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Background: Hospital electronic medical record (EMR) systems are becoming increasingly integrated for management of patient data, especially given recent policy changes issued by the Centers for Medicaid and Medicare Services. In addition to data management, these data provide evidence for patient-centered outcomes research for a range of diseases, including cancer. Integrating EMR patient data with existing disease registries strengthens all essential components for assuring optimal health outcomes. Objectives: To identify the mechanisms for extracting, linking, and processing hospital EMR data with the Florida Cancer Data System (FCDS); and to assess the completeness of existing registry treatment data as well as the potential for data enhancement. Methods: A partnership among the Florida Department of Health, FCDS, and a large Florida hospital system was established to develop methods for hospital EMR extraction and transmission. Records for admission years between 2007 and 2010 were extracted using ICD-9-CM codes as the trigger and were linked with the cancer registry for patients with invasive cancers of the breast. Results: A total of 11,506 unique patients were linked with a total of 12,804 unique breast tumors. Evaluation of existing registry treatment data against the hospital EMR produced a total of 5% of registry records with updated surgery information, 1% of records with updated radiation information, and 7% of records updated with chemotherapy information. Enhancement of registry treatment information was particularly affected by the availability of chemotherapy medications data. Conclusion: Hospital EMR linkages to cancer disease registries is feasible but challenged by lack of standards for data collection, coding and transmission, comprehensive description of available data, and the exclusion of certain hospital datasets. The FCDS standard treatment data variables are highly robust and complete but can be enhanced by the addition of detailed chemotherapy regimens that are commonly used in patient centered outcomes research.
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Registros Electrónicos de Salud , Registro Médico Coordinado , Sistema de Registros , Humanos , Proyectos Piloto , Florida/epidemiología , Femenino , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/terapia , Neoplasias/epidemiología , Neoplasias/terapiaRESUMEN
Understanding the structure-activity relationship of an active site is of great significance toward the rational design of highly active catalysts. In this study, we have performed density functional theory calculations to investigate the coordination environment effect of Fe-, N-, and O-doped carbon on their nitrogen reduction reaction (NRR) properties. Our results indicate that the presence of O atoms in the coordination environment favors the activation of N2 molecules but is unfavorable to the stability, while the existence of N will weaken the adsorption of N2 and increase the reaction barrier of the first hydrogenation step. Fe-C4-C has the lowest potential for activating N2. A compromise is Fe-NxC4-x-C, where the interaction of C and N in coordination regulates the spin polarization of Fe and thus the 3d states around the Fermi level. Fe-N2C2-C was found to be the best one and NRR can proceed via the distal and alternative reaction pathways with the first hydrogenation step of N2 being the potential-limiting step and the Gibbs free energy change (ΔG) being 0.75 eV.
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To examine the association of major types of comorbidity with late-stage prostate cancer, a random sample of 11,083 men diagnosed with prostate cancer during 2002-2007 was taken from the Florida Cancer Data System. Individual-level covariates included demographics, primary insurance payer, and comorbidity following the Elixhauser Index. Socioeconomic variables were extracted from Census 2000 data and merged to the individual level data. Provider-to-case ratio at county level was alsocomputed. Multilevel logistic regression was used to assess associations between these factors and late-stage diagnosis of prostate cancer. Higher odds of late-stage diagnosis was significantly related to presence of comorbidities, being unmarried, current smoker, uninsured, and diagnosed in not-for-profit hospitals. The study reported that the presence of certain comorbidities, specifically 10 out of the 45, was associated with late-stage prostate cancer diagnosis. Eight out of 10 significant comorbid conditions were associated with greater risk of being diagnosed at late-stage prostate cancer. On the other hand, men who had chronic pulmonary disease, and solid tumor without metastasis, were less likely to be diagnosed with late-stage prostate cancer. Late-stage diagnosis was associated with comorbidity, which is often associated with increased health care utilization. The association of comorbidity with late-stage prostate cancer diagnosis suggests that individuals with significant comorbidity should be offered routine screening for prostate cancer rather than focusing only on managing symptomatic health problems.
