Automated Central Tumor Registry Research Articles

Bone Sarcoma Survival in the US Military Health System: Comparison With the SEER Program.

Access to care is associated with cancer survival. The US Military Health System (MHS) provides universal health care to all beneficiaries. However, it is unknown whether survival among patients with bone sarcoma in a health system providing universal care is better than that in the general population. The aim of the study was to compare survival of patients with bone sarcoma in the US MHS with that of the US general population. The MHS data were obtained from the Department of Defense Automated Central Tumor Registry (ACTUR). The US general population data were obtained from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registry. Adult patients were defined as those aged 25 years or older with a histologically confirmed musculoskeletal bone sarcoma diagnosed from January 1, 1987, to December 31, 2013. Kaplan-Meier survival curves and multivariable Cox proportional hazards models were used to compare the overall survival of the two populations. The final analysis included 2,273 bone sarcoma cases from ACTUR and 9,092 bone sarcoma cases from SEER. ACTUR patients had significant lower 5-year all-cause death (hazard ratio = 0.72; 95% CI, 0.66 to 0.78) after adjustment for the potential confounders. ACTUR patients with bone sarcoma also exhibited significantly lower risk of all-cause death during the entire follow-up period than the SEER patients (hazard ratio = 0.75; 95% CI, 0.6 to 0.81). MHS beneficiaries with bone sarcoma may have longer survival than SEER patients. Our findings support the role of universal access to high-quality care in improving bone sarcoma outcomes.

Abstract 4861: Incidence rates of bladder and kidney cancers among U.S. military servicemen: Comparison with the rates in the general U.S. population

Abstract Background: The military population may differ from the general population in factors related to the incidence of bladder and kidney cancers. However, incidence rates of these cancers have not been systematically compared between the two populations. This study compared incidence rates of bladder and kidney cancers and their trends between active-duty servicemen and men in the general U.S. population. Methods: Data were obtained from the Department of Defense’s (DoD) Automated Central Tumor Registry (ACTUR) and the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) database. Patients were active-duty servicemen in ACTUR and men in SEER who were diagnosed with malignant bladder and kidney cancers and 18-59 years at diagnosis from 1990-2013. Age-adjusted rates, incidence rate ratios (IRR), and their 95% confidence intervals (95% CI) were compared between the two populations by age, race, and cancer stage. Trends in the incidence were also compared. Results: Incidence rates were lower in ACTUR than SEER for bladder cancer overall (IRR=0.55, 95% CI=0.48-0.62) and by age, race, or tumor stage. However, for 50-59-year-old men, the rates did not differ between the populations. Trend analysis showed bladder cancer incidence decreased more in ACTUR than SEER over the study period. Kidney cancer incidence rates were marginally lower overall (IRR=0.92, 95% CI=0.84-1.00) and significantly lower for 30-49-year-old Black men in the military than the general population. For kidney cancer, the trends were similar between the two populations with increased incidence from 1999 to 2013. Conclusion: Lower bladder and kidney cancer incidence in ACTUR, notably in younger individuals, may be primarily associated with healthier status and better health care. The lack of differences in bladder or kidney cancer incidence among 50-59-year-old men between the populations might result from more cumulative military-related exposures in this age group, which effects were offset by healthier status and better medical care. Disclaimer: The contents of this publication are the sole responsibility of the authors and do not necessarily reflect the views, opinions or policies of NCI, USUHS, HJF, the DoD or the Departments of the Army, Navy or Air Force. Mention of trade names, commercial products or organizations does not imply endorsement by the US Government. Citation Format: Julie A. Bytnar, Katherine A. McGlynn, Sean Q. Kern, Craig D. Shriver, Kangmin Zhu. Incidence rates of bladder and kidney cancers among U.S. military servicemen: Comparison with the rates in the general U.S. population [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4861.

Incidence rates of bladder and kidney cancers among US military servicemen: comparison with the rates in the general US population.

The military population may differ from the general population in factors related to bladder and kidney cancers. However, incidence rates of these cancers have not been systematically compared between the two populations. This study compared incidence rates of bladder and kidney cancers between active-duty servicemen and men in the general US population. Data were obtained from the Department of Defense's Automated Central Tumor Registry (ACTUR) and the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) database. Included were 18-59-year-old active-duty servicemen in ACTUR and men in SEER who were diagnosed with malignant bladder and kidney cancers from 1990 to 2013. Age-adjusted rates, incidence rate ratios (IRR) and their 95% confidence intervals (95% CI) were compared between the two populations by age, race, and cancer stage. Incidence rates were lower in ACTUR than SEER for bladder cancer overall (IRR = 0.55, 95% CI, 0.48-0.62) and by age (except ages 50-59), race, and tumor stage. For ages 50-59, rates did not differ between the populations. Kidney cancer incidence rates were lower in the military for younger groups and Black men, but higher for ages 50-59. Lower bladder and kidney cancer incidence in ACTUR, notably in younger men, may be primarily associated with better health and healthcare access. The lack of differences in bladder or kidney cancer incidence among 50-59-year-old men between the populations might result from multifactorial effects, such as the possible effects of cumulative military-related exposures offset by healthier status and better medical care.

