A Direct Wavepath-based Element Localization Algorithm to Enable Flexible Ultrasound Array Imaging

An algorithm is developed for determining the element locations of a flexible ultrasonic array when applied to a surface of unknown geometry. The algorithm forms a dataset of traveltimes from the direct wavepaths (i.e. rays) between transmitters and receivers, which serves as the input to an optimization scheme that iterates on the array element locations until an objective function is minimized. Once, the relative array locations have been determined, they are used as an input to a phased array ultrasound imaging algorithm. In this study, the total focusing method with full matrix capture is used as a testbed code to demonstrate the benefits of the relative array element localization algorithm. The algorithm is verified by simulation and experimentation.

Abstract P1-09-04: New Orleans has the highest incidence rates of triple negative breast cancer

Background: We previously demonstrated increased incidence rates of triple negative breast cancer (TNBC) in Black women (BW) in New Orleans (NO) and Louisiana (LA) compared with SEER 17. We explored the hypothesis that BW in NO had a higher incidence of TNBC than in BW other metro areas in the SEER Program.

Methods: We analyzed tumor characteristics of invasive female breast cancers diagnosed 2010-12 from SEER, focusing on racial disparities. We compared LA data with SEER 17 and metropolitan areas (Atlanta, Detroit, Los Angeles and San Francisco). Predictors of TNBC were identified in multivariate logistic regression.

Results: Overall incidence rate of TNBC in BW was significantly higher in NO (32 per 100,000) than in the rest of LA (24 per 100,000) and the SEER metro areas combined (23 per100,000). Detroit had the 2nd highest rates (27.3 per 100,000) followed by Los Angeles, San Francisco and Atlanta (23.2, 23, 22.4 respectively). Compared with SEER 17, the rate ratio of TNBC was 38% higher for BW in NO (CI: 1.17-1.61) and 17% higher for BW in Detroit (CI: 1.06-1.29). Compared with other LA metro areas, the rate ratio of TNBC was 44% higher for BW in NO (CI: 1.10-1.91). Young age (<65) and black race predicted TNBC after adjusting for insurance status, tumor size, lymph node status, grade and derived AJCC stage.

Conclusions: The incidence rates and rate ratios of TNBC in BW in NO and LA are not only significantly higher than in SEER 17 but also higher than any other SEER metro area. We will explore this dataset further by analyzing BMI, comorbidities and SES. This disparity in BW in NO has clinical implications and translational research potential as it enables us to broaden the understanding and treatment of this aggressive disease.

Citation Format: Loch MM, Li X, Hsieh M-C, Chen VW, Wu X-C. New Orleans has the highest incidence rates of triple negative breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-09-04.

Abstract P1-07-14: A statewide, population-based study of molecular subtypes of female breast cancer: Treatment and associated factors

Background: Breast cancer is now recognized as a heterogeneous disease with distinct biological molecular subtypes which have different prognoses and treatment options. We conducted the first statewide, population-based study to examine systemic treatment among invasive breast cancer (IBC) patients by subtype and determined their associated factors with treatment.

Methods: We analyzed data from the Louisiana Tumor Registry (LTR) and a Centers of Disease Control and Prevention (CDC)-funded special project of Enhancing Cancer Registry Data for Comparative Effectiveness Research (CER), which included Louisiana women diagnosed with microscopically-confirmed invasive breast cancer in 2011. Patient's socio-demographics, tumor characteristics and detailed information on the treatment, including chemotherapy, hormone, radiation and targeted therapy received within 12 months of diagnosis were collected from hospitals, radiation facilities, and medical oncology clinics. Systemic treatments received by each subtype were examined. Univariate and multivariate logistic regression analyses were used to identify factors associated with not receiving systemic treatment. Analyses were carried out using SAS version 9.4.

Results: About 70% of patients were hormone receptor (HR)+/ human epidermal growth factor receptor 2 (HER2)-, 15% triple negative (HR-/HER2-), 10 % HR+/HER2+ and only 5% HR-/HER2+. Among IBC patients with known HR and HER2 status, 72-78% with HR+ had hormonal therapy, 61-75% with HER2+ had Herceptin. About 0.5-6.1% of patients were given therapies which are contradictory to HR/HER2 status and 11-23% of IBC patients with known molecular subtypes did not receive any systemic treatment. Factors associated with not receiving systemic therapy include triple negative subtype and age >65 years. Patients younger than 50 years and with more advanced stages were more likely to receive systemic treatment. Race/ethnicity, grade, lymph node involvement, and comorbidity were not associated with receiving systemic treatment, adjusting for other covariates.

Conclusions: About 12-29% of breast cancer patients in our data set were not receiving treatment consistent with their HR/HER2 status or treatment guidelines. Some possible explanations may be advancing age, death prior to therapy and refusal by patients and/or family. Race, lymph node status and comorbidity were not associated with receiving systemic therapy after adjusting for other covariates. Further studies are needed to explore reasons why patients are not receiving therapy that is concordant with the guidelines and the access to care.

Citation Format: Loch MM, Zhang L, Hsieh M-C, Wu X-C, Chen VW. A statewide, population-based study of molecular subtypes of female breast cancer: Treatment and associated factors. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-07-14.

Sleep deprivation alters valuation signals in the ventromedial prefrontal cortex

Even a single night of total sleep deprivation (SD) can have dramatic effects on economic decision making. Here we tested the novel hypothesis that SD influences economic decisions by altering the valuation process. Using functional magnetic resonance imaging we identified value signals related to the anticipation and the experience of monetary and social rewards (attractive female faces). We then derived decision value signals that were predictive of each participant’s willingness to exchange money for brief views of attractive faces in an independent market task. Strikingly, SD altered decision value signals in ventromedial prefrontal cortex (VMPFC) in proportion to the corresponding change in economic preferences. These changes in preference were independent of the effects of SD on attention and vigilance. Our results provide novel evidence that signals in VMPFC track the current state of the individual, and thus reflect not static but constructed preferences.

Urbanisation and incidence of acute lymphocytic leukaemia among United States children aged 0-4

Acute lymphocytic leukaemia (ALL) incidence among children under 5 years of age was examined, utilising data from 24 United States cancer registries. County-based incidence rates among white children were compared across four levels of urbanisation: large and small metropolitan counties, and adjacent and nonadjacent rural counties. In metropolitan areas, the incidence of ALL was lower among blacks (rate ratio (RR)=0.38, confidence interval (CI)=0.33–0.44) and among Asians/Pacific Islanders (RR=0.78, CI=0.63–0.97) than among whites. Among white children, the incidence of ALL decreased across the four strata of urbanisation, from 67 to 62 to 65 to 54 cases per million person-years at-risk (two-sided trend P=0.009), such that rates were significantly lower in the most remote rural counties than in the most populous metropolitan counties (RR=0.80, 95% CI=0.70–0.91).

Subsite-specific incidence rate and stage of disease in colorectal cancer by race, gender, and age group in the United States, 1992-1997

BACKGROUND

Subsite specific incidence rates of colorectal cancer vary considerably by age, gender, and race. This variation may be related not only to distinctions in exposure to genetic and environment factors but also to current strategies of early detection screening. Patterns of stage of disease in anatomic subsite may reflect the effect of screening. This study used the largest aggregation of cancer incidence data in the U.S. to examine subsite specific incidence rates of colorectal cancer and the relation of stage of disease to anatomic subsites by race, gender, and age group.

