Surveillance, Epidemiology, And End Results Program Research Articles

Abstract B166: Impact of rurality on early-onset colorectal cancer outcomes: Age, geographic disparities, and the need for improved access and awareness in the United States

Abstract BACKGROUND: While overall colorectal cancer (CRC) rates have stabilized or declined in the United States (U.S.), early-onset CRC (EO-CRC), diagnoses before age 50, has increased. Rural U.S. residents face a higher CRC incidence (43.9 vs. 40.1 per 100,000) than urban residents. CRC mortality, once highest in the Northeast, is now most prevalent in the South and Midwest, particularly among Non-Hispanic Black populations. This geographic shift is also evident in EO-CRC. Existing literature lacks comprehensive analysis on the influence of rurality and age at CRC diagnosis. In this study, we sought to elucidate the relationships between age at diagnosis with CRC outcomes, while examining the moderating role of rurality. Methods: We used data from the 2006-2020 Surveillance, Epidemiology, and End Results (SEER) Program. Rurality was defined using census tract level U.S. Department of Agriculture (USDA)’s 2010 Rural Urban Commuting Area (RUCA) codes: rural (codes 8, 9, 10) and urban (all other listed codes). We conducted multilevel regression modeling (logistic and Cox proportional hazards) to examine the associations between age at diagnosis, rurality, and CRC outcomes (late-stage diagnosis and survival), adjusting for race, marital status, sex, and year of diagnosis. Results: We identified 835,907 patients aged 20-79 from the 2006-2020 SEER program. Most patients lived in urban areas (86%), were non-Hispanic white (66%), and married (41%). After adjusting for marital status, race, sex, and diagnosis year, we found that patients aged 30-39 (aOR: 1.49, 95% CI: 1.44–1.55) and 40-49 (aOR: 1.43, 95% CI: 1.39–1.46) had over a 40% increased likelihood of late-stage CRC compared to patients aged 50-59. Urban patients aged 30-39 had a 52% higher likelihood of late-stage CRC (aOR: 1.52, 95% CI: 1.46–1.58). Patients aged 20-29 (aOR: 0.81, 95% CI: 0.77–0.86) had a reduced risk of CRC death compared to those aged 50-59. Conversely, patients aged 40-49 (aOR: 1.09, 95% CI: 1.07–1.11), 60-69 (aOR: 1.16, 95% CI: 1.14–1.17), and 70-79 (aOR: 1.39, 95% CI: 1.28–1.36) had increased risks of CRC death compared to patients aged 50-59. Rural patients aged 20-29 (aOR: 0.79, 95% CI: 0.68–0.94) and 30-39 (aOR: 0.95, 95% CI: 0.87–1.03) had a reduced risk of CRC death compared to rural patients aged 50-59. Conclusion: We observed that patients aged 30-49 were more likely to be diagnosed with late- stage CRC compared to those aged 50-59, particularly in urban areas. To reduce the burden of EO-CRC and prevent advanced-stage diagnoses in young adults, it is essential to enhance access to care and raise awareness of CRC symptoms among younger Americans. Future research should explore urban -rural barriers to healthcare access, including the role of healthcare infrastructure, transportation, and provider availability, to develop strategies for improving EO-CRC early detection and treatment outcomes. Citation Format: Meng-Han Tsai, Justin X. Moore, Caitlyn Grunert. Impact of rurality on early-onset colorectal cancer outcomes: Age, geographic disparities, and the need for improved access and awareness in the United States [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B166.

A guide to large data sets for population-based cancer research: Strengths, limitations, and pitfalls.

With the proliferation of cancer research based on large databases, misalignment of research questions and data set capabilities is inevitable. Nationally maintained databases are appealing to cancer researchers because of the ease of access to large amounts of patient data available for analysis and risk estimation. Data sets that are commonly used in cancer research include the National Cancer Database, the SEER (Surveillance, Epidemiology, and End Results) program of the National Cancer Institute, the SEER-Medicare database, the American College of Surgeons National Surgical Quality Improvement Program, and the Healthcare Cost and Utilization Project databases, among others. Each data set has pros and cons with respect to variable availability and the ability to analyze cancer-specific outcomes. It is critical for researchers to understand the strengths and limitations of each database. Changing variable definitions, the length of postoperative data collection, and the availability of patient-reported outcomes or social determinants of health data are examples of factors that researchers must consider when selecting a data set for research purposes. For the current review, the authors summarized the advantages and disadvantages of various national data sets for cohort studies in cancer populations.

The SEER Program's evolution: supporting clinically meaningful population-level research.