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Diagnóstico Tardío/efectos adversos , Disparidades en Atención de Salud/economía , Neoplasias de la Próstata/diagnóstico , Determinantes Sociales de la Salud/economía , Adulto , Negro o Afroamericano/estadística & datos numéricos , Anciano , Comorbilidad , Bases de Datos Factuales , Diagnóstico Tardío/economía , Florida/epidemiología , Disparidades en el Estado de Salud , Disparidades en Atención de Salud/etnología , Humanos , Incidencia , Seguro de Salud/clasificación , Seguro de Salud/economía , Estilo de Vida , Modelos Logísticos , Masculino , Estado Civil , Persona de Mediana Edad , Análisis Multinivel , Estadificación de Neoplasias , Neoplasias de la Próstata/economía , Neoplasias de la Próstata/etnología , Neoplasias de la Próstata/mortalidad , Sistema de Registros , Índice de Severidad de la Enfermedad , Determinantes Sociales de la Salud/etnología , Población Blanca/estadística & datos numéricosRESUMEN
Individual-level data from the Florida Cancer Data System (1981-2007) were analysed to explore temporal trends of prostate cancer late-stage diagnosis, and how they vary based on race, income and age. Annual census-tract rates were computed for two races (white and black) and two age categories (40-65, >65) before being aggregated according to census tract median household incomes. Joinpoint regression and a new disparity statistic were applied to model temporal trends and detect potential racial and socio-economic differences. Multi-dimensional scaling was used as an innovative way to visualize similarities among temporal trends in a 2-D space. Analysis of time-series indicated that late-stage diagnosis was generally more prevalent among blacks, for age category 40-64 compared to older patients covered by Medicare, and among classes of lower socio-economic status. Joinpoint regression also showed that the rate of decline in late-stage diagnosis was similar among older patients. For younger patients, the decline occurred at a faster pace for blacks with rates becoming similar to whites in the late 90s, in particular for higher incomes. Both races displayed distinct spatial patterns with higher rates of late-stage diagnosis in the Florida Panhandle for whites whereas high rates clustered in South-eastern Florida for blacks.
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This study assessed spatial context and the local impacts of putative factors on the proportion of prostate cancer diagnosed at late-stages in Florida during the period 2001-2007. A logistic regression was performed aspatially and by geographically-weighted regression (GWR) at the nodes of a 5 km spacing grid overlaid over Florida and using all the cancer cases within a radius of 125 km of each node. Variables associated significantly with high percentages of late-stage prostate cancer included having comorbidities, smoking, being Black and living in census tracts with farmhouses. Having private or public insurance, being married or diagnosed in a for-profit facility, as well as living in census tracts with high household income reduced significantly this likelihood. Geographically-weighted regression allowed the identification of areas where the local odds ratio is significantly different from the ratio estimated using aspatial regression (State-level). For example, the local odds ratios for the comorbidity covariates were significantly smaller than the State-level odds ratio in Tallahassee and Pensacola, while they were significantly larger in Palm Beach. This emphasizes the need for local strategies and cancer control interventions to reduce the percentage of prostate cancer diagnosed at late-stages and ultimately eliminate health disparities.
