Though incidence of colorectal cancer (CRC) in the US, has declined in recent years, rates remain higher in men than women and the male-to-female incidence rate ratio (MF IRR) increases progressively across the colon from the cecum to the rectum. Rates among races/ethnicities other than Whites or Blacks have not been frequently reported. To examine CRC rates by sex across anatomic subsite, age, and racial/ethnic groups, we used the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program for cases diagnosed among residents of 13 registries during 1992–2006. Incidence rates were expressed per 100,000 person-years and age-adjusted to the 2000 US Standard Population; MF IRR and 95% confidence intervals were also calculated. Among each racial/ethnic group, the MF IRR increased fairly monotonically from close to unity for cecal cancers to 1.81 (Hispanics) for rectal cancers. MF IRRs increased with age most rapidly for distal colon cancers from <1.0 at ages <50 years to 1.4–1.9 at older ages. The MF IRR for rectal cancers also rose with age from about 1.0 to 2.0. For proximal cancer, the MF IRR was consistently <1.5; among American Indian/Alaska Natives it was <1.0 across all ages. The MF IRRs for CRC vary markedly according to subsite and age but less by racial/ethnic group. These findings may partially reflect differences in screening experiences and access to medical care but also suggest that etiologic factors may be playing a role.
colorectal cancer; sex ratio; incidence; SEER program; epidemiology; neoplasms
Greater tobacco smoking and alcohol consumption and lower body mass index (BMI) increase odds ratios (OR) for oral cavity, oropharyngeal, hypopharyngeal and laryngeal cancers; however, there are no comprehensive sex-specific comparisons of ORs for these factors.
We analyzed 2,441 oral cavity (925 females and 1,516 males), 2,297 oropharynx (564 females and 1,733 males), 508 hypopharynx (96 females and 412 males) and 1,740 larynx (237 females and 1,503 males) cases from the INHANCE consortium of 15 head and neck cancer case-control studies. Controls numbered from 7,604 to 13,829 subjects, depending on analysis. Analyses fitted linear-exponential excess ORs models.
ORs were increased in underweight (<18.5 BMI) relative to overweight and obese categories (≥25 BMI) for all sites and were homogeneous by sex. ORs by smoking and drinking in females compared to males were significantly greater for oropharyngeal cancer (p<0.01 for both factors), suggestive for hypopharyngeal cancer (p=0.05 and p=0.06, respectively), but homogeneous for oral cavity (p=0.56 and p=0.64) and laryngeal (p=0.18 and p=0.72) cancers.
The extent that OR modifications of smoking and drinking by sex for oropharyngeal and, possibly, hypopharyngeal cancers represent true associations, or derive from unmeasured confounders or unobserved sex-related disease subtypes (e.g., human papillomavirus positive oropharyngeal cancer) remains to be clarified.
Alcohol consumption; cigarette smoking; interactions; odds ratio models
To investigate the association between external beam radiotherapy (EBRT) for prostate cancer and mesothelioma using data from the US Surveillance, Epidemiology, and End Results (SEER) cancer registries.
We analyzed data from the SEER database (1973–2009). We compared EBRT versus no radiotherapy. Incidence rate ratios (IRR) and 95 % confidence intervals (95 % CI) of mesothelioma among prostate cancer patients were estimated with multilevel Poisson models adjusted by race, age, and calendar year. Confounding by asbestos was investigated using relative risk of mesothelioma in each case’s county of residence as a proxy for asbestos exposure.
Four hundred and seventy-one mesothelioma cases (93.6 % pleural) occurred in 3,985,991 person-years. The IRR of mesothelioma was increased for subjects exposed to EBRT (1.28; 95 % CI 1.05, 1.55) compared to non-irradiated patients, and a population attributable fraction of 0.49 % (95 % CI 0.11, 0.81) was estimated. The IRR increased with latency period: 0–4 years, IRR 1.08 (95 % CI 0.81, 1.44); 5–9 years, IRR 1.31 (95 % CI 0.93, 1.85); ≥10 years, IRR 1.59 (95 % CI 1.05, 2.42). Despite the fairly strong evidence of association with EBRT, the population attributable rate of mesothelioma was modest—3.3 cases per 100,000 person-years. The cumulative incidence of mesothelioma attributable to EBRT was 4.0/100,000 over 5 years, 24.5/100,000 over 10 years, and 65.0/100,000 over 15 years.
Our study provides evidence that EBRT for prostate cancer is a small but detectable risk factor for mesothelioma. Patients should be advised of risk of radiation-induced second malignancies.
