Showing papers by "Ahmedin Jemal published in 2009"

Cancer Statistics, 2009

Abstract: Each year, the American Cancer Society estimates the number of new cancer cases and deaths expected in the United States in the current year and compiles the most recent data on cancer incidence, mortality, and survival based on incidence data from the National Cancer Institute, Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries and mortality data from the National Center for Health Statistics. Incidence and death rates are standardized by age to the 2000 United States standard million population. A total of 1,479,350 new cancer cases and 562,340 deaths from cancer are projected to occur in the United States in 2009. Overall cancer incidence rates decreased in the most recent time period in both men (1.8% per year from 2001 to 2005) and women (0.6% per year from 1998 to 2005), largely because of decreases in the three major cancer sites in men (lung, prostate, and colon and rectum [colorectum]) and in two major cancer sites in women (breast and colorectum). Overall cancer death rates decreased in men by 19.2% between 1990 and 2005, with decreases in lung (37%), prostate (24%), and colorectal (17%) cancer rates accounting for nearly 80% of the total decrease. Among women, overall cancer death rates between 1991 and 2005 decreased by 11.4%, with decreases in breast (37%) and colorectal (24%) cancer rates accounting for 60% of the total decrease. The reduction in the overall cancer death rates has resulted in the avoidance of about 650,000 deaths from cancer over the 15-year period. This report also examines cancer incidence, mortality, and survival by site, sex, race/ethnicity, education, geographic area, and calendar year. Although progress has been made in reducing incidence and mortality rates and improving survival, cancer still accounts for more deaths than heart disease in persons younger than 85 years of age. Further progress can be accelerated by applying existing cancer control knowledge across all segments of the population and by supporting new discoveries in cancer prevention, early detection, and treatment.

Worldwide Variations in Colorectal Cancer

Abstract: Previous studies have documented significant international variations in colorectal cancer rates. However, these studies were limited because they were based on old data or examined only incidence or mortality data. In this article, the colorectal cancer burden and patterns worldwide are described using the most recently updated cancer incidence and mortality data available from the International Agency for Research on Cancer (IARC). The authors provide 5-year (1998-2002), age-standardized colorectal cancer incidence rates for select cancer registries in IARC's Cancer Incidence in Five Continents, and trends in age-standardized death rates by single calendar year for select countries in the World Health Organization mortality database. In addition, available information regarding worldwide colorectal cancer screening initiatives are presented. The highest colorectal cancer incidence rates in 1998-2002 were observed in registries from North America, Oceania, and Europe, including Eastern European countries. These high rates are most likely the result of increases in risk factors associated with "Westernization," such as obesity and physical inactivity. In contrast, the lowest colorectal cancer incidence rates were observed from registries in Asia, Africa, and South America. Colorectal cancer mortality rates have declined in many longstanding as well as newly economically developed countries; however, they continue to increase in some low-resource countries of South America and Eastern Europe. Various screening options for colorectal cancer are available and further international consideration of targeted screening programs and/or recommendations could help alleviate the burden of colorectal cancer worldwide.

Increasing incidence of differentiated thyroid cancer in the United States, 1988–2005

