Pennsylvania Cancer Registry Research Articles

Quality of life and mental health among women with ovarian cancer: examining the role of emotional and instrumental social support seeking

The purpose of the present study was to examine the role of emotional and instrumental social support seeking in the quality of life (QOL) and mental health of women with ovarian cancer. Participants were recruited through the Pennsylvania Cancer Registry, and one hundred women took part in a mail questionnaire that collected information on their demographics, medical status, social support seeking, QOL and mental health including anxiety, depression and stress. Hierarchical linear regression analyses were conducted to assess the influence of emotional and instrumental social support seeking on QOL and mental health. After controlling for remission status, greater emotional social support seeking was predictive of higher overall QOL, social/family QOL, functional QOL and lower depression scores. Instrumental social support seeking was not significant in the models. The results illustrate that social support seeking as a coping mechanism is an important consideration in the QOL and mental health of women with ovarian cancer. Future studies should examine the psychological and behavioral mediators of the relationship to further understand the QOL and mental health of women with ovarian cancer.

Administrative Database Research Overestimates the Rate of Interval Colon Cancer.

Our study reexamines the prevalence of interval colorectal cancer (I-CRC) by manually reviewing CRC cases at a single institution. In 2% to 8% of patients with CRC, diagnosis occurs during the interval 6 to 36 months after a cancer-free colonoscopy. Rates are often determined by linking the date of colonoscopy with cancer registry information. We examined all colonoscopies from 1993 to 2011. These examinations were linked with Pennsylvania Cancer Registry data. Matched charts were manually reviewed. We determined whether the CRC was "prevalent" or, for patients with a previous colonoscopy, whether they were interval or noninterval based on time from last colonoscopy. For interval cases, we identified "administrative errors" that could falsely increase the number of reported I-CRC. Over the study period, 43,661 colonoscopies were performed, with 1147 (2.6%) positive for CRC after excluding cases (n=52) in which patients had IBD, previous surgery, or nonadenocarcinoma malignancy. Prevalent CRCs totaled 1062 (92.6%). Noninterval CRCs (diagnosed over 36 mo from index colonoscopy) were present in 40 (3.5%). There remained 45 (3.9%) potential I-CRC cases. However, after manual review, 21 cases were found to be administrative errors. Therefore, the accurate proportion of colonoscopies that found an I-CRC was 2.1% (95% confidence interval, 1.5%-3.2%). The prevalence of I-CRC at our institution before adjustment was comparable with previously reported rates. This proportion was 47% lower after adjusting for administrative errors placing our figure at the lower end of reported I-CRC incidence. Reported rates of I-CRC may be falsely elevated due to errors unique to merging administrative databases.

MP60-13 EVIDENCE OF PROSTATE CANCER “REVERSE STAGE MIGRATION” TOWARD MORE ADVANCED DISEASE AT DIAGNOSIS

You have accessJournal of UrologyProstate Cancer: Detection and Screening II1 Apr 2015MP60-13 EVIDENCE OF PROSTATE CANCER “REVERSE STAGE MIGRATION” TOWARD MORE ADVANCED DISEASE AT DIAGNOSIS Sean Wessel and Adam Reese Sean WesselSean Wessel More articles by this author and Adam ReeseAdam Reese More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2215AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The introduction of PSA-based screening for prostate cancer led to a stage migration toward less advanced disease at the time of diagnosis. More recently, concern surrounding overdiagnosis and overtreatment of prostate cancer has resulted in a backlash against PSA screening, particularly in the primary care community. We hypothesize that this may have resulted in a “reverse stage-migration” toward more advanced disease at diagnosis. METHODS We analyzed the Pennsylvania Cancer registry, a statewide database of all cancers diagnosed in Pennsylvania. We collected data on stage (localized, regional, or metastatic) and PSA value at the time of diagnosis for all prostate cancers diagnosed between 2004 and 2011. RESULTS 82,849 prostate cancers were diagnosed in Pennsylvania between 2004 and 2011 with a peak incidence in 2007 (Figure 1). During this time, there has been an increase in the percentage of patients with advanced stage disease (regional or distant metastasis) (Figure 2) and high PSA values (≥10 ng/ml) (Figure 3) at diagnosis. CONCLUSIONS This analysis suggests that there has been a “reverse stage-migration” toward more advanced prostate cancer at the time of diagnosis, which predated the 2011 USPTF recommendations against PSA screening. The USPTF recommendation is likely to exacerbate this concerning trend toward advanced stage disease, potentially resulting in an increase in prostate cancer-specific mortality. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e742-e743 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sean Wessel More articles by this author Adam Reese More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Increasing incidence of thyroid cancer in the Commonwealth of Pennsylvania.

