Industrial air pollution: possible effect on lung cancer.

Higher lung cancer mortality rates occurred in males living in certain heavily industrialized areas of Los Angeles County, California. These areas were characterized by elevated concentrations of benzo[a]pyrene and other polynuclear aromatic hydrocarbons of primarily industrial origin in the soil and air.

Lung cancer risk among beauticians and other female workers: brief communication.

Lung cancer risk among occupational groups of women was reviewed. A previous suggestion of a sixfold risk of developing lung cancer among beauticians was not confirmed; however, an approximately twofold risk was found.

Lung cancer risk among beauticians and other female workers: brief communication.

Lung cancer risk among occupational groups of women was reviewed. A previous suggestion of a sixfold risk of developing lung cancer among beauticians was not confirmed; however, an approximately twofold risk was found.

Cancer incidence in the Mexican-American.

Lower incidence rates of cancer for all anatomic sites combined were found in male and female Spanish-surnamed residents of Los Angeles County when compared to other whites. These Mexican-Americans were at lower risk for cancer of the buccal cavity, colon, rectum, larynx, lung, breast, bladder, prostate, and testis, and were at higher risk for cancer of the stomach, gallbladder, liver, and cervix. Immigrant Mexican-Americans had incidence rates most divergent from other whites, whereas indigenous Mexican-Americans had rates between the other two groups. The cancer pattern in Mexican-Americans was generally similar to that in American Indians. These data were most consistent with environmental variations in cause.

Hodgkin's disease survival by stage and age.

OBJECTIVE: Prior reports on Hodgkin's disease have suggested a biologic behavior difference between young and old patients. A study of 35,033 patients could confirm that older patients do not do as well as young patients regardless of age. METHODS: The National Cancer Data Base provided data from U.S. tumor registries on 35,033 patients newly diagnosed with Hodgkin's disease from 1985 through 1994. For analysis the patients were divided into two time periods, 1985-1989 and 1990-1994. The earlier period provided survival data to assess the impact of age and stage. RESULTS: The overall disease-specific, 5-year survival rate for the 1985-1989 period was 84.9%. For stages I and II, it reached almost 90%. For both observed survival based on all deaths and disease-specific survival, the duration of survival decreased with increasing age. This decrease with age occurred for all stages of the disease. CONCLUSIONS: The data reflect the actual status of management of Hodgkin's disease in the United States rather than the best attainable results. The decreasing survival with increasing age and in all stages further supports the concept of a difference in biologic behavior of Hodgkin's disease associated with age.

An analysis of male and female breast cancer treatment and survival among demographically identical pairs of patients.

BACKGROUND: Male breast cancer is rare, and there are no large comparative studies to guide treatment. We used National Cancer Data Base data on 4755 men and 624,174 women who had breast cancer (1985-1994) to identify equivalent groups of male and female breast cancer patients. METHODS: For each man with breast cancer, the next woman treated at the same hospital was sought who matched the man's age (within 5 years), ethnicity, income category, and stage. We identified 3627 closely matched pairs of male and female patients with breast cancer. RESULTS: Men were more likely to be treated with mastectomy (modified radical, 65% of men versus 55.1% of women; radical, 2.5% of men versus 0.9% of women; simple, 7.6% of men versus 3.4% of women; P <.001), and more likely to receive radiation therapy after mastectomy (men, 29%; women, 11%; P <.001). Men treated with lumpectomy were less likely to receive radiation therapy (men, 54%; women, 68%; P <. 001). Men were also less likely to receive chemotherapy (26.7% of men versus 40.6% of women; P <. 001) after any surgical treatment. CONCLUSIONS: This large comparative study is the first to detail stage-specific differences in contemporary treatment strategies for highly comparable groups of men and women treated for breast cancer. Further studies of male breast cancer should focus on identifying prognostic factors and defining optimal therapy.

National treatment trends for ductal carcinoma in situ of the breast.

