Number Of Incident Cancer Cases Research Articles

Trend analysis of major cancer statistics according to sex and severity levels in Korea.

Existing epidemiologic reports or studies of cancer statistics in Korea lack sufficient data on cancer severity distributions and observed survival rates. This study analyzed trends in major cancer statistics according to sex and severity levels in Korea from 2006 to 2013. We included eight cancers (hepatocellular carcinoma, and thyroid, colorectal, gastric, lung, prostate, breast, and cervical cancer), using Korea Central Cancer Registry data. Severity level was classified by Surveillance, Epidemiology, and End Results (SEER) stage as follows: localized, regional, distant, or unknown. Numbers of incident cancer cases from 2006 to 2013 were described by sex and SEER stage. We estimated up to 8-year observed survival rates of major cancers by sex and SEER stage, and provided prevalence rates by sex and SEER stage in 2011, 2012, and 2013. Although increases in new cancer cases are slowing and the total number of incident cancer cases in 2013 decreased for the first time since 2006, the number of prevalent cancer cases was 663,530 in 2013, an increase of 13.3% compared to 2011. Among the five cancers affecting both sexes, sex-related differences in 5-year observed survival rates for lung cancer were greatest in the localized stage (men, 31.9%; women, 48.1%), regional stage (men, 20.0%; women, 31.3%), and unknown stage (men, 24.3%; women, 37.5%). The sum of the proportions of localized and regional stages for thyroid and breast cancer was over 90% in 2013, while the sum of the proportions of localized and regional stages for lung cancer was only 56.7% in 2013. Differences in observed survival rates between men and women were prominent in lung cancer for all SEER stages. The reported epidemiologic data from this study can be used to obtain a more valid measure of cancer burden using a summary measure of population health.

Cancers around the Roussillon chemical platform

Background The Roussillon region located in the department of Isere, 50 kilometers south of Lyon, is one of the three “multi-exposed” areas identified in the Auvergne-Rhone-Alpes (ARA) region. It concentrates one of the main chemical sites of France, as well as dense road traffic and an important population. The site is subject to global environmental monitoring. Local residents and associations expressed their fear of an excess of environmental-related cancers, which local media relayed. The Regional Health Agency and the Sub-Prefecture of Isere contacted “Sante publique France” to carry out a study to address this fear. Method An ecological study was conducted, analyzing cancer incidence and cancer mortality data over the period 2003–2013 in the six communes bordering the platform (28,000 inhabitants) likely to be the most affected by its activities. The Isere cancer registry is one of the 13 general cancer registries in metropolitan France. It provided the numbers of incident cancer cases by cancer site for each commune of the department. The Center of Epidemiology on Medical Causes of Death (CepiDC) provided data from death certificates, as well as the number of deaths by cancer site, for each commune in the department of Isere. The method of analysis is based on the calculation of the standardized mortality ratio (SMR) and the standardized incidence ratio (SIR). SMRs (SIRs) are the ratios between the number of deaths (cases) observed in the population studied and the number of deaths (of cases) expected in this population if it knew the mortality conditions (of incidence) at each age of the reference population (here the population of the Isere department). The standardized ratios are accompanied by 95% confidence intervals calculated according to the Byar approximation and are then adjusted to take into account a possible over-dispersion of the data greater than the variance of the theoretical model (Poisson's law). The analysis focuses principally on cancer sites for which the pollutants identified in the area are a known or suspected risk factor in the scientific literature. Results The study on all cancers shows a slightly higher incidence of cancers among men living in the area (+8%) and a mortality rate that is not statistically different from the departmental average. For women, incidence of cancer and cancer mortality are at the same level in the area as in the Isere department. Analyzes by cancer localization show that cancers affecting the respiratory tract and mainly the mesothelioma of the pleura are in excess in the Roussillon area. For mesothelioma of the pleura, the risk, in terms of incidence and mortality, is multiplied by more than 5 in the male population of the study (significant results), and by more than 2.5 in women (non-significant results). To a lesser extent, there is an excess mortality from cancers of the larynx, trachea, bronchi and lung in men and women in the sector. No other cancer sites are found in excess among the residents of the chemical platform of Roussillon. Conclusion This study shows an important excess mesothelioma in men living in the communes surrounding the Roussillon chemical platform, largely due to an occupational exposure rather than an environmental exposure, as occupational exposure to asbestos is the main risk factor for mesothelioma. Exposure of asbestos could also explain some of the excess deaths from lung cancer. Asbestos has been used in the Roussillon chemical platform as thermal insulator. An administrative procedure is currently underway to characterize companies of the platform as an “asbestos site”.

