United States Cancer Statistics Research Articles

Public Health Implications of Google Searches for Sunscreen, Sunburn, Skin Cancer, and Melanoma in the United States.

Google Trends (GT) offers insights into public interests and behaviors and holds potential for guiding public health campaigns. We evaluated trends in US searches for sunscreen, sunburn, skin cancer, and melanoma and their relationships with melanoma outcomes. Google Trends was queried for US search volumes from 2004 to 2017. Time-matched search term data were correlated with melanoma outcomes data from Surveillance Epidemiology and End Results Program and United States Cancer Statistics databases (2004-2014 and 2010-2014, respectively). Users of the Google search engine in the United States. Google search engine users in the United States. This represents approximately 65% of the population. Search volumes, melanoma outcomes. Pearson correlations between search term volumes, time, and national melanoma outcomes. Spearman correlations between state-level search data and melanoma outcomes. The terms "sunscreen," "sunburn," "skin cancer," and "melanoma" were all highly correlated ( P < .001), with sunscreen and sunburn having the greatest correlation ( r = 0.95). Sunscreen/sunburn searches have increased over time, but skin cancer/melanoma searches have decreased ( P < .05). Nationally, sunscreen, sunburn, and skin cancer were significantly correlated with melanoma incidence. At the state level, only sunscreen and melanoma searches were significantly correlated with melanoma incidence. We conclude that online skin cancer prevention campaigns should focus on the search terms "sunburn" and "sunscreen," given the decreasing online searches for skin cancer and melanoma. This is reinforced by the finding that sunscreen searches are higher in areas with higher melanoma incidence.

Public health implications of Google searches for sunscreen, sunburn, skin cancer, and melanoma in the United States

Purpose Google Trends (GT) offers insights into public interests and behaviors and holds potential for guiding public health campaigns. We evaluated trends in US searches for and and their relationships with outcomes. Design Google Trends was queried for US search volumes from 2004 to 2017. Time-matched search term data were correlated with outcomes data from Surveillance Epidemiology and End Results Program and United States Cancer Statistics databases (2004-2014 and 2010-2014, respectively). Setting Users of the Google search engine in the United States. Participants Google search engine users in the United States. This represents approximately 65% of the population. Measures Search volumes, outcomes. Analysis Pearson correlations between search term volumes, time, and national outcomes. Spearman correlations between state-level search data and outcomes. Results The terms sunscreen, sunburn, skin cancer, and melanoma were all highly correlated ( P Conclusions We conclude that online cancer prevention campaigns should focus on the search terms sunburn and sunscreen, given the decreasing online searches for cancer and melanoma. This is reinforced by the finding that sunscreen searches are higher in areas with higher incidence.

The Connection Between Testicular Cancer, Minority Males, and Planned Parenthood.

Testicular cancer (TCa) is the most prevalent neoplasm diagnosed in males aged 15–40 years. Lack of access to care is a key impediment to early-stage TCa diagnosis. Health equity concerns arise, however, as poor access largely manifests within underserved male populations, therefore, placing them at a higher risk to develop late-stage TCa. Planned Parenthood Federation of America (PPFA) offers a myriad of male reproductive/sexual health care options, including TCa screening and referral services. Therefore, expanding these amenities in traditionally underserved communities may address the concern of TCa screening opportunities. An ecological analysis was performed using data from the United States Cancer Statistics, American Community Survey, and PPFA databases to assess the impact of TCa upon minority males, identify associations between PPFA services and minority males, and provide future implications on the role PPFA may play in bridging health-care access gaps pertaining to TCa screenings. Results indicate that states with higher rates of poverty and uninsured individuals, as well as specifically Black/African American males, have lower TCa incidence and limited access to screening services. PPFA service presence and Black/African American, as well as uninsured, males had a negative association but revealed positive correlations with TCa incidence. Considering the emerging TCa outcome disparities among minority males, expanding PPFA men’s health services is crucial in providing affordable options to help identify testicular abnormalities that are early stage or carcinoma in situ. Many at-risk males have limited means to obtain TCa screening services. Expanding this discussion could provide a foundation for future advocacy.

Geographic Variation in Pediatric Cancer Incidence - United States, 2003-2014.

