Annual Age-adjusted Incidence Rates Research Articles

Trends in the Incidence of Early-Onset Colorectal Adenocarcinoma Among Black and White US Residents Aged 40 to 49 Years, 2000-2017

Early-onset colorectal cancer incidence rates are rising faster in White individuals than Black individuals. However, prior National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) racial stratification analyses used smaller SEER 13 databases, combined patients under age 50 years, did not stratify by sex, and did not focus on adenocarcinoma histologic subtypes (screening target). To perform a race- and sex-stratified adenocarcinoma incidence rate analysis in individuals aged 40 to 49 years using larger SEER 18 databases with expanded race data to better understand the colorectal cancer burden in those at or approaching screening age. This cross-sectional study used 2000 to 2017 SEER 18 annual age-adjusted colorectal cancer incidence rates stratified by anatomic subsite (colon or rectum), adenocarcinoma histology, race (non-Hispanic Black or non-Hispanic White), and sex for individuals aged 40 to 49 years, and yearly annual percent change (APC) incidence rates were calculated. Annual rate ratios (ARRs) between subgroups were determined. Statistical analysis was performed from January to March 2021. Early-onset colorectal cancer incidence rates, APCs, and ARRs. In this study, a total of 46 728 colorectal cancer cases were identified in 45 429 patients aged 40 to 49 years from 2000 to 2017. Among the 45 429 patients included in this study, 6480 (14.2%) were Black and 27 426 (60.4%) were White; the mean (SD) age was 45.5 (2.8) years. Among White individuals aged 40 to 49 years, colorectal adenocarcinoma incidence rates increased from 19.6 per 100 000 person-years in 2000 to 25.2 per 100 000 person-years in 2017 (APC, 1.6; 95% CI, 1.3 to 1.9). Among Black individuals aged 40 to 49 years, colorectal adenocarcinoma incidence rates were not significantly changed (26.4 per 100 000 person-years in 2000 and 25.8 per 100 000 person-years in 2017 [APC, -0.03; 95% CI, -0.5 to 0.5]). There were no significant differences in ARRs of absolute colorectal incidence rates between White and Black individuals from 2014 to 2017. Rectal-only absolute adenocarcinoma incidence rates in Black and White individuals remained similar from 2000 to 2008 but significantly diverged in 2009. As of 2017, rectal absolute incidence rates were 39% higher among White individuals than among Black individuals with increasing APC (APC, 2.2; 95% CI, 1.6 to 2.8) whereas rectal adenocarcinoma incidence rates among Black individuals were decreasing, although the APC was not statistically significant (APC, -1.4; 95% CI, -2.6 to 0.1). Absolute colonic adenocarcinoma incidence rates remained higher in Black individuals. The study subgroups with the largest divergence in APCs were rectal adenocarcinoma in White vs Black women (APC of 2.2 [95% CI, 1.6 to 2.8] vs APC of -1.7 [95% CI, -3.6 to 0.3], respectively). This study found that colorectal adenocarcinoma incidence rates in people aged 40 to 49 years were increasing among White individuals but stabilized among Black individuals with absolute incidence rates becoming equivalent. Absolute rectal adenocarcinoma incidence rates were 39% lower in Black individuals with a widening disparity in rectal cancer between White and Black women. Possible contributors include introduction of a screening threshold of age 45 years in Black individuals in 2008. Although the average-risk screening age has now shifted to age 45 years in all racial groups, these data can help motivate real-world implementation of guidelines to maximize screening rates that have historically been suboptimal in younger individuals.

Sidedness determines clinical characteristics and survival outcomes in medullary adenocarcinoma of the colon

Colon medullary adenocarcinoma (MAC) is a rare histologic subtype. Clinical presentation and cancer outcomes of MAC, compared to colon adenocarcinoma (AC), remain incompletely described. Annual age-adjusted incidence rates were computed using Surveillance, Epidemiology, and End Results (2002–2017). A cohort analysis using the National Cancer Database (2010–2016) compared patient characteristics in an unmatched dataset and prognostic characteristics in a 1:1 matched subset. Reported annual age-adjusted incidence of MAC has significantly increased, with an average annual percent change (APC) increase of 23.8% (95% CI: 19.2–28.6); concurrent AC incidence declined (APC: − 2.8, 95% CI: − 3.1 to − 2.8). Analyses of 1018 MAC and 210,784 AC unmatched patients showed that MAC patients were more often older, female, and white, with higher disease stage, poorly-differentiated tumors, right-sided laterality, and lymphovascular invasion (all p < 0.0001). Among those with known microsatellite status, instability was more prevalent among MAC than AC patients (82% vs. 24%, p < 0.0001). Multivariate analyses of the matched dataset revealed that MAC histology was not independently associated with overall survival. However, when stratifying by laterality, left-sided MAC was associated with shorter survival when compared to right-sided MAC (HR 1.66, 95% CI 1.16–2.38) and right-sided AC (HR 1.54, 95% CI 1.12–2.12). The reported incidence of MAC is increasing, in contrast to the declining incidence of AC. MAC clinical and molecular features are distinct from AC and likely account for outcome differences. Overall, left-sided MAC was associated with the shortest OS. Molecular profiling may improve treatment guidelines for MAC.

CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2014-2018.