METHODS

Data on the incidence of invasive colorectal cancer were obtained from 28 population-based central cancer registries. Age-specific and age-adjusted rates and stage distributions were analyzed by subsite, race, and gender.

RESULTS

The impact of screening can be observed in the percentage of localized disease, which increased from 31.9% among cancers in the proximal colon to 37.0% in the descending colon to 41.5% in the distal colorectum. Within the same subsite, blacks were less likely than whites to receive a diagnosis of localized disease and more likely to receive a diagnosis of distant disease whereas stage distributions were approximately the same for males and females. Blacks were more likely than whites to receive a diagnosis of proximal colon cancer than distal colorectal cancer. The male-to-female rate ratios progressively increased from the proximal colon to the distal colorectum. The ratios of proximal-to-distal colorectal cancer gradually increased with advancing age.

CONCLUSIONS

Differentials in stage of disease by subsites indicate a need for a targeted effort at early detection of cancer in the proximal colon. Risk factors and higher risk populations for colorectal cancers in each subsite need to be studied further to guide actions for improving the efficacy of screening.

Subsite-specific incidence rate and stage of disease in colorectal cancer by race, gender, and age group in the United States, 1992-1997

BACKGROUND

Subsite specific incidence rates of colorectal cancer vary considerably by age, gender, and race. This variation may be related not only to distinctions in exposure to genetic and environment factors but also to current strategies of early detection screening. Patterns of stage of disease in anatomic subsite may reflect the effect of screening. This study used the largest aggregation of cancer incidence data in the U.S. to examine subsite specific incidence rates of colorectal cancer and the relation of stage of disease to anatomic subsites by race, gender, and age group.

METHODS

Data on the incidence of invasive colorectal cancer were obtained from 28 population-based central cancer registries. Age-specific and age-adjusted rates and stage distributions were analyzed by subsite, race, and gender.

RESULTS

The impact of screening can be observed in the percentage of localized disease, which increased from 31.9% among cancers in the proximal colon to 37.0% in the descending colon to 41.5% in the distal colorectum. Within the same subsite, blacks were less likely than whites to receive a diagnosis of localized disease and more likely to receive a diagnosis of distant disease whereas stage distributions were approximately the same for males and females. Blacks were more likely than whites to receive a diagnosis of proximal colon cancer than distal colorectal cancer. The male-to-female rate ratios progressively increased from the proximal colon to the distal colorectum. The ratios of proximal-to-distal colorectal cancer gradually increased with advancing age.

CONCLUSIONS

Differentials in stage of disease by subsites indicate a need for a targeted effort at early detection of cancer in the proximal colon. Risk factors and higher risk populations for colorectal cancers in each subsite need to be studied further to guide actions for improving the efficacy of screening.

Breast cancer: incidence, mortality, and early detection in Louisiana, 1988-1997

Breast cancer is the most commonly diagnosed cancer and the second leading cause of cancer death among Louisiana women. The incidence data from Louisiana Tumor Registry were used to calculate breast cancer incidence rates, which were compared with the combined rates from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) program. Breast cancer mortality rates for Louisiana were compared with the US death rates from the National Center for Health Statistics (NCHS). Our data revealed that Louisiana women were not at a higher risk for developing breast cancer than women in the SEER areas, but that mortality rates in Louisiana were not correspondingly low. Although the percentage of cases diagnosed at an early stage (in situ and localized) increased in Louisiana from 1988 through 1997, the average in Louisiana was still below the level for the SEER areas (65.9% and 71.6%) in 1993-1997. The rates of in situ breast cancer significantly increased (on average 5.3% for whites per year and 7.1% for blacks), and localized breast cancer also significantly increased (2.6% for whites and 2.5% for blacks), while the incidence of distant stage breast cancer significantly decreased (3.4% for whites and 2.0% for blacks). Compared with white women, black women still were less likely to be diagnosed with early stage breast cancer in 1993-1997 (56.4% and 68.9%). Women residing in the parishes with high percentages of persons in poverty were less likely to be diagnosed with early stage of disease.

Use of coping strategies and breast cancer survival: results from the Black/White Cancer Survival Study

This analysis was designed to evaluate the association between coping strategies and breast cancer survival among Black and White women in a large population-based study. A total of 442 Black and 405 White US women diagnosed with invasive breast cancer during 1985-1986 and actively followed for survival through 1994 were administered a modified Folkman and Lazarus Ways of Coping questionnaire. Coping strategies were characterized via factor analyses of the responses. Hazard ratios associated with coping strategies were estimated using Cox proportional hazards models, with adjustment for age, race, tumor stage, study location, tumor hormone responsiveness, comorbidity, health insurance status, smoking, relative body weight, and alcohol consumption. Emotion-focused coping strategies were significantly associated with survival. Expression of emotion was associated with better survival (hazard ratio = 0.6; 95% confidence interval: 0.4, 0.9). When it was considered jointly with the presence or absence of perceived emotional support, women reporting low levels of both emotional expression and perceived emotional support experienced poorer survival than women reporting high levels of both (hazard ratio = 2.5; 95% confidence interval: 1.7, 3.7). Similar risk relations were evident for Blacks and Whites and for patients with early and late stage disease. These results suggest that the opportunity for emotional expression may help improve survival among patients with invasive breast cancer.

Bladder cancer: race differences in extent of disease at diagnosis

BACKGROUND

Blacks are less likely than whites to develop bladder cancer; although once diagnosed, blacks experience poorer survival. This study sought to examine multiple biological and behavioral factors and their influence on extent of disease.

METHODS

A population-based cohort of black bladder cancer patients and a random sample of frequency-matched white bladder cancer patients, stratified by age, gender, and race were identified through cancer registry systems in metropolitan Atlanta, New Orleans, and the San Francisco/Oakland area. Patients were ages 20-79 years at bladder cancer diagnosis from 1985-1987, and had no previous cancer history. Medical records were reviewed at initial diagnosis. Of the patients selected for study, a total of 77% of patients was interviewed. Grade, stage, and other variables (including age, socioeconomic status, symptom duration, and smoking history) were recorded. Extent of disease was modeled in 497 patients with urothelial carcinoma using logistic regression.

RESULTS

Extent of disease at diagnosis was significantly greater in Blacks than in Whites. Older age group, higher tumor grade, larger tumors, and presence of carcinoma in situ were related to greater extent of disease in blacks and in whites. Large disparities between blacks and whites were found for socioeconomic status and source of care. Blacks had greater symptom duration and higher grade. Black women were more likely to have invasive disease than white women; this difference was not seen among men. Blacks in unskilled occupational categories, perhaps reflecting socioeconomic factors, were at much higher risk for muscle invasion than whites.

CONCLUSIONS

While specific relationships between variables were noted, an overall pattern defining black and white differences in stage did not emerge. Future studies should examine the basis upon which occupation and life style factors operate by using biochemical and molecular methods to study the genetic factors involved.

Incidence of lymphohaematopoietic malignancies in a petrochemical industry cohort: 1983-94 follow up

OBJECTIVES

In response to a previous finding of increased mortality from lymphohaematopoietic (LH) malignancies, this study examines incidence of LH malignancy in a petrochemical industry cohort. Emphasis is on chronic lymphocytic leukaemia (CLL) and on comparisons by period of first employment.

METHOD

The study cohort consists of 8942 employees who were active in the period 1970-92 and alive on 31 December 1982. Record linkage with the Louisiana tumour registry (LTR) provided information on cancer for cases occurring between 1983 and 1994. Standardised incidence ratios (SIR), with the south Louisiana population as a comparison, were computed for all cancers, all LH malignancies and specific LH subtypes. Analyses were conducted for sex and race categories, and by period of first employment, job type, duration of employment, and latency.

