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1.  Men’s Perspectives on Selecting Their Prostate Cancer Treatment 
In the context of scientific uncertainty, treatment choices for localized prostate cancer vary, but reasons for this variation are unclear. We explored how black and white American men made their treatment decision.
Guided by conceptual model, we conducted semistructured interviews of 21 American (14 black and 7 white) men with recently diagnosed localized prostate cancer.
Physician recommendation was very important in the treatment decision, but patient self-perception/values and attitudes/beliefs about prostate cancer were also influential. Patients who chose surgery believed it offered the best chance of cure and were more concerned that the cancer might spread if not surgically removed. Patients who chose radiation therapy believed it offered equal efficacy of cure but fewer side effects than surgery. Fear of future consequences was the most common reason to reject watchful waiting. Anecdotal experiences of family and friends were also important, especially in deciding “what not to do.” The new technology of robotic-assisted prostatectomy provided optimism for men who wanted surgery but feared morbidity associated with traditional open surgery. Few men seemed aware that treatment did not guarantee improved survival.
Most men reported making “the best choice for me” by taking into account medical information and personal factors. Perceptions of treatment efficacy and side effects, which derived mainly from physicians’ descriptions and/or anecdotal experiences of family and friends, were the most influential factors in men’s treatment decision. By understanding factors that influence patients’ treatment decisions, clinicians may be more sensitive to individual patients’ preferences/ concerns and provide more patient-centered care.
PMCID: PMC4283563  PMID: 21830629
prostate cancer; treatment; racial disparities
2.  Use of Nephron Sparing Surgery among Renal Cell Carcinoma Patients with Diabetes and Hypertension 
Urologic oncology  2013;32(1):10.1016/j.urolonc.2012.09.014.
Nephron-sparing surgery (NSS) is recommended for renal cell carcinoma (RCC) patients at risk for chronic kidney disease. We assessed the prevalence of NSS among RCC patients with pre-existing diabetes and/or hypertension who participated in a population-based epidemiological RCC study.
Methods and Materials
Patients with RCC were enrolled in the United States Kidney Cancer Study (KCS), a case–control study in the metropolitan areas of Detroit and Chicago from 2002-2007. After determining whether patients had diabetes and/or hypertension, we ascertained the proportion of patients from the Detroit site who received NSS. Bivariate and multivariate analyses were performed to evaluate associations between these CKD risk factors and receipt of NSS.
We identified 835 patients treated with radical nephrectomy (78%) or NSS (22%) from 2002-2007. Among this cohort, 60% had pre-existing diabetes and/or hypertension. Patients with both diabetes and hypertension were more than twice as likely to receive NSS (OR 2.42, 95% CI 1.47-3.96). Conversely, patients with only hypertension (OR 1.33, 95% CI 0.92-1.93) or diabetes (OR 0.97, 95% CI 0.92-1.93) were no more likely to receive NSS than patients with neither risk factor.
The more frequent utilization of NSS among patients with both diabetes and hypertension suggests growing recognition by urologists of the importance of these risk factors for future development of CKD among patients facing surgical therapy for RCC. However, the concurrent observation that patients with only one of these CKD risk factors did not receive increased utilization of NSS highlights an immediate opportunity to improve the surgical treatment of patients with RCC.
PMCID: PMC3762909  PMID: 23419677
renal cell carcinoma; nephrectomy; diabetes; hypertension; physician practice patterns
3.  A genome-wide association study of renal cell carcinoma among African Americans 
Genome-wide association studies (GWAS) of renal cell carcinoma (RCC) in populations of European ancestry have identified four susceptibility loci. No GWAS has been conducted among African Americans (AAs), who experience a higher incidence of RCC. We conducted a GWAS in which we analyzed 1,136,723 common single-nucleotide polymorphisms (SNPs) among 255 cases and 375 controls of African ancestry, and further investigated 16 SNPs in a replication set (140 cases, 543 controls). The 12p11.23 variant rs10771279, located 77kb from the European-ancestry RCC marker rs718314, was associated with RCC risk in the GWAS (P=1.2 × 10−7) but did not replicate (P=0.99). Consistent with European-ancestry findings, the A allele of rs7105934 on 11q13.3 was associated with decreased risk [odds ratio (OR)=0.76, 95% confidence interval (CI)=0.64–0.91; P=0.0022]. The frequency of this allele was higher than that observed in the European-ancestry GWAS (0.56 and 0.07 respectively among controls). The rs7105934 association was stronger for clear cell RCC (ccRCC: OR=0.56; P=7.4 × 10−7) and absent for cases of other or unknown histology (OR=1.02; P=0.86). Analyses of rs7105934 by subtype among European-ancestry participants from these studies yielded similar findings (ORs 0.69 and 0.92 respectively). This study provides, to our knowledge, the first evidence that rs7105934 is an RCC susceptibility locus among AAs. Our finding that the association with this SNP may be specific to ccRCC is novel and requires additional investigation. Additional investigation of rs10771279 and other suggestive GWAS findings is also needed.
PMCID: PMC3901793  PMID: 24220910
4.  Patient Perspective on Watchful Waiting/Active Surveillance for Localized Prostate Cancer 
To describe prostate cancer treatment decision making, focusing on knowledge and attitudes toward observation, known as watchful waiting (WW) or active surveillance (AS), and reasons for not choosing WW/AS.
Semistructured in-person interviews were conducted with 21 men (14 black; 7 white) with recently diagnosed localized prostate cancer.
All cancers were detected by prostate-specific antigen screening; 14 men had low-risk disease. Nineteen chose surgery or radiation treatment. The majority wanted to “get rid of” or “cure” the cancer by undergoing aggressive therapy, even with awareness of the potential for significant side effects. Most men seemed unaware of the uncertainty/controversies that aggressive treatment may not cure their cancer or improve their survival. Limited knowledge about WW/AS was common, and few remembered WW/AS being presented as a viable option. Rather, many men perceived it as “doing nothing.” Some men, who initially were inclined toward WW/AS, yielded to pressure from family, physicians, or both to choose aggressive treatment. Lack of physician support was a significant barrier to WW/AS.
