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Pinheiro PS, Koru-Sengul T, Zhao W, Hernandez DR, Hernandez MN, Kobetz EN, Caban-Martinez AJ, Lee DJ. Distinct Prostate Cancer Survival Outcomes in Firefighters: A Population-Based Study. Cancers (Basel) 2024; 16:1305. [PMID: 38610983 PMCID: PMC11010940 DOI: 10.3390/cancers16071305] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/09/2024] [Accepted: 03/18/2024] [Indexed: 04/14/2024] Open
Abstract
Introduction: Survival outcomes for prostate cancer among specific occupational groups prone to regular medical check-ups vis-à-vis the general population have been understudied. For firefighters, a demographic subject to rigorous medical evaluations, possessing above-average medical expertise, and exposed to specific carcinogens of interest, prostate cancer survival in the US has never been studied. Methods: We conducted a retrospective study, utilizing data from the Florida Cancer Data System spanning 2004 to 2014, coupled with firefighter certification records from the Florida State Fire Marshal's Office. Our study cohort consisted of 1058 prostate cancer cases among firefighters as well as prostate cases for the Florida general population (n = 150,623). We compared cause-specific survival between the two using Cox regression models adjusted for demographics and clinical characteristics, including PSA levels, Gleason scores, and treatment modalities. Results: Firefighters demonstrated a higher five-year cause-specific survival rate (96.1%, 95% CI: 94.7-97.1%) than the general population (94.2%, 95%CI: 94.1-94.3%). Overall, firefighters' diagnoses were established at younger ages (median age 63 vs. 67 in the general population), exhibited a higher proportion of localized stage cancers (84.7% vs. 81.1%), and had a greater utilization of surgery (46.4% vs. 37.6%), a treatment modality with a high success rate but potential side effects. In multivariable analysis, firefighters displayed a survival advantage for localized stage (adjusted hazard ratio [aHR] = 0.53; 95%CI: 0.34-0.82). However, for regional or distant stages, firefighters aged 65 and above exhibited a higher risk of death (aHR = 1.84; 95% CI: 1.18-2.86) than the general population. Conclusion: Firefighters experience enhanced prostate cancer survival, primarily in cases diagnosed at localized stages, likely due to increased PSA testing. Nonetheless, for regional or distant stage, survival among older firefighters' lags behind that of the general population. Further investigations are warranted to unravel factors influencing the development of aggressive disease beyond PSA and Gleason scores in this population, as well as to assess the impact of a higher rate of surgical treatment on firefighters' quality of life.
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Affiliation(s)
- Paulo S. Pinheiro
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (T.K.-S.); (E.N.K.); (A.J.C.-M.); (D.J.L.)
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (W.Z.); (D.R.H.)
| | - Tulay Koru-Sengul
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (T.K.-S.); (E.N.K.); (A.J.C.-M.); (D.J.L.)
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (W.Z.); (D.R.H.)
| | - Wei Zhao
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (W.Z.); (D.R.H.)
| | - Diana R. Hernandez
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (W.Z.); (D.R.H.)
| | - Monique N. Hernandez
- Florida Cancer Data System, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA;
| | - Erin N. Kobetz
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (T.K.-S.); (E.N.K.); (A.J.C.-M.); (D.J.L.)
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (W.Z.); (D.R.H.)
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Alberto J. Caban-Martinez
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (T.K.-S.); (E.N.K.); (A.J.C.-M.); (D.J.L.)
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (W.Z.); (D.R.H.)
| | - David J. Lee
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (T.K.-S.); (E.N.K.); (A.J.C.-M.); (D.J.L.)
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (W.Z.); (D.R.H.)
- Florida Cancer Data System, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA;
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Koru-Sengul T, Pinheiro PS, Zhao W, Hernandez MN, Hernandez DR, Maggioni A, Kobetz EN, Caban-Martinez AJ, Lee DJ. Lung cancer survival among Florida male firefighters. Front Oncol 2023; 13:1155650. [PMID: 37664012 PMCID: PMC10473410 DOI: 10.3389/fonc.2023.1155650] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/27/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction Lung cancer is a leading cause of cancer incidence and death in the United States. Although most firefighters are fit and do not smoke, they are exposed to many known carcinogens during and in the aftermath of firefighting activities. Comprehensive epidemiologic investigations on lung cancer survival for both career and volunteer firefighters have not been undertaken. Methods Data from the Florida Cancer Data System (1981-2014) were linked with firefighter certification records from the Florida State Fire Marshal's Office to identify all patients of this occupational group; lung cancer cause-specific survival data were compared with other occupational groups using Cox regression models with occupation as the main effect. Adjusted hazard ratios (aHR) and 95% confidence intervals (95% CI) were calculated. Results Out of 210,541 male lung cancer cases diagnosed in Florida (1981-2014), 761 were firefighters (604 career, 157 volunteer). Lung cancer death was similar between volunteer (75.2%) and career firefighters (74.0%) but lower than non-firefighters (80.0%). Survival at 5 years was higher among firefighters (29.7%; career: 30.3%; volunteer: 27.4%) than non-firefighters (23.8%). In a multivariable model, compared with non-firefighters, firefighters have significantly higher cause-specific survival (aHR = 0.84; 95% CI: 0.77-0.91; p < 0.001). However, there were no significant survival differences between career and volunteer firefighters (1.14; 0.93-1.39; p = 0.213). In a separate multivariable model with firefighters as the comparator, other broad occupational groups had significantly lower cause-specific survival [white collar: 1.11 (1.02-1.21); blue collar: 1.15 (1.05-1.25); service: 1.13 (1.03-1.25); others/unknown: 1.21 (1.12-1.32); all p-values < 0.02]. Conclusion Lung cancer survival is significantly higher among firefighters compared with non-firefighters, but there is no significant difference between career and volunteer firefighters. Improved survival for firefighters might be due to a healthy worker effect, lower smoking prevalence relative to other worker groups, and possibly superior treatment adherence and compliance. Many firefighters are cross-trained as EMTs/paramedics and possess a level of medical knowledge that may favorably impact treatment engagement and better navigation of complex cancer care.
