-9104-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Predictive factors for efficacy of vascular endothelial growth factor pathway-targeted therapies have not been identified or confirmed. Hypertension has been observed as a side effect to anti-vascular endothelial growth factor therapy. The goal of our study was to retrospectively assess if hypertension induced during treatment with bevacizumab was associated with clinical outcome in metastatic colorectal cancer patients treated with bevacizumab. PATIENTS AND METHODS We conducted a retrospective chart review of patients with colorectal cancer treated with bevacizumab at Lombardi Comprehensive Cancer Center from 2004 to 2008. RESULTS Eighty-four patients with metastatic colorectal cancer were eligible. Eighteen patients (21%) developed grades 3 hypertension. Twelve patients (14%) developed grade 2 hypertension. Six patients (7%) developed grade 1 hypertension. Median overall survival (OS) was 29 months and progression-free survival (PFS) was 10 months. Patients with any grade hypertension while on bevacizumab had an adjusted hazard ratio for death of 0.32 (p = 0.03) and adjusted risk of progression of 51% (p = 0.02) compared to those without hypertension (HTN). When stratified by metastatic disease, patients presenting with metastases who developed HTN had better OS and PFS (p = 0.03 and 0.01.) Among patients without metastases at diagnosis, those with HTN on bevacizumab had better OS and PFS but results were not statistically significant (p = 0.60 and 0.62, respectively). CONCLUSIONS Our data indicate that bevacizumab-induced hypertension may represent an interesting prognostic factor for clinical outcome in advanced colorectal cancer patients receiving bevacizumab.
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Affiliation(s)
- Rebekah Ryanne Wu
- Department of Internal Medicine, Georgetown University Hospital, 3800 Reservoir Rd., Washington, DC 20007, USA.
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Yan B, Noone AM, Yee C, Banerjee M, Schwartz K, Simon MS. Racial differences in colorectal cancer survival in the Detroit Metropolitan Area. Cancer 2009; 115:3791-800. [PMID: 19598220 DOI: 10.1002/cncr.24408] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Colorectal carcinoma is the second most common cause of cancer death with African Americans having lower survival compared with White Americans. The purpose of this study was to investigate the effect of demographics, clinical factors, and socioeconomic status (SES) on racial disparities in colorectal cancer survival in the Detroit Metropolitan Area. METHODS The study population included 9078 individuals with primary invasive colorectal cancer identified between 1988 and 1992 through the Surveillance, Epidemiology, and End Results (SEER) program. Demographics, clinical information, and survival were obtained through SEER. SES was categorized using occupation, educational level, and poverty status at the census tract level. Kaplan-Meier survival curves and Cox proportional hazards regression were used to compare overall survival by race. RESULTS African Americans were more likely to be diagnosed with stage IV disease (P < .001), and to reside within poor census tracts (P < .001) compared with White Americans. Unadjusted analysis showed that African Americans had a significantly higher risk of death compared with their White American counterparts (hazards ratio [HR], 1.13; 95% confidence interval [CI], 1.07-1.20). After adjusting for age, marital status, sex, SES group, TNM stage, and treatment, race was no longer significantly associated with overall survival (HR, 1.00; 95% CI, 0.92-1.09). Similar results were seen with colorectal cancer-specific survival. CONCLUSIONS Racial disparities in colorectal cancer survival dissipate after adjusting for other demographic and clinical factors. These results can potentially affect medical guidelines regarding screening and treatment, and possibly influence public health policies that can have a positive impact on equalizing racial differences in access to care.
