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1.  Racial disparity in renal cell carcinoma patient survival according to demographic and clinical characteristics 
Cancer  2012;119(2):388-394.
Black renal cell carcinoma (RCC) patients tend to have poorer prognosis than white patients. We examined whether the racial disparity in RCC patient survival varies by demographic and clinical characteristics.
Nearly 40,000 patients (4,359 black and 34,991 white) diagnosed with invasive RCC from 1992 to 2007 were identified from 12 registries in NCI’s Surveillance, Epidemiology, and End Results program, covering about 14% of the U.S. population. Relative survival rates through 2008 were computed using the actuarial method.
Proportionally more blacks than whites were diagnosed with RCC under age 50 and with localized cancer. Overall, the 5-year relative survival rates were 72.6% (95% confidence interval 72.0% – 73.2%) for white and 68.0% (66.2% – 69.8%) for black patients. Survival was higher among women than men and among younger than older patients. Survival decreased with advancing tumor stage and, within each stage, decreased with increasing tumor size. Patients with clear cell RCC, a more common form among whites, had poorer prognosis than patients with papillary or chromophobe subtypes, which are more common among blacks. Survival for patients who received no surgical treatment (10.5% of white patients and 14.5% of black patients) was substantially lower than for patients treated with nephrectomy, with similar survival among whites and blacks. In all other demographic and clinical subgroups of patients, whites consistently had a survival advantage over blacks.
White RCC patients consistently have a survival advantage over black patients, regardless of age, sex, tumor stage or size, histological subtype, or surgical treatment.
PMCID: PMC3538913  PMID: 23147245
Renal cell carcinoma; survival; race; stage at diagnosis; histological type
2.  State-level Uterine Corpus Cancer Incidence Rates Corrected for Hysterectomy Prevalence, 2004-2008 
The interpretation of uterine cancer rates is hindered by the inclusion of women whose uterus has been surgically removed in the population at risk. Hysterectomy prevalence varies widely by state and race/ethnicity, exacerbating this issue.
We estimated hysterectomy-corrected, age-adjusted uterine corpus cancer incidence rates by race/ethnicity for 49 states and the District of Columbia during 2004-2008 using case counts obtained from population-based cancer registries; population data from the U.S. Census Bureau; and hysterectomy prevalence data from the Behavioral Risk Factor Surveillance System. Corrected and uncorrected incidence rates were compared with regard to geographic and racial/ethnic disparity patterns and the association with obesity.
Among non-Hispanic whites, uterine cancer incidence rates (per 100,000 woman-years) uncorrected for hysterectomy prevalence ranged from 17.1 in Louisiana to 32.1 in New Jersey, mirrored regional hysterectomy patterns, and were not correlated with obesity prevalence (Pearson’s correlation coefficient, r = 0.06, two-sided p = 0.68). In comparison, hysterectomy-corrected rates were higher by 30% (District of Columbia) to more than 100% (Mississippi, Louisiana, Alabama, and Oklahoma), displayed no discernible geographic pattern, and were moderately associated with obesity (r = 0.37, two-sided p = 0.009). For most states, hysterectomy correction diminished or reversed the black/white deficit and accentuated the Hispanic/white deficit.
Failure to adjust uterine cancer incidence rates for hysterectomy prevalence distorts true geographic and racial patterns and substantially underestimates the disease burden, particularly for Southern states.
Correction for hysterectomy is necessary for the accurate evaluation of uterine cancer rates.
PMCID: PMC3538963  PMID: 23125334
endometrium; uterus; hysterectomy; geographic pattern; disparity
3.  Pediatric, elderly, and emerging adult-onset peaks in Burkitt lymphoma incidence diagnosed in four continents, excluding Africa 
American Journal of Hematology  2012;87(6):573-578.