Methodology to Forecast Volume and Cost of Cancer Drugs in Low- and Middle-Income Countries.

PurposeIn low- and middle-income countries (LMICs), frequent outages of the stock of cancer drugs undermine cancer care delivery and are potentially fatal for patients with cancer. The aim of this study is to describe a methodologic approach to forecast chemotherapy volume and estimate cost that can be readily updated and applied in most LMICs.MethodsPrerequisite data for forecasting are population-based incidence data and cost estimates per unit of drug to be ordered. We used the supplementary guidelines from the WHO list of essential medicines for cancer to predict treatment plans and ordering patterns. We used de-identified aggregate data from the Botswana National Cancer Registry to estimate incident cases. The WHO Management Sciences for Health International Price Indicator was used to estimate unit costs per drug.ResultsChemotherapy volume required for incident cancer cases was estimated as the product of the standardized dose required to complete a full treatment regimen per patient, with a given cancer diagnosis and stage, multiplied by the total number of incident cancer cases with the respective diagnosis. The estimated chemotherapy costs to treat the 10 most common cancers in the public health care sector of Botswana is approximately 2.3 million US dollars. An estimated 66% of the budget is allocated to costs of rituximab and trastuzumab alone, which are used by approximately 10% of the cancer population.ConclusionThis method provides a reproducible approach to forecast chemotherapy volume and cost in LMICs. The chemotherapy volume and cost outputs of this methodology provide key stakeholders with valuable information that can guide budget estimation, resource allocation, and drug-price negotiations for cancer treatment. Ultimately, this will minimize drug shortages or outages and reduce potential loss of lives that result from an erratic drug supply.

The impact of the lookback period and definition of confirmatory events on the identification of incident cancer cases in administrative data

BackgroundThis cohort study examined the impact of the lengths of lookback and confirmation periods as well as the definition of confirmatory events on the number of incident cancer cases identified and age-standardized cumulative incidences (ACI) estimated in administrative data using German cancer registry data as a benchmark.MethodsACI per 100,000 insured persons for breast, prostate and colorectal cancer were estimated using BARMER Statutory Health Insurance claims data. Incident cancer cases were defined as having an in- or outpatient diagnosis in 2013, no diagnosis in a lookback period of 1 year and a second diagnosis (or death) in a confirmation period of 1 quarter. We varied lookback periods from 1 to 7 years, confirmation periods from 1 to 4 quarters as well as the definition of confirmatory events and compared ACI estimates to cancer registry data.ResultsACI were higher for breast (138.7) and prostate (103.6) but lower for colorectal cancer (42.1) when compared to cancer registries (119.3, 98.0 and 45.5, respectively). Extending the lookback period to 7 years reduced ACI to 129.0, 95.1 and 38.3. An extended confirmation period of 4 quarters increased ACI to 151.3, 114.9 and 46.8. Including breast and colorectal surgeries as a confirmatory event reduced ACI to 114.9 and 37.1, respectively.ConclusionsThe choice of lookback and confirmation periods and the definition of confirmatory events have considerable impact on the number of incident cancer cases identified and ACI estimated. Researchers need to be aware of potential misclassification when identifying incident cancer cases in administrative data. Further validation studies as well as studies using administrative data to estimate cancer incidences should consider several choices of the lookback and confirmation periods and the definition of confirmatory events to show how these parameters impact the validity and robustness of their results.

Hospitalizations in Pediatric and Adult Patients for All Cancer Type in Italy: The EPIKIT Study under the E.U. COHEIRS Project on Environment and Health.