Electronic supplementary material
The online version of this article (doi:10.1007/s10552-013-0230-0) contains supplementary material, which is available to authorized users.
Mesothelioma; EBRT; SEER; Cohort study; Neoplasms; Radiation-induced
Population-based plasmacytoma incidence and survival data are sparse. We analyzed incidence rates (IRs), IR ratios (IRRs), and 5-year relative survival for plasmacytoma overall and by site – bone (P-bone) and extramedullary (P-extramedullary) – in the Surveillance, Epidemiology and End Results (SEER) Program (1992−2004). For comparison, we included cases of multiple myeloma (MM) diagnosed over the same time period in SEER. Incidence of MM (n=23,544; IR 5.35/100,000 person-years) was 16-times higher than plasmacytoma overall (n=1,543; IR=0.34), and incidence of P-bone was 40% higher than P-extramedullary (p<0.0001). The male-to-female IRRs for P-bone, P-extramedullary, and MM were 2.0, 2.6, and 1.5, respectively. For plasmacytoma and MM, IRs were highest in Blacks, intermediate in Whites, and lowest in Asian/Pacific Islanders. Compared with Whites, the Black IR was ∼30% higher for P-extramedullary and P-bone and 120% higher for MM. IRs for all neoplasms increased exponentially with advancing age, less prominently at older ages for plasmacytoma than MM. Distinct age, gender, and race incidence patterns of plasma cell disorders suggest underlying differences in clinical detection, susceptibility, disease biology and/or aetiologic heterogeneity. Five-year relative survival for P-bone, P-extramedullary, and MM varied significantly by age (<60/60+ years), supporting age-related differences in disease burden at presentation, disease biology, and/or treatment approaches.
The unusually high relative frequency of cancer in the laryngeal region in males (18% of all histologically diagnosed cancers) and a sex ratio of unity for lung cancer in Northern Thailand were further explored in a hospital-based case-control study in Chiang Mai. This compared patients having cancers of the oral cavity (including oropharynx), larynx, hypopharynx and lung, with controls in relation to smoking and chewing habits. Statistical analysis indicated that chewing betel is strongly associated with the occurrence of oral cancer in both sexes, and with cancer of the laryngeal region in males. No factors were strongly linked to lung cancer in men, but, in women, urban residence and miang chewing were associated with lung cancer. Analysis of smoke from the two main types of cigars smoked in the region showed that both had high tar content, but there were marked differences in pH. Smoking cigars with alkaline smoke and high tar had an increased risk for laryngeal cancer in males, whereas other cigars with acid smoke and high tar together with manufactured cigarettes had increased risks for lung cancer. These increased risks were not, however, statistically significant.
The aim of this study was to investigate whether incidence rates of tonsil and base of tongue cancer in England are increasing using data from the UK cancer registry.
SUBJECTS AND METHODS
Cancer registrations for oral cavity and oropharynx cancer from 1985–2006 in England were obtained from the National Cancer Information Service. Population estimates were obtained from the Office for National Statistics. Age-adjusted incidence rates and age-specific incidence rates were calculated. The sexes were considered separately as incidence rates are known to differ significantly between men and women. Linear regression was performed to establish whether there was a relationship between incidence rates and time.
There has been an increase in all oral cavity and oropharyngeal cancer in the study period. Linear regression analysis suggests that approximately 90% of the variance in age-adjusted incidence rates for men and women for tonsil, base of tongue and other oral cavity cancer is explained by the passage of time. For other oropharyngeal cancer, the variance is 62% and 46% in men and women, respectively. The estimated annual percentage change from 1985 to 2006 in age-adjusted incidence rates for tonsil and base of tongue cancer is 5.7% and 6.7% for men, and 4.3% and 6.5% for women, respectively.
This study confirms a wide-spread clinical impression that there has been an increase in age-adjusted incidence rates, between 1985 and 2006, in all oral cavity cancer in England. The age range 40–69 years has seen the biggest increases in age-specific incidence rates for tonsil and base of tongue cancer. This reflects the findings of similar studies in other countries.
Tonsillar neoplasms; Tongue neoplasms; Incidence; England; Alpha-papillomavirus
Head and Neck Cancer (HNC) has been studied in different regions of the world but little is known about its incidence patterns in the Middle East and Egypt.
In this study from Egypt’s only population-based registry, we analyzed data from 1999-2006, to estimate incidence, incidence rate ratios (IRRs) and 95% confidence intervals (CIs) categorized by age, district and subsites.