The incidence of thyroid cancer in the United States has increased rapidly and Pennsylvania is the state with the highest rate of thyroid cancer in the country, although the factors driving this increase are unknown. Moreover, it remains unclear whether the increase in thyroid cancer represents a true increase in disease or is the result of overdiagnosis. To compare the increase in thyroid cancer incidence and tumor characteristics in Pennsylvania with the rest of the United States and gain insight into the factors influencing the increased incidence of thyroid cancer. In a population-based study, data on thyroid cancer from the Surveillance Epidemiology and End Results 9 (SEER-9) registry and the Pennsylvania Cancer Registry (PCR) from 1985 through 2009 were collected and reviewed for information regarding sex, race, histologic type of thyroid cancer, staging, and tumor size at diagnosis. International Classification of Diseases for Oncology, Third Edition code C739 (thyroid carcinoma) was used to identify 110,615 records in the SEER-9 registry and 29,030 records in the PCR. Average annual percent change (AAPC) in thyroid cancer incidence across various demographic groups in Pennsylvania. The AAPC for thyroid cancer in Pennsylvania was 7.1% per year (95% CI, 6.3%-7.9%) vs 4.2% (95% CI, 3.7%-4.7%) per year in the remainder of the United States, and trends in incidence were significantly different (P < .001). Females experienced a higher AAPC (7.6% per year; 95% CI, 6.9%-8.3%) compared with males (6.1% per year; 95% CI, 4.9%-7.2%) (P < .01), and trend analysis revealed that thyroid cancer may be increasing more rapidly among black females (8.6% per year; 95% CI, 5.4%-11.9%) than among white females (7.6% per year; 95% CI, 6.8%-8.4) (P = .60; but despite the similarity in AAPC between the 2 groups, the joinpoint models fit to the data were not parallel [P < .005]). The rate of tumors with regional (7.0% per year; 95% CI, 5.8%-8.1%) or distant (1.1% per year; 95% CI, 0.3%-1.8%) spread (P < .05) and tumors that were 2 to 4 cm (7.1% per year; 95% CI, 5.2%-9.0%) (P < .05) or larger than 4 cm (6.4% per year; 95% CI, 4.5%-8.2%) (P < .05) at diagnosis also increased. The incidence of thyroid cancer is rising at a faster rate in Pennsylvania than in the rest of the nation, as is the rate of tumors that are larger and higher stage at diagnosis. These findings suggest that rising disease burden has contributed to the increased incidence of thyroid cancer. Etiologic factors promoting the rise in thyroid cancer in Pennsylvania must be investigated and may provide insight into the drivers of the national increase in thyroid cancer.

Evaluating for a geospatial relationship between radon levels and thyroid cancer in Pennsylvania.

To determine whether there is an association between radon levels and the rise in incidence of thyroid cancer in Pennsylvania. Epidemiological study of the state of Pennsylvania. We used information from the Pennsylvania Cancer Registry and the Pennsylvania Department of Energy. From the registry, information regarding thyroid incidence by county and zip code was recorded. Information regarding radon levels per county was recorded from the state. Poisson regression models were fit predicting county-level thyroid incidence and change as a function of radon/lagged radon levels. To account for measurement error in the radon levels, a Bayesian Model extending the Poisson models was fit. Geospatial clustering analysis was also performed. No association was noted between cumulative radon levels and thyroid incidence. In the Poisson modeling, no significant association was noted between county radon level and thyroid cancer incidence (P = .23). Looking for a lag between the radon level and its effect, no significant effect was seen with a lag of 0 to 6 years between exposure and effect (P = .063 to P = .59). The Bayesian models also failed to show a statistically significant association. A cluster of high thyroid cancer incidence was found in western Pennsylvania. Through a variety of models, no association was elicited between annual radon levels recorded in Pennsylvania and the rising incidence of thyroid cancer. However, a cluster of thyroid cancer incidence was found in western Pennsylvania. Further studies may be helpful in looking for other exposures or associations.