RESULTS

672 Cases of cancer were identified, including 59 LH malignancies. Women (n=1169) had an overall cancer SIR below unity and four LH malignancies versus 2.28 expected. Among the 7773 men, those first employed before 1950 had no overall cancer excess, a significant 1.4-fold increase in overall LH malignancies (43 observed versus 30.78 expected), and four CLL cases versus 3.27 expected. Findings for men first employed after 1950 are based on fewer cases, but there was no indication of excesses of overall cancer or LH malignancy. Numbers were too small in the group first employed after 1950 for meaningful analysis of LH malignancy subtypes such as CLL (one case).

CONCLUSION

These findings do not suggest a continuing excess of CLL but do suggest a small increase in incidence of overall LH malignancy for workers first employed before 1950. This may reflect associations with earlier workplace conditions, although work related patterns are mixed. Interpretation is limited by the diverse group of diseases within LH malignancies, and the lack of control for non-work factors other than sex, age, race, and period of diagnosis. This study has a major advantage of more complete and reliable cancer ascertainment compared with the mortality investigation, and shows the feasibility and benefits of using cancer registry incidence data in an occupational cohort study.

Cancer of the colon and rectum in Louisiana

Cancer of the colon and rectum ranks fourth for incidence and second for mortality among Louisiana residents. Incidence rates calculated from Louisiana Tumor Registry data for 1991-95 show that whites in Louisiana were diagnosed with colon cancer at approximately the same rates as those in the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program, but rates for African Americans were significantly lower in Louisiana than nationally. For rectal cancer, Louisiana incidence rates approximate the national rates for all but African-American males, whose rate was significantly lower. Mortality rates for colon and rectal cancer in Louisiana were comparable to the SEER rates, suggesting Louisiana blacks, once diagnosed, have a poorer survival than their national counterparts. Risk factors for colorectal cancer and guidelines for screening are discussed, as is an upcoming study of patient care for colon cancer.

Louisiana Tumor Registry: new developments and activities

New developments in the Louisiana Tumor Registry (LTR) over the past 3 years have enhanced the operation of the LTR and broadened its functions. Recent funding for numerous special studies and research collaborations have expanded the registry activities from data collection and special etiologic studies to more completely address the mandates of registry law, which require the LTR to participate in studies of cancer causes, treatment, and survival in order to reduce cancer morbidity and mortality in Louisiana.

Cancer incidence in the industrial corridor: an update

Because of the high density of industries along the Lower Mississippi River, there is a concern about adverse impact on health, including cancer, among residents in these parishes. This study provides an update of cancer incidence in the Industrial Corridor for the period 1989-93. Age-adjusted cancer incidence rates were calculated for the seven-parish study area from Baton Rouge down to, but not including, New Orleans. Rates were also computed for the entire state of Louisiana and for the combined Surveillance, Epidemiology and End Results (SEER) program. Cancer incidence rates for the Industrial Corridor are either similar to, or lower than, the combined SEER rates for most of the common cancers as well as for rare tumors. The only two exceptions are lung cancer in white males and kidney cancer in white females that are significantly elevated when compared to the SEER averages. Significantly lower rates are found among white males for cancers of kidney, brain, and nervous system, and melanoma; among black males, cancers of all sites combined, oral cavity, stomach, rectum, and prostate, Hodgkin's disease, and non-Hodgkin's lymphoma; among white females, cancers of all sites combined, cervix, uterine corpus, ovary, bladder, and melanoma; and among black females, cancers of all sites combined, oral cavity, lung, breast, ovary, and melanoma. The persistent excess of lung cancer has led to the development of a multi-agency project to evaluate the impact of potential environmental exposures, genetic susceptibility, and their interactions on lung cancer risk. The findings also confirm the urgent need to include and strengthen tobacco prevention and cessation programs in our cancer control activities.

Aggressiveness of colon carcinoma in blacks and whites. National Cancer Institute Black/White Cancer Survival Study Group

Black patients with colon cancer in the Black/White Cancer Survival Study were found to have a poorer survival than white patients. More advanced-stage disease at diagnosis was the primary determinant, accounting for 60% of the excess mortality. After adjusting for stage, factors such as poverty, other socioeconomic conditions, and treatment did not further explain the remaining survival deficit. This study examined the aggressiveness of colon tumors in blacks and whites to explore its role in the racial survival differences. Tumor characteristics of 703 cases of newly diagnosed invasive colon adenocarcinoma were centrally evaluated by a gastrointestinal pathologist, blinded in regard to the age, race, and sex of the patients. Blacks were less likely to have poorly differentiated (grade 3) tumors [odds ratio (OR), 0.44; 95% confidence interval, 0.22-0.88] and lymphoid reaction (OR, 0.49; 95% confidence interval, 0.26-0.90) when compared with whites. These black/white (B/W) differences remained statistically significant after adjusting for age, sex, metropolitan area, summary stage, socioeconomic status, body mass index, and health care access and utilization. In addition, blacks were less likely to have high-grade (grade 3) nuclear atypia, mitotic activity, and tubule formation, although these ORs did not reach a statistical significance level of 0.05. Similar B/W differences were observed for patients with advanced disease but not with early stage. Comparison by anatomical subsite showed that blacks had statistically significantly better differentiated tumors for cancers of the proximal and transverse colon but not for the distal. No racial differences were found for blood vessel and lymphatic invasion, necrosis, fibrosis, and mucinous type of histology. The findings, therefore, are the opposite of those hypothesized. After adjusting for stage, more aggressive tumor characteristics do not explain the adverse survival differential in blacks. This suggests that there may be racial differences in environmental exposure, and that the intensity and mode of delivery of carcinogen insult as well as host susceptibility may differ by race and anatomical subsite. Future studies should explore the B/W differences in tumor biology using molecular markers that precede the conventional histological parameters evaluated here.

Highlights of cancer incidence in Louisiana, 1988-1992

This paper highlights the major findings from the recently released volume of the Louisiana Tumor Registry monograph series: Cancer Incidence in Louisiana, 1988-1992. One out of three Louisiana residents will develop cancer in his or her lifetime. Lung cancer remains the most common cancer for all races, both genders combined. Lung cancer rates for women continue to rise substantially (20% over the previous 5-year period) and African-American men in the Acadiana Region have the state's highest lung cancer rate. The number of prostate cancer cases has surpassed that of lung cancer for the first time in Louisiana men; the sizable increase since 1983 (about 50%) in prostate cancer likely reflects the recent aggressive screening by the PSA test. Breast cancer remains the most common cancer among Louisiana women and incidence rates have increased about 20% over the previous 5-year period. Geographic comparisons show that the New Orleans Region continues to have rates higher than state averages, and a clear pattern of high cancer risk has emerged for the Acadiana region. The Central Louisiana and the Baton Rouge Regions have rates lower than state averages.

