Advancing Social and Environmental Research in Cancer Registries Using Geomasking for Address-Level Data.

Understanding the social and environmental causes of cancer in the United States, particularly in marginalized communities, is a major research priority. Population-based cancer registries are essential for advancing this research, given their nearly complete capture of incident cases within their catchment areas. Most registries limit the release of address-level geocodes linked to cancer outcomes to comply with state health departmental regulations. These policies ensure patient privacy, uphold data confidentiality, and enhance trust in research. However, these restrictions also limit the conduct of high-quality epidemiologic studies on social and environmental factors that may contribute to cancer burden. Geomasking refers to computational algorithms that distort locational data to attain a balance between effectively "masking" the original address location while faithfully maintaining the spatial structure in the data. We propose that the systematic deployment of scalable geomasking algorithms could accelerate research on social and environmental contributions across the cancer continuum by reducing measurement error bias while also protecting privacy. We encourage multidisciplinary teams of registry officials, geospatial analysts, cancer researchers, and others engaged in this form of research to evaluate and apply geomasking procedures based on feasibility of implementation, accuracy, and privacy protection to accelerate population-based research on social and environmental causes of cancer.

BRCA1/2 testing among young women with breast cancer in Massachusetts, 2010-2013: An observational study using state cancer registry and All-Payer claims data.

BACKGROUND: Testing for BRCA1/2 pathogenic variants is recommended for women aged ≤45 years with breast cancer. Some studies have found racial/ethnic and socioeconomic disparities in testing. We linked Massachusetts' All-Payer Claims Database with Massachusetts Cancer Registry data to assess factors associated with BRCA1/2 testing among young women with breast cancer in Massachusetts, a state with high levels of access to care and equitable insurance coverage of breast cancer gene (BRCA) testing. METHODS: We identified breast cancer diagnoses in the Massachusetts Cancer Registry from 2010 to 2013 and linked registry data with Massachusetts All-Payer Claims Data from 2010 to 2014 among women aged ≤45 years with private insurance or Medicaid. We used multivariable logistic regression to examine factors associated with BRCA1/2 testing within 6 months of diagnosis. RESULTS: The study population included 2424 women; 80.3% were identified as non-Hispanic White, 6.4% non-Hispanic Black, and 6.3% Hispanic. Overall, 54.9% received BRCA1/2 testing within 6 months of breast cancer diagnosis. In adjusted analyses, non-Hispanic Black women had less than half the odds of testing compared with non-Hispanic White women (adjusted odds ratio [OR] = 0.45, 95% CI = 0.31, 0.64). Medicaid-insured women had half the odds of testing compared with privately-insured women (OR = 0.51, 95% CI = 0.41, 0.63). Living in lower-income areas was also associated with lower odds of testing. Having an academically-affiliated oncology clinician was not associated with testing. CONCLUSION: Socioeconomic and racial/ethnic disparities exist in BRCA1/2 testing among women with breast cancer in Massachusetts, despite equitable insurance coverage of testing. Further research should examine whether disparities have persisted with growing testing awareness and availability over time.

History of cancer and fertility treatment outcomes: a registry linkage study in Massachusetts.

PURPOSE: To investigate assisted reproductive technology (ART) outcomes among adolescent and young-adult female cancer survivors. METHODS: The Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) data were linked to the Massachusetts Cancer Registry for 90,928 ART cycles in Massachusetts to women ≥ 18 years old from 2004 to 2013. To estimate relative risks (RR) and 95% confidence intervals (CI), we used generalized estimating equations with a log link that accounted for multiple cycles per woman and a priori adjusted for maternal age and cycle year. The main outcomes of interest were ART treatment patterns; number of autologous oocytes retrieved, fertilized, and transferred; and rates of implantation, clinical intrauterine gestation (CIG), live birth, and pregnancy loss. RESULTS: We saw no difference in number of oocytes retrieved (aRR: 0.95 (0.89-1.02)) or proportion of autologous oocytes fertilized (aRR: 0.99 (0.95-1.03)) between autologous cycles with and without a history of cancer; however, cancer survivors required a higher total FSH administered (aRR: 1.12 (1.06-1.19)). Among autologous cycle starts, cycles in women with a history of cancer were less likely to result in CIG compared to no history of cancer (aRR: 0.73 (0.65-0.83)); this relationship was absent from donor cycles (aRR: 1.01 (0.85-1.20)). Once achieving CIG, donor cycles for women with a history of cancer were two times more likely to result in pregnancy loss (aRR: 1.99 (1.26-3.16)). CONCLUSIONS: Our analysis suggests that cancer may influence ovarian stimulation response, requiring more FSH and resulting in lower CIG among cycle starts.

