Surveillance Epidemiology End Results Research Articles

Conditional survival in patients with thyroid cancer.

Thyroid cancer is an increasingly common malignancy. Although likelihood of survival from well-differentiated thyroid cancer can vary by disease severity, it is not known how patients' life expectancies change the farther they are from time of diagnosis. Using data from the Surveillance, Epidemiology, End Results (SEER) registry, we selected patients diagnosed with well-differentiated thyroid cancer (N=43,392) between 1998 and 2005. Patients were followed for up to 12 years. Conditional survival estimates by SEER stage and age were obtained based on Cox proportional hazards regression model of disease-specific survival. Patients with localized thyroid cancer have excellent conditional 5-year survival, irrespective of where they are in their survivorship phase. Patients with regional thyroid cancer have relatively stable conditional 5-year survival, whereas for patients with distant thyroid cancer there is gradual improvement the farther from time of diagnosis. Age and gender influence conditional survival. Similarly, age has a strong effect on disease-specific survival for patients with thyroid cancer with localized (hazard ratio [HR] 88.7 [95% confidence interval {CI} 26.3-552), comparing age ≥80 with <30 years), regional (HR 105 [95% CI 52.6-250]), and distant disease [HR 86.8 (95% CI 32.5-354)]. Male gender is also associated with a significantly worse disease-specific survival among patients with regional disease (HR 1.56 [95% CI 1.31-1.85]) but not among patients with localized or distant disease. Cancer stage, gender, age at diagnosis, and length of time already survived can influence conditional survival for patients with thyroid cancer. Understanding the conditional 5-year disease-specific survival of well-differentiated thyroid cancer is key to creating treatment plans and tailoring surveillance.

Conditional survival in melanoma and thyroid cancer patients.

6599 Background: Melanoma and thyroid cancer are two increasingly common malignancies. Although likelihood of survival from both cancers can vary by disease severity, it isn't known how patients' life expectancy changes the further they are from time of diagnosis. Methods: Using Surveillance, Epidemiology, End Results (SEER) data we selected patients diagnosed with melanoma (N=95,041) or well-differentiated thyroid cancer (N=43,392) between 1998 - 2005. Patients were followed for up to 12 years. Cox regression provided estimates of disease-specific survival by SEER stage and age, which we then transformed to estimate conditional five year survival. Results: Patients with localized melanoma and thyroid cancer have an excellent five year survival at time of diagnosis and for subsequent years. For both regional melanoma and thyroid cancer there is an age gradient with improved conditional survival in melanoma patients over time. For distant melanoma, the initial five year survival is poor but improves rapidl...

PD5-02 THE IMPACT OF LACK OF INSURANCE ON TESTICULAR CANCER PROGNOSIS IN YOUNG PATIENTS IN THE UNITED STATES. DATA FROM THE SEER DATA BASE

You have accessJournal of UrologyPenis/Testis: Benign & Malignant Disease I1 Apr 2014PD5-02 THE IMPACT OF LACK OF INSURANCE ON TESTICULAR CANCER PROGNOSIS IN YOUNG PATIENTS IN THE UNITED STATES. DATA FROM THE SEER DATA BASE Mohamed Kamel, Mohammed Elfaramawi, Supriya Jadhav, and Rodney Davis Mohamed KamelMohamed Kamel More articles by this author , Mohammed ElfaramawiMohammed Elfaramawi More articles by this author , Supriya JadhavSupriya Jadhav More articles by this author , and Rodney DavisRodney Davis More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.405AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Young adults have the highest risk of testicular cancer and more likely to be uninsured in the United States. The objective of this study was to explore the relationship between lack of insurance and testicular cancer prognosis and mortality. The Surveillance, Epidemiology, End Results (SEER) data base of the National Cancer Institute (NCI) was utilized for this study. METHODS Insurance details are included in the SEER database since 2007. Between 2007 and 2011, 5986 patients with testicular cancer in the age group 20-49 years were included in the SEER database. Of these patients 3415 (57.04%) were diagnosed with Seminoma (S) and 2571 (42.96%) with Non Seminoma germ cell tumor (NS). Cancer Specific Survival (CSS), metastasis at diagnosis (M+) and radiation therapy were compared between the uninsured (UI) and insured (I) populations. The SEER database does not include information on adjuvant chemotherapy. RESULTS Overall, 2.64% of (UI) vs. 1.36% of (I) died from testicular cancer (p=0.025) and 16.73% of (UI) vs.10.52% of (I) had (M+) at diagnosis (p<0.0001). In the Seminoma group, 4.19% of (UI) vs. 2.79% of (I) died from testicular cancer (p=0.326) and 25.92% of (UI) vs. 18.46% of (I) had (M+) at diagnosis (p=0.0007). Also, 3.14% of (UI) vs. 1.6% of (I) received adjuvant radiation therapy (p=0.037). In the Non Seminoma group, 1.06% of (UI) vs. 0.33% of (I) died from testicular cancer (p=0.020) and 7.43% of (UI) vs. 4.81% of (I) had (M+) at diagnosis (p=0.029). Also 2.12% of (UI) vs. 2.17% of (I) had retroperitoneal lymph node dissection (p=0.949). CONCLUSIONS Uninsured testicular cancer patients present with more advanced cancer stages and higher mortality than the insured patients. Uninsured Seminoma patients were more likely to receive adjuvant radiation therapy indicating more advanced cancer stage at diagnosis. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e90 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Mohamed Kamel More articles by this author Mohammed Elfaramawi More articles by this author Supriya Jadhav More articles by this author Rodney Davis More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Hospital and Geographic Variability in Thirty‐Day All‐Cause Mortality Following Colorectal Cancer Surgery

