Incidence of testicular cancer in the United States related to marital status, histology, and ethnicity.

Analyses were made of the marital status of 3,346 patients with the diagnosis of testicular cancer. Among whites, blacks, and Puerto Rico Hispanics, the risk was greater among single than married men. Among whites and both Puerto Rico and New Mexico Hispanic groups, the elevated risk was apparent for histologic types other than seminoma. Among single white men, this excess risk began after 25-29 years of age. During the 10 years 1973 through 1982, incidence increased among single men under age 45, but little increase in incidence was found for married men. There was a striking increase among single men ages 30-44. These data confirm that single men are more susceptible to non-seminoma testicular cancer than are married men after the age of 30. Testicular cancer is increasing fastest among single men of ages 30-44.

Incidence of prostate cancer and marital status.

Analyses were made of the marital status of 48,106 men with adenocarcinoma of the prostate, who were reported to the Surveillance, Epidemiology, and End Results program of the National Cancer Institute during the 9 years ending in 1981. The hypothesis tested was that widowers and possibly divorced men were at higher risk for developing this cancer than were married men. Age- and marital-specific incidence rates were calculated for 4 age groups (45-54, 55-64, 65-74, and greater than or equal to 75 yr) for U.S. white, black, and Puerto Rico Hispanic men. Risks for other marital status groups were calculated relative to "married." Among the 45-54 age group, all ethnic groups had an excess risk for widowed as compared to the risk for married men [whites, relative risk (RR) = 1.7; blacks, RR = 1.5; Hispanics, RR = 2.5]. These excesses were not significantly different from unity. In the other 3 age groups and among each ethnic group, among whom 97.3% of all prostate cancers occurred, there was no suggestion of an excess risk for the development of prostate cancer among widowed men relative to married men. Unexpected findings were significant deficits in risk for single, separated, and divorced white men as compared to the risk for married men. Thus this study does not support an association between widowerhood and an increased risk for the development of prostate cancer. Additional studies are required to investigate a suggestion of decreased risk for older, separated, and divorced men.

Ethnic patterns of Hodgkin's disease incidence among children and adolescents in the United States, 1973-82.

The descriptive epidemiologic findings were summarized on 1,109 patients (white, black, and Hispanic) under 20 years of age who were diagnosed with Hodgkin's disease as reported to the Surveillance, Epidemiology, and End Results ("SEER") Program of the National Cancer Institute from 1973 to 1982. Across all ethnic strata, incidence rates increased with advancing age at diagnosis, with white adolescents 15-19 years old exhibiting the highest rates (male, 3.67; female, 4.18). Gender difference among children 0-14 years of age was most evident in blacks (male:female ratio: 4.0 for blacks, 1.0 for whites). Highest adolescent:childhood ratios of incidence rates were noted for females (5.81 for whites and 8.29 for New Mexico Hispanics) and lowest, for Hispanic males (1.25, New Mexico; 2.15, Puerto Rico). Whites exhibited the highest percentage of the nodular sclerosis histologic subtype (65%) and Hispanics, the lowest (45%). Conversely, Hispanics had higher rates of histologic types associated with a poorer prognosis (mixed cellularity and lymphocyte depletion). These differing age and histologic patterns were consistent with previously described international patterns of disease occurrence. Analysis of secular trends for whites from 1969 to 1982 revealed relatively stable rates for youngest ages and male adolescents. Rates increased over time for white female adolescents, but the trend was not statistically significant.

Incidence of cutaneous melanoma in the United States by histology with special reference to the face.