Overall urban incidence of HNC was twice or more that of rural incidence for both males (IRR = 2.59; 95% CI = 2.26, 2.97) and females (IRR = 2.00; 95% CI = 1.64, 2.43). Highest urban-rural difference for males was seen in 40-49 years (IRR = 2.79; 95% CI = 1.92, 4.05) and for females in 30-39 years (IRR = 2.94; 95% CI = 1.60, 5.40). Among subsites, highest incidence among males was for larynx (1.53/105) and among females for gum and mouth (0.48/105). Maximum urban-rural difference in males was for paranasal sinus (IRR = 4.66; 95% CI = 1.88, 11.54) and in females for lip (IRR = 8.91; 95% CI = 1.89, 41.98).
The study underscores the patterns of HNC incidence in Egypt while indicating the need for future analytical studies investigating specific risk factors of HNC in this population.
Head and neck cancer; risk factors; descriptive epidemiology; urban-rural; Egypt; Africa; SEER
Squamous cell carcinomas (SCC) of the oral tongue (OT) and of the base of the tongue and tonsils (BTT) differ with respect to etiology, treatment and prognosis. Human papillomavirus has been linked to the increased incidence of BTT, yet, the trends in incidence of BTT and OT tumors among gender and ethnic origin groups have not been well examined. We sought to examine the trend in gender-, ethnic origin- and age-specific incidence of these tumors over time.
Data were obtained from the Surveillance, Epidemiology and End Results Program of the US National Cancer Institute. We examined temporal trends in sex- and ethnic origin-specific incidence of SCC by calculating the annual percent changes followed by joinpoint analyses evaluating changes in trend.
While BTT increased in age-adjusted rates among white males with a more pronounced increase observed in the mid-1990s, white females experienced a significant increase in incidence of OT tumors. Patients with advanced OT carcinoma had a significantly lower survival compared to those with advanced BTT disease; however, patients with early-stage OT tumors had a better survival compared to patients with BTT.
While the increase in incidence of BTT tumors in white men is likely human papillomavirus driven, more studies are needed to elucidate the increasing incidence of OT tumors in white women. The differences in outcomes across ethnic origin groups are also described and discussed.
Copyright © 2011 S. Karger AG, Basel
Human papillomavirus; Oropharyngeal cancer; Oral tongue cancer; Gender disparities in head and neck cancer; Ethnic disparities in head and neck cancer
The authors present statistics and long-term trends in oral and pharyngeal cancer (OPC) incidence, mortality and survival among U.S. blacks and whites.
The authors obtained incidence, mortality and five-year relative survival rates via the Surveillance, Epidemiology and End Results (SEER) Program Web site. Current rates and time trends for 1975 through 2002 are presented.
From 1975 through 2002, age-adjusted incidence rates (AAIRs) and mortality rates (AAMRs) were higher among males than among females and highest for black males. By the mid-1980s, incidence and mortality rates were declining for black and white males and females; however, disparities persisted. During the period 1998–2002, AAIRs were more than 20 percent higher for black males compared with white males, while the difference in rates for black and white females was small. AAMRs were 82 percent higher for black males compared with white males, but rates were similar for black and white females. Five-year relative survival rates for patients diagnosed during the period 1995–2001 were higher for whites than for blacks and lowest for black males.
Despite recent declines in OPC incidence and mortality rates, disparities persist. Disparities in survival also exist. Black males bear the brunt of these disparities.
Dentists can aid in reducing OPC incidence and mortality by assisting patients in the prevention and cessation of tobacco use and alcohol abuse. Five-year relative survival may be improved through early detection.
Oral cancer; pharyngeal cancer; trends; incidence; mortality; survival
Assessment of cancer incidence trends within the U.S. have mostly relied upon Surveillance, Epidemiology, and End Results (SEER) data, with implicit inference that such is representative of the general population. However, many cancer policy decisions are based at a more granular level. To help inform such, analyses of regional cancer incidence data are needed. Leveraging the unique resource of National Program of Cancer Registries (NPCR)-SEER, we assessed whether regional rates and trends of esophageal cancer significantly deviated from national estimates.
From NPCR-SEER, we extracted cancer case counts and populations for whites aged 45–84 years by calendar year, histology, sex, and census region for the period 1999–2008. We calculated age-standardized incidence rates (ASRs), annual percent changes (APCs), and male-to-female incidence rate ratios (IRRs).