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Affiliation(s)
- Tulay Koru-Sengul
- Department of Public Health Sciences, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, United States
- Sylvester Comprehensive Cancer Center, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, United States
| | - Paulo S. Pinheiro
- Department of Public Health Sciences, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, United States
- Sylvester Comprehensive Cancer Center, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, United States
| | - Wei Zhao
- Sylvester Comprehensive Cancer Center, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, United States
| | - Monique N. Hernandez
- Florida Cancer Data System, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, United States
| | - Diana R. Hernandez
- Department of Public Health Sciences, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, United States
| | - Alessandra Maggioni
- Department of Public Health Sciences, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, United States
| | - Erin N. Kobetz
- Department of Public Health Sciences, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, United States
- Sylvester Comprehensive Cancer Center, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, United States
- Department of Medicine, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, United States
| | - Alberto J. Caban-Martinez
- Department of Public Health Sciences, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, United States
- Sylvester Comprehensive Cancer Center, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, United States
- Department of Physical Medicine and Rehabilitation, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, United States
| | - David J. Lee
- Department of Public Health Sciences, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, United States
- Sylvester Comprehensive Cancer Center, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, United States
- Florida Cancer Data System, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, United States
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Ogunsina K, Koru-Sengul T, Rodriguez V, Caban-Martinez AJ, Schaefer-Solle N, Ahn S, Kobetz EN, Hernandez MN, Lee DJ. A comparative analysis of histologic types of thyroid cancer between career firefighters and other occupational groups in Florida. BMC Endocr Disord 2022; 22:222. [PMID: 36056343 PMCID: PMC9438132 DOI: 10.1186/s12902-022-01104-5] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 07/18/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Florida Firefighters experience a higher risk of thyroid cancer than non-firefighters. This study examines whether the histologic types and tumor stage of thyroid cancer is different among firefighters compared to other occupational groups. METHODS Eligible cases were firefighters (n = 120) identified in a linkage of Florida Cancer Data System (FCDS) registry records (1981-2014) and Florida State Fire Marshal's Office employment and certification records, and non-firefighters classified into: blue-collar (n = 655), service (n = 834), white-collar (n = 4,893), and other (n = 1,789). Differences in thyroid histologic type (papillary, follicular, and rare/other less common forms of thyroid cancer), tumor stage, and age at diagnosis were evaluated using multinomial logistic regression models comparing blue-collar, service, white-collar, and other occupational groups with firefighters. Univariate odds ratios as well as odds ratios adjusted for age, gender, race, tumor stage, and year of diagnosis (aOR) and 95% confidence intervals (95%CI) were reported. RESULTS Service (aOR = 4.12; 95%CI: 1.25-13.65), white-collar (aOR = 3.51; 95%CI: 1.08-11.36), and blue-collar (aOR = 4.59; 95%CI: 1.40-15.07) workers had significantly higher odds of being diagnosed with rare histologic types of thyroid cancer vs papillary type compared to firefighters. Service (aOR = 0.42; 95%CI: 0.27-0.66), white-collar (aOR = 0.39; 95%CI: 0.26-0.59), blue-collar (aOR = 0.36; 95%CI: 0.23-0.56), and other (aOR = 0.34; 95%CI: 0.22-0.53) occupational groups have a significantly lower odds of being diagnosed with rare vs papillary type at a younger age (30-49 years) vs 50-69 years compared to firefighters. However, stage at diagnosis was not significantly different among occupational groups. CONCLUSION Firefighters diagnosed with thyroid cancer experience a higher odds of papillary compared to rare histologic types of thyroid cancer relative to other workers; there is no evidence of an increased odds of late-stage diagnosis in firefighters relative to other worker groups. Firefighters may benefit from routine screening and active surveillance of suspected thyroid tumors especially given the excellent treatment outcomes available for those diagnosed with early-stage papillary thyroid tumors.
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Affiliation(s)
- Kemi Ogunsina
- Department of Public Health Sciences, Leonard M. Miller School of Medicine University of Miami, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, Leonard M. Miller School of Medicine University of Miami, Miami, FL, USA
| | - Tulay Koru-Sengul
- Department of Public Health Sciences, Leonard M. Miller School of Medicine University of Miami, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, Leonard M. Miller School of Medicine University of Miami, Miami, FL, USA
| | - Valentina Rodriguez
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine Leonard M. Miller School of Medicine University of Miami, Miami, FL, USA
| | - Alberto J Caban-Martinez
- Department of Public Health Sciences, Leonard M. Miller School of Medicine University of Miami, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, Leonard M. Miller School of Medicine University of Miami, Miami, FL, USA
| | - Natasha Schaefer-Solle
- Sylvester Comprehensive Cancer Center, Leonard M. Miller School of Medicine University of Miami, Miami, FL, USA
- Department of Medicine Leonard M. Miller School of Medicine University of Miami, Miami, FL, USA
| | - Soyeon Ahn
- Department of Educational and Psychological Studies, School of Education and Human Development University of Miami, Miami, FL, USA
| | - Erin N Kobetz
- Sylvester Comprehensive Cancer Center, Leonard M. Miller School of Medicine University of Miami, Miami, FL, USA
- Department of Medicine Leonard M. Miller School of Medicine University of Miami, Miami, FL, USA
| | - Monique N Hernandez
- Florida Cancer Data System, Sylvester Comprehensive Cancer Center, Leonard M. Miller School of Medicine University of Miami, Miami, FL, USA
| | - David J Lee
- Department of Public Health Sciences, Leonard M. Miller School of Medicine University of Miami, Miami, FL, USA.
- Sylvester Comprehensive Cancer Center, Leonard M. Miller School of Medicine University of Miami, Miami, FL, USA.
- Florida Cancer Data System, Sylvester Comprehensive Cancer Center, Leonard M. Miller School of Medicine University of Miami, Miami, FL, USA.