The observational strategy (WW/AS) was not viewed as a reasonable approach, even for those with low-risk cancer. The desire for aggressive therapy may reflect the complex psychology associated with receiving a diagnosis of cancer and the limited supportive counseling received. Further efforts to better understand and educate patients and physicians may help men make informed and appropriate treatment decisions to maximize quality of life without compromising survival.
PMCID: PMC4212643  PMID: 23136314
Active Surveillance; Decision Making; Medical Oncology; Prostate Cancer; Watchful Waiting
5.  A Comparison of Criteria to Identify Inflammatory Breast Cancer Cases from Medical Records and the Surveillance, Epidemiology and End Results Data base, 2007–2009 
The breast journal  2013;20(2):185-191.
Inflammatory breast cancer (IBC) is a relatively rare and extremely aggressive form of breast cancer that is diagnosed clinically. Standardization of clinical diagnoses is challenging, both nationally and internationally; moreover, IBC coding definitions used by registries have changed over time. This study aimed to compare diagnostic factors of IBC reported in a U.S. Surveillance, Epidemiology, and End Results (SEER) registry to clinical criteria found in the medical records of all invasive breast cancer cases at a single institution. We conducted a medical record review of all female invasive breast cancers (n = 915) seen at an NCI-designated comprehensive cancer center in Detroit from 2007 to 2009. IBC cases were identified based on the presence of the main clinical characteristics of the disease (erythema, edema, peau d'orange). We compared the proportion of IBC out of all breast cancers, using these clinical criteria and the standard SEER IBC codes. In the reviewed cases, the clinical criteria identified significantly more IBC cases (n = 74, 8.1%) than the standard IBC SEER definition (n = 19, 2.1%; p < 0.0001). No IBC cases were identified in the cancer center records using the SEER pathologic coding, which requires the diagnosis of inflammatory carcinoma on the pathology report, a notation that is rarely made. Emphasis must be placed on the documentation of clinical and pathologic characteristics of IBC in the medical record, so that analysis of putative IBC subtypes will be possible. Our results indicate the need for a consensus on the definition of IBC to be utilized in future research.
PMCID: PMC4208694  PMID: 24372839
diagnostic criteria; inflammatory breast cancer; SEER
6.  Differences in the cancer burden among foreign-born and US-born Arab Americans living in metropolitan Detroit 
Cancer causes & control : CCC  2013;24(11):1955-1961.
Migrant studies often provide clues for cancer etiology. We estimated the cancer burden among Arab Americans (ArA) by immigrant status in the metropolitan Detroit area, home to one of the highest concentrations of ArA in USA.
A validated name algorithm was used to identify ArA cancer cases diagnosed 1990–2009 in the Detroit SEER database. Recorded birthplace was supplemented with imputation of nativity using birthdate and social security number. Age-adjusted, gender-specific proportional incidence ratios and 95 % confidence intervals were calculated comparing all ArA, foreign-born ArA, and US-born ArA, to non-Hispanic Whites (NHW).
Foreign-born ArA males had higher proportions of multiple myeloma, leukemia, kidney, liver, stomach, and bladder cancer than NHW, while bladder cancer and leukemia were higher among US-born ArA males. For ArA women, gall bladder and thyroid cancers were proportionally higher among both foreign- and US-born compared with NHW. Stomach cancer was proportionally higher only among foreign-born women.
Cancer proportional incidence patterns among ArA show some similarity to other migrant groups, with higher proportional incidences of stomach and liver cancers among foreign-born than US-born. Other patterns, such as tobacco-related cancers among ArA men and gall bladder and thyroid cancers among ArA women, will require more investigation of genetic, epigenetic, and environmental factors.
PMCID: PMC4189086  PMID: 24013772
Arab Americans; Migrant groups; Cancer incidence; Proportional incidence ratios
7.  Physical activity and renal cell carcinoma among black and white Americans: a case-control study 
BMC Cancer  2014;14(1):707.
Renal cell carcinoma (RCC) has a higher incidence in blacks than in whites. Physical activity may influence the risk of renal cell cancer, but the evidence is inconsistent. No previous study has investigated this relationship in the black population.
We examined the association between self-reported physical activity at different ages and risk of RCC in a population based case-control study of 1217 cases (361 black, 856 white) and 1235 controls (523 black, 712 white) frequency-matched on age, race, and gender. Multivariate-adjusted odds ratios (OR) and 95% confidence intervals (CI) were estimated using unconditional logistic regression.
Among whites, increased risks of RCC were observed among participants reporting low levels of transportation-related activity in their 20’s (OR <1 hr/wk vs >7 hr/wk (95% CI): 1.42 (1.10, 1.83)) and leisure time activity in their 50’s (OR <1 hr/wk vs >7 hr/wk (95% CI): 1.49 (1.00, 2.20)). We found no association between physical activity and RCC risk among blacks.
Our results suggest that physical activity may be inversely associated with RCC risk in whites, but there was no evidence of such an association in blacks. As this is the first study evaluating the effect of physical activity on RCC risk among blacks, further investigations are needed to clarify the relationship in this population.
Electronic supplementary material
The online version of this article (doi:10.1186/1471-2407-14-707) contains supplementary material, which is available to authorized users.
PMCID: PMC4181698  PMID: 25253394
Renal cell carcinoma; Physical activities; Racial differences; Case-control study
8.  Mortality Rates Among Arab Americans in Michigan 
The objectives of this study were to: (1) calculate age-specific and age-adjusted cause-specific mortality rates for Arab Americans; and (2) compare these rates with those for blacks and whites. Mortality rates were estimated using Michigan death certificate data, an Arab surname and first name list, and 2000 U.S. Census data. Age-specific rates, age-adjusted all-cause and cause-specific rates were calculated. Arab Americans (75+) had higher mortality rates than whites and blacks. Among men, all-cause and cause-specific mortality rates for Arab Americans were in the range of whites and blacks. However, Arab American men had lower mortality rates from cancer and chronic lower respiratory disease compared to both whites and blacks. Among women, Arab Americans had lower mortality rates from heart disease, cancer, stroke, and diabetes than whites and blacks. Arab Americans are growing in number. Future study should focus on designing rigorous separate analyses for this population.
