Showing papers by "Ahmedin Jemal published in 2011"

Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths.

Abstract: Each year, the American Cancer Society estimates the numbers 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, the 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. A total of 1,596,670 new cancer cases and 571,950 deaths from cancer are projected to occur in the United States in 2011. Overall cancer incidence rates were stable in men in the most recent time period after decreasing by 1.9% per year from 2001 to 2005; in women, incidence rates have been declining by 0.6% annually since 1998. Overall cancer death rates decreased in all racial/ethnic groups in both men and women from 1998 through 2007, with the exception of American Indian/Alaska Native women, in whom rates were stable. African American and Hispanic men showed the largest annual decreases in cancer death rates during this time period (2.6% and 2.5%, respectively). Lung cancer death rates showed a significant decline in women after continuously increasing since the 1930s. The reduction in the overall cancer death rates since 1990 in men and 1991 in women translates to the avoidance of about 898,000 deaths from cancer. However, this progress has not benefitted all segments of the population equally; cancer death rates for individuals with the least education are more than twice those of the most educated. The elimination of educational and racial disparities could potentially have avoided about 37% (60,370) of the premature cancer deaths among individuals aged 25 to 64 years in 2007 alone. Further progress can be accelerated by applying existing cancer control knowledge across all segments of the population with an emphasis on those groups in the lowest socioeconomic bracket. CA Cancer J Clin 2011. © 2011 American Cancer Society.

Breast cancer statistics, 2011†

Abstract: In this article, the American Cancer Society provides an overview of female breast cancer statistics in the United States, including trends in incidence, mortality, survival, and screening. Approximately 230,480 new cases of invasive breast cancer and 39,520 breast cancer deaths are expected to occur among US women in 2011. Breast cancer incidence rates were stable among all racial/ethnic groups from 2004 to 2008. Breast cancer death rates have been declining since the early 1990s for all women except American Indians/Alaska Natives, among whom rates have remained stable. Disparities in breast cancer death rates are evident by state, socioeconomic status, and race/ethnicity. While significant declines in mortality rates were observed for 36 states and the District of Columbia over the past 10 years, rates for 14 states remained level. Analyses by county-level poverty rates showed that the decrease in mortality rates began later and was slower among women residing in poor areas. As a result, the highest breast cancer death rates shifted from the affluent areas to the poor areas in the early 1990s. Screening rates continue to be lower in poor women compared with non-poor women, despite much progress in increasing mammography utilization. In 2008, 51.4% of poor women had undergone a screening mammogram in the past 2 years compared with 72.8% of non-poor women. Encouraging patients aged 40 years and older to have annual mammography and a clinical breast examination is the single most important step that clinicians can take to reduce suffering and death from breast cancer. Clinicians should also ensure that patients at high risk of breast cancer are identified and offered appropriate screening and follow-up. Continued progress in the control of breast cancer will require sustained and increased efforts to provide high-quality screening, diagnosis, and treatment to all segments of the population.

Annual Report to the Nation on the Status of Cancer, 1975–2007, Featuring Tumors of the Brain and Other Nervous System

Abstract: Methods Cancer incidence data were obtained from the National Cancer Institute, CDC, and NAACCR, and information on deaths was obtained from the CDC’s National Center for Health Statistics. The annual percentage changes in age-standardized incidence and death rates (2000 US population standard) for all cancers combined and for the top 15 cancers for men and for women were estimated by joinpoint analysis of long-term (1992–2007 for incidence; 1975–2007 for mortality) trends and short-term fixed interval (1998–2007) trends. Analyses of malignant neuroepithelial brain and ONS tumors were based on data from 1980–2007; data on nonmalignant tumors were available for 2004–2007. All statistical tests were two-sided. Results Overall cancer incidence rates decreased by approximately 1% per year; the decrease was statistically significant (P < .05) in women, but not in men, because of a recent increase in prostate cancer incidence. The death rates continued to decrease for both sexes. Childhood cancer incidence rates continued to increase, whereas death rates continued to decrease. Lung cancer death rates decreased in women for the first time during 2003– 2007, more than a decade after decreasing in men. During 2004–2007, more than 213 500 primary brain and ONS tumors were diagnosed, and 35.8% were malignant. From 1987–2007, the incidence of neuroepithelial malignant brain and ONS tumors decreased by 0.4% per year in men and women combined. Conclusions The decrease in cancer incidence and mortality reflects progress in cancer prevention, early detection, and treatment. However, major challenges remain, including increasing incidence rates and continued low survival for some cancers. Malignant and nonmalignant brain tumors demonstrate differing patterns of occurrence by sex, age, and race, and exhibit considerable biologic diversity. Inclusion of nonmalignant brain tumors in cancer registries provides a fuller assessment of disease burden and medical resource needs associated with these unique tumors.

