Subsite-specific colorectal cancer incidence rates and stage distributions among Asians and Pacific Islanders in the United States, 1995 to 1999.

OBJECTIVE: This study examined subsite-specific colorectal cancer incidence rates and stage distributions for Asians and Pacific Islanders (API) and compared the API data with data for Whites and African Americans. METHODS: Data included 336,798 invasive colorectal cancer incident cases for 1995 to 1999 from 23 population-based central cancer registries, representing about two thirds of API population in the United States. Age-adjusted rates, using the 2000 U.S. standard population, and age-specific rates and stage distributions were computed by anatomic subsite, race, and gender. All rates were expressed per 100,000. SEs and rate ratios were calculated for rate comparison. A significance level of 0.05 was used for all analyses. RESULTS: Overall, age-adjusted colorectal cancer incidence rates were significantly lower in API than in Whites and African Americans across anatomic subsites, particularly for proximal colon cancer in which rates were 40% to 50% lower in API males and females. Exception to this pattern was the significantly (10%) higher rectal cancer incidence rate in API males than in African American males. The incidence patterns by anatomic subsite within API differed from those of Whites and African Americans. Among API, the rate of rectal cancer (19.2 per 100,000) was significantly higher than the rates of proximal (15.2 per 100,000) and distal (17.7 per 100,000) colon cancers in males, with little variations in rates across anatomic subsites in females. In contrast, among White and African American males and females, proximal colon cancer rates were over 25% higher than the rates of distal colon and rectal cancers. Increases in age-specific rates with advancing age were more striking for proximal colon cancer than for distal colon and rectal cancers in Whites and African Americans, while age-specific rates were very similar for different subsites in API with parallel increases with advancing age, especially in API males. Similar to Whites and African Americans, in API, proximal colon cancers (32% to 35%) were also less likely to be diagnosed with localized stage compared with distal colon (38% to 42%) and rectal (44% to 52%) cancers. CONCLUSION: The patterns of subsite-specific colorectal cancer incidence in API, especially API males, differ from those of Whites and African Americans. Similar to Whites and African Americans, lower percentage of localized disease in API for proximal colon cancer than for distal colon and rectal cancers was also observed.     

Sex disparities in colorectal cancer incidence by anatomic subsite,race and age

Although incidence of colorectal cancer (CRC) in the United States has declined in recent years, rates remain higher in men than in women and the male‐to‐female incidence rate ratio (MF IRR) increases progressively across the colon from the cecum to the rectum. Rates among races/ethnicities other than Whites or Blacks have not been frequently reported. To examine CRC rates by sex across anatomic subsite, age and racial/ethnic groups, we used the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) program for cases diagnosed among residents of 13 registries during 1992–2006. Incidence rates were expressed per 100,000 person‐years and age‐adjusted to the 2000 US Standard Population; MF IRR and 95% confidence intervals were also calculated. Among each racial/ethnic group, the MF IRR increased fairly monotonically from close to unity for cecal cancers to 1.81 (Hispanics) for rectal cancers. MF IRRs increased with age most rapidly for distal colon cancers from <1.0 at ages <50 years to 1.4–1.9 at older ages. The MF IRR for rectal cancers also rose with age from about 1.0 to 2.0. For proximal cancer, the MF IRR was consistently <1.5; among American Indian/Alaska Natives, it was <1.0 across all ages. The MF IRRs for CRC vary markedly according to subsite and age but less by racial/ethnic group. These findings may partially reflect differences in screening experiences and access to medical care but also suggest that etiologic factors may be playing a role.     

Disparities in survival improvement for metastatic colorectal cancer by race/ethnicity and age in the United States

Purpose

Previous studies documented significant increase in overall survival for metastatic colorectal cancer (CRC) since the late 1990s coinciding with the introduction and dissemination of new treatments. We examined whether this survival increase differed across major racial/ethnic populations and age groups.

Methods

We identified patients diagnosed with primary metastatic colorectal cancer during 1992–2009 from 13 population-based cancer registries of the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program, which cover about 14 % of the US population. The 5-year cause-specific survival rates were calculated using SEER*Stat software.