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BACKGROUND: This study sought to determine the prevaccine type-specific prevalence of human papillomavirus (HPV)-associated cancers in the United States to evaluate the potential impact of the HPV types in the current and newly approved 9-valent HPV vaccines. METHODS: The Centers for Disease Control and Prevention partnered with seven US population-based cancer registries to obtain archival tissue for cancers diagnosed from 1993 to 2005. HPV testing was performed on 2670 case patients that were fairly representative of all participating cancer registry cases by age and sex. Demographic and clinical data were evaluated by anatomic site and HPV status. Current US cancer registry data and the detection of HPV types were used to estimate the number of cancers potentially preventable through vaccination. RESULTS: HPV DNA was detected in 90.6% of cervical, 91.1% of anal, 75.0% of vaginal, 70.1% of oropharyngeal, 68.8% of vulvar, 63.3% of penile, 32.0% of oral cavity, and 20.9% of laryngeal cancers, as well as in 98.8% of cervical cancer in situ (CCIS). A vaccine targeting HPV 16/18 potentially prevents the majority of invasive cervical (66.2%), anal (79.4%), oropharyngeal (60.2%), and vaginal (55.1%) cancers, as well as many penile (47.9%), vulvar (48.6%) cancers: 24 858 cases annually. The 9-valent vaccine also targeting HPV 31/33/45/52/58 may prevent an additional 4.2% to 18.3% of cancers: 3944 cases annually. For most cancers, younger age at diagnosis was associated with higher HPV 16/18 prevalence. With the exception of oropharyngeal cancers and CCIS, HPV 16/18 prevalence was similar across racial/ethnic groups. CONCLUSIONS: In the United States, current vaccines will reduce most HPV-associated cancers; a smaller additional reduction would be contributed by the new 9-valent vaccine.
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Alphapapillomavirus/aislamiento & purificación , Neoplasias/prevención & control , Neoplasias/virología , Infecciones por Papillomavirus/complicaciones , Vacunas contra Papillomavirus/inmunología , Adulto , Anciano , Alphapapillomavirus/genética , ADN Viral/aislamiento & purificación , Femenino , Papillomavirus Humano 16/aislamiento & purificación , Papillomavirus Humano 18/aislamiento & purificación , Humanos , Neoplasias Laríngeas/prevención & control , Neoplasias Laríngeas/virología , Masculino , Persona de Mediana Edad , Neoplasias Orofaríngeas/prevención & control , Neoplasias Orofaríngeas/virología , Infecciones por Papillomavirus/prevención & control , Infecciones por Papillomavirus/virología , Vacunas contra Papillomavirus/administración & dosificación , Neoplasias del Pene/prevención & control , Neoplasias del Pene/virología , Sistema de Registros , Estados Unidos/epidemiología , Neoplasias del Cuello Uterino/prevención & control , Neoplasias del Cuello Uterino/virología , Neoplasias de la Vulva/prevención & control , Neoplasias de la Vulva/virologíaRESUMEN
OBJECTIVE: Studies to determine the incidence and prevalence of amyotrophic lateral sclerosis (ALS) in defined geographic areas in the USA are needed. The Florida Department of Health received funding from the federal Agency for Toxic Substances and Disease Registry to implement a state-wide ALS Surveillance Project. The objectives of the project were to describe the demographic characteristics of ALS cases and to calculate the incidence and prevalence of ALS in Florida. SETTING/PARTICIPANTS: All neurologists were asked to submit case reports for persons with ALS diagnosed and/or under their care during 1 January 2009 through 31 December 2011. A medical record verification form and an electromyogram (EMG) report were requested for a sample of cases and reviewed by an independent consulting neurologist to confirm ALS diagnosis. Death data were used to aid with case report collection. PRIMARY AND SECONDARY OUTCOME MEASURES: Demographics, relevant history and clinical characteristics, El Escorial classifications, time from symptom onset to diagnosis, crude annual incidence rates and 2009 period prevalence are presented. RESULTS: The 1450 reported ALS cases were more likely to be older, male, white and non-Hispanic. Slightly more than 4% of cases were reported as also having dementia, and 4.8% were reported to have an immediate family member diagnosed with ALS. Incidence rates ranged from 1.7 to 1.9 per 100,000 person-years during the project period and the 2009 period prevalence was 4.0 per 100,000 persons. CONCLUSIONS: Project findings are generally consistent with findings of population-based studies in Europe, as well as geographically limited studies in the USA. Our findings add to the growing body of epidemiological literature about ALS in the USA. Future epidemiological studies in the USA should focus on identifying cases from minority groups and those that may have limited access to healthcare, and should consider conducting capture-recapture analysis to assess case ascertainment.