Cancer stage at diagnosis: Comparison of insurance status in SEER to the Department of Defense Cancer Registry.

Military individuals, retirees, and their families have free care or minimal out-of-pocket costs in the US military health system (MHS). In contrast, out-of-pocket costs in the US general population vary substantially. This study compared cancer patients with various insurance types in the general population to those in the MHS in cancer stage at diagnosis. Patients were identified from the US Department of Defense's (DoD) Automated Central Tumor Registry (ACTUR) and the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program. Tumor stage at diagnosis of breast, prostate, lung, and colon cancers during 2007-2013 was compared between ACTUR and SEER insurance categories of "insured," "insured-no specifics," "any Medicaid," and "uninsured," A multivariable logistic regression analysis estimated the odds ratio (OR) of late stage (Stages III and IV) versus early stage (Stages I and II) cancers comparing SEER insurance status to ACTUR. There were 18,440 eligible patients identified from ACTUR and 831,959 patients identified from SEER. For all cancer types, patients in the SEER-insured/no specifics, Medicaid, and uninsured groups had significantly greater likelihood of late stage diagnosis compared to ACTUR patients. The adjusted ORs were greatest among uninsured and Medicaid patients. The SEER-insured group also had a significantly higher odds of advanced stage disease than ACTUR patients for prostate cancer and lung cancer. Patients in the MHS with universal access to healthcare were diagnosed at an earlier stage than those in the general population. This difference was most evident compared to Medicaid and uninsured groups.

Cancer incidence in the US military: An updated analysis.

Military and general populations differ in factors related to cancer occurrence and diagnosis. This study compared incidence of colorectal, lung, prostate, testicular, breast, and cervical cancers between the US military and general US populations. Data from the US Department of Defense's Automated Central Tumor Registry (ACTUR) and the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program were analyzed. Persons in ACTUR were active-duty members 20-59 years old during 1990-013. The same criteria applied to persons in SEER. Age-adjusted incidence rates, incidence rate ratios, and 95% confidence intervals were calculated by sex, race, age, and cancer stage. Temporal trends were analyzed. ACTUR had higher rates of prostate and breast cancers, particularly in 40- to 59-year-olds. Further analyses by tumor stage showed this was primarily confined to localized stage. Incidence rates of colorectal, lung, testicular, and cervical cancers were significantly lower in ACTUR than in SEER, primarily for regional and distant tumors in men. Temporal incidence trends were generally similar overall and by stage between the populations, although distant colorectal cancer incidence tended to decrease starting in 2006 in ACTUR whereas it increased during the same period in SEER. Higher rates of breast and prostate cancers in servicemembers 40-59 years of age than in the general population may result from greater cancer screening utilization or cumulative military exposures. Lower incidence of other cancers in servicemembers may be associated with better health status.

Survival among lung cancer patients: comparison of the U.S. military health system and the surveillance, epidemiology, and end results (SEER) program by health insurance status.

The U.S. military health system (MHS) provides beneficiaries with universal health care while health care access varies in the U.S. general population by insurance status/type. We divided thepatients from the U.S. general population by insurance status/type and compared them to the MHS patients in survival. The MHS patients were identified from the Department of Defense's Automated Central Tumor Registry (ACTUR). Patients from the U.S. general population were identified from the Surveillance, Epidemiology, and End Results (SEER) program. Multivariable Cox regression analysis was conducted to compare different insurance status/type in SEER to ACTUR in overall survival. Compared to ACTUR patients with non-small cell lung cancer (NSCLC), SEER patients showed significant worse survival. The adjusted hazard ratios (HRs) were 1.08 [95% Confidence Interval (CI) = 1.03-1.13], 1.22 (95% CI = 1.16-1.28), 1.40 (95% CI = 1.33-1.47), 1.50 (95% CI = 1.41-1.59), for insured, insured/no specifics, Medicaid, and uninsured patients, respectively. The pattern was consistently observed in subgroup analysis by race, gender, age, or tumor stage. Results were similar for small cell lung cancer (SCLC), although they were only borderline significant in some subgroups. The survival advantage of patients receiving care from a universal health care system over the patients from the general population was not restricted to uninsured or Medicaid as expected, but was present cross all insurance types, including patients with private insurance. Our findings highlight the survival benefits of universal health care system to lung cancer patients.