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Affiliation(s)
- Ben Yan
- Department of Internal Medicine, Henry Ford Hospital and Medical Center, Detroit, Michigan, USA
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Liu MC, Shields PG, Warren RD, Cohen P, Wilkinson M, Ottaviano YL, Rao SB, Eng-Wong J, Seillier-Moiseiwitsch F, Noone AM, Isaacs C. Circulating tumor cells: a useful predictor of treatment efficacy in metastatic breast cancer. J Clin Oncol 2009; 27:5153-9. [PMID: 19752342 DOI: 10.1200/jco.2008.20.6664] [Citation(s) in RCA: 238] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Five or more circulating tumor cells (CTCs) per 7.5 mL of blood predicts for poorer progression-free survival (PFS) in patients with metastatic breast cancer (MBC). We conducted a prospective study to demonstrate that CTC results correlate strongly with radiographic disease progression at the time of and in advance of imaging. PATIENTS AND METHODS Serial CTC levels were obtained in patients starting a new treatment regimen for progressive, radiographically measurable MBC. Peripheral blood was collected for CTC enumeration at baseline and at 3- to 4-week intervals. Clinical outcomes were based on radiographic studies performed in 9- to 12-week intervals. RESULTS Sixty-eight patients were evaluable for the CTC-imaging correlations, and 74 patients were evaluable for the PFS analysis. Median follow-up was 13.3 months. A statistically significant correlation was demonstrated between CTC levels and radiographic disease progression in patients receiving chemotherapy or endocrine therapy. This correlation applied to CTC results obtained at the time of imaging (odds ratio [OR], 6.3), 3 to 5 weeks before imaging (OR, 3.1), and 7 to 9 weeks before imaging (OR, 4.9). Results from analyses stratified by type of therapy remained statistically significant. Shorter PFS was observed for patients with five or more CTCs at 3 to 5 weeks and at 7 to 9 weeks after the start of treatment. CONCLUSION We provide, to our knowledge, the first evidence of a strong correlation between CTC results and radiographic disease progression in patients receiving chemotherapy or endocrine therapy for MBC. These findings support the role of CTC enumeration as an adjunct to standard methods of monitoring disease status in MBC.
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Affiliation(s)
- Minetta C Liu
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20007-2198, USA.
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Aiello AE, Diez-Roux A, Noone AM, Ranjit N, Cushman M, Tsai MY, Szklo M. Socioeconomic and psychosocial gradients in cardiovascular pathogen burden and immune response: the multi-ethnic study of atherosclerosis. Brain Behav Immun 2009; 23:663-71. [PMID: 19150399 PMCID: PMC2694852 DOI: 10.1016/j.bbi.2008.12.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2008] [Revised: 12/16/2008] [Accepted: 12/17/2008] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The biologic mechanisms linking socioeconomic position and psychosocial factors to cardiovascular disease (CVD) are not well understood. Immune response to persistent pathogens may be one of these mechanisms. METHODS We analyzed cross-sectional data from the multi-ethnic study of atherosclerosis (N=999) composed of adults age 45-84. Log-binomial regression and ordinal logistic regression models were used to examine associations of socioeconomic factors and psychosocial factors with pathogen burden and immune response among those infected. Pathogen burden was assessed based on seroprevalence of Helicobacter pylori, cytomegalovirus, herpes simplex virus-1, and Chlamydia pneumoniae and antibody levels were used to characterize high immune response to all four pathogens. RESULTS Low education was a strong and significant independent predictor of higher pathogen burden after adjustment for covariates (adjusted odds ratio (OR) 95% confidence interval (CI) 1.37, 1.19-1.57). Among subjects seropositive for all four pathogens, low education and a higher level of chronic psychosocial stress showed a positive association with higher antibody response, although associations were no longer significant in models with all covariates included (OR=1.64, 95% CI 0.82-3.31 for lowest vs. highest educational category and OR=1.29, 95% CI 0.96-1.73 for a one level increase in chronic stress). CONCLUSION Pathogen burden and heightened immune response may represent a biological pathway by which low socioeconomic position and chronic stress are related to increased rates of cardiovascular disease.
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Affiliation(s)
- Allison E. Aiello
- Department of Epidemiology, University of Michigan-School of Public Health, Ann Arbor
| | - Ana Diez-Roux
- Department of Epidemiology, University of Michigan-School of Public Health, Ann Arbor
| | - Anne-Michelle Noone
- Department of Epidemiology, University of Michigan-School of Public Health, Ann Arbor
| | - Nalini Ranjit
- Department of Epidemiology, University of Michigan-School of Public Health, Ann Arbor
| | - Mary Cushman
- Department of Medicine, University of Vermont, Burlington
| | - Michael Y. Tsai
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis
| | - Moyses Szklo
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Sun JF, Wu RR, Norris C, Noone AM, Amankwa-Sakyi M, Slack R, Marshall JL. Safety of chronic low-dose capecitabine as maintenance therapy in gastrointestinal cancers. Gastrointest Cancer Res 2009; 3:134-140. [PMID: 19742139 PMCID: PMC2739638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Accepted: 06/11/2009] [Indexed: 05/28/2023]
Abstract
BACKGROUND Maintenance chemotherapy is not routinely used in gastrointestinal (GI) cancers. Capecitabine is an oral formulation that is enzymatically converted to 5-fluorouracil preferentially in tumor tissue. We hypothesize that capecitabine could be used as a long-term maintenance therapy to improve outcomes in patients with high-risk GI cancers following standard chemotherapy regimens. METHODS We conducted a retrospective study to assess the toxicity of maintenance capecitabine in 28 patients with a variety of advanced GI malignancies. Capecitabine 1,000 mg twice daily without interruption was used for the first 11 patients. The dose was reduced to 1,000 mg twice daily 5 days per week in 8 patients who developed hand-foot syndrome. The remaining patients began treatment on the same abbreviated schedule. All documented clinical adverse events were graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (v3.0, 2003). RESULTS Main toxicities were grade 1/2 fatigue and hand-foot syndrome. Only one grade 3 toxicity was observed and no grade 4 toxicities were seen. We also observed a significant increase in red blood cell mean corpuscular volume in participants, which may have potential use as a biomarker to monitor therapeutic response. CONCLUSIONS Fixed therapeutic doses of oral capecitabine 1,000 mg twice daily, 5 days on, 2 days off, can be administered chronically with a high level of safety and should be explored in larger prospective studies to demonstrate efficacy in GI malignancies, especially pancreatic and metastatic colorectal cancers.