Cutaneous melanoma has been classified into three distinct histological subtypes based on histopathological and clinical features. The incidence of the least common type, lentigo maligna melanoma, has been most strongly associated with chronic sunlight exposure as its cause, especially lesions presenting on the face area. The relationship of sunlight exposure to the other two major subtypes, superficial spreading melanoma and nodular melanoma, is unclear. Based on over 13,000 cases of cutaneous melanoma collected by the Surveillance, Epidemiology, and End Results (SEER) program of the NCI, we report histological-specific incidence rates within four major anatomic sites: face, trunk, arm and shoulder, and leg and hip. The anatomic distribution for all histologies combined was the same as often reported with a male preponderance of melanomas on the face and trunk and female preponderance on the arm and leg. Age-specific incidence for melanoma of the face increased steadily with age in both genders, whereas it did not for the other three sites. The nine SEER areas were divided into North, Central, and South based on the UV index for each area. For melanomas of the face, lentigo maligna melanoma was higher in the Central and South than the North for both genders and increased with age. For superficial spreading melanoma, the pattern of occurrence was different. Incidence was higher in the Central than the North and for males it increased with age. There was a smaller increase for females. This study documents the incidence of cutaneous melanoma by histological subtype within four anatomic sites. The different shapes of the age-incidence curves suggest that different histologies may react differently to sunlight exposure as an etiological factor. Our findings strongly support the importance of considering histological subtypes of cutaneous melanoma in future etiological studies.

Cancer and age.

Age is the greatest risk factor for the development of cancer. For etiologic purposes, newly diagnosed cases of cancer among a defined population during a specified time (incidence) is the usual way of depicting cancer as it relates to age. Exposure to carcinogens in utero or perinatally can produce cancers soon after birth or years later. Cancers in older children have been related to growth factors and/or a single exposure to high doses of radiation. Hodgkin's disease occurring among young adults is different histologically, clinically, and prognostically than Hodgkin's disease among older adults. For the disease among young adults, the hypothesis is that clinical disease reflects the rare consequences of a prevalent infection of low pathogenicity; age of infection is determined by socioeconomic status. In older adults, it more closely resembles the lymphomas. This suggests dynamic trends associated with changing social environments related to etiologic factors. Among adults, the steady increase in colon cancer among both genders represents constant exposure to a carcinogen(s) starting in early life and persisting throughout older ages. Breast cancer is divided into pre- and postmenopausal phases on the basis of its age distribution. International differences in postmenopausal breast cancer suggest environmental factors in postmenopausal women and genetic and hormonal factors in premenopausal women. The age distribution of lung cancer increases linearly with the amount of cigarettes smoked and there is no indication of a threshold below which cigarette smoke is safe. The downturn among the oldest age groups results from competing causes of death or reflects a cohort effect of different exposure over time. Further, the pattern of lung cancer suggests exposure to a carcinogenic agent including substances that act principally as promoters.

Incidence of salivary gland cancer in the United States relative to ultraviolet radiation exposure.

There is biologic and histogenetic plausibility for an association between salivary gland cancer and nonmelanoma skin cancer. To add further credence to this association, a descriptive epidemiologic study of salivary gland cancer incidence data from the Surveillance Epidemiology and End Results (SEER) program from 1973 to 1981 was undertaken. The objective was to determine whether the incidence of this cancer exhibited the inverse association with geographic latitude that is characteristic of skin cancer incidence. The SEER areas were grouped into three regions (north, central, and south), based on indices of ultraviolet radiation. The southern area had significantly higher rates for white males and females compared with the northern area for all histologic subtypes combined (standardized incidence ratios were 1.6 for males and 1.4 for females), as well as for specific histologic subtypes (adenocarcinoma, squamous cell carcinoma, and males only with mucoepidermoid carcinoma). However, there were no significant differences in incidence between the central and northern areas. These data provide further evidence of an association between skin and salivary neoplasms, both exhibiting a pattern of incidence suggestive of susceptibility to ultraviolet radiation exposure.

Encouraging trends in lung cancer mortality in Texas, 1970 to 1986.

Trends in lung cancer mortality among white and black men and women in Texas for the years 1970 to 1986 offer some measure of optimism. A decline in mortality for men and women aged 35 to 44 years and for men aged 45 to 54 years is now evident. However, the rates in older men and women continue to rise. Following a long trend of ascending death rates, a plateau in the overall age-adjusted death rates among white men is now suggested. A similar decline for women will probably not be evident until early in the next century. These patterns are consistent with profound changes that have occurred in the prevalence of cigarette smoking over the past 30 years. It is urgent to maintain the momentum by emphasizing smoking cessation and prevention programs.