Burkitt lymphoma (BL) in the general population and immunosuppressed persons with AIDS in United States was characterized by three age-specific incidence peaks near 10, 40 and 70 years. We hypothesized that BL from different geographical areas may exhibit pediatric, adult, and elderly age incidence peaks. We investigated this hypothesis using data on 3403 cases obtained from the International Agency for Research on Cancer (1978–2002). Data from Africa were sparse or incomplete, and thus were excluded. Age-standardized rates (ASR) and age-specific incidence rates were calculated, supplemented with calculations performed using age-period-cohort models. The ASR rose 5.3% (95% confidence interval (CI), 5.0–5.6) per year in males and 4.6% (95% CI, 4.5–4.8) in females. The ASR increased gradually in children and steeply in adults and most rapidly in the elderly both in males and females. Overall, BL male/female ASR ratio was 2.5, but it declined from 3.1 (95% CI, 3.0–3.3) for pediatric BL to 2.3 (95% CI 2.2–2.4) for adult BL and 1.5 (95% CI, 1.4–1.6) for elderly BL. Age-specific incidence peaks occurred near 10 years and 70 years in all regions and periods. A peak near 40 years of age emerged in the mid-1990s, particularly in men. Findings using APC models confirmed those based on standard analyses. Our findings, based on international BL cases, support our hypothesis that BL is multimodal and that BL peaks at different ages may be clues to differences in the etiology and/or biology of BL at those ages.
PMCID: PMC3358448  PMID: 22488262
Burkitt lymphoma; epidemiology; multimodal cancer; non-Hodgkin lymphoma; HIV/AIDS
4.  Global Patterns of Prostate Cancer Incidence, Aggressiveness, and Mortality in Men of African Descent 
Prostate Cancer  2013;2013:560857.
Prostate cancer (CaP) is the leading cancer among men of African descent in the USA, Caribbean, and Sub-Saharan Africa (SSA). The estimated number of CaP deaths in SSA during 2008 was more than five times that among African Americans and is expected to double in Africa by 2030. We summarize publicly available CaP data and collected data from the men of African descent and Carcinoma of the Prostate (MADCaP) Consortium and the African Caribbean Cancer Consortium (AC3) to evaluate CaP incidence and mortality in men of African descent worldwide. CaP incidence and mortality are highest in men of African descent in the USA and the Caribbean. Tumor stage and grade were highest in SSA. We report a higher proportion of T1 stage prostate tumors in countries with greater percent gross domestic product spent on health care and physicians per 100,000 persons. We also observed that regions with a higher proportion of advanced tumors reported lower mortality rates. This finding suggests that CaP is underdiagnosed and/or underreported in SSA men. Nonetheless, CaP incidence and mortality represent a significant public health problem in men of African descent around the world.
PMCID: PMC3583061  PMID: 23476788
5.  Racial variation in tumor stage at diagnosis among Department of Defense beneficiaries 
Cancer  2011;118(3):812-820.
Tumor stage at diagnosis often varies by racial/ethnic group, possibly due to inequitable healthcare access. Within the Department of Defense (DoD) Military Health System, beneficiaries have equal healthcare access. This study aimed to determine if tumor stage differed between whites and blacks for breast, cervical, colorectal and prostate cancers, which have effective screening regimens, based on data from the DoD’s Automated Cancer Tumor Registry from 1990–2003.
Distributions of tumor stage (localized vs. non-localized) between whites and blacks in the military were compared stratified by sex, active duty status, and age at diagnosis. Logistic regression was used to further adjust for age, marital status, year of diagnosis, geographic region, military service branch and tumor grade. Distributions of tumor stage were then compared between the military and general populations.
Racial differences in the distribution of stage were significant only among non-active duty beneficiaries. After adjusting for covariates, earlier stages of breast cancer after age 49 and prostate cancer after age 64 were significantly more common among white than black non-active duty beneficiaries (p<0.05), although the absolute difference for prostate cancer was minimal. Racial differences in stage for cervical and colorectal cancers were not significant after adjustment. Compared to the general population, the racial differences in the military were similar or slightly attenuated.
Racial disparities in stage at diagnosis were apparent in the DoD’s equal access healthcare system among older non-active duty beneficiaries. Socioeconomic status, supplemental insurance, cultural beliefs and biological factors may be related to these results.