Approximately 15,000 persons aged <20 years receive a cancer diagnosis each year in the United States (1). National surveillance data could provide understanding of geographic variation in occurrence of new cases to guide public health planning and investigation (2,3). Past research on pediatric cancer incidence described differences by U.S. Census region but did not provide state-level estimates (4). To adequately describe geographic variation in cancer incidence among persons aged <20 years in the United States, CDC analyzed data from United States Cancer Statistics (USCS) during 2003-2014 and identified 171,432 cases of pediatric cancer during this period (incidence = 173.7 cases per 1 million persons). The cancer types with the highest incidence rates were leukemias (45.7), brain tumors (30.9), and lymphomas (26.2). By U.S. Census region, pediatric cancer incidence was highest in the Northeast (188.0) and lowest in the South (168.0), whereas by state (including the District of Columbia [DC]), rates were highest in New Hampshire, DC, and New Jersey. Among non-Hispanic whites (whites) and non-Hispanic blacks (blacks), pediatric cancer incidence was highest in the Northeast, and the highest rates among Hispanics were in the South. The highest rates of leukemia were in the West, and the highest rates of lymphoma and brain tumors were in the Northeast. State-based differences in pediatric cancer incidence could guide interventions related to accessing care (e.g., in states with large distances to pediatric oncology centers), clinical trial enrollment, and state or regional studies designed to further explore variations in cancer incidence.

(P52) Rural-Urban Continuum as a Potential Geographic Correlate of Breast and Prostate Cancer Mortality in Nevada

Data suggest that incidence and mortality associated with breast and prostate cancer have shown favorable trends through time, wherein data for the US show decreasing trends in these measures, except for breast cancer incidence, which has plateaued since 2003. Examination of Nevada data, however, suggests that mortality for both cancers is slightly higher than the US average. Further, mortality rates for metro vs non-metro areas suggest potential geographic disparities in mortality. The objective of this investigation was to examine purported differences in metro, urban, and rural counties in Nevada as potential geographic correlates of cancer mortality. Data for breast and prostate cancer for Nevada were obtained from two sources: (1) statewide incidence and mortality were from the CDC’s United States Cancer Statistics Incidence and Mortality reports (1999-2014); and (2) county-based mortality was obtained from the Institute for Health Metrics and Evaluation, Global Health Data Exchange (1980-2014). Additional data on decadal Rural-Urban Continuum (RUCC) codes were obtained from SEER for decades starting in 1974 through 2013, and these were matched to counties in Nevada to obtain a temporal representation of cancer mortality as a function of metro, urban, or rural status to develop correlative associations of geography and mortality rates. Mortality distributional curves were compared using a Bonferroni-adjusted Kolmogorov-Smirnov test among the three geographic designations. Similar to the US average, both breast and prostate cancer incidence and mortality demonstrated a general temporal decline regardless of geography. For breast cancer, mortality did not differ between metro and urban counties (D = 1.01, p = .771), but both exceeded rural counties (D = 1.75, = .012; D = 2.30, p < .001), respectively. All geographic areas showed a plateau or slight increase in the most recent years of data, wherein rural mortality rates exceeded metro in 2013-2014. For prostate cancer, mortality rates for urban counties always exceeded metro and rural counties (D = 3.56, p < .001; D = 3.52, p < .001), respectively, though metro and urban rates did not differ (D = 1.40; p = .117). Similar to breast cancer, there were increases across all geographies in the most recent years of data, with rural mortality rates exceeding metro from 2010-2014. Geography may play a significant role in the incidence and mortality of certain cancers, particularly for patients who are located in areas with fewer medical resources for screening and/or treatment. This potentially results in increased mortality rates associated with treatment of late-stage disease that may not be predicated by increased morbidity estimates for those without ready access to screening and treatment. Further, mortality estimates may seem paradoxically higher in metro and urban areas compared to rural areas because patients likely travel to these geographies to obtain care, hence potentially increasing mortality estimates for these areas. This study provides some evidence of the importance of considering rural-urban continuum in exploring incidence and mortality rates for cancer, and provides an initial exploration of data relevant for understanding health disparities related to geography for the population of Nevada.

Incidence of gastric cancer in the USA during 1999 to 2013: a 50-state analysis.

