Florida Cancer Registry Research Articles

Survival of children and young adults with skin cancer: Analysis of a population-based Florida cancer registry: 1981-2013.

Although pediatric and young adult skin cancer is uncommon, recent epidemiologic studies have shown pediatric melanoma to be on the rise in the United States. Using a population-based cancer registry, this study examined skin cancer burden and survival disparities in children and young adults. Linked data from the Florida Cancer Data System and U.S. Census were analyzed to elucidate skin cancer burden distribution and survival disparities in 1543Florida children (0-9years), adolescents (10-19years), and young adults (20-24years). These disparities were assessed according to sociodemographic groups such as sex, race, ethnicity, and neighborhood level socioeconomic status. A multivariable Cox regression model adjusted for sociodemographic, clinical, and tumor characteristics was used to predict survival. Boys had a slightly greater burden of skin cancer among children (50.9%), whereas girls had the greatest burden for adolescents (54.5%) and young adults (60%). Survival differed between white, black, and other races; 1-year survival was 91.5% for whites and 77.9% for blacks. Average 3- and 5-year survival was comparable for blacks and whites. "Other" race had a 1- and 3-year survival of 96.2%. Because skin cancer is on the rise, it is important to elucidate the burden and determinants associated with survival outcomes to identify high-risk pediatric and young adult populations. Understanding these factors in the Florida pediatric population may provide a base for future endeavors to create culturally competent cancer prevention programs through screening, health promotion, and literacy.

Occurrence of Pancreatic Cancer Associated Insulin Dependent Diabetes

Patients with pancreatic cancer often present with non-specific symptoms and are often diagnosed at an advanced stage. The relationship between diabetes and the development of pancreatic cancer has been an area of intense research. In the present study we specifically aim to look at the hypothesis that the incidence of insulin dependent diabetes increases after the onset of pancreatic cancer. Materials and Methods: We retrospectively reviewed the chart of all pancreatic cancer patients in tumor registry admitted to University of Florida Tumor Registry in Jacksonville, Florida. Data was collective from January 2000 and December 2006. Each patient’s record was reviewed for histologic biopsy, demographic information, presence of risk factors, co-morbidities, presence and duration of diabetes. Assessment of diabetes was based on the guidelines provided by American Diabetes Association. Results: 82 patients were identified from the University of Florida Cancer Registry from the year 2000-2006. Complete data was available on 76 patients. Mean age at diagnosis was 66.4 years. 53 (69.7%) were African American, 23 (30.26%) were white. There was an equal male/female distribution of 1:1.07 (43 males; 40 females). 35 (46.0%) patients were smokers. Most common presentation was with obstructive jaundice (33/76 or 43.4%) followed by typical symptoms of weight loss, fatigue, abdominal and back pain (31/76 or 40.78%). In 11 (14.47%) patients, pancreatic cancer was noted as an incidental finding. Staging at the time of diagnosis was available in 76 patients. 48 (63.1%) patients were in Stage 4, 13 (17.1%) patients were in Stage 3, 10 (13.15%) patients were at stage 2 and 5 (6.5%) patients were in Stage 1. 15(19.7%) patients had diabetes at the time of diagnosis of pancreatic cancer. 5 (6.5%) developed one or more deep vein thrombosis (DVTs) after the diagnosis of PC. Diabetes was present in 15 (19.7%) for an average duration of 19 months. Only 4(26.6%) out of 15 patients were on insulin therapy before the diagnosis of pancreatic cancer. Six additional patients (an increase of 7.93%) developed diabetes after the diagnosis of pancreatic cancer. 13 (61.9%) of the 21 patients required insulin therapy after the diagnosis of pancreatic cancer. As many as 27 (35%) patients opted for hospice care after the diagnosis of pancreatic cancer. Whipple’s procedure or exploratory debulking surgery of the tumor was performed in 33 (43%) patients. 29 (38.1%) patients received Gemcitabine/carboplatin/5 FU based chemotherapy. Conclusion: We found that the Incidence of Insulin-dependent diabetes increased in patients diagnosed with pancreatic cancer.