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Hernandez MN, Levin G, Hylton T, Pordell P, White A, Senkomago V. Integration of Cancer Screening Data into Routine Cancer Surveillance Systems: A Florida Pilot Project. J Registry Manag 2022; 49:132-138. [PMID: 37260814 PMCID: PMC10229182] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Introduction Integration of screening data into routine cancer surveillance systems can create more robust data systems to inform cancer prevention and control activities. Currently, state central cancer registries do not routinely collect breast and cervical cancer screening data as part of state cancer surveillance activities. Florida conducted a pilot study involving: (1) linkage of breast and cervical cancer screening data from the Florida Breast and Cervical Cancer Early Detection Program (FBCCEDP) from 2009 to 2021 to the Florida Cancer Data System (FCDS) database to capture screening data for matched cancer cases in the FCDS; and (2) evaluation of the feasibility of developing a population-based breast and cervical cancer screening surveillance system by capturing electronic screening data from private health care providers. Methods In 2018, the FCDS worked with the Florida Department of Health to identify data partners for the 5-year cancer screening pilot project funded by the Centers for Disease Control and Prevention. Engagement of project partners required extensive review of available screening data; data standards and formatting; data transmission schedules and methods; and processing procedures. The FCDS developed a database to integrate multiple source data sets into a single database whereby linkage to the central cancer registry could be performed. Results The FCDS worked with Suncoast Health Systems, a clinical practice in the Hillsborough region of Florida, and the FBCCEDP to evaluate data availability, standardization of data sets, and data submission schedules for the pilot project. Extensive meetings and data reviews were conducted with both partners in the first phase of the project. The FCDS developed automated data processing procedures to integrate the data into a single cancer screening database and then linked records to the central cancer registry data set. Discussion Registry collaboration with the FBCCEDP and Suncoast team on data quality and standardization has produced positive results. The project required extensive review of data and produced many lessons learned for development of a cancer screening surveillance system. Our pilot project depended on partnership building, commitment to data quality, and consistency in data submission practices.
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Affiliation(s)
| | - Gary Levin
- Florida Cancer Data System, University of Miami Miller School of Medicine
| | | | - Paran Pordell
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control
| | - Arica White
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control
| | - Virginia Senkomago
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control
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McClure LA, Koru‐Sengul T, Hernandez MN, Caban‐Martinez AJ, Kobetz EN, Lee DJ. Comparing cancer risk estimates using occupational record linkage approaches in male Florida firefighters. Am J Ind Med 2021; 64:78-83. [PMID: 33283309 DOI: 10.1002/ajim.23205] [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: 05/21/2020] [Revised: 10/27/2020] [Accepted: 11/05/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Firefighters have an increased risk of cancer, but variations in reported results could be due to differences in occupational case ascertainment. This study compares cancer risk estimates generated by identifying firefighters from their occupational title available in the Florida Cancer Data System (FCDS) versus identification by a linkage method between the FCDS and the Florida State Fire Marshal's Office. METHODS Florida firefighter employment records (1972-2012; n = 109,009) were linked with FCDS data (1981-2014; ~3.3 million records), identifying 3760 primary cancers in male firefighters. Using the FCDS occupational data field we identified 1831 male cancer cases in those classified as firefighters, first-line supervisors of firefighting and prevention workers, fire inspectors, emergency medical technicians, or paramedics. Age and calendar year-adjusted odds ratios (aOR) and 95% confidence intervals for firefighters versus non-firefighters were calculated for both groups. RESULTS For skin cancers the risk estimate for FCDS-indentified firefighters was substantially lower than in the employment-record-linked firefighters (aOR = 1.06; 0.87-1.29 vs. 1.54; 1.37-1.73), but for endocrine system cancers it was greater (aOR = 2.36; 1.77-3.14 vs. 2.08; 1.71-2.53). Remaining cancer risk estimates were in the same direction for the two samples except for lymphoma (aOR = 1.10; 0.90-1.34 vs. 0.86; 0.75-0.99). CONCLUSION Reliance on occupational title in cancer registry records to characterize firefighter cancer risk may result in estimates that are over- or underestimated depending on cancer site. The authors recommend moving toward national linkages between cancer registries and certification or other administrative records, which are a vital resource for firefighter cancer research.
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Affiliation(s)
- Laura A. McClure
- Department of Public Health Sciences University of Miami Miller School of Medicine Miami Florida USA
| | - Tulay Koru‐Sengul
- Department of Public Health Sciences University of Miami Miller School of Medicine Miami Florida USA
- Sylvester Comprehensive Cancer Center University of Miami Miller School of Medicine Miami Florida USA
| | - Monique N. Hernandez
- Florida Cancer Data System, Sylvester Comprehensive Cancer Center University of Miami Miller School of Medicine Miami Florida USA
| | - Alberto J. Caban‐Martinez
- Department of Public Health Sciences University of Miami Miller School of Medicine Miami Florida USA
- Sylvester Comprehensive Cancer Center University of Miami Miller School of Medicine Miami Florida USA
| | - Erin N. Kobetz
- Department of Public Health Sciences University of Miami Miller School of Medicine Miami Florida USA
- Sylvester Comprehensive Cancer Center University of Miami Miller School of Medicine Miami Florida USA
- Department of Medicine University of Miami Miller School of Medicine Miami Florida USA
| | - David J. Lee
- Department of Public Health Sciences University of Miami Miller School of Medicine Miami Florida USA
