Atlanta, GA, United States
Atlanta, GA, United States

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Edwards B.K.,U.S. National Cancer Institute | Noone A.-M.,U.S. National Cancer Institute | Mariotto A.B.,U.S. National Cancer Institute | Simard E.P.,Surveillance Research Program | And 8 more authors.
Cancer | Year: 2014

BACKGROUND The American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR) collaborate annually to provide updates on cancer incidence and death rates and trends in these outcomes for the United States. This year's report includes the prevalence of comorbidity at the time of first cancer diagnosis among patients with lung, colorectal, breast, or prostate cancer and survival among cancer patients based on comorbidity level. METHODS Data on cancer incidence were obtained from the NCI, the CDC, and the NAACCR; and data on mortality were obtained from the CDC. Long-term (1975/1992-2010) and short-term (2001-2010) trends in age-adjusted incidence and death rates for all cancers combined and for the leading cancers among men and women were examined by joinpoint analysis. Through linkage with Medicare claims, the prevalence of comorbidity among cancer patients who were diagnosed between 1992 through 2005 residing in 11 Surveillance, Epidemiology, and End Results (SEER) areas were estimated and compared with the prevalence in a 5% random sample of cancer-free Medicare beneficiaries. Among cancer patients, survival and the probabilities of dying of their cancer and of other causes by comorbidity level, age, and stage were calculated. RESULTS Death rates continued to decline for all cancers combined for men and women of all major racial and ethnic groups and for most major cancer sites; rates for both sexes combined decreased by 1.5% per year from 2001 through 2010. Overall incidence rates decreased in men and stabilized in women. The prevalence of comorbidity was similar among cancer-free Medicare beneficiaries (31.8%), breast cancer patients (32.2%), and prostate cancer patients (30.5%); highest among lung cancer patients (52.9%); and intermediate among colorectal cancer patients (40.7%). Among all cancer patients and especially for patients diagnosed with local and regional disease, age and comorbidity level were important influences on the probability of dying of other causes and, consequently, on overall survival. For patients diagnosed with distant disease, the probability of dying of cancer was much higher than the probability of dying of other causes, and age and comorbidity had a smaller effect on overall survival. CONCLUSIONS Cancer death rates in the United States continue to decline. Estimates of survival that include the probability of dying of cancer and other causes stratified by comorbidity level, age, and stage can provide important information to facilitate treatment decisions. Cancer 2014;120:1290-1314. © 2013 American Cancer Society. Cancer death rates in the United States continue to decline. Estimates of survival that include the probability of dying of cancer and other causes stratified by comorbidity level, age, and stage can provide important information to facilitate treatment decisions. © 2013 American Cancer Society.


Simard E.P.,U.S. National Cancer Institute | Simard E.P.,Surveillance Research Program | Shiels M.S.,U.S. National Cancer Institute | Bhatia K.,U.S. National Cancer Institute | Engels E.A.,U.S. National Cancer Institute
Cancer Epidemiology Biomarkers and Prevention | Year: 2012

Background: Highly active antiretroviral therapy (HAART) results in partial immune restoration for people with AIDS, but its impact on cancer risk among children is unknown. Methods: Data from the U.S. HIV/AIDS Cancer Match Study were used to evaluate cancer risk for people diagnosed with AIDS as children (diagnosed with AIDS at ages 0-14 years, during 1980-2007, followed for up to 10 years; N = 5,850). We calculated standardized incidence ratios (SIR) to compare cancer risk to the general population. Poisson regression evaluated changes in cancer incidence between the pre-HAART (1980-1995) and HAART eras (1996-2007). Results: There were 106 cancers observed with significantly elevated risks for the two major AIDS-defining cancers: Kaposi sarcoma [KS; N = 20, SIR = 1,694; 95% confidence interval (CI), 986-2,712 and SIR = 1,146; 95% CI, 236-3,349] during the pre-HAART and HAART eras, respectively, and non-Hodgkin lymphoma (NHL; N = 64, SIR = 338; 95% CI, 242-458 and SIR = 116; 95% CI, 74-175). Incidence of both cancers declined 87% and 60%, respectively, in the HAART era (P < 0.05). Of non-AIDS-defining cancers, leiomyosarcoma risk (N = 9) was elevated during both time periods (SIR = 863; 95% CI, 235-2,211 and SIR = 533; 95% CI, 173-1,243). Conclusion: People diagnosed with AIDS during childhood remain at elevated risk for KS, NHL, and leiomyosarcoma in the HAART era. Incidence of KS and NHL declined relative to widespread HAART use, but there was no change in the incidence of other cancers. Impact: People diagnosed with AIDS during childhood remain at elevated risk for certain cancers. Continued monitoring is warranted as this immunosuppressed population ages into adulthood where cancer risks generally increase. ©2011 AACR.