Smoking cessation potential among newly diagnosed cancer patients: a population-based study of the ten most common cancers in Massachusetts, USA, 2008-2013.

PURPOSE: In cancer patients, cigarette smoking is causally linked with increased mortality. We examined the relationship between smoking status at the time of diagnosis and cancer mortality to help estimate the scope of smoking cessation services required to meet the needs of cancer patients. METHODS: We studied the ten most common cancers in Massachusetts, 2008-2013 including 175,489 incident cases and used smoking status at the time of diagnosis to provide smoking prevalence. We calculated adjusted hazard ratios of all-cause mortality comparing smoker subgroups. RESULTS: Smoking prevalence was more than threefold higher for lung cancer and more than twofold higher for head and neck cancer and bladder cancer than in the general population. Cancer cases who smoked at the time of diagnosis had a higher adjusted mortality rate than cancer cases who were former smokers. The three sites with the highest increased hazard ratios comparing current smokers with former smokers were cancers of the thyroid (HR = 1.67, 95% CI 1.14-2.45), head and neck (HR = 1.65, 95% CI 1.39-1.95), and prostate (HR = 1.60, 95% CI 1.36-1.90). CONCLUSIONS: Smoking remains high among cancer patients. More widespread adoption of smoking cessation programs among cancer patients may play a substantial role in improving cancer morbidity and mortality.

Early-life cancer, infertility, and risk of adverse pregnancy outcomes: a registry linkage study in Massachusetts.

PURPOSE: Investigate the relationship between history of cancer and adverse pregnancy outcomes according to subfertility/fertility treatment. METHODS: Deliveries (2004-2013) from Massachusetts (MA) Registry of Vital Records and Statistics were linked to MA assisted reproductive technology data, hospital discharge records, and Cancer Registry. The relative risks (RR) and 95% confidence intervals of adverse outcomes (gestational diabetes (GDM), gestational hypertension (GHTN), cesarean section (CS), low birth weight (LBW), small for gestational age (SGA), preterm birth (PTB), neonatal mortality, and prolonged neonatal hospital stay) were modeled with log-link and Poisson distribution generalized estimating equations. Differences by history of subfertility/fertility treatment were investigated with likelihood ratio tests. RESULTS: Among 662,630 deliveries, 2,983 had a history of cancer. Women with cancer history were not at greater risk of GDM, GHTN, or CS. However, infants born to women with prior cancer had higher risk of LBW (RR: 1.19 [1.07-1.32]), prolonged neonatal hospital stay (RR: 1.16 [1.01-1.34]), and PTB (RR: 1.19 [1.07-1.32]). We found clinically and statistically significant differences in the relationship between cancer history and SGA by subfertility/fertility treatment (p value, test for heterogeneity = 0.02); among deliveries with subfertility or fertility treatment, those with a history of cancer experienced a greater risk of SGA (RRsubfertile: 1.36 [1.02-1.83]). CONCLUSIONS: Women with a history of cancer had greater risk of some adverse pregnancy outcomes; this relationship varied by subfertility and fertility treatment.

Cancer Incidence Rate Variations among the Chinese, South Asian, and Vietnamese in Massachusetts, 2011-2015.