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Esclerosis Amiotrófica Lateral/epidemiología , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Demencia/epidemiología , Femenino , Florida/epidemiología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Vigilancia de la Población , Prevalencia , Distribución por SexoRESUMEN
OBJECTIVE: To investigate individual and contextual factors contributing to overall prostate cancer (PCa) survival in Florida. METHODS: A random sample of 6,457 PCa cases diagnosed between 10/1/2001 and 12/31/2007 was extracted from Florida Cancer Data System. Comorbidity was computed following Elixhauser Index. Survival probability curve was generated using Kaplan-Meier method. The Wei, Lin, and Weissfel model was used for the multivariate analysis. RESULTS: Older age at diagnosis was associated with shorter time to death. Current smokers had a higher hazard rate than non-current smokers. Higher hazard of overall mortality was associated with being diagnosed with advanced stage compared with localized stage and having poorly-differentiated tumor compared with well-moderately differentiated tumor. No definitive treatment, radiation alone, and hormone alone were significantly associated with elevated hazard rate compared with surgery. Fifteen comorbidities were significantly associated with shorter time-to-death. CONCLUSIONS: Effective control of comorbidity in PCa patients should help improve life expectancy and lead to prolonged survival.
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Neoplasias de la Próstata/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Bases de Datos Factuales , Florida/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Análisis Multinivel , Análisis de SupervivenciaRESUMEN
BACKGROUND: To capture the complete first course of therapy and cancer incidence, given the shift in cancer care from the hospital to the private physician practice, central cancer registries (CCRs) in the United States are actively pursuing cancer reporting from ambulatory providers. The 837 medical health claim is a national standard which CCRs can use to capture and translate data into standardized cancer reporting for surveillance. METHODS: The Florida Cancer Data System conducted a pilot project with a large medical oncology practice to transmit electronic claims from 2011 to 2013. Using the logic and platform developed under a previous National Cancer Institute (NCI) contract, claims were consolidated and translated into standardized cancer registry codes. Consolidated physician claims were compared against gold standard data from the practice electronic health record (EHR) and evaluated for enhancement to registry data. RESULTS: A total of 623 patient tumor cases were collected from the practice EHR and matched to the physician claims data, and to the original cancer registry record. The claims captured 256 cases (41 percent) with chemotherapy, compared to 28 percent in the registry data set, and 45 percent in the gold standard EHR data set. Combining physician claims with registry data produced 280 cases (45 percent) with chemotherapy. The physician claims plus the registry cancer chemotherapy treatment data produced 92 percent agreement, 92 percent sensitivity, and 91 percent positive predictive value. Claims added 103 cases, or 16.5 percent, to the total chemotherapy received. CONCLUSIONS: Physician medical claims data capture chemotherapy information not otherwise reported by hospitals, and is a standardized and efficient mechanism for cancer reporting.
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Recolección de Datos/métodos , Revisión de Utilización de Seguros/estadística & datos numéricos , Neoplasias/terapia , Médicos , Sistema de Registros/estadística & datos numéricos , Florida , Humanos , Incidencia , Proyectos PilotoRESUMEN
We conducted a study to determine prevalence of HPV types in oropharyngeal cancers in the United States and establish a prevaccine baseline for monitoring the impact of vaccination. HPV DNA was extracted from tumor tissue samples from patients in whom cancer was diagnosed during 1995-2005. The samples were obtained from cancer registries and Residual Tissue Repository Program sites in the United States. HPV was detected and typed by using PCR reverse line blot assays. Among 557 invasive oropharyngeal squamous cell carcinomas, 72% were positive for HPV and 62% for vaccine types HPV16 or 18. Prevalence of HPV-16/18 was lower in women (53%) than in men (66%), and lower in non-Hispanic Black patients (31%) than in other racial/ethnic groups (68%-80%). Results indicate that vaccines could prevent most oropharyngeal cancers in the United States, but their effect may vary by demographic variables.
