Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States and compiles the most recent data on population-based cancer occurrence. Incidence data (through 2016) were collected by the Surveillance, Epidemiology, and End Results Program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data (through 2017) were collected by the National Center for Health Statistics. In 2020, 1,806,590 new cancer cases and 606,520 cancer deaths are projected to occur in the United States. The cancer death rate rose until 1991, then fell continuously through 2017, resulting in an overall decline of 29% that translates into an estimated 2.9 million fewer cancer deaths than would have occurred if peak rates had persisted. This progress is driven by long-term declines in death rates for the 4 leading cancers (lung, colorectal, breast, prostate); however, over the past decade (2008-2017), reductions slowed for female breast and colorectal cancers, and halted for prostate cancer. In contrast, declines accelerated for lung cancer, from 3% annually during 2008 through 2013 to 5% during 2013 through 2017 in men and from 2% to almost 4% in women, spurring the largest ever single-year drop in overall cancer mortality of 2.2% from 2016 to 2017. Yet lung cancer still caused more deaths in 2017 than breast, prostate, colorectal, and brain cancers combined. Recent mortality declines were also dramatic for melanoma of the skin in the wake of US Food and Drug Administration approval of new therapies for metastatic disease, escalating to 7% annually during 2013 through 2017 from 1% during 2006 through 2010 in men and women aged 50 to 64 years and from 2% to 3% in those aged 20 to 49 years; annual declines of 5% to 6% in individuals aged 65 years and older are particularly striking because rates in this age group were increasing prior to 2013. It is also notable that long-term rapid increases in liver cancer mortality have attenuated in women and stabilized in men. In summary, slowing momentum for some cancers amenable to early detection is juxtaposed with notable gains for other common cancers.

https://acsjournals.onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21590

Cancer statistics, 2020.

Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths in the United States and compiles the most recent data on population‐based cancer occurrence and outcomes. Incidence data (through 2018) were collected by the Surveillance, Epidemiology, and End Results program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data (through 2019) were collected by the National Center for Health Statistics. In 2022, 1,918,030 new cancer cases and 609,360 cancer deaths are projected to occur in the United States, including approximately 350 deaths per day from lung cancer, the leading cause of cancer death. Incidence during 2014 through 2018 continued a slow increase for female breast cancer (by 0.5% annually) and remained stable for prostate cancer, despite a 4% to 6% annual increase for advanced disease since 2011. Consequently, the proportion of prostate cancer diagnosed at a distant stage increased from 3.9% to 8.2% over the past decade. In contrast, lung cancer incidence continued to decline steeply for advanced disease while rates for localized‐stage increased suddenly by 4.5% annually, contributing to gains both in the proportion of localized‐stage diagnoses (from 17% in 2004 to 28% in 2018) and 3‐year relative survival (from 21% to 31%). Mortality patterns reflect incidence trends, with declines accelerating for lung cancer, slowing for breast cancer, and stabilizing for prostate cancer. In summary, progress has stagnated for breast and prostate cancers but strengthened for lung cancer, coinciding with changes in medical practice related to cancer screening and/or treatment. More targeted cancer control interventions and investment in improved early detection and treatment would facilitate reductions in cancer mortality.

https://onlinelibrary.wiley.com/doi/pdfdirect/10.3322/caac.21708

Cancer statistics, 2022

The MMWR series of publications is published by the Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta, GA 30333.

/pdf/sexually-transmitted-diseases-treatment-guidelines-4zaqk3joit.pdf

Sexually transmitted diseases treatment guidelines.

The causal role of human papillomavirus infections in cervical cancer has been documented beyond reasonable doubt. The association is present in virtually all cervical cancer cases worldwide. It is the right time for medical societies and public health regulators to consider this evidence and to define its preventive and clinical implications. A comprehensive review of key studies and results is presented.

https://jcp.bmj.com/content/jclinpath/55/4/244.full.pdf

The causal relation between human papillomavirus and cervical cancer

Background: High-risk human papillomaviruses (HPVs) are etiologic agents for anogenital tract cancers and have been detected in head and neck squamous cell carcinomas (HNSCCs). We investigated, retrospectively, an etiologic role for HPVs in a large series of patients with HNSCC. Methods: Tumor tissues from 253 patients with newly diagnosed or recurrent HNSCC were tested for the presence of HPV genome by use of polymerase chain reaction (PCR)-based assays, Southern blot hybridization, and in situ hybridization. The viral E6 coding region was sequenced to confirm the presence of tumor-specific viral isolates. Exons 5‐9 of the TP53 gene were sequenced from 166 specimens. The hazard of death from HNSCC in patients with and without HPVpositive tumors was determined by proportional hazards regression analysis. Results: HPV was detected in 62 (25%) of 253 cases (95% confidence interval [CI] = 19%‐30%). Highrisk, tumorigenic type HPV16 was identified in 90% of the HPV-positive tumors. HPV16 was localized specifically by in situ hybridization within the nuclei of cancer cells in preinvasive, invasive, and lymph node disease. Southern blot hybridization patterns were consistent with viral integration. Poor tumor grade (odds ratio [OR] = 2.4; 95% CI = 1.2‐ 4.9) and oropharyngeal site (OR = 6.2; 95% CI = 3.1‐12.1) independently increased the probability of HPV presence. As compared with HPV-negative oropharyngeal cancers, HPVpositive oropharyngeal cancers were less likely to occur among moderate to heavy drinkers (OR = 0.17; 95% CI = 0.05‐0.61) and smokers (OR = 0.16; 95% CI = 0.02‐1.4), had a characteristic basaloid morphology (OR = 18.7; 95% CI = 2.1‐167), were less likely to have TP53 mutations (OR = 0.06; 95% CI = 0.01‐0.36), and had improved disease-specific survival (hazard ratio [HR] = 0.26; 95% CI = 0.07‐0.98). After adjustment for the presence of lymph node disease (HR = 2.3; 95% CI = 1.4‐ 3.8), heavy alcohol consumption (HR = 2.6; 95% CI = 1.4‐4.7), and age greater than 60 years old (HR = 1.4; 95% CI = 0.8‐2.3), all patients with HPV-positive tumors had a 59% reduction in risk of death from cancer when compared with HPV-negative HNSCC patients (HR = 0.41; 95% CI = 0.20‐0.88). Conclusions: These data extend recent molecular and epidemiologic studies and strongly suggest that HPV-positive oropharyngeal cancers comprise a distinct molecular, clinical, and pathologic disease entity that is likely causally associated with HPV infection and that has a markedly improved prognosis. [J Natl Cancer Inst 2000; 92:709‐20]

