Changes In Prevalence Of Risk Factors Research Articles

Sex and Race/Ethnic Differences in Risk Factors for Alzheimer’s Disease and Related Dementias: Implications for Prevention

AbstractBackgroundWe previously estimated that 1 in 3 cases of Alzheimer’s disease and related dementias (ADRD) in the U.S. may be attributable to modifiable risk factors, the most important being physical inactivity, depression, and smoking. However, these estimates do not account for changes in risk factor prevalence over the past decade and do not consider potential differences based on sex or race/ethnicity. The objective of this study was to update and estimate the proportion of ADRD in the U.S. that are potentially attributable to modifiable risk factors and to assess for differences by sex and race/ethnicity.MethodWe estimated individual and combined population attributable risks (PARs) for ADRD for the following risk factors: physical inactivity, current smoking, depression, low education, diabetes, midlife obesity, midlife hypertension, and hearing loss. To account for non‐independence of the risk factors, we estimated their communality and uniqueness via principal component analysis. Risk factor prevalence and communality were determined using data from the nationally‐representative Behavioral Risk Factor Surveillance Survey (BRFSS) and relative risks for each risk factor were extracted from recent meta‐analyses. Respondents included 378,615 noninstitutionalized adults in the U.S., older than 18 years.ResultApproximately 1 in 3 (37%) cases of ADRD in the U.S. are potentially attributable to 8 modifiable risk factors, the most important of which are midlife obesity (17.7%, 95% CI: 17.5,18.0) physical inactivity (11.8%, 95% CI: 11.7, 11.9), and low educational attainment (11.7%, 95% CI: 11.5, 12.0). Combined PARs were higher for men (36%) than women (30%) and differed by race/ethnicity: Black (40%), Native Americans/Alaska Natives (39%), Hispanic (any race, 34%), White (29%), and Asian (16%). The most important modifiable risk factors, regardless of sex, were midlife obesity for Whites, Native Americans/Alaska Natives and Blacks; low education for Hispanics; and physical inactivity for Asians.ConclusionOur findings suggested that the major contributors to ADRD have changed over the past decade and differ based on sex and race/ethnicity. Therefore, Alzheimer’s disease risk reduction strategies may be more effective if they target higher‐risk groups and consider current risk factor profiles.

Risk Factors Associated With Alzheimer Disease and Related Dementias by Sex and Race and Ethnicity in the US

Previous estimates suggested that 1 in 3 cases of Alzheimer disease and related dementia (ADRDs) in the US are associated with modifiable risk factors, the most prominent being physical inactivity, depression, and smoking. However, these estimates do not account for changes in risk factor prevalence over the past decade and do not consider potential differences by sex or race and ethnicity. To update estimates of the proportion of ADRDs in the US that are associated with modifiable risk factors and to assess for differences by sex and race and ethnicity. For this cross-sectional study, risk factor prevalence and communality were obtained from the nationally representative US Behavioral Risk Factor Surveillance Survey data from January 2018 to December 2018, and relative risks for each risk factor were extracted from meta-analyses. Data were analyzed from December 2020 to August 2021. Respondents included 378 615 noninstitutionalized adults older than 18 years. The number before exclusion was 402 410. Approximately 23 795 (~6%) had missing values on at least 1 of the variables of interest. Physical inactivity, current smoking, depression, low education, diabetes, midlife obesity, midlife hypertension, and hearing loss. Individual and combined population-attributable risks (PARs) associated with ADRDs, accounting for nonindependence between risk factors. Among 378 615 individuals, 171 161 (weighted 48.7%) were male, and 134 693 (weighted 21.1%) were 65 years and older. Race and ethnicity data were self-reported and defined by the US Behavioral Risk Factor Surveillance System Data; 6671 participants (weighted 0.9%) were American Indian and Alaska Native, 8043 (weighted 5.1%) were Asian, 29 956 (weighted 11.7%) were Black, 28 042 (weighted 16.0%) were Hispanic (any race), and 294 394 (weighted 64.3%) were White. Approximately 1 in 3 of ADRD cases (36.9%) in the US were associated with 8 modifiable risk factors, the most prominent of which were midlife obesity (17.7%; 95% CI, 17.5-18.0), physical inactivity (11.8%; 95% CI, 11.7-11.9), and low educational attainment (11.7%; 95% CI, 11.5-12.0). Combined PARs were higher in men (35.9%) than women (30.1%) and differed by race and ethnicity: American Indian and Alaska Native individuals, 39%; Asian individuals, 16%; Black individuals, 40%; Hispanic individuals (any race), 34%; and White individuals, 29%. The most prominent modifiable risk factors regardless of sex were midlife obesity for American Indian and Alaska Native individuals, Black individuals, and White individuals; low education for Hispanic individuals; and physical inactivity for Asian individuals. The findings suggest that risk factors associated with ADRDs have changed over the past decade and differ based on sex and race and ethnicity. Alzheimer risk reduction strategies may be more effective if they target higher-risk groups and consider current risk factor profiles.