Abstract 4208: Incidence of papillary thyroid cancer: comparison of the military with the general population by race, gender, and tumor stage/size

Abstract Background: A previous study found that the incidence of papillary thyroid cancer was higher in the US military than in the general population and the difference was larger among Black than White patients for both men and women. This study compared the military to the general population in thyroid cancer incidence by not only race and gender but also tumor stage and size to assess possible factors related to the identified differences. Methods: The study subjects were men and women aged 18-59 histologically diagnosed with papillary thyroid cancer from 1990-2013 in the military and the general population. The data were from the Department of Defense’s Automated Central Tumor Registry (ACTUR) and the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program. Age adjusted rates and incidence rate ratios (IRR) and 95% confidence intervals (95% CI) comparing ACTUR to SEER were calculated. Comparisons were made by race (Black, White), gender, cancer stage (local, regional, distant), and tumor size (0-2 cm, >2 cm). Results: Higher age-adjusted incidence rates in ACTUR than SEER were more obvious for Black (IRR=2.07, 95% CI=1.56-2.70) than White (IRR=1.17, 95% CI=1.07-1.26) men and for Black (IRR=2.30, 95% CI=1.91-2.71) than White (IRR=1.50, 95% CI=1.38-1.64) women, respectively. In further analysis by tumor stage, the difference between the two populations was observed only for localized tumors, which was larger for Blacks for both men and women. The analysis by tumor size showed that the difference between the populations existed in both 0-2 cm and >2 cm tumors, but only in Blacks among men and was larger for Blacks than Whites among women. Conclusion: The observations that a higher incidence in the military than the general population primarily existed in localized tumors suggest that universal care in the military may lead to earlier detection of the cancer. The larger differences for Blacks than Whites suggest that such impact may be larger for Blacks, who are less likely to have timely care in the general population. Nevertheless, the observed differences between the populations for tumors larger than 2cm suggest that other factors may also play a role. Disclaimer: The contents of this publication are the sole responsibility of the authors and do not necessarily reflect the views, opinions or policies of NCI, USUHS, HJF, the DoD or the Departments of the Army, Navy or Air Force. Mention of trade names, commercial products or organizations does not imply endorsement by the US Government. Citation Format: Julie A. Bytnar, Lindsey Enewold, Craig D. Shriver, Kangmin Zhu. Incidence of papillary thyroid cancer: comparison of the military with the general population by race, gender, and tumor stage/size. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4208.

Abstract 4209: Cancers of unknown primary: survival by histologic type, demographic features, and treatment in the US Military Health System

Abstract Background: Cancers of unknown primary (CUP), a group of heterogenous metastatic cancers lacking a known primary site, have poor prognosis. This study compared survival by histologic type, patient characteristics, and treatment in the U.S. Military Health System (MHS), which provides universal care to its members. Methods: Patients diagnosed with CUP were identified from the U.S. Department of Defense’s Automated Central Tumor Registry. Median survival with 95% confidence intervals was calculated for demographic and treatment variables by histologic type. A multivariable accelerated failure time model estimated time ratios and 95% confidence intervals. Results: The study included 3,358 CUP patients. The most prevalent CUP in this study was well and moderately differentiated adenocarcinomas. Median survival varied by histologic type with squamous cell carcinoma having the longest at 25.1 months and poorly differentiated carcinomas having the shortest at 3.0 months. For each histologic type, survival was generally similar by sex and active-duty status. Younger patients tended to have longer survival than those aged 65 years or older. Women with well and moderately differentiated adenocarcinoma had longer survival than their male counterparts. Generally, there were no racial differences in survival except poorer survival for Blacks than Whites with other histologic types. Patents with chemotherapy and radiation treatment generally had improved survival whereas patients with squamous cell carcinoma who received chemotherapy had shorter survival than those without. Conclusion: Survival generally did not differ between racial groups, which may be related to equal healthcare access despite racial background. Further studies are warranted to better understand how survival in the MHS compares with that in the general U.S. population. Disclaimer: The contents of this publication are the sole responsibility of the authors and do not necessarily reflect the views, opinions or policies of USUHS, HJF, the DoD or the Departments of the Army, Navy or Air Force. Mention of trade names, commercial products or organizations does not imply endorsement by the US Government. Citation Format: Julie A. Bytnar, Jie Lin, Joel T. Moncur, Craig D. Shriver, Kangmin Zhu. Cancers of unknown primary: survival by histologic type, demographic features, and treatment in the US Military Health System. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4209.

Five-year survival of patients with late-stage prostate cancer: comparison of the Military Health System and the U.S. general population.

While the 5-year survival rate for local and regional prostate cancer is nearly 100%, it decreases dramatically for advanced tumours. Accessibility to health care is an important factor for cancer prognosis. The U.S. Military Health System (MHS) provides universal health care to its beneficiaries, reducing financial barriers to medical care. However, whether the universal care translates into improved survival among patients with advanced prostate cancer in the MHS is unknown. In this study, we compared the MHS and the U.S. general population in survival of patients with advanced prostate cancer (stages III and IV). The MHS patients (N = 5379) were identified from the Department of Defense's (DoD) Automated Central Tumor Registry (ACTUR). Patients in the U.S. general population (N = 21,516) were identified from the Surveillance, Epidemiology, and End Results (SEER) programme. The two populations were matched on age, race, and diagnosis year. The ACTUR patients exhibited longer 5-year survival than the matched SEER patients (HR = 0.74, 95% CI = 0.67-0.83), after adjustment for the potential confounders. The improved survival was observed for ages 50 years or older, both White patients and Black patients, all tumour stages and grades. This was also demonstrated despite the receipt of surgery or radiation treatment. MHS beneficiaries with advanced prostate cancer had longer survival than their counterparts in the U.S. general population.

