Dermatitis in an irritable infant.

This is the case of an infant with a persistent dermatitis affecting the perioral, acral and napkin areas, in whom a simple oral therapy provided a rapid treatment response.

A case of genital pyoderma gangrenosum successfully treated with cyclosporine without relapse of established follicular lymphoma.

Management of pyoderma gangrenosum in established malignancy is challenging. When vital structures are at risk from ulceration, aggressive management is required; however, immunosuppressive therapy may compromise the prognosis for an underlying malignancy. The optimal management of pyoderma gangrenosum in this setting is unclear. We report on a 64-year-old woman with follicular lymphoma in partial remission, who had severe genital pyoderma gangrenosum. After multidisciplinary evaluation, she was treated with corticosteroids and cyclosporine and healed fully with scarring over 7 weeks. She has required low-dose cyclosporine for 3 years to maintain remission of her genital ulceration; however, she remains well with no relapse of her lymphoma on serial imaging.

Trends in colorectal cancer incidence among younger adults-Disparities by age, sex, race, ethnicity, and subsite.

Millennials (ages 18-35) are now the largest living generation in the US, making it important to understand and characterize the rising trend of colorectal cancer incidence in this population, as well as other younger generations of Americans. Data from the New Jersey State Cancer Registry (n = 181 909) and Surveillance, Epidemiology, and End Results program (n = 448 714) were used to analyze invasive CRC incidence trends from 1979 to 2014. Age, sex, race, ethnicity, subsite, and stage differences between younger adults (20-49) and screening age adults (≥50) in New Jersey (NJ) were examined using chi-square; and, we compared secular trends in NJ to the United States (US). Whites, men, and the youngest adults (ages 20-39) are experiencing greater APCs in rectal cancer incidence. Rates among younger black adults, overall, were consistently higher in both NJ and the US over time. When compared to older adults, younger adults with CRC in NJ were more likely to be: diagnosed at the late stage, diagnosed with rectal cancer, male, non-white, and Hispanic. Invasive CRC incidence trends among younger adults were found to vary by age, sex, race, ethnicity, and subsite. Large, case-level, studies are needed to understand the role of genetics, human papillomavirus (HPV), and cultural and behavioral factors in the rise of CRC among younger adults. Provider and public education about CRC risk factors will also be important for preventing and reversing the increasing CRC trend in younger adults.

Disparities in Female Breast Cancer Stage at Diagnosis in New Jersey: A Spatial-Temporal Analysis.

BACKGROUND: Despite improvements in early detection of breast cancer, disparities persist in stage at diagnosis, which is an important prognostic factor. METHODS: We used the space-time scan statistic in SaTScan to identify geographic areas and time periods with significantly elevated proportions of female breast cancer diagnosed at the in situ or distant stage in New Jersey. The analyses were conducted with census tracts as the geographic unit of analysis, elliptical spatial windows, 3-year temporal windows, and Poisson models. Statistical significance was determined by 999 Monte Carlo simulations (P < .05); significant clusters were mapped in ArcMap. Breast cancer cases within the clusters were compared with breast cancer cases outside the clusters on demographic, socioeconomic, and clinical factors using the Pearson chi-square test (P < .05). In addition, populations within the clusters were compared with the population outside the clusters on demographic and socioeconomic factors. RESULTS: After exclusions, 126 756 cases of primary female breast cancer diagnosed in 1997 to 2011 from the New Jersey State Cancer Registry were included in the analysis. One distant stage breast cancer cluster was identified in northeastern New Jersey from 1997 through 2011 (n = 26 244, relative risk [RR] = 1.42, P < .001). Two in situ breast cancer clusters were found in northeastern New Jersey from 2004 through 2011 (n = 12 496, RR = 1.35, P < .001) and in central New Jersey from 2006 through 2011 (n = 29 319, RR = 1.24, P < .001). The distant stage cluster contained relatively high percentages of minority and lower socioeconomic status (SES) breast cancer cases and populations, whereas the in situ clusters had relatively low percentages of minority and lower SES breast cancer cases and populations. CONCLUSION: Although there have been improvements since an earlier study of distant stage breast cancer diagnosed in 1995 to 1997, disparities in stage at diagnosis continue. These findings can be used by our local cancer control partners to target specific populations for interventions such as breast cancer education and mammography screening, as well as by state legislative and public health authorities for resource allocation.