The Central Brain Tumor Registry of the United States (CBTRUS), in collaboration with the CDC and NCI, is the largest population-based registry focused exclusively on primary brain and other central nervous system (CNS) tumors in the United States (US) and represents the entire US population. This report contains the most up-to-date population-based data on primary brain tumors available and supersedes all previous reports in terms of completeness and accuracy and is the first CBTRUS Report to provide the distribution of molecular markers for selected brain and CNS tumor histologies. All rates are age-adjusted using the 2000 US standard population and presented per 100,000 population. The average annual age-adjusted incidence rate (AAAIR) of all malignant and non-malignant brain and other CNS tumors was 24.25 (Malignant AAAIR=7.06, Non-malignant AAAIR=17.18). This overall rate was higher in females compared to males (26.95 versus 21.35) and non-Hispanics compared to Hispanics (24.68 versus 22.12). The most commonly occurring malignant brain and other CNS tumor was glioblastoma (14.3% of all tumors and 49.1% of malignant tumors), and the most common non-malignant tumor was meningioma (39% of all tumors and 54.5% of non-malignant tumors). Glioblastoma was more common in males, and meningioma was more common in females. In children and adolescents (age 0-19 years), the incidence rate of all primary brain and other CNS tumors was 6.21. An estimated 88,190 new cases of malignant and non-malignant brain and other CNS tumors are expected to be diagnosed in the US population in 2021 (25,690 malignant and 62,500 non-malignant). There were 83,029 deaths attributed to malignant brain and other CNS tumors between 2014 and 2018. This represents an average annual mortality rate of 4.43 per 100,000 and an average of 16,606 deaths per year. The five-year relative survival rate following diagnosis of a malignant brain and other CNS tumor was 66.9%, for a non-malignant brain and other CNS tumors the five-year relative survival rate was 92.1%.

Trends in Incidence and Mortality Rates of Uterine Cancer in Kentucky.

The objective of this analysis was to gauge how the incidence and mortality of uterine cancer in Kentucky have changed from 1995 through 2017. An assessment of the trends in incidence and mortality across different geographic areas and between different races was also performed. Age-adjusted annual incidence and mortality rates for uterine cancer were obtained from the Kentucky Cancer Registry. A meta-regression framework was used to assess changes in incidence and mortality rates during the time frame and to determine differences in these rates between rural versus urban counties, Appalachian versus non-Appalachian counties, and Black versus White women. The incidence of uterine cancer has significantly increased throughout the state of Kentucky since 1995. Uterine cancer incidence was 10% and 22% higher in rural and Appalachian counties, respectively, compared with urban and non-Appalachian counties (P < 0.0001) from 1995 through 2017. In contrast, urban and non-Appalachian women had higher or equivalent age-adjusted mortality from uterine cancer, compared with rural and Appalachian women, respectively. The incidence of uterine cancer was significantly higher in White women compared with Black women from 1995 through 2006, but since 2007, there has been no significant difference in uterine cancer incidence based on race. Black women had higher age-adjusted mortality than White women throughout the entire time period examined. The incidence of uterine cancer is higher in rural and Appalachian Kentucky, without a corresponding geographic trend in mortality. Uterine cancer mortality is significantly higher in Black women.

Secular decreasing trends in gastric cancer incidence in Taiwan: A population-based cancer registry study.

BACKGROUNDGastric cancer remains a leading cause of cancer death worldwide. In Taiwan, gastric cancer is the sixth leading cause of cancer mortality in both males and females.AIMTo evaluate secular trends in gastric cancer incidence according to age, sex, and Helicobacter pylori (H. pylori) treatment in Taiwan.METHODSIn this population-based study, we used the national Taiwan Cancer Registry database. Annual percent changes in incidence rates were used to describe secular trends in incidence rates and sex ratios of gastric cancer in Taiwan. Pearson’s product-moment correlation coefficients were used to analyze the correlation between annual age-adjusted incidence rates and the annual number of patients treated with antibiotic therapy for H. pylori infection.RESULTSThe annual percent changes showed continuously decreasing rates of gastric cancer among both males and females. However, the decreasing trends differed by sex, with an annual percent change of -2.58% in males and -2.14% in females. The age-specific incidence rates increased with age. Within the same age group, more recent time periods showed lower incidence rates than greater time periods. Similarly, the sex ratio was lower in later birth cohorts than in earlier birth cohorts. Age-adjusted incidence rates substantially decreased with increasing numbers of patients being treated with antibiotic therapy for H. pylori infection during 2005 to 2016 (r = 0.72).CONCLUSIONWe observed steadily decreasing trends with differential sex ratios in the incidence of gastric cancer in Taiwan. These results support H. pylori eradication programs in Taiwan.

Declined incidence of patients treated for vision-threatening diabetic retinopathy in South Korea: a 12-year nationwide population-based study.