Abstract 20: Cancer incidence in the U.S. military: An updated analysis

Abstract Background: Active duty military service members and the general US population differ in several ways related to cancer occurrence. This study aimed to update and expand our previous study which compared incidence of six cancers between the U.S. military and general populations. Methods: Cancers included in this study were pathologically confirmed malignant lung, colorectal, testicular, prostate, cervical and breast tumors diagnosed 1990-2013. The study populations were men and women aged 20-59 in the US active duty military and the population in nine areas covered by the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) cancer registry program. Military data were from the Department of Defense’s Automated Central Tumor Registry (ACTUR) and Defense Manpower Data Center. Age adjusted rates in ACTUR and SEER and incidence rate ratios (IRR) and 95% confidence intervals (95% CI) comparing ACTUR to SEER were calculated. Comparisons were made by sex, race, and cancer stage. Results: Age adjusted incidence rates of colorectal cancer were significantly lower in ACTUR than SEER among White (IRR 0.78; 95% CI 0.72-0.84) and Black men (IRR 0.86; 95% CI 0.74-1.00), respectively. Lung cancer incidence was lower in ACTUR than SEER among White (IRR 0.55; 95% CI 0.49-0.62) and Black men (IRR 0.34; 95% CI 0.26-0.42) and White women (IRR 0.74; 95% CI 0.53-0.98). Whites in ACTUR had significantly lower incidence of testicular cancer (IRR 0.92; 95% CI 0.88-0.96). Lower incidence of cervical cancer in ACTUR was observed among both Whites (IRR 0.82; 95% CI 0.69-0.97) and Blacks (IRR 0.39; 95% CI 0.27-0.54). Incidence of prostate cancer was higher in ACTUR than SEER among both Whites (IRR 2.31; 95% CI 2.18-2.45) and Blacks (IRR 2.35; 95% CI 2.13-2.58). Results by tumor stage showed similar results between the ACTUR and SEER populations for regional and distant tumors, while no differences between the two were observed for localized tumors, except in the case of prostate cancer. Incidence of localized and regional prostate tumors was higher in ACTUR than SEER, while there was no significant difference in distant tumors. Conclusion: Active duty service members had lower age adjusted incidence rates of colorectal, lung, testicular, and cervical cancers, but higher rates of prostate cancer than the general US population. While these findings may result from the combined effects of many factors, the lower incidence in the military may be associated with healthier status of service members. In addition, universal health care for active duty military may lead to earlier diagnosis of some tumors, such as prostate cancer, in the military. Disclaimer: The contents of this publication are the sole responsibility of the authors and do not necessarily reflect the views, opinions or policies of USUHS, HJF, the DoD or the Departments of the Army, Navy or Air Force. Mention of trade names, commercial products or organizations does not imply endorsement by the US Government. Citation Format: Julie A. Bytnar, Katherine A. McGlynn, Craig D. Shriver, Kangmin Zhu. Cancer incidence in the U.S. military: An updated analysis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 20.

Abstract 5861: Insurance and survival among lung cancer patients: Comparison of the US military health system and the surveillance, epidemiology, and end results (SEER) program