PMCID: PMC3197959  PMID: 21766298
6.  Thyroid cancer incidence among active duty U.S. military personnel, 1990-2004 
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.
PMCID: PMC3210876  PMID: 21914838
Thyroid Neoplasms; Incidence; SEER Program; Military Personnel; United States/epidemiology
7.  Assessment of follow-up, and the completeness and accuracy of cancer case ascertainment in three areas of India 
Cancer epidemiology  2011;35(4):334-341.
A prospective study of diet and cancer has not been conducted in India; consequently, little is known regarding follow-up rates or the completeness and accuracy of cancer case ascertainment.
We assessed follow-up in the India Health Study (IHS; 4,671 participants aged 35–69 residing in New Delhi, Mumbai, or Trivandrum). We evaluated the impact of medical care access and relocation, re-contacted the IHS participants to estimate follow-up rates, and conducted separate studies of cancer cases to evaluate registry coverage (604 cases in Trivandrum) and the accuracy of self- and proxy-reporting (1600 cases in New Delhi and Trivandrum).
Over 97% of people reported seeing a doctor and 85% had lived in their current residence for over six years. The 2-year follow-up rate was 91% for Trivandrum and 53% for New Delhi. No cancer cases were missed among public institutions participating in the surveillance program in Trivandrum during 2003–04; but there are likely to be unmatched cases (ranging from 5 to13% of total cases) from private hospitals in the Trivandrum registry, as there are no mandatory reporting requirements. Vital status was obtained for 36% of cancer cases in New Delhi as compared to 78% in Trivandrum after a period of 4 years.
A prospective cohort study of cancer may be feasible in some centers in India with active follow-up to supplement registry data. Inclusion of cancers diagnosed at private institutions, unique identifiers for individuals, and computerized medical information would likely improve cancer registries.
PMCID: PMC3460518  PMID: 21621499
Cancer; end-point; follow-up; registry; prospective cohort; India
8.  Sex Disparities in Cancer Mortality and Survival 
Previous research has noted higher cancer mortality rates and lower survival among males than females. However, systematic comparisons of these two metrics by sex has been limited.
We extracted U.S. vital rates and survival data from the Surveillance, Epidemiology and End Results Database for 36 cancers by sex and age for the period 1977–2006. We compared sex-specific mortality rates and male-to-female mortality rate ratios (MRRs). We also extracted case data which included age and date of diagnosis, sex, primary cancer site, tumor stage and grade, survival time, vital status, and cause of death. Relative cancer-specific hazard ratios (HRs) for death in the 5-year period following diagnosis were estimated with Cox proportional hazards models, adjusted for covariates.
For the vast majority of cancers, age-adjusted mortality rates were higher among males than females with the highest male-to-female MRR for lip (5.51), larynx (5.37), hypopharynx (4.47), esophagus (4.08) and urinary bladder (3.36). Cancer-specific survival was, for most cancers, worse for males than females, but such disparities were drastically less than corresponding MRRs; e.g., lip (HR = 0.93), larynx (1.09), hypopharynx (0.98), esophagus (1.05), and urinary bladder (0.83).
Male-to-female MRRs differed markedly while cancer survival disparities were much less pronounced. This suggests that sex-related cancer disparities are more strongly related to etiology than prognosis.
Future analytical studies should attempt to understand causes of observed sex disparities in cancer.
PMCID: PMC3153584  PMID: 21750167
Sex; Male; Female; SEER program; Neoplasms; Mortality; Epidemiology
9.  Oral Cavity and Pharynx Cancer Incidence Trends by Subsite in the United States: Changing Gender Patterns 
Journal of Oncology  2012;2012:649498.