To determine the age- and sex-specific annual incidence rates of patients treated for VTDR and the factors associated with increased treatment rates in patients with type 2 diabetes mellitus (T2DM) in South Korea. This was a nationwide, retrospective, 12-year, population-based study. Patients aged over 30years who were diagnosed with T2DM between 2006 and 2017 were included in this study. We evaluated the national health claims data acquired from the Korean National Health Insurance Service database. Main outcome measures were the annual incidence rates of patients treated for VTDR and the associated risk factors. The age-adjusted annual incidence rate of patients treated for VTDR significantly decreased from 10.05 per 1000 T2DM patients in 2006 to 6.11 in 2017 (β = - 0.3192, P < 0.0001). The sex-adjusted annual incidence rate also significantly decreased in both men (β = - 0.2861, P < 0.0001) and women (β = - 0.3666, P < 0.0001). Cox hazard analysis showed that factors such as insulin use, young age, chronic kidney disease and male sex were significantly associated with increased rate of treatments for VTDR. In addition, the risk was lower for rural than for metropolitan residents. Despite the increase in the number of T2DM patients in South Korea, the incidence rate of patients treated for VTDR decreases with early diagnosis and appropriate treatment. Therefore, it is important to detect and manage high-risk groups early to prevent visual impairment due to VTDR.

Abstract P085: Racism, Resilience, And Quality Of Life In Black Stroke Survivors: A Mixed-methods Cohort Study Protocol

Introduction: Annual age-adjusted incidence and death rates for stroke are significantly higher among Black Americans than among White Americans. Racism, which operates at structural, cultural and interpersonal levels, exerts significant stress on Black Americans and contributes to health disparities, including those related to stroke. Health-related quality of life (HRQoL) encompasses an individual’s self-perception of physical, mental, and social health. The combined effects of racism, stroke-related stress, and psychosocial stressors can result in negative outcomes, including poor HRQoL for Black stroke survivors. Resilience refers to maintaining relatively stable, healthy psychological and physical functioning in the aftermath of a stressful event like stroke. The purpose of this study will be to examine the effects of racism, resilience, and key psychosocial variables on Black stroke-survivor HRQoL. Hypothesis: We hypothesize racism and lower resilience will be associated with lower HRQoL. Methods: We will conduct a mixed-methods cohort study to examine the effects of racism and resilience on HRQoL of Black stroke survivors recruited from a stroke clinic in a large metropolitan area in the southeast US. Adult community-dwelling stroke survivors who self-identify as Black or African American and who have experienced a stroke event in the past 1 to 2 months will be eligible for study inclusion. Baseline quantitative data collection will occur at the initial clinic visit, with follow-up data collection at 5 to 6 months’ post-stroke. The exposure variables will be racism and resilience, and the outcome variable will be physical, mental, and social HRQoL. Qualitative data will be collected via focus groups. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines will be followed to report study results. Results: Power calculations for a two-tailed linear regression analysis with α ≤ .05, β .80, and an effect size of .15 (medium) resulted in a required sample size of 68. Our targeted sample size of 82 participants (41 males and 41 females) accounts for an attrition rate of 20%. The statistical approach to test the direct effects of each exposure variable on HRQoL will be multiple-level models. An interaction term for resilience will be included in the racism model. Qualitative data will be audio recorded, transcribed, and analyzed for themes regarding racism and resilience. Conclusions: Studies of the effects of racism on outcomes for Black stroke survivors are largely absent. This study will provide a first step toward identifying Black stroke survivors at risk for poor HRQoL in early stroke recovery.

Bladder Cancer Incidence and Survival in the United States and Texas Non-Latino Whites and Latinos

BACKGROUND: Bladder cancer (BC) poses an enormous burden on health care systems. Latinos in Texas (TX) were underrepresented in previous studies on racial/ethnic disparity of BC in the US. OBJECTIVE: To examine whether BC incidence and survival rates differ among Latinos compared to non-Latino whites (NLW) in South TX, TX, and the US SEER. METHODS: Data was collected from the US SEER Program and the Texas Cancer Registry. Annual age-specific and age-adjusted BC incidence rates and annual 5-year relative survival were calculated. RESULTS: South TX and TX had significantly lower BC incidence rates than SEER for both Latinos and NLW regardless of gender (Ps &lt; 0.05). South TX women had worse BC survival rates than SEER women for both Latinos and NLW (Ps &lt; 0.05). TX NLW had worse BC survival rates than SEER NLW for both genders together and men only (Ps &lt; 0.05). All Latino groups had lower incidence but worse survival rates than NLW groups for both men and women in each geographic area (all Ps &lt; 0.05). Women had significantly lower BC incidence but worse survival rates than men regardless of race/ethnicity in each geographic area (all Ps &lt; 0.05). CONCLUSIONS: South TX women had lower BC incidence but worse survival rates than US SEER women for both Latinos and NLW. Latinos had worse survival but lower incidence rates than NLW. Women had lower BC incidence but worse survival rates than men. The study identifies the BC distribution and high-risk population, racial/ethnic disparities, and geographic differences. It facilitates health care services planning.

CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2013-2017.