Background: Cancer Registries (CRs) remain the gold standard for providing official epidemiological estimations. However, due to CRs’ partial population coverage, hospitalization records might represent a valuable tool to provide additional information on cancer occurrence and expenditures at national/regional level for research purposes. The Epidemiology of Cancer in Italy (EPIKIT) study group has been built up, within the framework of the Civic Observers for Health and Environment: Initiative of Responsibility and Sustainability (COHEIRS) project under the auspices of the Europe for Citizens Program, to assess population health indicators. Objective: To assess the burden of all cancers in Italian children and adults. Methods: We analyzed National Hospitalization Records from 2001 to 2011. Based on social security numbers (anonymously treated), we have excluded from our analyses all re-hospitalizations of the same patients (n = 1,878,109) over the entire 11-year period in order to minimize the overlap between prevalent and incident cancer cases. To be more conservative, only data concerning the last five years (2007–2011) have been taken into account for final analyses. The absolute number of hospitalizations and standardized hospitalization rates (SHR) were computed for each Italian province by sex and age-groups (0–19 and 20–49). Results: The EPIKIT database included a total of 4,113,169 first hospital admissions due to main diagnoses of all tumors. The annual average number of hospital admissions due to cancer in Italy has been computed in 2362 and 43,141 hospitalizations in pediatric patients (0–19 years old) and adults (20–49 years old), respectively. Women accounted for the majority of cancer cases in adults aged 20–49. As expected, the big city of Rome presented the highest average annual number of pediatric cancers (n = 392, SHR = 9.9), followed by Naples (n = 378; SHR = 9.9) and Milan (n = 212; SHR = 7.3). However, when we look at SHR, minor cities (i.e., Imperia, Isernia and others) presented values >10 per 100,000, with only 10 or 20 cases per year. Similar figures are shown also for young adults aged 20–49. Conclusions: In addition to SHR, the absolute number of incident cancer cases represents a crucial piece of information for planning adequate healthcare services and assessing social alarm phenomena. Our findings call for specific risk assessment programs at local level (involving CRs) to search for causal relations with environmental exposures.

Cancers attributable to infections among adults with HIV in the United States.

HIV-infected people are at increased risk of cancers of infectious origin. We estimated the burden of cancer attributable to infections among HIV-infected people in the United States in 2008. Incidence rates for cancer sites associated with infections were estimated from record linkage between HIV/AIDS registries and cancer registries. Rates were applied to estimates of the population living with diagnosed HIV in the United States in 2008 to obtain the number of incident cancer cases. Site-specific attributable fractions and corresponding 95% confidence intervals (CIs) were estimated from infection prevalence among cancer cases. Infection prevalence data were derived from literature review of case series. Of an estimated 6200 incident cancer cases (95% CI 6000-6500), 2500 (95% CI 2400-2700) were attributable to infection (attributable fraction = 40%, 95% CI 39-42). The most important infections were Kaposi sarcoma herpes virus, Epstein-Barr virus, and human papillomavirus, which together were responsible for 2200 new cancer cases (95% CI 2100-2400), mainly Kaposi sarcoma, lymphomas, and ano-genital cancers. The attributable fraction in HIV-infected people was highest in the age group 20-29 years (69%, 95% CI 65-72). MSM were the HIV transmission group with the highest attributable fraction (48%, 95% CI 46-50), due to the high incidence of both Kaposi sarcoma and anal cancer. The very high fraction of cancer attributable to infection in HIV-infected people points to special opportunities to prevent these cancers, that is, avoidance, detection, and early treatment of cancer-associated infections, and universal early detection and uninterrupted treatment of HIV infection to avoid immunosuppression.

Abstract SY34-01: Infection causing cancer: An update on the global burden

Abstract SY34-01: Infection causing cancer: An update on the global burden

Abstract 256: Periodontal disease severity and incident cancer in postmenopausal women: the Buffalo OsteoPerio Study