Simard E.P.,U.S. National Institutes of Health | Simard E.P.,Surveillance Research Program | Pfeiffer R.M.,U.S. National Institutes of Health | Engels E.A.,U.S. National Institutes of Health
AIDS | Year: 2012

Objective: Deaths related to HIV/AIDS have declined due to improved HIV therapies. However, people with AIDS remain at elevated risk for cancer and cancer deaths. Prior studies evaluated cancer deaths using death certificates, which may be inaccurate. We utilized population attributable risk methods (which do not rely on death certificates) to assess cancer mortality. Design: Data from a US population-based record linkage study were used to identify incident cancers and deaths in 372-364 people with AIDS (1980-2006) followed for up to 5 years after AIDS onset. We utilized Cox regression to compare mortality in individuals with and without cancer and to calculate cancer-attributable mortality across calendar periods (AIDS onset in 1980-1989, 1990-1995, and 1996-2006). Results: Mortality declined across calendar periods for all people with AIDS but remained higher among those with cancer relative to those without. During 1996-2006, among individuals with an AIDS-defining cancer (ADC) who died, 88.3% of deaths were attributable to their ADC; likewise, among individuals with a non-AIDS-defining cancer (NADC), 87.1% of deaths were attributable to their NADC. The fraction of all deaths in people with AIDS attributable to ADC (i.e. population-attributable risk) decreased significantly from 6.3% (1980-1990) to 3.9% (1996-2006), but NADC population attributable mortality increased significantly over time from 0.5% (1980-1989) to 2.3% (1996-2006). Conclusion: Among individuals with AIDS and cancer who subsequently die, most deaths are attributable to cancer. With a decline in overall mortality, the proportion of all deaths attributable to NADCs has increased. These results highlight the need for improved cancer prevention and treatment. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Jemal A.,Surveillance Research Program | Bray F.,International Agency for Research on Cancer | Forman D.,International Agency for Research on Cancer | O'Brien M.,Global Access to Pain Relief Initiative | And 3 more authors.
Cancer | Year: 2012

Cancer is an emerging public health problem in Africa. About 715,000 new cancer cases and 542,000 cancer deaths occurred in 2008 on the continent, with these numbers expected to double in the next 20 years simply because of the aging and growth of the population. Furthermore, cancers such as lung, female breast, and prostate cancers are diagnosed at much higher frequencies than in the past because of changes in lifestyle factors and detection practices associated with urbanization and economic development. Breast cancer in women and prostate cancer in men have now become the most commonly diagnosed cancers in many Sub-Saharan African countries, replacing cervical and liver cancers. In most African countries, cancer control programs and the provision of early detection and treatment services are limited despite this increasing burden. This paper reviews the current patterns of cancer in Africa and the opportunities for reducing the burden through the application of resource level interventions, including implementation of vaccinations for liver and cervical cancers, tobacco control policies for smoking-related cancers, and low-tech early detection methods for cervical cancer, as well as pain relief at the palliative stage of cancer. Cancer 2012. © 2012 American Cancer Society.


Ma J.,Surveillance Research Program | Flanders W.D.,Emory University | Ward E.M.,Surveillance Research Program | Jemal A.,Surveillance Research Program
American Journal of Epidemiology | Year: 2011

Knowledge of the association between body mass index (weight (kg)/height (m) 2) and premature death in young adulthood is very limited, especially for specific causes of death. Using the US National Health Interview Survey linked mortality files, the authors examined the relation between body mass index and premature death from all causes, cardiovascular disease (CVD), and cancer among 112,328 persons aged 18-39 years who participated in the National Health Interview Survey in the years 1987, 1988, and 1990-1995. During an average of 16 years of follow-up (ending on December 31, 2006), there were 3,178 deaths: 573 from CVD and 733 from cancer. Hazard ratios and 95% confidence intervals were estimated using multivariate proportional hazards models adjusting for age, gender, race/ethnicity, education, and smoking status. In analyses restricted to participants who had never smoked, the hazard ratios for death from all causes were 1.07 (95% confidence interval (CI): 0.91, 1.26) for overweight participants, 1.41 (95% CI: 1.16, 1.73) for obese participants, and 2.46 (95% CI: 1.91, 3.16) for extremely obese participants, compared with those of normal weight. Monotonically increasing risks for excess body weight were also observed for deaths from cancer and CVD. The associations found in this young cohort were much stronger than those in middle-aged or older populations. © 2011 The Author.