PMCID: PMC4149176  PMID: 21318619
Arab; Mortality rates; Surnames
9.  An investigation of risk factors for renal cell carcinoma by histologic subtype in two case-control studies 
To investigate whether renal cell carcinoma (RCC) histologic subtypes possess different etiologies, we conducted analyses of established RCC risk factors by subtype (clear cell, papillary, chromophobe) in two case-control studies conducted in the United States (1,217 cases, 1,235 controls) and Europe (1,097 cases, 1,476 controls). Histology was ascertained for 706 U.S. cases (58% of total) and 917 European cases (84%) through a central slide review conducted by a single pathologist. For the remaining cases, histology was abstracted from the original diagnostic pathology report. Case-only analyses were performed to compute odds ratios (ORs) and 95% confidence intervals (CI) summarizing subtype differences by age, sex, and race. Case-control analyses were performed to compute subtype-specific ORs for other risk factors using polytomous regression. In case-only analyses, papillary cases (N=237) were older (OR=1.2, 95% CI=1.1–1.4 per 10-year increase), less likely to be female (OR=0.5, 95 % CI=0.4- 0.8) and more likely to be black (OR=2.6, 95% CI=1.8–3.9) compared to clear cell cases (N=1,524). In case-control analyses, BMI was associated with clear cell (OR=1.2, 95% CI=1.1–1.3 per 5kg/m2 increase) and chromophobe RCC (N=80; OR=1.2, 95% CI=1.1- 1.4), but not papillary RCC (OR=1.1, 95% CI=1.0–1.2; test vs. clear cell, P=0.006). No subtype differences were observed for associations with smoking, hypertension or family history of kidney cancer. Our findings support the existence of distinct age, sex and racial distributions for RCC subtypes, and suggest that the obesity-RCC association differs by histology.
PMCID: PMC3717609  PMID: 23150424
Renal cell carcinoma; histology; case-control studies; body mass index
10.  Postmastectomy Radiotherapy for Breast Cancer 
Cancer  2009;115(6):1185-1193.
Given accumulating evidence supporting postmastectomy radiotherapy (PMRT) in selected patients, it is important to evaluate patterns and correlates of PMRT utilization, including communication and attitudinal factors.
The authors surveyed 2382 patients diagnosed with breast cancer in 2002 and reported to the Los Angeles and Detroit Surveillance, Epidemiology, and End Results registries (n = 1844, 77.4% response rate). Analyses were restricted to patients with nonmetastatic invasive breast cancer treated by mastectomy who had decided whether or not to undergo PMRT (n = 396). The authors assessed rates of explanation, recommendation, and receipt of radiation by indication grouping, defined primarily by the 2001 American Society of Clinical Oncology guidelines. They evaluated correlates of PMRT receipt, including tumor and sociodemographic characteristics. They also explored patients’ self-reported reasons for nonreceipt of PMRT.
The adjusted proportion in each indication group reporting that a provider had explained radiation was high (77% of those in whom PMRT was indicated, 76% of those in whom medical opinion was divided, and 73% of those in whom PMRT was not indicated; P = .10). The adjusted proportions reporting recommendations for radiation (86%, 35%, and 17%, respectively) and receipt (81%, 34%, and 10%, respectively) varied significantly by indication grouping (P < .001). On multivariate analysis, tumor size (P < .001), lymph node status (P < .001), comorbidity (P = .02), and chemotherapy receipt (P = .003) were found to be independent significant correlates of PMRT receipt. The most common reasons cited for not pursuing PMRT were lack of physician recommendation and perceived lack of need.
PMRT receipt is strongly correlated with clinical indication. The authors found no sociodemographic disparities in utilization. However, approximately one-fifth of patients with strong indications did not receive treatment.
PMCID: PMC3905748  PMID: 19180636
mastectomy; radiotherapy; breast neoplasms; guideline adherence; quality of healthcare
11.  The association between chronic renal failure and renal cell carcinoma may differ between black and white Americans 
Cancer causes & control : CCC  2012;24(1):167-174.
In the United States, renal cell carcinoma (RCC) incidence is higher among blacks than among whites. Risk of RCC is elevated among end-stage renal disease patients, although no studies have looked at differences by race in the relationship between chronic renal failure and RCC.
We investigated RCC risk in relation to chronic renal failure in a population-based case-control study of blacks and whites in Chicago and Detroit. Data, including information on kidney disease, were collected from interviews with 1,217 RCC cases (361 blacks, 856 whites) and 1,235 controls (523 blacks, 712 whites). Odds ratios (OR) and 95% confidence intervals (CI) were estimated using unconditional logistic regression.
Risk of RCC was increased in relation to chronic renal failure (OR 4.7, 95% CI 2.2–10.1) and dialysis (OR 18.0, 95% CI 3.6–91). The association remained after defining exposure as those who had chronic renal failure ≥10 years prior to RCC diagnosis. Chronic renal failure was more strongly associated with RCC among blacks than among whites (OR 8.7, 95% CI 3.3–22.9 and 2.0, 0.7–5.6 respectively; Pinteraction=0.03) and among those without a history of diabetes relative to diabetic subjects (OR 8.3, 95% CI 3.1–22.7 and 1.9, 0.6–5.9 respectively; Pinteraction=0.03).
These results suggest that chronic renal failure is a strong risk factor for RCC, particularly among black and non-diabetic subjects. Our findings of differences in risk estimates by race, to our knowledge the first such report, require replication.
PMCID: PMC3531044  PMID: 23179659
renal cell carcinoma; kidney cancer; chronic renal failure; end-stage renal disease; racial disparities
12.  Serum leptin and adiponectin levels and risk of renal cell carcinoma 
Obesity (Silver Spring, Md.)  2013;21(7):1478-1485.