Although the Surveillance, Epidemiology, and End Results (SEER) Program has maintained high standards of quality and completeness, the traditional data captured through population-based cancer surveillance are no longer sufficient to understand the impact of cancer and its outcomes. Therefore, in recent years, the SEER Program has expanded the population it covers and enhanced the types of data that are being collected. Traditionally, surveillance systems collected data characterizing the patient and their cancer at the time of diagnosis, as well as limited information on the initial course of therapy. SEER performs active follow-up on cancer patients from diagnosis until death, ascertaining critical information on mortality and survival over time. With the growth of precision oncology and rapid development and dissemination of new diagnostics and treatments, the limited data that registries have traditionally captured around the time of diagnosis-although useful for characterizing the cancer-are insufficient for understanding why similar patients may have different outcomes. The molecular composition of the tumor and genetic factors such as BRCA status affect the patient's treatment response and outcomes. Capturing and stratifying by these critical risk factors are essential if we are to understand differences in outcomes among patients who may be demographically similar, have the same cancer, be diagnosed at the same stage, and receive the same treatment. In addition to the tumor characteristics, it is essential to understand all the therapies that a patient receives over time, not only for the initial treatment period but also if the cancer recurs or progresses. Capturing this subsequent therapy is critical not only for research but also to help patients understand their risk at the time of therapeutic decision making. This article serves as an introduction and foundation for a JNCI Monograph with specific articles focusing on innovative new methods and processes implemented or under development for the SEER Program. The following sections describe the need to evaluate the SEER Program and provide a summary or introduction of those key enhancements that have been or are in the process of being implemented for SEER.

Reporting tumor genomic test results to SEER registries via linkages.

Precision medicine has become a mainstay of cancer care in recent years. The National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER) Program has been an authoritative source of cancer statistics and data since 1973. However, tumor genomic information has not been adequately captured in the cancer surveillance data, which impedes population-based research on molecular subtypes. To address this, the SEER Program has developed and implemented a centralized process to link SEER registries' tumor cases with genomic test results that are provided by molecular laboratories to the registries. Data linkages were carried out following operating procedures for centralized linkages established by the SEER Program. The linkages used Match*Pro, a probabilistic linkage software, and were facilitated by the registries' trusted third party (an honest broker). The SEER registries provide to NCI limited datasets that undergo preliminary evaluation prior to their release to the research community. Recently conducted genomic linkages included OncotypeDX Breast Recurrence Score, OncotypeDX Breast Ductal Carcinoma in Situ, OncotypeDX Genomic Prostate Score, Decipher Prostate Genomic Classifier, DecisionDX Uveal Melanoma, DecisionDX Preferentially Expressed Antigen in Melanoma, DecisionDX Melanoma, and germline tests results in Georgia and California SEER registries. The linkages of cancer cases from SEER registries with genomic test results obtained from molecular laboratories offer an effective approach for data collection in cancer surveillance. By providing de-identified data to the research community, the NCI's SEER Program enables scientists to investigate numerous research inquiries.

Toward real-time reporting of cancer incidence: methodology, pilot study, and SEER Program implementation.

A lag time between cancer case diagnosis and incidence reporting impedes the ability to monitor the impact of recent events on cancer incidence. Currently, the data submission standard is 22 months after a diagnosis year ends, and the reporting standard is 27.5 months after a diagnosis year ends. This paper presents the National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER) Program's efforts to minimize the lag and achieve "real-time" reporting, operationalized as submission within 2 months from the end of a diagnosis year. Technology for rapidly creating a consolidated tumor case (CTC) from electronic pathology (e-path) reports is described. Statistical methods are extended to adjust for biases in incidence rates due to reporting delays for the most recent diagnosis years. A registry pilot study demonstrated that real-time submissions can approximate rates obtained from 22-month submissions after adjusting for reporting delays. A plan to be implemented across the SEER Program rapidly ascertains unstructured e-path reports and uses machine learning algorithms to translate the reports into the core data items that comprise a CTC for incidence reporting. Across the program, cases were submitted 2 months after the end of the calendar year. Registries with the most promising baseline values and a willingness to modify registry operations have joined a program to become certified as real-time reporting. Advances in electronic reporting, natural language processing, registry operations, and statistical methodology, energized by the SEER Program's mobilization and coordination of these efforts, will make real-time reporting an achievable goal.

History of the Surveillance, Epidemiology, and End Results (SEER) Program.