Invasive Cervical Cancer Incidence Disparities in New Jersey--a Spatial Analysis in a High Incidence State.

Although invasive cervical cancer incidence has declined, disparities persist. We identified spatial clusters of census tracts with elevated invasive cervical cancer incidence rates using New Jersey State Cancer Registry cases 20 years or older diagnosed in 2005-2009. Each cluster's population was compared with the rest of New Jersey's population on demographic and socioeconomic characteristics. Odds ratios that assessed associations between statistically significant characteristics (from a univariate comparison of cases in the clusters versus cases in the rest of New Jersey) and being a case in a cluster versus being a case in the rest of New Jersey were calculated from logistic regression models. Significant incidence clusters were identified around Newark, Trenton, and Camden. Being Black (all areas), Hispanic (Newark, Camden), unmarried (Newark), and uninsured/Medicaid-insured (Trenton) were significantly associated with being a case in these areas. These study results can be used to target invasive cervical cancer prevention efforts more effectively.

Cancer survival disparities by health insurance status.

Previous studies found that uninsured and Medicaid insured cancer patients have poorer outcomes than cancer patients with private insurance. We examined the association between health insurance status and survival of New Jersey patients 18-64 diagnosed with seven common cancers during 1999-2004. Hazard ratios (HRs) with 95% confidence intervals for 5-year cause-specific survival were calculated from Cox proportional hazards regression models; health insurance status was the primary predictor with adjustment for other significant factors in univariate chi-square or Kaplan-Meier survival log-rank tests. Two diagnosis periods by health insurance status were compared using Kaplan-Meier survival log-rank tests. For breast, colorectal, lung, non-Hodgkin lymphoma (NHL), and prostate cancer, uninsured and Medicaid insured patients had significantly higher risks of death than privately insured patients. For bladder cancer, uninsured patients had a significantly higher risk of death than privately insured patients. Survival improved between the two diagnosis periods for privately insured patients with breast, colorectal, or lung cancer and NHL, for Medicaid insured patients with NHL, and not at all for uninsured patients. Survival from cancer appears to be related to a complex set of demographic and clinical factors of which insurance status is a part. While ensuring that everyone has adequate health insurance is an important step, additional measures must be taken to address cancer survival disparities.

Multiple cutaneous nodules as the presenting sign of small cell lung cancer.

We describe a 67-year-old male smoker who presented with an 8 week history of productive cough, dyspnoea on minimal exertion, weight loss of 8 kg and multiple painful cutaneous nodules of varying size and morphology. A chest radiograph showed a mass at the right hilum. A CT examination showed extensive mediastinal lymphadenopathy with encasement of the lower trachea, carina and left main bronchus. The left main bronchus was 95% stenosed and there were multiple liver metastases. Innumerable cutaneous nodules were also seen. A biopsy of one of the cutaneous nodules confirmed metastases from a neuroendocrine lung primary tumour, consistent with extensive stage small cell lung cancer. The patient died soon after diagnosis.

Thyroid cancer incidence in New Jersey: time trend, birth cohort and socioeconomic status analysis (1979-2006).

The study's purpose was to investigate thyroid cancer incidence time trends, birth cohort effects, and association with socioeconomic status (SES) in New Jersey (NJ), a high incidence state, using NJ State Cancer Registry data. Thyroid cancer incidence rates in each sex, nearly all age groups, two major histologies and all stages significantly increased between 1979 and 2006. For each sex, age-specific incidence rates began greatly increasing in the 1924 birth cohort and, generally, the highest thyroid cancer incidence rate for each five-year age group occurred in the latest birth cohort and diagnosis period. Thyroid cancer incidence rates were significantly higher in NJ Census tracts with higher SES and in counties with a higher percentage of insured residents. These results support further investigation into the relationship between rising thyroid cancer incidence and increasing population exposure to medical (including diagnostic) radiation, as well as widespread use of more sensitive diagnostic techniques.