Results

From 1992–1997 to 2004–2009, 5-year cause-specific survival rates increased significantly from 9.8 % (95 % CI 9.2–10.4) to 15.7 % (95 % CI 14.7–16.6) in non-Hispanic whites and from 11.4 % (95 % CI 9.4–13.6) to 17.7 % (95 % CI 15.1–20.5) in non-Hispanic Asians, but not in non-Hispanic blacks [from 8.6 % (95 % CI 7.2–10.1) to 9.8 % (95 % CI 8.1–11.8)] or Hispanics [from 14.0 % (95 % CI 11.8–16.3) to 16.4 % (95 % CI 14.0–19.0)]. By age group, survival rates increased significantly for the 20–64-year age group and 65 years or older age group in non-Hispanic whites, although the improvement in the older non-Hispanic whites was substantially smaller. Rates also increased in non-Hispanic Asians for the 20–64-year age group although marginally nonsignificant. In contrast, survival rates did not show significant increases in both younger and older age groups in non-Hispanic blacks and Hispanics.

Conclusion

Non-Hispanic blacks, Hispanics, and older patients diagnosed with metastatic CRC have not equally benefitted from the introduction and dissemination of new treatments.     

Incidence of colorectal carcinoma in the U.S.: an update of trends by gender, race, age, subsite, and stage, 1975-1994

BACKGROUND: Colon carcinoma incidence rates have risen sharply over the second half of this century, particularly among males and blacks. In the late 1970s, incidence rates among whites began to decline for distant disease. Approximately 10 years later regional disease rates began to fall. The decline in incidence rates among whites largely has been attributed to more widespread colorectal carcinoma screening. However, similar trends by stage in blacks have not been observed. METHODS: The incidence of colorectal carcinoma was evaluated by race, gender, age, and stage of disease for each subsite using data from > 220,000 cases diagnosed between 1975 and 1994 in the U. S. Surveillance, Epidemiology, and End Results program. RESULTS: Recent data have continued to show a decrease in incidence rates of total colorectal carcinoma in whites since the mid-1980s, particularly for the distal colon and rectum. Overall, proximal colon carcinoma rates were higher than distal colon or rectal carcinoma rates throughout the study period. Proximal colon carcinoma rates in blacks were considerably higher than in whites and continued to increase, whereas rates in whites showed signs of declining. The age-specific and stage-specific trends for proximal colon carcinoma in blacks were not consistent with the possibility of earlier disease detection through screening. CONCLUSIONS: Etiologic studies are necessary to understand the large increases in the incidence of proximal colon carcinoma among blacks.     

The relationship between cancer incidence,stage and poverty in the United States

We extend a prior analysis on the relation between poverty and cancer incidence in a sample of 2.90 million cancers diagnosed in 16 US states plus Los Angeles over the 2005–2009 period by additionally considering stage at diagnosis. Recognizing that higher relative disparities are often found among less‐common cancer sites, our analysis incorporated both relative and absolute measures of disparities. Fourteen of the 21 cancer sites analyzed were found to have significant variation by stage; in each instance, diagnosis at distant stage was more likely among residents of high‐poverty areas. If the incidence rates found in the lowest‐poverty areas for these 21 cancer sites were applied to the entire country, 18,000 fewer distant‐stage diagnoses per year would be expected, a reduction of 8%. Conversely, 49,000 additional local‐stage diagnoses per year would be expected, an increase of 4%. These figures, strongly influenced by the most common sites of prostate and female breast, speak to the trade‐offs inherent in cancer screening. Integrating the type of analysis presented here into routine cancer surveillance activities would permit a more complete understanding of the dynamic nature of the relationship between socioeconomic status and cancer incidence.     

Use of smokeless tobacco by age, race, and gender in ten standard metropolitan statistical areas of the southeast United States

Most surveys of smokeless tobacco use have been limited to young people, and in the few studies of adults, researchers have not considered age, race, and gender simultaneously, although broad age groups have been used. Data on smokeless tobacco use by race and gender for 5-year age groups up to age 70 and older were compiled from 21,203 households in 10 Standard Metropolitan Statistical Areas of the southeastern United States.     