To assess hospital and geographic variability in 30-day mortality after surgery for CRC and examine the extent to which sociodemographic, area-level, clinical, tumor, treatment, and hospital characteristics were associated with increased likelihood of 30-day mortality in a population-based sample of older CRC patients. Linked Surveillance Epidemiology End Results (SEER) and Medicare data from 47,459 CRC patients aged 66 years or older who underwent surgical resection between 2000 and 2005, resided in 13,182 census tracts, and were treated in 1,447 hospitals. An observational study using multilevel logistic regression to identify hospital- and patient-level predictors of and variability in 30-day mortality. We extracted sociodemographic, clinical, tumor, treatment, hospital, and geographic characteristics from Medicare claims, SEER, and census data. Of 47,459 CRC patients, 6.6 percent died within 30days following surgery. Adjusted variability in 30-day mortality existed across residential census tracts (predicted mortality range: 2.7-12.3 percent) and hospitals (predicted mortality range: 2.5-10.5 percent). Higher risk of death within 30days was observed for CRC patients age 85+ (12.7 percent), census-tract poverty rate >20 percent (8.0 percent), two or more comorbid conditions (8.8 percent), stage IV at diagnosis (15.1 percent), undifferentiated tumors (11.6 percent), and emergency surgery (12.8 percent). Substantial, but similar variability was observed across census tracts and hospitals in 30-day mortality following surgery for CRC in patients 66 years and older. Risk of 30-day mortality is driven not only by patient and hospital characteristics but also by larger social and economic factors that characterize geographic areas.

Oropharyngeal Carcinoma in Young Adults: An Alarming National Trend

To assess the incidence, treatment methods, and outcomes of oropharyngeal squamous cell carcinoma (OPSCC) in patients younger than 45 years. Retrospective population based. Surveillance Epidemiology End Results (SEER) 9 database. The SEER 9 database was queried from 1973 to 2009 for OPSCC patients <45 years of age. There were 1603 patients with OPSCC younger than 45 years. The incidence in patients between 36 and 44 years increased from 0.79 to 1.39 (per 100,000). In the same time period, there was an increase in the rate from 0.20 to 0.42 in whites and a decrease in the rate in African American (AA) patients from 0.67 to 0.32. The proportion of grade III/IV tumors also steadily increased from 28% in 1973 to 1979 to 43% in 2000 to 2009 (P < .0001). Surgery alone was performed in 220 patients (13.72%) and in combination with radiation therapy in 734 patients (45.79%). Five-year survival for the study cohort is 54%. Compared with white patients, AA patients had worse survival (P < .0001). Patients who had surgery, either alone (localized stage patients) or in combination with radiation, had the highest 5-year survival followed by those who had radiation. There was an increase in OPSCC in the study patients within the past 4 decades, particularly in those aged 36 to 44 years. Interestingly, the incidence in whites increased and in AA patients it decreased. It is important to note that most of these patients were treated with surgery, either alone or with radiation therapy. The rising incidence within recent decades is thought to be related to human papillomavirus transmission and changes in sexual practices.

Gastrointestinal carcinoid: epidemiological and survival evidence from a large population-based study (n = 25 531)

BackgroundOwing to its rarity, the published evidence on gastrointestinal (GI) carcinoid is often based on small series of patients or population-based studies regarding all neuroendocrine tumors. Here, we present a comprehensive epidemiological and survival analysis of the largest cohort of patients with GI carcinoid ever reported. Patients and methodsPatients with histological diagnosis of GI carcinoid (n = 25 531) were identified from the Surveillance Epidemiology End Results (SEER) database (including 18 USA cancer registries and spanning the 1973–2009 time frame). Demographic and disease data were used for epidemiological and survival analyses. ResultsThe incidence of GI carcinoid is steadily increasing over the past three decades at a rate higher than any other cancer [annual percentage change (APC) = 4.4, 95% confidence interval (CI) 4.0–4.8]. These patients have a higher risk of further primary tumor (standardized incidence ratio, SIR = 1.15, 95% CI 1.10–1.21), but also a reduced risk of skin melanoma (SIR = 0.64, 95% CI 0.41–0.95). Despite the overall favorable prognosis (5-year disease-specific and relative survival rate: 91.3% and 87.4%, respectively), the mortality rate is increasing over time (APC = 3.5, 95% CI 3.0–4.0) and the 5-year survival rate of patients dying of GI carcinoid (28.5%), though better than that reported for GI cancers in general (8.4%), cannot be considered satisfactory. Finally, a nomogram is provided to predict patient survival on the basis of clinico-pathological factors independently associated with prognosis at multivariate analysis. ConclusionsThese findings can be clinically useful for the management of patients with GI carcinoid and eagerly prompt the continuous effort to develop more effective therapeutic strategies against this slow-growing but chemoresistant tumor.