- Sylvester Comprehensive Cancer Center University of Miami Miller School of Medicine Miami Florida USA
- Florida Cancer Data System, Sylvester Comprehensive Cancer Center University of Miami Miller School of Medicine Miami Florida USA
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Lee DJ, Koru‐Sengul T, Hernandez MN, Caban‐Martinez AJ, McClure LA, Mackinnon JA, Kobetz EN. Cancer risk among career male and female Florida firefighters: Evidence from the Florida Firefighter Cancer Registry (1981-2014). Am J Ind Med 2020; 63:285-299. [PMID: 31930542 DOI: 10.1002/ajim.23086] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [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: 10/09/2019] [Revised: 11/22/2019] [Accepted: 12/17/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Firefighters are at increased risk for select cancers. However, many studies are limited by relatively small samples, with virtually no data on the cancer experience of female firefighters. This study examines cancer risk in over 100,000 career Florida firefighters including 5000 + females assessed over a 34-year period. METHODS Florida firefighter employment records (n = 109 009) were linked with Florida Cancer Data System registry data (1981-2014; ~3.3 million records), identifying 3760 male and 168 female-linked primary cancers. Gender-specific age and calendar year-adjusted odds ratios (aOR) and 95% confidence intervals for firefighters vs non-firefighters were calculated. RESULTS Male firefighters were at increased risk of melanoma (aOR = 1.56; 1.39-1.76), prostate (1.36; 1.27-1.46), testicular (1.66; 1.34-2.06), thyroid (2.17; 1.78-2.66) and late-stage colon cancer (1.19;1.00-1.41). Female firefighters showed significantly elevated risk of brain (2.54; 1.19-5.42) and thyroid (2.42; 1.56-3.74) cancers and an elevated risk of melanoma that approached statistical significance (1.68; 0.97-2.90). Among male firefighters there was additional evidence of increased cancer risk younger than the age of 50 vs 50 years and older for thyroid (2.55; 1.96-3.31 vs 1.69; 1.22-2.34), prostate (1.88; 1.49-2.36 vs 1.36; 1.26-1.47), testicular (1.60; 1.28-2.01 vs 1.47; 0.73-2.94), and melanoma (1.87; 1.55-2.26 vs 1.42; 1.22-1.66) cancers. CONCLUSION Male career firefighters in Florida are at increased risk for five cancers with typically stronger associations in those diagnosed younger than the age of 50, while there was evidence for increased thyroid and brain cancer, and possibly melanoma risk in female firefighters. Larger cohorts with adequate female representation, along with the collection of well-characterized exposure histories, are needed to more precisely examine cancer risk in this occupational group.
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Affiliation(s)
- David J. Lee
- Sylvester Comprehensive Cancer CenterUniversity of Miami Miller School of Medicine Miami Florida
- Department of Public Health SciencesUniversity of Miami Miller School of Medicine Miami Florida
- Florida Cancer Data System, Sylvester Comprehensive Cancer CenterUniversity of Miami Miller School of MedicineMiami Florida
| | - Tulay Koru‐Sengul
- Sylvester Comprehensive Cancer CenterUniversity of Miami Miller School of Medicine Miami Florida
- Department of Public Health SciencesUniversity of Miami Miller School of Medicine Miami Florida
| | - Monique N. Hernandez
- Florida Cancer Data System, Sylvester Comprehensive Cancer CenterUniversity of Miami Miller School of MedicineMiami Florida
| | - Alberto J. Caban‐Martinez
- Sylvester Comprehensive Cancer CenterUniversity of Miami Miller School of Medicine Miami Florida
- Department of Public Health SciencesUniversity of Miami Miller School of Medicine Miami Florida
| | - Laura A. McClure
- Sylvester Comprehensive Cancer CenterUniversity of Miami Miller School of Medicine Miami Florida
- Department of Public Health SciencesUniversity of Miami Miller School of Medicine Miami Florida
| | - Jill A. Mackinnon
- Florida Cancer Data System, Sylvester Comprehensive Cancer CenterUniversity of Miami Miller School of MedicineMiami Florida
| | - Erin N. Kobetz
- Sylvester Comprehensive Cancer CenterUniversity of Miami Miller School of Medicine Miami Florida
- Department of Public Health SciencesUniversity of Miami Miller School of Medicine Miami Florida
- Department of MedicineUniversity of Miami Miller School of Medicine Miami Florida
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McClure LA, Koru-Sengul T, Hernandez MN, Mackinnon JA, Schaefer Solle N, Caban-Martinez AJ, Lee DJ, Kobetz E. Availability and accuracy of occupation in cancer registry data among Florida firefighters. PLoS One 2019; 14:e0215867. [PMID: 31039169 PMCID: PMC6490882 DOI: 10.1371/journal.pone.0215867] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 12/31/2018] [Accepted: 04/09/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Occupational exposures significantly contribute to the risk of adverse cancer outcomes, and firefighters face many carcinogenic exposures. Occupational research using cancer registry data, however, is limited by missing and inaccurate occupation-related fields. The objective of this study is to determine the frequency and predictors of missing and inaccurate occupation data for a cohort of career firefighters in a state cancer registry. METHODS We conducted a linkage between data from the Florida Cancer Data System (1981-2014) and the Florida State Fire Marshal's Office (1972-2012). The percentage and the odds of having a firefighting-related occupation code in the cancer record were calculated, adjusting for other occupation and cancer-related factors. RESULTS Among 3,928 career firefighters, nearly half (47%) were missing a registry-dervived occupation code and only 17% had a firefighting-related code. Males were more likely to have a firefighting-related code (OR = 2.31;95%CI: 1.41-3.76), as were those with more recent diagnoses (OR1992-2002 = 2.98;95%CI: 1.57-5.67; OR2003-2014 = 11.40;95%CI: 6.17-21.03), and those of younger ages (OR45-64y = 1.26;95%CI: 1.03-1.54; OR20-44y = 2.26;95%CI: 1.73-2.95). CONCLUSIONS Accurate occupation data is key for identifying increased risk of advserse cancer outcomes. Cancer registry occupation fields, however, are overwhelmingly missing for firefighters and are missing disproportionally by sociodemographic and diagnosis characteristics. This study highlights the lack of accurate occupation data available for hypothesis-driven cancer research. Cancer registry linkage with external occupational data sources represents an essential resource for conducting studies among at-risk populations such as firefighters.