OBJECTIVE: To evaluate the national treatment trends for the management of ductal carcinoma in situ as related to the individual characteristics of patients and to the reporting of demographics. DESIGN: National Cancer Data Base review. PATIENTS: Patients (N = 39010) who were diagnosed as having ductal carcinoma in situ between 1985 and 1993. MAIN OUTCOME MEASURES: Treatment principles, including the use of breast-preserving surgery, axillary lymph node dissection, and radiotherapy, as related to the following variables: age, income level, and ethnicity of the patient; the tumor size, grade, and anatomical subsite; year of diagnosis; geographic location of treatment; and hospital type and caseload. RESULTS: During the 8 years of analysis, the use of breast preservation therapy increased from 31% to 54%. Treatment selection varied to some degree with each of the variables examined. Tumors with favorable sizes and grades were associated with increased rates of breast preservation and lower rates of axillary lymph node dissection and radiotherapy utilization. Overall, only 45% of the patients who were treated with breast preservation received adjuvant radiotherapy. However, during this study, radiotherapy utilization increased from 38% to 54%. Axillary lymph node dissection was performed in 49% of the patients with a 12% reduction in use over time. CONCLUSIONS: Breast-preserving surgery now accounts for more than half of all cases of ductal carcinoma in situ followed by the National Cancer Data Base. However, there still remains an inappropriately high rate of axillary lymph node dissection and a low rate of radiotherapy utilization. Clinical trial results and professional education should continue to optimize the management of patients with ductal carcinoma in situ.

Pancreatic cancer: a report of treatment and survival trends for 100,313 patients diagnosed from 1985-1995, using the National Cancer Database.

BACKGROUND: The National Cancer Database is an electronic registry system sponsored jointly by the American College of Surgeons Commission on Cancer and the American Cancer Society. Patients diagnosed with pancreatic adenocarcinoma from 1985 to 1995 were analyzed for trends in stage of disease, treatment patterns, and outcomes. STUDY DESIGN: Seven annual requests for data were issued by the National Cancer Database from 1989 through 1995. Data on 100,313 patients were voluntarily submitted using a standardized reporting format. RESULTS: The anatomic site distribution was: head, 78%; body, 11%; and tail, 11%. The ratios of limited to advanced disease (Stage I/Stage IV) were 0.70 for tumors in the head, 0.24 for body tumors, and 0.10 for tail tumors. Of all patients, 83% did not have a surgical procedure and 58% did not have cancer-directed treatment. Resection was done for 9,044 (9%) patients, including 22% of those with Stage I disease. The overall 5-year survival rate was 23.4% for patients who had pancreatectomy, compared with 5.2% for those who had no cancer-directed treatment. CONCLUSIONS: Overall survival rates for pancreatic cancer have not changed in 2 decades. A small minority of patients presented with limited, resectable disease, but the best survival rates per stage were achieved after surgical resection. Five-year survival rates after resection reported herein corroborated the improved survival rates of more recent large, single institution studies.

A survey of hospital management practices for vulvar melanoma.

BACKGROUND: Vulvar melanoma is a very rare form of cancer. The purpose of this study was to describe practice patterns for the management of vulvar melanoma. STUDY DESIGN: The National Cancer Data Base was reviewed from 1985 through 1994 for patient reports submitted with a diagnosis of vulvar melanoma. RESULTS: Five hundred sixty-nine patients with vulvar melanoma were identified. A substantial number of patients were older; during the latter period of this study (1990 to 1994), 50% were 70 years old or older. Surgery was used in more than 90% of patients with stages 0 to III. Local excision was used mainly in early-stage (0 and I) disease. Adjuvant therapy was used infrequently. Lymph node evaluation was performed in more than half of the patients, with greater frequency for patients who had advanced disease. The overall 5-year relative survival rate was 62%. If the lymph nodes contained metastases, survival was poor. Patients with recurrent disease also had poor survival. CONCLUSIONS: Surgery remains the mainstay of therapy for vulvar melanoma. The use of excision and radical operations remained constant during the 10 years of the study.

Factors influencing the use of breast reconstruction postmastectomy: a National Cancer Database study.