The incidence of renal cell carcinoma (RCC) has increased rapidly in the U.S., particularly among African Americans. Despite a well-established link between obesity and RCC, the mechanism through which obesity increases cancer risk has yet to be established. Adipokines, such as leptin and adiponectin, may link obesity and cancer, with different quantitative effects by race. We evaluated the association between leptin and adiponectin concentrations and RCC risk among Caucasians (581 cases, 558 controls) and African Americans (187 cases, 359 controls) in a case-control study conducted in Detroit and Chicago. Odds ratios(ORs) and 95% confidence intervals(95%CIs) were estimated using unconditional logistic regression. Among controls, Caucasians had higher median adiponectin than African Americans (males: 8.2 vs. 7.0µg/ml, p=0.001; females: 13.4 vs. 8.4µg/ml, p<0.0001), and lower median leptin than African Americans (males: 11.8 vs. 14.1ng/ml, p=0.04; females: 28.3 vs. 45.9ng/ml, p<0.0001). Among Caucasians, the ORs for RCC comparing the highest (Q4) to the lowest (Q1) sex-specific quartile of leptin were 3.2 (95%CI:1.9–5.2) for males and 4.7 (95%CI:2.6–8.6) for females. Serum leptin was not significantly associated with RCC among African American males (OR 1.5, 95%CI:0.7–3.1) or females (OR 2.1, 95%CI:0.8–5.5). Higher adiponectin was associated with RCC risk among African American males (Q4 vs. Q1: OR 2.3, 95%CI:1.1–4.6) and females (OR 2.1, 95%CI:1.2–6.7), but not significantly among Caucasian males (OR 1.6, 95%CI:0.99–2.7) and females (OR 1.6, 95%CI:0.9–3.1). In conclusion, we observed an association between both leptin and adiponectin concentrations and risk of RCC, which may differ by race. Confirmation in further investigations is needed.
PMCID: PMC3742622  PMID: 23666639
13.  Surgical approach and the use of lymphadenectomy and adrenalectomy among patients undergoing radical nephrectomy for renal cell carcinoma 
Urologic oncology  2011;30(6):856-863.
We assessed the influence of tumor size and surgical approach on the use of lymphadenectomy and adrenalectomy with radical nephrectomy.
We evaluated patients with renal cell carcinoma (RCC) enrolled in the US Kidney Cancer Study, a case–control study in the metropolitan areas of Detroit and Chicago from 2002–2007. We identified patients who underwent open (ORN) or laparoscopic radical nephrectomy (LRN). We used medical records and SEER data to determine the proportion of patients who underwent lymphadenectomy or adrenalectomy. Bivariate analyses were performed to evaluate associations between tumor size, surgical approach, and receipt of lymphadenectomy or adrenalectomy.
We identified 730 patients who underwent ORN (427, 58%) or LRN (303, 42%) for RCC from 2002–2007. Among this group, 11% and 24% underwent lymphadenectomy or adrenalectomy, respectively. Lymphadenectomy was more common among patients treated from an open surgical approach (14.1% ORN vs 5.9% LRN, p<0.01); this difference was most pronounced for cases with tumors between 4–7 cm (15.9% vs 2.9%, p=0.01). Patients treated with ORN were also more likely to undergo adrenalectomy, with the greatest discrepancy among cases with tumors ≤ 4 cm (21.7% vs. 11.4%, p<0.01).
Among patients undergoing radical nephrectomy for RCC, the use of lymphadenectomy and adrenalectomy is relatively uncommon and varies by tumor size and surgical approach. With an increasing number of patients with small tumors, the diffusion of laparoscopy, and the emergence of clinical trials evaluating systemic adjuvant therapies, our findings highlight important considerations for optimizing surgical management of patients with RCC.
PMCID: PMC3123686  PMID: 21419672
lymph node excision; adrenalectomy; carcinoma; renal cell; laparoscopy; neoplasm staging
14.  Body Mass Index and Renal Cell Cancer: The Influence of Race and Sex 
Epidemiology (Cambridge, Mass.)  2012;23(6):821-828.
Obesity is a risk factor for renal cell (or renal) cancer. The increasing prevalence of obesity may be contributing to the rising incidence of this cancer over the past several decades. The effects of early-age obesity and change in body mass index (BMI) on renal cancer have been studied less thoroughly, and the influence of race has never been formally investigated.
Using data gathered as part of a large case-control study of renal cancer (1,214 cases and 1,234 controls), we investigated associations with BMI at several time points, as well as with height. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were computed using logistic regression modeling. Race- and sex-stratified analyses were conducted to evaluate subgroup differences.
Obesity (BMI ≥ 30 kg/m2) early in adulthood (OR=1.6 [95% CI=1.1 to 2.4]) and 5 years before diagnosis (1.6 [1.1 to 2.2]) was associated with renal cancer. The association with early-adult obesity was stronger among whites than blacks (Test for interaction, P=0.006), while the association with obesity near diagnosis was marginally stronger in women than men (Test for interaction, P=0.08). The strongest association with renal cancer was observed for obese whites both in early adulthood and prior to interview (2.6 [1.5 to 4.4]); this association was not present among blacks. Estimates of the annual excess rate of renal cancer (per 100,000 persons) attributed to both overweight and obesity (BMI > 25 kg/m2) ranged from 9.9 among black men to 5.6 among white women.
Obesity, both early and later in life, is associated with an increased risk of renal cancer. The association with early obesity appears to be stronger among whites than blacks.
PMCID: PMC3466395  PMID: 23007040
15.  Racial Differences in Colorectal Cancer Survival in the Detroit Metropolitan Area 
Cancer  2009;115(16):3791-3800.
Colorectal carcinoma is the second most common cause of cancer death with African Americans having lower survival compared with White Americans. The purpose of this study was to investigate the effect of demographics, clinical factors, and socioeconomic status (SES) on racial disparities in colorectal cancer survival in the Detroit Metropolitan Area.
The study population included 9078 individuals with primary invasive colorectal cancer identified between 1988 and 1992 through the Surveillance, Epidemiology, and End Results (SEER) program. Demographics, clinical information, and survival were obtained through SEER. SES was categorized using occupation, educational level, and poverty status at the census tract level. Kaplan-Meier survival curves and Cox proportional hazards regression were used to compare overall survival by race.