Patterns of DNA ploidy and S-phase fraction associated with breast cancer survival in blacks and whites

A significant survival difference between black and white breast cancer patients has been observed in the United States. Evaluation of the prognostic value of DNA ploidy and S-phase fraction (SPF) in black and white breast cancer patients may contribute to our understanding of the mechanisms of racial disparity in survival. A sample of 98 patients (50 blacks and 48 whites) who participated in the Black/White Cancer Survival Study was selected for DNA flow cytometry analysis. Patients were followed between 4.5 and 6.5 years. The impacts of DNA ploidy and SPF on breast cancer survival were examined. Kaplan-Meier survival curves, log rank statistics, and Cox proportional hazards regression were used for survival analyses. Black patients were more likely than white patients to have tumors with high SPF (P < 0.05), but there was no difference in DNA ploidy (P = 0.79). Because there were significant interactions of both DNA ploidy and SPF with race, survival was examined separately for blacks and whites. Significantly poorer survival was observed for white patients with class A ploidy (hypodiploidy, hypotetraploidy, and hypertetraploidy; P = 0.001) and with high SPF (P = 0.025). The elevated hazard ratios remained significant after adjusting for age and stage. Further adjustment for adjuvant therapy and histopathological characteristics of tumor reduced the hazard ratios of SPF to a nonsignificant level. No significant associations were found between survival and DNA ploidy or SPF among blacks. DNA ploidy and SPF are prognostic factors for breast cancer survival in white patients but not in blacks. This may have clinical implication in breast cancer management.

Racial differences in endometrial cancer survival: the black/white cancer survival study

OBJECTIVE

To identify factors that explain a lower survival rate among black women with endometrial cancer when compared to white women.

METHODS

Data are from the National Cancer Institute's Black/White Cancer Survival Study, a population-based study of racial differences in cancer survival. Subjects included 329 white and 130 black women, ages 20-79 years, residing in the metropolitan areas of Atlanta, New Orleans, or San Francisco-Oakland, diagnosed with endometrial cancer from 1985 to 1987. Known prognostic factors were assessed as potential explanatory variables for the black-white survival difference using proportional hazards regression. Information was derived from interviews, abstracts of hospital and physicians' records, and a centralized review of biopsy and surgical specimens.

RESULTS

Adjusting for age and geographic location, risk of death among black women was 4.0 times (95% confidence interval [CI] 2.8, 5.6) that of white women. Approximately 40% of this difference could be attributed to a more advanced stage at diagnosis among black women, and 23% to tumor characteristics and treatment. Further adjustment for all remaining factors reduced the hazard ratio to 1.6 (95% CI 1.0, 2.6).

CONCLUSION

Eighty percent of the excess mortality among black women is explained by racial differences in stage at diagnosis, tumor characteristics, treatment, sociodemographic characteristics, hormonal and reproductive factors, and factors related to comorbidities and health behavior. Difference in stage at diagnosis is prominent in explaining the disparity in endometrial cancer survival rates in black and white women. Potential differences in treatment within stage merit further exploration.

Differences between black and white patients with cancer of the uterine corpus in interval from symptom recognition to initial medical consultation (United States)

To determine whether Black women with symptoms of uterine corpus cancer had longer times from symptom recognition to initial medical consultation than did White women in the United States, 331 newly diagnosed patients living in Atlanta (GA), New Orleans (LA), and San Francisco/Oakland (CA) during 1985-87 were interviewed to collect information on symptoms, dates of recognition and consultation, and other factors that might affect the interval. Data were analyzed to estimate medical consultation rates and rate ratios following symptom recognition. Median recalled times between symptom recognition and consultation were 16 days for Black women and 14 days for White women. Although poverty, having no usual source of healthcare, and other factors were associated with lower consultation rates, the adjusted rate among Black women was only somewhat lower (0.87) than among White women, and the 95 percent confidence interval (CI = 0.58-1.31) was consistent with no true difference between the races. In addition, the median time to consultation for women with stage IV cancer was only 15 days longer than the time (14 days) for the women with stage I cancer. These results suggest that time from symptom recognition to initial medical consultation does not contribute importantly to the more advanced stage cancer of the uterine corpus commonly found among Black women.

Is there a 'cancer corridor' in Louisiana?

Cancer mortality rates in South Louisiana are higher than the national averages, leading to the area's designation as a "cancer corridor". This study was conducted to assess whether incidence data substantiate the reputation derived from mortality statistics. Age-adjusted cancer incidence rates for 1983-1987 were calculated for South Louisiana as a whole, for five regional divisions of it, and for the combined nine areas of the Surveillance, Epidemiology, and End Results (SEER) program. Significantly lower (p < 0.0001) incidence rates were found in South Louisiana among white females, black males, and black females for cancers of all sites combined; among women of both races for cancer of the breast; among men of both races for cancers of the colon and prostate; and among whites of both sexes for melanoma and rectal cancer. South Louisiana incidence rates were significantly higher than the SEER rates only for lung and larynx cancers in white males. The excess of lung cancer was statistically significant in four out of five regions while the laryngeal cancer excess was significant only in the New Orleans area. The excessive mortality rates reported for South Louisiana are not the result of excessive incidence. These results indicate poorer cancer prognosis in this region, a phenomenon that deserves more scrutiny by the health profession.

Louisiana Tumor registry: new developments and services provided

Recent major developments in the Louisiana Tumor Registry (LTR) have enhanced the operation of LTR and broadened its available services. As a population-based cancer registry, the LTR assesses the magnitude of cancer burden in the state, identifies high-risk groups and areas, monitors time trends, evaluated cancer control programs, and provides resources to the health professionals in the state to address the considerable cancer problem in Louisiana. The registry is also available to provide research collaboration as well as to participate in cancer control and prevention programs.

Louisiana Cancer and Lung Trust Fund Board

The attached article briefly describes the Louisiana Cancer and Lung Trust Fund Board and its current activities. The Board was established by legislation in 1980 to: (1) determine eligibility for research funds, and (2) establish policies for the operation of the statewide tumor registry. There are currently 12 seats on the Board, each appointed by the Governor. The Grants Program has funded 66 research projects since 1984, focusing on cancer and pulmonary diseases. This represents a total of $1,731,853 of state funds used for research at academic institutions and state agencies throughout Louisiana.

Racial comparison of p53 alterations in breast cancer: difference in prognostic value

A significant difference in breast cancer survival between blacks and whites has been observed in the United States. Biological variation between races has been suggested to explain the difference. We investigated the difference by comparing the prognostic value of p53 alterations (mutations and protein accumulation) between black and white breast cancer patients. Black, but not white, patients with p53 mutations had a significantly poorer survival than those without p53 mutations (p < 0.05). In contrast, white, but not black, patients having tumors with p53 protein accumulation tended to have a poorer survival than those without accumulation of p53 protein (p = 0.058). Among patients who died of breast cancer, blacks were often to have p53 mutations without protein accumulation, and whites frequently had p53 protein accumulation without mutations. The racial disparities in the associations of p53 alterations with breast cancer survival could have clinical implications in terms of treatment management.

Determinants of black/white differences in colon cancer survival

BACKGROUND

Blacks have lower survival rates for colon cancer than whites, possibly related to more advanced stages of disease at diagnosis and to socioeconomic differences between blacks and whites. While the black/white difference in colon cancer survival is well documented, the few studies that have investigated this difference have been limited by the modest number and type of explanatory factors that were considered.

PURPOSE

We analyzed data from the National Cancer Institute Black/White Cancer Survival Study to determine 1) what characteristics might contribute to the racial difference in colon cancer survival and 2) if a survival disparity remained between black and white patients after adjustment was made for these characteristics.