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Affiliation(s)
- Jun F Sun
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
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Movva S, Noone AM, Banerjee M, Patel DA, Schwartz K, Yee CL, Simon MS. Racial differences in cervical cancer survival in the Detroit metropolitan area. Cancer 2008; 112:1264-71. [PMID: 18257090 DOI: 10.1002/cncr.23310] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND African-American (AA) women have lower survival rates from cervical cancer compared with white women. The objective of this study was to examine the influence of socioeconomic status (SES) and other variables on racial disparities in overall survival among women with invasive cervical cancer. METHODS One thousand thirty-six women (705 white women and 331 AA women) who were diagnosed with primary invasive cancer of the cervix between 1988 and 1992 were identified through the Metropolitan Detroit Cancer Surveillance System (MDCSS), a registry in the Surveillance, Epidemiology, and End Results (SEER) database. Pathology, treatment, and survival data were obtained through SEER. SES was categorized by using occupation, poverty, and educational status at the census tract level. Cox proportional hazards models were used to compare overall survival between AA women and white women adjusting for sociodemographics, clinical presentation, and treatment. RESULTS AA women were more likely to present at an older age (P<.001), with later stage disease (P<.001), and with squamous histology (P=.01), and they were more likely to reside in a census tract categorized as Working Poor (WP) (P<.001). After multivariate adjustment, race no longer had a significant impact on survival. Women who resided in a WP census tract had a higher risk of death than women from a Professional census tract (P=.05). There was a significant interaction between disease stage and time with the effect of stage on survival attenuated after 6 years. CONCLUSIONS In this study, factors that affected access to medical care appeared to have a more important influence than race on the long-term survival of women with invasive cervical cancer.
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Affiliation(s)
- Sujana Movva
- Department of Internal Medicine, Mclaren Regional Medical Center, Michigan State University, Flint, Michigan, USA
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Kroon HM, Li Q, Teitz-Tennenbaum S, Whitfield JR, Noone AM, Chang AE. 4-1BB Costimulation of Effector T Cells for Adoptive Immunotherapy of Cancer: Involvement of Bcl Gene Family Members. J Immunother 2007; 30:406-16. [PMID: 17457215 DOI: 10.1097/cji.0b013e31802eecc6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
We previously reported that in vitro costimulation of murine MCA 205 tumor-draining lymph node (TDLN) cells through a third signal, 4-1BB (CD137), in addition to CD3 and CD28 engagement significantly increases T-cell yield and amplifies antitumor responses in adoptive therapy. The increased T-cell yield seemed to be related to inhibition of activation-induced cell death. In this study, using real time-polymerase chain reaction and intracellular staining, we tested our hypothesis that antiapoptotic Bcl gene members are modulated in 4-1BB ligated TDLN cells. TDLN cells activated through 4-1BB in conjunction with CD3/CD28 demonstrated elevated Bcl-2 and Bcl-xL gene and protein expression compared with CD3/CD28 activation. Furthermore, Bcl-2 and/or Bcl-xL inhibition abrogated 4-1BB-conferred rescue of activation-induced cell death in TDLN cells, and as a result, 4-1BB-enhanced TDLN cell yield was abolished. Congenic mice were used as donors for TDLN cells labeled with CFSE to evaluate proliferation and persistence of activated cells after intravenous adoptive transfer. The effector function of transferred cells was assessed by determining the incidence of interferon-gamma-producing cells in response to tumor stimulation in serial blood samples drawn from treated mice using intracellular cytokine staining. CD28 and CD28/4-1BB costimulation significantly enhanced in vivo proliferation and survival of the infused cells compared with CD3 activation. 4-1BB coligation augmented the proliferation and effector function of the infused cells compared with both CD3 and CD3/CD28-activated cells. Characterizing the function of signaling molecules involved in T-cell activation pathways may allow optimization of conditions in the generation of effector T cells for cancer immunotherapy.