The Role of Patient–Clinician Information Engagement and Information Seeking from Nonmedical Channels in Fruit and Vegetable Intake Among Cancer Patients

Previous research suggests positive effects of health information seeking on prevention behaviors such as diet, exercise, and fruit and vegetable consumption. The present study builds upon this research and strengthens causal claims from it by examining the lagged effect of patient–clinician information engagement on fruit and vegetable consumption as well as the indirect effect on the outcome through seeking information from nonmedical channels. The results are based on data collected from a randomly drawn sample of breast, prostate, and colorectal cancer patients from the Pennsylvania Cancer Registry who completed mail surveys in the Fall of 2006 and 2007. There was a 65% response rate for baseline subjects (resulting n = 2,013); of those, 1,293 were interviewed 1 year later, and 1,257 were available for our analyses. Results show a positive lagged main effect of patient–clinician information engagement at baseline on fruit and vegetable consumption at follow-up (B = 0.26, SE = 0.10, p = .01). The mediation analysis shows that patient–clinician information engagement leads to increased fruit and vegetable consumption among cancer patients, in part through patients' information seeking from nonmedical channels. Implications of these findings for the cancer patient population and for physicians are discussed.

Does the Number of Cancer Patients' Close Social Ties Affect Cancer-Related Information Seeking Through Communication Efficacy? Testing a Mediation Model

This study addresses whether having a broad social network of close friends equips cancer patients with increased efficacy to engage in communication about their cancer, which then leads to an increased likelihood of patients actively seeking cancer-related information. Guided by the theory of motivated information management, the study also tests whether the effect of the number of close social ties on information seeking is mediated, in part, by communication efficacy. Results are based on data collected from a randomly drawn sample from the Pennsylvania Cancer Registry of 2,013 cancer patients who completed mail surveys in the Fall of 2006. Results are consistent with a cross-sectional mediation effect in which the number of close social ties in one's social network is positively associated with communication efficacy (b = .17, p = .001), which, in turn, is positively associated with cancer-related information seeking (b = .13, p < .001).

Potential Spillover Educational Effects of Cancer-Related Direct-to-Consumer Advertising on Cancer Patients’ Increased Information Seeking Behaviors: Results from a Cohort Study

Spillover effects of exposure to direct-to-consumer advertising (DTCA) of cancer treatments on patients' general inquiry about their treatments and managing their illness are not well understood. This study examines the effects of cancer patients' exposure to cancer-related DTCA on subsequent health information seeking behaviors from clinician and non-clinician sources (lay media and interpersonal contacts). Using a longitudinal survey design over 3 years, data was collected from cancer survivors diagnosed with colorectal, breast, or prostate cancer who were randomly sampled from the Pennsylvania Cancer Registry. Study outcome measures include patients' information engagement with their clinicians and information seeking from non-medical sources about cancer treatment and quality of life issues, measured in the second survey. The predictor variable is the frequency of exposure to cancer-related DTCA since diagnosis, measured at the round 1 survey. The analyses utilized lagged-weighted multivariate regressions and adjusted for round 1 levels of patient-clinician engagement, information seeking from nonmedical sources, and confounders. Exposure to cancer-related DTCA is associated with increased levels of subsequent patient-clinician information engagement (B = .023, 95% CI = .005-.040, p = .012), controlling for confounders. In comparison, exposure to DTCA is marginally significant in predicting health information seeking from non-clinician sources (B = .009, 95% CI = -.001-.018, p = .067). Cancer-related DTCA has potentially beneficial spillover effects on health information seeking behaviors among cancer patients. Exposure to DTCA predicts (a little) more patient engagement with their physicians.