Trends in esophageal cancer incidence by histology, United States, 1998-2003

Esophageal adenocarcinoma rates may be increasing, whereas, squamous cell carcinoma rates appear to be decreasing in the United States. Previous population-based research on esophageal cancer has only covered up to 68% of the country. Additional, updated research on a larger percentage of the country is needed to describe racial, ethnic and regional trends in histologic subtypes of esophageal cancer. Invasive esophageal cancer cases diagnosed between 1998 and 2003 (n = 65,926), collected by the National Program of Cancer Registries or the Surveillance, Epidemiology, and End Results program, were included. These data cover 83% of the US population. Esophageal squamous cell carcinoma incidence fell by 3.6%/year, whereas esophageal adenocarcinoma increased by 2.1%/year. Squamous cell carcinoma rates decreased among both sexes in most racial or ethnic groups, whereas adenocarcinoma rates increased primarily among white or non-Hispanic men. Except for white or non-Hispanic men, squamous cell carcinoma rates were similar to, or greater than, adenocarcinoma rates for men and women of all other races and ethnicities. The largest decrease in squamous cell carcinoma rates occurred in the West census region, which also exhibited no increase in adenocarcinoma rates. The rate of regional and distant-staged adenocarcinomas increased, while rates for local-staged adenocarcinoma remained stable. This is the first article to characterize esophageal cancer trends using data covering the majority of the US. Substantial racial, ethnic and regional variation in esophageal cancer is present in the US. Our work may inform interventions related to tobacco and alcohol use, and overweight/obesity prevention, and provide avenues for further research.     

Annual cancer incidence rates for Hispanics in the United States: surveillance, epidemiology, and end results, 1992-1996

BACKGROUND: The expansion of the Surveillance, Epidemiology, and End Results (SEER) program and the determination of annual population estimates by county level for different racial/ethnic groups since 1990 allow the calculation of annual cancer incidence rates for Hispanics. METHODS: Incidence rates were calculated for 11 SEER areas representing 25% of the Hispanic population. Standard regression analyses of log-transformed rates were used to determine the trends of the rates. RESULTS: An important measure of the cancer burden among Hispanics is the rank order of their cancers. For Hispanic males, the five major cancers (in declining order) are prostate, lung and bronchus, colon/rectum, non-Hodgkin lymphoma, and stomach cancers. For Hispanic females, the top five cancers are breast, colon/rectum, lung and bronchus, cervix, and endometrial cancers. Another measure of cancer burden is their rates relative to white non-Hispanics. Hispanic males have rates greater than white non-Hispanic males for stomach (1.6 times greater) and liver and IBD cancers (2.2), whereas Hispanic females have greater rates for cervix (2.2 times greater), liver and IBD (2.0), stomach (2.1), and gallbladder cancers (3.3). Other measures of cancer burden include the trends in Hispanic rates. Hispanic males have significant declining trends for all sites, prostate cancer, and urinary bladder cancer, and an increasing trend for liver and IBD cancers. Hispanic females have significant declining trends for cervix and urinary bladder cancers. CONCLUSIONS: The SEER cancer incidence rates and trends provide a general overview of the cancer burden among Hispanics residing in the SEER sites. This type of information is critical for determining interventions to reduce the cancer burden among Hispanics in the United States.     

Changes in breast cancer incidence rates in the United States by histologic subtype and race/ethnicity, 1995 to 2004.

Breast cancer incidence rates rose throughout the 1980s and 1990s in the United States but have recently declined through 2004. Studies reporting this decline primarily attribute it to the sharp decline in menopausal hormone use following publication of the Women's Health Initiative trial results. However, they have not stratified rates by either histologic type or race/ethnicity, which could further inform contributors to these trends. Using data from 13 cancer registries that participate in the Surveillance, Epidemiology, and End Results program, we evaluated annual percent changes (APC) in breast cancer incidence rates from 1995 to 2004 by histologic type and race/ethnicity for intervals identified using joinpoint regression. Invasive ductal carcinoma and invasive lobular carcinoma incidence rates fell steadily from 1998 to 2004 [APC, -3.07% (95% confidence interval, -4.10 to -2.02) and APC, -3.18% (95% confidence interval, -5.18 to -1.03), respectively]. Declines in rates of breast cancer overall and invasive ductal carcinoma were primarily limited to women > or = 50 years of age and to non-Hispanic whites and Asian/Pacific Islanders, and declines in rates of invasive lobular carcinoma were primarily limited to non-Hispanic whites. The majority of these declines began around 1998 and all began before 2002 when the Women's Health Initiative trial results were published; thus, the abrupt decline in hormone therapy use starting in 2002 is unlikely to be primarily responsible for the recent decline in breast cancer rates. The declines observed thus far are likely attributable to saturation of screening, although further declines related to the widespread cessation of hormone use may follow.     