The incidence of gastric cancer, while declining in many places worldwide, is characterized by considerable geographical variability. The USA has large racial, ethnic and regional variation; we collected data from all 50 states to better characterize recent changes in gastric cancer incidence nationwide. Annual gastric cancer incidence rates from 1999 to 2013 were extracted from the United States Cancer Statistics (USCS) registry. Secular trends of gastric cancer incidence were examined overall and by sociodemographic factors and states. We used Joinpoint regression to compute annual percent change (APC) and average annual percent change (AAPC) and corresponding 95% confidence intervals (CIs). SEER 13 registries data were extracted to examine the secular trends by cardia and non-cardia gastric cancers. Overall gastric cancer incidence decreased until 2007 (APC = -1.55, 95% CI: -1.88, -1.21), and remained stable thereafter (APC = -0.32, 95% CI: -0.84, 0.20). However, rates increased among persons <50 years of age (AAPC = 0.89, 95% CI: 0.61, 1.16), especially among non-Hispanic white females and Hispanic females. Incidence of non-cardia gastric cancer increased among persons <50 years of age (AAPC = 0.69, 95% CI: -0.06, 1.44), whereas rates of gastric cardia cancer remained unchanged. States with rapid increases in high-risk population groups (e.g. Hispanic females aged <50), including California and Texas, had highest annual increases in gastric cancer incidence. Divergent trends for gastric cancer incidence were observed in the USA. Incidence rates, particularly for non-cardia gastric cancer, were stable or increasing among persons aged <50 years.

Stage-specific incidence rates and trends of prostate cancer by age, race, and ethnicity, United States, 2004–2014

PurposeCurrent literature shows different findings on the contemporary trends of distant-stage prostate cancer incidence, in part, due to low study population coverage and wide age groupings. This study aimed to examine the stage-specific incidence rates and trends of prostate cancer by age (5-year grouping), race, and ethnicity using nationwide cancer registry data. MethodsData on prostate cancer cases came from the 2004–2014 United States Cancer Statistics data set. We calculated stage-specific incidence and 95% confidence intervals by age (5-year age grouping), race, and ethnicity. To measure the changes in rates over time, we calculated annual percentage change (APC). ResultsWe identified 2,137,054 incident prostate cancers diagnosed during 2004–2014, with an age-adjusted incidence rate of 453.8 per 100,000. Distant-stage prostate cancer incidence significantly decreased during 2004–2010 (APC = −1.2) and increased during 2010–2014 (APC = 3.3). Significant increases in distant prostate cancer incidence also occurred in men aged older than or equal to 50 years except men aged 65–74 and older than or equal to 85 years, in men with white race (APC = 3.9), and non-Hispanic ethnicity (APC = 3.5). ConclusionsUsing data representing over 99% of U.S. population, we found that incidence rates of distant-stage prostate cancer significantly increased during 2010–2014 among men in certain ages, in white, and with non-Hispanic ethnicity.

Trends in the incidence of serous fallopian tube, ovarian, and peritoneal cancer in the US

ObjectiveTo identify the trends in incidence of serous fallopian tube, ovarian, and peritoneal epithelial cancers in the United States. MethodsData was obtained from United States Cancer Statistics (USCS) from 2001 to 2014. All incidences are per 100,000 women. Analyses were performed using SEER*Stat and Joinpoint regression programs. ResultsOf the 146,470 patients with serous cancers, 9381 (6.4%) were fallopian tube, 121,418 (82.9%) were ovarian, and 15,671 (10.7%) were primary peritoneal. The study period was divided from 2001 to 2005, 2006–2010, and 2011–2014, and there was an increase in fallopian tube incidence from 0.19 to 0.35 to 0.63, with a corresponding decrease in ovarian incidence from 5.31 to 5.08 to 4.86. There was no significant change in peritoneal cancers from 0.64 to 0.69 to 0.62. The age-specific peak incidence of fallopian tube cancer was younger at age 70–74, compared to ovarian and peritoneal cancer at age 75–79. Further, the incidence of serous fallopian tube cancer was highest in Whites at 0.42, compared to Blacks at 0.24, Hispanics at 0.27, and Asians at 0.28. ConclusionFrom 2001 to 2014, the diagnosis of serous fallopian tube cancer increased fourfold with a corresponding decrease in ovarian cancer. The peak incidence of tubal cancer was 70–74years with an increased incidence in Whites.

Vital Signs: Trends in Incidence of Cancers Associated with Overweight and Obesity - United States, 2005-2014.