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Alphapapillomavirus/clasificación , Neoplasias Orofaríngeas/epidemiología , Neoplasias Orofaríngeas/virología , Infecciones por Papillomavirus/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Orofaríngeas/prevención & control , Infecciones por Papillomavirus/prevención & control , Vacunas contra Papillomavirus , Prevalencia , Vigilancia en Salud Pública , Sistema de Registros , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: Human papillomavirus (HPV) is estimated to play an etiologic role in 40-50% of penile cancers worldwide. Estimates of HPV prevalence in U.S. penile cancer cases are limited. METHODS: HPV DNA was evaluated in tumor tissue from 79 invasive penile cancer patients diagnosed in 1998-2005 within the catchment areas of seven U.S. cancer registries. HPV was genotyped using PCR-based Linear Array and INNO-LiPA assays and compared by demographic, clinical, and pathologic characteristics and survival. Histological classification was also obtained by independent pathology review. RESULTS: HPV DNA was present in 50 of 79 (63%) of invasive penile cancer cases. Sixteen viral genotypes were detected. HPV 16, found in 46% (36/79) of all cases (72% of HPV-positive cases) was the most prevalent genotype followed equally by HPV 18, 33, and 45, each of which comprised 5% of all cases. Multiple genotypes were detected in 18% of viral positive cases. HPV prevalence did not significantly vary by age, race/ethnicity, population size of geographic region, cancer stage, histology, grade, penile subsite, or prior cancer history. Penile cases diagnosed in more recent years were more likely to be HPV-positive. Overall survival did not significantly vary by HPV status. CONCLUSION: The relatively high prevalence of HPV in our study population provides limited evidence of a more prominent and, possibly, increasing role of infection in penile carcinogenesis in the U.S. compared to other parts of the world.
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OBJECTIVE: We conducted a baseline study of human papillomavirus (HPV) type prevalence in invasive cervical cancers (ICCs) using data from 7 cancer registries (CRs) in the United States. Cases were diagnosed between 1994 and 2005 before the implementation of the HPV vaccines. MATERIALS AND METHODS: Cancer registries from Florida, Kentucky, Louisiana, Michigan, Hawaii, Iowa, and Los Angeles, California identified eligible ICC cases and obtained sections from representative blocks of archived tumor specimens for DNA extraction. All extracts were assayed by linear array and, if inadequate or HPV negative, retested with INNO-LiPA Genotype test. Clinical and demographic factors were obtained from the CRs and merged with the HPV typing data to analyze factors associated with different types and with HPV negativity. RESULTS: A total of 777 ICCs were included in this analysis, with broad geographic, age, and race distribution. Overall, HPV was detected in 91% of cases, including 51% HPV-16, 16% HPV-18 (HPV-16-negative), and 24% other oncogenic and rare types. After HPV-16 and -18, the most common types were 45, 33, 31, 35, and 52. Older age and nonsquamous histology were associated with HPV-negative typing. CONCLUSIONS: This study provides baseline prevaccine HPV types for postvaccine ICC surveillance in the future. HPV-16 and/or -18 were found in 67% of ICCs, indicating the potential for vaccines to prevent a significant number of cervical cancers.