Administrative Database Research May Overestimate the Rate of Interval Colon Cancer: Presidential Poster

Purpose: In 2-5% of patients with colorectal cancer (CRC), the diagnosis occurs within 6-36 months after a cancer-free colonoscopy (i.e. interval CRC). These rates are often determined by linking the date of colonoscopy from administrative (e.g., insurance) databases with information from cancer registries. Our purpose was to re-examine interval CRC rates by reviewing all CRC cases at a single institution. Methods: We selected all colonoscopy exams performed at our institution from 1993-2011. We linked our colonoscopic database with data from the Pennsylvania Cancer Registry (PCR) from the same time period. Data is entered into the PCR after final pathologic staging. The charts of all matches were thoroughly reviewed individually. We determined whether the CRC was “prevalent” (no previous colonoscopy). For patients with a previous colonoscopy, we determined if they were interval or non-interval based on the length of time from the last colonoscopy. For interval cases, we identified “administrative errors,” which could falsely increase the interval CRC rate. For example, one patient delayed surgery 9 months for a malignant-appearing mass seen on colonoscopy with non-diagnostic biopsies. A second example is a patient with a poor preparation who failed to return for a scheduled repeat colonoscopy and developed CRC two years later. Without manual review, it could be erroneously inferred that these are interval CRC cases missed at colonoscopy. Results: Over the 19-year study period, there were 43,661 colonoscopies with 1,147 (2.6%) positive for CRC after excluding cases (n=54) in which the patient had IBD, previous colon surgery, or a non-adenocarcinoma malignancy. Prevalent and non-interval CRC's totaled 1,102 (96.3%). There remained 43 (3.7%) potential interval CRC cases. However, after chart review, 19 cases were found to be administrative errors. Therefore, the final, accurate interval CRC rate was 2.1%. Conclusion: The incidence of interval CRC at our institution prior to adjustment was comparable to the published literature. The rate was 43% lower after removing cases of administrative errors and placed our figure at the lower end of reported rates. This low rate was seen despite the fact that exams were performed for all indications, not just screening, which would bias the results toward a higher interval CRC rate. Due to errors unique to merging administrative databases, the rate of interval CRC reported in the literature may be falsely elevated. Future publications, particularly meta-analyses and position papers, need to consider this potential error.

382 Occupational and genetic risk factors for myeloproliferative neoplasms (MPN): A case-control study

ObjectivesThe aetiology of a rare category of myeloproliferative neoplasms (MPN), bone marrow diseases with an excess of blood cells, is currently unknown. An MPN cluster in northeastern Pennsylvania allowed investigation...

Radon Levels in Pennsylvania and the Rise in Incidence of Thyroid Cancer

Objective: Determine if there is a temporal association between radon levels and the rise in incidence of thyroid cancer in Pennsylvania. Methods: Ecological study: The Pennsylvania Cancer Registry and the Department of Environmental Protection were used as data sources for this study for the years 1990-2009. From the registry, geographic information regarding thyroid incidence was recorded. Using SAS, Poisson regression models were fit predicting county level thyroid incidence and change as a function of radon/ lagged radon levels. To account for measurement error in radon levels, a Bayesian Model extending the Poisson models was fit using the winBUGS program. Results: Contour plots showing correlations between radon levels by year and yearly thyroid incidence rates failed to detect any association consistent with a causal connection. In the Poisson modeling, no significant association was noted between county radon level and thyroid cancer incidence ( P = 0.23). Looking for a lag between the radon level and its effect, no significant effect was seen for a lag of 0 to 6 years between exposure and expected effect ( P = 0.063 to P = 0.59). The Bayesian models fit also failed to show a statistically significant association. Conclusions: While there is evidence of rising levels of radon as well as thyroid cancer in Pennsylvania, the two do not correlate according to our analysis. Through a variety of models, no association could be elicited between radon levels in Pennsylvania and the rising incidence of thyroid cancer. Further studies, such as using an animal model, may be helpful in determining an association.

