Trends In Cancer Rates Research Articles

Abstract B049: Investigating standard of care treatments for cancers and their efficacy in Pacific Islander populations

Abstract Lung, Colorectal, and Pancreatic cancers are among the deadliest due to lack of early detection methods and few effective treatments. Among these cancers, patients who come from White or Black backgrounds have been shown to have the highest incidence and mortality when compared to other racial groups including Pacific Islanders. Although, most data aggregate Asian Americans and Pacific Islanders together, previous studies show that the trends in cancer rates and treatment efficacy is drastically different among these two groups. The Surveillance, Epidemiology and End Results (SEERs) Program conducted by the NIH is one such database that shows Asian Americans and Pacific Islanders as having the lowest incidence and mortality for all three of the top deadly cancers. The SEER is a database that collects cancer statistics from 33 different registries including Hawai'i, four California registries, Alaska, Texas and Utah, which are states with the highest populations of Pacific Islanders. The SEER also identifies White and Black Patients to have the highest incidence of Prostate Cancer but former studies have shown that Pacific Islanders surpass White non-Hispanics which the SEER establishes as the second highest in prostate cancer incidence. By disaggregating the data to analyze Pacific Islanders compared to other racial and ethnic groups, we can determine the true trends of cancer rates and mortality in the Pacific Islander Community. Through this work we will also determine if the standard of care treatments available to patients of these most deadly cancers is effective in those with a Pacific Islander background. Our data and data from other studies have shown that standard of care treatments are more effective in patients of European descent and are not as effective with patients from other communities due to the trials and tools used focusing a majority on caucasian patients. This is due to afflictions such as diabetes, obesity, history of smoking or drinking, and other criteria that may disqualify patients for clinical trials and treatments, however the communities most effected and have the highest prevalence of these criteria are people of color including Pacific Islanders. Our work is meant to do two things 1) lay a foundation to start collecting disaggregated data to get true trends of cancer statistics and 2) to understand the efficacy of treatments on the Pacific Islander community that is usually collected with Asian Americans which may mask the true effect on the microminority community of Pacific Islanders. Citation Format: Daniel J. Salas-Escabillas, Nicholas A. Sowizral, Sarah McNally, Sela V. Panapasa. Investigating standard of care treatments for cancers and their efficacy in Pacific Islander populations [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B049.

Trends in the Incidence Rates of Breast and Gynecological Cancers in Asia from 1998-2012: An Ecological Study.

There is limited evidence on the epidemiology and time trend analysis of incidence rates of gynecological cancer in Asia as a whole. We conducted this study to demonstrate breast and gynecological cancers incidence and trends in selected Asian populations. We conducted this ecological study using cancer and population data from cancer incidence in five continents (CI5). We extracted the data of breast, uterine, cervix and ovary cancers in selected Asian populations from 1998 to 2012 from CI5plus. We used Joinpoint regression model (version 4.8.0.1) to evaluate the annual percentage change (APC), which characterizes trends in cancer rates over time, and the average annual percent changes (AAPCs), which describes the average APCs over a period of multiple years. Results were considered statistically significant at P < 0.05. Between breast and gynecological cancers, breast cancer has the highest incidence rates among women in Asia. The time trend of the incidence rates showed a constant growth in breast, ovary and corpus uteri cancers. This rising trend was obviously sharper for uterine cancer (AAPC 95% CI = 3.4 [3.0, 3.7]) followed by breast [AAPC 95% CI = 2.1 (2.0, 2.2)] and ovarian cancers (AAPC 95% CI = 0.5 [-0.4, 1.3]). The age-adjusted incidence rate (ASR) of cervical cancer displayed a declining trend from 1998 to 2012 (AAPC 95% CI = -1.4 [-2.4, -0.5]). Incidence rates of breast and gynecological cancers have a rising trend in Asian countries. However, breast and gynecological cancers have different patterns of time trend.

A blueprint for the primary prevention of cancer: Targeting established, modifiable risk factors.