Cancer survival disparities by race/ethnicity and socioeconomic status in New Jersey.

We investigated racial/ethnic and socioeconomic disparities in cancer survival and assessed if racial disparities can be explained by socioeconomic status (SES) using New Jersey State Cancer Registry data. We included cancer cases diagnosed during 1986-1999 (n=471,939). Hazard ratios were calculated for all cancers combined and female breast, colorectal, lung, and prostate cancers by race/ethnicity and SES for cases diagnosed in 1993-1999. Survival rates were compared for diagnosis years 1986-1992 and 1993-1999. We observed worse survival in Black patients and a SES gradient in the risk of cancer death after adjusting for age and stage at diagnosis. Following adjustment by SES, the higher risks of cancer death for Blacks were attenuated for breast, colorectal, and prostate cancer and became non-significant for lung cancer. Racial/ethnic disparities in cancer survival can be partially explained by SES. Cancer survival rates improved significantly from 1986-1992 to 1993-1999 except for women in the poorest areas.

Colorectal cancer stage at diagnosis and area socioeconomic characteristics in New Jersey.

Despite effective screening methods, research suggests consistently higher rates of late stage colorectal cancer (CRC) among persons living in low socioeconomic areas compared to those living in affluent areas. This population-based study evaluated the association between area-based socioeconomic measures (ABSMs) and CRC stage at diagnosis in New Jersey. Cases of CRC among persons 50 years and older, diagnosed from 2000-2005, were obtained from the New Jersey State Cancer Registry. Associations between census tract-level ABSMs and CRC stage at diagnosis were evaluated using logistic regression and geographic variation assessed using a spatial scan statistic. After adjusting for covariates, including individual-level health insurance, ABSMs were significantly associated with stage at diagnosis. As area socioeconomic conditions worsened, the odds of being diagnosed at a late stage increased. While increasing CRC screening services for all New Jersey populations is warranted, this study suggests that persons living in low socioeconomic areas could benefit the most from enhanced CRC education, screening efforts, and guided interventions.

Linkage study of cancer risk among lead-exposed workers in New Jersey.

OBJECTIVES: Epidemiologic studies have illustrated a possible association between occupational exposure to lead and cancer, specifically cancers of the kidney, lung, stomach, and nervous system. We performed a linkage between two New Jersey databases: the Adult Blood Lead Epidemiology and Surveillance System (ABLES) and the New Jersey State Cancer Registry (NJSCR) for 1985-2001 to ascertain the risk of cancer in lead-exposed workers and to evaluate the usefulness of this type of linkage. METHODS: A cohort of 3192 men from the ABLES database met the selection criteria before the linkage. AUTOMATCH was used to link the two databases. Person-time was stratified for each worker by five-year age group and calendar year. A standardized incidence ratios (SIR) analysis was performed. RESULTS: 83 cases of cancer were found among 3165 men after all exclusions were made. Workers were followed for an average of ten years and contributed 30,401 person-years. The SIR analysis showed a large overall deficit of cancer (SIR=0.51; 95% CI 0.41 to 0.62). Cancers of the stomach, breast, larynx, intrahepatic bile duct, and chronic myeloid leukemia were non-significantly elevated. Prostate cancer showed the only statistically significant result, a deficit with an SIR of 0.35 (95% CI 0.20 to 0.57). Deficits also occurred in cancers of the lung, kidney, and brain. CONCLUSIONS: The results do not indicate that occupational exposure to lead is associated with cancer. However, firm conclusions are not possible because of various study limitations, including small numbers, a large percentage of workers without age information, short follow-up time, and lack of vital status information. Cancer incidence in this cohort was expected to be low due to the Healthy Worker Effect and young age. Further follow-up of this cohort may be warranted since additional cancers may accrue as time from first exposure increases. Increased worker cohort information would also improve this type of study.