This analysis included 65,823 esophageal adenocarcinomas and 27,094 esophageal squamous cell carcinomas diagnosed during 778 million person-years. We observed significant geographic variability in incidence rates and trends, especially for esophageal adenocarcinomas in males: ASRs were highest in the Northeast (17.7 per 100,000) and Midwest (18.1). Both were significantly higher than the national estimate (16.0). In addition, the Northeast APC was 62% higher than the national estimate (3.19% vs. 1.97%). Lastly, IRRs remained fairly constant across calendar time, despite changes in incidence rates.
Significant regional variations in esophageal cancer incidence trends exist in the U.S. Stable IRRs may indicate the predominant factors affecting incidence rates are similar in men and women.
Cigarette smoking is the major cause of laryngeal cancer. The time to first cigarette after waking in the morning is a behavior associated with several dimensions of nicotine dependence including the dose of smoke uptake. We hypothesized that a short TTFC increases the risk of laryngeal cancer.
The analysis was based on data from a hospital-based case-control study of laryngeal cancer. The current analysis included only subjects who were ever cigarette smokers, including 570 cases and 343 controls (832 whites and 81 blacks). Odds ratios (OR) and 95% confidence intervals (CI) were calculated using unconditional logistic regression adjusting for smoking history and other potential confounders. Incidence data from the Surveillance, Epidemiology and End Results (SEER) Program of the National Cancer Institute from 1975 to 2006 were analyzed for trends in laryngeal cancer.
There was a dose-response relationship between TTFC and supraglottic cancer. Compared to subjects who smoked more than 60 minutes after waking, the adjusted odds ratio was 1.51 (95% CI 0.63–3.61) for 30–60 minutes and 3.13 (95% CI 1.56–6.30) for 0–30 minutes. No association was observed between TTFC and cancer of the glottis. In blacks, the TTFC was not associated with the risk of laryngeal cancer. Trends in SEER rates were similar for cancer of the glottis and supraglottis, indicating that the site-specific differences were not affected by unknown confounders.
A nicotine dependence behavior that is associated with cigarette smoke uptake increases the risk of cancer of the supraglottis larynx but not glottis larynx.
nicotine; smoking; addiction; larynx cancer
This study was conducted in order to demonstrate changing trends in colorectal cancer incidence according to sex, age group, and anatomical location in the Korean population.
Materials and Methods
Data from the Korea Central Cancer Registry between 1999 and 2009 were analyzed. Annual percent changes (APCs) of sex- and age-specific incidence rates for cancer of the proximal colon (International Statistical Classification of Diseases and Related Health Problems, 10th revision [ICD-10] code C18.0-18.5), distal colon (C18.6-18.7), and rectum (C19-20), and male-to-female incidence rate ratios (IRR) were calculated.
The age-standardized incidence rate (ASR) of colorectal cancer was 27 (per 100,000) in 1999 and increased to 50.2 in 2009 among men (APC, 6.6%). The ASR for women was 17.2 in 1999 and 26.9 in 2009 (APC, 5.1%). The rectum was the most common site of cancer among both men and women during 1999 and 2009. However, the distal colon had the highest APC (10.8% among men and 8.4% among women), followed by the proximal colon (7.9% among men and 6.6% among women), and rectum (5.2% among men and 2.4% among women). The proportion of rectal cancer decreased from 51.5% in 1999 to 47.1% in 2009 among men, and from 50.5% to 42.8% among women. An increase in the male-to-female IRR was observed for distal colon cancer and rectal cancer, whereas the IRR for proximal colon cancer was stable.
The rapid increase in colorectal cancer incidence is mainly attributed to the increase in colon cancer, especially distal colon cancer, and may be explained by a transition of risk factors for subsites or by the effect of colorectal cancer screening.
Colorectal neoplasms; Incidence; Korea; Trends
The higher incidence of acute lymphoblastic leukemia (ALL) among Hispanic children relative to that in other racial/ethnic groups is well-known. We evaluated incidence patterns of ALL in adults.
We analyzed the incidence patterns of ALL (ICD-03 codes 9835–9837) among all patients diagnosed from 1988–2004 in California using data from the California Cancer Registry to determine whether adult Hispanics also had higher incidence rates of ALL compared to non-Hispanic Whites (Whites). Age-adjusted incidence rates (AAIR), incidence rate ratios (IRR) and 5-year survival rates were obtained using SEER*Stat. AAIRs of other leukemia subtypes and IRRs relative to non-Hispanic whites were also examined as references of ALL.