Monitoring Information-Seeking Patterns and Obesity Prevalence in Africa With Internet Search Data: Observational Study.

BackgroundThe prevalence of chronic conditions such as obesity, hypertension, and diabetes is increasing in African countries. Many chronic diseases have been linked to risk factors such as poor diet and physical inactivity. Data for these behavioral risk factors are usually obtained from surveys, which can be delayed by years. Behavioral data from digital sources, including social media and search engines, could be used for timely monitoring of behavioral risk factors.ObjectiveThe objective of our study was to propose the use of digital data from internet sources for monitoring changes in behavioral risk factors in Africa.MethodsWe obtained the adjusted volume of search queries submitted to Google for 108 terms related to diet, exercise, and disease from 2010 to 2016. We also obtained the obesity and overweight prevalence for 52 African countries from the World Health Organization (WHO) for the same period. Machine learning algorithms (ie, random forest, support vector machine, Bayes generalized linear model, gradient boosting, and an ensemble of the individual methods) were used to identify search terms and patterns that correlate with changes in obesity and overweight prevalence across Africa. Out-of-sample predictions were used to assess and validate the model performance.ResultsThe study included 52 African countries. In 2016, the WHO reported an overweight prevalence ranging from 20.9% (95% credible interval [CI] 17.1%-25.0%) to 66.8% (95% CI 62.4%-71.0%) and an obesity prevalence ranging from 4.5% (95% CI 2.9%-6.5%) to 32.5% (95% CI 27.2%-38.1%) in Africa. The highest obesity and overweight prevalence were noted in the northern and southern regions. Google searches for diet-, exercise-, and obesity-related terms explained 97.3% (root-mean-square error [RMSE] 1.15) of the variation in obesity prevalence across all 52 countries. Similarly, the search data explained 96.6% (RMSE 2.26) of the variation in the overweight prevalence. The search terms yoga, exercise, and gym were most correlated with changes in obesity and overweight prevalence in countries with the highest prevalence.ConclusionsInformation-seeking patterns for diet- and exercise-related terms could indicate changes in attitudes toward and engagement in risk factors or healthy behaviors. These trends could capture population changes in risk factor prevalence, inform digital and physical interventions, and supplement official data from surveys.

Assessing the future medical cost burden for the European health systems under alternative exposure-to-risks scenarios.

BackgroundAgeing populations and rising prevalence of non-communicable diseases (NCDs) increasingly contribute to the growing cost burden facing European healthcare systems. Few studies have attempted to quantify the future magnitude of this burden at the European level, and none of them consider the impact of potential changes in risk factor trajectories on future health expenditures.MethodsThe new microsimulation model forecasts the impact of behavioural and metabolic risk factors on NCDs, longevity and direct healthcare costs, and shows how changes in epidemiological trends can modify those impacts. Economic burden of NCDs is modelled under three scenarios based on assumed future risk factors trends: business as usual (BAU); best case and worst case predictions (BCP and WCP).FindingsThe direct costs of NCDs in the EU 27 countries and the UK (in constant 2014 prices) will grow under all scenarios. Between 2014 and 2050, the overall healthcare spending is expected to increase by 0.8% annually under BAU. In the all the countries, 605 billion Euros can be saved by 2050 if BCP is realized compared to the BAU, while excess spending under the WCP is forecast to be around 350 billion. Interpretation: Although the savings realised under the BCP can be substantial, population ageing is a stronger driver of rising total healthcare expenditures in Europe compared to scenario-based changes in risk factor prevalence.

Protecting the gains: What changes are needed to prevent a reversal of the downward cardiovascular disease mortality trend?

