Showing papers by "Elizabeth Ward 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.

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.

Insurance Status, Comorbidity Level, and Survival Among Colorectal Cancer Patients Age 18 to 64 Years in the National Cancer Data Base From 2003 to 2005

Abstract: Purpose Previous analyses have found that insurance status is a strong predictor of survival among patients with colorectal cancer aged 18 to 64 years. We investigated whether differences in comorbidity level may account in part for the association between insurance status and survival. Methods We used 2003 to 2005 data from the National Cancer Data Base, a national hospital-based cancer registry, to examine the relationship between baseline characteristics and overall survival at 1 year among 64,304 white and black patients with colorectal cancer. In race-specific analyses, we used Cox proportional hazards models to assess 1-year survival by insurance status, controlling first for age, stage, facility type, and neighborhood education level and income, and then further controlling for comorbidity level. Results Comorbidity level was lowest among those with private insurance, higher for those who were uninsured or insured by Medicaid, and highest for those insured by Medicare. Survival at 1 year was signif...

Indoor tanning use among adolescents in the US, 1998 to 2004†

Abstract: BACKGROUND: A recent meta-analysis found that indoor tanning use before the age of 35 years increases the risk of melanoma, supporting policies to restrict indoor tanning use among adolescents The objectives of the current study were to provide a national assessment of prevalence and trends of indoor tanning use among US adolescents, to examine changes in the prevalence of indoor tanning use from 1998 to 2004 in relation to state policies on minors' access, and to assess the prevalence of burns, rashes, and infections among users METHODS: Two cross-sectional population-based surveys of US youths ages 11 to 18 years and their parents/guardians conducted in 1998 (N = 1196) and 2004 (N = 1613) used identical questions to assess use of indoor tanning and correlates of this behavior RESULTS: The prevalence of indoor tanning use by adolescents within the past year changed little from 1998 to 2004 (10% to 11%) In states with policies regarding minors' access to indoor tanning, the prevalence stayed the same or decreased from 1998 to 2004, whereas it increased in states without such policies Neither trend was found to be statistically significant Youth tanning attitudes, parental indoor tanning use, and parents' permission were strongly associated with youth use of indoor tanning Fifty-eight percent of users reported burns from indoor tanning CONCLUSIONS: The presence of state legislation restricting minors' access to indoor tanning appears to have limited effectiveness, perhaps because most states' policies permit use with parental consent Multipronged approaches are needed to reduce indoor tanning use in youths Cancer 2009 Published 2008 by the American Cancer Society

Impact of treating facilities' volume on survival for early-stage laryngeal cancer.

Abstract: Background Treatment at a high-volume facility has been associated with better outcomes in a variety of conditions. The relationship between volume and survival from laryngeal cancer has not been examined previously. Methods A total of 11,446 early-stage laryngeal cancer patients (1996–1998) who reported to the National Cancer Database (NCDB) were analyzed. Proportional hazards regression was used to assess the relationship between survival and treatment volume controlling for other factors associated with survival. Results Treatment at low-volume facilities was associated with a significantly increased likelihood of death (hazard ratio 1.20, 95% CI 1.04–1.38). Surgical resection, as compared with radiation treatment, was associated with lower mortality (HR 0.74, 95% CI 0.69–0.80). Conclusion This study is the first to assess the relationship between survival and treatment volume in laryngeal cancer. Treatment at a high-volume facility is associated with better survival. Surgical treatment rather than radiation was also associated with better survival, although we could not control for confounders that may bias treatment selection. © 2009 Wiley Periodicals, Inc. Head Neck, 2009

Factors associated with colon cancer stage at diagnosis.

Abstract: We analyzed data from 1998-2004 from the National Cancer Data Base to evaluate associations between patient/treatment facility factors and stage at diagnosis for all colon cancers combined and by anatomic location. Compared to patients with private insurance, uninsured patients were significantly more likely to present with advanced-stage disease; Medicaid patients had likelihoods of advanced-stage colon cancer in-between those of privately insured and uninsured patients. Increased odds of advanced-stage colon cancer at diagnosis were also observed among Black (vs. White) patients, women (vs. men), and patients from low socioeconomic status (SES) regions (vs. those from higher SES regions). While the likelihood of advanced-stage disease at diagnosis decreased in later years overall, this decrease was not observed among patients with ascending colon cancers. Screening disparities may lead to more advanced stage at diagnosis among colon cancer patients; programs to improve access to screening among underserved populations may address this disparity.

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.

Occupational Exposure to Polychlorinated Biphenyls and Risk of Breast Cancer

Abstract: BackgroundDespite the endocrine system activity exhibited by polychlorinated biphenyls (PCBs), recent studies have shown little association between PCB exposure and breast cancer mortality.Objectiv...