Clusters of census tracts with high proportions of men with distant-stage prostate cancer incidence in New Jersey, 1995 to 1999.

BACKGROUND: Although the etiology of prostate cancer is uncertain, cancer control programs need to know the factors that contribute to variations in prostate cancer incidence from place to place. Geographic patterns of prostate cancer cases diagnosed at the distant stage are particularly important, because survival is substantially lower than for prostate cancer diagnosed at earlier stages. The purpose of this study was to identify and characterize clusters of census tracts in New Jersey with significantly high proportions of men diagnosed with distant-stage prostate cancer. METHODS: Prostate cancer cases diagnosed in New Jersey residents from 1995 to 1999 (n=30,505) were geocoded at the census tract level (n=1938) based on their residences at time of diagnosis. A spatial scan statistic (SaTScan) then was applied to identify clusters of census tracts with elevated proportions of cases of distant stage prostate cancer, using a case-control Bernoulli probability model study design. Distant-stage prostate cancers were defined as cases (n=1230), and all other prostate cancers as controls. Population characteristics from the 1990 Census for the area of the most likely cluster were compared to the remainder of the state. RESULTS: SaTScan identified a large geographic area in northeast New Jersey as the most likely cluster (RR=1.25, p=0.001). Compared to the remainder of the state, the underlying population in the most likely cluster area had higher proportions of African-American, Hispanic, and Asian men, and was more likely to be foreign-born, undereducated, in poverty, and have limited English speaking ability. CONCLUSIONS: Spatial analyses of late stage prostate cancer cases can provide additional insights into less favorable outcomes for disadvantaged populations and racial and ethnic minorities.

Incidence of noncutaneous melanomas in the U.S.

BACKGROUND: Description of the epidemiology of noncutaneous melanoma has been hampered by its rarity. The current report was the largest in-depth descriptive analysis of incidence of noncutaneous melanoma in the United States, using data from the North American Association of Central Cancer Registries. METHODS: Pooled data from 27 states and one metropolitan area were used to examine the incidence of noncutaneous melanoma by anatomic subsite, gender, age, race, and geography (northern/southern and coastal/noncoastal) for cases diagnosed between 1996 and 2000. Percent distribution by stage of disease at diagnosis and histology were also examined. RESULTS: Between 1996 and 2000, 6691 cases of noncutaneous melanoma (4885 ocular and 1806 mucosal) were diagnosed among 851 million person-years at risk. Ocular melanoma was more common among men compared with women (6.8 cases per million men compared with 5.3 cases per million women, age-adjusted to the 2000 U.S. population standard), whereas mucosal melanoma was more common among women (2.8 cases per million women compared with 1.5 cases per million men). Rates of ocular melanoma among whites were greater than eight times higher than among blacks. Rates of mucosal melanoma were approximately two times higher among whites compared with blacks. CONCLUSIONS: In contrast to cutaneous melanoma, there was no apparent pattern of increased noncutaneous melanoma among residents of southern or coastal states, with the exception of melanoma of the ciliary body and iris. Despite their shared cellular origins, both ocular and mucosal melanomas differ from cutaneous melanoma in terms of incidence by gender, race, and geographic area.

Use of a geographic information system to identify and characterize areas with high proportions of distant stage breast cancer.

A spatial scan statistic was used to search for geographic areas with significantly elevated proportions of women diagnosed with distant stage breast cancer in New Jersey in 1995-1997. The identified areas then were mapped and characterized using data from the 1990 U.S. Census and locations of mammography facilities. These areas' population characteristics included relatively high proportions of black or Hispanic women and linguistically isolated households. Targeted education and screening programs using this information may increase the diagnosis of breast cancer in the early stages, thereby reducing breast cancer mortality.