BackgroundOverweight and obesity are associated with increased risk of at least 13 different types of cancer.MethodsData from the United States Cancer Statistics for 2014 were used to assess incidence rates, and data from 2005 to 2014 were used to assess trends for cancers associated with overweight and obesity (adenocarcinoma of the esophagus; cancers of the breast [in postmenopausal women], colon and rectum, endometrium, gallbladder, gastric cardia, kidney, liver, ovary, pancreas, and thyroid; meningioma; and multiple myeloma) by sex, age, race/ethnicity, state, geographic region, and cancer site. Because screening for colorectal cancer can reduce colorectal cancer incidence through detection of precancerous polyps before they become cancerous, trends with and without colorectal cancer were analyzed.ResultsIn 2014, approximately 631,000 persons in the United States received a diagnosis of a cancer associated with overweight and obesity, representing 40% of all cancers diagnosed. Overweight- and obesity-related cancer incidence rates were higher among older persons (ages ≥50 years) than younger persons; higher among females than males; and higher among non-Hispanic black and non-Hispanic white adults compared with other groups. Incidence rates for overweight- and obesity-related cancers during 2005–2014 varied by age, cancer site, and state. Excluding colorectal cancer, incidence rates increased significantly among persons aged 20–74 years; decreased among those aged ≥75 years; increased in 32 states; and were stable in 16 states and the District of Columbia.ConclusionsThe burden of overweight- and obesity-related cancer is high in the United States. Incidence rates of overweight- and obesity-related cancers except colorectal cancer have increased in some age groups and states.Implications for Public Health PracticeThe burden of overweight- and obesity-related cancers might be reduced through efforts to prevent and control overweight and obesity. Comprehensive cancer control strategies, including use of evidence-based interventions to promote healthy weight, could help decrease the incidence of these cancers in the United States.

Regional Sociodemographic Determinants of Colon Cancer Incidence in the United States

Introduction: Numerous studies have assessed the correlation between Colon cancer incidence and some socio-demographic factors; but little has been done at the population level and has included the following socio-demographics factors body max index (BMI), smoking rate, median income, insurance coverage rate. Here, we investigate the correlation between these socio-demographic factors and Colon cancer incidence at the population level. We planned to use regional variations in these socio-demographic factors to examine correlation patterns with U.S Colon cancer incidence geographical variations. Methods: From 1999 to 2012, the following data per state were obtained to construct the datasetmedian income and insurance coverage rate data from the United States census bureau, BMI data from the Robert Wood Johnson Foundation, smoking rate data from the Institute for Health Metrics and Evaluation, colon cancer incidence data from the Centers for Disease Control and Prevention (United States Cancer Statistics). All 50 states were grouped into 7 regional subdivisions (West, Southern Rockies, Northern Rockies, South Central, North Central, Southeast and Northeast). A regression analysis was performed using IBM SPSS for data analysis and results are reported as Unstandardized Correlation Coefficient. Results: Yearly colon cancer incidence increases in the West, Southern Rockies and Southeast (1.293, 1.215 and 0.860 respectively). The incidence increases as BMI decreases in the West, Southern Rockies and Southeast (1.565, 1.702 and 1.056 respectively). The incidence is not affected by income and it increases as smoking rates increases everywhere except in the North Central (2.241). The incidence increases as the percentage of insured increases in the Northern Rockies and South Central (0.693 and 0.894 respectively) but not in the Southeast (0.624). Conclusion: Regional differences exist in the correlation coefficient between Colon cancer incidence and the selected socio-demographic factors, suggestive of their various level of influence in Colon cancer incidence. Our results suggest that ways to decrease Colon cancer incidence will be to decrease smoking rate. BMI and insurance coverage had various effects depending on the region. Our study shows that we need to look at the population level and address socio-demographic determinants by working with governmental, state and local public health entities to enact strategies to reduce colon cancer incidence even further.

Regional Socio-Demographic Determinants of Lung Cancer Incidence in the United States