Abstract LB-175: Gender and racial disparities in incidence trends of tobacco-related cancers from 2010 to 2013

Abstract Over one in three cancer-related deaths are associated with tobacco use. Although the overall incidence trend of tobacco-related cancers (TRCs) has been decreasing in the past a few decades, evidence suggests that not all TRCs have decreasing incidence and there exists gender and racial disparities in the TRC trends. Prior studies of TRC incidence have used the Surveillance, Epidemiology, and End Results Program (SEER) database. However, the SEER database includes limited information regarding the United States southeastern region and has been shown not to be representative of the US. In this study, we analyzed TRC incidence trends from 2010 to 2013 using the Florida cancer registry data, collected from a large ethno-racially diverse state. We computed annual age-adjusted incidence rates and annual percentage change (APC) to characterized the incidence trends of the following cancers: oral cavity, cervical, respiratory (lung, bronchitis, and larynx), urinary (bladder, kidney, and renal pelvis), digestive (esophagus, stomach, and pancreas), non-Hodgkin’s lymphoma, and pharyngeal. All incidence trends were also evaluated stratifying by gender (men and women) and race (Non-Hispanic (NH) Whites, NH Blacks, and Hispanics). Overall, all TRCs had a significant decrease in age-adjusted incidence rates for the study period, except for non-Hodgkin’s lymphoma and pharyngeal cancer for which the incidence remained unchanged. Oral cavity cancer had the biggest decline in age-adjusted incidence rates (APC= −2.5; 95% CI= −3.4, −1.6), while cancers of the digestive system had the smallest decline in incidence rates (APC= −0.6; 95% CI= −1.0, −0.2). When broken down by gender, males have a greater decrease in incidence rates than women for urinary and respiratory cancers. In addition, while pharyngeal cancer incidence rate stayed unchanged overall, there was a significant increase in the rate among male (APC= 1.0; 95% CI= 0.3, 1.7), but not female. When broken down by race and ethnic groups, NH Blacks and Hispanics had greater decline in cancer incidence for cervical cancer, oral cavity cancer, and respiratory cancer. For pharyngeal cancer, there was a significant decrease in incidence among NH Blacks (APC= −3.7; 95% CI= −5.5, −1.9), while the incidence significantly increased among NH Whites (APC= 1.6; 95% CI= 0.7, 2.5). In summary, there was an overall decreasing trend of TRC incidence. However, increasing incidence of pharyngeal cancer was observed for male and NH Whites. Citation Format: Danyell S. Wilson, Alice Parish, Yi Guo. Gender and racial disparities in incidence trends of tobacco-related cancers from 2010 to 2013 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr LB-175. doi:10.1158/1538-7445.AM2017-LB-175

Characterization of germline and tumor genomic profile in unselected young black breast cancer patients.

e13090 Background: Young black women bear a disproportionate burden of breast cancer (BC), yet there is limited characterization of these cancers based on BRCA1 and BRCA2 ( BRCA) status and tumor genomics. In this pilot study, we characterized: tumor and clinical characteristics based on BRCA carrier status and overlap of basal-like (BL) and triple negative (TN) BC. Methods: A population-based sample of 481 black women diagnosed with invasive BC < age 50 were recruited through the Florida Cancer Registry (FCR). BRCA status was determined based on germline testing. TN status was determined based on pathology reports and FCR data. Among a subset of 90 participants, gene expression profiling (GEP) was conducted on tumor samples through PAM50 analyses to classify intrinsic subtypes and risk of recurrence (ROR) scores. Results: Mean age at BC diagnosis was 41.9 (range: 25-50) and mean ROR score was 49.6 (range: 8.7-80.7). Participants included 7 BRCA1 carriers, 5 BRCA2 carriers, 67 non-carriers (NC), and 11 with no confirmed testing. Of 46 BL tumors, 33 were TN (71.7%) constituting 94.3% of TN tumors (the remaining 5.7% were Luminal A). All BRCA1 carriers had BL tumors, of which 5 were TN. Sensitivity, positive predictive value, and negative predictive value in identifying BRCA1 carrier was higher based on BL compared to TN status (Table 1). BRCA2-associated tumors included 3 Luminal A, 1 Luminal B, and 1 BL. Mean ROR score was highest among BRCA1 carriers (57.7), followed by NC (50.5) and BRCA2 carriers (41.5). Conclusions: Study findings suggest BL status predicted BRCA1 positivity better than TN status. BRCA2- (compared to BRCA1-) associated tumors were more heterogeneous with over half being Luminal A, which may explain the lower ROR among BRCA2 carriers. Additional follow-up and expansion of this cohort with collection of clinical outcomes will be useful in assessing the predictive utility of ROR scores among young black women with BC. [Table: see text]