OBJECTIVES: To examine cancer incidence among the 3 Asian, non-Hispanic ethnicities with the highest frequency of cases (South Asian, Chinese, and Vietnamese). METHODS: Age-adjusted incidence rates for all invasive cancers were calculated for South Asian (Indian, Pakistani), Chinese, and Vietnamese cancer cases reported to the Massachusetts Cancer Registry (MCR). Additionally, rates were calculated for the most frequent cancers among non-Hispanic Asians (prostate, colorectal, female breast, female thyroid, lung, and male liver). The 95% confidence intervals were calculated to determine statistical significance between the rates. RESULTS: South Asian and Vietnamese females had significantly elevated rates of all invasive cancers compared to Chinese females, while Chinese and South Asian females had a significantly elevated breast cancer rate. Vietnamese males had a significantly elevated rate of all invasive cancers, liver cancer, and lung cancer compared to the other 2 groups. Due to the high rates of lung cancer among Vietnamese males, MCR current/previous smoking data were compared for all cancers. Among Vietnamese, Chinese, and South Asian male cancer cases, current/ previous smoking percentages were 64%, 51%, and 35%, respectively. CONCLUSIONS: Our analyses showed a significant difference of rates for several cancers by specific Asian ethnicity within the broader Asian, non-Hispanic race category. Differences in tobacco use, maternal hepatitis B infection, and diet likely contribute to some of the differences. These data can aid in the development of prevention programs, such as smoking cessation and mammography screening that are culturally and linguistically specific within this large and diverse group.

Tobacco-Associated Cancer Incidence and Mortality in Massachusetts, 2006-2015.

OBJECTIVE: To describe the epidemiology of tobacco-associated cancers in Massachusetts from 2006-2015. METHODS: Incident cases of tobacco-associated cancers diagnosed from 2006-2015 were provided by the Massachusetts Cancer Registry. Tobacco-associated cancers include lung, oral cavity, esophageal, laryngeal, pancreatic, cervical, liver, bladder, kidney, stomach, colorectal, and acute myeloid leukemia. Cancer deaths due to those cancers were provided by the Massachusetts Registry for Vital Records and Statistics. Joinpoint regression was used to assess trends in the rates and 95% confidence intervals were used to assess significant differences over the time period. RESULTS: From 2006-2015, 42% of all cancer cases and 60% of all cancer deaths were due to a tobacco-associated cancer. Lung and colorectal cancers had the highest incidence (65.8 and 39.8 per 100,000, respectively) and mortality rates (44.6 and 13.6 per 100,000, respectively) of all the tobacco-associated cancers in Massachusetts. The incidence and mortality rates of lung, esophageal, laryngeal, and colorectal cancer decreased with statistical significance from 2006-2015. Non-Hispanic Whites and non-Hispanic Blacks had the highest incidence (203.9 and 189.2/100,000, respectively) and mortality rates (100.7 and 97.4/100,000, respectively) from tobacco-associated cancers, and these rates have decreased with statistical significance from 2006-2015. CONCLUSION: Tobacco cessation initiatives remain important even as the incidence and mortality rates of some tobacco-associated cancers have decreased in recent years. Understanding the distribution of these cancers by sex and race will provide public health officials with information on populations still affected by these cancers.

Cancers Among the Oldest Old in Massachusetts from 2004-2014.

OBJECTIVE: Describing the burden of cancer in the oldest old (those aged ≥85 years at diagnosis) is important, as the growing elderly population in Massachusetts lives to older ages. METHODS: Incident cases of invasive cancer in Massachusetts from 2004-2014 were provided by the Massachusetts Cancer Registry. The incidence of cancer among the oldest old was compared with the population aged 65-74 years and 75-84 years. Joinpoint regression was used to assess trends in the rates of the most common cancers in the oldest old population. RESULTS: In Massachusetts from 2004-2014, 7.4% of incident cancers in men and 10.2% of incident cancers in women were diagnosed in people aged ≥85 years. The cancer with the highest incidence among the oldest old was lung cancer among men (473.7 cases per 100,000) and breast cancer among women (347.0 cases per 100,000). From 2004-2014, there were statistically significant annual decreases in prostate cancer and colorectal cancer among the oldest old men and women, as well as lung cancer among oldest old men and breast cancer among oldest old women. The oldest old were more likely to be diagnosed at a distant stage of prostate and breast cancer than people diagnosed at ages 65-74 years and ages 75-84 years. CONCLUSIONS: The oldest old population in Massachusetts has a different burden of cancer incidence than the general population, including high incidence and more distant-stage disease. Informing public health departments and practitioners of the common cancers in the population 85 and above is important to improve cancer care in this high comorbidity population.

Hysterectomy-corrected incidence rates of cervical and uterine cancers in Massachusetts, 1995 to 2010.