SESSION TITLE: Quality Improvement 2 SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: Lung cancer is the leading cause of cancer death in the United States (U.S). Several studies done at the individual level, have assessed the correlation between lung cancer incidence and some socio-demographic factors; but little has been done at the population level and has included body max index (BMI), smoking rate, median income, insurance coverage rate. We wanted to investigate the correlation between the following reported socio-demographic factors (BMI, smoking rate, median income, insurance coverage rate) and lung cancer incidence at the population level. Because cancer incidence can vary by socio-demographic characteristics, we planned to use regional variations in these socio-demographic factors to examine correlation patterns with U.S lung cancer incidence geographical variations between 1999-2012. METHODS: From 1999 to 2012, data for median income and for insurance coverage rate per state were obtained from the United States census bureau (Current Population Survey), data for body mass index per state were obtained from the Robert Wood Johnson Foundation, data for smoking rate per state were obtained from the Institute for Health Metrics and Evaluation, data for lung cancer incidence were obtained from the Centers for Disease Control and Prevention (United States Cancer Statistics) to construct the dataset. All 50 states were grouped into 7 regional subdivisions (West, Southern Rockies, Northern Rockies, South Central, North Central, Southeast and Northeast). A regression analysis was performed using IBM SPSS for data analysis. RESULTS: Our study revealed that yearly lung cancer incidence decreased in most regions with the exception of states in the Southern Rockies and the Northeast (Unstandardized Correlation Coefficient (UCC) 3.78 and 1.39 respectively). Additionally, lung cancer incidence increased as BMI increased in most regions with the exception of states in the Southern Rockies (UCC 2.05). Generally, lung cancer incidence decreased as income increased with the exception of the Southern Rockies (UCC 0.002), and lung cancer incidence increased as smoking rates increased in most of the regions (UCC varying from 1.37 to 6.57). Likewise, lung cancer incidence increased as the percentage of insured increased in some of the regions (UCC from 0.69 to 2.00). CONCLUSIONS: Regional differences exist in the correlation coefficient between lung cancer incidence and the selected socio-demographic factors, suggestive of their various level of influence in lung cancer incidence. CLINICAL IMPLICATIONS: Our results suggest that the most efficient way to decrease lung cancer incidence will be to concomitantly decrease smoking rate, decrease average BMI, increase median income and insurance coverage. As healthcare professionals, we tend to focus on the individual level as we care for our patient. Our study shows that we need to be looking at the population level as well and advocate for policies that address some socio-demographic determinants by working in a more concerted effort wih governmental, state and local public health entities to inact strategies to reduce lung cancer incidence even further. DISCLOSURE: The following authors have nothing to disclose: Hermann Simo, Zaid Ammari, Abhinav Tiwari, Sheza Darr, William Barnett, Mohammad Khan, Arjan Flora No Product/Research Disclosure Information

Rates and Trends of Pediatric Acute Lymphoblastic Leukemia - United States, 2001-2014.

Acute lymphoblastic leukemia (ALL) is the most prevalent cancer among children and adolescents in the United States, representing 20% of all cancers diagnosed in persons aged <20 years, or >3,000 new cases each year (1). Past studies reported increasing trends of ALL overall and among Hispanics, but these represented ≤28% of the U.S. population and did not provide state-based estimates (1-3). To describe U.S. ALL incidence rates and trends among persons aged <20 years during 2001-2014, CDC analyzed rigorous data (based on established publication criteria) from the United States Cancer Statistics data set, which includes incidence data on approximately 15,000 new cases per year of all types of invasive cancer among children and adolescents aged <20 years (4). The data set represented 98% of the U.S. population during the study period. Overall incidence of pediatric ALL during 2001-2014 was 34.0 cases per 1 million persons and among all racial/ethnic groups was highest among Hispanics (42.9 per 1 million). Both overall and among Hispanics, pediatric ALL incidence increased during 2001-2008 and remained stable during 2008-2014. ALL incidence was higher in the West than in any other U.S. Census region. State-specific data indicated that the highest rates of pediatric ALL incidence were in California, New Mexico, and Vermont. These demographic and geographic ALL incidence data might better inform public health interventions targeting the following areas: exposures to recognized risk factors for leukemia; ALL treatment, including clinical trial enrollment; survivorship care planning; and studies designed to understand the factors affecting changes in pediatric cancer incidence.

Surveillance for Cancer Incidence and Mortality - United States, 2013.

This report provides, in tabular and graphic form, official federal statistics on cancer incidence and mortality for 2013 and trends for 1999-2013 as reported by CDC and the National Cancer Institute (NCI). Data in this report come from the United States Cancer Statistics (USCS) system (1), which includes cancer incidence data from population-based cancer registries that participate in CDC's National Program of Cancer Registries (NPCR) and NCI's Surveillance, Epidemiology, and End Results (SEER) program reported as of November 2015 and cancer mortality data from death certificate information reported to state vital statistics offices as of June 2015 and compiled into a national file for the entire United States by CDC's National Center for Health Statistics (NCHS) National Vital Statistics System (NVSS).

Patterns and Trends in Age-Specific Black-White Differences in Breast Cancer Incidence and Mortality - United States, 1999-2014.