Incidence trends in triple-negative breast cancer among women in the United States from 2010 to 2019 by race/ethnicity,age and tumor stage

There were substantial ethnic disparities in the incidence rates of triple-negative breast cancer, but few studies were conducted on the incidence trend of triple-negative breast cancer by race/ethnicity. This study aimed to address the longer trends in the incidence of triple-negative breast cancer by race/ethnicity in women from 2010 to 2019, examine the incidence trends by patient age, tumor stage and time periods, and explore the changing proportions of three component receptors over time for triple-negative breast cancer. Our study identified 573,168 women with incident breast cancer at age ≥20 years between 2010 and 2019 in 18 SEER (Surveillance, Epidemiology, and End Results) registries. Of them, 62,623 (10.9%) were incident triple-negative breast cancer and 510,545 were non-triple negative breast cancer cases. The denominator of population included 320,117,009 women aged ≥20 in the same SEER areas. The study found that overall age-adjusted incidence rate of triple-negative breast cancer in women aged ≥20 years was 18.3 cases per 100,000 women. Age-adjusted incidence rate of triple-negative breast cancer was the highest in black women (33.8 cases per 100,000 women), followed by white (17.5), American Indian and Alaska Native (AIAN) (14.7), Hispanic (14.7), and Asian women (12.4). The significantly higher age-adjusted incidence of triple-negative breast cancer in black women as compared to white women appeared to be limited in younger women aged 20-44 only. Annual percentage changes in age-adjusted incidence of triple-negative breast cancer slightly decreased insignificantly in white, black and Asian women aged 20-44 and 45-54 years. There was a statistically significant annual percentage increase in age-adjusted incidence of triple-negative breast cancer in Asian and black women aged ≥55 years. In conclusion, there was a significantly higher incidence of triple-negative breast cancer in black women aged 20-44 years. From 2010 to 2019, there were no significant annual percentage changes in age-adjusted incidence of triple-negative breast cancer in all ethnic groups of women aged <55 years, with the exception of a significant decrease among AIAN women aged 45-54 years. However, there was a statistically significant annual percentage increase in age-adjusted incidence of triple-negative breast cancer in Asian and black women aged ≥55 years.     

Incidence and mortality trends in gastric cancer in the United States, 1992-2019

Our study aimed to estimate the epidemiological trends of gastric cancer in the United States from 1992 to 2019. This population-based study used the US Surveillance, Epidemiology and End Results-12 database as a fundamental cohort to analyze gastric cancer incidence, incidence-based mortality (IBM), overall survival (OS) and cancer-specific survival (CSS) probabilities from 1992 to 2019. The Global Burden of Disease study (1990-2018) was used as a likely validation cohort. Age-period-cohort analyses were performed to explore the underlying causes of trend changes. We found that the incidence rate of gastric cancer decreased from 1992 to 2019. IBM also decreased significantly from 1997 to 2019. The 3-year OS and CSS of gastric cancer increased from 22.3% to 28.7% and 25.7% to 33.5%, respectively. However, the proportion of distant gastric cancer cases had unexpectedly increased rapidly from 33.1% in 1992 to 44.7% in 2019. Age-period-cohort modeling found that the incidence and IBM rates remained stable in the groups aged below 50 years, while that in all age groups older than 50 years showed a significant downward trend. High incidence and mortality risks were observed in the younger birth cohorts (birth year after 1990). To conclude, we observed a decline in incidence and mortality rates of gastric cancer in the United States in the past decades. We determined that progression of primary and tertiary preventive measures is the main reason for the reduction in the disease burden of gastric cancer. However, secondary preventive measures for gastric cancer still need to be strengthened.     

Cholesterol-lowering drugs and colorectal cancer incidence in a large United States cohort

3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, commonly known as statins, account for most cholesterol-lowering drug use in the United States. A recent large case-control study reported that use of statins for more than 5 years was associated with a 47% reduction in risk of colorectal cancer. No other large studies have examined this association. We examined the association between use of cholesterol-lowering drugs and colorectal cancer incidence among 132,136 men and women in the Cancer Prevention Study II Nutrition Cohort. We identified 815 incident cases of colorectal cancer among study participants during follow-up from the date of completion of a study questionnaire in 1997 through August 31, 2001. Current use of cholesterol-lowering drugs was not associated with colorectal cancer incidence (multivariable adjusted rate ratio [RR] = 1.03, 95% confidence interval [CI] = 0.85 to 1.26). Current use of cholesterol-lowering drugs for 5 years or more was also not associated with colorectal cancer incidence (multivariable adjusted RR = 1.09, 95% CI = 0.83 to 1.43). Our results do not support the hypothesis that statin use strongly reduces risk of colorectal cancer. However, we cannot rule out a small reduction in risk or an effect associated with only specific types or doses of statins.     