American Cancer Society Perspectives on Environmental Factors and Cancer

Abstract: Cancer prevention is central to the mission of the American Cancer Society (ACS). The ACS's prevention activities take many forms, but are primarily focused on modifiable risk factors that have been demonstrated to have the largest impact on cancer risk in the general population (with particular emphasis on tobacco use because of its large impact on cancer), and well-proven policy and program interventions. The ACS addresses nutrition, physical inactivity and obesity, alcohol consumption, excessive sun exposure, prevention of certain chronic infections, and selected other environmental factors through a variety of venues, including consensus guidelines (eg, nutrition and physical activity, human papillomavirus vaccination) and developing educational materials for health care providers and the general public. In contrast to the broad definition of environmental factors used by the ACS and most other public health agencies, some members of the general public associate the term "environmental" only with toxic air and water pollutants and other, predominantly manmade, hazards that people encounter, often involuntarily, in their daily life. This article will provide an overview of the ACS's approach to the prevention of cancer associated with such toxic pollutants in the context of its mission and priorities with respect to cancer prevention.

Increased frequency of chromosome translocations in airline pilots with long-term flying experience

Abstract: Background: Translocations, the most stable form of chromosome aberrations, are an established biomarker of cumulative exposure to external ionizing radiation. Airline pilots are exposed to varying levels of cosmic ionizing radiation, but to date, there have been few flight crew studies that have examined translocations in relation to flight experience. Methods: We determined the frequency of translocations in the peripheral blood lymphocytes of 83 airline pilots and 50 comparison subjects (mean age = 47 and 46 years, respectively). Translocations were scored in an average of 1039 cell equivalents (CE) per subject using fluorescence in situ hybridization (FISH) whole chromosome painting and expressed per 100 CE. Negative binomial regression models were used to assess the relationship between translocation frequency and exposure status and flight years, adjusting for age, self-reported personal diagnostic x-ray procedures, and military flying. Results: There was no significant difference in the adjusted mean translocation frequency of pilots and the comparison group (0.37 ± 0.04 vs. 0.38 ± 0.06 translocations/100 CE, respectively). However, among the pilots, the adjusted translocation frequency was significantly associated with flight years (P = 0.01) with rate ratios of 1.06 (95% CI 1.01 to 1.11) and 1.81 (95% CI 1.16 to 2.82) for a 1- and 10-year incremental increase in flight years, respectively. The adjusted rate ratio for pilots in the highest compared to those in the lowest quartile of flight years was 2.59 (95% CI 1.26 to 5.33). Conclusions: Our data suggest that pilots with long-term flying experience may be exposed to biologically significant doses of ionizing radiation. Epidemiologic studies with longer follow-up of larger cohorts of pilots with a wide range of radiation exposure levels are needed to clarify the relationship between cosmic radiation exposure and cancer risk.

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.

Disparities in Receipt of Lymph Node Biopsy Among Early-Stage Female Breast Cancer Patients

Abstract: Accurate staging of early breast cancer requires pathological assessment of axillary lymph node involvement. We evaluated the proportion of women receiving surgery for early-stage breast cancer who do not receive any lymph node biopsy (LNB) and factors associated with not receiving LNB. Patients receiving surgery for early-stage breast cancer (T1a/T1b/T1c/T2N0) during the period 2003–2005 were selected from the National Cancer Database. Patient sociodemographic, clinical, health insurance, and facility information was collected. Logistic regression was used to assess factors predictive of not receiving LNB. The number of women meeting study inclusion criteria was 184,050, 11% of whom did not receive any LNB. Compared with White patients, Black patients had greater likelihood [odds ratio (OR) 1.10, p < 0.001] of receiving no LNB; there were no significant differences for Hispanic or other non-White patients. Individuals who were uninsured (OR 1.24, p < 0.0005) or covered by Medicare at age <65 years (OR 1.29, p < 0.0001) had greater likelihoods of no LNB compared with those with private insurance. Medicaid patients and Medicare patients ≥65 years were not significantly different from private insurance patients. Compared with the youngest quartile of patients (age ≤51 years), patients in the oldest quartile (age ≥73 years) were more than three times as likely (OR 3.30, p < 0.0001) not to receive any LNB. We conclude that, while guidelines indicate that LNB may be considered optional in certain patient groups, it remains a key component in determining stage, and thereby prognosis and appropriate treatment options. These results indicate that significant disparities exist in sampling of axillary lymph nodes among women with early-stage breast cancer.

The Relationship Between Insurance Coverage and Cancer Care: A Literature Synthesis

Abstract: This paper summarizes key literature on the relationship between health care insurance status and screening, diagnosis, and medical care patterns and outcomes for individuals with cancer. All studies included for this literature synthesis were identified using the National Library of Medicine’s Medline database; only English language articles published in the past 10 years were considered. Based on article titles and abstracts, we selected the most relevant studies for full review and inclusion in this manuscript. Although the summarized literature is mixed, individuals who are uninsured or have insurance coverage through programs for low-income persons (e.g., Medicaid coverage) are significantly less likely to use cancer screening services and significantly more likely to present with advanced stage cancer at diagnosis and to have significantly worse survival. The relationship between insurance status and cancer treatment patterns is less clear, as fewer studies have examined this relationship, but the available evidence suggests that uninsured patients are less likely to receive optimal cancer care. The research reviewed here suggests that the benefits of extending appropriate insurance coverage to uninsured and underinsured individuals could be substantial. These benefits are likely to include reduced morbidity, improved quality of life, and increased survival for cancer patients as well as a positive impact on overall health care and societal costs.

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.