Breast cancer continues to be the most commonly diagnosed cancer and the second leading cause of cancer deaths among U.S. women (1). Compared with white women, black women historically have had lower rates of breast cancer incidence and, beginning in the 1980s, higher death rates (1). This report examines age-specific black-white disparities in breast cancer incidence during 1999-2013 and mortality during 2000-2014 in the United States using data from United States Cancer Statistics (USCS) (2). Overall rates of breast cancer incidence were similar, but death rates remained higher for black women compared with white women. During 1999-2013, breast cancer incidence decreased among white women but increased slightly among black women resulting in a similar average incidence at the end of the period. Breast cancer incidence trends differed by race and age, particularly from 1999 to 2004-2005, when rates decreased only among white women aged ≥50 years. Breast cancer death rates decreased significantly during 2000-2014, regardless of age with patterns varying by race. For women aged ≥50 years, death rates declined significantly faster among white women compared with black women; among women aged <50 years, breast cancer death rates decreased at the same rate among black and white women. Although some of molecular factors that lead to more aggressive breast cancer are known, a fuller understanding of the exact mechanisms might lead to more tailored interventions that could decrease mortality disparities. When combined with population-based approaches to increase knowledge of family history of cancer, increase physical activity, promote a healthy diet to maintain a healthy bodyweight, and increase screening for breast cancer, targeted treatment interventions could reduce racial disparities in breast cancer.

Affluence and Breast Cancer.

High income, high socioeconomic status, and affluence increase breast cancer incidence. Socioeconomic status in USA breast cancer studies has been assessed by block-group socioeconomic measures. A block group is a portion of a census tract with boundaries that segregate, as far as possible, socioeconomic groups. In this study, we used US Census income data instead of block groups to gauge socioeconomic status of breast cancer patients in relationship with incidence, prognostic markers, and survival. US state breast cancer incidence and mortality data are from the U.S. Cancer Statistics Working Group, United States Cancer Statistics: 1999-2011. Three-Year-Average Median Household Income by State, 2010 to 2012, is from the U.S. Census Bureau, Current Population Survey, 2011 to 2013 Annual Social and Economic Supplements. County incomes are from the 2005-2009 American Community Survey of the U.S. Census Bureau. The American Community Survey is an ongoing statistical survey that samples a small percentage of the population yearly. Its purpose is to provide communities the information they need to plan investments and services. Breast cancer county incidence and survival data are from the National Cancer Institute's Surveillance, Epidemiology and End Results Program (SEER) data base. We analyzed SEER data from 198 counties in California, Connecticut, Georgia, Hawaii, Iowa, New Mexico, Utah, and Washington. SEER uses the Collaborative Stage (CS) Data Collection System. We have retained the SEER CS variables. There was a significant relationship of income with breast cancer incidence in 50 USA states and the District of Columbia in White women (r = 0.623, p < 0.001). There was a significant relationship between node involvement and income in Whites in 198 USA counties. Income was significantly correlated with 5-year relative survival in Whites with localized breast cancer. Income was not correlated with 5-year survival of Black race (p = 0.364) or other races (p = 0.624). The multivariate general linear model with income as covariate, 5-year survival by race as a dependent variable, showed a significant effect of income and White race on 5-year survival (p < 0.001), unrelated to Black race (p = 0.780) or other races (p = 0.618). In men, we found a nonsignificant positive correlation between county breast cancer incidence and income (r = 0.098, p = 0.168). Breast cancer risk factors, such as delayed childbirth, less breast-feeding, and use of hormone supplements, are more common in affluent women. Affluent women are more likely to have mammograms, which detect many cancers that might not otherwise be diagnosed. In addition, women in certain affluent ethnic groups-Ashkenazi Jews, Icelanders and the Dutch-are more likely to carry genetic mutations known to predispose to breast cancer. We hypothesize that women with more income can afford better cancer care and survive longer than poorer women. But our hypothesis does not explain why this effect should be limited to White women; or why node involvement increased with income in White women but not in Blacks or Hispanics. Further studies may be worthwhile.

Cancer Incidence in Appalachia, 2004-2011.

Limited literature is available about cancer in the Appalachian Region. This is the only known analysis of all cancers for Appalachia and non-Appalachia covering 100% of the US population. Appalachian cancer incidence and trends were evaluated by state, sex, and race and compared with those found in non-Appalachian regions. US counties were identified as Appalachian or non-Appalachian. Age-adjusted cancer incidence rates, standard errors, and confidence intervals were calculated using the most recent data from the United States Cancer Statistics for 2004 to 2011. Generally, Appalachia carries a higher cancer burden compared with non-Appalachia, particularly for tobacco-related cancers. For all cancer sites combined, Appalachia has higher rates regardless of sex, race, or region. The Appalachia and non-Appalachia cancer incidence gap has narrowed, with the exception of oral cavity and pharynx, larynx, lung and bronchus, and thyroid cancers. Higher cancer incidence continues in Appalachia and appears at least in part to reflect high tobacco use and potential differences in socioeconomic status, other risk factors, patient health care utilization, or provider practices. It is important to continue to evaluate this population to monitor results from screening and early detection programs, understand behavioral risk factors related to cancer incidence, increase efforts to reduce tobacco use and increase cancer screening, and identify other areas where effective interventions may mediate disparities. Surveillance and evaluation of special populations provide means to monitor screening and early detection programs, understand behavioral risk factors, and increase efforts to reduce tobacco use to mediate disparities.