Salivary gland cancer and risk of subsequent skin cancer.

There are epidemiologic similarities between salivary and skin neoplasms that could be attributed to exposure to ultraviolet radiation. To explore further the etiologic parallels between these two types of cancer, we studied the multiple primary association between salivary gland cancer with that of other cancers known to be induced by ultraviolet light exposure, using data from the SEER program for 1973-1984. Because nonmelanoma skin cancers other than cancers of the lip are not routinely reported to the SEER registries, we specifically evaluated the associations with melanoma and lip cancers. Expected numbers of subsequent primaries (melanoma and lip) for the 904 white men and 784 white women with an initial salivary gland cancer were computed from incidence rates using the Connecticut Tumor Registry. There were significantly increased risks for subsequent lip cancer among men (RR = 8.7) and for melanoma among women (RR = 7.1). Among men there was also a significant association between an initial lip cancer and risk of subsequent salivary gland cancer (RR = 12.7). These observations, together with reported increases in incidence of these tumors, suggest a common etiology, which could partly be explained because of exposure to ultraviolet radiation.

Cancer prevention practices among Texas primary care physicians.

Primary care physicians are uniquely positioned to practice primary and secondary cancer prevention. However, despite a positive commitment, many physicians are pessimistic about the success of their interventions. This study describes the self-reported cancer prevention practices and perceived obstacles of 1600 Texas primary care physicians. These practices differed by primary care specialty and by length of time in practice. Time constraints were uniformly perceived as the leading obstacle to the provision of smoking cessation counseling. High cost, lack of third-party reimbursement, and poor patient compliance were cited as the leading barriers to patient referral for screening mammography. Professional education should stress to physicians that interventions need not be elaborate, expensive, or time consuming, the main purpose being to motivate and reinforce patient behavior. The special challenges of introducing health promotion activities into the clinical setting must be addressed with practical aids such as prompting systems, flowsheets, and computer-based aids for monitoring compliance rates.

Incidence and anatomic distribution of cutaneous melanoma among United States Hispanics.

Using the data base for melanoma incidence compiled by the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute, we compared the incidence and anatomic distribution of primary cutaneous melanomas in Hispanic and non-Hispanic Caucasian populations and in blacks between 1973 and 1981. Cases were divided into United States whites, New Mexico (NM) whites (non-Hispanic Caucasians), NM Hispanics, Puerto Rico (PR) residents by definition Hispanic, and US blacks. Among whites, the highest incidence was 8.0 per 100,000 and was ten times that of US blacks. The incidence among PR and NM Hispanic residents was 1.6 to 3.7 times that of US blacks. The anatomic distribution among NM Hispanics was similar to US and NM whites for both genders. In contrast, among PR residents the anatomic distribution in both genders was most common for the leg, similar to that for blacks. Spaniards who migrated to PR have more admixture with blacks from Africa than Spaniards who migrated to the mainland. This suggests a genetic predilection for the occurrence of melanoma on the lower extremity among PR residents as opposed to NM Hispanics.

Association between malignancies of the upper aerodigestive tract and uterine cervix.

Cancers of the cervix and buccal cavity share histologic, epidemiologic, and exposure characteristics. In particular, cigarette smoking and human papillomavirus (HPV) have been cited as etiologic cofactors of both malignancies. Using incidence data from the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute for the years 1973 through 1984, we evaluated the incidence of second cancers of the buccal cavity following an initial cervical cancer. Standardized incidence ratios (SIR) were uniformly elevated for both white (SIR = 2.0), and black (SIR = 3.5) women. There were also elevated risks for the development of cervical cancer following an initial buccal cavity cancer (SIRs = 3.3 and 2.5, respectively). A similar pattern was evident for laryngeal cancer among white women. HPV transmission could account in part for the paired occurrence of these two anatomically distinct cancer sites. Cigarette smoking could act as a synergistic cofactor in the malignant transformation of viral genome-harboring tissue.