BACKGROUND: Advances in surgical techniques and changes in our understanding of the biology of breast cancer have made immediate or early breast reconstruction a viable option for the majority of women with breast cancer. Little is known about national patterns of use of reconstruction. This study was undertaken to determine national patterns of care and factors that influence the use of breast reconstruction. STUDY DESIGN: A large convenience sample reported to the National Cancer Data Base was studied. Patients coded as undergoing mastectomy between 1985 and 1990 (n = 155,463) and between 1994 and 1995 (n = 68,348) were evaluated. The use of reconstruction in the two time periods was compared, and patient and tumor factors influencing the use of the procedure were compared. RESULTS: Between 1985 and 1990, 3.4% of mastectomy patients had early or immediate reconstruction, increasing to 8.3% in 1994-5. Patient age, income, geographic location, type of hospital where treatment occurred, and tumor stage all influenced the use of reconstruction in univariate analysis. In multivariate analysis, patients age 50 or under had a 4.3-fold greater likelihood of having reconstruction than their older counterparts. Patients with ductal carcinoma in situ were twice as likely as those with invasive cancer to have reconstruction. Family income of $40,000 or more (Odds Ratio 2.0), ethnicity other than African-American (Odds Ratio 1.6), surgery in a National Cancer Institute-designated cancer center (Odds Ratio 1.4), and surgery in a geographic region other than the Midwest or South (Odds Ratio 1.3) remained significant predictors of the use of reconstruction in multivariate analysis. CONCLUSIONS: Breast reconstruction is an underused option in breast cancer management. Predictors of the use of reconstruction do not reflect contraindications to the procedure, and indicate the need for both physician and patient education.

A comparative analysis of lobular and ductal carcinoma of the breast: presentation, treatment, and outcomes.

BACKGROUND: Compared with invasive ductal carcinoma, invasive lobular carcinoma of the breast is considered by many to be a more indistinct and multicentric form of cancer that is detected later and is treated less optimally by breast-preservation techniques. This study analyzed the presentation, treatment trends, and survival rates of women who had invasive lobular and ductal breast carcinoma. The objective was to determine the utility of breast-preservation therapy for invasive lobular carcinoma by analysis of historic data on tumor features and survival. STUDY DESIGN: Data on 291,273 women diagnosed with invasive carcinoma between 1985 and 1993 were obtained from the National Cancer Data Base. Analysis included the patient's age at diagnosis; tumor histology, anatomic site, diameter, grade, and stage; treatment; and disease status 5 years after diagnosis. RESULTS: The mean patient age at diagnosis was 61.0 years for invasive ductal carcinoma, 63.0 years for invasive lobular carcinoma, and 60.6 years for tumors with combined histology. The anatomic location, tumor diameter, and tumor grade were similar for each histotype. Breast-preservation therapy was less frequent for invasive lobular carcinoma. The 5-year overall survival and local disease-free survival rates for women treated with breast preservation were similar for invasive ductal carcinoma (84% overall survival; 97% disease-free survival) and invasive lobular carcinoma (87% overall survival; 98% disease-free survival). CONCLUSIONS: Invasive lobular carcinoma presents with a similar age distribution, anatomic subsite, diameter, and grade as invasive ductal carcinoma. Breast preservation is selected less commonly for women who have invasive lobular carcinoma, but this choice of therapy does not compromise the disease-free or overall survival status of this group of patients.

Management and survival of patients with adenocarcinoma of the colon and rectum: a national survey of the Commission on Cancer.

BACKGROUND: The Commission on Cancer (COC) of The American College of Surgeons periodically reviews criteria for evaluation of the care of patients with cancer related to diagnosis, treatment, rehabilitation, and follow-up. The COC annually performs a national survey of practices for several cancer sites. STUDY DESIGN: Data collection forms for carcinoma of the colon and rectum were field-tested and then forwarded to participating hospitals. The study included a long-term survey to permit evaluation of five-year survival rates and a short-term survey to review current practices and time trends. Specific questions were asked concerning disease presentation, preoperative evaluation, surgical treatment, postoperative care, use of adjuvant therapy, and disease status at the last follow-up examination. RESULTS: A total of 39,502 reports from 943 hospitals were analyzed, including 12,682 patients with carcinoma of the colon diagnosed in 1983, 16,527 patients with carcinoma of the colon diagnosed in 1988, 4,597 patients with carcinoma of the rectum diagnosed in 1983; and 5,696 patients with carcinoma of the rectum diagnosed in 1988. Patterns of care, including changes in presentation, diagnostic and therapeutic management, and survival rates, are presented. Specific data showing results for various ethnic groups are also included. CONCLUSIONS: The distribution of cases by anatomic site was consistent with a hypothesis of rightward migration of colon carcinoma. Colon and rectal carcinomas in African-Americans were reported in more advanced stages and with corresponding decreases in survival rates. Some patterns of nonoptimal diagnostic use were noted. The increasing use of sphincter-sparing surgical alternatives for carcinoma of the rectum was evident. Adjuvant therapy was not widely used during this period. This study suggests evolving patterns of evaluation, increased preservation of continence, and improved but varying survival among ethnic groups. It further suggests that survival as measured across these 943 hospitals may be lower than that attained at some individual centers.