The Surveillance, Epidemiology, and End Results (SEER) Program established in 1973 was the first laboratory for experimenting with new methods for cancer data collection and translating the data into population-based cancer statistics. The SEER Program staff have been instrumental in the development of the International Classification of Disease-Oncology and successfully implemented the routine collection of anatomic and prognostic cancer stage at diagnosis. Currently the program consists of 21 central registries that generate cancer statistics covering more than 48% of the US population and an additional 10 research support registries contributing to certain research projects, such as the National Childhood Cancer Registry. In parallel with the geographical expansion, the program built an architecture of methods and tools for population-based cancer statistics, with SEER*Explorer as the most recent online tool for descriptive statistics. In addition, SEER releases annual updates for a comprehensive data product line, which includes SEER*Stat databases with an annual caseload of more than 800 000 incident cases. Furthermore, the program developed a full suite of analytical applications for population-based cancer statistics that include Joinpoint (regression-based trend analysis), DevCan (risk of diagnosis and death), CanSurv (survival models), and ComPrev and PrejPrev (cancer prevalence), among others. The future of the SEER Program is closely aligned to the overall goals of the "war on cancer." The program aims to release longitudinal treatment data coupled with a comprehensive genomic characterization of cancers with a declared goal of decreasing the cancer burden and disparities across a wide spectrum of diseases and communities.

The SEER Program's longstanding commitment to making cancer resources available.

The Surveillance, Epidemiology, and End Results (SEER) Program, an authoritative source of cancer statistics in the United States, has been funded by the National Cancer Institute (NCI) since 1973. The goals of SEER include measuring the cancer burden in the United States, making the results available, and supporting cancer research. These goals render products that serve as resources for different audiences, such as cancer registrars, researchers, and the public. Cancer registrars have access to a dedicated tab on the SEER website for questions, assistance with cancer coding, and training and technical resources such as SEER*Rx and SEER Data Management System (SEER*DMS). For researchers, SEER provides access to databases and software such as SEER*Stat and other linked databases such as SEER-Medicare that may offer answers to emerging issues in the field of cancer outcomes, cancer burden, health disparities, healthcare access, diagnosis, and prevention. The public can access cancer materials such as the SEER Cancer Stat Facts sheets, SEER*Explorer, and Did You Know? video series to learn more about cancer. SEER continues to update its resources with and ahead of legislation such as the Plain Writing Act and 21st Century Integrated Digital Experience Act (IDEA) to improve both clarity and user experience. Moving forward, SEER continues to promote awareness of SEER resources, remains accessible and understandable across all audiences, and standardizes how new resources are shared with these groups. The longstanding commitment to making cancer resources available is fundamental to the value of SEER, as evidenced by testimonials from members of various audience types.

Histology-specific standardized incidence ratio improves the estimation of second primary lung cancer risk

BackgroundLung cancer (LC) survivors are at increased risk for developing a second primary cancer (SPC) compared to the general population. While this risk is particularly high for smoking-related SPCs, the published standardized incidence ratio (SIR) for lung cancer after lung cancer is unexpectedly low in countries that follow international multiple primary (IARC/IACR MP) rules when compared to the USA, where distinct rules are employed. IARC/IACR rules rely on histology-dependent documentation of SPC with the same location as the first cancer and only classify an SPC when tumors present different histology. Thus, SIR might be underestimated in cancer registries using these rules. This study aims to assess whether using histology-specific reference rates for calculating SIR improves risk estimates for second primary lung cancer (SPLC) in LC survivors.MethodsWe (i) use the distribution of histologic subtypes of LC in population-based cancer registry data of 11 regional cancer registries from Germany to present evidence that the conventional SIR metric underestimates the actual risk for SPLC in LC survivors in registries that use IARC/IACR MP rules, (ii) present updated risk estimates for SPLC in Germany using a novel method to calculate histological subtype-specific SIRs, and (iii) validate this new method using US SEER (Surveillance, Epidemiology, and End Results Program) data, where different MP rules are applied.ResultsThe adjusted relative risk for lung cancer survivors in Germany to develop an SPLC was 2.98 (95% CI 2.53–3.49) for females and 1.15 (95% CI 1.03–1.27) for males using the novel histology-specific SIR. When using IARC/IACR MP rules, the conventional SIR underestimates the actual risk for SPLC in LC survivors by approximately 30% for both sexes.ConclusionsOur proposed histology-specific method makes the SIR metric more robust against MP rules and, thus, more suitable for cross-country comparisons.