Abstract: BACKGROUND: Studies have reported an increasing incidence of thyroid cancer since 1980. One possible explanation for this trend is increased detection through more widespread and aggressive use of ultrasound and image-guided biopsy. Increases resulting from increased detection are most likely to involve small primary tumors rather than larger tumors, which often present as palpable thyroid masses. The objective of the current study was to investigate the trends in increasing incidence of differentiated (papillary and follicular) thyroid cancer by size, age, race, and sex. METHODS: Cases of differentiated thyroid cancer (1988-2005) were analyzed using the National Cancer Institute's Surveillance Epidemiology and End Results (SEER) dataset. Trends in incidence rates of papillary and follicular cancer, race, age, sex, primary tumor size ( 4 cm), and SEER stage (localized, regional, distant) were analyzed using joinpoint regression and reported as the annual percentage change (APC). RESULTS: Incidence rates increased for all sizes of tumors. Among men and women of all ages, the highest rate of increase was for primary tumors <1.0 cm among men (1997-2005: APC, 9.9) and women (1988-2005: APC, 8.6). Trends were similar between whites and blacks. Significant increases also were observed for tumors ≥4 cm among men (1988-2005: APC, 3.7) and women (1988-2005: APC, 5.70) and for distant SEER stage disease among men (APC, 3.7) and women (APC, 2.3). CONCLUSIONS: The incidence rates of differentiated thyroid cancers of all sizes increased between 1988 and 2005 in both men and women. The increased incidence across all tumor sizes suggested that increased diagnostic scrutiny is not the sole explanation. Other explanations, including environmental influences and molecular pathways, should be investigated. Cancer 2009. © 2009 American Cancer Society.

International Trends in Colorectal Cancer Incidence Rates

Abstract: Background: Previous studies have documented significant variations in colorectal cancer incidence rates and trends regionally and across countries. However, no study has examined the worldwide pattern using the most recently updated incidence data from the IARC. Methods: We obtained sex-specific colorectal cancer incidence for 1953-57 through 1998-2002 by cancer registry from Cancer Incidence in Five Continents (CI5) databases. For 51 cancer registries with long-term incidence data, we assessed the change in the incidence rates over the past 20 years by calculating the ratio of the incidence rates in 1998-2002 to that in 1983-87. Results: Colorectal cancer incidence rates for both males and females statistically significantly increased from 1983-87 to 1998-2002 for 27 of 51 cancer registries considered in the analysis, largely confined to economically transitioning countries including Eastern European countries, most parts of Asia, and select countries of South America. These increases were more prominent for men than for women. We also observed substantial variations in colorectal cancer incidence trends within countries such as Japan. Similarly, trends in Israel and Singapore varied significantly according to ethnicity. The United States is the only country where colorectal cancer incidence rates declined in both males and females. Conclusions: Colorectal cancer incidence rates continue to increase in economically transitioning countries, with incidence rates among men in the Czech Republic and Slovakia exceeding the peak incidence observed in the United States and other long-standing developed nations. Targeted prevention and early detection programs could help reverse the trend in these countries. (Cancer Epidemiol Biomarkers Prev 2009;18(6):1688–94)

Increase in Incidence of Colorectal Cancer Among Young Men and Women in the United States

Abstract: The recent, accelerated decline in colorectal cancer incidence rates has largely been attributed to an increase in screening rates among adults 50 years and older. We used data from 13 Surveillance, Epidemiology, and End Results cancer registries to report on colorectal cancer incidence trends from 1992 through 2005 among adults under age 50 years, for whom screening is not recommended for persons at average risk, by sex, race/ethnicity, age, stage at diagnosis, and anatomic subsite. Overall, incidence rates of colorectal cancer per 100,000 young individuals (ages 20-49 years) increased 1.5% per year in men and 1.6% per year in women from 1992 to 2005. Among non-Hispanic Whites, rates increased for both men and women in each 10-year age grouping (20-29, 30-39, and 40-49 years) and for every stage of diagnosis. The increase in incidence among non-Hispanic Whites was predominantly driven by rectal cancer, for which there was an average increase of 3.5% per year in men and 2.9% per year in women over the 13-year study interval. In contrast to the overall decreasing trend in colorectal cancer incidence in the United States, rates are increasing among men and women under age 50 years. Further studies are necessary to elucidate causes for this trend and identify potential prevention and early detection strategies.

Tobacco control in the United States--recent progress and opportunities.