Utility and Impact Of Early t(15;17) Identification By Fluorescence In Situ Hybridization (FISH) In Clinical Decision Making For Patients With Acute Promyelocytic Leukemia (APL)

BackgroundAcute Promyelocytic Leukemia (APL) is a highly curable malignancy with most large co-operative group studies showing greater than 90% long term survival. Despite this, recent studies looking at survival in population-based studies suggest that approximately 30% of patients with APL die during induction. This has been confirmed in large population-based studies in Sweden and the US. A recent analysis of Surveillance, Epidemiology & End Results (SEER) data from 13 population-based cancer registries with 1400 APL patients in the US showed that 17% of all patients and 24% of patients > 55 years of age die within one month of diagnosis. Swedish registry data also showed that 29% of patients died within 30 days of diagnosis with most of them dying in the first two weeks. Early initiation of treatment is critical in improving outcomes. Early demonstration of t(15;17) will lead to more accurate decision making regarding treatment especially in the setting when patients are referred from rural areas or treated in academic institutions where confirmation is essential for research protocol purposes. The aim of this project was to validate earlier time frames for the Abbott Molecular Vysis LSI PML/RARA FISH probe (ASR 6-16 hrs). Materials and Methods15 patients (AML-M0, M1, leukocytosis, NHL, pregnancy loss & APL) were selected for validating various hybridization (hybe) times for FISH probe. After preparing the slides, they were chemically aged by treatment of 2XSSC at 73°C for 2 minutes. 2uL of probe (Abbott Molecular Vysis LSI PML/RARA) was applied to each sample after dehydrating with an ethanol series (70%, 85% & 90%) for 1 minute each. The slides were then placed in the Thermobrite for 2, 4, 6 hours and overnight to denature and hybridize. After each hybe the slides were treated with 0.4xSSC/0.3%NP-40 for 2 minutes at 73°C and later immersed in 0.2xSSC/0.3% NP-40 for 1 minute at room temp. 2uL of DAPI Antifade SS was added with a micropipette onto each hybridized area, and a coverslip was applied. 200 cells with robust signals were identified and calculated. Hybe efficiency was graded as acceptable (good), intermediate (okay) and unacceptable (poor). Expected normal signal pattern was two red and two green signals (2R2G), and the expected most common abnormal signal pattern was two fusion (yellow) signals, one red and one green (2F1R1G) and/or one fusion, one red and one green (1F1R1G). ResultsThe specificity of the probe ranged from 84% at two hours, 86% at four hours, 84% at 6 hours, and 87% for overnight hybe. The sensitivity increased from 79% at two hours, 80% at four hours, 81% at 6 hours, to 87% for overnight hybe, which was expected. Conclusion and DiscussionMajority of the APL patients who survive the induction phase are cured with a low chance of relapse. Early mortality continues to be a significant problem with deaths attributable to bleeding, differentiation syndrome and infection. Coagulopathy abnormalities are a hallmark of this disorder and can be rapidly corrected with early institution of treatment. Also, in patients with co-morbid conditions that would exclude the use of anthracyclines, arsenic is the treatment of choice and starting of arsenic is not recommended unless cytogenetic diagnosis is confirmed. The utility of early t(15;17) detection by FISH helps in initiating treatment early and may lead to improved outcomes. This can be easily achieved by shortening the timeframe for FISH results. Based on the validation studies the current recommendations are to read FISH results at the 4 hour incubation mark for a preliminary diagnosis and confirmation with overnight hybridization. Disclosures:Kota:Teva: Speakers Bureau; Ariad: Advisory board, Advisory board Other.

Evaluation of the cost of CA-125 measurement, physical exam, and imaging in the diagnosis of recurrent ovarian cancer

ObjectiveOvarian cancer accounts for 50% of deaths from gynecologic malignancies. We sought to determine the cost of common methods of surveillance of women with ovarian cancer in first clinical remission. The current standard for post treatment surveillance is the National Comprehensive Cancer Network (NCCN) guidelines. MethodsWe retrospectively determined how recurrence was initially detected at our institution and a cost model was created and applied to the United States population to calculate surveillance costs using the Surveillance Epidemiology & End Results (SEER) database. Results57% (n=60) of first recurrences were identified by increasing CA 125 level. Routine office visit identified 27% (n=29) of recurrences, and 15% (n=16) were diagnosed initially with CT scan. In 5% (5/105), CT abnormality was the only finding. 95% (100/105) of patients had either elevated CA 125 or office visit findings at time of recurrence. Of the 22,000 women diagnosed with ovarian cancer yearly, 60% (n=13,266) will have advanced disease and are likely to recur. The surveillance cost for this population for 2years using our model is $32,500,000 using NCCN guidelines and $58,000,000 if one CT scan is obtained. ConclusionsOur data suggests that following NCCN guidelines will detect 95% of recurrences. An additional $26million will be needed to identify the 5% of women with recurrence seen on CT only. Post treatment surveillance of ovarian cancer patients contributes significantly to health care costs. Use of CT scan to follow these patients largely increases cost with only a small increase in recurrence detection.