Abstract Background: Periodontal disease has an infectious etiology and there is growing evidence that it may be positively associated with cancer occurrence. Potential mechanisms may involve the host inflammatory response to oral infection and the potential mobility of the oral microbiome to extra-oral sites. However, few studies have focused on older postmenopausal women who are susceptible to both periodontal disease and cancer and where comprehensive periodontal assessments have been made. This study aims to determine whether loss of alveolar crestal bone height (ACH) in the oral cavity, a measure of chronic periodontitis, is associated with incident cancer in a well-characterized cohort of postmenopausal women. Methods: We prospectively followed a cohort of 1,337 postmenopausal women (aged 53-85 years at baseline; 3% current smokers) who participated in the Buffalo OsteoPerio Study, an ancillary study of the Women's Health Initiative. Whole mouth mean and worst site ACH (mm of loss) were assessed from oral radiographs. Incident cancer was ascertained from annual health updates and confirmed using medical records by physician adjudicators. Cox proportional hazard regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for associations of ACH with total and site-specific cancer risk in multivariate-adjusted models. Results: During an average follow-up of 9.6 years (SD=2.7), there were 170 confirmed incident cancer cases. The most common sites were breast (N=77), lung (N=15), colorectum (N=14), and endometrium (N=12), accounting for 69% of all cancers. When analyzed as a continuous exposure and after adjusting for age, education, and pack-years of smoking, worst site ACH was not associated with total cancer risk (HR=1.04 per 1mm loss, 95% CI=0.94-1.15). However, there was a statistically significant increased risk of lung (HR=1.49, 95% CI=1.18-1.89) and colorectal cancer (HR=1.35, 95% CI=1.04-1.74). No associations were found for worst site ACH with breast (HR=0.91, 95% CI=0.77-1.09) or endometrial cancer (HR=0.77, 95% CI=0.46-1.30). Whole mouth mean ACH was also significantly associated with incident lung cancer (HR=2.05 per 1mm loss, 95% CI=1.40-3.01), but not with total cancer (HR=1.09, 95% CI=0.89-1.33), or with colorectal (HR=1.45, 95% CI=0.91-2.33), breast (HR=0.83, 95% CI=0.57-1.20) or endometrial (HR=0.62, 95% CI=0.21-1.85) cancers in multivariate-adjusted models. These estimates did not change appreciably after further adjustments. Conclusions: This study provides evidence that chronic periodontitis is positively associated with risk of lung and colorectal cancer in postmenopausal women. These results need to be interpreted cautiously given the small number of incident cancer cases. Further research utilizing a larger sample is warranted to confirm these results. Citation Format: Xiaodan Mai, Jo L. Freudenheim, Michael J. LaMonte, Kathleen M. Hovey, Christopher A. Andrews, Robert J. Genco, Jean Wactawski-Wende. Periodontal disease severity and incident cancer in postmenopausal women: the Buffalo OsteoPerio Study. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 256. doi:10.1158/1538-7445.AM2014-256

Prediction of cancer incidence in Tyrol/Austria for year of diagnosis 2020.

Prediction of the number of incident cancer cases is very relevant for health planning purposes and allocation of resources. The shift towards elder age groups in central European populations in the next decades is likely to contribute to an increase in cancer incidence for many cancer sites. In Tyrol, cancer incidence data have been registered on a high level of completeness for more than 20 years. We therefore aimed to compute well-founded predictions of cancer incidence for Tyrol for the year 2020 for all frequent cancer sites and for all cancer sites combined. After defining a prediction base range for every cancer site, we extrapolated the age-specific time trends in the prediction base range following a linear model for increasing and a log-linear model for decreasing time trends. The extrapolated time trends were evaluated for the year 2020 applying population figures supplied by Statistics Austria. Compared with the number of annual incident cases for the year 2009 for all cancer sites combined except non-melanoma skin cancer, we predicted an increase of 235 (15 %) and 362 (21 %) for females and males, respectively. For both sexes, more than 90 % of the increase is attributable to the shift toward older age groups in the next decade. The biggest increase in absolute numbers is seen for females in breast cancer (92, 21 %), lung cancer (64, 52 %), colorectal cancer (40, 24 %), melanoma (38, 30 %) and the haematopoietic system (37, 35 %) and for males in prostate cancer (105, 25 %), colorectal cancer (91, 45 %), the haematopoietic system (71, 55 %), bladder cancer (69, 100 %) and melanoma (64, 52 %). The increase in the number of incident cancer cases of 15 % in females and 21 % in males in the next decade is very relevant for planning purposes. However, external factors cause uncertainty in the prediction of some cancer sites (mainly prostate cancer and colorectal cancer) and the prediction intervals are still broad. Therefore, our predictions must be interpreted with some caution.