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Papillomaviridae/clasificación , Papillomaviridae/aislamiento & purificación , Neoplasias del Cuello Uterino/epidemiología , Neoplasias del Cuello Uterino/virología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Genotipo , Técnicas de Genotipaje/métodos , Humanos , Persona de Mediana Edad , Epidemiología Molecular , Prevalencia , Sistema de Registros , Estados Unidos/epidemiología , Adulto JovenRESUMEN
To identify individual and contextual factors contributing to overall mortality among men diagnosed with prostate cancer in Florida, a random sample of patients (between October 1, 2001, and December 31, 2007) was taken from the Florida Cancer Data System. Patient's demographic and clinical information were obtained from the Florida Cancer Data System. Comorbidity was computed following the Elixhauser Index method. Census-tract-level socioeconomic status and farm house presence were extracted from Census 2000 and linked to patient data. The ratio of urologists and radiation oncologists to prostate cancer cases at the county level was computed. Multilevel logistic regression was conducted to identify significance of individuals and contextual factors in relation to overall mortality. A total of 18,042 patients were identified, among whom 2,363 died. No racial difference was found in our study. Being older at diagnosis, unmarried, current smoker, uninsured, diagnosed at late stage, with undifferentiated, poorly differentiated, or unknown tumor grade were significantly associated with higher odds of overall mortality. Living in a low-income area was significantly associated with higher odds of mortality (p = .0404). After adjusting for age, stage, and tumor grade, patients who received hormonal, combination of radiation with hormone therapy, and no definitive treatment had higher odds of mortality compared with those who underwent surgery only. A large number of comorbidities were associated with higher odds of mortality. Although disease-specific mortality was not examined, our findings suggest the importance of careful considerations of patient sociodemographic characteristics and their coexisting conditions in treatment decision making, which in turn affects mortality.
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Neoplasias de la Próstata/mortalidad , Adulto , Factores de Edad , Anciano , Comorbilidad , Bases de Datos Factuales , Diagnóstico Tardío , Florida/epidemiología , Humanos , Masculino , Pacientes no Asegurados/estadística & datos numéricos , Persona de Mediana Edad , Clasificación del Tumor , Áreas de Pobreza , Neoplasias de la Próstata/diagnóstico , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/terapia , Grupos Raciales/estadística & datos numéricos , Persona Soltera/estadística & datos numéricos , Fumar/epidemiologíaAsunto(s)
Neoplasias de la Próstata/diagnóstico , Neoplasias de la Próstata/terapia , Tiempo de Tratamiento , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Instituciones de Atención Ambulatoria , Población Negra , Comorbilidad , Detección Precoz del Cáncer , Florida/epidemiología , Hospitales , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de la Próstata/epidemiología , Neoplasias de la Próstata/patología , Sistema de Registros , Población BlancaRESUMEN
BACKGROUND: Hospital electronic medical record (EMR) systems are becoming increasingly integrated for management of patient data, especially given recent policy changes issued by the Centers for Medicaid and Medicare Services. In addition to data management, these data provide evidence for patient-centered outcomes research for a range of diseases, including cancer. Integrating EMR patient data with existing disease registries strengthens all essential components for assuring optimal health outcomes. OBJECTIVES: To identify the mechanisms for extracting, linking, and processing hospital EMR data with the Florida Cancer Data System (FCDS); and to assess the completeness of existing registry treatment data as well as the potential for data enhancement. METHODS: A partnership among the Florida Department of Health, FCDS, and a large Florida hospital system was established to develop methods for hospital EMR extraction and transmission. Records for admission years between 2007 and 2010 were extracted using ICD-9-CM codes as the trigger and were linked with the cancer registry for patients with invasive cancers of the breast. RESULTS: A total of 11,506 unique patients were linked with a total of 12,804 unique breast tumors. Evaluation of existing registry treatment data against the hospital EMR produced a total of 5 percent of registry records with updated surgery information, 1 percent of records with updated radiation information, and 7 percent of records updated with chemotherapy information. Enhancement of registry treatment information was particularly affected by the availability of chemotherapy medications data. CONCLUSION: Hospital EMR linkages to cancer disease registries is feasible but challenged by lack of standards for data collection, coding and transmission, comprehensive description of available data, and the exclusion of certain hospital datasets. The FCDS standard treatment data variables are highly robust and complete but can be enhanced by the addition of detailed chemotherapy regimens that are commonly used in patient centered outcomes research.