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Affiliation(s)
- Hidde M Kroon
- Division of Surgical Oncology, Surgery Department, University of Michigan, Ann Arbor, MI 48109-0932, USA
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Simon MS, Banerjee M, Crossley-May H, Vigneau FD, Noone AM, Schwartz K. Racial differences in breast cancer survival in the Detroit Metropolitan area. Breast Cancer Res Treat 2005; 97:149-55. [PMID: 16322888 DOI: 10.1007/s10549-005-9103-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2005] [Accepted: 10/18/2005] [Indexed: 10/25/2022]
Abstract
African American (AA) women have poorer breast cancer survival compared to Caucasian American (CA) women. The purpose of this analysis was to determine whether socioeconomic status (SES) and treatment differences influence racial differences in breast cancer survival. The study population included 9,321 women (82% CA, 18% AA) diagnosed with local (63%) or regional (37%) stage disease between 1988 and 1992, identified through the Metropolitan Detroit SEER registry. Data on SES were obtained through linkage with the 1990 Census of Population and Housing Summary Tape and cases were geocoded to census block groups. Pathology, treatment and survival data were obtained through SEER. Cox proportional hazards models were used to compare survival for AA versus CA women after adjusting for age, SES, tumor size, number of involved lymph nodes, and treatment. AA women were more likely to live in a geographic area classified as working poor than were CA women (p<0.001). AA women were less likely to have lumpectomy and radiation and more likely to have mastectomy with radiation (p<0.001). After multivariable adjusted analysis, there were no significant racial differences in survival among women with local stage disease, although AA women with regional stage disease had persistent but attenuated poorer survival compared to CA women. After adjusting for known clinical and SES predictors of survival, AA and CA women who are diagnosed with local disease demonstrate similar overall and breast cancer-specific survival, while race continues to have an independent effect among women presenting at a later stage of disease.
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Affiliation(s)
- Michael S Simon
- Division of Hematology and Oncology, Karmanos Cancer Institute at Wayne State University, Detroit, MI, USA.
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Abstract
STATEMENT OF PROBLEM The use of polyurethane liners beneath silicone facial prostheses is recommended to improve the effectiveness of water-based adhesives, reduce bacterial colonization, and allow very thin margins. Patients using silicone prostheses with a polyurethane lining often observe different degrees of debonding which may lead to failure of the prosthesis. Aggressive cleaning may be associated with debonding of the silicone to polyurethane. PURPOSE The purpose of this investigation was to determine the effect on bond strength of soaking specimens of silicone to polyurethane in hot or room-temperature soapy water. MATERIAL AND METHODS Specimens of silicone to primed polyurethane were divided into 3 groups of 16 specimens for testing: control (no soak), room-temperature soapy water soak, and hot soapy water soak. The soaked specimens were placed in soapy water at different temperatures for 1825 minutes to simulate 1 year of a 5 min/day cleaning cycle. One examiner performed the assessment of T-peel strength (N/mm) for all specimens. Each specimen was attached to an adhesive testing machine and separated in tension at the crosshead speed of 25.4 mm/min. Data were analyzed with a 1-way ANOVA followed by post hoc pairwise testing using the Tukey test (alpha=.05). RESULTS A significant difference in bonding strength between the 3 groups was found (P<.001), with post hoc tests indicating that the control group bonding strength (6.06 +/- 1.84 N/mm) was significantly higher than both room-temperature water soapy soak (3.93 +/- 1.84 N/mm; P=.005) and the hot soapy water soak group values (2.49 +/- 1.75 N/mm; P<.001). However, there was no significant difference found between the hot and room-temperature soapy soak values. CONCLUSION Within the limitations of this study, soaking in hot or room-temperature soapy water produced a significant reduction of bond strength of silicone to polyurethane.
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Affiliation(s)
- Hong-Ying Deng
- Department of Oral and Maxillofacial Surgery/Hosptial Dentistry, School of Dentistry, University of Michigan, Ann Arbor, USA
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