Are physician recommendations for BRCA1/2 testing in patients with breast cancer appropriate? A population‐based study

BACKGROUNDTo the best of the authors' knowledge, few population‐based studies to date have examined the use of BRCA1/2 testing or patterns of physician recommendations for genetic testing among women diagnosed with breast cancer. The objective of the current study was to evaluate the rates and predictors of physician recommendation for BRCA1/2 testing among patients with breast cancer.METHODSWomen aged 18 years to 64 years who were diagnosed with invasive breast cancer in 2007 were identified from the Pennsylvania Cancer Registry and mailed a survey regarding their family history of cancer, physician treatment recommendations, and BRCA1/2 testing. Of the 4009 women who were sent surveys, 2258 responded (56%). Based on age at diagnosis and family history, women were categorized as being at high, moderate, or low risk of BRCA1/2 mutations.RESULTSNearly 25% of the participants were classified as being at high risk of carrying a BRCA1/2 mutation based on their age at the time of breast cancer diagnosis and family history of breast and/or ovarian cancer. Physician recommendations for BRCA1/2 testing were found to be strongly associated with risk of carrying a mutation, with 53% of high‐risk women reporting a testing recommendation compared with 9% of low‐risk women. In addition, physician recommendations were strongly correlated with the use of testing in all risk groups. Among high‐risk women, the lack of a recommendation for BRCA1/2 testing was more common among older, low‐income, and employed women.CONCLUSIONSAlthough BRCA1/2 testing recommendations appear to be appropriately correlated with mutation risk, a significant percentage of patients with breast cancer who meet criteria for BRCA1/2 testing may not receive a recommendation for such testing from their health care providers. Cancer 2013;119:3596–3603. © 2013 American Cancer Society.

Agreement of self-reported hormone receptor status with cancer registry data in young breast cancer patients

BackgroundThough breast cancer subtype is a key determinant of treatment choice and prognosis, few studies have assessed breast cancer patients’ knowledge of estrogen and progesterone receptor (ER/PR) status. MethodsWomen diagnosed with invasive breast cancer at age 18–64 years in 2007 were recruited from the Pennsylvania Cancer Registry, and mailed a questionnaire that asked respondents to identify their ER/PR status. There were 2191 respondents included in the analysis. Agreement between self-report and cancer registry ER/PR status was assessed using kappa statistic. Logistic regression was used to assess the association of demographic, socioeconomic, and tumor factors with inaccurate self-report of ER/PR status. ResultsFifty-nine percent of respondents reported ER/PR positive status, 15% reported ER/PR negative status, 17% responded ‘don’t know’, and 9% did not respond. Overall, there was 69% agreement between self-report and cancer registry data, and fair agreement as measured by kappa (0.36). After excluding women who did not know or did not report their ER/PR status, there was 93% agreement, and substantial agreement as measured by kappa (0.76). Women who were older, non-white, less educated, lower income, and had ER/PR negative disease were significantly more likely to inaccurately report their ER/PR status. ConclusionsThough a significant proportion of women do not know their hormone receptor status, women who reported their ER/PR status were accurate. Our results suggest room for improvement in patient knowledge of tumor subtypes, but also that self-reported ER/PR status may be a useful surrogate when medical record or cancer registry data is unavailable.

Incidence of thyroid cancer surrounding three mile island nuclear facility: The 30‐year follow‐up

Original data reported a potential increased incidence of thyroid cancer surrounding the Three Mile Island (TMI) nuclear facility. A causal link to the accident, however, was indeterminate. Our objective was to determine if data 30 years later will change original conclusions, explore thyroid cancer incidence rates near nuclear power plants, and better understand effects of chronic low level radiation. Retrospective cross-sectional study. Retrospective data for specific Pennsylvania counties were provided by the Pennsylvania Cancer Registry Dataset for thyroid cancer using the Epidemiological Query and Mapping System search engine. Our study examines thyroid cancer incidence from 1985 through 2009 analyzed by year, county, and age. Thirty years after the TMI accident, an increased incidence of thyroid cancer is seen in counties south of TMI and in high-risk age groups. The average incidence rates from 1990 through 2009 were greater than expected in York, Lancaster, Adams, and Chester Counties. Thyroid cancer incidence since the TMI accident was greater than expected in the counties analyzed when compared to local and national population growth. This supports a link to chronic low level radiation exposure and thyroid cancer development. Despite these findings, a direct correlation to the accident remains uncertain as incidence rates may coincide with other factors, and original data were limited.