The Central Brain Tumor Registry of the United States (CBTRUS), in collaboration with the Centers for Disease Control (CDC) and National Cancer Institute (NCI), is the largest population-based registry focused exclusively on primary brain and other central nervous system (CNS) tumors in the United States (US) and represents the entire US population. This report contains the most up-to-date population-based data on primary brain tumors (malignant and non-malignant) and supersedes all previous CBTRUS reports in terms of completeness and accuracy. All rates (incidence and mortality) are age-adjusted using the 2000 US standard population and presented per 100,000 population. The average annual age-adjusted incidence rate (AAAIR) of all malignant and non-malignant brain and other CNS tumors was 23.79 (Malignant AAAIR=7.08, non-Malignant AAAIR=16.71). This rate was higher in females compared to males (26.31 versus 21.09), Blacks compared to Whites (23.88 versus 23.83), and non-Hispanics compared to Hispanics (24.23 versus 21.48). The most commonly occurring malignant brain and other CNS tumor was glioblastoma (14.5% of all tumors), and the most common non-malignant tumor was meningioma (38.3% of all tumors). Glioblastoma was more common in males, and meningioma was more common in females. In children and adolescents (age 0-19 years), the incidence rate of all primary brain and other CNS tumors was 6.14. An estimated 83,830 new cases of malignant and non-malignant brain and other CNS tumors are expected to be diagnosed in the US in 2020 (24,970 malignant and 58,860 non-malignant). There were 81,246 deaths attributed to malignant brain and other CNS tumors between 2013 and 2017. This represents an average annual mortality rate of 4.42. The 5-year relative survival rate following diagnosis of a malignant brain and other CNS tumor was 23.5% and for a non-malignant brain and other CNS tumor was 82.4%.

Incidence of Primary Central Nervous System Tumors Among the Hispanic Population in Texas 1995-2013.

Introduction: Primary central nervous system (CNS) tumors constitute a group of rare and heterogeneous tumors. A rising incidence rate in the United States has been linked to modern changes in early diagnosis and reporting. This study aims to examine temporal incidence trends, geographic variation, and the average annual age-adjusted rates among Hispanic populations in Texas from 1995 to 2013.Methods: SEER*STAT (Surveillance Research Program, National Cancer Institute (seer.cancer.gov/seerstat) version 8.3.2) and Joinpoint Regression 4.4.0.0 (Statistical Methodology and Applications Branch, Surveillance Research Program, National Cancer Institute) software were used to analyze incidence of primary brain and CNS tumors among Texas residents. Data were obtained from the Texas Cancer Registry of the Texas Department of State Health Services.Results: From the 30,122 cases of primary CNS tumors diagnosed throughout the state of Texas from 2008 to 2012, the overall average annual age-adjusted incidence rate for Hispanics and non-Hispanics combined was 25.35 per 100,000 persons. Among Hispanics, West Texas had the highest incidence trends and the highest average age-adjusted incidence rate of 27.17, followed by North Texas at 26.01 and the Panhandle at 23.63. East Texas had the lowest incidence rate of 16.23. The incidence trend among Hispanics has decreased consistently at a rate of 0.83 % from 1995 to 2013.Conclusions: The incidence of tumors was more pronounced in the Hispanic population in northern Texas compared with southern Texas. The presence of oil and gas production industries with farming and construction could play a role in the observed incidence of disease. Further studies with a focus on occupational health among Hispanics in Texas will be needed to elucidate the cause of such distribution.

Epidemiology of brain tumors in the United Arab Emirates: a National Registry Cross-sectional Study

BackgroundCancer is the third leading cause of death in the United Arab Emirates (UAE); brain cancer ranks 10th among the cancers, with 2.9% of the primary cancers originating from the nervous system. The epidemiology of brain cancers has not been explored. The unique population dynamics of UAE make it a fertile ground for analyzing the epidemiology of brain cancer. In this study, we aim to look at the frequency patterns and distribution of malignant primary brain tumors in the UAE.MethodsA cross sectional study was carried out using data obtained from the Tawam Hospital Cancer Registry for the years 1984–2017. The sample size included 756 diagnosed cases of malignant primary brain tumors in the UAE. Using SPSS and Excel software, frequencies, mean ages, histological type frequencies, average annual crude incidence rates and average annual age adjusted incidence rates were analyzed.ResultsThe expatriate population had higher percentage of brain tumors (72%) than the locals. The mean age at diagnosis was 33.48 years (± 21.14 years) with a male to female ratio of 1.69. Diffuse astrocytic and oligodendroglial tumors were the most commonly diagnosed tumors overall. Older adults had more cases of lymphoma while embryonal and ependymal tumors were most commonly seen in younger age groups. The overall average annual crude incidence rate for 2013–2016 for all primary brain tumors was 0.56 per 100,000 population.ConclusionThis is the first cancer registry study in the UAE that describes histological types of primary brain tumors based on the WHO 2016 classification of brain tumors and highlights their incidence rates. Through this study, several patterns of incidence trends for brain tumors in the UAE, according to histological types, sex and age groups have been recognized. Comparative studies would help identify the influence of potential changes in lifestyle, environmental or occupational risk factors on primary brain tumors.

Abstract D111: Incidence and survival patterns of gastroenteropancreatic neuroendocrine neoplasms in California