Cancer incidence trends among Asian American populations in the United States, 1990-2008.

National cancer incidence trends are presented for eight Asian American groups: Asian Indians/Pakistanis, Chinese, Filipinos, Japanese, Kampucheans, Koreans, Laotians, and Vietnamese. Cancer incidence data from 1990 through 2008 were obtained from 13 Surveillance, Epidemiology, End Results (SEER) registries. Incidence rates from 1990 through 2008 and average percentage change were computed using SEER*Stat and Joinpoint software. The annual percentage change (APC) in incidence rates was estimated with 95% confidence intervals (95% CIs) calculated for both the rate and APC estimates. Rates for non-Hispanic whites are presented for comparison. Prostate cancer was the most common malignancy among most groups, followed by lung, colorectal, liver, and stomach cancers. Breast cancer was generally the most common cancer in women, followed by colorectal and lung cancers; liver, cervix, thyroid, and stomach cancers also ranked highly. Among men, increasing trends were observed for prostate (Asian Indians and Pakistanis: APC 1990-2003 = 2.2, 95% CI = 0.3 to 4.1; Filipinos: APC 1990-1994 = 19.0, 95% CI = 4.5 to 35.4; Koreans: APC 1990-2008 = 2.9, 95% CI = 1.8 to 4.0), colorectal (Koreans: APC 1990-2008 = 2.2, 95% CI = 0.9 to 3.5), and liver cancers (Filipinos: APC 1990-2008 = 1.6, 95% CI = 0.4 to 2.7; Koreans: APC 1990-2006 = 2.1, 95% CI = 0.4 to 3.7; Vietnamese: APC 1990-2008 = 1.6, 95% CI = 0.3 to 2.8), whereas lung and stomach cancers generally remained stable or decreased. Among women, increases were observed for uterine cancer (Asian Indians: APC 1990-2008 = 3.0, 95% CI = 0.3 to 5.8; Chinese: APC 2004-2008 = 7.0, 95% CI = 1.4 to 12.9; Filipina: APC 1990-2008 = 3.0, 95% CI = 2.4 to 3.7; Japanese: APC 1990-2008 = 1.1, 95% CI = 0.1 to 2.0), colorectal cancer (Koreans: APC 1990-2008 = 2.8, 95% CI = 1.7 to 3.9; Laotians: APC: 1990-2008 = 5.9, 95% CI = 4.0 to 7.7), lung cancer (Filipinas: APC 1990-2008 = 2.1, 95% CI = 1.4 to 2.8; Koreans: APC 1990-2008 = 2.1, 95% CI = 0.6 to 3.6), thyroid cancer (Filipinas: APC 1990-2008 = 2.5, 95% CI = 1.7 to 3.3), and breast cancer in most groups (APC 1990-2008 from 1.2 among Vietnamese and Chinese to 4.7 among Koreans). Decreases were observed for stomach (Chinese and Japanese), colorectal (Chinese), and cervical cancers (Laotians and Vietnamese). These data fill a critical knowledge gap concerning the cancer experience of Asian American groups and highlight where increased preventive, screening, and surveillance efforts are needed-in particular, lung cancer among Filipina and Korean women and Asian Indian/Pakistani men, breast cancer among all women, and liver cancer among Vietnamese, Laotian, and Kampuchean women and Filipino, Kampuchean, and Vietnamese men.

Thyroid Cancer Incidence Patterns in Sao Paulo, Brazil, and the U.S. SEER Program, 1997–2008

Thyroid cancer incidence has risen steadily over the last few decades in most of the developed world, but information on incidence trends in developing countries is limited. Sao Paulo, Brazil, has one of the highest rates of thyroid cancer worldwide, higher than in the United States. We examined thyroid cancer incidence patterns using data from the Sao Paulo Cancer Registry (SPCR) in Brazil and the National Cancer Institute's Surveillance Epidemiology End Results (SEER) program in the United States. Data on thyroid cancer cases diagnosed during 1997-2008 were obtained from SPCR (n=15,892) and SEER (n=42,717). Age-adjusted and age-specific rates were calculated by sex and histology and temporal patterns were compared between the two populations. Overall incidence rates increased over time in both populations and were higher in Sao Paulo than in the United States among females (SPCR/SEER incidence rate ratio [IRR]=1.65) and males (IRR=1.23). Papillary was the most common histology in both populations, followed by follicular and medullary carcinomas. Incidence rates by histology were consistently higher in Sao Paulo than in the United States, with the greatest differences for follicular (IRR=2.44) and medullary (IRR=3.29) carcinomas among females. The overall female/male IRR was higher in Sao Paulo (IRR=4.17) than in SEER (IRR=3.10) and did not change over time. Papillary rates rose over time more rapidly in Sao Paulo (annual percentage change=10.3% among females and 9.6% among males) than in the United States (6.9% and 5.7%, respectively). Regardless of sex, rates rose faster among younger people (<50 years) in Sao Paulo, but among older people (≥50 years) in the United States. The papillary to follicular carcinoma ratio rose from <3 to >8 among both Sao Paulo males and females, in contrast to increases from 9 to 12 and from 6 to 7 among U.S.males and females, respectively. Increased diagnostic activity may be contributing to the notable rise in incidence, mainly for papillary type, in both populations, but it is not likely to be the only reason. Differences in iodine nutrition status between Sao Paulo and the U.S. SEER population might have affected the observed incidence patterns.