Abstract Accessibility to medical care is related health insurance. The U.S. military health system (MHS) provides beneficiaries with universal health care. Our previous studies showed improved survival of the MHS patients with lung cancer compared to those in the US general population covered by the Surveillance, Epidemiology, and End Results (SEER) program. This study expanded the previous studies by further comparing MHS patient with SEER patients with different insurances to provide evidence on the effects of insurance status on survival. The MHS patients were identified from the Department of Defense's (DoD) Automated Central Tumor Registry (ACTUR). The SEER patients were identified from the 18 cancer registries of the SEER program. All patients were diagnosed with histologically confirmed lung cancer between 2007 and 2013. The SEER program defines insurance type as insured (private insurance, Medicare administered through a managed care plan or private supplement), insured/no specifics (Medicare NOS, insurance NOS), any Medicaid (Indian/Public health Service, Medicaid, Medicaid administered through a managed care plan, Medicare with Medicaid eligibility), and uninsured (no insurance, self-pay). The results showed that compared to ACTUR, SEER patients with non-small cell lung cancer exhibited increased risk of mortality regardless of their insurance type. Specifically, the adjusted HR (95% CI) was 1.08 (1.03-1.13), 1.22 (1.16-1.28), 1.40 (1.33-1.47), 1.49 (1.41-1.58), for SEER insured, insured/no specifics, Medicaid, and uninsured, respectively. This pattern was consistently observed in subgroups by age, gender, race, and tumor stage. Among small-cell lung cancer patients, the higher HR compared to ACTUR was significant only for Medicaid (HR=1.24, 95% CI=1.11-1.38) and uninsured (HR=1.28, 95% CI=1.13-1.45). Furthermore, compared to ACTUR, the likelihood of receiving surgery was significantly lower in SEER with odds ratios (95% CIs) of 0.85 (0.76-0.95), 0.64 (0.57-0.72), 0.40 (0.36-0.45), and 0.34 (0.29-0.39) for insured, insurance/no specifics, Medicaid, and uninsured, respectively, and was observed regardless of tumor stage. Our study suggests that the MHS lung cancer patients had survival advantage over the SEER patients and the advantage was even larger when compared to Medicaid or uninsured patients. In addition, the SEER patients were less likely to receive surgery regardless of tumor stage, especially for Medicaid or uninsured patients. Disclaimer: The contents of this publication are the sole responsibility of the authors and do not necessarily reflect the views, opinions, or policies of the USUHS, HJF, the DoD or the Departments of the Army, Navy, or Air Force. Mention of trade names, commercial products, or organizations does not imply endorsement by the U.S. Government. Citation Format: Jie Lin, Craig Shriver, Kangmin Zhu. Insurance and survival among lung cancer patients: Comparison of the US military health system and the surveillance, epidemiology, and end results (SEER) program [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5861.

Abstract 5860: Five-year survival of patients with late stage prostate cancer: Comparison of the military health system with the US general population

Abstract While the five-year survival for local and regional prostate cancer is nearly 100%, it decreases dramatically for advanced (stages III and IV) prostate cancer. Access to health care is an important factor that affects cancer prognosis. The Military Health System (MHS) provides universal health care to beneficiaries. However, it is unclear whether the universal care translates into improved survival among patients with advanced prostate cancer. We compared survival of patients with advanced prostate cancer between the MHS and the U.S. general population. The MHS patients (N= 5,379) were identified from the Department of Defense's (DoD) Automated Central Tumor Registry (ACTUR). Patients in the U.S. general population (N=21,516) were identified from the Surveillance, Epidemiology, and End Results (SEER) program. All patients were diagnosed between January 1, 1987 and December 31, 2013. The two populations were matched on age (within 5 years), race, and diagnosis year. Multivariable Cox regression hazard model was used to estimate hazard ratios (HRs) for ACTUR compared to SEER. ACTUR patients exhibited longer 5-year survival than matched SEER patients (HR=0.74, 95% CI=0.67-0.83), after adjustment for the potential confounders. In stratified analysis, the improved survival was observed for ages 50 years or older, both white and black races, all tumor stages, and grades. In stratified analysis by treatment receipt, the improved survival of ACTUR patients compared to SEER patients remained regardless of the receipt of surgery or radiation treatment. Our results suggested that MHS beneficiaries with advanced prostate cancer had longer survival than their counterparts in the U.S. general population. Universal health care in the MHS might translate into improved survival for advanced prostate cancer. Disclaimers: The contents of this publication are the sole responsibility of the authors and do not necessarily reflect the views, opinions, or policies of the USUHS, HJF, the DoD or the Departments of the Army, Navy, or Air Force. Mention of trade names, commercial products, or organizations does not imply endorsement by the U.S. Government. Citation Format: Jie Lin, Darryl Nousome, Jiji Jiang, Gregory Chesnut, Craig Shriver, Kangmin Zhu. Five-year survival of patients with late stage prostate cancer: Comparison of the military health system with the US general population [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5860.

Survival among patients with multiple myeloma in the U.S. military health system compared to the Surveillance, Epidemiology, and End Results (SEER) program.

6524 Background: Multiple myeloma (MM) is the second most common hematologic malignancy and remains incurable despite therapeutic advances. The US Military Health System (MHS) provides universal healthcare to beneficiaries and has been associated with improved survival across multiple malignancies. It is unknown whether access to universal healthcare via the MHS translates to improved survival for MM patients. We sought to answer this question by comparing survival data from the Department of Defense’s Automated Central Tumor Registry (ACTUR) and the NCI’s SEER database. Methods: Patients 18 years and older diagnosed with histologically confirmed MM between 1987-2013 were identified in ACTUR (N=1,488) and SEER (N=2,976) databases. Two SEER patients were matched to an ACTUR patient by age group, sex, race, and diagnosis year group. Five and 10-year survival was compared between ACTUR and SEER patients using Kaplan-Meier curves and log-rank tests. Cox proportional hazard model was used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI) adjusted for potential confounders of age at diagnosis, sex, race and diagnosis year. The proportional hazards assumption for the analysis was assessed with log-log survival curves. Results: Median survival in the ACTUR patients was 47.1 months (95% CI: 43.9-50.4) compared to 33.0 months (95% CI: 32.0-35.0) in the SEER group. Five and 10-year survival was superior in patients from the ACTUR group compared to the SEER group with an aHR of 0.74 (95% CI: 0.68-0.81) and 0.79 (95% CI: 0.74-0.85) after adjustment for potential confounders, respectively. The survival advantage of ACTUR patients was preserved when stratified by age, sex, race, and diagnosis year. Conclusions: Patients treated with MM in the MHS had superior 5 and 10-year overall survival when compared to the general population. This benefit remained despite age, sex, race, and diagnosis year. Our study findings suggest the benefits of universal healthcare provided by the MHS improve survival among MM patients. Further research is warranted to delineate factors which improve survival and reduce disparity in the treatment of MM patients.[Table: see text]