AAIRs of ALL in Hispanic males and females ages 20–54 years were higher compared to those in White males and females (IRR=1.99,95% CI=1.74–2.28 and IRR=1.91,95% CI=1.60–2.25 respectively). A higher AAIR of ALL was also observed among older (55+ years) Hispanic females (IRR=1.84, 95% CI=1.52–2.21), but not males (IRR= 1.07, 95% CI= 0.84–1.34). Among Hispanics, low socioeconomic status (SES) was associated with a higher AAIR compared to high/middle SES (IRR= 1.33, 95% CI=1.04–1.70). The respective five-year survival rates among ALL patients were 38% and 30% for Whites and Hispanics ages 20–54 years, and 8% and 12% for patients 55 years of age or older. Compared to other racial/ethnic groups, Hispanics did not have an increased IRR of the other major leukemia subtypes.
Hispanics experience a higher incidence of ALL throughout life, but not other subtypes.
Hodgkin lymphoma (HL) demonstrates heterogenous histologic findings, clinical presentation, and outcomes. Using the United States Surveillance, Epidemiology, and End Results (SEER) data we examined relationships between patient characteristics, clinical features at diagnosis, and survival in HL patients. From 2000 to 2007, 16,710 cases were recorded in 17 SEER registries. Blacks and Asians had low incidence (black/white incidence rate ratio (IRR) 0.86, P < .01; Asian/white IRR 0.43, P < .01). The bimodal pattern of incidence was less prominent for black males. Asians and Blacks presented at a mean age of 38 years compared to 42 years for Whites (P < .001). Race was a predictor for survival with HR of 1.19 (95% CI 1.11–1.28) for Blacks. Age was the most important predictor of survival (HR for patients ≥45 years 5.08, 95% CI 4.86–5.31). These current patterns for presentation and outcomes of HL help to delineate key populations in order to explore risk factors for HL and strategies to improve treatment outcomes.
Bladder cancer is the most common malignancy among Egyptian males and previously has been attributed to Schistosoma infection, a major risk factor for squamous cell carcinoma (SCC). Recently, transitional cell carcinoma (TCC) incidence has been increasing while SCC has declined. To investigate this shift, we analyzed the geographical patterns of all bladder cancers cases recorded in Egypt’s Gharbiah Population-Based Cancer Registry from 1999 through 2002. Data on tumor grade, stage, and morphology, as well as smoking, community of residence, age and sex, were collected on 1,209 bladder cancer cases. Age-adjusted incidence rates were calculated for males, females, and the total population for the eight administrative Districts and 316 communities in Gharbiah. Incidence Rate Ratios (IRR) and 95% Confidence Intervals (CI) were computed using Poisson Regression. The male age-adjusted incidence rate (IR) in Gharbiah Province was 13.65/100,000 person years (PY). The District of Kotour had the highest age-adjusted IR 28.96/100,000 among males. The District of Kotour also had the highest IRR among all Districts, IRR=2.15 95% CI (1.72, 2.70). Kotour’s capital city had the highest bladder cancer incidence among the 316 communities (IR=73.11/100,000 PY). Future studies on sources and types of environmental pollution and exposures in relation to the spatial patterns of bladder cancer, particularly in Kotour District, may improve our understating of risk factors for bladder cancer in the region.
bladder carcinoma; environmental exposures; developing countries; pollution; schistosomiasis
Head and neck cancers have never been systematically studied for clinical purposes yet in Korea. This epidemiological survey on head and neck cancer patients was undertaken from January to December 2001 in 79 otorhinolaryngology resident-training hospitals nationwide. The number of head and neck cancer patients was 1,063 cases in the year. The largest proportion of cases arose in the larynx, as many as 488 cases, which accounted for 45.9%. It was followed by, in order of frequency, oral cavity (16.5%), oropharynx (10.0%), and hypopharynx (9.5%). The male:female ratio was 5:1, and the mean age was 60.3 yr. Surgery was the predominant treatment modality in head and neck cancers: 204 (21.5%) cases were treated with only surgery, 198 (20.8%) cases were treated with surgery and radiotherapy, 207 cases (21.8%) were treated with combined therapy of surgery, radiotherapy, and chemotherapy. Larynx and hypopharynx cancers had a stronger relationship with smoking and alcohol drinking than other primary site cancers. Of them, 21 cases were found to be metastasized at the time of diagnosis into the lung, gastrointestinal tract, bone, or brain. Coexisting second primary malignancies were found in 23 cases. At the time of diagnosis, a total of 354 cases had cervical lymph node metastasis accounting for 42.0%.
Aims: To report the temporal pattern and change in trend of mesothelioma incidence in the United States since 1973.