Current status of the implementation of gene expression testing in breast cancer management in the United States.

6562 Background: Data on implementation of genetic diagnostic (GDx) tests are lacking yet are crucial to evaluate population differences in access and outcomes. Previous studies identified substantial underuse of GDx tests. Greater access existed in states with NCI cancer centers. This pattern of diffusion may exacerbate disparities. Since 2008, the 21-gene recurrence score (21-gene RS), which assesses the 10-year risk of breast cancer (BC) recurrence in ER+, node-negative, early-stage disease, has been recommended by ASCO/NCCN to guide chemotherapy decisions. This study examines regional and site-of-care differences in use. We report national implementation rate and state-level differences in utilization. Methods: Hospital level data on 2011 orders for the test were provided by Genomic Health. We aggregated this dataset at the state-level and linked it to public datasets (Census and CDC State Cancer Profiles). Using Surveillance Epidemiology End Results (SEER) data, we estimated number of guideline-directed BC cases. The outcome variable, state utilization ratio, was calculated by dividing the number of tests ordered by guideline-directed BC cases. For some states utilization ratios may be higher than 1 because patients may have crossed state boundaries to obtain care. Results: Of approximately 101,702 guideline-directed BC cases nationally, 59,053 patients had the test; a utilization ratio of 0.58. Utilization ratio by state ranged from 0.21 to 1.71 (25th/75thpercentile range 0.48-0.64). The District of Columbia had the highest utilization ratio at 1.71 (8 institutions ordered 367 tests on an estimated 213 patients); Iowa had the lowest at 0.21 (39 institutions, 458 tests, 2094 patients). Only 7 states had utilization ratios &lt;0.45. Conclusions: In contrast to other GDx tests, 21-gene RS has achieved notable market penetration. Overall, utilization across states is remarkably consistent, especially considering potential variations in age, comorbidities, stage, and incidence of ER+ BC. Despite widespread use, there are likely county-level and site-of-care differences in use. Hospital level analysis is ongoing and will be presented at the meeting.

Are Disparities in Acute Myelogenous Leukemia Due to Poor Prognostic Factors At Diagnosis? A National Study

Abstract 2061 Background:Disparities in Acute myelogenous leukemia (AML) have been described but not studied extensively in adults. Younger age at diagnosis and cytogenetic profiles of t(8;21) and acute promyelocytic leukemia (APL) subtypes of AML have been associated with improved survival from AML but no studies to date have evaluated these factors by race. The purpose of the current study is to evaluate differences by race/ethnicity in age and select cytogenetic factors at diagnosis. The hypothesis is that disparities for minorities will be explained by older age at diagnosis and lower rates of select favorable cytogenetics. Methods:Patients with AML were identified in the Surveillance Epidemiology End Results (SEER) database during the years 1999–2008. Kaplan-Meier survival curves were generated to predict survival by race/ethnicity, stratified by age. Multivariable Cox proportional hazard models estimated mortality by race with adjustment for age, gender, year of diagnosis, t(8;21) and APL subtypes. Results:A total of 27,252 patients were included in the study. Blacks and Hispanics were diagnosed at younger ages (<61 years) and had higher rates of t(8;21) and APL compared with non-Hispanic Whites (NHW). The overall KM curve demonstrates that NHWs had a worse survival compared to other races/ethnicities. However when KM curves were stratified by age, blacks and Hispanics had worse survival in every age category below age 61. In multivariable models adjusted for age, black patients had an increased risk of death compared to NHWs (HR 1.10 95% CI (1.04–1.16). In multivariable models adjusted for t(8;21) and APL subtypes, there was no attenuation for the disparity. For APL subtype, in particular, there was an increased disparity for blacks (HR 1.11 95% CI (1.05–1.17) and Hispanics (HR 1.05 95% CI (1.01–1.11) compared to NHWs. Conclusions:Despite younger age and higher prevalence of favorable cytogenetics, blacks have worse mortality from AML compared to other racial/ethnic groups. Blacks and Hispanics with the APL subtype have worse mortality compared to other racial/ethnic groups. Future studies should investigate other reasons for disparities among black and Hispanics with acute myelogenous leukemia. Disclosures:No relevant conflicts of interest to declare.

Abstract B68: Breast cancer mortality differences by race/ethnicity: Distinct differences by decade and hormone status.