Abstract Background. Neuroendocrine neoplasms (NEN) are a heterogeneous group of rare tumors. There is a paucity of epidemiologic data regarding risk factors. We aimed to characterize the burden of NEN in California with its diverse racial/ethnic populations. Methods Using California Cancer Registry, we identified all newly diagnosed NEN from gastroenteropancreatic (GEP) sites 1992-2015. Annual age-adjusted incidence rates (AIR) per 100,000 person-years were compared, and average annual percent change (APC) in rates were compared according to sex, race-ethnicity (non-Hispanic (NH) white, NH black, Asian/Pacific Islander, American Indian, Hispanic), primary tumor site (stomach, small intestine, colon or rectum, appendix, pancreas), stage, and type of county of residence (urban, suburban, rural) using incidence rate ratios (IRR). Overall survival from diagnosis to death by any cause was estimated by Kaplan-Meier method and compared using log-rank tests. Results There were 23,983 GEP NEN incident cases and 9,910 deaths 1992-2015. All AIRs increased over the 24 years, with the greatest increase in Hispanics with pancreatic NEN (APC 8.9). Rates for the period 2011-2015 varied according to primary tumor site: colorectal (AIR 1.41); small intestinal (AIR 0.97); pancreatic (AIR 0.92); stomach (AIR 0.44); and appendiceal (AIR 0.36). Comparing rates by populations the greatest disparities were for NH blacks vs. Asians with small intestinal NEN (IRR 7.01 95% confidence interval (CI) [5.37-9.21]) or appendiceal NEN (IRR 3.74 95% CI [2.34-6.08]), for NH whites vs. Asians with small intestinal NEN (IRR 4.34 95% CI [3.44-5.53]) or appendiceal NEN (IRR 5.10 95% CI [3.54-7.59]), for NH blacks vs. NH whites with colorectal NEN (IRR 2.59 95% CI [2.27-2.94]), and for NH whites vs. Hispanics with appendiceal NEN (IRR 2.54 95% CI [2.08-3.12]). Statistically significantly longer survival estimates were observed in women (median 13.1 years) vs. men (11.6 years), and in Asians/Pacific Islanders (20.7 years) and Hispanics (16.7 years) vs. NH blacks (12.3 years) and NH whites (9.6 years). No significant survival differences were detected across county types. Survival estimates were significantly different across primary tumor sites: colorectal (median 19.9 years); appendiceal (16.0 years); small intestinal (10.1 years); stomach (9.7 years); and pancreatic (4.4 years). Conclusions Incidence rates of GEP NEN in California steadily increase from 1992 through 2015 for all populations. Recent AIRs for particular race-ethnicities and primary tumor sites are more than double others, exposing large disparities. Survival estimates differ significantly by primary tumor site, sex, race-ethnicity, and stage, but not by county. These findings show some higher incidence rates and longer survival than in previously published estimates nationwide and add information about GEP NEN in Hispanic and Asian/Pacific Islander populations in California. Additional research is needed to clarify reasons for the disparities. Citation Format: Alan Paciorek, Brandon Shih, Meg McKinley, Iona Cheng, Li Zhang, Claire Mulvey, Ann Griffin, Eric Nakakura, Quan-Yang Duh, Insoo Suh, Katherine Van Loon, Emily Bergsland. Incidence and survival patterns of gastroenteropancreatic neuroendocrine neoplasms in California [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D111.

Trends in gender-based disparity in incidence, mortality and survival for major digestive disease cancers in the U.S. (2000-2016).

e13621 Background: Males have excess risk of most digestive cancers; whether cancer mainly due to virus (stomach), lifestyle including obesity/alcohol (colon/esophagus), or both (liver). We evaluated for secular trends in gender-specific incidence, mortality and survival for these cancers in the U.S. Methods: We used official U.S. Cancer Statistics [USCS] data (2000-2016) to calculate annual age-adjusted incidence and mortality rates (IR/MR). It covers &gt;98% population/all states (vs. SEER-10 statewide registries, covers &lt;1/3rd African-Americans/Whites). We calculated mortality-to-incidence rate ratios (MIR), an established 5-year survival proxy. We used Joinpoint to assess trends in average annual percentage change (AAPC). Results: Table shows age-adjusted IRs and MRs for colon, esophagus and stomach cancer decreased for men and women (all AAPCs negative, all significant but stomach IR women), with both liver IR/MR significantly increasing in both genders. Gender differences in relative burden were seen (e.g., MRs in colon&gt;esophagus&gt;liver&gt;stomach in men vs. colon&gt;stomach&gt;liver&gt;esophagus in women), with greatest male excess in esophagus (e.g., 4.4-fold IR). MIRs suggested less favorable survival (higher=worse) for men for esophagus/colon. Conclusion: Substantial gender disparity persists in digestive cancers, with male excess gap decreasing for colon and increasing for liver. [Table: see text]

Prion disease incidence in the United States: 2003-2015.

To report the incidence of prion disease in the United States. Prion disease decedents were retrospectively identified from the US national multiple cause-of-death data for 2003-2015 and matched with decedents in the National Prion Disease Pathology Surveillance Center (NPDPSC) database through comparison of demographic variables. NPDPSC decedents with neuropathologic or genetic test results positive for prion disease for whom no match was found in the multiple cause-of-death data were added as cases for incidence calculations; those with cause-of-death data indicating prion disease but with negative neuropathology results were removed. Age-specific and age-adjusted average annual incidence rates were then calculated. A total of 5,212 decedents were identified as having prion disease, for an age-adjusted average annual incidence of 1.2 cases per million population (range 1.0 per million [2004 and 2006] to 1.4 per million [2013]). The median age at death was 67 years. Ten decedents were <30 years of age (average annual incidence of 6.2 per billion); only 2 of these very young cases were sporadic forms of prion disease. Average annual incidence among those ≥65 years of age was 5.9 per million. Prion disease incidence can be estimated by augmenting mortality data with the results of neuropathologic and genetic testing. Cases <30 years of age were extremely rare, and most could be attributed to exogenous factors or the presence of a genetic mutation. Continued vigilance for prion diseases in all age groups remains prudent.

CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2012-2016.

The Central Brain Tumor Registry of the United States (CBTRUS), in collaboration with the Centers for Disease Control and Prevention and National Cancer Institute, is the largest population-based registry focused exclusively on primary brain and other central nervous system (CNS) tumors in the United States (US) and represents the entire US population. This report contains the most up-to-date population-based data on primary brain tumors available and supersedes all previous reports in terms of completeness and accuracy. All rates are age-adjusted using the 2000 US standard population and presented per 100,000 population. The average annual age-adjusted incidence rate (AAAIR) of all malignant and non-malignant brain and other CNS tumors was 23.41 (Malignant AAAIR = 7.08, non-Malignant AAAIR = 16.33). This rate was higher in females compared to males (25.84 versus 20.82), Whites compared to Blacks (23.50 versus 23.34), and non-Hispanics compared to Hispanics (23.84 versus 21.28). The most commonly occurring malignant brain and other CNS tumor was glioblastoma (14.6% of all tumors), and the most common non-malignant tumor was meningioma (37.6% of all tumors). Glioblastoma was more common in males, and meningioma was more common in females. In children and adolescents (age 0-19 years), the incidence rate of all primary brain and other CNS tumors was 6.06. An estimated 86,010 new cases of malignant and non-malignant brain and other CNS tumors are expected to be diagnosed in the US in 2019 (25,510 malignant and 60,490 non-malignant). There were 79,718 deaths attributed to malignant brain and other CNS tumors between 2012 and 2016. This represents an average annual mortality rate of 4.42. The five-year relative survival rate following diagnosis of a malignant brain and other CNS tumor was 35.8%, and the five-year relative survival rate following diagnosis of a non-malignant brain and other CNS tumors was 91.5%.

Abstract 628: Smoking and risk of colorectal cancer by sex and histological subsites: the Multiethnic Cohort (MEC) study

Abstract Background. Smoking is an established risk factor for colorectal cancer (CRC). The purpose of this study was to examine if the increased risk of CRC due to cigarette smoking differ by sex and tumor subsite in the Multiethnic Cohort (MEC). Methods: We analyzed data from 188,052 participants (45% men) who were enrolled in the MEC at 45-75 years of age between 1993 and 1996. We identified CRC cases overall and by anatomic subsite (proximal, distal and rectal) via linkage to the Hawaii and California Surveillance, Epidemiology, and End Results Program cancer registries through December 2013. We used Cox proportional hazards regressions to estimate multivariable-adjusted hazard ratios (HR) with 95% confidence intervals (CI). Results: During a mean follow-up of 16.7 ± 5.2 years, we identified 4,879 incident cases of invasive colorectal adenocarcinoma. For men and women, the annual age-adjusted incidence rate was 126.4 and 91.8 per 100,000 person-years (truncated to ages 45-85), respectively. Men had a higher incidence rate than women for all three subsites of CRC. Men had a larger proportion of rectal and a lower proportion of proximal colon cancer than women.Altogether, 70% of the men and 44% of women reported to be ever smokers. Men compared with women ever smokers, had smoked for more years, smoked more cigarettes per day and consequently had smoked more pack-years. . For both men and women, age at diagnosis was lower for ever compared with never smokers. Among men, compared with never smokers, ever smokers had a 38% (HR=1.38; 95% CI: 1.15-1.65) higher risk of distal, but not of proximal (HR=1.03; 95% CI: 0.90-1.18) colon cancer. The corresponding figures for women were a 21% (HR=1.21; 95% CI: 1.07-1.37) higher risk of proximal, but not of distal (HR= 0.97; 95% CI: 0.81-1.16) colon cancer. We observed a direct association for the three (duration, number of cigarettes per day and number of pack-years) measures of smoking exposure with proximal (all Ptrend &amp;lt; 0.001) colon cancer for women and with distal (all Ptrend &amp;lt; 0.001) colon cancer for men. Male ever smokers had a 40% (HR=1.40; 95% CI: 1.16-1.69) and female ever smokers a 58% (HR=1.58; 95% CI: 1.28-1.95) higher risk of rectal cancer compared with sex specific never smokers. Heavy smokers i.e. those who had smoked &amp;gt;20 pack-years had a 61% (HR =1.61; 95% CI: 1.29-2.00) higher risk of rectal cancer for men and a doubling in risk for women (HR= 2.09; 95% CI: 1.54-2.83) compared with sex specific never smokers (Pheterogeneity by sex = 0.03). Conclusions: Our main findings shows that the smoking related colorectal cancer risk varies by sex for the subsites of colon cancer, and possibly also for rectal cancer. Citation Format: Inger T. Gram, Song-Yi Park, Lynne R. Wilkens, Christopher A. Haiman, Loïc Le Marchand. Smoking and risk of colorectal cancer by sex and histological subsites: the Multiethnic Cohort (MEC) study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 628.

