Cancer patterns in Hmong in Minnesota, 2000 to 2012.

BACKGROUND: Minnesota has the second largest Hmong population in the United States. The objective of the current study was to estimate the cancer incidence among Hmong individuals in Minnesota between 2000 and 2012 to determine targets for screening and interventions. METHODS: Cancer cases in Minnesota between 2000 and 2012 were obtained from the Minnesota Cancer Surveillance System, and proportional incidence ratios (PIRs) were calculated. The 2000 and 2010 US Census reports were used to obtain total population estimates. Age-adjusted cancer incidence rates (AAR) and 95% confidence intervals (95% CIs) were calculated for Hmong individuals, Asian/Pacific Islander individuals, and all Minnesotans using direct method and Poisson regression. RESULTS: Compared with all Minnesotans, the Hmong had elevated PIRs and AARs for malignancies related to infections, including nasopharyngeal, stomach, liver, and cervical cancers. The AAR ratios in Hmong versus all Minnesotans were found to be significantly increased for nasopharyngeal (AAR, 15.90; 95% CI, 9.48-26.68), stomach (AAR, 2.99; 95% CI, 2.06-4.33), liver (AAR, 1.77; 95% CI, 1.04-3.02), and cervical (AAR, 3.88; 95% CI, 2.61-5.77) cancers. The AARs in Hmong versus all Minnesotans were significantly lower for all-cause cancer (AAR, 0.39; 95% CI, 0.35-0.44); cancers of the breast, lung, and colorectum; melanoma; and non-Hodgkin lymphoma. Compared with Asian/Pacific Islander individuals, the rates in Hmong were significantly higher for melanoma and cervical cancer, with AAR ratios of 2.23 (95% CI, 1.09-4.56) and 1.59 (95% CI, 1.01-2.49), respectively. CONCLUSIONS: Compared with all Minnesotans, the Hmong have an increased incidence of cancers related to infectious agents. These findings indicate a need for cancer prevention and screening programs in this population.

Hierarchical Multiresolution Approaches for Dense Point-Level Breast Cancer Treatment Data.

The analysis of point-level (geostatistical) data has historically been plagued by computational difficulties, owing to the high dimension of the nondiagonal spatial covariance matrices that need to be inverted. This problem is greatly compounded in hierarchical Bayesian settings, since these inversions need to take place at every iteration of the associated Markov chain Monte Carlo (MCMC) algorithm. This paper offers an approach for modeling the spatial correlation at two separate scales. This reduces the computational problem to a collection of lower-dimensional inversions that remain feasible within the MCMC framework. The approach yields full posterior inference for the model parameters of interest, as well as the fitted spatial response surface itself. We illustrate the importance and applicability of our methods using a collection of dense point-referenced breast cancer data collected over the mostly rural northern part of the state of Minnesota. Substantively, we wish to discover whether women who live more than a 60-mile drive from the nearest radiation treatment facility tend to opt for mastectomy over breast conserving surgery (BCS, or "lumpectomy"), which is less disfiguring but requires 6 weeks of follow-up radiation therapy. Our hierarchical multiresolution approach resolves this question while still properly accounting for all sources of spatial association in the data.

Validation of a modified Rotterdam Symptom Checklist for use with cancer patients in the United States.

The Rotterdam Symptom Checklist (RSCL) is a well-known instrument for the assessment of symptom-related distress among cancer patients. Despite its broad application, the utility of the RSCL with patients of some cancers is hindered by the omission of several important physical symptoms and methodological limitations of previous validation studies. The aims of the present study were to modify the RSCL through the addition of several physical symptoms and to subsequently validate the modified version of the Rotterdam Symptom Checklist (RSCL-M) with a heterogeneous sample of cancer patients from the United States. A total of 1,005 male and female cancer patients from two midwestern states completed the RSCL-M and several other self-report instruments. Results indicated that the RSCL-M is a reliable and valid instrument for use with cancer patients in the United States and is sensitive to differences in physical distress across groups expected to have distinct symptom-related distress profiles.

Treatment patterns for female breast cancer in Minnesota, 1995-1996.

Breast-conserving surgery (BCS) followed by radiation is an accepted alternative to mastectomy for treatment of early-stage breast cancer. This study evaluated age-group, geographic, and cancer-stage variables associated with the likelihood of receiving BCS or receiving mastectomy and the likelihood of receiving radiation therapy following BCS. Minnesota Cancer Surveillance System data on 6,594 women diagnosed with breast cancer in Minnesota during the years 1995-1996 were analyzed. Of those women who underwent breast cancer surgeries, 39% received BCS. Seventy-two percent of cases in which BCS was used were followed by radiotherapy. Women 65 years and older were less likely than younger women to receive BCS. Age and the stage of the cancer were independently associated with the likelihood of receiving radiation therapy following BCS. Breast cancer patients 75 years and older were 73% less likely to receive radiation following BCS than patients ages 40 to 49. Radiation following BCS was more likely among women in the Twin Cities metropolitan area and south central Minnesota than among women in other regions.