Abstract PO4-17-11: Normalized Breast Cancer Survival Outcomes in U.S. Tumor Registries

Abstract Background The largest U.S. tumor registries, NCDB (National Cancer Database) and SEER (Surveillance, Epidemiology, and End Results Program), are vital sources of epidemiological data and are frequently utilized in research. Although the NCDB includes the majority of patients diagnosed with breast cancer, it is a hospital-based registry. In contrast, SEER is a population-based registry, but includes less than half of all breast cancer patients diagnosed each year. While the US Cancer Statistics Public Use Database (USCS) captures nearly all breast cancers, treatment and survival data are not included. As such, we sought to normalize the NCDB and SEER populations to mirror the USCS population and examine survival outcomes after normalization. Methods All patients diagnosed with stage I-IV breast cancer (2010-2018) were selected from the NCDB and SEER. Frequencies of patients by select characteristics were exported from the USCS. Rates from the USCS were then used to normalize the NCDB and SEER cohorts, using patient weighted frequencies for age, sex, race/ethnicity, tumor biomarkers [estrogen receptor (ER), HER2], and extent of disease (local, regional, distant; anatomic staging data not available in USCS). Of note, the USCS does not have individual patient-level data (only summary data for select variables), and thus, weighted frequencies were used for normalization. The weighted frequencies were calculated based on the total number of patients in the USCS database divided by the total number of patients in the NCDB or SEER separately for each variable (age, sex, race/ethnicity, etc). Weighted and unweighted data were summarized with N (%). Unweighted patient and disease characteristics (crude data) were compared using Chi-square tests. Overall survival (OS) was estimated using the Kaplan-Meier method before and after normalization. Results The USCS cohort included 2,473,739 patients; the NCDB included 1,441,556 and SEER 504,938. The median followup was 54.9 months for NCDB and 57 months for SEER. There were minimal differences between the cohorts based on age (age < 50y: USCS 18.1%, NCDB 19.3%, SEER 18.9%) or sex (female: USCS 99.1%, NCDB 99.1%, SEER 99.3%). However, there were notable differences in the racial/ethnic composition; non-Hispanic White: USCS 75%, NCDB 78.2%, SEER 68.2%; non-Hispanic Black: USCS 11.4%, NCDB 11.4%, SEER 9.9%; Hispanic: USCS 8.3%, NCDB 5.9%, SEER 11.7%; p< 0.001 for USCS vs NCDB and USCS vs SEER). There were minimal differences in tumor biomarkers (ER+: USCS 82.9%, NCDB 83%, SEER 84.9%; HER2+: USCS 14.5%, NCDB 14.1%, SEER 13.8%), but significant differences in extent of disease (local: USCS 66.1%, NCDB 80.2%, SEER 68.4%; distant: USCS 6%, NCDB 3.9%, SEER 3.9%; p< 0.001 for USCS vs NCDB and USCS vs SEER). For the variables that were similar without weighting (age, sex, tumor biomarkers), OS was also similar after weighting (Table). After normalizing the NCDB based on race, 8-year OS remained comparable (crude 77.2% vs weighted 77.3%); similar findings were noted after normalizing SEER (crude 75.8% vs weighted 75.3%). After normalizing the NCDB based on extent of disease, 8-year OS was notably worse (crude 77.2% vs weighted 74.2%); similar findings were noted for SEER (crude 75.8% vs weighted 74.4%). Conclusions While national tumor registries afford researchers the opportunity to study large breast cancer cohorts, they do not always fully represent the entire breast cancer population. This limitation should be considered when working with these data sets. Table. Citation Format: Tori Chanenchuk, Kerri-Anne Crowell, Samantha Thomas, Rachel Greenup, Jennifer Plichta. Normalized Breast Cancer Survival Outcomes in U.S. Tumor Registries [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-17-11.

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

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

Increased risk of multiple metastases and worse overall survival of metastatic pancreatic body and tail cancer: a retrospective cohort study.