Objective. To evaluate oral cavity and pharynx cancer (OCPC) patterns by gender. Methods. We used Surveillance, Epidemiology, and End Results program data for 71,446 cases diagnosed during 1975–2008 to classify OCPC by anatomic subsite as potentially HPV-related or not, with oral tongue cancer considered a separate category. Results. Total OCPC rates among men were 2–4 times those among women. Among whites, total OCPC rates rose in the younger age groups due to substantial increases in successive birth cohorts for HPV-related cancers, more rapid among men than women, and oral tongue cancers, more rapid among women than men. Among blacks, total OCPC rates declined among cohorts born since 1930 reflecting the strong downward trends for HPV-unrelated sites. Among Hispanics and Asians, HPV-unrelated cancer rates generally declined, and oral tongue cancer rates appeared to be converging among young men and women. Conclusions. Decreases in total OCPC incidence reflect reductions in smoking and alcohol drinking. Rising HPV-related cancers among white men may reflect changing sexual practices. Reasons for the increasing young oral tongue cancer rates are unknown, but the narrowing of the gender differences provides a clue.
PMCID: PMC3345247  PMID: 22577381
10.  Thyroid Cancer Incidence Patterns in the United States by Histologic Type, 1992–2006 
Thyroid  2011;21(2):125-134.
The increasing incidence of thyroid cancer in the United States is well documented. In this study, we assessed the incidence patterns by histologic type according to demographic and tumor characteristics to further our understanding of these cancers.
We used the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program for cases diagnosed during 1992–2006 to investigate patterns for the four major histologic types of thyroid cancer by gender, race/ethnicity, and age as well as registry, tumor stage, and size.
Among women, papillary thyroid cancer rates were highest among Asians (10.96 per 100,000 woman-years) and lowest among blacks (4.90 per 100,000 woman-years); follicular cancer rates did not vary substantially by race/ethnicity (p-values >0.05), medullary cancer rates were highest among Hispanics (0.21 per 100,000 woman-years) and whites (0.22 per 100,000 woman-years), and anaplastic rates were highest among Hispanics (0.17 per 100,000 woman-years). Among men, both papillary and follicular thyroid cancer rates were highest among whites (3.58 and 0.58 per 100,000 man-years, respectively), medullary cancer rates were highest among Hispanics (0.18 per 100,000 man-years), and anaplastic rates were highest among Asians (0.11 per 100,000 man-years). Racial/ethnic-specific rates did not vary notably across registries. In contrast to age-specific rates of papillary thyroid cancer that peaked in midlife (age 50), especially pronounced among women, rates for follicular, medullary, and anaplastic types continued to rise across virtually the entire age range, especially for anaplastic carcinomas. Female-to-male incidence rate ratios among whites decreased with age most steeply for the follicular type and least steeply for the medullary type; it was <1 until the very oldest ages for the anaplastic type.
We conclude that the similar age-specific patterns and lack of geographical variation across the SEER racial/ethnic groups indicate that detection effects cannot completely explain the observed thyroid cancer incidence patterns as variation in the amount or quality of healthcare provided has been shown to vary by SEER racial/ethnic groups, gender, and age. We find that the variations in age-specific patterns by gender and across histologic types are intriguing and recommend that future etiologic investigation focus on exogenous and endogenous exposures that are experienced similarly by racial/ethnic groups, more strongly among women, and distinctively by age.
PMCID: PMC3025182  PMID: 21186939
11.  Melanoma of the skin and laterality 
PMCID: PMC3011927  PMID: 21167412
12.  Brain cancer incidence trends in relation to cellular telephone use in the United States 
Neuro-Oncology  2010;12(11):1147-1151.
The use of cellular telephones has grown explosively during the past two decades, and there are now more than 279 million wireless subscribers in the United States. If cellular phone use causes brain cancer, as some suggest, the potential public health implications could be considerable. One might expect the effects of such a prevalent exposure to be reflected in general population incidence rates, unless the induction period is very long or confined to very long-term users. To address this issue, we examined temporal trends in brain cancer incidence rates in the United States, using data collected by the Surveillance, Epidemiology, and End Results (SEER) Program. Log-linear models were used to estimate the annual percent change in rates among whites. With the exception of the 20–29-year age group, the trends for 1992–2006 were downward or flat. Among those aged 20–29 years, there was a statistically significant increasing trend between 1992 and 2006 among females but not among males. The recent trend in 20–29-year-old women was driven by a rising incidence of frontal lobe cancers. No increases were apparent for temporal or parietal lobe cancers, or cancers of the cerebellum, which involve the parts of the brain that would be more highly exposed to radiofrequency radiation from cellular phones. Frontal lobe cancer rates also rose among 20–29-year-old males, but the increase began earlier than among females and before cell phone use was highly prevalent. Overall, these incidence data do not provide support to the view that cellular phone use causes brain cancer.