METHODS

This prospective study included 454 blacks and a stratified random sample of 521 whites, aged 20-79 years, with cancer of the colon diagnosed from January 1, 1985, through December 31, 1986, and who were residents of the metropolitan areas of Atlanta, New Orleans, and San Francisco/Oakland. Follow-up was truncated on December 31, 1990. Cox proportional hazards regression was used to estimate the death rate among blacks relative to that among whites after adjustment for potential explanatory factors, including sociodemographic factors, concurrent (comorbid) medical conditions, stage at diagnosis, tumor characteristics, and treatment. All P values were calculated from two-tailed tests of statistical significance.

RESULTS

After adjustment for age, sex, and geographic area, the black-to-white mortality hazard ratio (HR) was 1.5 (95% confidence interval [CI] = 1.2-1.9), indicating that the risk of death among black patients was 50% higher than that among white patients. Further adjustment for stage reduced the excess cancer mortality to 20% (HR = 1.2; 95% CI = 1.0-1.5), decreasing the overall racial difference in excess mortality from 50% to 20% or to a 60% reduction in excess mortality. Although adjustment for poverty reduced the excess mortality by 20%, adjusting for both stage and poverty did not further reduce the racial difference. Among patients with stages II and III disease, blacks had lower survival rates than whites (HR = 1.8; 95% CI = 1.0-3.1 and HR - 1.5; 95% CI = 1.0-2.3, respectively). Among those patients with metastatic disease (stage IV), survival was similar for whites and blacks.

CONCLUSIONS

Stage at diagnosis accounted for more than half of the excess colon cancer mortality observed among blacks. Poverty and other socioeconomic conditions, general health status, tumor characteristics, and general patterns of treatment did not further explain the remaining survival disadvantage among blacks.

IMPLICATIONS

Because the racial disparity was confined to earlier stages, future studies should investigate whether blacks have more advanced disease at diagnosis and whether less aggressive treatment is provided because of understanding.

Endometrial cancer: stage at diagnosis and associated factors in black and white patients

OBJECTIVE

This study examined the relationship of clinicopathologic, health status, medical system, and socioeconomic factors to differences in stage at diagnosis of endometrial cancer in black and white patients.

STUDY DESIGN

A population-based study of 130 black and 329 white patients with invasive endometrial cancer was conducted as part of the National Cancer Institute's Black/White Cancer Survival Study. Logistic regression was used to determine the relative importance of factors thought to be related to stage at diagnosis after age and geographic location were adjusted for.

RESULTS

High-grade (poorly differentiated) lesions increased the risk for stage III or IV disease (odds ratio 8.3, 95% confidence interval 3.4 to 20.3), as did serous histologic subtype (odds ratio 3.5, 95% confidence interval 1.4 to 8.8) and no usual source of care (odds ratio 5.5, 95% confidence interval 1.4 to 20.9). In the final statistical model these three factors also accounted for the majority of the excess risk of advanced stage for blacks.

CONCLUSIONS

Black-white racial disparities in stage at diagnosis appear to be related to higher-grade lesions and more aggressive histologic subtypes occurring more frequently in black patients with endometrial cancer.

Racial disparity in the association of p53 gene alterations with breast cancer survival

A significant black/white difference in breast cancer prognosis has been observed in the United States. Alterations of p53 tumor suppressor gene in breast cancer have been associated with poor prognosis. This study was designed to test the hypothesis that p53 gene alterations are related to the difference in prognosis between black and white breast cancer patients. Formalin-fixed paraffin-embedded breast tissue blocks were available from 45 black and 47 white patients for PCR-single strand conformation polymorphism analysis and DNA sequencing. The types of p53 gene alterations were compared between blacks and whites. Associations between p53 gene alterations and survival were also evaluated. Three missense, 2 nonsense, 1 microdeletion, 1 intron, and 4 silent mutations were detected in blacks, while 7 missense, 1 microdeletion, 1 silent mutation, and 3 polymorphisms were observed in whites. Among the point mutations, G:C to A:T transitions at non-CpG sites were found in 80.0% of blacks (8 of 10) and 62.5% of whites (5 of 8). Significantly poorer survival associated with p53 gene alterations was observed for blacks (P = 0.012), but not for whites. Black patients with p53 alterations had a significant 4-5-fold excess risk of death from breast cancer than those without p53 alterations. Adjustment for stage, age, tumor histopathology, receptor status, and adjuvant treatment did not change the excess risk. The findings suggest that the types of p53 gene alterations may contribute to the racial difference in breast cancer survival.

Endocrine gland cancer

BACKGROUND

Incidence and prognosis of cancers of the endocrine glands vary greatly by histologic type.

METHODS

Population-based data from SEER registries, 1973-1987, were analyzed.

RESULTS

Thyroid cancer accounts for most (92%) of the cancers of the endocrine glands. The four major histologic types of thyroid cancer display distinct patterns, reflecting different biologic entities. Papillary carcinoma, the most common type, occurs more frequently in women than in men and in whites than in blacks and has an early onset. Follicular carcinoma, the second most common type, shows a steady increase in incidence with age and a female preponderance but no racial disparity. Medullary carcinoma, the rare differentiated thyroid tumor, has a female excess in whites only and a slow increase in incidence with age. Anaplastic carcinoma shows few racial or sex variations and reaches a substantial level only after age 50. The prognosis also varies greatly by histologic type. The overall 5-year relative survival rate is greater than 90% for papillary and follicular carcinomas, 82% for medullary carcinoma, and less than 10% for anaplastic carcinoma. Carcinomas of the suprarenal gland and thymus are rare, accounting for about 3% of endocrine cancers each. These tumors, unlike the differentiated thyroid cancer, show no female preponderance, have a higher incidence rate in blacks, and have a poorer survival rate.

CONCLUSIONS

The marked predominance of papillary carcinoma and the continued increase in its relative frequency characterize the postgoiter era and an increased use of scintigraphy and fine needle aspiration. Underdiagnosis of small tumors may explain the observed lower incidence of papillary carcinoma in blacks.

Endocrine gland cancer

BACKGROUND

Incidence and prognosis of cancers of the endocrine glands vary greatly by histologic type.

METHODS

Population-based data from SEER registries, 1973-1987, were analyzed.

RESULTS

Thyroid cancer accounts for most (92%) of the cancers of the endocrine glands. The four major histologic types of thyroid cancer display distinct patterns, reflecting different biologic entities. Papillary carcinoma, the most common type, occurs more frequently in women than in men and in whites than in blacks and has an early onset. Follicular carcinoma, the second most common type, shows a steady increase in incidence with age and a female preponderance but no racial disparity. Medullary carcinoma, the rare differentiated thyroid tumor, has a female excess in whites only and a slow increase in incidence with age. Anaplastic carcinoma shows few racial or sex variations and reaches a substantial level only after age 50. The prognosis also varies greatly by histologic type. The overall 5-year relative survival rate is greater than 90% for papillary and follicular carcinomas, 82% for medullary carcinoma, and less than 10% for anaplastic carcinoma. Carcinomas of the suprarenal gland and thymus are rare, accounting for about 3% of endocrine cancers each. These tumors, unlike the differentiated thyroid cancer, show no female preponderance, have a higher incidence rate in blacks, and have a poorer survival rate.

CONCLUSIONS

The marked predominance of papillary carcinoma and the continued increase in its relative frequency characterize the postgoiter era and an increased use of scintigraphy and fine needle aspiration. Underdiagnosis of small tumors may explain the observed lower incidence of papillary carcinoma in blacks.

Racial differences in survival from breast cancer. Results of the National Cancer Institute Black/White Cancer Survival Study

OBJECTIVE

To examine the ability of recognized prognostic factors for breast cancer to account for the observed poorer survival in blacks compared with their white counterparts.