Evidence for a Causal Association Between Human Papillomavirus and a Subset of Head and Neck Cancers

7547 Background: Utilizing a new 3D morphometric analytical device called Cell-CT, we analyzed cells from sputum to detect lung cancer in patients with malignant nodules found using low-dose x-ray ...

Early detection of lung cancer based on three-dimensional, morphometric analysis of cells from sputum.

In this issue of Cancer Cytopathology, Kopp et al from the Mayo Clinic show how properly trained cytotechnologists can go outside their traditional scope of practice to aid the pathologist in the making of tissue microarrays (TMAs) for research. As background, at the Mayo Clinic, demands on pathologists’ time have been increasing, and this is associated with workforce shortages, increasing specimen complexity and interpretation requirements, and decreased reimbursement. As such, important research has been substantially postponed because up to the present, pathologists have been completely responsible for the making of TMAs. TMAs are composite specimens in which small sections (donor cores) from many different paraffin blocks and/or cases are placed into a single block that can then be used to test reagents against multiple samples simultaneously. TMAs are, therefore, very useful in determining the operating characteristics of immunohistochemical and molecular tests. However, to make an optimal TMA, the proper tissue and area within that tissue need to be selected from each case. This selection process means not only that the tissue containing the best, or most representative, target area (eg, the neoplasm or infectious organism) needs to be appropriately identified but also that the selected areas must be free of technical artifacts and other confounding features. This process requires significant morphologic knowledge and skill and diligent screening of the samples under consideration. In this study, cytotechnologists, under the supervision of pathologists, reviewed the study design to understand the research goals for each TMA construction, reviewed the glass slides of the target tissues, and selected the most appropriate blocks for inclusion in the TMA. They then reviewed blocks and slides together to identify the best blocks and areas within the blocks from which the donor cores would be taken. Cytotechnologists then scored the TMA cores for immunohistochemical results. Scoring included the reactivity in the invasive or in situ tumor, stroma, and benign tissues; the type of staining (nuclear, cytoplasmic, or membranous); the quantity of staining (the percentage of cells) and/or the staining intensity; and so forth as needed for each individual TMA research objective. The results of the study showed that appropriately trained cytotechnologists completed all of these tasks successfully. In either complete or percentage spot checks by supervising pathologists, disagreements on tissue selection or scoring were well within the ranges expected from interpathologist correlations and were associated with expected areas of subjective disagreement, such as the best area for obtaining donor cores or stain intensity. Interestingly, cytotechnologists actually performed better at some aspects of the process, most notably in technical assessments of the paraffin block material. The authors concluded their work by noting that research requiring TMAs that had been on hold for years because of a lack of pathologist time was now being completed successfully. This study shows that cytotechnologists have the skill set to successfully assist the pathologist in the performance of research requiring an understanding of pathologic morphology, the screening of large volumes of

Advanced practitioner in anatomic pathology: The time has come

Advanced (Mid-Level) Pathology Practitioner Report

Context.—In 2006, 9643 participants took the initial College of American Pathologists (CAP) Proficiency Test (PT). Failing participants may appeal results on specific test slides. Appeals ...

Appeals in gynecologic cytology proficiency testing: review and analysis of data from the 2006 College of American Pathologists gynecologic cytology proficiency testing program.

Context.—In 2006, the first gynecologic cytology proficiency tests were offered by the College of American Pathologists. Four years of data are now available using field-validated slides, including conventional and liquid-based Papanicolaou tests. Objective.—To characterize the pattern of error types that resulted in initial proficiency-test failure for cytotechnologists, primary screening pathologists, and secondary pathologists (those whose slides are prescreened by cytotechnologists). Design.—The results of 37 029 initial College of American Pathologists Papanicolaou proficiency tests were reviewed from 4 slide-set modules: conventional, ThinPrep, SurePath, or a module containing all 3 slide types. Results.—During this 4-year period, cytotechnologists were least likely to fail the initial test (3.4%; 614 of 18 264), followed by secondary pathologists (ie, those reviewing slides already screened by a cytotechnologist) with a failure rate of 4.2% (728 of 17 346), and primary pathologists (ie, those scree...

Gynecologic Cytology Proficiency Testing Failures: What Have We Learned?: Observations From the College of American Pathologists Gynecologic Cytology Proficiency Testing Program

David C. Wilbur

Papers

Early detection of lung cancer based on three-dimensional, morphometric analysis of cells from sputum.

Advanced practitioner in anatomic pathology: The time has come

Advanced (Mid-Level) Pathology Practitioner Report

Appeals in gynecologic cytology proficiency testing: review and analysis of data from the 2006 College of American Pathologists gynecologic cytology proficiency testing program.

Gynecologic Cytology Proficiency Testing Failures: What Have We Learned?: Observations From the College of American Pathologists Gynecologic Cytology Proficiency Testing Program