Highlights of This Issue

Several studies have found inverse associations between glioma susceptibility and a history of allergies or other atopic conditions. Using data from the Glioma International Case-Control Study (GICC), Amirian and colleagues examined the effects of respiratory allergies and other atopic conditions on glioma risk. The authors report that a history of respiratory allergies was associated with an approximately 30% lower glioma risk. This GICC study further strengthens the existing evidence that the relationship between atopy and glioma is unlikely to be coincidental.Wilson and colleagues evaluated cancer incidence and trends in Appalachia and non-Appalachian regions of the US. Age-adjusted cancer incidence rates were calculated using the most recent data from the United States Cancer Statistics for 2004 to 2011. Generally, Appalachia carries a higher cancer burden compared to non-Appalachia, particularly for tobacco-related cancers. It is important to continue to evaluate this population to better understand behavioral risk factors related to cancer incidence.In this study, Moss and colleagues evaluated the seasonal uptake of human papillomavirus (HPV) vaccine and other adolescent vaccines in the United States. Data came from health care provider–verified vaccination records and seasonal patterns in uptake of HPV and other recommended adolescent vaccines [tetanus, diphtheria, and pertussis (Tdap) booster and meningococcal vaccine]. HPV vaccine initiation (receipt of the first of the three-dose series) data were for female adolescents. HPV vaccine initiation was highest in June, July, and August. These summer peaks are an important opportunity for interventions focused on concomitant vaccination.Chronic inflammation and oxidative stress are thought to be involved in colorectal cancer development, and both processes are contributed to by leakage of bacterial lipopolysaccharide (LPS) and flagellin, across the gut barrier. In this study, Kong and colleagues examined associations between circulating LPS and flagellin serum antibody levels and colorectal cancer risk. In this prospective study on European populations, the authors found that bacterial exposure levels were positively associated to colorectal cancer risk among men while in women, a possible inverse association may exist.

EPID-04PREVALENCE OF MALIGNANT PRIMARY BRAIN TUMORS IN THE UNITED STATES COMPARED TO OTHER COMMON CANCERS, 2010

BACKGROUND: Prevalence rates reflect the complex relationship between incidence, survival, and population demographics and illustrate the total burden of disease in a population. This study estimates the 2010 prevalence of malignant primary brain tumors overall and by Central Brain Tumor Registry of the United States (CBTRUS) histology groups, and compares them to the prevalence of other common cancers by age at diagnosis: children (0-14 years), adolescent and young adult (AYA) (15-39 years), and adult (40+ years). METHODS: The prevalence of common cancers was estimated using 2010 incidence data from the United States Cancer Statistics (USCS) with 10-year survival data from Surveillance, Epidemiology, and End Results program (SEER). Malignant primary brain tumor prevalence was estimated using incidence data from CBTRUS with 10-year survival data from SEER. RESULTS: The overall prevalence rate for malignant primary brain tumors in 2010 was 29.65 per 100,000 population (∼92,000 prevalent tumors). The most prevalent cancer in children was childhood leukemia (48.48), the most prevalent in AYA was lymphoma (77.49), and the most prevalent in adults was prostate (1,477.94). The most prevalent brain tumor histology was pilocytic astrocytoma (3.47) among children, diffuse astrocytoma (1.03) among AYA, and glioblastoma (7.16) among adults. CONCLUSIONS: The relative impact of malignant primary brain tumors is higher among children than any other age group. For AYA, malignant primary brain tumors are the third most prevalent cancer. While less common in adults, malignant primary brain tumors contribute disproportionately to mortality and morbidity in adults in the United States. Prevalence estimates can provide critical information towards public health and healthcare planning, including treatment, decision-making, funding, and advocacy programs.