Factors associated with survival in patients with meningioma.

OBJECT: To explore factors affecting the survival rate in patients with meningiomas, the authors used the National Cancer Data Base (NCDB), which includes tumors from approximately 1000 hospitals participating in the American College of Surgeons tumor registry program. METHODS: Analysis included over 9000 cases diagnosed from 1985 to 1988 and 1990 to 1992. Survival estimates were computed and prognostic factors were identified using a proportional hazards model. The overall 5-year survival rate was 69% and it declined with patient age. This rate was 81% in patients aged 21 to 64 years and 56% for patients 65 years of age or older. When patients were grouped by the histological type of their tumors, those with benign tumors had an overall 5-year survival rate of 70%, whereas the overall 5-year survival rates in patients with atypical and malignant meningiomas were 75% and 55%, respectively. Prognostic factors for benign tumors included age at diagnosis, tumor size, whether treated surgically, hospital type, and radiation therapy; for malignant tumors, the prognostic factors included: age at diagnosis, whether treated surgically, and radiation therapy. These factors were statistically significant. The 5-year rate for recurrence of symptoms (regardless of the method of treatment) was 19.2% for those with benign tumors and 32.4% for those with malignant tumors. In patients whose benign tumor had been completely removed, the 5-year rate of tumor recurrence was 20.5%. CONCLUSIONS: Although not population-based, the NCDB has the potential for providing pertinent information regarding patient characteristics and methods of treatment for benign, as well as malignant, brain tumors.

Superior survival of young women with malignant melanoma.

BACKGROUND: The Commission on Cancer data from the National Cancer Data Base (NCDB) relating to patients with malignant melanoma are used to examine patterns of long-term survival by patient gender and age, stage of disease, disease morphology, and anatomic subsite. METHODS: Five calls for data have yielded more than 3,700,000 cases of cancer for the years 1985 through 1993, including 23,341 cases of malignant melanoma between 1985 and 1989, from hospital cancer registries across the US, representing slightly less than a quarter of all melanoma cases diagnosed in the US between 1985 and 1989. RESULTS: Three statements can be made from this data: (1) There is little difference in the frequency of malignant melanoma between men and women with respect to stage of disease or morphology. However, differences between the genders do appear with respect to the anatomic subsite of melanotic tumors. (2) Overall, young women (45 years of age and under) enjoy superior survival rates when compared with older women (55 years of age and older) and men of any age. (3) The survival advantage held by young women is particularly pronounced among patients diagnosed with advanced stage disease. CONCLUSIONS: These data suggest that factors present in younger women may be critical in the superior survival rates seen among premenopausal women and might be hormonal in nature.

The National Cancer Data Base report on cancer of the head and neck.

BACKGROUND: The National Cancer Data Base (NCDB), a large sample of cancer cases accrued from hospital-based cancer registries, is sponsored by the Commission on Cancer of the American College of Surgeons and the American Cancer Society. The NCDB permits a detailed analysis of case-mix, treatment, and outcome variables. OBJECTIVE: To provide an overview of the contemporary status of the subset of patients with head and neck cancer in the United States. METHODS: The NCDB, which obtains data from US as well as Canadian and Puerto Rican hospitals, accrued 4 583 455 cases of cancer between 1985 and 1994. Of these cases, 301350 (6.6%) originated in the head and neck. We address 295022 cases of head and neck cancer limited to the 50 United States and District of Columbia. Cases were segregated into an earlier group (1985-1989) to permit 5-year follow-up and into a later group (1990-1994) to analyze a more contemporary group. Comparison between both periods permits identification of trends. RESULTS: The largest proportion of cases arose in the larynx (20.9%) and oral cavity, including lip (17.6%) and thyroid gland (15.8%). Squamous cell carcinoma (55.8%) was the most common histological finding, followed by adenocarcinoma (19.4%) and lymphoma (15.1%). Income level (low), race (African American), and tumor grade (poorly differentiated) were most notably associated with advanced stage. Treatment was most commonly surgery alone (32.4%), combined surgery with irradiation (25.0%), and irradiation alone (18.9%). Overall 5-year, disease-specific survival was 64.0%. Cancer of the lip demonstrated the best survival (91.1%) and cancer of the hypopharynx the worst survival (31.4%). CONCLUSIONS: This NCDB analysis of cancer of the head and neck provides a contemporary overview of head and neck cancer in the United States. It also serves to introduce a series of NCDB articles that address specific anatomical sites and histological types through separate, detailed analysis.