DESIGN AND PARTICIPANTS

Subjects included 1130 women (612 blacks and 518 whites) aged 20 to 79 years residing in metropolitan Atlanta, Ga, New Orleans, La, or San Francisco/Oakland, Calif, who were diagnosed with primary invasive breast cancer. Information on stage, tumor characteristics, treatment, comorbid conditions, and sociodemographic factors was obtained from personal interview, physician and hospital records, and a pathology review of biopsy and surgical specimens.

MAIN OUTCOME MEASURE

Multivariable survival models were used to estimate the hazard ratio (relative risk of mortality) for blacks compared with whites, adjusting for various combinations of potential explanatory factors.

RESULTS

After controlling for geographic site and age, the risk of dying was 2.2 times (95% confidence interval [CI], 1.8 to 2.8) greater for blacks than whites. Adjustment for stage reduced the risk from 2.2 to 1.7; further adjustment for sociodemographic variables had no effect. Treatment was not a contributing factor once stage and tumor pathology were in the model. After adjusting for stage, treatment, comorbid illness, and pathologic and sociodemographic variables, blacks continued to demonstrate a slightly increased, but not statistically significant, risk of death (hazard ratio = 1.3; 95% CI, 1.0 to 1.8). Results were similar for all-cause mortality and breast cancer-specific mortality.

CONCLUSIONS

Approximately 75% of the racial difference in survival was explained by the prognostic factors studied. Sociodemographic variables appeared to act largely through racial differences in stage at diagnosis, which may be amenable to change through improved access to and use of screening for black women.

Environmental tobacco smoke and lung cancer in nonsmoking women. A multicenter study

OBJECTIVE

To determine the relative risk (RR) of lung cancer in lifetime never smokers associated with environmental tobacco smoke (ETS) exposure.

DESIGN

Multicenter population-based case-control study.

SETTING

Five metropolitan areas in the United States: Atlanta, Ga, Houston, Tex, Los Angeles, Calif, New Orleans, La, and the San Francisco Bay Area, Calif.

PATIENTS OR OTHER PARTICIPANTS

Female lifetime never smokers: 653 cases with histologically confirmed lung cancer and 1253 controls selected by random digit dialing and random sampling from the Health Care Financing Administration files for women aged 65 years and older.

MAIN OUTCOME MEASURE

The RR of lung cancer, estimated by adjusted odds ratio (OR) with 95% confidence interval (CI), associated with ETS exposure.

RESULTS

Tobacco use by spouse(s) was associated with a 30% excess risk of lung cancer: all types of primary lung carcinoma (adjusted OR = 1.29; P < .05), pulmonary adenocarcinoma (adjusted OR = 1.28; P < .05), and other primary carcinomas of the lung (adjusted OR = 1.37; P = .18). An increasing RR of lung cancer was observed with increasing pack-years of spousal ETS exposure (trend P = .03), such that an 80% excess risk of lung cancer was observed for subjects with 80 or more pack-years of exposure from a spouse (adjusted OR = 1.79; 95% CI = 0.99 to 3.25). The excess risk of lung cancer among women ever exposed to ETS during adult life in the household was 24%; in the workplace, 39%; and in social settings, 50%. When these sources were considered jointly, an increasing risk of lung cancer with increasing duration of exposure was observed (trend P = .001). At the highest level of exposure, there was a 75% increased risk. No significant association was found between exposure during childhood to household ETS exposure from mother, father, or other household members; however, women who were exposed during childhood had higher RRs associated with adult-life ETS exposures than women with no childhood exposure. At the highest level of adult smoke-years of exposure, the ORs for women with and without childhood exposures were 3.25 (95% CI, 2.42 to 7.46) and 1.77 (95% CI, 0.98 to 3.19), respectively.

CONCLUSION

Exposure to ETS during adult life increases risk of lung cancer in lifetime nonsmokers.

Advanced stage at diagnosis: an explanation for higher than expected cancer death rates in Louisiana?

Data from the Louisiana Tumor Registry, Louisiana Vital Statistics Division, and the SEER program of the National Cancer Institute were explored to evaluate reasons for elevated cancer death rates in the absence of elevated cancer incidence in Louisiana. The results indicate that cancer patients in South Louisiana are more likely to be diagnosed with advanced stage disease than SEER patients. The Louisiana-SEER differences are greater for blacks than whites, and black patients are more likely to have advanced stage cancer than whites in Louisiana as well as in the SEER program. Of particular interest and concern is the finding that the increased risk of advanced stage disease in Louisiana is significant for cancers which can be detected early and, if so, effectively treated: colon, breast, and cervix. The findings reinforce the need for cancer control programs.

The relationship between social ties and survival among black and white breast cancer patients. National Cancer Institute Black/White Cancer Survival Study Group

The relationship between social ties, stage of disease, and survival was analyzed in a population-based sample of 525 black and 486 white women with newly diagnosed breast cancer. There were significant differences between the two race groups in reported social ties. Using logistic regression to adjust for the effects of age, race, study area, education, and the presence of symptoms, there was little or no evidence for an association between individual network measures of social ties and stage of disease. However, a summary measure of social networks was found to be associated modestly with late stage disease, attributable in part to significantly more advanced disease among black, but not white, women reporting few friends and relatives [relative risk (RR) = 1.8; 95% confidence interval (CI) = 1.1-3.0]. With adjustments for differences in stage of disease and other covariates, and with the use of Cox proportional hazards modeling to estimate hazard ratios, the absence of close ties and perceived sources of emotional support were associated significantly with an increased breast cancer death rate. White women in the lowest quartile of reported close friends and relatives had twice the breast cancer death rate of white women in the highest quartile (RR = 2.1; 95% CI = 1.1-4.4). Notably, both black and white women reporting few sources of emotional support had a higher death rate from their disease during the 5-year period of follow-up (RR = 1.8; 95% CI = 1.3-2.5).(ABSTRACT TRUNCATED AT 250 WORDS)

Histological characteristics of breast carcinoma in blacks and whites

Tumor characteristics of 963 newly diagnosed invasive breast cancer cases from the population-based Black/White Cancer Survival Study were evaluated. Representative slides of the tumors were requested from all participating hospitals of three metropolitan areas and reviewed by one expert pathologist, blinded in regard to the age and race of patients. Nine tumor characteristics were evaluated for black and white patients. After adjusting for age, stage, and metropolitan area, blacks were significantly more likely to have high grade nuclear atypia [odds ratio (OR) = 1.97, 95% confidence interval (CI) = 1.27-3.04]; high mitotic activity (OR = 2.05, 95% CI = 1.34-3.14), grade 3 tumors (OR = 1.58, 95% CI = 1.02-2.45), and more necrosis (OR = 1.51, 95% CI = 1.16-1.98); and less likely to have well defined tubular formation (OR = 0.57, 95% CI = 0.42-0.77), marked fibrosis (OR = 0.65, 95% CI = 0.45-0.94), and positive estrogen receptor status (OR = 0.78, 95% CI = 0.58-1.05). These black/white differences remained after controlling for socioeconomic status (SES), body mass index, use of alcohol and tobacco, reproductive experience, and health care access and utilization. No significant racial differences were found for blood vessel invasion and lymphatic invasion. Although white women of high SES had more favorable tumors than those of low SES, the same pattern was not observed for blacks. High SES black women had statistically nonsignificant elevated ORs of a high mitotic index and tumor grade. These racial differences in tumor biology may have etiological and clinical implications.