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Registros Electrónicos de Salud/organización & administración , Registro Médico Coordinado/métodos , Neoplasias/epidemiología , Neoplasias/terapia , Sistema de Registros/estadística & datos numéricos , Codificación Clínica , Comorbilidad , Florida , Administración Hospitalaria , Humanos , Neoplasias/patología , Alta del Paciente , Proyectos PilotoRESUMEN
OBJECTIVE: This study aimed to conduct a representative survey of human papillomavirus (HPV) prevalence and its genotype distribution in invasive anal cancer specimens in the United States. MATERIALS AND METHODS: Population-based archival anal cancer specimens were identified from Florida, Kentucky, Louisiana, and Michigan cancer registries and Surveillance, Epidemiology, and End Results (SEER) tissue repositories in Hawaii, Iowa, and Los Angeles. Sections from 1 representative block per case were used for DNA extraction. All extracts were assayed first by linear array and retested with INNO-LiPA if inadequate or HPV negative. RESULTS: Among 146 unique invasive anal cancer cases, 93 (63.7%) were from women, and 53 (36.3%) were from men. Human papillomavirus (any type) was detected in 133 cases (91.1%) and 129 (88.4%) contained at least 1 high risk-type, most (80.1%) as a single genotype. Human papillomavirus type 16 had the highest prevalence (113 cases, 77.4%); HPV types 6, 11, 18, and 33 were also found multiple times. Among HPV-16-positive cases, 37% were identified as prototype variant Ep, and 63% were nonprototypes: 33% Em, 12% E-G131G, 5% Af1, 4% AA/NA-1, 3% E-C109G, 3% E-G131T, 2% As, and 1% Af2. No significant differences in the distributions of HPV (any), high-risk types, or HPV-16/18 were seen between sex, race, or age group. CONCLUSIONS: The establishment of prevaccine HPV prevalence in the United States is critical to the surveillance of vaccine efficacy. Almost 80% of anal cancers were positive for the vaccine types HPV-16 or HPV-18, and in 70%, these were the only types detected, suggesting that a high proportion might be preventable by current vaccines.
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Neoplasias del Ano/virología , Papillomaviridae/aislamiento & purificación , Infecciones por Papillomavirus/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Genotipo , Humanos , Masculino , Persona de Mediana Edad , Papillomaviridae/clasificación , Papillomaviridae/genética , Prevalencia , Estudios Retrospectivos , Estados Unidos/epidemiología , Adulto JovenRESUMEN
INTRODUCTION: Identifying clinically relevant comorbid conditions might lead to effective control of prostate cancer- specific risk factors and provide opportunities to improve patient care and outcomes. There are challenges in assessing comorbidity using linked databases such as statewide hospital administrative data and state cancer registry. The objective was to compile a comprehensive list of clinically relevant comorbid conditions for patients with prostate cancer using registry and statewide diagnosis databases. METHODS: Florida Cancer Data System cases were linked with the inpatient/ outpatient diagnosis information. The Elixhauser Comorbidity Index was used as a reference. Conditions not captured by Elixhauser were identified, and grouped into clinically meaningful categories. Descriptive analysis was performed on comorbidity conditions and major study population variables. Associations of comorbidity with selected demographic and disease characteristics were examined. RESULTS: Twenty-nine Elixhauser and 16 additional categories were examined within the 1 record per patient data set. Statistically significant association was found between comorbidity with race, stage, and age. Blacks had a higher mean number of conditions compared to whites. A higher proportion of blacks had at least 1 comorbid condition compared to whites. Additional conditions identified by this research capture more comorbidities for white men. Distinct trends towards larger number of comorbidities with older age at diagnosis and advanced disease stage were observed. CONCLUSIONS: The Elixhauser Comorbidity Index captured the majority of comorbidities in the study population while the additional conditions identified by this research add more information. This study offers important insights into the challenges and process to identify relevant comorbidities for prostate cancer patients.