Human Papilloma Virus (HPV)-Associated Cancers in Women: Multivariable Survival Analysis of Population-Based Florida Cancer Registry (1981–2009)

Human Papilloma Virus (HPV)-Associated Cancers in Women: Multivariable Survival Analysis of Population-Based Florida Cancer Registry (1981–2009)

A high frequency of BRCA mutations in young black women with breast cancer residing in Florida.

Black women are disproportionately affected with triple-negative breast cancer and have relatively poor survival. To the authors' knowledge, it is not known to what extent differences in the clinical presentation of breast cancer between non-Hispanic white women and black women can be accounted for by the presence of mutations in the BRCA1 and BRCA2 genes. The authors sought to evaluate the frequency of BRCA pathogenic variants in a population-based sample of young black women with breast cancer. Black women diagnosed with invasive breast cancer at age ≤50 years from 2009 to 2012 were recruited to the study through the Florida Cancer Registry. Participants underwent genetic counseling, completed a study questionnaire, and consented to release of their medical records. Saliva specimens were collected for BRCA sequencing and large rearrangement testing through multiplex ligation-dependent probe amplification. A DNA sample was evaluated for 396 women, 49 of whom (12.4%) had a mutation in BRCA1 or BRCA2. Eight recurrent mutations accounted for 49% of all pathogenic variants. To the authors' knowledge, the prevalence of BRCA mutations among the Florida-based sample of young black women with breast cancer in the current study exceeds that previously reported for non-Hispanic white women. It is appropriate to recommend BRCA testing in all young black women with invasive breast cancer.

Survival disparities in pediatric acute lymphocytic leukemia and acute myeloid leukemia: Analysis of population-based Florida cancer registry (1981-2009).

e21000 Background: Leukemia is the most common cancer in children and teenagers. Acute Lymphocytic Leukemia (ALL) is more common than Acute Myeloid Leukemia (AML) and Chronic Myeloid Leukemia (CML)...

Survival disparities in pediatric skin cancer: Analysis of population-based Florida cancer registry (1981-2009).

e21033 Background: Pediatric melanoma is increasing in incidence, and differences in incidence rates between children and adolescents exist. We identified disparities in pediatric skin cancer survi...

Factors associated with contralateral preventive mastectomy.

IntroductionContralateral prophylactic mastectomy (CPM) is an option for women who wish to reduce their risk of breast cancer or its local recurrence. There is limited data on demographic differences among patients who choose to undergo this procedure.MethodsThe population-based Florida cancer registry, Florida’s Agency for Health Care Administration data, and US census data were linked and queried for patients diagnosed with invasive breast cancer from 1996 to 2009. The main outcome variable was the rate of CPM. Primary predictors were race, ethnicity, socioeconomic status (SES), marital status and insurance status.ResultsOur population was 91.1% White and 7.5% Black; 89.1% non-Hispanic and 10.9% Hispanic. Out of 21,608 patients with a single unilateral invasive breast cancer lesion, 837 (3.9%) underwent CPM. Significantly more White than Black (3.9% vs 2.8%; P<0.001) and more Hispanic than non-Hispanic (4.5% vs 3.8%; P=0.0909) underwent CPM. Those in the highest SES category had higher rates of CPM compared to the lowest SES category (5.3% vs 2.9%; P<0.001). In multivariate analyses, Blacks compared to Whites (OR =0.59, 95% CI =0.42–0.83, P=0.002) and uninsured patients compared to privately insured (OR =0.60, 95% CI =0.36–0.98, P=0.043) had significantly less CPM.ConclusionCPM rates were significantly different among patients of different race, socio-economic class, and insurance coverage. This observation is not accounted for by population distribution, incidence or disease stage. More in-depth study of the causes of these disparities in health care choice and delivery is critically needed.