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Affiliation(s)
- Laura A. McClure
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Tulay Koru-Sengul
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States of America
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Monique N. Hernandez
- Florida Cancer Data System, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Jill A. Mackinnon
- Florida Cancer Data System, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Natasha Schaefer Solle
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Alberto J. Caban-Martinez
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States of America
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - David J. Lee
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States of America
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States of America
- Florida Cancer Data System, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Erin Kobetz
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States of America
- Florida Cancer Data System, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States of America
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, United States of America
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Calvo MF, Allemand C, Valerio AC, Hernandez MN, Corrao FH, Castro Barba M, Wernicke A, Orti R, Ilzarbe F, Gogorza SJ, Albrecht A, Izbizky GH, Lorusso C. Abstract P3-13-09: Prediction of underestimation associated with flat epithelial atypia, atypical ductal hyperplasia and atypical lobular hyperplasia by needle biopsy: Experience in an Argentine breast unit. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p3-13-09] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
INTRODUCTION: Flat Epithelial Atypia (FEA), Atypical Ductal Hyperplasia (ADH), and Atypical Lobular Hyperplasia (ALH) are well known non-obligate precursors of breast malignancy. Management of FEA, ADH and ALH after image-guided needle biopsy (NB) still remains controversial. The aim of this study was to evaluate the rate of malignancy underestimation associated to FEA, ADH or ALH diagnosis by image-guided NB, either core needle biopsies (CNB) or vacuum assisted breast biopsy (VABB). As a secondary objective, we attempted to identify clinical characteristics and imaging features associated with malignancy.
MATERIAL AND METHOD: We retrospectively reviewed all consecutive image-guided NB performed between January 2006 and April 2016 that resulted in a diagnosis of FEA, ADH or ALH which were subsequently submitted to surgical biopsy. All pathological reports were available. We compared the pathology specimens obtained from biopsy to those obtained from surgery. The rate of underestimation was calculated by means of specific mathematical equations.
RESULTS: Among 4715 patients who underwent image guided NB, 174 (3.7%) resulted in diagnosis of FEA, ADH and ALH. 49 patients were excluded because of loss in follow up.The diagnosis in the remaining 126 cases, were 45 (36%) FEA, 66 (51%) ADH, 9 (7%) ALH and 8 (6%) combined diagnoses. Of these, 16 (13%) were ultrasound-guided CNB procedures and 110 (87%) stereotactic VABBs. In thirty-six cases (28,3%) the diagnosis was upgraded to malignancy. For CNB specimens, we found underestimation in 10 of 16 procedures (62.5%) and at VABB there were 26 cases of underestimation out of a total of 110 biopsies (23%). Univariate analysis indicated that use of CNB (p=0.001), residual calcifications (p=0.008), and presence of ALH in NB specimens (p=0.08) were independent predictors of underestimation. The presence of a mass on ultrasound was more likely to be associated with malignancy, as 5 out of 10 lumps (50%) resulted in lesion upgrade. Neither age at diagnosis nor hormonal status were significant predictors for malignancy underestimation. The final pathological results of the underestimated NBs, distributed by lesion type were as follows: For FEA, we found 7 low grade DCIS, 1 high grade DCIS and 1 invasive tubular carcinoma. Among 20 cases of ADH, we encountered 15 low grade DCIS, 1 invasive tubular carcinoma, and 4 NST ductal carcinoma. In 5 cases originally diagnosed as ALH we upgraded to LCIS, we found 1 invasive lobular carcinoma, and 1 invasive ductal carcinoma. Finally, both of the combined lesions resulted in upgrade to invasive ductal carcinomas.
CONCLUSION: In our experience, we found that the diagnostic underestimation rate when using CNB is approximately three times than for VABB. Residual microcalcifications and presence of ALH on NB were found to be independent predictors of underestimation. In our country, surgical excision of FEA, ADH and ALH remains the standard of care. Further research is needed in order to establish which patients with atypical findings on initial biopsy will achieve benefit from surgery, and which might be suitable candidates for surveillance.
Citation Format: Calvo MF, Allemand C, Valerio AC, Hernandez MN, Corrao FH, Castro Barba M, Wernicke A, Orti R, Ilzarbe F, Gogorza SJ, Albrecht A, Izbizky GH, Lorusso C. Prediction of underestimation associated with flat epithelial atypia, atypical ductal hyperplasia and atypical lobular hyperplasia by needle biopsy: Experience in an Argentine breast unit [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-13-09.
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Affiliation(s)
- MF Calvo
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - C Allemand
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - AC Valerio
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - MN Hernandez
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - FH Corrao
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - M Castro Barba
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - A Wernicke
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - R Orti
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - F Ilzarbe
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - SJ Gogorza
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - A Albrecht
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - GH Izbizky
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - C Lorusso
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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McClure LA, Miller EA, Tannenbaum SL, Hernandez MN, MacKinnon JA, He Y, LeBlanc WG, Lee DJ. Linking the National Health Interview Survey with the Florida Cancer Data System: A Pilot Study. J Registry Manag 2016; 43:16-22. [PMID: 27195994 PMCID: PMC5682620] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Cancer registry data are vital for the surveillance of cancer trends, but registries are limited in the number of data items that can be collected for hypothesis-driven research. Linkage with other databases can add valuable information and is a potentially effective tool for increasing our understanding of and identifying the causes of cancer and health disparities along the cancer continuum. We conducted a pilot study to link data from the 1981-2010 Florida Cancer Data System (FCDS) with data from the 1986-2009 National Health Interview Survey (NHIS). The NHIS data contain important information on sociodemographics, screening behaviors, comorbidities, risk factors, health care access, and quality of life, which are not available from FCDS. The linkage resulted in a total of 6,281 linked cases. After removing cases with a first cancer diagnosis before 1981 (prior to FCDS creation) or missing date of diagnosis information, there were 1,908 cases diagnosed with cancer prior to their NHIS interview and 4,367 cases diagnosed after their NHIS interview. The enriched data set resulting from the linkage allows us to evaluate risk factors associated with developing cancer as well as conduct analyses on cancer survivorship issues and mortality. This pilot study demonstrates the feasibility and utility of a linkage between cancer registries and national health surveys, while also acknowledging the cost and challenges associated with such linkages.