In the United States, it is estimated that more than 1.7 million people will be diagnosed with cancer, and more than 600,000 will die of the disease in 2018. The financial costs associated with cancer risk factors and cancer care are enormous. To substantially reduce both the number of individuals diagnosed with and dying from cancer and the costs associated with cancer each year in the United States, government and industry and the public health, medical, and scientific communities must work together to develop, invest in, and implement comprehensive cancer control goals and strategies at the national level and expand ongoing initiatives at the state and local levels. This report is the second in a series of articles in this journal that, together, describe trends in cancer rates and the scientific evidence on cancer prevention, early detection, treatment, and survivorship to inform the identification of priorities for a comprehensive cancer control plan. Herein, we focus on existing evidence about established, modifiable risk factors for cancer, including prevalence estimates and the cancer burden due to each risk factor in the United States, and established primary prevention recommendations and interventions to reduce exposure to each risk factor.

Contribution of demographic and behavioral factors on the changing incidence rates of oropharyngeal and oral cavity cancers in northern California.

It is unknown to what extent patient demographics, smoking, and alcohol use have contributed to changes in oropharyngeal and oral cavity cancer incidence rates. We performed a cohort study of Kaiser Permanente health plan members, ages 20 to 89, for years 1995-2010 (n = 2.2 million annual members). Poisson Regression models estimated calendar trends in cancer rates both adjusted for and stratified by age, sex, smoking, and alcohol abuse history. We identified 1,383 human papillomavirus (HPV)-related and 1,344 HPV-unrelated oral cavity and oropharyngeal cancer cases. With adjustment for age and sex, HPV-related cancer incidence rates increased 3.8% per year (P < 0.001) between 1995 and 2010, whereas rates for HPV-unrelated cancers decreased 2.4% per year (P < 0.001). For years 2007 to 2010, with additional adjustment for smoking and alcohol abuse, results were nonsignificant, but similar in magnitude. The increasing rates for HPV-related cancers were more prominent among nonsmokers (+14.5%) compared with smokers (-2.5%; P-interaction = 0.058). The decreased rates for HPV-unrelated sites were more prominent among those ≥ 60 years (-11.0%) compared with those <60 years (+16.8%; P-interaction = 0.006), among smokers (-9.7%) compared with nonsmokers (+8.4%; P-interaction = 0.055), and among those with an alcohol abuse history (-20.4%) compared with those without a history (+5.8%; P-interaction = 0.009). The observed increasing HPV-related cancer rates are most evident among nonsmokers, whereas the decreasing HPV-unrelated cancer rates are least evident among younger individuals, nonsmokers, and those without an alcohol abuse history. Continued vigilance for oropharyngeal and oral cavity cancer is warranted, including among those without traditional risk factors such as smoking and alcohol abuse.

Global Patterns of Cancer Incidence and Mortality Rates and Trends

While incidence and mortality rates for most cancers (including lung, colorectum, female breast, and prostate) are decreasing in the United States and many other western countries, they are increasing in several less developed and economically transitioning countries because of adoption of unhealthy western lifestyles such as smoking and physical inactivity and consumption of calorie-dense food. Indeed, the rates for lung and colon cancers in a few of these countries have already surpassed those in the United States and other western countries. Most developing countries also continue to be disproportionately affected by cancers related to infectious agents, such as cervix, liver, and stomach cancers. The proportion of new cancer cases diagnosed in less developed countries is projected to increase from about 56% of the world total in 2008 to more than 60% in 2030 because of the increasing trends in cancer rates and expected increases in life expectancy and growth of the population. In this review, we describe these changing global incidence and mortality patterns for select common cancers and the opportunities for cancer prevention in developing countries.

Proportional hazards models and age–period–cohort analysis of cancer rates

Age-period-cohort (APC) analysis is widely used in cancer epidemiology to model trends in cancer rates. We develop methods for comparative APC analysis of two independent cause-specific hazard rates assuming that an APC model holds for each one. We construct linear hypothesis tests to determine whether the two hazards are absolutely proportional or proportional after stratification by cohort, period, or age. When a given proportional hazards model appears adequate, we derive simple expressions for the relative hazards using identifiable APC parameters. To demonstrate the utility of these new methods, we analyze cancer incidence rates in the United States in blacks versus whites for selected cancers, using data from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. The examples illustrate that each type of proportionality may be encountered in practice.