Rectal Cancer and Teaching Hospitals: Hospital Teaching Status Affects Use of Neoadjuvant Radiation and Survival for Rectal Cancer Patients

For rectal cancer, it is unknown how use of radiation, treatment cost, and survival differ based on hospital teaching designation. Private insurance claims data linked with the Pennsylvania Cancer Registry were used to identify rectal cancer patients undergoing surgery from 2004 to 2006. Patients with missing data of interest were excluded. Hospitals were characterized as follows: large (≥200beds) versus small size (<200beds), teaching versus nonteaching, and urban versus rural. Logistic regression was used to model the use of neoadjuvant radiotherapy, and Cox proportional hazards models were used to compare cancer-specific survival between hospital types. A total of 432 patients were analyzed. There was no difference in the distribution of cancer stages among the various hospital types (all p>0.20). Teaching hospitals were associated with significantly higher utilization of neoadjuvant radiotherapy for stage II and III cancers compared with nonteaching facilities (57 vs. 28%; p<0.0001). On multivariate analysis, teaching status was the only hospital designation associated with use of neoadjuvant radiation (p<0.001); hospital size and rural/urban designation were not significant. Nonteaching hospitals were more likely to use adjuvant radiotherapy for stage II and III disease (13 vs. 30%; p<0.01). Teaching hospitals had lower odds of death from rectal cancer when evaluating all stages [hazard ratio (HR)=0.35; p<0.0001] with similar costs of inpatient treatment (teaching: US $30,769 versus nonteaching: US $26,892; p=0.22). Teaching designation was associated with higher incidence of neoadjuvant radiotherapy for stage II and III disease, with improved cancer-specific survival compared with nonteaching hospitals, and with similar treatment costs.

Thyroid cancer characteristics in the population surrounding three mile island

To determine differences in disease characteristics between the thyroid cancer populations in the area around the Three Mile Island (TMI) nuclear power plant and the rest of the state of Pennsylvania. Retrospective cross-sectional study. Data from the Pennsylvania Cancer Registry from 1985 to 2008 were reviewed and information regarding age at diagnosis, sex, race, residential status, county of residence, thyroid pathology, thyroid surgery, and staging was recorded. Dauphin, Lancaster, and York counties were defined as the TMI area. Records of 26,357 thyroid cancer patients were reviewed, with 2,611 patients within the TMI area. A higher proportion of papillary thyroid cancer (P < .001) and lower proportion of follicular thyroid cancer (P < .001) were noted in the TMI area population. Thyroid cancer cases from the TMI area were found to be more likely to be diagnosed before the age of 65 years (P < .001), be Pennsylvania born (P < .001), be well differentiated (P < .001), be <10 mm in size (P < .001), and be localized without spread (P < .001). Although the TMI area shows a higher incidence of thyroid cancer as compared to the rest of the state, this was not statistically significant. The TMI population showed a higher proportion of papillary thyroid cancer and less aggressive pathology and earlier diagnosis compared to the rest of Pennsylvania. No statistically significant difference in thyroid cancer incidence was noted. Overall, the study does not show a clear link with more advanced thyroid cancer and proximity to the TMI nuclear reactors.

Looking Beyond the Internet: Examining Socioeconomic Inequalities in Cancer Information Seeking Among Cancer Patients

The gap in cancer information seeking between high-socioeconomic-status (high-SES) cancer patients and low-SES cancer patients deserves serious attention, considering the importance of information and knowledge in cancer control. We thus explored the association of SES, as measured by education, with cancer patients' overall cancer information seeking, and with seeking from each source (i.e., the Internet, mass media, medical sources, and nonmedical interpersonal sources) and across two topic categories (i.e., treatment, quality of life). We then asked whether the effect of education on treatment information seeking is reduced among those who are particularly motivated to control treatment choices. We conducted a survey with breast, prostate, and colon cancer patients diagnosed in 2005 (n = 2,013), who were randomly drawn from the Pennsylvania Cancer Registry in the fall of 2006. We found that education was more strongly associated with Internet use than with the use of other sources regardless of topics. Also, when information was sought from mass media, education had a greater association with treatment information seeking than with quality-of-life information seeking. Preference for active participation in treatment decision making, however, did not moderate the effect of education on treatment information seeking. The implications of these findings for public health research and cancer patient education were discussed.

