Not Just a Pretty Picture: The U.S. Cancer Statistics Data Visualization Tool

Background: The United States Centers for Disease Prevention and Control (CDC) National Program of Cancer Registries (NPCR) works to disseminate cancer surveillance data to multiple audiences in accessible, discoverable, and usable formats. To this end, CDC released the official federal cancer statistics, U.S. Cancer Statistics (USCS), in a data visualization tool available at www.cdc.gov/cancer/dataviz . We made further enhancements to the online tool since its initial release in 2017. Aim: We describe the process and enhancements made to the USCS data visualization tool's content, graphical displays, and sharing capabilities. Methods: CDC partnered with Agency for Toxic Substances and Disease Registry's Geospatial Research, Analysis, and Services Program to further work initiated by a group of cancer registrars, program planners, epidemiologists, computer programmers, and communication specialists to improve the visual presentation of USCS cancer incidence and mortality data. We conducted usability testing and implemented changes to the Web site's layout and added content, including county-level data, survival data, and prevalence estimates. Results: New features include county statistics, survival, prevalence, Puerto Rico data, and tobacco-, alcohol-, and obesity-related cancers data displays. The tool was also enhanced to better display on mobile devices. Data displays on national and state incidence, mortality and trends are available as maps and bar charts with interpretive text when users scroll over each graphic. Users can customize displays of overall and cancer-specific statistics, download data tables, and share each page via social media. Conclusion: Surveillance data are fundamental to measure progress and target action. CDC's interactive USCS data visualization tool is designed to make cancer data more accessible and usable to multiple users, including the general public, media, policy makers and planners. We will continue to improve the tool's accessibility and usefulness to facilitate the interpretation and sharing of cancer data.

Malignant Syphilis in an Immunocompetent Adult Male

The occurrence of malignant syphilis in an immunocompetent individual is rare. We present malignant syphilis in a 35-year-old immunocompetent male who presented with a 1-month history of noduloulcerative lesions on the torso. Examination revealed multiple pustules, nodules, and deep-seated ulcers distributed on the trunk, face, and upper and lower limbs. Characteristic morphology of lesions, positive serological tests for syphilis, characteristic histopathology, and resolution of lesions following institution of penicillin therapy confirmed the clinical diagnosis of malignant syphilis.

Abstract P2-09-02: Validation of a Novel Staging System for Disease-Specific Survival in Breast Cancer Patients Treated with Neoadjuvant Chemotherapy

Purpose We previously described a novel breast cancer staging system for assessing prognosis after neoadjuvant chemotherapy based on pretreatment clinical stage (CS), estrogen receptor status (E), grade (G) and post-treatment pathologic stage (PS). This CPS+EG staging system assigned and summed points for each factor, allowing for better determination of breast cancer-specific survival than CS or PS alone. The current study was undertaken to validate this staging system using internal and external cohorts.

Methods We identified 804 patients treated with neoadjuvant chemotherapy at our institution from 2003-2005 who were not part of the original determination of the CPS+EG staging system and an external cohort of 165 patients treated at another institution. Clinicopathologic characteristics, treatment regimens, and patient outcomes were assessed. Outcomes were stratified by CPS+EG score in order to test whether the 5-year disease-specific survival (DSS) in each CPS+EG group was numerically as predicted.

Results The 5-year DSS for the internal cohort was 77% (95% CI: 72-82) at a median follow-up of 3.4 years (range, 03-5.9). The 5-year DSS for the external cohort was 86% (95% CI: 7 -91) at a median follow-up of 4.7 years (range, 0.5-10.5). The ability of the CPS+EG score to distinguish outcomes based on good or poor prognosis was confirmed in both the internal and external cohorts. In both cohorts, application of the CPS+EG staging system facilitated more accurate categorization of patients into prognostic subgroups than CS or final PS as defined by the American Joint Committee on Cancer (AJCC) staging system.

Disease-Specific Survival Outcomes Based on the CPS+EG Staging System

Application of the CPS+EG to all three cohorts combined, demonstrated 5-year DSS ranging from 23% to 99% versus 5-year DSS ranging from 61% to 92% based on presenting CS or 58% to 95% based on post-treatment PS.

Conclusion The current study validates the CPS+EG staging system in independent patient cohorts. We recommend that biologic markers and response to treatment be incorporated into revised versions of the AJCC staging system for patients receiving neoadjuvant chemotherapy.

Development of (p-O-sulfamoyl)-N-alkanoyl-phenylalkyl amines as non-steroidal estrone sulfatase inhibitors

Estrogen levels in breast tumors of postmenopausal women are as much as 10 times higher than estrogen levels in plasma, presumably due to in situ formation of estrogen. The major source of estrogen in breast cancer cells may be conversion of estrone sulfate to estrone by the enzyme estrone sulfatase. Thus, inhibitors of estrone sulfatase are potential agents for treatment of estrogen-dependent breast cancer. Several steroidal compounds have been developed that are potent estrone sulfatase inhibitors, most notably estrone-3-O-sulfamate. However, these compounds and their metabolites may have undesired effects, including estrogenicity. To avoid the problems associated with a potentially active steroid nucleus, we designed and synthesized a series of nonsteroidal estrone sulfatase inhibitors, the (p-O-sulfamoyl)-N-alkanoyl phenylalkyl amines. The compounds synthesized vary in the length of their alkanoyl chain and in the number of carbons separating the phenyl ring and the carbonyl carbon. The ability of these compounds to inhibit estrone sulfatase activity was tested using human placental microsomes and intact cultured human breast cancer cells. Estrogenicity was also evaluated, using growth of estrogen-dependent human breast cancer cells. All of the test compounds inhibited estrone sulfatase activity of human placental microsomes to some extent, with the most effective compound having an IC50 value of 72 nM. In general, compounds with longer alkanoyl chains (12-14 carbons) were more effective than those with shorter chains. The test compounds also inhibited estrone sulfatase activity in intact cultures of MDA-MB-231 human breast cancer cells. Again, the longer chain compounds were more effective. In both the placental and breast cancer cell sulfatase assays, the optimal distance between the phenyl ring and the carbonyl carbon was 1-2 carbons. The MCF-7 cell proliferation assay revealed that estrone and estrone-3-O-sulfamate were both estrogenic, but the (p-O-sulfamoyl)-N-alkanoyl phenylalkyl amines were not. Our data indicate the utility of (p-O-sulfamoyl)-N-alkanoyl phenyl alkylamines for inhibition of estrone sulfatase activity. Furthermore, our data support the concept that nonsteroidal estrone sulfatase inhibitors may be useful as therapeutic agents for estrogen-dependent breast cancers.