Factors associated with increasing rates of contralateral prophylactic mastectomy.

57 Background: Contralateral prophylactic mastectomy (CPM) is an option increasingly used by women who wish to reduce their risk of breast cancer or its local recurrence. There is limited data on demographic differences among patients who choose to undergo this procedure. Methods: The population-based Florida cancer registry, Florida’s Agency for Health Care Administration (AHCA) data, and U.S. census data were linked and queried for patients diagnosed with invasive breast cancer from 1996 to 2009. The main outcome variable was the rate of CPM in those with a single unilateral cancer diagnosis. Primary predictors were race, ethnicity, socioeconomic status (SES), marital status, and insurance status. Results: The rates of CPM rose from 2% in 1996 to 4.8% in 2006 up to 8% in 2009. The population studied was 91.1% white and 7.5% black; 89.1% non-Hispanic and 10.9% Hispanic. Out of 21,608 included patients, 837 (3.9%) underwent CPM. Significantly more white than black (3.9 versus 2.8%; p &lt; 0.001) and more Hispanic than non-Hispanic (4.5 versus 3.8%; p = 0.0909) underwent CPM. Those in the highest SES category had higher rates of CPM compared to the lowest SES category (5.3 versus 2.9%; p &lt; 0.001). In multivariate analyses, Blacks and uninsured patients had significantly less CPM compared to whites and private patients (OR = 0.59, 95% CI 0.42- 0.83, p = 0.002) and (OR = 0.60, 95% CI 0.36- 0.98, p = 0.043), respectively. Conclusions: CPM rates are significantly increasing; these rates were significantly different among patients of different race, socioeconomic class, and insurance coverage. This observation is not accounted for by population distribution, incidence or disease stage. More in-depth study of the causes of this increase and the disparities in healthcare delivery is critically needed.

High rate of uncaptured myelodysplastic syndrome cases and an improved method of case ascertainment

The myelodysplastic syndromes (MDS) are often diagnosed in outpatient clinics and may be under-reported to state cancer registries, which predominantly rely on hospital records and laboratory reports. We used a new method of cancer case capture to determine the rate of missed cases and estimate a more accurate incidence of MDS. Using a unique keyword algorithm, we queried all electronic pathology (E-path) reports sent to the state of Florida cancer registry in 2006 to identify potential MDS cases. A stratified, random sample of E-path reports was then reviewed to confirm diagnosis and assign MDS subtype. Characteristics were compared between captured and uncaptured MDS cases. 7111 E-path reports with MDS keyword hits were identified, of which only 18% linked to a registered MDS case, 47% linked to a different cancer, and 34% did not link with any record. Case review of a stratified, random sampling of 285 individuals led to the discovery that uncaptured cases made up 37.7% of the total true MDS cases in 2006. It is estimated that the true incidence of MDS is 5.3 individuals out of 100,000, compared to previous reports of 3.3 out of 100,000. Uncaptured MDS cases were younger and more likely to have information in the pathology report facilitating MDS subtype assignment. Only two-thirds of true MDS cases are captured in Florida using current case-finding mechanisms. Application of a keyword search strategy to identify cases among E-path reports is a feasible technique to improve MDS case ascertainment.