ED-07 * TRENDS IN CENTRAL NERVOUS SYSTEM TUMOR INCIDENCE RELATIVE TO OTHER COMMON CANCERS IN ADULTS, ADOLESCENTS, AND CHILDREN IN THE UNITED STATES, 2000-2010

SIGNIFICANCE: Time trends in cancer incidence rates (IR) measure the changing burden of cancer on a population over time. Overall IR of cancer in the US is declining, but trends in common cancers may obscure trends in rare cancers that contribute disproportionately to mortality and morbidity. We examined incidence time trends of the most common cancers in children, adolescents, and adults between 2000 and 2010 as compared to central nervous system tumors (CNST). METHODS: Data from the United States Cancer Statistics and the Central Brain Tumor Registry of the United States were used to analyze incidence trends by selected histologies and age. Age-adjusted IR per 100,000 population with 95% confidence intervals (95% CI) and Annual Percent Change (APC) with 95% CIs were calculated for CNST and selected common cancers overall, by age, gender, race/ethnicity, selected CNST histologies, and CNST malignancy status. RESULTS: In adults, there were significant decreases in malignant CNST (2008-2010: APC = -3.1), colon (2000-2010: APC = -3.1), breast (2000-2010: APC = -0.8), lung (2000-2010: APC = -1.1), and prostate cancer (2000-2010: APC = -2.4), but a significant increase in non-malignant CNST (2004-2010: APC = 2.7). In adolescents, there were significant increases in malignant CNST (2000-2008: APC = 1.0) and non-malignant CNST (2004-2010: APC = 3.9). In children, there were significant increases in malignant CNST (2000-2010: APC = 0.6), acute lymphocytic leukemia (2000-2010: APC = 1.0), and non-Hodgkin lymphoma (2000-2010: APC = 0.6). CONCLUSIONS: Between 2000 and 2010, there were significant decreases in malignant CNST and other common cancers in adults, significant increases in malignant CNST in adolescents, significant increases in malignant CNST and other common cancers in children, and significant increases in non-malignant CNST in adults and adolescents. Surveillance of IR trends is an important way to measure the changing public health and economic burden of cancer; histology-specific analyses are essential to measure the potential disproportionate impact of rare cancers.

Cold Climate Is a Risk Factor for Thyroid Cancer.

The incidence rates of differentiated thyroid cancers of all sizes increased between 1988 and 2005 in both men and women. Exposure to ionizing radiation is the best-established environmental risk factor for thyroid cancer. Nonionizing radiation from cell phones has also been implicated. A positive correlation between all-cancer incidence rates and latitude and an inverse correlation between all-cancer incidence rates and temperature have been reported. In the present study, we examined the relationship between thyroid cancer incidence and average temperature in 50 U.S. states. The age-adjusted incidence of thyroid cancer is from U.S. Cancer Statistics Working Group, United States Cancer Statistics: 1999-2010, Incidence and Mortality Web-based Report (Atlanta: Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute; 2013, available at: www.cdc.gov/uscs). Average temperature by state is from the National Climatic Data Center, National Oceanic and Atmospheric Administration (http://www.ncdc.noaa.gov). Information on high-impact exposure to nuclear radiation by state is from the National Radiation Exposure Screening and Education Program, U.S. Health Resources and Services Administration (http://www.hrsa.gov/gethealthcare/conditions/radiationexposure). Cell-phone subscriber data for 2007 is from the Governing State and Local Sourcebook (http://sourcebook.governing.com). Mean elevation and latitude of U.S. states is from "Elevations and Distances in the United States," Reston, VA: U.S. Geological Survey, April 29, 2005 (http://pubs.er.usgs.gov). There was a significant negative correlation between average temperature by state and the age-adjusted incidence of all thyroid cancers (r2 = -0.212, P = 0.001). Because of the possible effects of ionizing radiation exposure from nuclear testing and nonionizing radiation exposure from cell phones, multiple linear regression analysis was performed. The analysis was done only for all thyroid cancers and for thyroid cancers in whites. The data from blacks and Hispanics were too fragmentary to analyze. In all thyroid cancers and thyroid cancers in whites, there was a significant negative correlation between average temperature and incidence that was unrelated to nuclear testing, cell-phone use, altitude, and latitude and was independent of the significant correlation of cell-phone subscriptions per population with thyroid cancer in whites. Living in a cold-climate state, such as Alaska, doubles the risk of thyroid cancer as compared with a warm state such as Texas. Because of climate change, a significantly raised risk of heat-related and cold-related mortality is expected in the years to come. The elderly will be most at risk. No doubt, incidence patterns of thyroid cancer and other cancers may be affected.