Ethnic patterns of thyroid cancer incidence in the United States, 1973-1981.

Descriptive epidemiological findings for 7,696 patients with newly diagnosed thyroid cancer reported to the Surveillance, Epidemiology, and End Results (SEER) program for the years 1973 through 1981 are summarized. The preponderance of this tumor in women and of the papillary histologic subtype are well documented. The data suggest that previously reported increases in the incidence of thyroid cancer among Whites levelled off in the late 1970s. Differences in the incidence of this cancer according to ethnic group were particularly striking. Compared with White men and women, Puerto Rico Hispanics and Blacks had significantly lower thyroid cancer rates (weighted rate ratios ranged from 0.48 to 0.65). New Mexico Hispanic men and Chinese, Japanese, Hawaiian and Filipino men and women had significantly higher rates (weighted rate ratios ranged from 1.56 to 3.17). Elevated thyroid cancer rates for residents of Hawaii, regardless of ethnic group, were also a noteworthy finding. Variations in thyroid cancer risk according to ethnic group and geographical residence may reflect socio-economic or local environmental influences, including the possibility of a carcinogenic agent in volcanic lava.

Incidence and descriptive features of testicular cancer among United States whites, blacks, and Hispanics, 1973-1982.

This is a descriptive epidemiologic report based on over 3000 incident testicular cancer cases occurring among residents of the US and Puerto Rico, as reported to the Surveillance, Epidemiology and End Results (SEER) program of the National Cancer Institute for the years 1973 through 1982. White men had significantly higher incidence rates than their New Mexico Hispanic, black, and Puerto Rican Hispanic counterparts with weighted risk ratios of 1.36, 4.62, and 4.80, respectively. Ethnic differences in incidence were least evident at the extremes of age. Although the distribution of histologic subtypes did not differ across ethnic strata, morphologic expression was related to age at diagnosis. There was a predominance of right-sided tumor involvement in each ethnic group in childhood (less than 15 years of age), but not in the oldest age categories or among tumors presenting in cryptorchid testes. Never married men appeared to be at greater risk of developing nonseminoma testicular cancer than their married counterparts. Analysis of ethnic secular trends, using data from comparable geographic areas, showed a consistent increase in incidence among young men for all three ethnic groups. The contrast between the rate differences and the homogeneity of descriptive parameters across ethnic strata suggest the impact of quantitative rather than qualitative differences in environmental etiology.

Improving residents' knowledge of cancer prevention: are physicians prepared for prevention?

BACKGROUND: Primary care physicians recognize the goal of integrating cancer-prevention strategies into clinical practice. However, there is little formal training in cancer prevention and early detection. This study describes the effectiveness of a cancer-prevention curriculum called "Recommendations for Cancer Prevention (ReCaP) for Residents" for primary care residency programs. METHODS: The ReCaP for Residents curriculum was organized into eight instructional modules by organ site-specific areas for which there are established primary and secondary cancer-prevention recommendations. The modules include content outlines, learning objectives, slides, and case studies. In-house faculty and 21 residents of two family practice programs participated in an intervention comprising seven one-hour modular presentations during their regular summer teaching program. An established cancer-prevention knowledge test with 100 test items was used to test the residents' knowledge before and after the intervention; the data were analyzed by factor analysis with principal-component extraction and varimax rotation. RESULTS: The residents knew significantly more about cancer prevention after the ReCaP for Residents program. The mean overall prevention knowledge increased significantly (p < .05), and the scores of six of eight specific organ-site areas also increased. CONCLUSION: This study provided evidence that ReCaP for Residents was an effective curriculum for increasing residents' knowledge of cancer prevention. The authors recommend that more extensive programs of this type be implemented.