Cardiovascular disease (CVD) mortality has decreased over 60% over the past 50 years in the United States; however, emerging data indicate CVD incidence may be rising because of shifting demographics, increasing risk factor prevalence, and competing needs for limited resources. We projected CVD mortality from 2015 to 2040 given varying informed assumptions regarding changes in risk factor prevalence, uptake of current therapeutic options, and future innovations. A microsimulation model was used to project US CVD mortality trends. National Health and Nutrition Examination Survey data were used to estimate population-level trends in CVD risk factors. Risk factors were used to generate Framingham Risk Scores for cohorts of 1 000 000 individuals from the general population to determine each individuals' CVD risk. Annual cardiovascular incidence, prevalence, and mortality were projected for scenarios differing by uptake of current therapies, anticipated pharmaceutical innovations with variable efficacy, risk factor prevalence, and changes in health disparities. When incorporating a demographic shift, continued changes in risk factors, current treatment utilization, and no major innovations, we predicted the CVD mortality rate would increase 41% by 2040. If innovations providing incremental benefits equal to those associated with the introduction of statins are identified and widely utilized, CVD mortality could remain constant through 2040. With more efficacious innovations, CVD mortality could be further reduced. Given demographic and risk prevalence changes, increasing access and adherence to current preventative therapeutics could slow the expected mortality increase, but new therapies may be needed to maintain the downward trend in CVD deaths.

Less overdiagnosis of kidney cancer? an age-period-cohort analysis of incidence trends in 16 populations worldwide.

The increasing rates of kidney cancer incidence, reported in many populations globally, have been attributed both to increasing exposures to environmental risk factors, as well as increasing levels of incidental diagnosis due to widespread use of imaging. To better understand these trends, we examine long-term cancer registry data worldwide, focusing on the roles of birth cohort and calendar period, proxies for changes in risk factor prevalence and detection practice respectively. We used an augmented version of the Cancer Incidence in Five Continents series to analyze kidney cancer incidence rates 1978-2007 in 16 geographically representative populations worldwide by sex for ages 30-74, using age-period-cohort (APC) analysis. The full APC model provided the best fit to the data in most studied populations. While kidney cancer incidence rates have been increasing in successive generations born from the early twentieth century in most countries, equivalent period-specific rises were observed from the late-1970s, although these have subsequently stabilized in certain European countries (the Czech Republic, Lithuania, Finland, Spain) as well as Japan from the mid-1990s, and from the mid-2000s, in Colombia, Costa Rica and Australia. Our results indicate that the effects of both birth cohort and calendar period contribute to the international kidney cancer incidence trends. While cohort-specific increases may partly reflect the rising trends in obesity prevalence and the need for more effective primary prevention policies, the attenuations in period-specific increases (observed in 8 of the 16 populations) highlight a possible change in imaging practices that could lead to mitigation of overdiagnosis and overtreatment.

High prevalence of cardiovascular risk factors in Durban South African Indians: The Phoenix Lifestyle Project.

Previous studies show a high prevalence of cardiovascular (CV) risk factors in South African (SA) Asian Indians, with the emergence of premature coronary artery disease in young Indian subjects. To determine the prevalence of CV risk factors in this population. This was a cross-sectional study of randomly selected adults aged 15 - 64 years from the suburb of Phoenix in Durban, KwaZulu-Natal Province, SA. All participants had demographic, anthropometric and biochemical measurements using the modified World Health Organization (WHO) STEPwise survey methods. Hypertension, obesity, lipid abnormalities and diabetes mellitus (DM) were diagnosed using WHO criteria. Age-standardised frequencies for glycaemic indices were calculated according to the WHO standard world population distribution. Of the 1 428 subjects who responded (response rate 72.1%), complete data for analysis were available on 1 378 (1 001 women). The mean age was 45.5 (standard deviation 13) years. There were high prevalences of hypertension (47.5%), DM (20.1%), total body obesity (raised body mass index) (32.4%) and increased waist circumference (73.1%). The 'thin-fat' Asian phenotype (isolated abdominal obesity) was found in only 4.8% of participants. High prevalences of total body obesity (32.1%), increased waist circumference (31.3%) and insulin resistance (28.2%) were documented in the youngest age group. Over half of the males and 14.6% of females were current smokers. Diabetic dyslipidaemia was found in 61 subjects (4.4%). In multivariate analysis, age, triglycerides and waist circumference measurement were significant independent risk factors associated with DM and, together with fasting glucose, also predicted hypertension. Compared with Asian Indian subjects with similar environmental exposure in previous studies, the magnitude of change in risk factor prevalence over the past two decades has been of epidemic proportions.

Influence of mammographic screening on breast cancer incidence trends in South Australia.