Abstract LB-170: Breast cancer incidence and hormone therapy use before and after the Women’s Health Initiative (WHI) estrogen (E) plus progestin (P) trial by race/ethnicity

Abstract We examined breast cancer incidence in US women, 50 years or older, from the Surveillance, Epidemiology and End Results (SEER) program through 2015 in relation to estrogen (E) plus progestin (P) and E alone use before and after 2002, when adverse E plus P breast cancer effects in the WHI trial were initially reported. Age-adjusted annual breast cancer incidence rates for all US women averaged over the five-year intervals of 1983-1987, 1988-1992, 1993-1997, 1998-2002, 2003-2007, 2008-2012, 2013-2015 (3 year interval) were 330, 358, 368, 387, 345, 352 and 357 breast cancers per 100,000 women. After early quinquennial-to-quinquennial interval increases in breast cancer incidence, the surprising and sustained reduction in breast cancer incidence rates seen beginning in 2003 (Ravdin et al NEJM 2007) has been largely attributed to the substantial (70%) reduction in E plus P use over the same period (Jewett et al Obstet Gynecol 2014). However, differences in breast cancer incidence trends by race/ethnicity have emerged. Over the same quinquennial intervals, among White women, there were 343, 374, 383, 407, 359, 362 and 367 breast cancers per 100,000 women, following the same pattern of increases followed by sustained decrease beginning in 2003. In contrast, Black women experienced no substantial reduction in breast cancer incidence after 2003 with subsequent sustained increases through 2015 with quinquennial intervals rates of 277, 302, 327, 329, 328, 350, 356 breast cancers per 100,000 women with most recent incidence rates now comparable to White women. Based on reported findings of the WHI hormone therapy clinical trials and the sustained reduction seen in the US for both E plus P and E alone use (the latter for women with prior hysterectomy), we propose a hypothesis that the discordant trends in breast cancer incidence between White and Black women can largely be explained by the sustained changes in hormone therapy use beginning in 2003. In the WHI randomized trials, E plus P and E alone had opposite effects on breast cancer risk, E plus P initiation increasing breast cancer risk, further increasing with duration, with increased risk sustained for over a decade following cessation, and E alone decreasing risk at initiation and cessation (Chlebowski et al JAMA Oncology 2015). In 2003, E plus P use was higher in White compared to Black women. Thus, the reduction in E plus P use, cessation and decreased imitation, in White women was associated with prolonged reduction in breast cancer incidence. In contrast, with hysterectomy more common in Black women, decisions not to initiate E alone use could have increased their breast cancer risk. Thus, consideration of differential use of these two hormone regimens in Black and White women provides a plausible explanation for differential changes in breast cancer incidence seen in these two populations over recent quinquennial periods. Citation Format: Rowan T. Chlebowski, Aaron K. Aragaki, Garnet L. Anderson, Ross L. Prentice. Breast cancer incidence and hormone therapy use before and after the Women’s Health Initiative (WHI) estrogen (E) plus progestin (P) trial by race/ethnicity [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr LB-170.

Partnership for defining the impact of 12 selected rare CNS tumors: a report from the CBTRUS and the NCI-CONNECT.

Population-based cancer statistics, including histology-specific incidence, prevalence, and survival are essential to evaluating the total burden due to disease in a population. The National Cancer Institute's (NCI) Comprehensive Oncology Network Evaluating Rare CNS Tumors (NCI-CONNECT) was developed to better understand tumor biology and patient outcomes for 12 selected brain and other central nervous system (CNS) tumor histologies that are rare in adults to improve approaches to care and treatment. The aim of this study was to determine the incidence, prevalence, and survival of these selected rare histologies. Data from the Central Brain Tumor Registry of the United States (CBTRUS) from 2000 to 2014 were used to calculate average annual age-adjusted incidence rates (AAIR) per 100,000 population overall and by sex, race, ethnicity, and age. NCI's Surveillance, Epidemiology and End Results (SEER) data were used to calculate relative survival (RS) estimates. Point prevalence for 2014 was estimated using annual age-specific incidence and survival from CBTRUS and SEER, respectively. Overall AAIR was 1.47 per 100,000 for all 12 rare histologies combined, with the highest histology-specific incidence in oligodendrogliomas (AAIR = 0.40/100,000). Overall, most histologies were more common in males, adults (age 40 + ), Whites, and non-Hispanics. Ependymomas were the most prevalent histology at 4.11 per 100,000; followed by oligodendrogliomas at 3.68 per 100,000. Relative survival at 1-, 5-, and 10-years was 82.3%, 64.0%, and 55.4%, respectively for all 12 selected brain and other CNS tumor types combined. Ependymomas had the highest RS (1-year = 94.2%, 5-year = 83.9%, 10-year = 78.6%) and gliosarcomas had the lowest relative survival rate (1-year = 42.5%, 5-year = 5.6%, 10-year = 2.9%) at all three time points. Incidence and prevalence of these rare brain and other CNS tumor histologies have not been previously reported. Along with survival, these data provide a statistical foundation to understand the impact of these cancers and provide important disease-specific data for the design of prospective clinical trials.

Glioma incidence and survival variations by county-level socioeconomic measures.