Methods: The Surveillance, Epidemiology, and End Results (SEER) programme of the National Cancer Institute has since 1973 provided annual age adjusted incidence for mesothelioma in representative cancer registries dispersed throughout the USA. SEER data are analysed to describe the trend of male mesothelioma incidence in the USA.
Results: The US male mesothelioma incidence data indicate that after two decades of increasing incidence, a likely decline has been observed since the early 1990s, when a highly significant change in the upward course occurred.
Conclusions: Increasing male mesothelioma incidence for many years was undoubtedly the result of exposure to asbestos. The high mesothelioma risk was prominently influenced by exposure to amphibole asbestos (crocidolite and amosite), which reached its peak usage in the 1960s and thereafter declined. A differing pattern in some other countries (continuing rise in incidence) may be related to their greater and later amphibole use, particularly crocidolite. The known latency period for the development of this tumour provides biological plausibility for the recent decline in mesothelioma incidence in the USA. This favourable finding is contrary to a widespread fear that asbestos related health effects will show an inevitable increase in coming years, or even decades.
We analysed data obtained from the Hawaii Tumor Registry, a population-based participant in the Surveillance, Epidemiology, and End Results (SEER) programme that monitors cancer incidence and mortality for the entire state. A total of 138 males and 116 females, under the age of 15, were diagnosed with leukaemia between 1960 and 1984, with average annual age-adjusted incidence rates of 49.6 and 44.8 per million, respectively. Time trend analysis by 5-year calendar periods revealed an increasing rate for leukaemia among females only, whereas other populations have shown a positive trend in both sexes. The incidence rates for all ethnic groups combined were similar to those for US whites. Japanese and Chinese males had a slightly higher rate for leukaemia than US whites, while Filipinos, Hawaiians and whites in Hawaii had relatively lower rates. Among females, incidence was higher among whites, Filipinos, Hawaiians and Chinese than among US whites, and lower among Japanese. Thus, there were notable sex differences in the ethnic distribution of this disease.
OBJECTIVES: This community based case-referent study was initiated to investigate aetiological factors for squamous cell carcinoma of the upper gastrointestinal tract. METHODS: The study was based on all Swedish men aged 40-79 living in two regions of Sweden during 1988-90. Within that base, efforts were made to identify all incident cases of squamous cell carcinoma of the oral cavity, oropharynx and hypopharynx, larynx, and oesophagus. Referents were selected as a stratified (age, region) random sample of the base. The response was 90% among cases and 85% among referents. There were 545 cases and 641 referents in the final study group. The study subjects were interviewed about several lifestyle factors and a life history of occupations and work tasks. The exposure to 17 specific agents were coded by an occupational hygienist. The relative risk (RR) of cancer was calculated by logistic regression, standardising for age, geographical region, and alcohol and tobacco consumption. RESULTS: Exposure to asbestos was associated with an increased risk of laryngeal cancer, and a dose-response relation was present. The RR was 1.8 (95% confidence interval (95% CI) 1.1 to 3.0) in the highest exposure group. More than eight years of exposure to welding fumes was associated with an increased risk of pharyngeal cancer (RR 2.3 (1.1 to 4.7)), and laryngeal cancer (RR 2.0 (1.0 to 3.7)). There were indications of a dose-response for duration of exposure. Associations were also found for high exposure to polycyclic aromatic hydrocarbons (PAHs) and oesophageal cancer, RR 1.9 (1.1 to 3.2). Exposure to wood dust was associated with a decreased risk of cancer at the studied sites. CONCLUSIONS: Some of the present findings confirm known or suspected associations--such as asbestos and laryngeal cancer. The study indicates that welding may cause an increased risk of pharyngeal as well as laryngeal cancer. The findings corroborate an association between exposure to PAHs and oesophageal cancer.
It is unknown whether there are survival disparities between men and women with squamous cell carcinoma of the head and neck (SCCHN), though some data suggest that men have worse outcomes. We conducted a matched-pair study that controlled for several potentially confounding prognostic variables to assess whether a survival advantage exists for female compared with male SCCHN patients receiving similar care.
We selected 286 female patients and 286 matched male patients from within a prospective epidemiologic study of 1654 patients with incident SCCHN evaluated and treated at a single large multidisciplinary cancer center. Matching variables included age (± 10 years), race/ethnicity, smoking status (never versus ever), tumor site (oral cavity versus oropharynx versus larynx versus hypopharynx), tumor classification (T1–2 versus T3–4), nodal status (negative versus positive), and treatment (surgery, radiation therapy, surgery and radiation therapy, surgery and chemotherapy, chemoradiotherapy, or surgery and chemoradiotherapy).