Predicting future cancer incidence by age,race, ethnicity,and sex

IntroductionCancer remains a substantial burden on society. Our objective was to update projections on the number of new cancer diagnoses in the United States by age, race, ethnicity, and sex through 2040.Materials and MethodsPopulation-based cancer incidence data were obtained using Surveillance, Epidemiology, and End Results (SEER) data. Population estimates were made using the 2010 US Census data population projections to calculate future cancer incidence. Trends in age-adjusted incidence rates for 23 cancer types along with total cancers were calculated and incorporated into a second projection model.ResultsIf cancer incidence remains stable, annual cancer diagnoses are projected to increase by 29.5% from 1.86 million to 2.4 million between 2020 and 2040. This increase outpaces the projected US population growth of 12.3% over the same period. The population of older adults is projected to represent an increasing proportion of total cancer diagnoses with patients ≥65 years old comprising 69% of all new cancer diagnoses and patients ≥85 years old representing 13% of new diagnoses by 2040. Cancer diagnoses are projected to increase in racial minority groups, with a projected 44% increase in Black Americans (from 222,000 to 320,000 annually), and 86% in Hispanic Americans (from 175,000 to 326,000 annually).DiscussionThe landscape of cancer care will continue to change over the next several decades. The burden of disease will remain substantial, and the growing proportion of older and minority patients with cancer remains of particular interest. These projections should help guide future health policy and research priorities.     

Carcinoma in situ of the colorectum: SEER trends by race, gender, and total colorectal cancer.

BACKGROUND AND OBJECTIVES: To determine if Americans of African origin (blacks) have less access to colonoscopic polypectomy than Americans of European origin (whites), the rate of carcinoma in situ of the colorectum (CIS), a disease more similar to benign adenoma of the colorectum than invasive cancer in its symptomatology, discovery, and treatment, was determined in the United States from 1973 to 1994. The hypothesis being tested is that CIS will be far less common in blacks than in whites and that rates of CIS should be increasing in whites from 1973 to 1994. METHODS: CIS and invasive carcinoma of the colorectum incidence data were obtained from Surveillance, Epidemiology, and End Results (SEER) Public Use Files from 1973 through 1994. Rates were age adjusted and proportions determined by division of CIS rates for each subsite by total carcinoma rates, for each year, race, and gender. The colorectum was divided anatomically in this analysis at the junction of the descending and sigmoid colon. RESULTS: The relationships between male/female and black/white CIS incidence rates were broadly similar to invasive cancer rates over the 21 years of SEER, demonstrating a white male predominance for distal disease, a black male predominance for proximal disease, and a decline in incidence since 1988. CIS as a proportion of total colorectal cancer increased in all races and genders from 1973 to 1987, but then declined in all groups. CONCLUSIONS: The majority of CIS is excised by endoscopic resection. Therefore, this might be considered a surrogate population for those individuals who have colonoscopic resection of benign adenomas. It is this latter treatment that has been hypothesized to be the cause for the declining incidence of invasive colorectal cancer. However, data presented herein do not support this hypothesis.     

Racialized economic segregation and stage at diagnosis of colorectal cancer in the United States

Purpose

In order to improve colorectal cancer outcomes in the United States, there is an urgent need for research on the drivers of geographic disparities in stage at diagnosis. Our objective was to determine the effects of racialized economic segregation on the odds of late diagnosis.

Methods

Among 187,843 adults (≥?18 years old) with new diagnoses of colorectal cancer reported to the Surveillance, Epidemiology and End-Results program between 1st January 2009 and 31st December 2013, exposure to racialized economic segregation was measured at the county-level using Index of Concentration at the Extremes metrics. Multilevel logistic regression models including registry and county random effects were fit to examine the association between racialized economic segregation and odds of metastatic disease at time of diagnosis.

Results

Odds of late diagnosis were greatest in counties with the lowest compared to highest quintile for racial and economic privilege (OR 1.14; 95% CI 1.09–1.20). In multilevel models adjusting for individual-level covariates, odds of late diagnosis were greater for all patients except those living in counties with the highest concentration of white high-income individuals. There was significant effect modification of this relationship by age, with greater adverse effects for younger adults (OR 1.16; 95% CI 1.02–1.32) than older adults (OR 1.06; 95% CI 1.00–1.11). Racialized economic segregation was strongly associated with access to affordable healthcare.

Conclusions

Spatial social polarization, quantified in relation to racialized economic segregation, increases the odds of late diagnosis of colorectal cancer for persons residing in the least compared to most privileged counties.