To examine breast cancer (BC) incidence trends in relation to mammographic screening and risk factor prevalence in South Australia (SA). Trends in annual BC incidence rates were calculated using direct standardisation and compared with projected incidence derived from Poisson regression analysis of pre-screening rates. Annual percentage change and change time points were estimated using Joinpoint software. Biennial mammography screening participation rates were calculated using data from BreastScreen SA. Trends in overweight/obesity, alcohol use and hormone replacement therapy (HRT) use were examined using 1991-2009 Health Omnibus Survey data. Trends in total fertility were examined using data from the Australian Bureau of Statistics. BC incidence increased around the time BreastScreen commenced and then stabilised in the mid-1990s. However rates have remained higher than projected, even though the proportion and age distribution of first time screening attendees stabilised around 1998. A decrease in BC incidence was observed among women aged 50-59yrs from the late-1990's but not among older women. Obesity and alcohol use have increased steadily in all age groups, while HRT use declined sharply from the late-1990s. BC incidence has remained higher than projected since mammography screening began. The sustained elevation is likely to be due to lead time effects, though over-diagnosis cannot be excluded. Declining HRT use has also impacted incidence trends. Studies using individual level data, which can account for changes in risk factor prevalence and lead time effects, are required to evaluate 'over-diagnosis' due to screening.

Abstract PL08-02: Colorectal cancer health disparities: Role of racial disparities in stage.

Abstract Colorectal cancer (CRC) is the second leading cause of cancer death in the US. Over the last four decades, advances in screening, early detection, and treatment have led to large reductions in age-adjusted CRC mortality rates. However, as the overall CRC mortality rate has declined, disparities in CRC mortality have worsened. For example, using data from the nine original registries in the Surveillance, Epidemiology, and End Results Program (denoted as SEER 9), in 1975–79, age-adjusted CRC mortality rates for whites and blacks were 29.0 and 29.7 per 100,000, respectively. However, during 2005–09, the corresponding rates were 15.1 and 23.1, respectively (53.0% higher rate in blacks). (All incidence and mortality rates in this presentation are per 100,000 population and age-adjusted to the 2000 US Standard Population. Stage at diagnosis was grouped into local, regional, distant, and unstaged, according to SEER Summary Stage guidelines.) Cancer mortality rates are driven by trends in stage-specific incidence rates and stage-specific survival. Because of the poorer survival for advanced disease, decreases in the incidence of regional and distant stage, and increases in survival for advanced disease have particularly favorable impacts on the mortality rate. Overall and stage-specific incidence rates are affected by changes in risk factor prevalence as well as screening and early detection programs, while stage-specific survival rates are primarily affected by improvements in treatment. This presentation describes trends for whites and blacks in the US from 1975 to 2009, using data from SEER 9, which covers approximately 10% of the US population. Race-specific trend data are presented for CRC mortality, incidence, and 5-year relative survival rates (relative survival is the ratio of observed to expected survival and represents the probability of surviving cancer for a specific period of time). Between 1975–79 and 2005–09, for whites, overall CRC incidence decreased from 62.3 to 44.4 (–28.7%), while for blacks, overall incidence only decreased from 58.7 to 55.5 (–5.5%). For whites, stage-specific changes in incidence during this time were as follows: localized, from 20.9 to 19.0 (–9.1%); regional, from 22.2 to 15.1 (–32.0%); distant, from 12.9 to 8.3 (–35.7%); and unstaged, from 6.2 to 2.0 (–67.7%). For blacks, corresponding stage-specific incidence changes were: localized, from 17.9 to 21.9 (+22.3%); regional, from 19.5 to 17.0 (–12.8%); distant, from 14.8 to 13.1 (–11.5%); and unstaged, from 6.4 to 3.6 (–43.8%). Changes in stage-specific 5-year relative survival were also examined, using data from CRC cases diagnosed during 1975–77 and cases diagnosed during 2002–08; all cases were followed through December 2009. For whites, the changes in stage-specific survival were as follows: localized, from 82.2% to 91.1% (+10.8%); regional, from 53.8% to 72.2% (+34.2%); distant, from 5.6 % to 12.6% (+125.0%); and unstaged, from 31.3 % to 28.9% (+%). For blacks, corresponding changes in survival were: localized, from 76.5% to 85.9% (+12.3%); regional, from 50.0% to 65.4% (+30.8%); distant, from 6.3% to 8.3% (+31.7%); and unstaged, from 34.9% to 32.6% (6.6%). These data suggest that both decreases in stage-specific incidence and increases in stage-specific survival have played important roles in the downward trend in CRC mortality rates, particularly for whites. With respect to stage-specific incidence, whites experienced much larger decreases in the incidence of advanced (regional and distant) disease, particularly distant stage. As noted above, 5-year survival for distant stage is very poor (from SEER-9, 13% for whites and 8% for blacks in the most recent time period). Whites also experienced larger increases in stage-specific survival, particularly for distant stage, where their survival more than doubled over this four-decade period. These data suggest that advances in screening, early detection, and treatment of CRC have not equally benefitted whites and blacks, and that these inequities have contributed to worsening racial disparities in CRC mortality. Citation Format: Anthony S. Robbins. Colorectal cancer health disparities: Role of racial disparities in stage. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr PL08-02.