PMCID: PMC3098028  PMID: 20639214
brain cancer; cellular telephones; epidemiology; SEER
13.  Small intestinal cancer: a population-based study of incidence and survival patterns in the United States, 1992-2006 
The etiology of cancers of the small intestine (SI) is largely unknown. To gain insight into these rare malignancies, we evaluated contemporaneous incidence and survival patterns.
Using SI cancer data from 12 population-based registries of the Surveillance, Epidemiology and End Results Program, we calculated age-adjusted and age-specific incidence rates (IRs), IR ratios (IRRs) and relative survival (RS) rates.
In total, 10,945 SI cancers (IR=2.10/100,000 person-years) were diagnosed during 1992-2006, including carcinomas (n=3,412, IR=0.66), neuroendocrine cancers (n=4,315, IR=0.83), sarcomas (n=1,084, IR=0.20), and lymphomas (n=2,023, IR=0.38). For all histologic groups, males had significantly higher IRs than females, and distinct age-specific gender patterns were limited to intermediate-/high-grade lymphomas. Neuroendocrine cancer rates varied significantly by race, with rates highest among Blacks and lowest among Asians/Pacific Islanders (APIs). Carcinoma IRs were highest among Blacks, sarcoma IRs were highest among APIs, and lymphoma IRs were highest among Whites. Age-specific IR patterns were similar across racial/ethnic groups. During 1992-2006 duodenal cancer IRs increased more markedly than those for other subsites. RS varied little by gender or race. Neuroendocrine cancers had the most favorable RS and carcinomas the least favorable. The greatest improvement in 5-year RS from 1992-1998 to 1999-2005 was observed for sarcomas and lymphomas.
Distinct SI cancer IR patterns according to histologic subtype suggest different underlying etiologies and/or disease biology, with susceptibility varying by gender, racial/ethnic groups, and subsite. Temporal patterns support a possible role for diagnostic bias of duodenal cancers.
Future epidemiologic studies of SI cancer should consider histologic subtype by gender, race/ethnicity, and subsite.
PMCID: PMC2919612  PMID: 20647399
Small intestinal cancers; epidemiology; minority populations; incidence; survival
14.  Prostate Cancer Incidence Rates in Africa 
Prostate Cancer  2011;2011:947870.
African American men have among the highest prostate cancer incidence rates in the world yet rates among their African counterparts are unclear. In this paper, we compared reported rates among black men of Sub-Saharan African descent using data from the International Agency for Research on Cancer (IARC) and the National Cancer Institute Surveillance, Epidemiology, and End Results Program for 1973–2007. Although population-based data in Africa are quite limited, the available data from IARC showed that rates among blacks were highest in the East (10.7–38.1 per 100,000 man-years, age-adjusted world standard) and lowest in the West (4.7–19.8). These rates were considerably lower than those of 80.0–195.3 observed among African Americans. Rates in Africa increased over time (1987–2002) and have been comparable to those for distant stage in African Americans. These patterns are likely due to differences between African and African American men in medical care access, screening, registry quality, genetic diversity, and Westernization. Incidence rates in Africa will likely continue to rise with improving economies and increasing Westernization, warranting the need for more high-quality population-based registration to monitor cancer incidence in Africa.
PMCID: PMC3200287  PMID: 22111004
15.  Primary cutaneous adenoid cystic carcinoma in the United States: incidence, survival, and associated cancers, 1976-2005 
Primary cutaneous adenoid cystic carcinoma (PCACC) is a rare appendageal tumor of uncertain origin. Details on epidemiologic features of PCACC are sparse and largely based on clinical reports.
To develop an understanding of PCACC incidence, survival, and associated cancers using population-based data.