Soft-tissue Sarcoma Survival in the US Military Health System: Comparison With the SEER Program.

The US Military Health System (MHS) provides universal health care to beneficiaries. Few studies have evaluated the potential influence of access to universal care on survival outcomes for sarcoma. This study compared the survival of adult patients with soft-tissue sarcoma in the MHS with the US general population. MHS data were obtained from the Department of Defense Automated Central Tumor Registry (ACTUR). US population data were obtained from the National Cancer Institute's Surveillance, Epidemiology, and End Results registry. Patients who were 25 years or older with a histologically confirmed musculoskeletal soft-tissue sarcoma were matched based on age, sex, and race. Kaplan-Meier survival curves and Cox proportional hazards models were used to compare 5-year survival in the two groups. Adult patients in ACTUR had markedly lower 5-year mortality for soft-tissue sarcomas (hazard ratio=0.82; 95% confidence interval, 0.73 to 0.92) after adjustment for potential confounders. Lower 5-year mortality was found in most demographic subgroups for ACTUR patients compared with Surveillance, Epidemiology, and End Results patients. Five-year survival in the MHS compared with the US general population may suggest an important role of universal health care in improving the survival of patients with soft-tissue sarcoma.

Abstract PO-229: Racial/ethnic differences in tumor characteristics among endometrial cancer patients in an equal-access healthcare population

Abstract Introduction: Endometrial cancer is the most prevalent gynecologic malignancy. Compared with White women, endometrial cancer incidence is 30% lower in Black women yet mortality is 80% higher. In retrospective review of young women, [MM1] Black women (<50 years old) presented with more advanced clinical stage and more aggressive histologic subtypes. Multivariable analysis adjusting for these factors showed that risk of mortality[MM2] is 19% higher in Black women than their White counterparts. Native Hawaiian/Pacific Islander race has also been associated with worse survival when compared to their White counterparts. In this retrospective review of endometrial cancer patients treated within the Military Health System we assessed whether there were racial/ethnic disparities in tumor characteristics [MM3] in a system that provides equal access to healthcare and treatment. Methods: The study population included women diagnosed with endometrial cancer among US Department of Defense beneficiaries reported in the Automated Central Tumor Registry (ACTUR) database between 2001-2018. We evaluate differences in tumor characteristics by self-reported racial/ethnic group using the Chi-square test or Fisher test for small sample sizes (a two tailed P<0.05 was considered statistically significant). Results: After excluding women who had non-invasive tumors, non-epithelial histology and those who were not represented in the five major racial/ethnic groups for this study, the study population included 2574 women diagnosed with invasive endometrial cancer (including 1729 Non-Hispanic White[ZA4], 318 Asian, 286 Black, 140 Pacific Islander and 101 Hispanic White women). We observed differences in histology, stage and grade by racial/ethnic group (P<0.001). Specifically, comparing age-standardized endometrial tumor characteristics by racial/ethnic groups we observed that Black women had a lower proportion of endometrioid histology (56%) as compared with other racial/ethnic groups (≥70.6% endometrioid). Black, Hispanic and Pacific Islander women had a higher proportion of distant stage and poorly differentiated (grade 3-4) disease (≥8.9% distant stage; ≥30.5% poorly differentiated) versus (≤5.7% distant stage; ≤23.8% poorly differentiated) in White and Asian women. Conclusions: Endometrial cancer is common and population-wide screening is not recommended which makes it a good case-study for the value of access to care when patients identify concerning symptoms (bleeding, spotting). In our analysis of endometrial cancer cases in an equal-access healthcare environment, there appear to be racial/ethnic disparities among Black, Hispanic and Pacific Islander women. Our review affirms prior data showing more aggressive histology, grade and stage at diagnosis. Further studies will focus on whether these patterns persist among women with endometrioid histology tumors. The views expressed in this abstract are those of the author and do not reflect the official policy of the Department of Army/Navy/Air Force, Department of Defense, or U.S. Government. Citation Format: Daniel Desmond, Zhaohui Arter, Jeffrey Berenberg, Melissa Merritt. Racial/ethnic differences in tumor characteristics among endometrial cancer patients in an equal-access healthcare population [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-229.