Cancer Costs Projected to Reach at Least $158 Billion in 2020

The estimated total cost of cancer care in the United States in 2020 is expected to be $158 billion, assuming the most recent observed patterns of incidence, survival, and cost remain the same. This represents a 27% increase from 2010 due solely to the projected aging and growth of the US population, according to a study published online January 12th in the Journal of the National Cancer Institute. However, the authors also note the cost of cancer care could rise even more quickly under other reasonable assumptions, such as a 2% annual increase in costs of the initial and final phases of cancer care. Cancer disproportionately affects the elderly population, which is expected to increase from 40 million in 2009 to 70 million in 2030. With changes in risk factor prevalence and stage at diagnosis, and development of new diagnostic tools and treatments for cancer in the 1990s, cancer incidence declined and survival improved, but cancer care became more expensive. Under a different scenario of continuing trends in cancer incidence, survival, and costs of care, the total cost of cancer care in 2020 is expected to be $173 billion, an even larger increase (39% from 2010). To estimate the national medical cost of cancer care through the year 2020 for 13 cancers in men and 16 cancers in women, Angela Mariotto, PhD, and colleagues from the National Cancer Institute analyzed data on cancer incidence (the rates of newly diagnosed cancer in any given year) and survival from the Surveillance, Epidemiology, and End Results (SEER) database (available at: http://seer.cancer.gov/) and Medicare expenditures associated with cancer from the linked SEER-Medicare database (available: http://healthservices.cancer.gov/seermedicare/). They combined prevalence (the population rates of people alive with cancer in any given year) and cancer costs by phase of care and used US Census population projections to calculate cancer care costs through 2020. The researchers projected prevalence by phase of care under different assumptions about future incidence and survival. Incidence is decreasing for cancers at most sites. But even with declining incidence rates, the absolute number of individuals diagnosed with cancer will continue to increase because of population changes. The researchers also projected costs by phase of care under different assumptions about future trends. “Costs of care for cancer patients who die of their disease follows a U-shaped curve, with the highest costs in the initial phase following diagnosis and the phase before death, and the lowest costs in the period in-between, the continuing phase,” the authors state.

Stroke Risk Profiles

The impact of risk factors can be summarized in a quantitative way to provide a multivariate assessment of an individual’s probability of a stroke in a specified time period, usually 10 years. Multivariable risk factor modeling really was begun in Framingham in the 1960s and evolved to the present. Specific risk profiles for a number of cardiovascular disease (CVD) outcomes can be found at www.framinghamheartstudy.org, including the stroke risk profile published in 19911 with a modification for antihypertensive medication interaction in women.2 The ability to synthesize and summarize in a quantitative manner the additive impact of an array of CVD risk factors provides a way to identify persons at substantial elevated risk even if they have multiple borderline or slightly elevated risk factor levels. These persons whose significantly increased probability of stroke …

How much can current interventions reduce colorectal cancer mortality in the U.S.?

Although colorectal cancer (CRC) is the second leading cause of cancer death in the U.S., available interventions to reduce CRC mortality are disseminated only partially throughout the population. This study assessed the potential reduction in CRC mortality that may be achieved through further dissemination of current interventions for risk-factor modification, screening, and treatment. The MISCAN-COLON microsimulation model was used to simulate the 2000 U.S. population with respect to CRC risk-factor prevalence, screening use, and treatment use. The model was used to project age-standardized CRC mortality from 2000 to 2020 for 3 intervention scenarios. Without changes in risk-factor prevalence, screening use, and treatment use after 2000, CRC mortality would decrease by 17% by the Year 2020. If the 1995 to 2000 trends continue, then the projected reduction in mortality would be 36%. However, if trends in the prevalence of risk-factors could be improved above continued trends, if screening use increased to 70% of the target population, and if the use of chemotherapy increased among all age groups, then a 49% reduction would be possible. Screening drove most (23%) of the projected mortality reduction with these optimistic trends; however, decreasing risk-factors (16%) and increasing use of chemotherapy (10%) also contributed substantially. The contribution of risk-factors may have been overestimated, because effect estimates could not be obtained from randomized controlled trials. Currently available interventions for risk-factor modification, screening, and treatment have the potential to reduce CRC mortality by almost 50% by the Year 2020. However, without action now to further increase the uptake of current effective interventions, the reduction in CRC mortality may be only 17%.