We utilized the Surveillance, Epidemiology and End Results program to calculate age-adjusted incidence rates (IRs), IR ratios, 95% confidence intervals, standardized incidence ratios (SIRs), and 5-year relative survival rates of PCACC diagnosed during 1976-2005.
In a population of 723,174,580 person-years, the overall PCACC IR was 0.23 per one million person-years (n=152), with similar IRs among males and females (IR=0.24). Most cases of PCACC presented at a localized stage and arose on the face/head/neck. Among 122 two-month survivors of PCACC and more than 2.4 million two-month cancer survivors, risk of associated cancers overall was not significantly increased (SIR=1.17 (n=24) and SIR=1.43 (n=16), respectively). However, PCACC was associated with significantly increased risks of subsequent lymphohematopoietic (n=6; SIR=3.70) and thyroid (n=2; SIR=15.25) cancers, whereas the converse associations were not observed. Five-year relative survival was excellent (96.1%; n=122) with more favorable survival noted for PCACC involving the face/head/neck than the trunk.
A pathologic review of reported cases was not undertaken.
PCACC is a rare appendageal tumor that affects males and females equally, primarily presents at localized stage, predominates in the face/head/neck, and is associated with favorable survival. Immunosuppression does not appear to contribute to the development of PCACC, and the observed associated cancer patterns will need to be confirmed in larger studies.
PMCID: PMC2885489  PMID: 20447723
adenoid cystic carcinoma; skin cancer; epidemiology; incidence; survival; second primary cancers
16.  International trends in the incidence of testicular cancer, 1973–2002 
While testicular cancer incidence rates have been widely reported in populations of Northern European ancestry, rates in other population have been less frequently examined. In a prior report, global testicular cancer incidence rates and trends for the years 1973–1997 were summarized. The current report extends these analyses with an additional 5 years of data from Cancer Incidence in Five Continents.
Age-standardized incidence rates over successive 5-year time periods were obtained for populations in the Americas, Asia, Europe, and Oceania.
In general, testicular cancer incidence remained highest in Northern European populations (8.0–9.0 per 100,000) and lowest in Asian and African populations (<1 per 100,000). One notable exception to this pattern, however, was the very high rate reported by the Valdivia, Chile registry (8.8 per 100,000). In many populations, incidence rates rose between 1973 and 2002, although the increases were strongest and most consistent among populations of European ancestry. In some European populations, such as those of Denmark and of Geneva, Switzerland, some plateauing of rates was evident in recent years. There was little evidence of increase and possible evidence of modest decline in rates in east Asian populations. In general, the trends by histology (seminoma, nonseminoma) were similar to one another.
Risk of testicular cancer remains high in Northern European populations and low in Asian and African populations. Reasons for increasing rates among Northern Europeans and more stable or declining rates among East Asians are unexplained, supporting the need for future etiologic studies.
PMCID: PMC2867073  PMID: 20447912
testicular cancer; trends; seminoma; nonseminoma
17.  Contemporary Renal Cell Cancer Epidemiology 
Cancer journal (Sudbury, Mass.)  2008;14(5):288-301.
We analyzed renal cell cancer incidence patterns in the United States and reviewed recent epidemiologic evidence with regard to environmental and host genetic determinants of renal cell cancer risk. Renal cell cancer incidence rates continued to rise among all racial/ethnic groups in the United States, across all age groups, and for all tumor sizes, with the most rapid increases for localized stage disease and small tumors. Recent cohort studies confirmed the association of smoking, excess body weight, and hypertension with an elevated risk of renal cell cancer, and suggested that these factors can be modified to reduce the risk. There is increasing evidence for an inverse association between renal cell cancer risk and physical activity and moderate intake of alcohol. Occupational exposure to TCE has been positively associated with renal cell cancer risk in several recent studies, but its link with somatic mutations of the VHL gene has not been confirmed. Studies of genetic polymorphisms in relation to renal cell cancer risk have produced mixed results, but genome-wide association studies with larger sample size and a more comprehensive approach are underway. Few epidemiologic studies have evaluated risk factors by subtypes of renal cell cancer defined by somatic mutations and other tumor markers.