Recent trends in cutaneous melanoma incidence and death rates in the United States, 1992-2006.

Abstract: Background Increasing cutaneous melanoma incidence rates in the United States have been attributed to heightened detection of thin (≤1-mm) lesions. Objective We sought to describe melanoma incidence and mortality trends in the 12 cancer registries covered by the Surveillance, Epidemiology, and End Results program and to estimate the contribution of thin lesions to melanoma mortality. Methods We used joinpoint analysis of Surveillance, Epidemiology, and End Results incidence and mortality data from 1992 to 2006. Results During 1992 through 2006, melanoma incidence rates among non-Hispanic whites increased for all ages and tumor thicknesses. Death rates increased for older (>65 years) but not younger persons. Between 1998 to 1999 and 2004 to 2005, melanoma death rates associated with thin lesions increased and accounted for about 30% of the total melanoma deaths. Limitations Availability of long-term incidence data for 14% of the US population was a limitation. Conclusions The continued increases in melanoma death rates for older persons and for thin lesions suggest that the increases may partly reflect increased ultraviolet radiation exposure. The substantial contribution of thin lesions to melanoma mortality underscores the importance of standard wide excision techniques and the need for molecular characterization of the lesions for aggressive forms.

International Trends in Liver Cancer Incidence Rates

Abstract: Background: Several previous studies have documented region or country-specific liver cancer incidence trends around the world. However, no study has systematically examined the international pattern using the most recently updated incidence data from the International Agency for Research on Cancer. Methods: We examined recent trends in liver cancer incidence rates from 1993 to 2002 by joinpoint analysis for 32 cancer registries worldwide, using Cancer Incidence in Five Continents. We also examined the male to female rate ratios for these and four additional registries, based on the 1998–2002 incidence data. Results: Liver cancer incidence rates for both men and women statistically significantly increased from 1993 to 2002 for 8 of 32 cancer registries considered in the analysis. Increases were largely confined to economically developed countries of Western Europe, North America, and Oceania. In contrast, rates decreased in both men and women in 5 registries including 3 in Asia. Despite this, the incidence rates in Asian countries are twice as high as those in Africa and more than four times as high as rates in North America. Male to female rate ratios varied from 0.9 in sub-Saharan African and South American registries to 5.0 in France and Egypt. Conclusions: Liver cancer incidence rates continue to increase in some low-risk parts of the world whereas they are decreasing in some of the highest risk countries in Asia. Etiologic studies are required to further elucidate factors contributing to the divergent liver cancer incidence trends worldwide. Impact: Our description of international liver cancer incidence trends may stimulate further etiologic studies. Cancer Epidemiol Biomarkers Prev; 20(11); 2362–8. ©2011 AACR . This article is featured in Highlights of This Issue, [p. 2329][1] [1]: /lookup/volpage/20/2329?iss=11

Melanoma in adolescents and young adults (ages 15-39 years): United States, 1999-2006