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Affiliation(s)
- Laura A. McClure
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida
| | - Eric A. Miller
- National Center for Health Statistics, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stacey L. Tannenbaum
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida
| | - Monique N. Hernandez
- Florida Cancer Data System, University of Miami Miller School of Medicine, Miami, Florida
| | - Jill A. MacKinnon
- Florida Cancer Data System, University of Miami Miller School of Medicine, Miami, Florida
| | - Yulei He
- National Center for Health Statistics, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - William G. LeBlanc
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - David J. Lee
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida
- Florida Cancer Data System, University of Miami Miller School of Medicine, Miami, Florida
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Sussman DA, McClure LA, Hernandez MN, Tannenbaum SL, Bonner JM, Zheng DD, Lee DJ. Factors associated with receipt of radiation therapy for rectal cancer. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.3_suppl.747] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
747 Background: Appropriate treatment for rectal cancer is vital to increasing the likelihood of survival. Disparities in receipt of appropriate radiation treatment have been observed with respect to race/ethnicity and socioeconomic status. We used enriched cancer registry data to identify alternative factors associated with receipt of appropriate radiation therapy for rectal cancer. Methods: Data were obtained from the Florida Cancer Data System and were enriched with detailed treatment information collected from a Centers for Disease Control and Prevention Comparative Effectiveness Research study. Using multivariable regression, we evaluated factors associated with receipt of radiation therapy among rectal cancer cases summary stage II/III. Our sample (n=403) included cases diagnosed in Florida in 2011 who were 18 years and older. Cases clinically staged as 0/1/4 were excluded. Though patients over age 80 years (n=67) and those with stage IIA disease (n=185) may not routinely be prescribed radiation, these cases were included in order to maximize the sample size. Results: Our sample was an average of 64 years-old, more often male (59%), NH White (56%), diagnosed with stage III disease (54%), insured (92%), had received surgical intervention (87%), chemotherapy (68%), or radiation (57%), were in the highest SES quartile (56%), and had one or more comorbid condition (57%). Older age (OR=0.96; 95%CI=0.94-0.97), the presence of more than one comorbidity (0.61; 0.39-0.96), and receipt of surgical intervention (0.44; 0.22-0.90) were predictors of not receiving radiation. Conclusions: Contrary to our hypothesis, socio-demographic factors such as race/ethnicity, insurance status, and socioeconomic status, did not influence the receipt of radiation. Further research is needed, however, to understand why age, comorbidity, and surgery present a barrier to radiation, particularly given that radiotherapy is a well-tolerated modality.
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Affiliation(s)
| | - Laura A. McClure
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Monique N. Hernandez
- Florida Cancer Data System, University of Miami Miller School of Medicine, Miami, FL
| | - Stacey L. Tannenbaum
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Judith M. Bonner
- Florida Cancer Data System, University of Miami Miller School of Medicine, Miami, FL
| | - D. Diane Zheng
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - David J. Lee
- Sylvester Comprehensive Cancer Center, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
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Sussman DA, Tannenbaum SL, McClure LA, Hernandez MN, Zheng DD, Koru-Sengul T, Carrasquillo O, Lee DJ. Colorectal cancer mortality among Cuban and non-Cuban Hispanics. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.3_suppl.775] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
775 Background: We examined all-cause mortality of Floridian colorectal cancer (CRC) patients among Hispanics of Cuban and non-Cuban origin, non-Hispanic Whites (NHWs) and non-Hispanic Blacks (NHBs). We hypothesized that Cuban Hispanics would have a higher mortality risk relative to other Hispanics in Florida with CRC. Methods: We obtained data from the Florida Cancer Data System for all incident CRC cases (2007-2011) among Floridians 18+ years and linked these files with data from Florida’s Agency for Health Care Administration and the 2006-2010 American Community Survey (n=46,579). Race/ethnic groups were Cuban, non-Cuban Hispanic, NHW, and NHB. Log-rank tests were performed among race/ethnic groups with multivariable Cox proportional hazard regression models for mortality adjusting for demographic and clinical factors to produce adjusted hazard ratios (HR). Results: Cubans’ mortality were not significantly different from NHWs (p=0.8254) or NHBs (p=0.3047) but significantly different from non-Cuban Hispanics (p=0.0006). Adjusting for all covariates and compared with highest SES within each race/ethnicity, residing in lower SES neighborhoods was associated with increased mortality risk for NHWs (HR=1.19; 95%CI=1.12-1.27) and NHBs (1.33; 1.13-1.57) but not for Hispanics. Among Hispanics, Cubans with proximal CRC had a 42% higher mortality risk than those with distal disease (1.42; 1.11-1.82); however, tumor location was not predictive of mortality for other racial/ethnic groups. Single or widowed Cuban Hispanics had higher mortality risk compared to those who were married (1.42; 1.07-1.88 for both comparisons) but this was not true for non-Cuban Hispanics. Conclusions: Cuban Hispanics are a distinct and understudied population group who should not be aggregated into a general category of Hispanic with respect to CRC mortality studies. Further research to understand the Cuban Hispanic differences in CRC mortality risk is needed to reduce the burden of disease, especially in the ever growing Hispanic population.