Simard E.P.,Surveillance Research Program | Naishadham D.,Surveillance Research Program | Saslow D.,American Cancer Society | Jemal A.,Surveillance Research Program
Gynecologic Oncology | Year: 2012

Background: Although overall cervical cancer incidence rates have decreased in both black and white women in the U.S. since the mid 1950s due to widespread screening, rates continue to be higher among blacks than among whites. However, whether this pattern differs by age is unknown. Methods: Cervical cancer cases (1975-2009, N = 36,503) were obtained from nine Surveillance, Epidemiology, and End Results (SEER) Program registries. Age-standardized incidence rates for white and black women were calculated from 1975-1979 through 2005-2009 by age group (< 50, 50-64, and ≥ 65 years). Rate ratios (RRs) and 95% confidence intervals (CIs) evaluated differences in rates for blacks vs. whites by age group and stage at diagnosis during 1975-1979 and 2005-2009. Results: Among women aged < 50 years, the black-to-white disparity RR decreased from nearly two-fold (RR, 1.9; 95% CI, 1.7-2.1) during 1975-1979 to unity during 2005-2009 (RR, 0.9; 95% CI, 0.8-1.0). In contrast, rates remained significantly elevated for blacks vs. whites aged 50-64 years (RR, 2.4; 95% CI, 2.1-2.7 and 1.7; 95% CI, 1.5-2.0), and for those aged ≥ 65 years (RR, 3.3; 95% CI, 2.9-3.8 and 2.2; 95% CI, 1.9-2.7) during both time periods, although the disparities decreased over time. Similar disparities persisted for older black women with cervical cancer of all stages. Conclusion: Disparities in cervical cancer incidence rates were eliminated for younger blacks vs. whites but persisted for blacks aged 50 years and older. Additional strategies are needed to increase follow-up and treatment of precancerous lesions among middle-aged and older black women. © 2012 Elsevier Inc. All rights reserved.


Arnold M.,International Agency for Research on Cancer | Sierra M.S.,International Agency for Research on Cancer | Laversanne M.,International Agency for Research on Cancer | Soerjomataram I.,International Agency for Research on Cancer | And 2 more authors.
Gut | Year: 2016

Objective The global burden of colorectal cancer (CRC) is expected to increase by 60% to more than 2.2 million new cases and 1.1 million deaths by 2030. In this study, we aim to describe the recent CRC incidence and mortality patterns and trends linking the findings to the prospects of reducing the burden through cancer prevention and care. Design Estimates of sex-specific CRC incidence and mortality rates in 2012 were extracted from the GLOBOCAN database. Temporal patterns were assessed for 37 countries using data from Cancer Incidence in Five Continents (CI5) volumes I-X and the WHO mortality database. Trends were assessed via the annual percentage change using joinpoint regression and discussed in relation to human development levels. Results CRC incidence and mortality rates vary up to 10-fold worldwide, with distinct gradients across human development levels, pointing towards widening disparities and an increasing burden in countries in transition. Generally, CRC incidence and mortality rates are still rising rapidly in many low-income and middleincome countries; stabilising or decreasing trends tend to be seen in highly developed countries where rates remain among the highest in the world. Conclusions Patterns and trends in CRC incidence and mortality correlate with present human development levels and their incremental changes might reflect the adoption of more western lifestyles. Targeted resourcedependent interventions, including primary prevention in low-income, supplemented with early detection in highincome settings, are needed to reduce the number of patients with CRC in future decades. © 2016 BMJ Publishing Group Ltd & British Society of Gastroenterology.


Ma J.,Surveillance Research Program | Ward E.M.,American Cancer Society | Smith R.,American Cancer Society | Jemal A.,Surveillance Research Program
Cancer | Year: 2013

BACKGROUND: The National Lung Screening Trial (NLST), which was conducted between 2002 and 2009, demonstrated that screening with low-dose computed tomography (LDCT) reduced lung cancer mortality by 20% among screening-eligible populations compared with chest x-ray. In this article, the authors provide an estimate of the annual number of lung cancer deaths that can be averted by screening, assuming the screening regimens adopted in the NLST are fully implemented in the United States. METHODS: The annual number of lung cancer deaths that can be averted by screening was estimated as a product of the screening effect, the US population size (obtained from the 2010 US Census data), the prevalence of screening eligibility (estimated using the 2010 National Health Interview Survey [NHIS] data), and the lung cancer mortality rates among screening-eligible populations (estimated using the NHIS data from 2000-2004 and the third National Health and Nutrition Examination Survey linked mortality files). Analyses were performed separately by sex, age, and smoking status, with Poisson regression analysis used for mortality rate estimation. Uncertainty of the estimates of the number of avertable lung cancer deaths was quantified by simulation. RESULTS: Approximately 8.6 million Americans (95% confidence interval [95% CI], 8.0 million-9.2 million), including 5.2 million men (95% CI, 4.8 million-5.7 million) and 3.4 million women (95% CI, 3.0 million -3.8 million), were eligible for lung cancer screening in 2010. If the screening regimen adopted in the NLST was fully implemented among these screening-eligible US populations, a total of 12,250 (95% CI, 10,170-15,671) lung cancer deaths (8990 deaths in men and 3260 deaths in women) would be averted each year. CONCLUSIONS: The data from the current study indicate that LDCT screening could potentially avert approximately 12,000 lung cancer deaths per year in the United States. Further studies are needed to estimate the number of avertable lung cancer deaths and the cost-effectiveness of LDCT screening under different scenarios of risk, various screening frequencies, and various screening uptake rates. (See editorial on pages 000-000, this issue.) Cancer 2013. © 2012 American Cancer Society. In 2010, approximately 8.6 million Americans were eligible for low-dose computed tomography (LDCT) screening for lung cancer according to the criteria used in the National Lung Screening Trial (NLST). Approximately 12,000 lung cancer deaths could potentially be averted in the United States each year if LDCT screening is fully implemented among the entire screening-eligible population following the screening protocol and regimens adopted in the NLST. Copyright © 2012 American Cancer Society.