Demographischer Wandel und Krebserkrankungen in der Zukunft

Hintergrund: Die demographischen Entwicklungen in Deutschland führen zu einem Umbau der Alterszusammensetzung der Bevölkerung hin zu deutlich mehr älteren Menschen. Der Erkrankungsgipfel vieler Krankheiten wie Krebs liegt im höheren Alter. Die Quantifizierung des dadurch zu erwartenden Anstiegs der Erkrankungszahlen stellt eine wichtige Kenngröße für die zukünftige Belastung unseres Gesundheitswesens dar. Material und Methoden: Auf der Basis der 12. koordinierten Bevölkerungsvorausberechnung des Statistischen Bundesamtes wurden aktuell verfügbare alters- und geschlechtsspezifische Inzidenzraten der epidemiologischen Krebsregister für die häufigsten Tumorerkrankungen nach dem Ceteris-paribus-Prinzip auf die Bevölkerung der Jahre 2030, 2050 und 2060 projiziert. Ergebnisse: Die Zahl jährlicher Krebsneuerkrankungen wird von 494 000 im Jahr 2010 auf 642 000 im Jahr 2050 steigen (+26%). Zwischen den einzelnen Tumorarten finden sich deutliche Unterschiede (–29% bis +47%). Schlussfolgerungen: Die demographischen Veränderungen in Deutschland lassen zukünftig insgesamt deutlich erhöhte Krebserkrankungszahlen erwarten. Bei weiter sinkender Bevölkerungszahl steigt die Krebslast der Bevölkerung noch stärker an.

Evaluation of cancer surveillance completeness among the Italian army personnel, by capture–recapture methodology

Objective: This study provides an assessment of completeness of cancer surveillance and incidence estimates for all malignancies, Hodgkin's lymphoma and thyroid cancer in the Italian army, for the years 2001–2007. Methods: The two-source capture–recapture method was employed, using both Chapman's and Chao's formulae, on the basis of cancer notifications from military hospitals and unit infirmaries. The estimated incident cases were then confronted with the corresponding expected cases; the standardized incidence ratios and 95% confidence intervals (SIR [95% CI]) were then calculated. Results: A total of 442 cancer notifications, concerning 371 cases, were reported (311 from army hospitals and 131 from unit infirmaries; of these, 71 were overlapping). The estimated total number of cases, by Chapman's and Chao's formulae, was 571 and 688, respectively. Overall, sensitivity of the surveillance system was 65% by Chapman's and 54% by Chao's estimators. Completeness of notification was significantly higher in younger patients, in those previously deployed in Bosnia or Kosovo, and for cases of Hodgkin's lymphoma. Estimated SIRs, using both formulae, were not significant for all malignancies and Hodgkin's lymphoma, but significant for thyroid cancer (SIR: 2.25 [1.61–2.89] by Chapman's formula, and 3.12 [1.81–4.43] by Chao's estimator). Conclusion: Completeness of cancer registry of the Italian military is low, and methods to improve its sensitivity are discussed. Overall, the estimated number of incident cancer cases, including Hodgkin's lymphoma, is not significantly higher than expected, except thyroid cancer. The increased incidence of this malignancy requires further investigation; however, in the military, as well as in the general population, this may be partly due to the growing availability of diagnostic opportunities in the last decades. Moreover, detection of thyroid cancer may be further facilitated by a selection bias generated by the annual and pre-/post-deployment medical examinations and blood tests routinely performed on all military personnel.

Do cancer predictions work?

Two different types of simple extrapolation models were investigated as tools for cancer incidence prediction. The number of incident cancer cases by sex and site in Finland was predicted using a prediction interval for each year from 1967 to 2003 on the basis of historical cancer incidence data obtained 5 to 15 years earlier. Cancer sites where major human-made changes in aetiology and diagnostics had occurred were analysed separately. Assuming that such changes had not occurred, the 95% prediction intervals based on normal errors of the age-standardised rate and on Poisson models included the observed number in 65–100% of the years. The Poisson models produced, on average, shorter intervals and were more capable of indicating a site where the model assumptions did not hold true. Simple extrapolation models may be used with some caution on coverage when there are no known factors that might make abrupt changes in the temporal development of cancer incidence. On the other hand, they may be used for detecting the effects of such factors.

Sensibilité et spécificité de deux méthodes d’identification des cancers du sein incidents dans les services spécialisés à partir des données médico-administratives