Pancreatic cancer (PC) is a lethal disease, especially metastatic PC. And it can be divided into two types: head pancreatic cancer (H-PC) and body and tail pancreatic cancer (BT-PC). Prior studies have proved that they have different overall survival (OS) and should be regarded as two different categories of PC. At present, there remains a gap in the field regarding OS across different primary tumor locations and metastatic sites, as well as the metastatic patterns associated with various primary tumor locations in patients with metastatic PC. Thus, our study aims to address this gap by analyzing data from a large population sourced from the Surveillance, Epidemiology, and End Results (SEER) database. The different prognosis of different primary tumor locations and metastatic sites may indicate that different primary locations and metastatic sites may require different therapy and follow-up strategy. It is hoped that these findings will lay the groundwork for future guideline updates and related research. Patients with pathologically confirmed stage IV metastatic PC from the National Cancer Institute's SEER program between 2010 and 2015 were included, excluding patients with various tumors, without specifying age, specific sites of metastasis, or OS. Data including age, race, gender, tumor size, T stage, N stage, grade, sites, number of metastatic sites, surgery, radiotherapy, chemotherapy and years of diagnoses were collected from the SEER database. OS was defined as the period from initial diagnosis to the date of death. Specific metastatic sites for the different primary locations of tumor were compared. Survival was analyzed by Cox regression analyses. Overall, 14,406 patients with metastatic PC were included in this research (7,104 of H-PC and 7,302 of BT-PC). Gender proportion, tumor size, T stage, N stage, number of metastatic sites surgery of the primary lesions and radiotherapy were different between BT-PC and H-PC. The proportion of only 1 metastatic site was 68.3% in H-PC compared with 58.3% in the BT-PC. The BT-PC was an independent risk factor for liver metastases compared with the H-PC [odds ratio (OR) =1.510; 95% confidence interval (CI): 1.320-1.727]. No matter for those with multiple metastases, or for those with solitary liver or lung metastases, patients with metastatic H-PC showed better OS (P<0.001, P=0.001, P=0.04, respectively). In patients with solitary liver metastases, worse OS was observed in the BT-PC than the H-PC [hazard ratio (HR) =1.109; 95% CI: 1.046-1.175]. The metastatic BT-PC had worse OS and increased risk to suffer from liver and multiple metastases. Moreover, in patients with solitary metastases, those with liver metastases presented poorest survival.

Estimation of the tumor size at cure threshold among adult patients with adrenocortical carcinoma: A populational-based study

BackgroundThe prognostic significance of tumor size with adrenocortical carcinoma (ACC) patients has not yet been thoroughly evaluated. Our objective was to investigate the influence of tumor size on prognostic value in adult ACC patients. MethodsThe Surveillance, Epidemiology and End Results Program (SEER) was employed to identify adult ACC patients who had been diagnosed from 2004 to 2015. The “X-Tile” program determined the optimal cutoff value of tumor size. Cancer-specific survival (CSS) and overall survive (OS) were estimated. The survival outcomes and risk factors were analyzed by the Kaplan-Meier methods and the multivariable cox regression respectively. ResultsA total 426 adult ACC patients were included. Univariable and multivariable cox analysis revealed age, larger tumor size and metastasis as consistent predictors of lower CSS and OS. The optimal cutoff value of tumor size was identified as 8.5 cm using X-tile software, and Kaplan-Meier method showed dramatic prognostic difference between patients with larger tumors (＞8.5 cm) and smaller tumors (≤8.5 cm) (log-rank test, P < 0.001). Subgroup analyses revealed no statistical significance and a consistent proportionate effect of tumor size on CSS and OS across all eight pre-specified subgroups. Interestingly, an additional subgroup analysis showed that ACC patients could not benefit from chemotherapy in terms of CSS and OS. ConclusionThe study suggests that tumor size is a crucial prognostic factor in ACC patients and a cutoff value 8.5 cm might indicate a poor outcome. Given the limitations of the available data, it is challenging to conclusively determine the benefit of chemotherapy in adult ACC patients across different tumor size ranges.

Incidence of Undifferentiated Pleomorphic Sarcoma (UPS) in the United States.

The classification of undifferentiated pleomorphic sarcoma (UPS) has been evolving with advances in immunohistochemistry and genomic profiling over the past 20 years. There is a lack of current information on UPS incidence. Due to the lack of designated histology codes for UPS in the Surveillance, Epidemiology, and End Results (SEERs) program, we estimated UPS incidence by three different definitions based on clinical opinions using the 2000-2020 data from 22 registries of the SEER program. The incidence varied widely across the three definitions with 0.06 per 100,000 persons for the least inclusive definition and 0.67 per 100,000 persons for the most inclusive definition in 2016-2020, making it challenging to estimate the exact incidence of UPS. Regardless, all the incidences decreased between 2000 and 2020. Guidelines in UPS diagnosis and classification need to be better implemented in the US.

A SEER program study of survival trends in Merkel cell carcinoma of the eyelid: 2000–2019

ABSTRACT Purpose Merkel cell carcinoma of the eyelid (MCCE) is a rare yet aggressive neuroendocrine tumour associated with significant morbidity and mortality. This study aimed to investigate survival trends and demographic factors related to MCCE, 2000–2019, using the Surveillance, Epidemiology, and End Results (SEER) Program. Methods Cases were analysed by demographic parameters, disease properties, and survival. Statistical analyses were performed via a dedicated computerized software package. Results A total 349 cases of MCCE were identified, accounting for 2% of all MCC cases in the United States during that time. Of note, the incidence of MCCE remained stable over the study period (p = .35). Female patients accounted for 56% of the cases, and males for 44%. White patients accounted for 90.8% of the the cases, and Black patients for 2.9%. MCCE incidence increased with age, with the majority of patients age 85+ (p < .05). Incidence was greatest in metropolitan areas and among those with median incomes >$75,000/year. Income correlated with likelihood of MCCE diagnosis (p < .05). Analysis of 5-year survival data showed 20% of the patients died due to MCCE within 5 years of diagnosis. Of these, the majority died within one year of diagnosis. Conclusions Consistent with previous reports, most patients were white, female, and age 85+.Incidence correlated with metropolitan environments and median income. While most patients did not die from MCCE, majority of recorded deaths occurred within one year of diagnosis.