Bandi P.,Surveillance Research Program | Cokkinides V.,Surveillance Research Program | Smith R.A.,American Cancer Society | Jemal A.,Surveillance Research Program
Cancer | Year: 2012

BACKGROUND: National surveys have reported declines in rates of home-based fecal occult blood test (FOBT) screening for colorectal cancer (CRC) in the last decade. However, socioeconomic status (SES) and racial/ethnic differences in FOBT trends and their changes relative to endoscopic CRC screening have not been evaluated. METHODS: Data on adults ages 50 to 64 years from the 2000, 2005, and 2008 National Health Interview Surveys were used. Weighted analyses and multivariate logistic regression were used to study trends in the use of FOBT and endoscopic CRC screening during this period. RESULTS: Between 2000 and 2008, significant declines in FOBT prevalence occurred in higher SES groups, but not in lower SES groups (uninsured and publicly insured, those without a usual source of care, lower educated, lower income, and immigrants to the United States) or Hispanics. Endoscopic CRC screening during the period studied consistently increased in all higher SES subgroups. In contrast, few lower SES subgroups (publicly insured, lower educated, near poor individuals, long-term immigrants) and Hispanics experienced increases in CRC endoscopic screening, and these increases were smaller than those observed in higher SES subgroups. CONCLUSIONS: Socially and economically disadvantaged groups experienced little or no change in FOBT prevalence, and few of these groups experienced contemporaneous increases in CRC endoscopic screening. These trends suggest the continued availability and acceptance of FOBT in these groups. If national CRC screening goals are to be achieved in populations with lower access to colonoscopy, then annual high-sensitivity FOBT should be promoted as an immediately accessible and viable alternative. Copyright © 2012 American Cancer Society.


Simard E.P.,Surveillance Research Program | Fedewa S.,Health Services Research Program | Ma J.,Surveillance Research Program | Siegel R.,Surveillance Research Program | Jemal A.,Surveillance Research Program
Cancer | Year: 2012

BACKGROUND: Despite substantial declines in cervical cancer mortality because of widespread screening, socioeconomic status (SES) disparities persist. The authors examined trends in cervical cancer mortality rates and the risk of late-stage diagnoses by SES. METHODS: Using data from the National Vital Statistics System, trends in age-standardized mortality rates among women ages 25 to 64 years (1993-2007) by education level (≤12 years, 13-15 years, and a;circyen&16 years) and race/ethnicity for non-Hispanic white (NHW) women and non-Hispanic black (NHB) women in 26 states were assessed using log-linear regression. Rate ratios (RRs) and 95% confidence intervals (CIs) were used to assess disparities between those with a;circ12 years versus ≤16 years of education during 1993 to 1995 and 2005 to 2007. Avertable deaths were calculated by applying mortality rates from the most educated women to others in 48 states. Trends in the risk of late-stage diagnosis by race/ethnicity and insurance status were evaluated in the National Cancer Data Base. RESULTS: Declines in mortality were steepest for those with the highest education levels (3.2% per year among NHW women and 6.8% per year among NHB women). Consequently, the education disparity widened between the periods 1993 to 1995 and 2005 to 2007 from 3.1 (95% CI, 2.4-3.9) to 4.4 (95% CI, 3.5-5.6) for NHW women and from 3.8 (95% CI, 2.0-7.0) to 5.6 (95% CI, 3.1-10.0) for NHB women. The risk of late-stage diagnosis increased for uninsured versus privately insured women over time. During 2007, 74% of cervical cancer deaths in the United States may have been averted by eliminating SES disparities. CONCLUSIONS: SES disparities in cervical cancer mortality and the risk of late-stage diagnosis increased over time. Most deaths in 2007 may have been averted by eliminating SES disparities. Copyright © 2012 American Cancer Society.

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