Cancer incidence in the Mexican American.

Mexican Americans of Los Angeles County, both those born in Mexico and in the United States, were at lower risk to all sites of cancer combined, than other whites. These Mexican Americans were at increased risk to some specific cancers, including those of the stomach, gallbladder, and cervix. For those tumors for which racial differences existed, clear migrant patterns were present.

Incidence of biliary tract cancer in Los Angeles.

Incidence data reported for biliary tract cancer in 4 ethnic groups of Los Angeles County are consistent with earlier reports of a similarity between the ethnic-gender distribution of gallbladder cancer and bile lithogenicity, and between that of other biliary cancer and free bilirubin. The female excess of biliary cancer proved to be highest in those ethnic groups with highest average parity, and risk was related to parity correlates such as marital status and religion (Catholic). A migration effect in Spanish-surnamed and other white females was present for both diseases.

The National Cancer Data Base report on trends in cancer patient staging.

BACKGROUND: Previous Commission on Cancer studies have examined trends in the staging of cancer patients. Reported herein are the most current National Cancer Data Base (NCDB) data on staging. METHODS: Two "calls for data" have yielded a total of 770,100 reports of patients with cancer eligible for staging. RESULTS: For all stageable sites combined, the percentage of cases with documentation of staging increased from 1985 through 1990 (53% in 1985 vs. 77% in 1990). Cancers of the colon and breast were staged most frequently. Of the 837 NCDB-participating hospitals, 557 (67%) staged 80% or more of the patients with cancer. CONCLUSIONS: These results suggest that the frequency of staging is a function of hospitals rather than physicians or types of patients. Many interrelated factors contributed to the increase in the frequency of staging.

The influence of urbanization, age, ethnicity, and income on the early diagnosis of breast carcinoma: opportunity for screening improvement.

BACKGROUND: Because most risk factors for breast carcinoma are not readily amenable to primary prevention, and early diagnosis is a powerful prognostic determinant, screening for the disease is crucial. Consequently, assessment of the progress and comprehensiveness of screening and other breast carcinoma early detection activities is important. The relative frequency of early diagnosis may provide a useful indicator of such activities. Nationwide, time trends in the early diagnosis of breast carcinoma have been improving for decades, but not all population subgroups may have benefited equally. METHODS: Using 1994-1997 data from the California Cancer Registry (CCR), a review of diagnostic patterns of in situ and local stage breast carcinoma was undertaken. For analytic purposes, the CCR includes 10 regional registries and 36 county reporting groups. Three early diagnostic measures were designated, including in situ breast carcinoma with tumor size < 10 mm in greatest dimension, in situ breast carcinoma, and localized breast carcinoma with tumor size < 21 mm in greatest dimension. These are referred to hereinafter as early diagnosis breast carcinomas. RESULTS: The percentage of early diagnosis breast carcinomas differed markedly by age, ethnicity, diagnosis year, and county of residence. Lower percentages of early diagnosis breast carcinomas were diagnosed in older women age >/= 85 years. Hispanic women were diagnosed with lower levels of in situ breast carcinoma. Hispanic and black women were diagnosed with less localized breast tumors of small size. There was an increase in the percentage of early diagnosis breast carcinomas over the 4-year observation period. Lower percentages of early diagnosis breast carcinomas were reported for the nonurban county/county groups, which were characterized by greater distances, lower population density, and lower household incomes. CONCLUSIONS: The authors conclude that elderly women, Hispanic and black women, and women who reside in nonurban areas should be targeted as high-priority subpopulations for mammographic screening.

The National Cancer Data Base report on cancer in Hispanics. Relationships between ethnicity, poverty, and the diagnosis of some cancers.

BACKGROUND: Previous Commission on Cancer studies have examined time trends in stage of disease, treatment patterns, and survival for special populations. Reported herein are the most current National Cancer Data Base data for Hispanics. METHODS: Two Calls for Data have yielded a total of 23,650 cancer reports for Hispanics from hospitals across the country. RESULTS: There were differences in the relative frequency with which different cancer sites were reported among different Hispanic sub-populations. For seven of eight types of cancers studied, Hispanics had a less favorable stage of disease at first diagnosis than non-Hispanic whites. CONCLUSIONS: Poverty may be an important factor affecting the outcome of different cancers. Ethnicity may have a different and additional impact on patients with cancer.