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Affiliation(s)
| | - Stacey L. Tannenbaum
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Laura A. McClure
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Monique N. Hernandez
- Florida Cancer Data System, University of Miami Miller School of Medicine, Miami, FL
| | - D. Diane Zheng
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Tulay Koru-Sengul
- Department of Epidemiology and Public Health and Sylvester Comprehensive Cancer Center of University of Miami Miller School of Medicine, Miami, FL
| | | | - David J. Lee
- Sylvester Comprehensive Cancer Center, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
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Sussman DA, Hernandez MN, Tannenbaum SL, Bonner JM, McClure LA, Lee DJ. New strategies immediately needed for molecular marker reporting in colorectal cancer. Am J Gastroenterol 2015; 110:197-8. [PMID: 25567180 DOI: 10.1038/ajg.2014.360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Daniel A Sussman
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | | | - Judith M Bonner
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - L A McClure
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - D J Lee
- University of Miami Miller School of Medicine, Miami, Florida, USA
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Miller EA, Miller DM, Judson DH, He Y, Day HR, Zevallos K, Parker JD, MacKinnon JA, Hernandez MN, Wohler B, Sherman R, Fernandez CA, McClure LA, LeBlanc WG, Tannenbaum SL, Zheng DD, Lee DJ, Christ SL. Linkage of 1986-2009 National Health Interview Survey with 1981-2010 Florida Cancer Data System. Vital Health Stat 2 2014:1-16. [PMID: 25406513] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND National survey data linked with state cancer registry data has the potential to create a valuable tool for cancer prevention and control research. A pilot project-developed in a collaboration of the Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS) and the Florida Cancer Data System (FCDS) at the University of Miami -links the records of the 1986-2009 National Health Interview Survey (NHIS) and the 1981-2010 FCDS. The project assesses the feasibility of performing a record linkage between NCHS survey data and a state-based cancer registry, as well as the value of the data produced. The linked NHIS-FCDS data allow researchers to follow NHIS survey participants longitudinally to examine factors associated with future cancer diagnosis, and to assess the characteristics and quality of life among cancer survivors. METHODS This report provides a preliminary evaluation of the linked national and state cancer data and examines both analytic issues and complications presented by the linkage. CONCLUSIONS Residential mobility and the number of years of data linked in this project create some analytic challenges and limitations for the types of analyses that can be conducted. However, the linked data set offers the ability to conduct analyses not possible with either data set alone.
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Affiliation(s)
| | | | | | - Yulei He
- National Center for Health Statistics
| | | | | | | | - Jill A MacKinnon
- Florida Cancer Data System, University of Miami Miller School of Medicine
| | | | - Brad Wohler
- Florida Cancer Data System, University of Miami Miller School of Medicine
| | - Recinda Sherman
- Florida Cancer Data System, University of Miami Miller School of Medicine
| | | | | | | | | | | | - David J Lee
- University of Miami Miller School of Medicine
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Chen VW, Eheman CR, Johnson CJ, Hernandez MN, Rousseau D, Styles TS, West DW, Hsieh M, Hakenewerth AM, Celaya MO, Rycroft RK, Wike JM, Pearson M, Brockhouse J, Mulvihill LG, Zhang KB. Enhancing cancer registry data for comparative effectiveness research (CER) project: overview and methodology. J Registry Manag 2014; 41:103-112. [PMID: 25419602 PMCID: PMC4524450] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Following the Institute of Medicine's 2009 report on the national priorities for comparative effectiveness research (CER), funding for support of CER became available in 2009 through the American Recovery and Re-investment Act. The Centers for Disease Control and Prevention (CDC) received funding to enhance the infrastructure of population-based cancer registries and to expand registry data collection to support CER. The CDC established 10 specialized registries within the National Program of Cancer Registries (NPCR) to enhance data collection for all cancers and to address targeted CER questions, including the clinical use and prognostic value of specific biomarkers. The project also included a special focus on detailed first course of treatment for cancers of the breast, colon, and rectum, as well as chronic myeloid leukemia (CML) diagnosed in 2011. This paper describes the methodology and the work conducted by the CDC and the NPCR specialized registries in collecting data for the 4 special focused cancers, including the selection of additional data variables, development of data collection tools and software modifications, institutional review board approvals, training, collection of detailed first course of treatment, and quality assurance. It also presents the characteristics of the study population and discusses the strengths and limitations of using population-based cancer registries to support CER as well as the potential future role of population-based cancer registries in assessing the quality of patient care and cancer control.
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Affiliation(s)
- Vivien W. Chen
- Louisiana Tumor Registry and Epidemiology Program, School of Public Health, Louisiana State, University Health Sciences Center, New Orleans, Louisiana
| | - Christie R. Eheman
- Cancer Surveillance Branch, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Monique N. Hernandez
- Florida Cancer Data System, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida
| | - David Rousseau
- Rhode Island Cancer Registry, Hospital Association of Rhode Island, Rhode Island
| | - Timothy S. Styles
- Cancer Surveillance Branch, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Dee W. West
- Cancer Registry of Greater California, Public Health Institute, Sacramento, California
| | - Meichin Hsieh
- Louisiana Tumor Registry and Epidemiology Program, School of Public Health, Louisiana State, University Health Sciences Center, New Orleans, Louisiana
| | - Anne M. Hakenewerth
- Texas Cancer Registry, Cancer Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas
| | | | - Randi K. Rycroft
- Colorado Central Cancer Registry, Colorado Department of Public Health and Environment, Denver, Colorado
| | | | - Melissa Pearson
- North Carolina Cancer Registry, Division of Public Health, Department of Health and Human Services, Raleigh, North Carolina
| | | | - Linda G. Mulvihill
- Cancer Surveillance Branch, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Hernandez MN, MacKinnon JA, Penberthy L, Bonner J, Huang YX. Enhancing central cancer registry treatment data using physician medical claims: a Florida pilot project. J Registry Manag 2014; 41:51-56. [PMID: 25153009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND To capture the complete first course of therapy and cancer incidence, given the shift in cancer care from the hospital to the private physician practice, central cancer registries (CCRs) in the United States are actively pursuing cancer reporting from ambulatory providers. The 837 medical health claim is a national standard which CCRs can use to capture and translate data into standardized cancer reporting for surveillance. METHODS The Florida Cancer Data System conducted a pilot project with a large medical oncology practice to transmit electronic claims from 2011 to 2013. Using the logic and platform developed under a previous National Cancer Institute (NCI) contract, claims were consolidated and translated into standardized cancer registry codes. Consolidated physician claims were compared against gold standard data from the practice electronic health record (EHR) and evaluated for enhancement to registry data. RESULTS A total of 623 patient tumor cases were collected from the practice EHR and matched to the physician claims data, and to the original cancer registry record. The claims captured 256 cases (41 percent) with chemotherapy, compared to 28 percent in the registry data set, and 45 percent in the gold standard EHR data set. Combining physician claims with registry data produced 280 cases (45 percent) with chemotherapy. The physician claims plus the registry cancer chemotherapy treatment data produced 92 percent agreement, 92 percent sensitivity, and 91 percent positive predictive value. Claims added 103 cases, or 16.5 percent, to the total chemotherapy received. CONCLUSIONS Physician medical claims data capture chemotherapy information not otherwise reported by hospitals, and is a standardized and efficient mechanism for cancer reporting.