PMCID: PMC3077538  PMID: 18836333
renal cell cancer; incidence trends; cohort studies; smoking; obesity; hypertension; diet; occupation; genetic polymorphism; somatic mutation
Burkitt lymphoma (BL) is a unique B-cell non-Hodgkin lymphoma with three established clinical-epidemiological variants: endemic, sporadic, and AIDS-related BL shows characteristic dysregulation of MYC gene, but the causes of MYC dysregulation or BL arising at different ages are poorly understood. Therefore, we examined population-based BL incidence patterns in the United States to determine age-related risk. BL case and population data were obtained from the NCI’s Surveillance, Epidemiology, and End Results Databases (1973–2005). Standard cross-sectional, age-standardized, and age-specific incidence rates were stratified by sex and race and supplemented with age-period-cohort (APC) models. We analyzed 3058 BL cases diagnosed during 1,160,300,297 person-years of observation. Age-standardized incidence rates rose 6.8% per year (95% CI 4.5–9.1) for males and 7.1% (95% CI 3.2–11.1) for females during the study period. The rate among males was 3.2 times that among females, and among Whites 1.3 times that among Blacks. Male-to-female incidence rate ratios did not differ by race, but were 4.2 for pediatric (0–19 years), 4.1 for adult (20–59 years) and 2.0 for geriatric (≥ 60 years) BL. Cross-sectional age-specific rates showed two separate peaks among males and females, near ages 10 and 75 years, and a third peak near age 40 years among males. The tri/bimodal incidence pattern was present in sensitivity analyses excluding registries with many HIV/AIDS cases and in period-specific, cohort-specific analyses. To our knowledge tri/bimodal incidence patterns have not previously been reported for BL. Trimodal/bimodal BL suggests heterogeneity in etiology or biology of BL diagnosed at different ages in males and females.
PMCID: PMC2818154  PMID: 19810101
19.  Sex Disparities in Colorectal Cancer Incidence by Anatomic Subsite, Race and Age 
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.
PMCID: PMC3031675  PMID: 20503269
colorectal cancer; sex ratio; incidence; SEER program; epidemiology; neoplasms
20.  Epidemiology and risk factors for kidney cancer 
Nature reviews. Urology  2010;7(5):245-257.
After over two decades of increasing rates, kidney cancer incidence trends worldwide show signs of plateauing or decreases in recent years. In the United States, rates for renal cell cancer, the predominant form of kidney cancer in adults, continue to rise but mainly for early stage tumors. Incidence rates for renal pelvis cancer have declined, while kidney cancer mortality rates overall have leveled. These patterns are consistent with reports of incidental diagnosis and downward shift of tumor stage and size in clinical series. The changing prevalence of known risk factors for renal cell cancer, including cigarette smoking, obesity, and hypertension, may also be influencing the incidence trends, although their relative impact may differ in various populations,. Evidence is accumulating to suggest an etiologic role for physical activity, alcohol consumption, occupational exposure to trichloroethylene, and high parity among women, but causal conclusions are not yet supported. Genetic susceptibility and its interaction with environmental exposures are believed to influence renal cell cancer risk, but limited studies based on candidate gene approaches have not produced conclusive results. Large consortium efforts employing genome-wide scanning technology are underway, which hold promise for novel discoveries in renal carcinogenesis.
PMCID: PMC3012455  PMID: 20448658
23.  Sporadic childhood Burkitt lymphoma incidence in the United States during 1992–2005 
Pediatric blood & cancer  2009;53(3):366-370.
The risk factors and co-factors for sporadic childhood BL are unknown. We investigated demographic and age-specific characteristics of childhood BL (0–14 years) in the U.S.
BL age-standardized incidence rates (2000 U.S. standard population), were calculated using data obtained from 12 registries in the NCI’s Surveillance, Epidemiology, and End Results program for cases diagnosed from 1992 through 2005. Incidence rate ratios and 95% confidence intervals (95% CI) were calculated by gender, age-group, race, ethnicity, calendar-year period, and registry.