PURPOSE: The aim was to provide ethnicity-specific incidence trends of cervical and uterine cancers uncorrected and corrected for the prevalence of hysterectomy in Massachusetts. METHODS: We used incidence data of invasive cervical (International Classification of Diseases for Oncology, Third Edition: C53) and uterine cancer (International Classification of Diseases for Oncology, Third Edition: C54-C55) diagnosed from 1995 to 2010 from the Massachusetts Cancer Registry. Data from the Behavioral Risk Factor Surveillance Survey for Massachusetts were used to model the ethnicity-specific prevalence of hysterectomy. We standardized rates by the US 2000 population standard for the periods 1995 to 1998, 1999 to 2002, 2003 to 2006, and 2007 to 2010. RESULTS: Depending on the period, corrected cervical cancer rates increased by 1.2 to 2.8, 5.6 to 8.3, and 3.2 to 8.2 per 100,000 person-years, and uterine cancer rates increased by 14.3 to 16.7, 14.8 to 29.3, and 6.7 to 15.4 per 100,000 person-years among white non-Hispanic women, black non-Hispanic women, and Hispanic women, respectively. Corrected estimated annual percentage changes increased for uterine cancer among black non-Hispanic women aged 60 years and older. Ethnic disparities between white non-Hispanic women and the other groups became smaller for uterine cancer and larger for cervical cancer after correction. DISCUSSION: Corrections of cervical and uterine cancer rates for hysterectomy prevalence are important as ethnic disparities, age patterns and time trends of cervical and uterine cancer incidence rates change.

Survival and time interval from surgery to start of chemotherapy among colon cancer patients.

BACKGROUND: Colon cancer is one of the most common cancers diagnosed within the United States. Survival with stage III colon cancer has improved with the addition of adjuvant chemotherapy as a component of treatment. Some patients with stage II colon cancer also receive chemotherapy. There has been a dearth of research about the effect of the timing of chemotherapy on survival. Recent studies have shown a possible link between the length of time between surgery and chemotherapy treatment and probability of survival. The present study investigated the association of chemotherapy with survival, and the association of initiating treatment within 45 days vs. more than 45 days after surgery with survival. METHODS: We used Kaplan-Meier methods and multivariable Cox proportional hazards models to analyze the association of treatment and its timing with survival among patients who were listed as diagnosed with and having surgery for stage II or III colon cancer from 1997 to 1999 in the Massachusetts Cancer Registry. All tests were two-sided. RESULTS: Of the 3,006 patients who met the eligibility criteria, 61% were still alive on December 31, 2003. Patients who received chemotherapy after surgery were more likely to survive than those who received surgery alone. However, those who received chemotherapy within 45 days did not have better survival than those who began treatment later (hazard ratio 1.16, 95% CI 0.92-1.47). Among stage II colon cancer patients alone, those who received chemotherapy after surgery had significantly lower mortality than those who received surgery alone (hazard ratio 0.75, 95% CI 0.58-0.96). CONCLUSIONS: Adjuvant chemotherapy treatment after surgery for stage II and III colon cancer cases, but not the timing of its initiation, was associated with improved survival. Our study shows a benefit of chemotherapy for patients with stage II disease.

The satisfaction of doing national work, the delight of change and a good salary: the health of British colonial nurses going to work in the concentration camps of the Anglo-Boer War (1899-1902).

During the South African/Anglo-Boer War(1899-1902), the British established concentration camps in retaliation to Boer guerilla fighters. Thousands of Boer women and children and thousands of blacks and "coloured" people were interned within these camps. The conditions in the camps were unsanitary and led to the death by disease,mostly respiratory illnesses, of many of the inmates. There were outcries in Britain over the camps among Liberal members of Parliament and social reformers such as Emily Hobhouse. In response to this, the Secretary of War sent an all ladies commission to South Africa. Their final report cited unsanitary conditions and insufficient camp administration as contributing factors to the high death rates.Among their recommendations was to increase the nursing staff. The Colonial Nursing Association provided nurses for these jobs. This article uses a previously unused archival source, the case notes of the medical advisor to the Colonial Office. In 1901-1902, he examined a group of nurses going out to work in the concentration camps of South Africa. This article presents the results of the examinations of 89 nurses, three of whom were rejected, and places them in the context of medical concerns at the time.