Hospital claims databases from acute care units are available nationwide and contain most patients at the beginning of their cancer. The goal is to define the ability of these databases to provide a number of incident breast cancer cases using identification methods. Two identification methods were assessed in three specialized sections of a teaching hospital. The first method identified women who had at least one stay with a principal diagnosis of breast cancer. The second, which is more restrictive, identified women who had at least one stay with a principal diagnosis of breast cancer and a breast cancer-specific surgical treatment code. Both methods were applied to 4588 women 20 Years of age or older hospitalized in three specialized sections of the Hospices Civils de Lyon in 2000. To categorize these women in two groups, incident breast cancer cases or non-incident breast cancer cases, 150 women were randomized in each of two groups, one for incident breast cancer cases and one for non-incident breast cancer cases. Their medical records were used as references. Sensitivity, specificity and their credibility intervals were respectively 99.4% (84-99.9) and 91.7% (90.3-93.3) for the first method and 93.8% (76.2-98.7) and 97.3% (96.1-98) for the second. Among women wrongly identified with an incident breast cancer in 2000, 75.4% (43/57) had a breast cancer that was not incident that Year with the first method, compared to 96% (24/25) with the second. Among these women wrongly identified with an incident breast cancer, coding errors of the principal diagnosis were found for 24.6% (14/57) of patients with the first method and for 4% (1/25) with the second. Their correction led to 99.2% (86.5-99.9) sensitivity and 92.9% (91.4-94.6) specificity for the first method and to 94.2% (76.5-98.7) sensitivity and 97.3% (96.2-98.1) specificity for the second. The second method using cancer-specific surgical codes appeared more specific with a slight loss in sensitivity. The use of identification methods to assess the number of incident cancer cases still have to be defined.

Study of completeness of registration at the Estonian cancer registry.

Every cancer registry should be able to quantify the level of completeness of registration. The current study describes a routine quality control procedure in the Estonian Cancer Registry (ECR) for assessing the completeness of registration. The registry's database was compared with the databases of the Tartu University Lung Clinic and the Maarjamõisa Hospital of the Tartu University Clinics, and active retrieval to obtain missing cancer cases diagnosed in 1998 was carried out. The overall completeness of case ascertainment based on this study was 90.8%. As a result of this procedure, 67 cases of malignant neoplasms (1.1% of the total number of incident cancer cases for 1998) and 11 cases of other reportable neoplasms were detected and recorded at the ECR. Cancers of the lung, thyroid gland and prostate were most frequently under-notified. For these sites, the number of cancer cases for 1998 for Estonia as a whole increased 2.6%, 11.8% and 2.2%, respectively. To conclude, the existence of electronic databases is a positive development, but cancer registrars still need to employ labour-intensive methods to validate diagnostic codes and to decide whether to include in the ECR cases found by active retrieval. Based on the findings of our study, which is the first one of its kind in Estonia, the completeness of cancer reporting varied by cancer site, and it appeared to be a substantial concern for several sites.

Representation of African-Americans, Hispanics, and Whites in National Cancer Institute Cancer Treatment Trials

The National Cancer Institute (NCI)-sponsored clinical trials cooperative groups place more than 25 000 American patients in treatment trials every year. Equal access and proportional representation of all races/ethnicities is desired. Our objectives were to evaluate the inclusion of African-Americans, Hispanics, and non-Hispanic whites in NCI-sponsored treatment trials and to determine if there is proportional racial/ethnic representation. During the period of January 1, 1991, through June 30, 1994, 99 495 cancer patients were enrolled in clinical trials and declared themselves as non-Hispanic black, non-Hispanic white, or Hispanic (of any race). In the analysis, participants in NCI treatment trials were subdivided into three age groups: birth to 19 years, 20-49 years, and 50 or more years. The racial/ethnic composition of each of these age groups was compared with the racial/ethnic makeup of the American population with cancer. Estimates of the number of incident cancer cases per year were made for each racial/ethnic group within each age group using data from the Surveillance, Epidemiology, and End Results (SEER) Program and the 1990 Census. The percentage of all cancer patients who were in each racial/ethnic group were compared with the population that entered clinical trials. Comparisons are also made separately for patients with leukemia and breast, colorectal, lung, and prostate cancers. Among patients 0-19 years old, 20-49 years old, and 50 years old or older there is relatively proportional representation of non-Hispanic blacks, Hispanics, and non-Hispanic whites in trials. It is noted that more than 70% of cancer patients aged 0-19 years are estimated to enter cooperative group clinical trials compared with 4.0% of cancer patients aged 20-49 years and 1.5% of patients aged 50 years or older. Accrual of American cancer patients to NCI-sponsored treatment trials generally parallels the incident burden of disease among non-Hispanic African-Americans, Hispanics, and non-Hispanic whites. This study shows that the NCI clinical trials are, as a whole, racially/ethnically representative of the American population and suggests that there is equal access to NCI clinical trials.