African Americans were more likely to be diagnosed with stage IV disease (P < .001), and to reside within poor census tracts (P < .001) compared with White Americans. Unadjusted analysis showed that African Americans had a significantly higher risk of death compared with their White American counterparts (hazards ratio [HR], 1.13; 95% confidence interval [CI], 1.07–1.20). After adjusting for age, marital status, sex, SES group, TNM stage, and treatment, race was no longer significantly associated with overall survival (HR, 1.00; 95% CI, 0.92–1.09). Similar results were seen with colorectal cancer-specific survival.
Racial disparities in colorectal cancer survival dissipate after adjusting for other demographic and clinical factors. These results can potentially affect medical guidelines regarding screening and treatment, and possibly influence public health policies that can have a positive impact on equalizing racial differences in access to care.
PMCID: PMC3799766  PMID: 19598220
survival; colorectal cancer; SEER; racial disparities; socioeconomic status
16.  Racial Differences in Cervical Cancer Survival in the Detroit Metropolitan Area 
Cancer  2008;112(6):1264-1271.
African-American (AA) women have lower survival rates from cervical cancer compared with white women. The objective of this study was to examine the influence of socioeconomic status (SES) and other variables on racial disparities in overall survival among women with invasive cervical cancer.
One thousand thirty-six women (705 white women and 331 AA women) who were diagnosed with primary invasive cancer of the cervix between 1988 and 1992 were identified through the Metropolitan Detroit Cancer Surveillance System (MDCSS), a registry in the Surveillance, Epidemiology, and End Results (SEER) database. Pathology, treatment, and survival data were obtained through SEER. SES was categorized by using occupation, poverty, and educational status at the census tract level. Cox proportional hazards models were used to compare overall survival between AA women and white women adjusting for sociodemographics, clinical presentation, and treatment.
AA women were more likely to present at an older age (P < .001), with later stage disease (P < .001), and with squamous histology (P = .01), and they were more likely to reside in a census tract categorized as Working Poor (WP) (P < .001). After multivariate adjustment, race no longer had a significant impact on survival. Women who resided in a WP census tract had a higher risk of death than women from a Professional census tract (P = .05). There was a significant interaction between disease stage and time with the effect of stage on survival attenuated after 6 years.
In this study, factors that affected access to medical care appeared to have a more important influence than race on the long-term survival of women with invasive cervical cancer.
PMCID: PMC3799770  PMID: 18257090
cervical cancer; survival; race; socioeconomic status; Surveillance; Epidemiology; End Results
17.  Androgen Deprivation Therapy and Cataract Incidence Among Elderly Prostate Cancer Patients in the United States 
Annals of epidemiology  2010;21(3):156-163.
The side-effects associated with androgen deprivation therapy (ADT) include weight gain, dyslipidemia, and insulin resistance. As cataracts have been linked to these metabolic abnormalities, an increased risk of cataract may be another adverse consequence of ADT use.
Using data from the Surveillance, Epidemiology and End Results-Medicare database, we estimated risk of cataract associated with ADT among 65,852 prostate-cancer patients. ADT treatment was defined as at least one dose of a gonadotropin-releasing hormone agonist or orchiectomy within 6 months after prostate cancer diagnosis. The outcome measure was a first claim of cataract diagnosis identified in Medicare claim files. Cox regression was used to estimate hazard ratios (HR) for the effects of ADT treatment, controlling for confounders.
Gonadotropin-releasing hormone agonist use was associated with a modest increase in cataract incidence (HR 1.09, 95% confidence interval 1.06–1.12). rchiectomy was also associated with an increased risk of cataract among men with no history of cataract prior to prostate cancer diagnosis (HR 1.26, 95% confidence interval 1.07–1.47).
In the first systematic investigation of the association between ADT and cataract, our results suggest an elevation in the incidence of cataract among ADT users. Further study, preferably prospective in design, is needed to provide additional evidence to support or refute these findings.
PMCID: PMC3792579  PMID: 21109456
Epidemiology; GnRH Agonist; Lens Opacities; Orchiectomy; Prostate Cancer; SEER-Medicare
18.  Cigarette smoking and renal cell carcinoma risk among black and white Americans: effect modification by hypertension and obesity 
Incidence of kidney cancer has been increasing over the past three decades, with more rapid increases and higher incidence rates among blacks than whites in the United States. An association between cigarette smoking and renal cell carcinoma (RCC), the most common form of kidney cancer, has been reported for whites, but the association in blacks is less clear.
The association between smoking and RCC was examined in 1,217 incident cases and 1,235 population controls frequency-matched on age, race, gender and study site in the Kidney Cancer Study in Detroit, MI and Chicago, IL.
In white individuals, increasing duration and number of pack years of were both associated with increased risk of RCC after adjusting for age, gender, education, study site, body mass index (BMI) and history of hypertension (p-trend=0.0002 and p-trend=0.002, respectively). Among black individuals, RCC risk increased with duration of smoking (p- trend=0.02), but not other measures. Compared to current smokers, RCC risk decreased with increasing years of smoking cessation among both whites and blacks (p- trend=0.01 and 0.02, respectively). When examining risk according to hypertension history, associations between smoking and RCC risk were observed only among individuals who reported never having been diagnosed with hypertension. Similarly, cigarette smoking was associated with increased risk of RCC among non-obese individuals, but not among those with BMI≥30 kg/m2.
Our observation that smoking is associated with RCC only in non-obese individuals and those with no history of hypertension are novel findings
The complex relationships between RCC, smoking, hypertension and obesity require additional confirmation.
PMCID: PMC3348421  PMID: 22426145
Renal Cell Carcinoma; Cigarette Smoking; Hypertension; Body Mass Index; Race/Ethnicity
19.  The chromosome 2p21 region harbors a complex genetic architecture for association with risk for renal cell carcinoma 
Human Molecular Genetics  2011;21(5):1190-1200.