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Hernandez MN, Voti L, Feldman JD, Tannenbaum SL, Scharber W, Mackinnon JA, Lee DJ, Huang YX. Cancer registry enrichment via linkage with hospital-based electronic medical records: a pilot investigation. J Registry Manag 2013; 40:40-47. [PMID: 23778697] [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: 06/02/2023]
Abstract
BACKGROUND Hospital electronic medical record (EMR) systems are becoming increasingly integrated for management of patient data, especially given recent policy changes issued by the Centers for Medicaid and Medicare Services. In addition to data management, these data provide evidence for patient-centered outcomes research for a range of diseases, including cancer. Integrating EMR patient data with existing disease registries strengthens all essential components for assuring optimal health outcomes. OBJECTIVES To identify the mechanisms for extracting, linking, and processing hospital EMR data with the Florida Cancer Data System (FCDS); and to assess the completeness of existing registry treatment data as well as the potential for data enhancement. METHODS A partnership among the Florida Department of Health, FCDS, and a large Florida hospital system was established to develop methods for hospital EMR extraction and transmission. Records for admission years between 2007 and 2010 were extracted using ICD-9-CM codes as the trigger and were linked with the cancer registry for patients with invasive cancers of the breast. RESULTS A total of 11,506 unique patients were linked with a total of 12,804 unique breast tumors. Evaluation of existing registry treatment data against the hospital EMR produced a total of 5 percent of registry records with updated surgery information, 1 percent of records with updated radiation information, and 7 percent of records updated with chemotherapy information. Enhancement of registry treatment information was particularly affected by the availability of chemotherapy medications data. CONCLUSION Hospital EMR linkages to cancer disease registries is feasible but challenged by lack of standards for data collection, coding and transmission, comprehensive description of available data, and the exclusion of certain hospital datasets. The FCDS standard treatment data variables are highly robust and complete but can be enhanced by the addition of detailed chemotherapy regimens that are commonly used in patient centered outcomes research.
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Abstract
OBJECTIVES: Hispanic colorectal cancer (CRC) rates historically have been lower than for non-Hispanic Whites in the United States and in Florida. The aim of this study is to understand CRC trends in Florida Hispanics and non-Hispanic Whites. METHODS: Using a cross-sectional study design, all invasive CRCs diagnosed among Florida residents between 1989 and 2006 were accessed from the Florida Cancer Data System (FCDS). These cases were analyzed by Hispanic and non-Hispanic White ethnic identification. The Hispanic Origin Identification Algorithm was applied to the FCDS data to identify Hispanic subjects. Primary cancer site and histology data were organized according to SEER (Surveillance Epidemiology and End Results) categories. Joinpoint regression was used to generate incidence trends by stage and subsite location. RESULTS: Rates of CRC incidence were higher for Florida Hispanics compared with non-Hispanic Whites since the mid 1990s. There was a consistent significant increase in the incidence of distant stage CRC in Hispanics (annual percent change (APC) of 1.26 and 0.90 in males and females), whereas rates in non-Hispanics decreased significantly during the same time period (APC −1.36 and −1.28, respectively). Similar trends were found in distant-stage right-sided CRC. Among right-sided CRCs, local stage incidence rate increased for both non-Hispanic Whites and Hispanics, whereas the incidence rate for regional stage decreased for both racial/ethnic groups. CONCLUSIONS: Trends for distant-stage CRC are increasing among Florida Hispanics. This is a particular public health concern given that CRC is a cancer for which screening modalities exist and could imply a concomitant increase in CRC-related mortality among Florida Hispanics. Lower rates of CRC screening in Hispanics are documented at the state level, relative to non-Hispanic Whites. Screening programs targeting the Florida Hispanic population are warranted.
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Affiliation(s)
- M N Hernandez
- Florida Cancer Data System, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
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Nielsen AL, Hill TD, French MT, Hernandez MN. Racial/Ethnic Composition, Social Disorganization, and Offsite Alcohol Availability in San Diego County, California*. Soc Sci Res 2010; 39:165-175. [PMID: 20161391 PMCID: PMC2782843 DOI: 10.1016/j.ssresearch.2009.04.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
We draw upon social disorganization theory to examine the effects of community characteristics on the distribution of offsite alcohol outlets in San Diego County, California. Of particular interest is whether alcohol availability varies according to neighborhood racial/ethnic composition once measures of social disorganization (socioeconomic disadvantage, residential instability, and racial/ethnic heterogeneity) are controlled. Using data from the 1990 Census and 1993 alcohol license reports, we estimate a series of negative binomial regression models with corrections for spatial autocorrelation. The results show that percent Asian is associated with lower offsite alcohol outlet density. Once socioeconomic disadvantage is controlled, percent Latino is related to lower alcohol availability. Although similar suppressor patterns are observed, percent Black is generally unrelated to outlet density. Consistent with social disorganization theory, socioeconomic disadvantage and residential instability predict increased alcohol availability. Neighborhood racial/ethnic composition is either unrelated or inversely related to outlet density once social disorganization and other neighborhood characteristics are taken into account.
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Affiliation(s)
- Amie L. Nielsen
- Department of Sociology and Health Economics Research Group, University of Miami, Coral Gables, FL 33124, USA
| | - Terrence D. Hill
- Department of Sociology and Health Economics Research Group, University of Miami, Coral Gables, FL 33124, USA
| | - Michael T. French
- Department of Sociology, Department of Economics, Department of Epidemiology and Public Health, and Health Economics Research Group, University of Miami, Coral Gables, FL 33124, USA
| | - Monique N. Hernandez
- Department of Geography and Health Economics Research Group, University of Miami, Coral Gables, FL, 33124, USA
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