BRCA sequencing and large rearrangement testing in young Black women with breast cancer

Young Black women in the United States are disproportionately afflicted with breast cancer, a proportion of which may be due to BRCA1 and BRCA2 (BRCA) gene mutations. In a cancer registry-based sample of young Black women with breast cancer, we evaluated: (1) the prevalence of BRCA mutations detected through full gene sequencing and large rearrangements testing and (2) proportions that accessed genetic services pre-dating study enrollment. Black women diagnosed with invasive breast cancer ≤age 50years in 2009-2012 were recruited through the Florida Cancer Registry. Participants completed genetic counseling, a study questionnaire, and consent for medical record release. Saliva specimens were collected for BRCA testing. Overall, 13 participants (9%) had BRCA mutations detected (including 11 through full gene sequencing and two through large rearrangements testing). One of these large rearrangements, BRCA1 (delExon8), was identified in a participant who had previously tested negative on clinical comprehensive BRCAnalysis that was performed prior to undergoing a lumpectomy. Although all 144 participants met national criteria for referral for cancer genetic risk assessment, 61 (42%) were referred for genetic counseling and/or had genetic testing preceding study enrollment, and only 20 (14%) received genetic counseling. Our findings emphasize the importance of large rearrangements testing to increase detection of deleterious BRCA mutations in young Black women with breast cancer. The registry-based design of our study increase the generalizability of findings compared with efforts focused on clinic-based populations. Furthermore, results suggest efforts are needed to improve access to genetic counseling and testing.

Participation in Cancer Clinical Trials

Participation in cancer clinical trials is low, particularly in racial and ethnic minorities in some cases, which has negative consequences for the generalizability for study findings. The objective of this study was to determine what factors are associated with patients' participation or willingness to participate and whether these factors vary by race/ethnicity. or . White, Hispanic, and black participants were obtained through the Florida cancer registry and who were diagnosed with breast, lung, colorectal, or prostate cancer (N = 1100). Participants were surveyed via telephone to obtain demographic information, past participation, and willingness to participate in clinical trials, as well as barriers and facilitators to participation. Logistic and Poisson regressions were performed. . Respondents were on average 67.4 years old, 42.7% were male, and 50.1% were married. In this population, 7.7% of respondents had participated in a clinical trial, and 36.5% stated that they would be willing to participate. In multivariate models, blacks and Hispanics were equally likely as whites to be willing to participate in cancer trials, but Hispanics were less likely to have participated, and this was especially more likely in non-English-speaking Hispanics compared with English-speaking Hispanics. Notable barriers across race/ethnicity were mistrust and lack of knowledge of clinical trials. Limitations. Cross-sectional design limits cause-and-effect conclusions. . There are racial differences in participation rates but not in willingness to participate. We hypothesize that willingness to participate is not very high because people are uninformed about participating, particularly in non-English-speaking Hispanics. Barriers and facilitators to participation vary by race. Improved understanding of cultural differences that can be addressed by physicians may restore faith, comprehension, and acceptability of clinical trials by all patients.

Abstract A34: How important is comprehensive rearrangement testing for BRCA mutations in African American women with early-onset breast cancer?

Abstract Background: Young Black women are disproportionately afflicted with breast cancer, a proportion of which may be due to BRCA1 and BRCA2 (BRCA) gene mutations. Deleterious mutations in the BRCA genes include those identified by sequencing technology as well as large genomic rearrangements that are found with different technologies (i.e., multiplex ligation-dependent probe amplification (MLPA)). The sole provider of clinical BRCA genetic testing in the United States is Myriad Genetics Laboratories, the company which owns the patent on these genes. When BRCA testing is ordered through this company, the standard test is called ‘Comprehensive BRCAnalysis’, which includes BRCA sequencing and testing for five rearrangements in BRCA1. In addition, testing for large rearrangements has been available since 2006, but is ordered and billed as a separate test from Comprehensive BRCAnalysis (at a cost of $700, often as an out-of-pocket expense). Objectives: In a cancer registry-based sample of Black women with early onset breast cancer, we evaluated prevalence of: 1) BRCA mutations; and 2) individuals who had BRCA testing (+counseling) predating study enrollment. Methods: Black women diagnosed with invasive breast cancer &amp;lt; age 50 in 2009-2010 were recruited through the Florida Cancer Registry utilizing state-mandated recruitment methods. Participants completed genetic counseling and a comprehensive risk factor questionnaire which included uptake of clinical BRCA testing pre-dating study enrollment. All participants consented to medical record release, including release of prior genetic test results. Saliva specimens were collected and BRCA testing was performed on all individuals through full gene sequencing and comprehensive rearrangement testing. Results: Of the first 48 participants in whom results of genetic testing are currently available through the study, two mutations in the BRCA genes were detected. Both mutations were identified in women who had undergone comprehensive BRCAnalysis pre-dating study enrollment. This included one participant identified to have a deleterious BRCA2 mutation through prior clinical testing (BRCA2 exon11 5844del5), in whom the same mutation was detected through the study. The second mutation was identified through comprehensive rearrangement testing (BRCA1 delExon8) in a woman who had previously had clinical BRCA testing during her breast cancer treatment in whom no mutation was detected through ‘Comprehensive BRCAnalaysis’. Of note, 15 women overall (31.3%) had clinical BRCA testing pre-dating study enrollment, which included both women identified as mutation carriers. Conclusions: Our findings suggest that it is critical to offer comprehensive rearrangement testing as part of BRCA testing in African American women, as one of the two mutations identified in our study was only identified through MLPA. Furthermore, in contrast to prior publications which suggest low uptake of BRCA testing in African American women, our results suggest reasonable uptake of BRCA testing in a registry-based sample of African American women with rates comparable to that previously reported in White women. Citation Format: Tuya PalDevon Bonner, Mohammad Akbari, Steven Narod, Susan Vadaparampil. How important is comprehensive rearrangement testing for BRCA mutations in African American women with early-onset breast cancer? [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 A34.