Matched-pair and log-rank analyses showed no significant differences between women and men in recurrence-free, disease-specific, or overall survival. When the analysis was restricted to individual sites (oral cavity, oropharynx, or larynx/hypopharynx), there was also no evidence of a disparity in survival associated with sex.
We conclude that there is no evidence to suggest that a survival advantage exists for women as compared to men with SCCHN receiving similar multidisciplinary directed care at a tertiary cancer center.
Survival disparity; Head and neck cancer; Gender-related disparity; Matched pair study; Gender-related prognosis
Increases in thyroid papillary carcinoma incidence rates have largely been attributed to heightened medical surveillance and improved diagnostics. We examined papillary carcinoma incidence in an equal-access healthcare system by demographics, which are related to incidence.
Incidence rates during 1990-2004 among white and black individuals aged 20-49 years in the military and the general U.S. population were compared using data from the Department of Defense’s Automated Central Tumor Registry and the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER-9) program.
Incidence was significantly higher in the military than in the general population among white women [incidence rate ratio (IRR)=1.42, 95% 95% confidence interval (CI)=1.25-1.61], black women (IRR=2.31, 95% CI=1.70-2.99), and black men (IRR=1.69, 95% CI=1.10-2.50). Among whites, differences between the two populations were confined to rates of localized tumors (women: IRR=1.73, 95% CI=1.47-2.00; men: IRR=1.51, 95% CI=1.30-1.75), which may partially be due to variation in staging classification. Among white women, rates were significantly higher in the military regardless of tumor size, and rates rose significantly over time both for tumors ≤2 cm (military: IRR=1.64, 95% CI=1.18-2.28; general population: IRR=1.55, 95% CI=1.45-1.66) and >2 cm (military: IRR=1.74, 95% CI=1.07-2.81; general population: IRR=1.48, 95% CI=1.27-1.72). Among white men, rates increased significantly only in the general population. Incidence also varied by military service branch.
Heightened medical surveillance does not appear to fully explain the differences between the two populations or the temporal increases in either population.
These findings suggest the importance of future research into thyroid cancer etiology.
Thyroid Neoplasms; Incidence; SEER Program; Military Personnel; United States/epidemiology
Carcinomas of the major salivary glands (M-SGC) comprise a morphologically diverse group of rare tumors of largely unknown cause. To gain insight into etiology, we evaluated incidence of M-SGC utilizing the World Health Organization classification schema (WHO-2005).
We calculated age-adjusted incidence rates (IRs) and IR ratios (IRRs) for M-SGC diagnosed between 1992–2006 in the Surveillance, Epidemiology and End Results Program.
Overall, 6,391 M-SGCs (IR=11.95/1,000,000 person-years) were diagnosed during 1992–2006. Nearly 85% of cases (n=5,370; IR=10.00) were encompassed within WHO-2005 and among these, males had higher IRs than females (IRR=1.51, 95%CI=1.43–1.60). Squamous cell (IR=3.44) and mucoepidermoid (IR=3.23) carcinomas occurred most frequently among males, whereas, mucoepidermoid (IR=2.67), acinic cell (IR=1.57), and adenoid cystic (IR=1.40) carcinomas were most common among females. Mucoepidermoid, acinic cell, and adenoid cystic carcinomas predominated in females through approximately age 50 years; thereafter IRs of acinic cell and adenoid cystic carcinomas were nearly equal among females and males, whereas IRs of mucoepidermoid carcinoma among males exceeded IRs among females (IRR=1.57; 95%CI=1.38–1.78). Except for mucoepidermoid and adenoid cystic carcinomas which occurred equally among all races, other subtypes had significantly lower incidence among Blacks and Asian/Pacific Islanders than among Whites. Adenoid cystic carcinoma occurred equally in the submandibular and parotid glands, and other M-SGCs evaluated had 77–98% lower IRs in the submandibular gland. Overall M-SGC IRs remained stable during 1992–2006.
Distinct incidence patterns according to histologic subtype suggest that M-SGCs are a diverse group of neoplasms characterized by etiologic and/or biologic heterogeneity with varying susceptibility by gender and race.
major salivary gland cancer; epidemiology; incidence; SEER; WHO
Plateau in testicular cancer incidence in some parts of the United States (US) especially among non-Hispanic white males in Los Angeles had been observed. We conducted three decades temporal trends analysis to assess the evidence of such a plateau, and to examine whether the rate remains stable across racial/ethnic groups as well as the influence of age at diagnosis on the incidence rate.