Screening mammography in Minnesota cancer patients.

BACKGROUND: Although a decrease in mortality due to breast cancer is the most definitive measure to assess the effectiveness of screening mammography, stage at diagnosis is an interim measure. OBJECTIVES: The objectives were to (1) examine the association between screening mammography and cancer stage at diagnosis and (2) provide information about mammography utilization in an insured population diagnosed with cancer. RESEARCH DESIGN: We utilized an existing data set of linked cancer registry-claims data. We computed an odds ratio for the association between screening mammography and breast cancer stage at diagnosis and examined mammography utilization patterns. SUBJECTS: Women in Minnesota with available claims data who developed cancer in 1995. MEASURES: Mammography claims and breast cancer stage at diagnosis (grouped according to AJCC and summary stage). RESULTS: Screening mammography was associated with significantly increased odds of an early (versus late) stage cancer diagnosis, consistent with the goal of screening. Mammography utilization was generally highest in the age group 50-64 and decreased in each successive age group. CONCLUSIONS: Linkage between insurance claims and cancer registry data provides useful information not available in either data set alone. The results contribute to the cohesiveness of the evidence that mammography prevents death due to breast cancer.

Using hierarchical spatial models for cancer control planning in Minnesota (United States).

OBJECTIVE: Region-specific maps of cancer incidence, mortality, late detection rates, and screening rates can be very helpful in the planning, targeting, and coordination of cancer control activities. Unfortunately, past efforts in this area have been few, and have not used appropriate statistical models that account for the correlation of rates across both neighboring regions and different cancer types. In this article we develop such models, and apply them to the problem of cancer control in the counties of Minnesota during the period 1993-1997. METHODS: We use hierarchical Bayesian spatial statistical methods, implemented using modern Markov chain Monte Carlo computing techniques and software. RESULTS: Our approach results in spatially smoothed maps emphasizing either cancer prevention or cancer outcome for breast, colorectal, and lung cancer, as well as an overall map which combines results from these three individual cancers. CONCLUSIONS: Our methods enable us to produce a more statistically accurate picture of the geographic distribution of important cancer prevention and outcome variables in Minnesota, and appear useful for making decisions regarding targeting cancer control resources within the state.

Cancer in the Minnesota Hmong population.

BACKGROUND: The Hmong are an isolated, agrarian people who settled in the mountainous regions of what today are Vietnam, Cambodia, and Laos. After the Vietnam War, many Hmong were relocated to the U.S. Minnesota has the second largest population (after California) of Hmong individuals. The objective of this study was to examine cancer incidence in this population, because it may indicate areas for targeted surveillance and intervention. METHODS: The Minnesota Cancer Surveillance System database was screened for Hmong surnames, and proportional incidence ratios (PIRs) were calculated for the period 1988-1999. RESULTS: Compared with all Minnesotans, the Hmong population had increased PIRs for nasopharyngeal cancer (PIR, 39.39; 95% confidence interval [95% CI], 21.01-66.86), gastric cancer (PIR, 8.70; 95% CI, 5.39-13.25), hepatic cancer (PIR, 8.08; 95% CI, 3.88-14.71), and cervical cancer (PIR, 3.72; 95% CI, 2.04-6.20) and had decreased PIRs for prostate cancer, breast cancer, Hodgkin disease, and melanoma. CONCLUSIONS: The current observations have implications for cancer control interventions. In particular, an increased incidence of cervical cancer might be addressed in part by targeting culturally sensitive screening programs in the Hmong population.

Weight and length at birth and risk of early-onset prostate cancer (United States).

OBJECTIVE: A case-control study was conducted to examine the association of weight and length at birth with early-onset prostate cancer. METHODS: Cases of prostate cancer diagnosed between 1988 and 1995 (n = 192) were identified through the Minnesota Cancer Surveillance System. Two separate control groups were selected using driver's license (DL) and birth certificate (BC) listings. RESULTS: Using the DL control group, an inverse association was observed between birth weight and prostate cancer risk; adjusted odds ratios (95% confidence intervals) for < or = 3000, 3001-3500, 3501-4000, and > 4000 g at birth were 1.0, 0.72 (0.40-1.28), 0.58 (0.31-1.10), and 0.49 (0.24-1.00). In analyses using the BC control group, adjusted odds ratios (95% CIs) for the aforementioned birth weight categories were 1.0, 1.18 (0.64-2.18), 0.80 (0.42-1.54), and 1.04 (0.48-2.26), respectively. For both control groups, adjusted odds ratios were somewhat elevated for the upper three categories of birth length, but all confidence intervals included the null value. CONCLUSIONS: These findings do not support the hypothesis that greater weight or length at birth increases risk of prostate cancer.