Tendências da mortalidade por câncer nas capitais dos estados do Brasil, 1980-2004

Cancer mortality rates began to decline in developed countries in the 1990s, but their behavior in developing countries is less well-known. An earlier study on cancer mortality in Brazil showed a declining mortality trend for cancer as a whole. however the quality of data results raised some criticism t. The population of state capitals comprises about a quarter of the total Brazilian population and for these cities mortality data available have a better quality than for the entire country, enabling analyses of trends in cancer rates based on more accurate data.Mortality and population data were collected from government databases (SIM/DATASUS and IBGE, respectively). Age-adjusted (world standard) and age-specific mortality rates were calculated for both genders . Linear regression was used to investigate changes in trends.For all cancers as a whole mortality rates declined throughout the study period for both men and women (-4.6% and -10.5%, respectively). For both genders , the cancer that decreased most was stomach cancer. Among men, lung cancer death rates presented a slight reduction, while prostate cancer rates increased. Among women, "uterus, site unspecified' presented a downward trend, while lung cancer rates increased. The trend for breast cancer remained stable, and cervix uterus rates showed a slight increase at the end of the period.As already seen in developed countries, all cancer mortality rates tended to decline in Brazilian state capitals over the period 1980-2004, a tendency largely due to a decline in stomach cancer death rates for both genders.

Estimating average annual per cent change in trend analysis

Trends in incidence or mortality rates over a specified time interval are usually described by the conventional annual per cent change (cAPC), under the assumption of a constant rate of change. When this assumption does not hold over the entire time interval, the trend may be characterized using the annual per cent changes from segmented analysis (sAPCs). This approach assumes that the change in rates is constant over each time partition defined by the transition points, but varies among different time partitions. Different groups (e.g. racial subgroups), however, may have different transition points and thus different time partitions over which they have constant rates of change, making comparison of sAPCs problematic across groups over a common time interval of interest (e.g. the past 10 years). We propose a new measure, the average annual per cent change (AAPC), which uses sAPCs to summarize and compare trends for a specific time period. The advantage of the proposed AAPC is that it takes into account the trend transitions, whereas cAPC does not and can lead to erroneous conclusions. In addition, when the trend is constant over the entire time interval of interest, the AAPC has the advantage of reducing to both cAPC and sAPC. Moreover, because the estimated AAPC is based on the segmented analysis over the entire data series, any selected subinterval within a single time partition will yield the same AAPC estimate—that is it will be equal to the estimated sAPC for that time partition. The cAPC, however, is re-estimated using data only from that selected subinterval; thus, its estimate may be sensitive to the subinterval selected. The AAPC estimation has been incorporated into the segmented regression (free) software Joinpoint, which is used by many registries throughout the world for characterizing trends in cancer rates. Copyright © 2009 John Wiley & Sons, Ltd.

Comparing Trends in Cancer Rates Across Overlapping Regions

Monitoring and comparing trends in cancer rates across geographic regions or over different time periods have been major tasks of the National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results (SEER) Program as it profiles healthcare quality as well as decides healthcare resource allocations within a spatial-temporal framework. A fundamental difficulty, however, arises when such comparisons have to be made for regions or time intervals that overlap, for example, comparing the change in trends of mortality rates in a local area (e.g., the mortality rate of breast cancer in California) with a more global level (i.e., the national mortality rate of breast cancer). In view of sparsity of available methodologies, this article develops a simple corrected Z-test that accounts for such overlapping. The performance of the proposed test over the two-sample "pooled"t-test that assumes independence across comparison groups is assessed via the Pitman asymptotic relative efficiency as well as Monte Carlo simulations and applications to the SEER cancer data. The proposed test will be important for the SEER * STAT software, maintained by the NCI, for the analysis of the SEER data.

A method for identifying abrupt changes in U.S. cancer mortality trends.