Multiple studies have reported higher rates of glioma in areas with higher socioeconomic status (SES) but to the authors' knowledge have not stratified by other factors, including race/ethnicity or urban versus rural location. The authors identified the average annual age-adjusted incidence rates and calculated hazard ratios for death for gliomas of various subtypes, stratified by a county-level index for SES, race/ethnicity, US region, and rural versus urban status. Rates of glioma were highest in counties with higher SES (rate ratio, 1.18; 95% CI, 1.15-1.22 comparing the highest with the lowest quintiles [P<.001]). Stratified by race/ethnicity, higher rates in high SES counties persisted for white non-Hispanic individuals. Stratified by rural versus urban status, differences in incidence by SES were more pronounced among urban counties. Survival was higher for residents of high SES counties after adjustment for age and extent of surgical resection (hazard ratio, 0.82; 95% CI, 0.76-0.87 comparing the highest with the lowest quintile of SES [P<.001]). Survival was higher among white Hispanic, black, and Asian/Pacific Islander individuals compared with white non-Hispanic individuals, after adjustment for age, SES, and extent of surgical resection, and when restricted to those individuals with glioblastoma who received radiation and chemotherapy. The incidence of glioma was higher in US counties of high compared with low SES. These differences were most pronounced among white non-Hispanic individuals and white Hispanic individuals residing in urban areas. Better survival was observed in high SES counties, even when adjusting for extent of surgical resection, and when restricted to those who received radiation and chemotherapy for glioblastoma. Differences in incidence and survival were associated with SES and race, rather than rural versus urban status.

Integrated West Nile Virus Surveillance in Harris County, Texas, 2003 to 2018

ObjectiveThis abstract aims to: 1) describe human WNV infections in Harris County excluding the City of Houston, Texas, 2003 to 2018; 2) explore geographical distributions of WNV positive mosquito pools in relation to human cases; 3) provide a brief overview of the county’s rigorous multidisciplinary WNV surveillance and control in mosquitoes and humans.IntroductionWest Nile virus (WNV) is the leading cause of autochthonous arboviral disease in the United States1. The virus is primarily spread to people through the bite of infected Culex species of mosquitos. WNV was first identified in Harris County, Texas, in 20022. Since then, the mosquito-borne virus has become endemic in the region, with surges in 2012 and 2014. Although majority of individuals infected are asymptomatic, WNV induced neuroinvasive infections often result in hospitalizations and adverse outcomes3-7, thus may pose a significant concern in public health and healthcare. The Harris County Public Health (HCPH) Surveillance and Epidemiology Unit (SEU) conducts surveillance of WNV in humans, in collaboration with Mosquito and Vector Control Division (MVCD) that monitors the virus in mosquito populations and birds. Mosquito abatement activities are implemented in areas where positive mosquitoes and human cases are identified. In this integrated model, clusters of WNV positive mosquito pools in relation with human cases provide comprehensive surveillance data to guide targeted efforts of mosquito control, disease prevention, and community education.MethodsSurveillance data of human WNV cases and WNV tested mosquito pools 2003 to 2018 in Harris County excluding the City of Houston were used for the analysis. Human cases included were confirmed and probable cases. Frequencies, percentages, age-adjusted annual average rates were used to describe the data. Geographical locations of WNV positive mosquito pools and human cases were mapped and analyzed using ESRI ArcGIS to determine the spatial relationship between the positive mosquito pools and human cases. Space-Time analysis was performed on 16 years of human disease data using Scan statistics in SatScan™ to test the effect of time and identify significant geographical clusters of WNV cases over time, which revealed a statistically significant cluster in 2012 to 2014 in northwest of Harris County. Subsequently, human cases and WNV positive mosquito pools of 2012 to 2014 were selected for hotspot analysis to verify the results from Satscan analysis and visualize the geographical cluster. Human cases were aggregated into census tracts and analyzed by optimized hotspot method; the positive mosquito pools were geocoded using their intersection locations and analyzed by ESRI Getis-Ord Gi hotspot method.ResultsFrom 2003 to 2018, a total of 295 confirmed and probable human WNV cases were identified, including 217 neuroinvasive and 78 fever cases. The median age of patients was 58 years old; 64.8% were male. The onset of majority of the cases (80.7%) concentrated in July to September. Among case-patients, 72.9% were hospitalized, and 3.4% died. The annual average age-adjusted incidence rate of WNV was 0.7 per 100,000 during 2003 to 2018. However, the rate was 1.8 and 2.7 per 100,000 in 2012 and 2014, respectively. Over 68% of the cases clustered in west and northwest of the county.The annual WNV positive mosquito pools ranged from 0.2% to 10.2% amongst the years. The number of WNV positive mosquito pools in 2014 was more than 4 times higher than the average number during those years, the highest record in the County.Hot spots of human cases and the positive mosquito pools were both identified in northwest Harris County. There was a significant geographical overlap between human cases and the positive mosquito pools.The space-time analysis for the 16 years detected a significant high-risk cluster in 2012 to 2014 in northwest Harris County. Findings from optimized hotspot analysis on human cases are consistent with the results from SatScan analysis. Statistically significant hot spots of positive mosquito pools identified by Getis-Ord Gi hotspot analysis displayed highly overlay with the statistically significant cluster of human cases detected by Satscan space-time analysis.ConclusionsWNV infection is underestimated. Studies suggest that every one case identified represent five infections 8-9. Therefore, the actual number of cases is likely substantially higher. Clinicians should be alerted in WNV season and consider testing and reporting as early as possible, especially in neuroinvasive patients. The public should be encouraged to utilize personal protection, particularly during peak seasons. This analysis shows that GIS mapping and optimized hotspot analysis of WNV human cases in relation to positive mosquito pools can provide statistical evidences of areas most affected, thus inform targeted mosquito control, prevention and education strategies in people living in areas with high virus activitie