Of 296 cases identified, 56% were diagnosed in lymph nodes, 21% in abdominal organs, not including retroperitoneal lymph nodes, 14% were Burkitt cell leukemia, and 9% on face/head structures. The male-to-female case ratio was highest for facial/head tumors (25:1) and lowest for Burkitt cell leukemia (1.6:1). BL incidence rate was 2.5 (95% CI 2.3–2.8) cases per million person-years and was higher among boys than girls (3.9 vs. 1.1, p<0.001) and higher among Whites and Asians/Pacific Islanders than among Blacks (2.8 and 2.9 vs.1.2, respectively, p<0.001). By ethnicity, BL incidence was higher among non-Hispanic Whites than Hispanic Whites (3.2 vs. 2.0, p=0.002). Age-specific incidence rate for BL peaked by age 3–5 years (3.4 cases per million), then stabilized or declined with increasing age, but it did not vary with calendar-year or registry area.
Our results indicate that early childhood exposures, male-sex, and White race may be risk factors for sporadic childhood BL in the United States.
PMCID: PMC2713377  PMID: 19434731
epidemiology; pediatric cancer; non-Hodgkin lymphoma; HIV/AIDS
24.  Stomach carcinoma incidence patterns in the United States by histologic type and anatomic site 
Using data from the U.S. National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program, we analyzed stomach carcinoma incidence patterns by both histologic type and anatomic site.
We calculated age-adjusted (2000 U.S. standard) rates for 1978–2005 and for five time periods from 1978–1983 through 2001–2005 according to histologic type and anatomic site separately and jointly. We also analyzed rates by race, gender, and age group.
During 1978–2005, more than 54,000 stomach carcinoma cases were diagnosed among residents of the nine SEER areas. Total stomach carcinoma rates declined 34% from 1978–1983 to 2001–2005. By histologic type, intestinal rates decreased consistently while those for diffuse rose through 2000 and declined in recent years. By anatomic site, cardia rates increased during the earlier years and then decreased, while rates for all other sites declined. When considered jointly by histologic type and anatomic site, intestinal carcinoma rates decreased for all sites except the cardia; diffuse rates increased through 2000 and decreased in recent years for all sites except overlapping/non-specified sites Both diffuse and intestinal rates were lowest among whites, intermediate among blacks, and highest among the other, primarily Asian, races, with only modest gender differences for the diffuse type. In contrast, cardia carcinoma rates were highest among whites and were notably higher among males, especially whites among whom the male/female rate ratio was five.
Stomach carcinoma incidence patterns differ by histologic type, anatomic site, race, gender, and age, suggesting etiologic heterogeneity to be pursued in future research.
PMCID: PMC2786772  PMID: 19531677
stomach cancer; intestinal type carcinoma; diffuse carcinoma; gastric cardia; incidence
25.  Cancer Incidence in the U.S. Military Population: Comparison with Rates from the SEER Program 
The U.S. active-duty military population may differ from the U.S. general population in its exposure to cancer risk factors and access to medical care. Yet, it is not known if cancer incidence rates differ between these two populations. We therefore compared the incidence of four cancers common in U.S. adults (lung, colorectum, prostate, and breast cancers) and two cancers more common in U.S. young adults (testicular and cervical cancers) in the military and general populations. Data from the Department of Defense's Automated Central Tumor Registry (ACTUR) and the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) nine cancer registries for the years 1990-2004 for persons aged 20-59 years were analyzed. Incidence rates were significantly lower in the military population for colorectal cancer in white men, lung cancer in white and black men and white women, and cervical cancer in black women. In contrast, incidence rates of breast and prostate cancers were significantly higher in the military among both whites and blacks. Incidence rates of testicular cancer did not differ between ACTUR and SEER. Although the numbers of diagnoses among military personnel were relatively small for temporal trend analysis, we found a more prominent increase in prostate cancer in ACTUR than in SEER. Overall, these results suggest that cancer patterns may differ between military and non-military populations. Further studies are needed to confirm these findings and explore contributing factors.
PMCID: PMC2780333  PMID: 19505907
Active duty; cancer; incidence; military; SEER

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