Abstract: Background Invasive melanoma of the skin is the third most common cancer diagnosed among adolescents and young adults (aged 15-39 years) in the United States. Understanding the burden of melanoma in this age group is important to identifying areas for etiologic research and in developing effective prevention approaches aimed at reducing melanoma risk. Methods Melanoma incidence data reported from 38 National Program of Cancer Registries and/or Surveillance Epidemiology and End Results statewide cancer registries covering nearly 67.2% of the US population were used to estimate age-adjusted incidence rates for persons 15-39 years of age. Incidence rate ratios were calculated to compare rates between demographic groups. Results Melanoma incidence was higher among females (age-adjusted incidence rates = 9.74; 95% confidence interval 9.62-9.86) compared with males (age-adjusted incidence rates = 5.77; 95% confidence interval 5.68-5.86), increased with age, and was higher in non-Hispanic white compared with Hispanic white and black, American Indians/Alaskan Natives, and Asian and Pacific Islanders populations. Melanoma incidence rates increased with year of diagnosis in females but not males. The majority of melanomas were diagnosed on the trunk in all racial and ethnic groups among males but only in non-Hispanic whites among females. Most melanomas were diagnosed at localized stage, and among those melanomas with known histology, the majority were superficial spreading. Limitations Accuracy of melanoma cases reporting was limited because of some incompleteness (delayed reporting) or nonspecific reporting including large proportion of unspecified histology. Conclusions Differences in incidence rates by anatomic site, histology, and stage among adolescents and young adults by race, ethnicity, and sex suggest that both host characteristics and behaviors influence risk. These data suggest areas for etiologic research around gene-environment interactions and the need for targeted cancer control activities specific to adolescents and young adult populations.

Breast Cancer Incidence Rates in U.S. Women Are No Longer Declining

Abstract: Background: Several publications reported breast cancer incidence rates continued to decrease among white women, following the decline of about 7% from 2002-2003. However, none of these reports exclusively examined the trend after 2003. In this paper, we examined breast cancer incidence rates among non-Hispanic (NH) white women from 2003-2007 to determine whether the decrease in breast cancer incidence rates indeed persisted through 2007. In addition, we present breast cancer incidence trends for NH black and Hispanic women and postmenopausal hormone use for all three racial/ethnic groups. Methods: Breast cancer incidence rates were calculated by race/ethnicity, age and ER status using data from the Surveillance, Epidemiology, and End Results (SEER) 12 registries for 2000-2007. Prevalence of postmenopausal hormone use was calculated using National Health Interview Survey data from 2000, 2005, and 2008. Results: From 2003-2007, overall breast cancer incidence rates did not change significantly among NH white women in any age group. However, rates increased (2.7% per year) for ER+ breast cancers in ages 40-49, and decreased for ER- breast cancers in ages 40-49 and 60-69. Similarly, overall breast cancer incidence rates did not change significantly for black and Hispanic women. Hormone use continued to decrease from 2005 to 2008 in all groups, although the decreases were smaller compared to those from 2000 to 2005. Conclusions: The sharp decline in breast cancer incidence rates that occurred from 2002-2003 among NH white women did not continue through 2007. Impact: Further studies are needed to better understand the recent breast cancer trends.

State Disparities in Colorectal Cancer Mortality Patterns in the United States

Abstract: Background: Colorectal cancer (CRC) mortality rates have been decreasing for many decades in the United States, with the decrease accelerating in the most recent time period. The extent to which this decrease varies across states and its influence on the geographic patterns of rates is unknown. Methods: We analyzed the temporal trend in age-standardized CRC death rates for each state from 1990 to 2007 using joinpoint regression. We also examined the change in death rates between 1990-1994 and 2003-2007 using rate ratios with 95% confidence intervals and illustrated the change in pattern using maps. The relationship between the change in mortality rates and CRC screening rates for 2004 by state was examined using Pearson's correlation. Results: CRC mortality rates significantly decreased in all states except Mississippi between 1990 and 2007 based on the joinpoint model. The decrease in death rates between 1990-1994 and 2003-2007 ranged from 9% in Alabama to greater than 33% in Massachusetts, Rhode Island, New York, and Alaska; Mississippi and Wyoming showed no significant decrease. Generally, the northeastern states showed the largest decreases, whereas southern states showed the smallest decreases. The highest CRC mortality rates shifted from the northeastern states during 1990 to 1994 to the southern states along the Appalachian corridor during 2003 to 2007. The decrease in CRC mortality rates by state correlated strongly with uptake of screening (r = -0.65, P < 0.0001). Conclusions: Progress in reducing CRC mortality varies across states, with the Northeast showing the most progress and the South showing the least progress. Impact: These findings highlight the need for wider dissemination of CRC screening.