Abstract A71: BRCA mutations and surgical decision making in a sample of young black women with invasive breast cancer

Abstract Background: On average, Black women develop breast cancer ten years earlier than White women and are more likely to die from the disease. Early onset breast cancer is a hallmark feature of the BRCA1 and BRCA2 (BRCA) gene mutations and may contribute to a portion of breast cancers in Black women. Widespread availability of genetic testing for hereditary breast cancer has resulted in an increasing number of women considering their BRCA test results prior to surgical treatment decisions for their breast cancer surgery (e.g., consideration of a risk-reducing bilateral mastectomy, contralateral prophylactic mastectomy). However, little is known about use of BRCA testing prior to definitive surgery specifically among Black women. The purpose of this abstract is to describe baseline utilization of BRCA testing in Black breast cancer patients prior to surgery and to document the prevalence of BRCA mutations in a cohort of Black women with early onset breast cancer. Methods: Black women diagnosed with invasive breast cancer ≤ age 50 between the years of 2005 and 2006 were recruited through the Florida Cancer Registry utilizing state-mandated recruitment methods. Participants completed genetic counseling and a comprehensive risk factor questionnaire including 7 items specific to referral and uptake of genetics clinical services. Biological specimens (either blood or saliva) were collected, and BRCA testing was performed. Results: Of the 209 eligible cases, 48 women consented to study participation. Of the 46 women with usable biological specimens: the average age of diagnosis was 42.8 ±6.14 and 50% (n=23) reported a positive family history of breast cancer (i.e., ≥ 1 first and/or second-degree relative with breast cancer). A previous BRCA test was reported by 30.4% (n=14) of those completing the study with only 2 participants (4.3%) receiving a genetic test result prior to making a breast surgery decision. Seven women (15.2 %) chose a bilateral mastectomy, 4 of which were risk reducing. No association was observed between family history and the type of breast surgery elected. Mutations in the BRCA genes were identified in three participants (including 1 in BRCA1 and 2 in BRCA2). In 16 additional participants, there were a total of 28 variants of uncertain significance (VUS) identified. Conclusions: Our results suggest that few Black women utilized genetic test results and/or family history to make surgical decisions for their breast cancer treatment despite data documenting similar BRCA prevalence rates in Black women with early onset breast cancers as those previously reported in White women. These findings highlight an important health disparity in access to and utilization of genetics services among Black women with breast cancer. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A71.