Abstract Introduction: Our limited understanding of breast cancer mortality differences by race/ethnicity may be enhanced by examination of changes in those differences over time, and by further assessment of such differences by hormone receptor status, an important prognostic indicator. We sought to determine whether mortality disparities remained consistent with calendar time, and whether any differences were apparent between hormone receptor subgroups, in a large population-based study. Methods: Using Surveillance Epidemiology End Results (SEER) data for invasive breast cancer cases in 9 registries diagnosed from 1975-2004 and followed through 2009, we utilized Cox regression to calculate hazard ratios (HR) for 5-year breast cancer-specific mortality among women of African American race or Hispanic ethnicity, compared with non-Hispanic white women. Women considered Hispanic due only to a Hispanic surname were omitted. HR were estimated separately for women diagnosed in each succeeding 5 years to examine trends with calendar time. Separate models were fit for cases diagnosed in 1990 or later by estrogen receptor (ER) status. The proportion of mortality disparity by race/ethnicity attributable to ER status was evaluated using the change in the HR estimate when ER status was included in Cox models. Results: During the 5 years following diagnosis, 65300 deaths occurred in 418229 women. Among African-Americans, the HR for 5 year cause-specific mortality increased steadily every 5 calendar years, from 1.6 (95% Confidence Interval (CI) 1.5-1.7) among 1975-79 diagnoses to 2.4 (95% CI 2.2-2.5) in 2000-04 diagnoses. Among Hispanics, the corresponding HR increased from 1.0 (95% CI 0.9-1.2) to 1.5 (95% CI 1.4-1.7), with most change occurring in 1995 or later diagnoses. Mortality declined in all groups with calendar time, but white non-Hispanic women had a lower baseline mortality in 1975, and experienced a greater decline. Among 1990 or later diagnoses, the HR for ER-positive disease exceeded that for ER-negative disease (African-American: ER-positive HR =2.1 (95% CI 2.0-2.2) ; ER-negative HR=1.6 (95% CI 1.5-1.7); p-interaction &amp;lt;.0001 ; Hispanic: ER-positive HR=1.4 (95% CI 1.3-1.6); ER-negative HR=1.2 (95% CI 1.1-1.6);p-interaction=.02). The greater mortality among ER-positive cases accounted for 27% of the total mortality disparity in African-Americans in 1990-2009, and 30% in Hispanics. Conclusions: Misclassification of Hispanic ethnicity in earlier decades may have attenuated HR estimates, thus improved categorization may be responsible in part for the Hispanic HR increase with calendar year. Our results pertain only to the 5 years following diagnosis, and not to subsequent years, during which HR decline in both groups and the proportional hazards assumption is violated. Our findings suggest increasing mortality differences during the initial years following diagnosis among African-American (and possibly Hispanic) women from 1975-2004 that cannot be attributable to genetics alone. Further, our results imply that such disparities are stronger among those that are ER-positive. Thus efforts to reduce mortality differences in these groups might be directed to improving survival in ER-positive women. Citation Format: Deirdre Hill, Catherine Axtell, Huining Kang, Melanie Royce. Breast cancer mortality differences by race/ethnicity: Distinct differences by decade and hormone status. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr B68.

Contralateral breast cancer: Effect of stage on survival after unilateral breast cancer.

69 Background: Contralateral breast cancer (CBC) is the most common malignancy among breast cancer survivors. We investigated the impact of CBC on overall survival (OS) after unilateral primary breast cancer (UPBC) in women treated with mastectomy. Methods: Using the Surveillance Epidemiology End Results registry, we identified women age 25-80 diagnosed 1998-2006 with UPBC stage 0-III, treated with mastectomy and free of CBC at 1-year landmark. Subjects were split into test and validation samples. Follow-up continued until the earliest occurrence: death, end of 2008, or age 85. Primary risk factor was incident CBC, a time-dependent variable categorized as advanced-stage (IIB-IV), early-stage (0-IIA), or none. Proportional hazards regression adjusted for primary tumor characteristics, treatment including contralateral prophylactic mastectomy (CPM), demographics, and aging. Results: Subjects (n= 109,411, age 53.7[+12.7] years at UPBC diagnosis) were followed median 51 months. Most UPBC were early stage (63%), moderately/poorly differentiated (78%), ER+PR+ (52%). Few (9.8%) women underwent CPM at primary diagnosis. Incident CBC (n=867, 0.79%) was diagnosed median 23.5 (95% CI 1.2-72) months beyond the 1-year landmark. Test and validation samples did not differ. Only CBC of stage IIB-IV increased mortality; early stage CBC had no effect on OS. Among CBC cases, advanced stage was independently associated with aggressive UPBC (more positive nodes; larger tumor; greater extension), African-American race, and shorter time from UPBC. Conclusions: Among women who undergo mastectomy +/-CPM for UPBC, few develop CBC, which impacts survival only when diagnosed at advanced stage. Efforts to improve survival after UPBC should emphasize earlier detection and prevention of advanced-stage CBC, especially in African-American women and women with more aggressive UPBC. [Table: see text]