Abstract 16756: Trends of Cardiovascular Deaths in Patients With Melanoma From 2005 to 2019: An Analysis Based on SEER Program Database

Introduction: Melanoma is the fifth most common cancer diagnosis in the United States. With recent advances in treatment modalities, including immune checkpoint inhibitors (ICIs), targeted therapies, there has been improvement in survival among melanoma patients. However, increasing resistance and treatment related adverse effects (TrAEs) are being reported including cardiovascular side effects. Objectives: To evaluate the trend of cardiovascular specific death rate among patients with melanoma. Methods: We used Surveillance, Epidemiology, and End Results (SEER) Program database 17 registries from 2000 to 2019 and SEER*Stat Version 8.4.1 software to analyze the data using the rate session. Joinpoint software, version 4.7.1.0 was used to create log-linear time trends annually. Results: Our study included 301,632 patients with melanoma from 2005 to 2019. The annual percentage change (APC) of melanoma was 0.46% (95% CI -1.45 to 1.07, p&gt;0.05) annually from 2005 to 2011 and 3.33% (95% CI 1.79 to 4.27, p&lt;0.05) annually from 2011 to 2014 and the incidence rate decreased by 0.06% (95% CI -1.44 to 0.5, p&gt;0.05) annually from 2014 to 2019. Melanoma specific mortality rate increased annually by 2.03 % (95% CI 0.78 to 3.94, P &lt;0.05) from 2005 to 2013 and decreased by 5.49% annually (95% CI -8.65 to -3.65, P &lt;0.05) from 2013 to 2019. Cardiovascular disease specific mortality rate increased by 7.08% annually (95% CI 4.66 to 9.64, P &lt;0.05) from 2005 to 2019. (Figure 1) Conclusion: Our study shows that there has been an annual increase in cardiovascular specific mortality rate from 2005 to 2019, while there was annual decrease in melanoma specific mortality rate from 2013 to 2019. Increase in cardiovascular specific death rates could be due to the direct toxicity of newer therapies and prolonged survival, which further could be due to advancement in diagnostics and newer therapies.

Risk of chronic liver disease and cirrhosis mortality among patients with digestive system cancers: a registry-based analysis.

Non-cancer deaths are now becoming a great threat to the health of cancer survivors. There are no comprehensive and systematic reports on chronic liver disease and cirrhosis mortality (CLDCM) among patients with digestive system cancers (DSCs). This research aimed to quantitatively assess the risks and patterns of CLDCM among patients with DSCs. From the surveillance, epidemiology and end results (SEER) program, we extracted the data of patients diagnosed with DSCs between 2000 and 2017. Trends in incidence-based mortality rate (IBMR) were calculated using Joinpoint software. The standardized mortality ratio (SMR) was obtained based on the reference of the general United States population. The cumulative incidence function curves were constructed by all causes of death. Independent indicators were identified using the multivariate Fine and Gray competing risk model. We included 906,292 eligible patients from the SEER program, of which 3068 (0.34%) died from chronic liver disease and cirrhosis (CLDC). The IBMR of CLDC continued to increase during the study period [average annual percent change (APC): 6.7%; 95% confidence interval (CI) 5.1-8.2] and the SMR was significantly increased (SMR: 3.19; 95% CI 3.08-3.30). The cumulative mortality of CLDC was the lowest in all causes of death. Furthermore, the age at diagnosis, race, gender, marital status, year of diagnosis, SEER stage, surgery, chemotherapy and radiotherapy were identified as independent indicators. Better screening, diagnostic and management approaches need to be implemented as a preferred method to protect the liver among patients with DSCs.