Survival among Breast Cancer Patients: Comparison of the U.S. Military Health System with the Surveillance, Epidemiology and End Results Program

IntroductionAccessibility to health care is important to cancer survival. The U.S. military health system (MHS) provides universal health care access. However, whether the universal care has been translated into improved cancer survival is unknown. We compared survival of patients with breast cancer in the MHS with that in the U.S. general population and assessed the differences in cancer stage at diagnosis and treatment receipt between the two populations. MethodsThe MHS patients (n = 31,548) were identified from the Department of Defense's (DoD) Automated Central Tumor Registry (ACTUR). Patients in the U.S. general population (n = 63,096) were identified from the Surveillance, Epidemiology, and End Results (SEER) program. The two populations were matched on age, race, and diagnosis year. Multivariable Cox regression hazard modeling was used to estimate hazard ratios (HRs) comparing ACTUR with SEER. Multivariable logistic regression was used to estimate odds ratios (ORs) comparing stage and treatment receipt. ResultsACTUR patients exhibited a 24% lower overall mortality than the SEER patients (HR = 0.76, 95% CI, 0.71-0.80). They were less likely to present with later stage compared to the SEER patients (OR = 0.61, 95% CI, 0.55-0.67 for stage IV tumors). The ACTUR patients with stages I-III tumors were more likely to receive surgery (OR = 1.35, 95% CI, 1.20-1.52) but less likely to receive radiation (OR = 0.91, 95% CI, 0.88-0.94). The survival advantage of ACTUR patients remained regardless of surgery or radiation receipt. ConclusionsBreast cancer patients with universal health care access had improved survival compared to patients in the general population.

With Equal-Access, Service Members with Lymphoma Have Better Outcomes Than Their Civilian Counterparts

Introduction: The Military Health System (MHS) is a single-payer, equal-access healthcare system that provides healthcare to 1.4 million active-duty service members (ADSMs) from diverse socioeconomic backgrounds. ADSMs with cancer receive prompt care without copayments, deductibles, prior authorizations, or other insurance barriers. Lymphoma is the most common hematologic malignancy diagnosed in ADSMs. We sought to compare overall survival (OS) of ADSMs with lymphoma with matched civilian lymphoma patients. We also sought to identify variables among ADSMs that predicted OS.Methods: The Department of Defense Automated Central Tumor Registry (ACTUR) was retrospectively accessed to identify ADSMs with Hodgkin Lymphoma (HL), diffuse large B-cell lymphoma (DLBCL), and indolent lymphomas over a 20-year span from 1997-2017. A comparator arm was created from the National Cancer Institute's Surveillance, Epidemiology and End-Result (SEER)-18 database and was matched in a 4:1 ratio by age, sex, race, ethnicity, year of diagnosis, and stage. OS was assessed with Cox proportional hazards models. Kaplan Meier curves were constructed and compared using log rank tests. Among ADSMs, univariate and multivariable analyses were performed to assess OS based on race, ethnicity, sex, age at diagnosis, stage, year of diagnosis, rank, branch of service, and geographic region at diagnosis. All data analyses were conducted using STATA/SE 15.1 for Windows; the alpha level for statistical significance was set to 0.05.Results: There were 1,170 ADSMs with HL, 443 with DLBCL, and 284 with indolent lymphomas identified from ACTUR. Most ADSMs were between ages 20-40, white/non-Hispanic, enlisted, and in the Army. All three groups of ADSMs had superior OS when compared with their matched civilian counterparts. There were 49%, 48%, and 35% reductions in the risk of death among ADSMs with DLBCL, indolent lymphoma and Hodgkin lymphoma, respectively (DLBCL hazard ratio [HR] 0.51, 95% CI 0.40-0.65, p<0.0001; indolent HR 0.52, 95% CI 0.33-0.81, p <0.002; HL HR 0.65, 95% CI 0.52-0.82, p <0.002). Among the ADSMs, variables that reached statistical significance in the univariate and/or the multivariable analyses for OS include increasing age (DLBCL, indolent), advanced stage (DLBCL, HL), and geographic residence at diagnosis (DLBCL, HL). Notably, there were no statistically significant differences in OS based on race, ethnicity, sex, rank, or branch of service.Discussion: ADSMs with lymphoma treated within the MHS have significantly better survival than their matched civilian counterparts. Further, disparities based on race/ethnicity and sex are not present in the MHS, despite being pervasive in the civilian sector. It is possible that better access to care within the equal-access MHS might explain our results. Alternatively, regular fitness tests and periodic health assessments may render ADSMs are more fit and less comorbid than their civilian counterparts, translating to a better chance of long-term survival. Although this study is limited by its retrospective design and possible coding inaccuracies, the finding of advanced age and stage impacting OS serves as a good internal control and confirms the quality of ACTUR data. Findings from this study reflect favorably on ADSMs with cancer. The absence of racial/ethnic or gender disparities reflects favorably on cancer care received within the equal-access MHS. [Display omitted] DisclosuresThornton: Undisclosed Companies: Current equity holder in publicly-traded company.