Sarcomas other than Kaposi sarcoma occurring in immunodeficiency

In immunodeficiency, an increased sarcoma risk is confirmed for Kaposi's sarcoma. Whether rates of other sarcoma subtypes are elevated in the setting of immunodeficiency is not known. We therefore reviewed published case reports on HIV and AIDS patients and organ transplant recipients with sarcomas. For comparison, we assessed sarcomas in the U.S. general population using Surveillance Epidemiology End Results (SEER) data. A total of 176 non-Kaposi sarcoma were identified, 75 in people with HIV and AIDS and 101 in transplant recipients. Leiomyosarcomas (n = 101) were the most frequently reported sarcomas, followed by angiosarcomas (n = 23) and fibrohistiocytic tumors (n = 17). Leiomyosarcomas were reported with two age peaks, in children and young adults. Epstein-Barr virus (EBV) was detected in the tumor cells in 85 and 88% of leiomyosarcomas in HIV-infected people and transplant recipients, respectively. Angiosarcomas and fibrohistiocytic tumors were most frequently reported in men. Among kidney transplant recipients, 20% of sarcomas arose at the site of an arteriovenous fistula. In comparison, leiomyoscarcomas, angiosarcomas, and fibrohistiocytic tumors comprised 16.9, 3.8, and 18.7% of sarcomas in the U.S. general population. Leiomyosarcoma and angiosarcoma may occur disproportionately in immunodeficiency. Leiomyosarcomas appear causatively linked to EBV, whereas angiosarcomas might be correlated with an arteriovenous fistula. Additional studies are necessary to understand the contribution of immunodeficiency to the cause of these sarcomas.

Characteristics of colorectal cancer in the human immunodeficiency virus-infected African American population

Colorectal Cancer (CRC) is the second leading cause of cancer mortality in the United States. African Americans (AAs) have the highest incidence of CRC of any American ethnic group. Survival from CRC in AAs is lower than in Caucasians, and the mean age of CRC development in AAs is younger. The AA community also has a high rate of HIV infection, accounting for 50.3% of all cases despite making up only 13.6% of the population. This retrospective cohort study identified 17 AA HIV patients with CRC. The patients were matched with 42 HIV-negative CRC patients (controls), based on age, sex, and TNM stage. Data were obtained from 3 hospitals in New Jersey: St. Michael's Medical Center, Trinitas Medical Center and St. Joseph's Medical Center. The age, sex, HIV status, tumor site, stage, drug usage, Hepatitis C status, and survival outcome of subjects and controls were compared. Data from the Surveillance Epidemiology & End Results (SEER) specific to AAs were also compared. The mean age of CRC diagnosis was younger, 50.7 years (median: 52 years, range: 35-71 years), versus 59.42 years (median: 66 years) (P < 0.0001) in the SEER AA population. Of the patients, 29.4% were diagnosed with CRC at less than 45 years of age, versus only 6.35% of the SEER AA population (P < 0.0002). The male-to-female ratio was 11:6. Seven individuals used IV drugs, and 7 had hepatitis C. The mean CD4+ T-cell count was 510.81 cells/mm(3) (median 419). At the time of CRC diagnosis, the average duration of HIV infection was 7.6 years (range 0-22.4 years).Of patients, 87.5% had left-sided CRC, versus 57.55% of the SEER population (P < 0.024). Of the patients, 52.94% had stage III-IV, at diagnosis, versus 43.84% in SEER. There was no statistically significant survival difference between the cases and controls. In our cohort of HIV-infected AA's with CRC, the staging and outcome of CRC did not appear to be affected by the degree of immunosuppression. HIV-infected AA with CRC presented with a higher percentage of left-sided CRC than AA's without HIV. Additionally, AAs with HIV tended to be younger at the time of CRC diagnosis. Our findings suggest that screening for CRC should be offered to HIV-infected AAs before the age of 45, and that sigmoidoscopy with fecal occult blood testing might be an acceptable screening modality. However, the exact age of initiation, optimal frequency, and preferred method of screening (colonoscopy vs. sigmoidoscopy) in this population requires further study.

Validation of the prognostic value of lymph node ratio in patients with cutaneous melanoma: A population-based study of 8,177 cases

The proportion of positive among examined lymph nodes (lymph node ratio [LNR]) has been recently proposed as an useful and easy-to-calculate prognostic factor for patients with cutaneous melanoma. However, its independence from the standard prognostic system TNM has not been formally proven in a large series of patients. Patients with histologically proven cutaneous melanoma were identified from the Surveillance Epidemiology End Results database. Disease-specific survival was the clinical outcome of interest. The prognostic ability of conventional factors and LNR was assessed by multivariable survival analysis using the Cox regression model. Eligible patients (n = 8,177) were diagnosed with melanoma between 1998 and 2006. Among lymph node-positive cases (n = 3,872), most LNR values ranged from 1% to 10% (n = 2,187). In the whole series (≥5 lymph nodes examined) LNR significantly contributed to the Cox model independently of the TNM effect on survival (hazard ratio, 1.28; 95% confidence interval, 1.23-1.32; P < .0001). On subgroup analysis, the significant and independent prognostic value of LNR was confirmed both inpatients with ≥10 lymph nodes examined (n = 4,381) and in those with TNM stage III disease (n=3,658). In all cases, LNR increased the prognostic accuracy of the survival model. In this large series of patients, the LNR independently predicted disease-specific survival,improving the prognostic accuracy of the TNM system. Accordingly, the LNR should be takeninto account for the stratification of patients' risk, both in clinical and research settings.