Breast cancer risk factors in African-American women: the Howard University Tumor Registry experience

This retrospective case-control study examines risk factors for breast cancer in African-American women, who recently have shown an increase in the incidence of this malignancy, especially in younger women. Our study involves 503 cases from the Howard University Hospital and 539 controls from the same hospital, seen from 1978 to 1987. Using information culled from medical charts, an analysis of various factors for their effect on breast cancer risk was made. The source of data necessarily meant that some known risk factors were missing. Increases in risk were found for known risk factors such as decreased age at menarche and a family history of breast cancer. No change in risk was observed with single marital status, nulliparity, premenopausal status, or lactation. An increased odds ratio was found for induced abortions, which was significant in women diagnosed after 50 years of age. Spontaneous abortions had a small but significant protective effect in the same subgroup of women. Birth control pill usage conferred a significantly increased risk. It is of note that abortions and oral contraceptive usage, not yet studied in African Americans, have been suggested as possibly contributing to the recent increase in breast cancer in young African-American women.

Breast cancer: factors associated with stage at diagnosis in black and white women. Black/White Cancer Survival Study Group

BACKGROUND

Numerous studies have reported differences in cancer staging at diagnosis and in survival between Black and White patients with breast cancer. Utilizing data obtained from the National Cancer Institute's (NCI's) Black/White Cancer Survival Study for the period 1985-1986, a new study is presented here that systematically examines multiple explanatory factors (e.g., lack of mammograms) associated with these cancer-staging differences.

PURPOSE

We evaluated within a single study the relationship of selected demographic, lifestyle, antecedent medical experiences, and health care access factors to cancer staging at diagnosis in Black and White breast cancer patients.

METHODS

Data utilized in this population-based cohort study of 1222 eligible women (649 Black and 573 White) newly diagnosed for the period 1985-1986 with histologically confirmed primary breast cancer were obtained from the NCI's Black/White Cancer Survival Study. Sources of data included abstracts of hospital medical records, central review of histology slides by a study consultant pathologist, and patient interviews obtained from three metropolitan areas: Atlanta, New Orleans, and San Francisco-Oakland. Within each area, 70% of all Black incident cases were randomly selected, and a sample of White cases, frequency matched by age groups (20-49 years, 50-64 years, and 65-79 years), was selected for comparison. Stage of breast cancer at diagnosis was classified according to the international tumor-lymph node-metastases (TNM) system. Statistical models utilized in this study included the log-linear and polychotomous logistic regression with multiple predictor variables.

RESULTS

Factors associated with cancer staging were differentially expressed in Blacks and Whites. Indicators of access to health care, a lack of mammograms, and an increased body mass index significantly (P < .02) contributed to stage differences in Blacks, whereas income was marginally associated (P = .06) with stage for Whites only. Nuclear grade, having a breast examination by a physician, and a history of patient delay explained approximately 50% of the excess risk for stage III-IV cancer versus stage I-IIN0 cancer among Blacks compared with Whites (odds ratio reduction from 2.19 to 1.68).

CONCLUSION

These findings suggest that no single factor or group of factors can explain more than half of the race-stage differences noted in this study with respect to Black and White breast cancer patients.

Passive smoking and lung cancer

The findings of a multicenter national study of lung cancer in lifetime-never smokers are reported. An increased lung cancer risk of approximately 30% was found among women whose husbands smoked. Elevated risks of 40% to 60% were also found associated with workplace exposures and other exposures outside the home. The findings of this study have been included in the recent Environmental Protection Agency assessment of the health effects of passive smoking, and have implications for regulation of environmental tobacco smoke exposure in Louisiana.

Smoking and the health gap in minorities

Over the past decade, tobacco companies have targeted minority populations when advertising and promoting their products, containing the most widely available, legal addictive drug in the United States. This has contributed to a greater prevalence of cigarette smoking among some minorities and lower-income groups. Black males are more likely to smoke than white males and more often they smoke high-tar cigarettes. They are also less likely to quit smoking. Compared to the national average, a greater proportion of Hispanic males smoke, but not Hispanic females. Smoking prevalence rates among Asians and Native Americans are available from local surveys but there are no reliable national estimates. Blacks experience substantially higher rates of mortality and morbidity from all causes, heart disease, stroke, and smoking-related cancers as well as adverse pregnancy outcomes. Substantially lower rates of death from heart disease, stroke, and cancers are observed among Asians and Native Americans than among whites. Disparities in cigarette smoking among racial and ethnic groups do not mirror the observed racial and ethnic disparities in mortality. Other health risk factors, access to medical care and premature death from other causes, may partially explain the morbidity/mortality gap between minorities and nonminorities. Reliable national estimates on smoking prevalence and morbidity and mortality among minorities are needed. The role of tobacco use in the etiology of diseases that are disproportionately prevalent among minorities should be studied. Culturally sensitive and acceptable smoking interventions should be developed with the involvement of minorities.

Treatment plans for black and white women with stage II node-positive breast cancer. The National Cancer Institute Black/White Cancer Survival Study experience

BACKGROUND

The National Cancer Institute Black/White Cancer Survival Study began patient accrual in 1985 and was designed to investigate factors that might contribute to the observed racial differences in survival for cancer of the breast, uterine corpus, colon, and bladder.

METHODS

To determine whether there were racial differences in treatment in a clinically homogeneous set of patients, 305 (25%) of the 1222 women in this study with Stage II node-positive (N+) breast cancer were evaluated.

RESULTS

Patient characteristics for blacks and whites were similar for age, metropolitan area of residence, tumor size, extent of nodal involvement, and steroid receptors. Differences in histologic findings, tumor grade, and nuclear atypia were observed. Blacks had a higher frequency of comorbid conditions, especially hypertension (P < 0.00001). Fewer blacks underwent breast-conserving surgery (P = 0.004). In a multivariate analysis, race was no longer a significant factor in the selection of primary treatment, but education and metropolitan area of residence remained significant. Blacks and whites received similar postoperative systemic therapy, with combination chemotherapy (cyclophosphamide, methotrexate, and 5-fluorouracil) and tamoxifen, the most common cytotoxic and endocrine therapies used.

CONCLUSIONS

The National Cancer Institute consensus statement concerning adjuvant therapy for breast cancer was published in the middle of the 2-year period that study cases were accrued, and treatment plans in this study generally agreed with consensus guidelines. Should survival differences in black and white patients with Stage II N+ disease in this study be found, they are unlikely to be attributable to differences in initial or postoperative treatment.

A collaborative study of differences in the survival rates of black patients and white patients with cancer

In 1983, the National Cancer Institute began a social-epidemiologic study of possible behavioral and biologic determinants of black/white racial disparities in cancer survival. The design, methodology, underlying hypotheses, and patient accrual of this study are discussed. Survival differences in four organ sites are investigated: cancers of the uterine corpus, breast, bladder, and colon. The first three sites were chosen because of significant observed black/white differentials in survival. Although racial disparities in survival from colon cancer are less prominent, this site was included because it is a leading cause of deaths attributable to cancer, because regional variations have been observed in black/white survival disparities, and because colon data permit cross-gender comparisons. Data collection centers for the study included the Georgia Center for Cancer Statistics, the Louisiana Tumor Registry, and the California Tumor Registry. Probability samples of patients newly diagnosed with these cancers were drawn from the areas served by these registries. Diagnostic years of eligibility were 1985 to 1986 for breast and colon cancer, and 1985 to 1987 for bladder and uterine corpus cancer. Data were collected by personal interview, medical records abstract, physician records, and pathology review. Analyses focus on seven main explanatory hypotheses.