Role of Radiation Therapy in Liver-Only Oligometastatic Disease: A SEER Analysis

Radiation therapy (RT) for oligometastasis has the potential to prolong survival in certain disease sites. There is a paucity of data regarding the benefit of RT for overall survival (OS) or disease-specific survival (DSS) in patients with liver-only oligometastatic disease. The Surveillance, Epidemiology and End Results Program (SEER) includes comprehensive metastasis data for patients from 2016-2019. The SEER database was queried for patients with liver-only metastatic disease at diagnosis by selecting stage IV cases with liver-only metastasis, without metastatic disease in bone, brain, lung, distant lymph nodes, or other sites. OS and DSS were estimated using Kaplan-Meier with log-rank analysis to compare patients who received RT versus no RT. Cox proportional hazards regression was applied to identify potential confounders. Subgroup analysis was used to explore the benefit of RT in different primary tumor sites including pancreas (N = 8846), followed by colon (N = 6535), lung (N = 3075), rectum (N = 1739), and stomach (N = 1448). A total of 29,422 patients with liver-only metastatic disease treated from 2016-2019 were included. The median age was 67 years old and 77.0% of the patients were Caucasian. 2448 (8.3%) patients were confirmed to have received RT. Patients who received RT had better OS (median survival, RT vs no RT: 18 vs 6 months, P<0.001) and DSS (18 vs 7 months, P<0.001). On multivariable analyses, RT still significantly improved both OS (HR: 0.705, 95% CI: 0.665-0.747, P<0.001) and DSS (HR: 0.390, 95% CI: 0.378-0.402, P<0.001) after adjusting for potential confounders, including age, tumor size, lymph node status, and chemotherapy. RT was significantly associated with improved OS and DSS (all P<0.001) in all primary tumors sites queried except for stomach primary for which RT did not impact OS (P = 0.122) and DSS (P = 0.229). In patients who received chemotherapy, RT also prolonged OS (P<0.001) and DSS (P<0.001). In the SEER database of patients with liver-only oligometastatic disease, RT improves OS as well as DSS, however the benefit varies for the different primary tumor sites. Prospective studies could help further clarify the survival benefits of RT in liver-only oligometastatic disease.

Estimating Breast Cancer Overdiagnosis After Screening Mammography Among Older Women in the United States.

Overdiagnosis is increasingly recognized as a harm of breast cancer screening, particularly for older women. To estimate overdiagnosis associated with breast cancer screening among older women by age. Retrospective cohort study comparing the cumulative incidence of breast cancer among older women who continued screening in the next interval with those who did not. Analyses used competing risk models, stratified by age. Fee-for-service Medicare claims, linked to the SEER (Surveillance, Epidemiology, and End Results) program. Women 70 years and older who had been recently screened. Breast cancer diagnoses and breast cancer death for up to 15 years of follow-up. This study included 54 635 women. Among women aged 70 to 74 years, the adjusted cumulative incidence of breast cancer was 6.1 cases (95% CI, 5.7 to 6.4) per 100 screened women versus 4.2 cases (CI, 3.5 to 5.0) per 100 unscreened women. An estimated 31% of breast cancer among screened women were potentially overdiagnosed. For women aged 75 to 84 years, cumulative incidence was 4.9 (CI, 4.6 to 5.2) per 100 screened women versus 2.6 (CI, 2.2 to 3.0) per 100 unscreened women, with 47% of cases potentially overdiagnosed. For women aged 85 and older, the cumulative incidence was 2.8 (CI, 2.3 to 3.4) among screened women versus 1.3 (CI, 0.9 to 1.9) among those not, with up to 54% overdiagnosis. We did not see statistically significant reductions in breast cancer-specific death associated with screening. This study was designed to estimate overdiagnosis, limiting our ability to draw conclusions on all benefits and harms of screening. Unmeasured differences in risk for breast cancer and differential competing mortality between screened and unscreened women may confound results. Results were sensitive to model specifications and definition of a screening mammogram. Continued breast cancer screening was associated with greater incidence of breast cancer, suggesting overdiagnosis may be common among older women who are diagnosed with breast cancer after screening. Whether harms of overdiagnosis are balanced by benefits and for whom remains an important question. National Cancer Institute.

Non-Hodgkin Lymphoma - Nodal and Extranodal: 20-Year Comparative Mortality, Survival & Biologic Behavior Analysis by Age, Sex, Race, Stage, Cell Morphology/Histology, Cohort Entry Time-Period and Disease Duration: A Systematic Review of 384,651 Total NHL Cases Including 261,144 Nodal and 123,507 Extranodal Cases for Diagnosis Years 1975-2016: (SEER*Stat 8.3.6).