In follow-up of a recent genome-wide association study (GWAS) that identified a locus in chromosome 2p21 associated with risk for renal cell carcinoma (RCC), we conducted a fine mapping analysis of a 120 kb region that includes EPAS1. We genotyped 59 tagged common single-nucleotide polymorphisms (SNPs) in 2278 RCC and 3719 controls of European background and observed a novel signal for rs9679290 [P = 5.75 × 10−8, per-allele odds ratio (OR) = 1.27, 95% confidence interval (CI): 1.17–1.39]. Imputation of common SNPs surrounding rs9679290 using HapMap 3 and 1000 Genomes data yielded two additional signals, rs4953346 (P = 4.09 × 10−14) and rs12617313 (P = 7.48 × 10−12), both highly correlated with rs9679290 (r2 > 0.95), but interestingly not correlated with the two SNPs reported in the GWAS: rs11894252 and rs7579899 (r2 < 0.1 with rs9679290). Genotype analysis of rs12617313 confirmed an association with RCC risk (P = 1.72 × 10−9, per-allele OR = 1.28, 95% CI: 1.18–1.39) In conclusion, we report that chromosome 2p21 harbors a complex genetic architecture for common RCC risk variants.
PMCID: PMC3277315  PMID: 22113997
20.  “It’s up to you and God”: understanding health behavior change in older African American survivors of colorectal cancer 
This study investigated the beliefs and attitudes of older African American colorectal cancer (CRC) survivors that may influence health behavior changes after treatment. Drawing from existing theories of health behavior change and cultural beliefs about health, a semi-structured interview guide was developed to elicit survivors’ perspectives. Qualitative focus groups and interviews were conducted with 17 survivors identified through the Detroit Surveillance Epidemiology and End Results registry. Using verbatim transcripts from the sessions and NVivo software, thematic analysis was conducted to analyze patterns of responses. Transcripts were coded for seven categories (health behaviors, who/what motivates change, self-efficacy, fatalism, religion/spirituality, beliefs about cancer, race/ethnicity). Five themes emerged from the data (personal responsibility, resilience, desire for information, intentions to change, beliefs in divine control). Findings support the relevance of existing theories of health behavior change to older African American CRC survivors. Cultural considerations are suggested to improve interventions seeking to maximize changes in diet and exercise among this group of survivors.
PMCID: PMC3717987  PMID: 23646096
African Americans; Health behaviors; Colorectal cancer; Cancer survivorship; Qualitative methods
21.  Individual and Neighborhood Socioeconomic Status and Healthcare Resources in Relation to Black-White Breast Cancer Survival Disparities 
Journal of Cancer Epidemiology  2013;2013:490472.
Background. Breast cancer survival has improved significantly in the US in the past 10–15 years. However, disparities exist in breast cancer survival between black and white women. Purpose. To investigate the effect of county healthcare resources and SES as well as individual SES status on breast cancer survival disparities between black and white women. Methods. Data from 1,796 breast cancer cases were obtained from the Surveillance Epidemiology and End Results and the National Longitudinal Mortality Study dataset. Cox Proportional Hazards models were constructed accounting for clustering within counties. Three sequential Cox models were fit for each outcome including demographic variables; demographic and clinical variables; and finally demographic, clinical, and county-level variables. Results. In unadjusted analysis, black women had a 53% higher likelihood of dying of breast cancer and 32% higher likelihood of dying of any cause (P < 0.05) compared with white women. Adjusting for demographic variables explained away the effect of race on breast cancer survival (HR, 1.40; 95% CI, 0.99–1.97), but not on all-cause mortality. The racial difference in all-cause survival disappeared only after adjusting for county-level variables (HR, 1.27; CI, 0.95–1.71). Conclusions. Improving equitable access to healthcare for all women in the US may help eliminate survival disparities between racial and socioeconomic groups.
PMCID: PMC3590635  PMID: 23509460
22.  A genome-wide association study identifies a novel susceptibility locus for renal cell carcinoma on 12p11.23 
Wu, Xifeng | Scelo, Ghislaine | Purdue, Mark P. | Rothman, Nathaniel | Johansson, Mattias | Ye, Yuanqing | Wang, Zhaoming | Zelenika, Diana | Moore, Lee E. | Wood, Christopher G. | Prokhortchouk, Egor | Gaborieau, Valerie | Jacobs, Kevin B. | Chow, Wong-Ho | Toro, Jorge R. | Zaridze, David | Lin, Jie | Lubinski, Jan | Trubicka, Joanna | Szeszenia-Dabrowska, Neonilia | Lissowska, Jolanta | Rudnai, Peter | Fabianova, Eleonora | Mates, Dana | Jinga, Viorel | Bencko, Vladimir | Slamova, Alena | Holcatova, Ivana | Navratilova, Marie | Janout, Vladimir | Boffetta, Paolo | Colt, Joanne S. | Davis, Faith G. | Schwartz, Kendra L. | Banks, Rosamonde E. | Selby, Peter J. | Harnden, Patricia | Berg, Christine D. | Hsing, Ann W. | Grubb, Robert L. | Boeing, Heiner | Vineis, Paolo | Clavel-Chapelon, Françoise | Palli, Domenico | Tumino, Rosario | Krogh, Vittorio | Panico, Salvatore | Duell, Eric J. | Quirós, José Ramón | Sanchez, Maria-José | Navarro, Carmen | Ardanaz, Eva | Dorronsoro, Miren | Khaw, Kay-Tee | Allen, Naomi E. | Bueno-de-Mesquita, H. Bas | Peeters, Petra H.M. | Trichopoulos, Dimitrios | Linseisen, Jakob | Ljungberg, Börje | Overvad, Kim | Tjønneland, Anne | Romieu, Isabelle | Riboli, Elio | Stevens, Victoria L | Thun, Michael J | Diver, W. Ryan | Gapstur, Susan M. | Pharoah, Paul D. | Easton, Douglas F. | Albanes, Demetrius | Virtamo, Jarmo | Vatten, Lars | Hveem, Kristian | Fletcher, Tony | Koppova, Kvetoslava | Cussenot, Olivier | Cancel-Tassin, Geraldine | Benhamou, Simone | Hildebrandt, Michelle A. | Pu, Xia | Foglio, Mario | Lechner, Doris | Hutchinson, Amy | Yeager, Meredith | Fraumeni, Joseph F. | Lathrop, Mark | Skryabin, Konstantin G. | McKay, James D. | Gu, Jian | Brennan, Paul | Chanock, Stephen J.