Abstract: Effective tobacco control efforts have resulted in substantial declines in tobacco use and tobacco-related cancer deaths in the United States. Nearly 40% of reductions in male lung cancer deaths between 1991 and 2003 can be attributed to smoking declines in the last half century. Nevertheless, tobacco use still remains the single, largest preventable cause of disease and premature death in the United States. Each year, smoking and exposure to secondhand smoke result in nearly half a million premature deaths of which nearly one-third are due to cancer. In a previous report, we described youth and adult smoking prevalence and patterns and discussed policy measures that had proven effective in comprehensive tobacco control. In this report, we update trends in youth and adult smoking prevalence. We find that while adult smoking prevalence has declined overall, socioeconomic gradients in smoking still persist within race and ethnic subgroups. In addition, we describe the diffusion of tobacco-control strategies at the national, state, and community level. Although recent developments, such as the Food and Drug Administration's (FDA) regulation of tobacco products, hold promise for tobacco control, there continues to be a need for broader dissemination of sustainably funded comprehensive national and state tobacco-control programs.

Trends in colorectal cancer incidence rates by age, race/ethnicity, and indices of access to medical care, 1995–2004 (United States).

Abstract: Colorectal cancer (CRC) incidence rates in the US decreased rapidly since 1998. This is largely thought to reflect increases in utilization of CRC screening through detection and removal of adenomatous polyps. However, the extent to which the decrease varies by age, race/ethnicity, and differences in access to medical care is largely unknown. Temporal trends in CRC incidence rates were examined from 1995 to 2004 by regression analysis according to age (50–64, ≥65), race/ethnicity (whites, African Americans, and Hispanics), and categories of county-level indicators of access to care (poverty, primary care physician supply [PCP], uninsured rate [age 50–64], and metro/nonmetro) using incidence data from 19 cancer registries, covering about 53% of the US population. Changes in colorectal endoscopic screening and fecal occult blood stool test (FOBT) from 1995–1997 to 2002–2004 for the same set of county-level indicators were also analyzed, using data from the Behavioral Risk Factor Surveillance System (BRFSS). Among whites, CRC incidence rates decreased significantly from 1998 through 2004 in age ≥65, but not in age 50–64 in counties with high uninsured or poverty rates, fewer PCPs, or in nonmetro areas. Among African Americans or Hispanics, rates did not decrease in age 50–64 in general and age ≥65 in counties with high poverty rates, low PCP supply, and nonmetro counties (African Americans). Colorectal endoscopic screening rates increased significantly among whites in both age groups, but not among Hispanics (aged 50–64 in general and aged ≥65 residing in high poverty counties) or African Americans residing in counties with higher uninsured rates (age 50–64), low PCP supply, high poverty rates, and nonmetro counties (age ≥ 65). FOBT rates remained unchanged during the study time period. Our results suggest that individuals residing in poorer communities with lower access to medical care have not experienced the reduction in CRC incidence rates that have benefited more affluent communities; these disparities may be related to health care access barriers to colorectal endoscopic screening.

The convergence of lung cancer rates between blacks and whites under the age of 40, United States.

Abstract: Lung cancer rates in the United States have been consistently higher in blacks than in whites at all ages in men and at younger ages in women. However, since the 1970s, smoking initiation decreased more rapidly among blacks than whites. We examined trends in lung cancer rates for white and black young adults (ages 20-39) from 1992 to 2006 using joinpoint models and black-to-white rate ratios by sex. Lung cancer death rates in 20- to 39-year-olds significantly decreased in all groups but was much steeper for blacks than for whites. From 1992 to 1994 and 2004 to 2006, the black-to-white mortality rate ratio (95% confidence interval) decreased from 2.16 (1.90-2.44) to 1.28 (1.05-1.55) for men and from 1.47 (1.25-1.71) to 0.97 (0.78-1.19) for women. A similar convergence was observed in the lung cancer incidence rates. These findings suggest that if current smoking trends in the young continue, racial differences in overall lung cancer rates in men will be eliminated in the next 40 to 50 years.

An overview of the cancer burden for primary care physicians.