Association of cutaneous melanoma incidence with area-based socioeconomic indicators–United States, 2004-2006

Abstract: Background Socioeconomic status (SES) has been associated with melanoma incidence and outcomes. Examination of the relationship between melanoma and SES at the national level in the United States is limited. Expanding knowledge of this association is needed to improve early detection and eliminate disparities. Objective We sought to provide a detailed description of cutaneous melanoma incidence and stage of disease in relationship to area-based socioeconomic measures including poverty level, education, income, and unemployment in the United States. Methods Invasive cutaneous melanoma data reported by 44 population-based central cancer registries for 2004 to 2006 were merged with county-level SES estimates from the US Census Bureau. Age-adjusted incidence rates were calculated by gender, race/ethnicity, poverty, education, income, unemployment, and metro/urban/rural status using software. Poisson multilevel mixed models were fitted, and incidence density ratios were calculated by stage for area-based SES measures, controlling for age, gender, and state random effects. Results Counties with lower poverty, higher education, higher income, and lower unemployment had higher age-adjusted melanoma incidence rates for both early and late stage. In multivariate models, SES effects persisted for early-stage but not late-stage melanoma incidence. Limitations Individual-level measures of SES were unavailable, and estimates were based on county-level SES measures. Conclusion Our findings show that melanoma incidence in the United States is associated with aggregate county-level measures of high SES. Analyses using finer-level SES measures, such as individual or census tract level, are needed to provide more precise estimates of these associations.

Body Mass Index in Young Adulthood and Premature Death: Analyses of the US National Health Interview Survey Linked Mortality Files

Abstract: Knowledge of the association between body mass index (weight (kg)/height (m)(2)) and premature death in young adulthood is very limited, especially for specific causes of death. Using the US National Health Interview Survey linked mortality files, the authors examined the relation between body mass index and premature death from all causes, cardiovascular disease (CVD), and cancer among 112,328 persons aged 18-39 years who participated in the National Health Interview Survey in the years 1987, 1988, and 1990-1995. During an average of 16 years of follow-up (ending on December 31, 2006), there were 3,178 deaths: 573 from CVD and 733 from cancer. Hazard ratios and 95% confidence intervals were estimated using multivariate proportional hazards models adjusting for age, gender, race/ethnicity, education, and smoking status. In analyses restricted to participants who had never smoked, the hazard ratios for death from all causes were 1.07 (95% confidence interval (CI): 0.91, 1.26) for overweight participants, 1.41 (95% CI: 1.16, 1.73) for obese participants, and 2.46 (95% CI: 1.91, 3.16) for extremely obese participants, compared with those of normal weight. Monotonically increasing risks for excess body weight were also observed for deaths from cancer and CVD. The associations found in this young cohort were much stronger than those in middle-aged or older populations.

Changes in smoking prevalence among U.S. adults by state and region: Estimates from the Tobacco Use Supplement to the Current Population Survey, 1992-2007

Abstract: Background: Tobacco control policies at the state level have been a critical impetus for reduction in smoking prevalence. We examine the association between recent changes in smoking prevalence and state-specific tobacco control policies and activities in the entire U.S. Methods: We analyzed the 1992-93, 1998-99, and 2006-07 Tobacco Use Supplement to the Current Population Survey (TUS-CPS) by state and two indices of state tobacco control policies or activities [initial outcome index (IOI) and the strength of tobacco control (SOTC) index] measured in 1998-1999. The IOI reflects cigarette excise taxes and indoor air legislation, whereas the SOTC reflects tobacco control program resources and capacity. Pearson Correlation coefficient between the proportionate change in smoking prevalence from 1992-93 to 2006-07 and indices of tobacco control activities or programs was the main outcome measure. Results: Smoking prevalence decreased from 1992-93 to 2006-07 in both men and women in all states except Wyoming, where no reduction was observed among men, and only a 6.9% relative reduction among women. The percentage reductions in smoking in men and women respectively were the largest in the West (average decrease of 28.5% and 33.3%) and the smallest in the Midwest (18.6% and 20.3%), although there were notable exceptions to this pattern. The decline in smoking prevalence by state was correlated with the state’s IOI in both women and men (r = -0.49, p < 0.001; r = -0.31, p = 0.03; respectively) and with state’s SOTC index in women(r = -0.30, p = 0.03 0), but not men (r = -0.21, p = 0.14). Conclusion: State level policies on cigarette excise taxes and indoor air legislation correlate strongly with reductions in smoking prevalence since 1992. Strengthening and systematically implementing these policies could greatly accelerate further reductions in smoking.