Effects of Poverty and Race on Outcomes in Acute Myeloid Leukemia

To determine how patient race, ethnicity, and degree of poverty affect treatment and survival for acute myeloid leukemia (AML). A linked database of the Florida cancer registry and State inpatient and outpatient hospital data for 1998-2002 was queried. Effects of demographic and treatment characteristics on survival were explored using univariate and multivariate analyses methods. A total of 4659 patients with AML were identified. Over 50% of patients with AML were 70 years of age or older. African American (AA) patients were diagnosed at significantly younger ages than were whites (P < 0.001). In multivariate analysis, independent predictors of worse survival in AML were aged over 50 (hazard ratios [HRs]: 1.60, 2.15, 3.04, and 3.62 over the decade-cohorts, all P < 0.001), AA race (HR: 1.27, P < 0.001), being a former or current user of tobacco (HR: 1.13, P = 0.004 and HR: 1.28, P < 0.001, respectively), residing in an area with the highest poverty level (HR: 1.15, P = 0.007), and being covered only by Medicaid (HR: 1.23, P = 0.014). No differences in outcomes were observed related to gender or ethnicity. Receipt of chemotherapy was strongly associated with improved survival (HR: 0.59, P < 0.001). When only those patients who received and appeared to respond to treatment are included, AAs continued to demonstrate a worse outcome than Whites. AML disproportionately affects the elderly. AA patients and patients from poorer communities with AML have significantly worse survival. Interventions to provide earlier diagnosis in these patients as well as to improve overall outcomes are needed to address these disparities.

Do racial or socioeconomic disparities exist in lung cancer treatment?

Determine the effects of race, socioeconomic status, and treatment on outcomes for patients diagnosed with lung cancer. The Florida cancer registry and inpatient and ambulatory data were queried for patients diagnosed from 1998-2002. A total 76,086 of lung cancer patients were identified. Overall, 55.6% were male and 44.4% were female. The demographic distribution of patients was 92.7% Caucasian, 6.7% African American, and 5.7% Hispanic. The mean age of diagnosis was 70 years old. African American patients presented at a younger age, with more advanced disease, and were less likely to undergo surgical therapy than their Caucasian counterparts. Median survival time (MST) for the entire cohort was 8.7 months, while MST for African American patients was 7.5 months. Patients who received surgery, chemotherapy, or radiation therapy demonstrated significantly improved outcomes. Stepwise multivariate analysis revealed that African American race was no longer a statistically significant predictor of worse outcomes once corrections were made for demographics and comorbid conditions, suggesting that the originally reported disparities in lung cancer outcomes and race may be in part because of poor pretreatment performance status. In contrast, patients of the lowest socioeconomic status continue to have a slightly worse overall prognosis than their affluent counterparts (hazard ratio = 1.05, P = .001). Lung cancer continues to carry a poor prognosis for all patients. Once comorbidities are corrected for, African American patients carry equivalently poor outcomes. Nonetheless, emphasis must be placed on improving pretreatment performance status among African American patients and efforts for earlier diagnosis among the impoverished patients must be made.

Survival Effects of Adjuvant Chemoradiotherapy After Resection for Pancreatic Carcinoma

The survival benefit of adjuvant chemotherapy alone or chemoradiotherapy in patients with pancreatic cancer who have undergone surgical resection remains unclear. To identify the additional benefit of adjuvant therapy by retrospectively examining a large population-based registry of patients who underwent definitive surgical resection for pancreatic adenocarcinoma. The Florida cancer registry and state inpatient and outpatient hospital data records were queried for pancreatic adenocarcinoma diagnosed between 1998 and 2002. A total of 2877 patients who underwent surgical resection with curative intent for pancreatic adenocarcinoma were identified. Main Outcome Measure Overall survival time. Overall, 58.7% of patients were older than 65 years. Most patients were white (90.7%), were non-Hispanic (86.7%), and did not consume alcohol abusively (89.2%). Approximately half of the patients (51.9%) did not receive chemotherapy or chemoradiotherapy. Approximately 25.0% of the patients underwent chemoradiotherapy, and 10.0% received chemotherapy alone. Patients were more frequently treated at low-volume centers (57.6%) and nonteaching facilities (72.8%). Multivariate analysis correcting for patient comorbidities demonstrated that postoperative chemoradiotherapy (hazard ratio = 0.69, P = .04) and treatment at high-volume centers (hazard ratio = 0.85, P < .001) and teaching facilities (hazard ratio = 0.84, P < .001) were independent predictors of improved survival. Adjuvant chemoradiotherapy was found to provide a significant additional survival benefit to surgical resection for patients with pancreatic adenocarcinoma. Furthermore, this benefit is independent of the additional survival advantage when patients are treated at teaching facilities or high-volume centers. Although selection bias may be contributing to the observed differences, these data nonetheless support the use of adjuvant chemoradiotherapy for pancreatic cancer.