Summaries of trends in cancer rates evaluated over a fixed, short period are informative, but methods that evaluate trends over a longer time period, identifying when changes occur as well as the magnitude of the changes, can provide additional information. Cancer mortality trends from 1973-1995 were determined for more than 15 anatomic sites for white and black males and females using weighted piecewise linear regression analysis with a stepwise selection procedure. The dependent variable was the natural logarithm of the annual mortality rate, and the weight was the annual number of cancer deaths. The variability of estimated change points was examined by bootstrapping the residuals from the resulting models. For black males, cancer mortality rates declined in the 1990s due to decreases in lung, esophageal, oral cavity, and prostate cancer rates. However, there was no significant decline for cancer of the colon and rectum. For white males, cancer mortality rates declined in the 1990s due to declines in cancer of the lung and colon/rectum since the mid-1980s and declines in prostate cancer in the 1990s. For black females and white females, total cancer mortality rates declined, but not significantly. Cancer rates for all sites except the lung declined significantly in the 1990s for white, but not black, females due to declining trends for carcinoma of the colon and rectum since the mid-1980s and for breast cancer in the 1990s. A method for identifying major changes in cancer trends has been developed. Trends for cancer of the breast and colon/rectum indicate that gaps between rates for blacks and whites are widening.

Trends in survival rates of cancer in Cuba.

Reports of population-based survival rates of cancer from developing countries are infrequent. In Latin America, only the Cancer Registry of Puerto Rico has published population-based survival data. The National Cancer Registry of Cuba has achieved three survival studies with cases incident in 1976, 1982 and 1988-1989. This article deals with the global observed and relative survival rates estimated in the latter study. Survival time trends are analysed. In the period 1988-1989, 12,985 primary cancer cases were included from the most common cancer sites, with the exclusion of cancer in situ cases and 8900 cases reported by 'death certificate only' (DCO) (35.8%). The vital status of cases was checked up to 31 December 1994 using a mixed follow-up system with the exclusion of 2900 cases lost to follow-up (11.2%). DCO proportions are shown for the major sites and compared to those of 1982. Observed survival rates were estimated by Kaplan-Meier method using the SPSS Statistical Software. The relative rates were estimated by the Hakulinen's Computer Program Package for Cancer Survival Studies (1988) using life tables from Cuban population. Statistical comparisons of survival curves by year of diagnosis were achieved by using the Log-Rank and Pearson statistic tests. Global results are shown by year of follow-up and a comparative analysis is done in time and with internationals values. Survival rates decreased in the period 1982/1988-1989 for colon, prostate and lung cancer. Prostate cancer shows a low five years relative survival rate when compared with the USA, but its observed rate is comparable with Puerto Rico's. Figures for mouth and lung cancer were comparable with the corresponding figures of the USA and Europe. Breast and cervix cancers rates are comparable with the European mean and the blacks in USA.

Incidence of cancer of the corpus uteri in the elderly in Canada, after adjustment for previous hysterectomy

The objectives of this study were first, to describe the trends in rates of cancer of the corpus uteri in Canada between 1969 and 1990 after adjustment for previous hysterectomy and second, to assess the role of improved diagnosis in recent periods. Cases were defined as women of ages 65 years and older with a diagnosis of cancer of the corpus uteri. Rates were calculated using national data and adjusted to reflect previous hysterectomy. A chart review was performed at a regional cancer centre to obtain information on stage of the disease, duration of the symptoms and initial method of diagnosis. Age-specific rates, adjusted for previous hysterectomy, showed increases in women aged 70–74, 75–79 and 80–84 years. The cohort analysis revealed that the 1915–19 birth cohort experienced a high incidence of cancer of the corpus uteri in women aged 55–69 years at diagnosis. Stage I disease was more common in recent periods at the regional centre (71.1%, 74.1% and 92.3% for 1969–72, 1980–81 and 1990–91; χ2 for linear trend 10.676, P = 0.001). In 1990–91, 6.7% of cases were identified by endometrial biopsy. In conclusion, incidence adjusted for hysterectomy prevalence is increasing in women aged 65–84 years in Canada. There is increased risk for women 55–69 years of age born in 1915–19 cohort. There is weak evidence of improved diagnosis in elderly women in recent periods.

Relation between population density and cancer incidence, Illinois, 1986-1990.

