Showing papers by "Benjamin F. Hankey published in 1991"

The increasing incidence of breast cancer since 1982: relevance of early detection

Abstract: Breast cancer incidence in the United States has been rising dramatically since 1982, as shown in data collected by the Surveillance, Epidemiology, and End Results (SEER) Program. In women aged 50 and older, incidence rates for in situ and localized invasive tumors have increased over the period 1982–86, while rates for regional and distant tumors have remained stable. The incidence of localized tumors <1.0 cm, 1.0–1.9 cm, and 2.0–2.9 cm in size has increased more rapidly than that of tumors 3.0 cm or more in size among women over age 50. Survival rates also have improved among cases diagnosed over this time period. These data suggest that early detection may be playing a role in the recent increase in female breast cancer incidence, though other factors cannot be ruled out. Conclusions regarding improved cancer control await confirmation by reduced breast cancer mortality.

Problems in cancer surveillance: delineating in situ and invasive bladder cancer.

Abstract: In this issue of the Journal, Lynch et al (7) describe the implications of combining in situ and invasive bladder cancers for reporting purposes by the Surveillance, Epidemiology, and End Results (SEER) Program based at the National Cancer Institute. They discuss the implications of this practice in regard to the importance ascribed to bladder cancer relative to other cancers in the general population, using data from the registry for Iowa, one of the nine SEER areas. The SEER Program has combined in situ and invasive bladder cancers when reporting incidence and survival rates beginning with the 1985 annual report (2) (cases diagnosed 1973 through 1983). Reasons for making this decision included the following. Incidence rates for invasive bladder cancer had decreased rather dramatically in 1982 and 1983, while the rates for in situ bladder cancer had increased by nearly the same amount over the same period (Fig 1). Consultation with some pathologists in local SEER registry areas indicated that this trend was due in part to difficulties created by the absence of statements in the final diagnosis and microscopic description in pathology reports regarding the behavior (ie, in situ vs invasive) of bladder tumors. Such vagaries were resulting in variable and unpredictable results associated with the identification of in situ and invasive bladder cancers from the hospital medical record. Table 1 indicates that the incidence rates of in situ bladder cancer and the percents of in situ bladder cancer incidence relative to the total incidence of in situ and invasive bladder cancer varied by SEER registry area. Moreover, analysis of survival rates by behavior, extent of disease, and histologic type (Table 2) indicate that rates for cases of invasive bladder tumors confined to the mucosa that were papillary or papillary transitional cell cancer were higher than rates for cases of in situ transitional cell cancer. In order not to show a false decrease in invasive bladder cancer, it was decided that in situ and invasive bladder cancers would be combined for reporting purposes until the source of the problem could be determined and addressed. The study carried out by Lynch et al describes SEER data collection and reporting procedures for bladder cancer as well as a review of tissue slides from a limited subset of cases diagnosed in Iowa in 1983, to assess tumor behavior. The purpose of the study was to investigate problems in interpreting bladder cancer 1973 1976 1977 1979 1981 1983 1985 1987 1989