Cancer Incidence in First Generation U.S. Hispanics: Cubans, Mexicans, Puerto Ricans, and New Latinos

The diversity among Hispanics/Latinos, defined by geographic origin (e.g., Mexico, Puerto Rico, Cuba), has been neglected when assessing cancer morbidity. For the first time in the United States, we estimated cancer rates for Cubans, Mexicans, Puerto Ricans, and other Latinos, and analyzed changes in cancer risk between Hispanics in their countries of origin, U.S. Hispanics in Florida, and non-Hispanic Whites in Florida. Florida cancer registry (1999-2001) and the 2000 U.S. Census population data were used. The Hispanic Origin Identification Algorithm was applied to establish Hispanic ethnicity and subpopulation. The cancer rate of 537/100,000 person-years (95% confidence interval, 522.5-552.5) for Hispanic males in Florida was lower than Whites (601; 595.4-606.9). Among women, these rates were 376 (365.6-387.1) and 460 (455.6-465.4), respectively. Among Florida Hispanics, Puerto Ricans had the highest rates, followed by Cubans. Mexicans had the lowest rates. Rates for Hispanics in Florida were at least 40% higher than Hispanics in their countries of origin, as reported by the IARC. Substantial variability in cancer rates occurs among Hispanic subpopulations. Cubans, unlike other Hispanics, were comparable with Whites, especially for low rates of cervical and stomach cancers. Despite being overwhelmingly first generation in the U.S. mainland, Puerto Ricans and Cubans in Florida showed rates of colorectal, endometrial, and prostate cancers similar to Whites in Florida. Because rates are markedly lower in their countries of origin, the increased risk for cancer among Cubans, Mexicans, and Puerto Ricans who move to the United States should be further studied.

Food Groups and Renal Cell Carcinoma: Results from a Case-Control Study

Background The role of diet in renal cell carcinoma risk has been inconclusive. This study uses an integrative approach to assess the role of food groups and food items in renal cell carcinoma risk. Design A case-control study was conducted from 2003-2006. Subjects/setting Incident cases (n=335) were identified from hospital records and the Florida cancer registry, and population controls (n=337) frequency matched by age (±5 years), sex, and race were identified through random-digit dialing. Eating habits were assessed through the use of the 70-item Block food frequency questionnaire. Statistical analyses Odds ratios (ORs), 95% confidence intervals (CIs), and tests for trends were calculated using logistic regression, controlled for age, sex, race, income, body mass index, and pack-years of smoking. Results Decreased renal cell carcinoma risk was observed among the total sample and for men for vegetable consumption (all subjects: OR 0.56, 95% CI 0.35, 0.88; men: OR 0.49, 95% CI 0.25, 0.96) but not for fruit consumption. Tomato consumption decreased renal cell carcinoma risk for the total population and for men (all subjects: OR 0.50, 95% CI 0.31, 0.81; men: OR 0.47, 95% CI 0.24, 0.95). Increased risk of renal cell carcinoma was observed among all subjects and among women with increased consumption of red meat (all subjects: OR 4.43, 95% CI 2.02, 9.75; women: OR 3.04, 95% CI 1.60, 5.79). White bread consumption increased renal cell carcinoma risk among women only (OR 3.05, 95% CI 1.50, 6.20), as did total dairy consumption (OR 2.36, 95% CI 1.21, 4.60). Conclusions The protective role of vegetables and the increased risk of renal cell carcinoma with meat consumption are supported. The protective role of fruits is not. Novel findings include the increased risk of renal cell carcinoma with white bread and white potato consumption and the decreased risk of renal cell carcinoma with tomato consumption.