Cancer in south Louisiana. Part II: Gastrointestinal tract cancers

Incidence rates for the most common cancers of the gastrointestinal tract are presented for the 5 geographic regions in South Louisiana for the period 1983-1986. The risk of colorectal cancer, the most frequent GI cancer in males and females, is uniformly lower in these regions of South Louisiana than in other areas of the United States. Gastric cancer rates are significantly high in black males, as are pancreatic cancer rates in whites of both sexes compared to national rates.

Cancer in south Louisiana. Part III: Cancers of the breast and the reproductive system

Cancers of the breast and reproductive system are less common in South Louisiana than other parts of the nation. The only exception is invasive cervical cancer. Incidence rates for breast cancer in South Louisiana women are 20% lower than the SEER combined rates, and rates for cancer of the uterine corpus and the ovary among white women are 43% and 32% lower respectively than the SEER averages. South Louisiana men also have risks 14% (whites) and 30% (blacks) less than the national of developing prostatic cancer. These significantly low rates are observed for all regions in South Louisiana. The reasons for the low rates are not clearly understood. Possible explanations include: less frequent use of cancer screening tests, high prevalence of hysterectomy, lower risk exposures, and host/genetic factors. The low incidence rates for these cancers are not accompanied by more favorable mortality outcomes, suggesting a poorer survival among Louisiana cancer patients partially due to late stage disease at the time of diagnosis and treatment. Programs to increase the accessibility of cancer screening tests and improve early detection are greatly needed.

Cancer in south Louisiana. Part 1: Tobacco-related cancers

Tobacco-related cancers comprise about one third of the newly-diagnosed cancer in South Louisiana. These cancers are three times more common in men than in women. For cancers originating from anatomic sites where there is a direct contact with tobacco, ie, lung, larynx, oral cavity and pharynx, and esophagus, incidence rates for blacks are either higher than or similar to the rates for whites. For cancers of the bladder and the kidney, sites which have no direct contact with tobacco products, incidence rates are higher in whites than blacks. In general, white men in South Louisiana tend to have risks significantly higher than national for tobacco-related cancers, in particular, cancers of the lung (31% higher) and the larynx (42% higher). A similar pattern is observed for white females but is less pronounced. Black men in South Louisiana, on the other hand, have significantly lower rates than the SEER averages for cancers of the esophagus, oral cavity, and pharynx. Risks for other tobacco-related cancers are very comparable. There are very small differences in rates for black women between South Louisiana and SEER areas. Tobacco-related cancers are most preventable. Any effective cancer program in Louisiana must emphasize prevention and cessation of tobacco use.

Lung cancer in nonsmoking women: a multicenter case-control study

The association between exposure to environmental tobacco smoke and lung cancer in female lifetime nonsmokers was evaluated using data collected during the first 3 years of an ongoing case-control study. This large, multicenter, population-based study was designed to minimize some of the methodological problems which have been of concern in previous studies of environmental tobacco smoke and lung cancer. Both a cancer control group and a population control group were selected in order to evaluate recall bias. A uniform histopathological review of diagnostic material was conducted for case confirmation and detailed classification. Biochemical determination of current exposure to tobacco and screening of multiple sources of information to determine lifetime nonuse were utilized to minimize misclassification of smokers as nonsmokers. A 30% increased risk of lung cancer was associated with exposure to environmental tobacco smoke from a spouse, and a 50% increase was observed for adenocarcinoma of the lung. A statistically significant positive trend in risk was observed as pack-years of exposure from a spouse increased, reaching a relative risk of 1.7 for pulmonary adenocarcinoma with exposures of 80 or more pack-years. The predominant cell type of the reviewed, eligible lung cancer cases was adenocarcinoma (78%). Results were very similar when cases were compared to each control group and when separate analyses were conducted for surrogate and personal respondents. Other adult-life exposures in household, occupational, and social settings were each associated with a 40-60% increased risk of adenocarcinoma of the lung. No association was found between risk of any type of lung cancer and childhood exposures from a father, mother, or other household members.

Cancer control in Louisiana: assessment of needs and development of a plan

A cancer control plan for Louisiana has been developed by the Office of Public Health with funding from the National Cancer Institute. Priorities in the plan are the prevention of cancer through tobacco control and improved nutrition and the early detection of cancer through increased access to screening tests. Findings of the task forces and pilot cancer control interventions planned for Louisiana are described.

Cancer mortality in the 30s foretells cancer of the 80s in Louisiana

Examination of secular trends suggests that the high cancer mortality rates of the 1980s could have been foretold by the excessive rates in the 1930s in Louisiana. Those same sites which were excessive in the 1930s, reflecting exposure to risk factors in the early 1900s, still predominate in the 1980s. Because of the poor survival associated with lung cancer and the increase in smoking, the increase in lung cancer had the greatest impact on the mortality trend in the all sites combined category. The stability of the cancer problem and the lack of progress in reducing cancer over the last 50 years is seen as a harbinger of the cancer problem over the next 50 years.

Pediatric cancer in New Orleans

Rates for pediatric cancer in the Greater New Orleans area were compared with rates from the National Cancer Institute's SEER (Surveillance, Epidemiology, and End Results) Program. The same patterns observed nationally were seen in New Orleans over a 10-year period. Rates were comparable with the exception of cancers of the brain and central nervous system for which New Orleans children displayed higher rates. Using the large number of cases in the SEER Program, three etiological patterns of childhood cancer were apparent based on the age at diagnosis.

Risk factors of gastric precancerous lesions in a high-risk Colombian population. II. Nitrate and nitrite

Gastric nitrite content was studied in relation to precancerous lesions of the stomach in a case-control study conducted in a high-risk Colombian population. The proportion of detectable nitrite in gastric juice and the mean pH were significantly higher among those with precancerous lesions (chronic atrophic gastritis, intestinal metaplasia, and dysplasia) than among the controls (normal and superficial gastritis); the proportion and mean pH increased with the progression of histological changes from normal to dysplasia. Nitrite was not detectable in gastric juice with a pH less than 5.0. A positive association was found between the proportion of detectable nitrite and the risk of gastric precancerous lesions. Odds ratios of 4.39 for intestinal metaplasia and 24.72 for dysplasia remained significant after controlling for confounders. This finding suggests that nitrite may be a precursor of a mutagen that targets gastric epithelial cells.

Risk factors of gastric precancerous lesions in a high-risk Colombian population. I. Salt

A case-control study for stomach cancer was conducted in a high-risk population in Nariño, Colombia to determine the risk of gastric precancerous lesions associated with salt intake measured by sodium-to-creatinine ratio of a single urine sample. Gastric biopsies and urine samples were collected from 263 individuals. Urinary sodium-to-creatinine ratios were studied in relation to histological data from the biopsies. Significantly high odds ratios for precancerous lesions (chronic atrophic gastritis, intestinal metaplasia, and dysplasia) were associated with higher sodium-to-creatinine ratios. Adjusted odds ratios (OR) of 2.50 for chronic atrophic gastritis and 7.24 for dysplasia were found. The association with intestinal metaplasia was weaker and not significant (OR = 1.57). Furthermore, an excess risk associated with adding salt to food at the table was found among patients with precancerous lesions (OR = 1.80). These findings support the two-step involvement of salt in the process of gastric precancerous lesions.