Abstract: Primary care physicians and other caregivers are uniquely positioned to communicate with patients about their real risks of developing or dying from cancer and actions that can reduce these risks. This article discusses the statistics used to measure the cancer burden in a manner intended to help primary caregivers communicate more effectively with patients about cancer. The basic terms used to measure incidence, mortality, and relative survival, and considerations that influence the interpretation of cancer trends are described; opportunities to accelerate progress in reducing cancer incidence and death rates are identified. Although integrating effective prevention measures into standard clinical care will require changes in health care policy and in clinical practice, the combination of these approaches is essential to prevent the massive anticipated increase in the number of cancer cases, due to growth and aging of the population.

Axillary lymphatic disruption does not increase risk of breast carcinoma.

Abstract: To the Editor: Surveys of the general public have identified substantial misunderstanding regarding cancer risk factors and prevention (1). One example, proposed in a nonpeer-reviewed book and promoted on the Internet, is that wearing a bra increases breast cancer risk (2). As insightfully summarized in an on-line book review, the index case that inspired this theory was a breast lump noticed by an anthropologist. Her lesion is virtually certain to have been benign, as it was never biopsied and regressed without intervention (other than going braless and following a natural dietary regimen). She and her co-investigator ⁄ husband hypothesized that the lesion was malignant and that, because she had been wearing a bra and the indigenous people she was living among were not, there might be a causal association. They surveyed a convenience sample of women (not blinded regarding this hypothesis prior to the survey) and analyzed results without adjusting for known breast cancer risk factors (3). The proposed carcinogenic mechanism was that frequent ⁄ prolonged bra use impedes elimination of toxins via the lymphatic system (2). Six percent of respondents in a 2002 survey agreed that ‘‘Under-wire bras can cause breast cancer,’’ and 31% expressed uncertainty (1). We know of only one epidemiologic study of bra use and breast cancer incidence in the peer-reviewed literature; Hsieh and Trichopoulos observed a nonsignificant association among premenopausal, but not postmenopausal women, and concluded that, ‘‘The association, if real, could point to obesity or breast size as the relevant risk factor. ... in all four study centres bra-wearing controls were substantially heavier than those who did not wear a bra and cup size was strongly correlated with body weight and obesity’’ (4). Numerous studies identify obesity as a risk for postmenopausal breast cancer (5). Although studies of breast size and breast cancer risk have yielded inconsistent results, a recent analysis from a large cohort study showed a positive association, but only among premenopausal, lean (BMI < 25) women (6). We are unaware of any peer-reviewed research that supports or refutes a causal association between bra use and breast cancer risk, or suggests such an association might be due to reduced lymphatic elimination of toxins. Consequently, clinicians have little evidence (except biological implausibility) to cite in discussing this topic with patients. We explored this hypothesis by comparing breast cancer incidence in survivors of shoulder or upper extremity (SUE) melanoma treated with or without axillary lymph node surgery (ALNS) which in the vast majority of cases consisted of axillary lymph node dissection (ALND). ALND impedes lymphatic drainage from the ipsilateral arm and breast, often sufficiently to result in lymphedema and, in rare cases, lymphangiosarcoma. If wearing a bra causes lymphatic obstruction sufficiently severe to cause breast cancer, one would expert a far greater increase following ALNS for SUE melanoma. Incidence data were from the nine oldest SEER cancer registries, covering about 10% of the US population (7). Using SEER*Stat software (8), we calculated the standardized incidence ratios (SIR, 95% CI) of breast cancer and of other site-specific cancers for women who had ALNS for localized (SEER summary stage) SUE melanoma between 1983 and 1997 and were followed through 2004 (7). We restricted this analysis to cases diagnosed between 1983 and 1997 because sentinel lymph node biopsy (which minimizes lymphatic disruption) was not used at all during most of this period and was quite uncommon even by 1997. Women with localized melanoma treated with or without ALND were unlikely to have had any Address correspondence to: Ted Gansler, MD, American Cancer society, 250 Williams Street, Atlanta, GA 30303, USA, or e-mail: Ted.gansler @cancer.org.