Comparative study of survival among small cell lung cancer patients in the U.S. military health system and those in the surveillance, epidemiology, and end results (SEER) program

Purpose: The U.S. military health system provides universal health care access to beneficiaries. However, whether the universal access has translated into improved patient outcome is unknown. We compared survival of small-cell lung cancer patients in the military health system with that in the U.S. general population. Stage and receipt of cancer treatment were also compared to see if they could contribute to survival difference. Methods: The data were obtained from The Department of Defense's Automated Central Tumor Registry (ACTUR) and the national Surveillance, Epidemiology, and End Results (SEER) program, respectively. ACTUR (N = 3040) and SEER patients (N = 12,160) were matched on age, sex, race and diagnosis year. Multivariable Cox regression model was used to compare all-cause mortality between ACTUR and SEER. Multivariable logistic regression was performed to compare cancer stage and treatment. Results: ACTUR patients exhibited significantly better survival than SEER counterparts (HR = 0.77, 95% CI= 0.71–0.83). ACTUR and SEER patients had similar stage, but ACTUR patients were more likely to receive radiation treatment (OR = 1.26, 95% CI = 1.12–1.42). The survival advantage of ACTUR patients remained across all tumor stages and radiation groups. Conclusions: Survival of small-cell lung cancer patients with universal health care access had better survival than similar patients in the U.S. general population. Future studies are warranted to identify factors that may contribute to the improved survival.

Racial disparities in survival among women with endometrial cancer in an equal access system

ObjectiveThe mortality rate for Black women with endometrial cancer (EC) is double that of White women, although the incidence rate is lower among Black women. Unequal access to care may contribute to this racial disparity. This study aimed to assess whether survival varied between non-Hispanic Black (NHB) and non-Hispanic White (NHW) women with EC in the Military Health System (MHS) which provides equal access care to its beneficiaries despite racial/ethnic background. MethodsThe study was conducted using data from the U.S. Department of Defense's (DoD) Automated Central Tumor Registry (ACTUR). Study subjects included NHB and NHW women with histologically confirmed and surgically managed EC diagnosed between 1988 and 2013. The study outcome was all-cause death. Overall survival between NHB and NHW women was compared using multivariable Cox modeling. ResultsThe study included 144 NHB and 1439 NHW women with EC. Kaplan-Meier curves showed NHB women had worse survival than NHW women (log-rank P < 0.0001). The disparity in survival between NHB and NHW women persisted after adjusting for age, diagnosis period, tumor stage, tumor histology/grade, and adjuvant treatment (HR = 1.64, 95% CI = 1.19 to 2.27). Multivariable analyses stratified by tumor features or treatment showed that the racial disparity was confined to women with low-risk features (stage I/II disease or low-grade EC) or no adjuvant treatment. ConclusionThere were racial differences in overall survival between NHB and NHW women with EC in the MHS equal access healthcare system, suggesting that factors other than access to care may be related to this racial disparity.

Cancers of Unknown Primary: A Descriptive Study in the U.S. Military Health System.

Cancers of unknown primary (CUP) are defined as histologically confirmed metastatic cancers that do not have an identified primary site of origin despite an appropriate diagnostic workup. Although accessibility to and quality of medical care influence diagnosis of cancer including CUP, previous studies describing CUP have generally been conducted in patients with various accessibilities to care. This study aimed to describe the demographic, histologic, and temporal trend characteristics of CUP patients in the DoD Cancer Registry of the Military Health System (MHS), which provides universal health care access, reducing the potential effects of accessibility to care on research results. The data were obtained from the DoD's Automated Central Tumor Registry (ACTUR), which collects cancer data from beneficiaries who were diagnosed or received treatment in the MHS. We described the demographic and histologic distributions in CUP patients aged 18 years or older diagnosed from 1987 to 2013. We calculated the proportion of CUP patients among all metastatic cancers and the most common histologic categories of those tumors. We then evaluated whether the proportion of histologic types changed over time. CUP comprised 13.3% of all metastatic cancers in ACTUR during the study period. The majority of CUP within ACTUR was moderately and well-differentiated adenocarcinoma (51.3%) and poorly differentiated carcinomas (23.2%) followed by squamous cell carcinomas (12.5%). The percentages of CUP among metastasized cancers of the same histologic category ranged 12%-15% for moderately and well-differentiated adenocarcinomas, squamous cell, and poorly differentiated carcinomas, and 41%-46% for malignant neuroendocrine carcinomas and undifferentiated neoplasms. However, the percentages varied by sex, race, and age for certain pathologies. The proportion of CUP patients among all metastatic cancer patients has steadily declined from 22.4% to 8.3% from 1987 to 2013. The proportion and trends of CUP in the ACTUR were generally consistent with other descriptive CUP studies. This study provides a description of CUP in a health care system with universal access in the USA and provides a foundation for future studies on CUP.