Seeking Cancer-Related Information From Media and Family/Friends Increases Fruit and Vegetable Consumption Among Cancer Patients

Previous research suggests positive effects of health information seeking on prevention behaviors such as diet, exercise, and fruit and vegetable consumption among the general population. The current study builds upon this research by examining the effect of cancer patients' active information seeking from media and (nonmedical) interpersonal sources on fruit and vegetable consumption. The results of this longitudinal study are based on data collected from a randomly drawn sample from the Pennsylvania Cancer Registry, comprising breast, prostate, and colorectal cancer patients who completed mail surveys in the fall of 2006 and 2007. There was a 65% response rate for baseline subjects (resulting n = 2013); of those, 1,293 were interviewed one year later and 845 were available for final analyses. We used multiple imputation to replace missing data and propensity scoring to adjust for effects of possible confounders. There is a positive effect of information seeking at baseline on fruit and vegetable servings at follow-up; seekers consumed 0.43 (95% CI: 0.28 to 0.58) daily servings more than nonseekers adjusting for baseline consumption and other confounders. Active information seeking from media and interpersonal sources may lead to improved nutrition among the cancer patient population.

Time Trends and Racial Differences in Female Breast Cancer Incidence in Pennsylvania, 1985–2004

Background: Differences in breast cancer incidence time trends can result from changes in ascertainment, new diagnostic codes, or possibly changes in underlying risk factors. Methods: Female breast cancer incidence data between 1985 and 2004 were obtained from the Pennsylvania Cancer Registry. Joinpoint regression was applied to characterize time trends of age-specific, race-specific, and histology-specific breast cancer incidence. Estimated annual percent change (APC) was calculated. Spatial analysis was applied to detect spatial clusters of county-specific incidence for breast cancer in Pennsylvania. Results: The age-adjusted incidence of invasive breast carcinoma and breast carcinoma in situ was higher in white women than in black women. Invasive breast carcinoma incidence began to decrease significantly in 2001 (APC -3.0%) among white women but has been stable among black women since 1987. Among white women, the age-adjusted incidence of ductal carcinoma in situ increased significantly from 1985 to 1999 but was stable for lobular carcinoma in situ. Among black women, the incidence for both ductal and lobular carcinoma in situ increased significantly over time. For women under the age of 40, breast carcinoma in situ incidence increased significantly over time (APC 4.5% and 10.0% in white women and black women, respectively, 1985-2004). Young black women had a higher incidence of both invasive breast carcinoma and breast carcinoma in situ compared to young white women. Conclusions: Although the increase in breast carcinoma in situ is partly explained by improved diagnosis and screening, other risk factors should be considered. In addition, factors responsible for higher breast cancer rates among younger black women and women living in urban areas should be carefully assessed.

Positive Changes, Increased Spiritual Importance, and Complementary and Alternative Medicine (CAM) Use Among Cancer Survivors

Spirituality is an important component of the cancer experience. This study aims to assess characteristics of spiritual health following a cancer diagnosis, and evaluate the relationship between spiritual change and the use of complementary and alternative medicine (CAM) among a population-based cohort of cancer survivors. A mailed, cross-sectional survey was completed by 614 cancer survivors identified through the Pennsylvania Cancer Registry. All subjects were 3 to 4.5 years postdiagnosis. Relationships between various characteristics of spiritual health and CAM use were examined, along with clinical and sociodemographic factors. Although large proportions of individuals reported that having cancer had positively affected their spiritual well-being (eg, 40.3% experienced highly positive spiritual changes, 68% felt a high sense of purpose, 75.9% reported being very hopeful), some individuals experienced negative spiritual change (36.1%) and continued to experience high levels of uncertainty (27.2%). In multivariate analyses, those survivors who felt spiritual life became more important (adjusted odds ratio [AOR] = 1.92, 95% confidence interval (CI) = 1.21-3.04, P = .006), or experienced positive changes resulting from the cancer experience (AOR = 1.99, 95% CI = 1.26-3.15, P = .003), were more likely to use CAM than those who stated otherwise. Having cancer affects many different aspects of spiritual well-being, both positively and negatively. Positive changes and increased spiritual importance appear to be associated with the use of CAM. Prospective research is needed to test whether integrating CAM into conventional cancer care systems will facilitate positive, spiritually transformative processes among diverse groups of cancer survivors.