US mortality rates for oral cavity and pharyngeal cancer by educational attainment.

Abstract: Objective To describe trends in mortality rates for patients with oral cavity and pharynx cancer by educational attainment, race/ethnicity, sex, and association with human papillomavirus infection. Design Study of age-standardized mortality rates for patients with oral cavity and pharynx cancer by level of education using National Center for Health Statistics data. Setting Twenty-six states. Patients White and black men and women aged 25 to 64 years. Main Outcome Measure Age-standardized mortality rates for 2005 to 2007 and trends for 1993 to 2007. Results From 1993 to 2007, overall mortality rates for patients with oral cavity and pharynx cancer decreased among black and white men and women; however, rates among white men have stabilized since 1999. The largest decreases in mortality rates were among black men and women with 12 years of education (−4.95% and −3.72%, respectively). Mortality rates for patients with oral cavity and pharynx cancers decreased significantly among men and women with more than 12 years of education, regardless of race/ethnicity (except for black women), whereas rates increased among white men with less than 12 years of education. Mortality trends vary substantially for human papillomavirus–related and human papillomavirus–unrelated sites. Conclusions We observed decreasing mortality rates for patients with oral cavity and pharyngeal cancer among whites and blacks; however, decreases were greatest among those with at least 12 years of education. This difference in mortality trends may reflect the changing prevalence of smoking and sexual behaviors among populations of different educational attainment.

Abstract B13: Widening socioeconomic disparities in cervical cancer mortality among women in 26 states: 1993–2007

Abstract: Background: Despite declines in cervical cancer mortality in the U.S. due to widespread Pap testing, mortality disparities persist. Previous studies were limited to area-level determinants of socioeconomic status (SES). We examined recent temporal trends in cervical cancer mortality by individual levels of educational attainment as a proxy for SES. Methods: Data from the National Vital Statistics System were used to calculate age-standardized cervical cancer mortality rates for women aged 25–64 years (1993–2007) by individual levels of education: Results: A total 6,613 cervical cancer deaths occurred during 1993–2007. Mortality rates declined from 4.18 during 1993–1995 to 3.01 during 2005–2007 (−2.9% per year, P Conclusions: Overall cervical cancer mortality declined among women aged 25–64 during 1993–2007; however, the rate of decline was much slower for women with lower levels of educational attainment, leading to widening of SES disparities in cervical cancer mortality rates. We note that many cervical cancer deaths could be avoided by addressing SES disparities, and that additional research is needed to assess individual determinants of these disparities in cervical cancer mortality as well as interventions to reduce them. Citation Information: Cancer Prev Res 2011;4(10 Suppl):B13.

Long-term survival rates of older breast cancer patients: Population-based estimates over three decades.

Abstract: Significant progress has been made in the treatment of breast cancer. However, treatment effect on survival in older patients, particularly the “oldest old” (85+ years), with breast cancer is not clear. Data from the Surveillance, Epidemiology, and End Results databases were used to determine relative survival of older patients with breast cancer for up to 9 years following diagnosis. We compared trends in survival and stage distribution in the years 1977–1986, 1987–1996, and 1997–2006 in patients from 65 to 74, 75 to 84, and 85+ years of age. Between 1977–1986 and 1997–2006, 1 year survival increased from 94.9 to 97.9 %, 93.6 to 96.7 %, and 88.5 to 93.5 % in the 65–74, 75–84, and 85+ age groups, respectively. Survival gains increased with each year in all three age groups with the largest improvement seen at 9 years of follow-up. Although the “oldest old” had the lowest survival rates, improvement in survival was greatest in this age group with greater than 20 % increase in survival at 9 years. There was an increased diagnosis of localized breast cancer and decrease in regional disease in all age groups over the three decades. In conclusion, relative survival for older patients has increased considerably in the interval between 1977 and 2006, with the largest improvement seen in those 85 years and older. These results likely indicate that the benefit from advances in therapy and supportive care also extends to older patients with breast cancer, including the ‘oldest old’, but the impact of early diagnosis on survival requires further clarification.