Many investigators have examined urbanization gradients in cancer rates. The authors used incidence data for 1986 through 1990 from the Illinois State Cancer Registry, a large, population-based incidence registry, to identify race-specific, urban-rural trends in cancer rates. Using population density, they categorized an urbanization gradient into four groups. Five-year, average annual age-adjusted, site-specific incidence rates were calculated for all sex-race strata within each population density group. Monotonic and statistically significant cancer incidence trends across all race-sex groups were found for cancers of the esophagus, liver, lung, female breast and cervix, male prostate, nervous system, non-Hodgkin's lymphomas, and all cancers combined. No trend was observed for blacks that was not also seen for whites; however, significant trends for cancer of the pancreas and Hodgkin's disease were seen for whites but not for blacks. Colon cancer in males was the only sex-specific trend in cancer that can occur in both sexes. Analytic studies for sites with consistent urban-rural trends across all race-sex groups may be fruitful in identifying the aspect of population density, or other unmeasured factor, that contribute to these trends.

Implications of birth cohort patterns in interpreting trends in breast cancer rates.

Most investigations of trends in cancer rates are based on a cross-sectional approach, i.e., an examination of trends in rates by year of diagnosis or death. When there are longitudinal effects (i.e., trends in rates with successive birth cohorts), interpretation of cross-sectional trends can be misleading. Based on cross-sectional comparisons, U.S. breast cancer mortality rates have been reported to be decreasing over the last 20 years in younger women but to be increasing during the same period in older women. To examine the impact of longitudinal effects on the divergence of cross-sectional trends in breast cancer mortality with age, we examined breast cancer mortality rates from 1969 to 1988 by birth cohort for White women in the United States. By using a novel, nonparametric, permutational method to analyze 2-year, age-specific mortality rates for women aged 30-89 years, we identified trends in rates with successive birth cohorts. The divergence in trends with age is shown to be consistent with an increase in breast cancer risk with successive birth cohorts from 1900 to 1916 and with a decrease in breast cancer risk with successive birth cohorts beginning around 1926. Longitudinal effects have a significant impact on cross-sectional trends in breast cancer mortality. Continuation of the birth cohort trend in younger women, which could correspond to changes in reproductive patterns accompanying the "baby boom," would result in decreasing cross-sectional trends in women 60-69 years of age over the next decade and in women 70-79 years of age in the subsequent decade. Longitudinal effects must be taken into consideration when monitoring and evaluating the effects of early detection, treatment, and intervention programs using national rates.

CANCER NEAR THE THREE MILE ISLAND NUCLEAR PLANT: RADIATION EMISSIONS

As a public charge, cancers among the 159,684 residents living within a 10-mile (16-km) radius of the Three Mile Island nuclear plant were studied relative to releases of radiation during the March 28, 1979, accident as well as to routine plant emissions. The principal cancers considered were leukemia and childhood malignancies. Estimates of the emissions delivered to small geographic study tracts were derived from mathematical dispersion models which accounted for modifying factors such as wind and terrain; the model of accident emissions was validated by readings from off-site dosimeters. Incident cancers among area residents for the period 1975-1985 (n = 5,493) were identified by a review of the records at all local and regional hospitals; preaccident and postaccident trends in cancer rates were examined. For accident emissions, the authors failed to find definite effects of exposure on the cancer types and population subgroups thought to be most susceptible to radiation. No associations were seen for leukemia in adults or for childhood cancers as a group. For leukemia in children, the odds ratio was raised, but cases were few (n = 4), and the estimate was highly variable. Moreover, rates of childhood leukemia in the Three Mile Island area are low compared with national and regional rates. For exposure to routine emissions, the odds ratios were raised for childhood cancers as a whole and for childhood leukemia, but confidence intervals were wide and included 1.0. For leukemia in adults, there was a negative trend. Trends for two types of cancer ran counter to expectation. Non-Hodgkin's lymphoma showed raised risks relative to both accident and routine emissions; lung cancer (adjusted only indirectly for smoking) showed raised risks relative to accident emissions, routine emissions, and background gamma radiation. Overall, the pattern of results does not provide convincing evidence that radiation releases from the Three Mile Island nuclear facility influenced cancer risk during the limited period of follow-up.