Human Molecular Genetics  2011;21(2):456-462.
Renal cell carcinoma (RCC) is the most lethal urologic cancer. Only two common susceptibility loci for RCC have been confirmed to date. To identify additional RCC common susceptibility loci, we conducted an independent genome-wide association study (GWAS). We analyzed 533 191 single nucleotide polymorphisms (SNPs) for association with RCC in 894 cases and 1516 controls of European descent recruited from MD Anderson Cancer Center in the primary scan, and validated the top 500 SNPs in silico in 3772 cases and 8505 controls of European descent involved in the only published GWAS of RCC. We identified two common variants in linkage disequilibrium, rs718314 and rs1049380 (r2 = 0.64, D ′ = 0.84), in the inositol 1,4,5-triphosphate receptor, type 2 (ITPR2) gene on 12p11.23 as novel susceptibility loci for RCC (P = 8.89 × 10−10 and P = 6.07 × 10−9, respectively, in meta-analysis) with an allelic odds ratio of 1.19 [95% confidence interval (CI): 1.13–1.26] for rs718314 and 1.18 (95% CI: 1.12–1.25) for rs1049380. It has been recently identified that rs718314 in ITPR2 is associated with waist–hip ratio (WHR) phenotype. To our knowledge, this is the first genetic locus associated with both cancer risk and WHR.
PMCID: PMC3276284  PMID: 22010048
23.  Characterizing inflammatory breast cancer among Arab Americans in the California, Detroit and New Jersey Surveillance, Epidemiology and End Results (SEER) registries (1988–2008) 
SpringerPlus  2013;2:3.
Inflammatory breast cancer (IBC) is characterized by an apparent geographical distribution in incidence, being more common in North Africa than other parts of the world. Despite the rapid growth of immigrants to the United States from Arab nations, little is known about disease patterns among Arab Americans because a racial category is rarely considered for this group. The aim of this study was to advance our understanding of the burden of IBC in Arab ethnic populations by describing the proportion of IBC among different racial groups, including Arab Americans from the Detroit, New Jersey and California Surveillance, Epidemiology and End Results (SEER) registries.
We utilized a validated Arab surname algorithm to identify women of Arab descent from the SEER registries. Differences in the proportion of IBC out of all breast cancer and IBC characteristics by race and menopausal status were evaluated using chi-square tests for categorical variables, t-tests and ANOVA tests for continuous variables, and log-rank tests for survival data. We modeled the association between race and IBC among all women with breast cancer using hierarchical logistic regression models, adjusting for individual and census tract-level variables.
Statistically significant differences in the proportion of IBC out of all breast cancers by race were evident. In a hierarchical model, adjusting for age, estrogen and progesterone receptor, human epidermal growth receptor 2, registry and census-tract level education, Arab-Americans (OR=1.5, 95% CI=1.2,1.9), Hispanics (OR=1.2, 95% CI=1.1,1.3), Non-Hispanic Blacks (OR=1.3, 95% CI=1.2, 1.4), and American Indians/Alaskans (OR=1.9, 95% CI=1.1, 3.4) had increased odds of IBC, while Asians (OR=0.6, 95% CI=0.6, 0.7) had decreased odds of IBC as compared to Non-Hispanic Whites.
IBC may be more common among certain minority groups, including Arab American women. Understanding the descriptive epidemiology of IBC by race may generate hypotheses about risk factors for this aggressive disease. Future research should focus on etiologic factors that may explain these differences.
PMCID: PMC3568481  PMID: 23420611
Inflammatory breast cancer; Arab; Race; Hierarchical logistic regression
24.  Detectable clonal mosaicism and its relationship to aging and cancer 
Jacobs, Kevin B | Yeager, Meredith | Zhou, Weiyin | Wacholder, Sholom | Wang, Zhaoming | Rodriguez-Santiago, Benjamin | Hutchinson, Amy | Deng, Xiang | Liu, Chenwei | Horner, Marie-Josephe | Cullen, Michael | Epstein, Caroline G | Burdett, Laurie | Dean, Michael C | Chatterjee, Nilanjan | Sampson, Joshua | Chung, Charles C | Kovaks, Joseph | Gapstur, Susan M | Stevens, Victoria L | Teras, Lauren T | Gaudet, Mia M | Albanes, Demetrius | Weinstein, Stephanie J | Virtamo, Jarmo | Taylor, Philip R | Freedman, Neal D | Abnet, Christian C | Goldstein, Alisa M | Hu, Nan | Yu, Kai | Yuan, Jian-Min | Liao, Linda | Ding, Ti | Qiao, You-Lin | Gao, Yu-Tang | Koh, Woon-Puay | Xiang, Yong-Bing | Tang, Ze-Zhong | Fan, Jin-Hu | Aldrich, Melinda C | Amos, Christopher | Blot, William J | Bock, Cathryn H | Gillanders, Elizabeth M | Harris, Curtis C | Haiman, Christopher A | Henderson, Brian E | Kolonel, Laurence N | Le Marchand, Loic | McNeill, Lorna H | Rybicki, Benjamin A | Schwartz, Ann G | Signorello, Lisa B | Spitz, Margaret R | Wiencke, John K | Wrensch, Margaret | Wu, Xifeng | Zanetti, Krista A | Ziegler, Regina G | Figueroa, Jonine D | Garcia-Closas, Montserrat | Malats, Nuria | Marenne, Gaelle | Prokunina-Olsson, Ludmila | Baris, Dalsu | Schwenn, Molly | Johnson, Alison | Landi, Maria Teresa | Goldin, Lynn | Consonni, Dario | Bertazzi, Pier Alberto | Rotunno, Melissa | Rajaraman, Preetha | Andersson, Ulrika | Freeman, Laura E Beane | Berg, Christine D | Buring, Julie E | Butler, Mary A | Carreon, Tania | Feychting, Maria | Ahlbom, Anders | Gaziano, J Michael | Giles, Graham G | Hallmans, Goran | Hankinson, Susan E | Hartge, Patricia | Henriksson, Roger | Inskip, Peter D | Johansen, Christoffer | Landgren, Annelie | McKean-Cowdin, Roberta | Michaud, Dominique S | Melin, Beatrice S | Peters, Ulrike | Ruder, Avima M | Sesso, Howard D | Severi, Gianluca | Shu, Xiao-Ou | Visvanathan, Kala | White, Emily | Wolk, Alicja | Zeleniuch-Jacquotte, Anne | Zheng, Wei | Silverman, Debra T | Kogevinas, Manolis | Gonzalez, Juan R | Villa, Olaya | Li, Donghui | Duell, Eric J | Risch, Harvey A | Olson, Sara H | Kooperberg, Charles | Wolpin, Brian M | Jiao, Li | Hassan, Manal | Wheeler, William | Arslan, Alan A | Bas Bueno-de-Mesquita, H | Fuchs, Charles S | Gallinger, Steven | Gross, Myron D | Holly, Elizabeth A | Klein, Alison P | LaCroix, Andrea | Mandelson, Margaret T | Petersen, Gloria | Boutron-Ruault, Marie-Christine | Bracci, Paige M | Canzian, Federico | Chang, Kenneth | Cotterchio, Michelle | Giovannucci, Edward L | Goggins, Michael | Bolton, Judith A Hoffman | Jenab, Mazda | Khaw, Kay-Tee | Krogh, Vittorio | Kurtz, Robert C | McWilliams, Robert R | Mendelsohn, Julie B | Rabe, Kari G | Riboli, Elio | Tjønneland, Anne | Tobias, Geoffrey S | Trichopoulos, Dimitrios | Elena, Joanne W | Yu, Herbert | Amundadottir, Laufey | Stolzenberg-Solomon, Rachael Z | Kraft, Peter | Schumacher, Fredrick | Stram, Daniel | Savage, Sharon A | Mirabello, Lisa | Andrulis, Irene L | Wunder, Jay S | García, Ana Patiño | Sierrasesúmaga, Luis | Barkauskas, Donald A | Gorlick, Richard G | Purdue, Mark | Chow, Wong-Ho | Moore, Lee E | Schwartz, Kendra L | Davis, Faith G | Hsing, Ann W | Berndt, Sonja I | Black, Amanda | Wentzensen, Nicolas | Brinton, Louise A | Lissowska, Jolanta | Peplonska, Beata | McGlynn, Katherine A | Cook, Michael B | Graubard, Barry I | Kratz, Christian P | Greene, Mark H | Erickson, Ralph L | Hunter, David J | Thomas, Gilles | Hoover, Robert N | Real, Francisco X | Fraumeni, Joseph F | Caporaso, Neil E | Tucker, Margaret | Rothman, Nathaniel | Pérez-Jurado, Luis A | Chanock, Stephen J
Nature genetics  2012;44(6):651-658.
In an analysis of 31,717 cancer cases and 26,136 cancer-free controls drawn from 13 genome-wide association studies (GWAS), we observed large chromosomal abnormalities in a subset of clones from DNA obtained from blood or buccal samples. Mosaic chromosomal abnormalities, either aneuploidy or copy-neutral loss of heterozygosity, of size >2 Mb were observed in autosomes of 517 individuals (0.89%) with abnormal cell proportions between 7% and 95%. In cancer-free individuals, the frequency increased with age; 0.23% under 50 and 1.91% between 75 and 79 (p=4.8×10−8). Mosaic abnormalities were more frequent in individuals with solid-tumors (0.97% versus 0.74% in cancer-free individuals, OR=1.25, p=0.016), with a stronger association for cases who had DNA collected prior to diagnosis or treatment (OR=1.45, p=0.0005). Detectable clonal mosaicism was common in individuals for whom DNA was collected at least one year prior to diagnosis of leukemia compared to cancer-free individuals (OR=35.4, p=3.8×10−11). These findings underscore the importance of the role and time-dependent nature of somatic events in the etiology of cancer and other late-onset diseases.
PMCID: PMC3372921  PMID: 22561519
25.  A case-control study of reproductive factors and renal cell carcinoma among black and white women in the United States 
Cancer causes & control : CCC  2011;22(11):1537-1544.
Renal cell carcinoma (RCC) incidence is higher among blacks than whites in the United States, and has been associated with the frequency and timing of childbirth among women in some epidemiologic studies. We investigated whether reproductive factors are associated with RCC, overall and by race, within a population-based case-control study.
Between 2002 and 2007, 497 female cases of incident RCC (136 black, 361 white) and 546 female controls (273 black, 273 white) within the Detroit and Chicago metropolitan areas were enrolled. Information on reproductive history and other factors was collected through in-person interviews. Multivariate adjusted odds ratios (OR) and 95% confidence intervals (CI) were computed using unconditional logistic regression.
Reduced RCC risk was observed among women aged ≥30 years at first live birth, relative to an age of <20 years (OR 0.5, 95% CI 0.3–0.9). This association was present among both white (OR 0.4, 95% CI 0.2–0.9) and, though not statistically significant, black women (OR 0.6, 95% CI 0.2–1.8). In analyses restricted to clear cell adenocarcinoma, the most common RCC histologic subtype, the association was particularly strong (OR 0.3, 95% CI 0.2–0.8). We did not observe clear evidence of association with RCC for other reproductive factors.
Our findings further support an association between late maternal age at first birth and reduced RCC risk, and suggest that the association may be particularly strong for clear cell adenocarcinoma.
PMCID: PMC3460515  PMID: 21866373
Renal cell carcinoma; reproductive factors; case-control studies; hysterectomy; parity

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