Population-based temporal trends analysis.
Using the Surveillance Epidemiology and End Results (SEER), we identified between 1975 and 2004, 16,580 of newly diagnosed testicular cancer cases, aged 15−49 years. The incidence rates were examined by calculating the age-adjusted rates and their 95% Confidence Interval (CI) for the age at diagnosis, SEER areas, and race by the year of diagnosis. The percent change and annual percent change were examined for trends.
Incidence of testicular cancer continues to increase among US males, albeit the plateau of the 1990s. Between 1975 and 2004 the age-adjusted incidence rate for ages, 15−49 years increased from 2.9 (1975) to 5.1(2004) per 100,000. The trends indicated a percent change of 71.9% and a statistically significant annual percent change of 1.6 %,( 95% CI, 1.3−2.0), p < 0.05. Though the rates in blacks remained strikingly low, 0.3 to 1.4 per 100,000, the highest annual percent change was observed among blacks, 2.3%, (95%, CI, 0.8−3.9), p < 0.05 for trends. The rates were intermediate among Asians/ Pacific Islanders and American Indian and Alaska Natives 0.7 to 2.9 per 100,000, percent change (117.3%) and a statistically significant annual change of 1.5%, (95% CI, 0.3−2.7) p < 0.05 for trends. The highest rates were reported among Whites, 3.2 to 6.3 per 100,000, percent change (90.4%) , with a statistically significant annual percent change of 2.0%, (95% CI, 1.6−2.3), p < 0.05. The peak age at diagnosis was, 30−34 years while the lowest rates were reported in 15−19 age group. Likewise, incidence rates varied by SEER areas with predominantly white states representing areas associated the highest reported rates.
Overall, testicular cancer incidence rate remains to plateau in the United States, while racial variance persists in rates, black males demonstrated the highest increase in the annual percent change. Further studies are needed to examine the recent increase among black males and the potential determinants.
testicular cancer; incidence rates; race; population-based study; trends
The time trend and the distribution of malignant mesothelioma in Denmark are described on the basis of all notifications of cancer cases to the Danish Cancer Registry during the period 1943-1980. The age and sex adjusted incidence rates of pleural as well as peritoneal mesothelioma are increasing with time and reached in the latest 3-year registration period 1978-1980 a remarkably high total incidence of 14.7 cases per million men and 7.0 cases per million women. Towards the end of the observation period, however, the rate of increase was stagnating and for the younger age-groups even a fall in incidence of this malignancy was noted, perhaps reflecting the introduction of compulsory hygienic precautions in the handling of asbestos in Denmark. The incidence and time trend of peritoneal mesothelioma was similar among males and females while pleural mesothelioma was three times more common among males compared with females and showed an increase in incidence 15 years previous to females. For pleural mesothelioma in men notified through the 10-year period 1968, 1977, a significant excess was associated with residence in areas with high degrees of urbanization and in ship building towns.
Adjuvant radiotherapy is common for uterine corpus cancer patients, yet the long-term carcinogenic effects of different types of radiotherapy have not been studied adequately.
Second primary cancer risks were quantified in a cohort of 60,949 individuals surviving one or more years of uterine corpus cancer diagnosed 1973–2003 in Surveillance, Epidemiology and End Results Program cancer registries. Incidence Rate Ratios (IRR) were estimated by comparing patients treated with surgery plus various types of radiotherapy with patients receiving surgery only.
The IRRs of a second cancer were increased among irradiated patients compared with patients having surgery only (combination radiotherapy, IRR=1.26, 95% confidence interval [CI] 1.16–1.36; external beam therapy, IRR=1.15, CI 1.08–1.22; brachytherapy, IRR=1.07, CI 1.00–1.16). IRRs were highest for heavily-irradiated sites (i.e., colon, rectum, and bladder) and for leukemia following any external beam therapy, with the largest risks for solid cancers among ten-year survivors. Any external beam therapy had a 44% higher cancer risk at heavily-irradiated sites than brachytherapy when the two treatments were directly compared (five-year survivors: IRR=1.44, CI 1.19–1.75). We estimated that of 2012 solid cancers developing five or more years after irradiation, 213 (11%) could be explained by radiotherapy.
Radiotherapy for uterine cancer increases the risk of leukemia and second solid cancers at sites in close proximity to the uterus, emphasizing the need for continued long-term surveillance for new malignancies. The overall risk of a second cancer was lower following brachytherapy compared with any external beam radiotherapy.
endometrial adenocarcinomas; epidemiology; gynecologic malignancy; radiation; radiotherapy