Cutaneous Melanoma In Situ: Translational Evidence from a Large Population-Based Study

Cutaneous melanoma in situ (CMIS) is a nosologic entity surrounded by health concerns and unsolved debates. We aimed to shed some light on CMIS by means of a large population-based study. Patients with histologic diagnosis of CMIS were identified from the Surveillance Epidemiology End Results (SEER) database. The records of 93,863 cases of CMIS were available for analysis. CMIS incidence has been steadily increasing over the past 3 decades at a rate higher than any other in situ or invasive tumor, including invasive skin melanoma (annual percentage change [APC]: 9.5% versus 3.6%, respectively). Despite its noninvasive nature, CMIS is treated with excision margins wider than 1 cm in more than one third of cases. CMIS is associated with an increased risk of invasive melanoma (standardized incidence ratio [SIR]: 8.08; 95% confidence interval [CI]: 7.66-8.57), with an estimated 3:5 invasive/in situ ratio; surprisingly, it is also associated with a reduced risk of gastrointestinal (SIR: 0.78, CI: 0.72-0.84) and lung (SIR: 0.65, CI: 0.59-0.71) cancers. Relative survival analysis shows that persons with CMIS have a life expectancy equal to that of the general population. CMIS is increasingly diagnosed and is often overtreated, although it does not affect the life expectancy of its carriers. Patients with CMIS have an increased risk of developing invasive melanoma (which warrants their enrollment in screening programs) but also a reduced risk of some epithelial cancers, which raises the intriguing hypothesis that genetic/environmental risk factors for some tumors may oppose the pathogenesis of others.

An Analysis of Immediate Postmastectomy Breast Reconstruction Frequency Using the Surveillance, Epidemiology, and End Results Database

Mastectomy is used to treat one third of the nearly 180,000 women diagnosed with breast cancer in the United States annually. In this study, we use population-level data from multiple years of the Surveillance, Epidemiology, End Results (SEER) database to further define patient, tumor, and geographic characteristics associated with immediate and early-delayed breast reconstruction. Population level de-identified data for the years 1998 to 2002 were extracted from the National Cancer Institute's (NCI) SEER cancer database. All female patients who were treated with mastectomy for a diagnosis of ductal and/or lobular breast cancer (including Paget disease) were included. The primary end point of interest was odds of reconstruction. Multivariate analysis was performed to control for patient demographic and oncologic characteristics. A total of 52,249 patients met the inclusion criteria. Reconstruction was performed in 8,446 patients (16.2%). Odds of reconstruction varied by region from 0.60 (Seattle) to 2.81 (Atlanta). African Americans were noted to have a significantly lower likelihood of reconstruction when compared with Caucasian patients (OR 0.60 versus 1.00). Patients living in nonmetropolitan regions were also significantly less likely to undergo reconstruction. Receipt of radiation therapy was also negatively correlated with likelihood of reconstruction. In this multicenter, multiyear analysis of factors associated with immediate or early-delayed reconstruction after mastectomy, we demonstrate that younger age, white race, metropolitan locale, and lower stage disease were all independently associated with higher likelihood of reconstruction. This information provides insight into breast reconstruction utilization and will help guide future studies to understand how these factors affect patient and physician decision-making.

Treatment profile and complications associated with cryotherapy for localized prostate cancer: a population-based study.

The aim of this study was to assess the treatment patterns and 3 to 12-month complication rates associated with receiving prostate cryotherapy in a population-based study. Men > 65 years diagnosed with incident localized prostate cancer in Surveillance Epidemiology End Results (SEER) - Medicare linked database from 2004 to 2005 were identified. A total of 21,344 men were included in the study, of which 380 were treated initially with cryotherapy. Recipients of cryotherapy versus aggressive forms of prostate therapy (i.e. radical prostatectomy or radiation therapy) were more likely to be older, have one co-morbidity, low income, live in the South, and be diagnosed with indolent cancer. Complication rates increased from 3 to 12 months following cryotherapy. By the twelfth month, the rates for urinary incontinence, lower urinary tract obstruction, erectile dysfunction, and bowel bleeding reached 9.8%, 28.7%, 20.1%, and 3.3%, respectively. Diagnoses of hydronephrosis, urinary fistula, or bowel fistula were not evident. The rates of corrective invasive procedures for lower urinary tract obstruction and erectile dysfunction were both <2.9% by the twelfth month. Overall, complications post cryotherapy were modest; however, diagnoses for lower urinary tract obstruction and erectile dysfunction were common.