-To update trends in incidence and prevalence in the United States of non-Hodgkin lymphoma, examine, compare and contrast short and long-term patterns of survival and mortality, and consider the outcome impacts of anatomic location of NHL nodal and extranodal subdivisions, utilizing selected ICD-O-3 histologic oncotypes stratified by age, sex, race/ethnicity, stage, cell behavioral morphology and histologic typology, cohort entry time-period and disease duration, employing the statistical database of the National Cancer Institute SEER*Stat 8.3.6 program for diagnosis years 1975-2016.4 Methods.- A retrospective, population-based cohort study using nationally representative data from the National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results (SEER) program to evaluate 384,651 NHL cases for diagnosis years 1975-2016 comparing multiple variables of age, sex, race, stage, cell behavioral morphology, cohort entry time-period, disease duration and histologic oncotype. Relative survival statistics were analyzed in two cohorts: 1975-1995 and 1996-2016. Survival statistics were derived from SEER*Stat Database: Incidence - SEER 9 Regs Research Data, November 2018 Submission (1975-2016) <Katrina/Rita Population Adjustment> released April 2019, based on the November 2018 submission. - Incidence rates, relative frequency distributions, survival and mortality by age, sex, stage and cell behavioral morphology, of adult nodal (N) and extranodal (EN) NHL in 2 entrant time-periods as recorded in the SEER Program of the National Cancer Institute for diagnosis years 1975-2016 (SEER Stat 8.3.6) are summarized. Shifts in trends over time are identified, and the findings are correlated with prognosis, including short and long-term observed (actual), expected and relative survival, median observed and relative survival, mortality rates and excess death rates per 1000 people. - Trends in SEER incidence, prevalence, survival and mortality by age, sex, race, stage, cell behavioral morphology, cohort entry time-period, relative frequency and percent distribution, were examined to provide a current epidemiologic and medical-actuarial risk assessment framework for nodal (N) and extranodal (EN) non-Hodgkin's lymphoma in the 1975-2016 timeframe.

Comparison of incident breast cancer cases in the largest national US tumor registries.

6512 Background: National tumor registries, such as the NCDB (National Cancer Database) and SEER (Surveillance, Epidemiology, and End Results Program), have been used to explore numerous research questions related to trends in disease incidence, treatment patterns, and outcomes. However, some have criticized that they may not fully represent the general population. As such, we sought to compare the incident breast cancer cases in the NCDB and SEER to a national population cancer registry. Methods: All patients diagnosed with malignant or in situ breast cancer 2010-2019 were selected from the NCDB (Fall 2022 release) and SEER-22 (November 2021 release) and compared to breast cancer patient counts from the US Cancer Statistics Public Use Database (USCS, 2021 submission). Patient frequencies were summarized by age, sex, race/ethnicity, and year of diagnosis. Percent case coverage was estimated as the number of patients in the NCDB or SEER divided by the number of patients in the USCS. Chi-square tests were used to compare patient counts across data sources. Results: In total, the USCS database reported 3,047,509 patients diagnosed with breast cancer between 2010-2019, of which, 77.5% (N=2,362,477) were included in the NCDB and 46.0% (N=1,403,272) in SEER. Over time, case coverage steadily improved for the NCDB (72.8% in 2010 to 81.5% in 2019), while only a minor increase was observed in SEER (46.0% in 2010 to 46.6% in 2019). When compared to the USCS, case ascertainment was notably lower for individuals age ≥50 in both the NCDB and SEER (both p&lt;0.001). The overwhelming majority of patients were captured by the NCDB (age &lt;50: 81.7%; age ≥50: 76.6%) while SEER identified approximately half (age &lt;50: 49.4%; age ≥50: 45.3%). Case ascertainment also varied significantly by patient sex across registries (both p&lt;0.001). For male breast cancers, 84.1% were captured in the NCDB, only 77.5% of female patients were included. In contrast, case coverage in SEER was better for females than males (46.1% vs 43.5%). Notably, registries varied significantly by race/ethnicity (both p&lt;0.001). Case coverage in the NCDB was highest for non-Hispanic White (78.2%), non-Hispanic Black (77.7%), and non-Hispanic Asian or Pacific Islander (72.5%) patients, and it was lowest for Hispanic (56.4%) and non-Hispanic American Indian/Alaska Native (41.1%). In SEER, case coverage was highest for non-Hispanic Asian or Pacific Islander (78.1%) and Hispanic (69.6%) patients, and it was considerably lower for all other subgroups (non-Hispanic Black 44.8%, non-Hispanic White 42.4%, and non-Hispanic American Indian/Alaska Native 36.6%). Conclusions: National US tumor registries provide data for a large sampling of breast cancer patients, and case coverage has improved over time. However, significant differences in case coverage were observed based on age, sex, and race/ethnicity, suggesting that analyses using these data sets should be interpreted with caution.