Changes in traffic crash mortality rates attributed to use of alcohol, or lack of a seat belt, air bag, motorcycle helmet, or bicycle helmet, United States, 1982–2001

Objective: To estimate the contributions of five risk factors to changes in US traffic crash mortality: (1) alcohol use by drivers and pedestrians, (2) not wearing a seat belt, (3)...

Estimation and projections of colorectal cancer trends in Italy.

Occurrence of and prognosis for tumours of the colon and rectum are thought to be changing rapidly due to simultaneous changes in risk factor prevalence, early diagnosis and treatment. In this paper time trends of morbidity, survival and mortality for colorectal cancer during the period 1970-1990 are estimated and analysed. Mortality trends were obtained from official death certificates. Relative survival rates were computed from population-based cancer registries. Incidence and prevalence rates were estimated from mortality and survival data. Incidence rates were increasing during the period considered, with a lower rate of increase for the youngest birth cohorts. Relative survival rates of both colon and rectum cancers were higher for women, and for younger age groups, and were positively associated with period of diagnosis. No significant survival difference among the cancer registries used was found. A total of about 155,000 prevalent cases, 40% of which had been diagnosed > or = 7 years before, were estimated in the Italian population for the year 1990. Mortality rates were slightly increasing for men and stable for women. Projections of colorectal cancer trends to the year 2000 indicate major expected rises in both incidence and prevalence. Colorectal cancer represents a problem of growing impact for health services in Italy. This conclusion can probably be extended to many developed countries.

Timeless epidemiology or history cannot be ignored

Epidemiology has produced some useful effect measures, the etiologic fraction and the potential impact fraction, with which the effects of changes in risk factor prevalence on disease specific incidence can be estimated. However to be able to use them for decisions in health policy, adjustments need to be made, in order to incorporate elements that can be avoided in carefully designed epidemiologic studies but cannot be ignored if the results are applied to the “real world”. Such necessary adjustments include an approach in which the multi factorial aspects of chronic disease epidemiology and time dimensions can be taken into account. In this article we show the effect of including a time dimension in epidemiologic effect measures. Such a time dimension is important, e.g. to be able to incorporate the effect of a gradual reduction in excess risk following cessation of exposure to a risk factor such as cigarette smoking.

Recent trends in cervix uteri cancer

Since the prevalence of several risk factors for cervix uteri cancer, such as sexual activity patterns, cigarette smoking, and contraceptive use, has changed over time, the authors analyzed US trends for this cancer during the 1970s to 1980s to search for corresponding variations. Invasive cervical cancer incidence and mortality rates continued to decrease among blacks and whites, although declines are moderating or plateauing among young whites. Carcinoma in situ rates have not changed greatly or have declined, more so among blacks than whites. Excess risks among blacks are less evident among younger than older age groups. Increasing trends were seen only among whites in certain age groups or with certain histologic types. Declining trends in cervical cancer appear related to the widespread use of cervical cytologic screening programs, which have counteracted increases anticipated from changes in risk factor prevalence. Continued surveillance is warranted, however, with special attention to the trends in cervical adenocarcinoma.

Trends in the incidence of cancer of the corpus uteri in Connecticut, 1964-1979, in relation to consumption of exogenous estrogens.

The incidence of cancer of the uterine corpus diagnosed in the localized 1964 and 1969. During the next six years, however, it increased substantially, reaching a peak in 1975, followed by an irregular decline through 1979. Women aged 45-64 years showed both the largest increase and the sharpest decline. The incidence of tumors diagnosed with regional or distant spread has been rising slightly but consistently through the period 1970-1979; this upward trend is statistically significant (p less than 0.01). Rates corrected for hysterectomized women not truly at risk are 40-50% higher than uncorrected rates but trends are the same. Explanations which are considered are changes in diagnostic practices and changes in risk factor prevalence. The use of noncontraceptive oral estrogens, a well documented risk factor for endometrial cancer, increased between 1964 and 1975 and then declined sharply through 1979 in the United States. The importance of these compounds in explaining the observed incidence trends is considered in terms of the major time- and stage-specific features of the exogenous estrogen-endometrial cancer association reported in the case-control studies.