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Recolección de Datos/métodos , Neoplasias de la Próstata/epidemiología , Sistema de Registros , Negro o Afroamericano , Anciano , Comorbilidad , Grupos Diagnósticos Relacionados , Florida , Humanos , Clasificación Internacional de Enfermedades , Masculino , Persona de Mediana Edad , Neoplasias de la Próstata/etnologíaRESUMEN
A method was developed to categorize prostate cancer treatments for epidemiologic and outcomes studies. A total of 60,497 prostate cancer cases from the Florida Cancer Data System diagnosed between 2001 and 2007 were used. The classification has the following properties. First, the treatments classified in the same group are clinically comparable and capture all prostate cancer treatments or combinations of treatments (exhaustive classification). Second, the grouping was set up in a way that each patient is captured in only 1 treatment category without leaving out any patient due to treatment type (mutually exclusive categories). The prostate cancer cases were initially categorized into 14 combinations of treatment, which were then collapsed into 8 broader groups in order to maintain a large sample size for all groups, with treatments remaining clinically comparable within a group.
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Protocolos Antineoplásicos/clasificación , Investigación Biomédica , Neoplasias de la Próstata/terapia , Sistema de Registros , Adulto , Distribución por Edad , Anciano , Florida , Gestión de la Información en Salud , Humanos , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: The study aimed to determine the baseline prevalence of human papillomavirus (HPV) types in invasive vulvar cancer (IVC) and vulvar intraepithelial neoplasia 3 (VIN 3) cases using data from 7 US cancer registries. MATERIALS AND METHODS: Registries identified eligible cases diagnosed in 1994 to 2005 and requested pathology laboratories to prepare 1 representative block for HPV testing on those selected. Hematoxylin-eosin-stained sections preceding and following those used for extraction were reviewed to confirm representation. Human papillomavirus was detected using L1 consensus polymerase chain reaction (PCR) with PGMY9/11 primers and type-specific hybridization, with retesting of samples with negative and inadequate results with SPF10 primers. For IVC, the confirmatory hematoxylin-eosin slides were re-evaluated to determine histological type. Descriptive analyses were performed to examine distributions of HPV by histology and other factors. RESULTS: Human papillomavirus was detected in 121/176 (68.8%) cases of IVC and 66/68 (97.1%) cases of VIN 3 (p < .0001). Patients with IVC and VIN 3 differed by median age (70 vs 55 y, p = .003). Human papillomavirus 16 was present in 48.6% of IVC cases and 80.9% of VIN 3 cases; other high-risk HPV was present in 19.2% of IVC cases and 13.2% of VIN 3 cases. Prevalence of HPV differed by squamous cell carcinoma histological subtype (p < .0001) as follows: keratinizing, 49.1% (n = 55); nonkeratinizing, 85.7% (n = 14), basaloid, 92.3% (n = 14), warty 78.2% (n = 55), and mixed warty/basaloid, 100% (n = 7). CONCLUSIONS: Nearly all cases of VIN 3 and two thirds of IVC cases were positive for high-risk HPV. Prevalence of HPV ranged from 49.1% to 100% across squamous cell carcinoma histological subtypes. Given the high prevalence of HPV in IVC and VIN 3 cases, prophylactic vaccines have the potential to decrease the incidence of vulvar neoplasia.
Asunto(s)
Carcinoma in Situ/virología , Papillomaviridae/clasificación , Papillomaviridae/aislamiento & purificación , Infecciones por Papillomavirus/complicaciones , Infecciones por Papillomavirus/virología , Neoplasias de la Vulva/virología , Adulto , Anciano , Anciano de 80 o más Años , ADN Viral/genética , Femenino , Genotipo , Histocitoquímica , Humanos , Microscopía , Persona de Mediana Edad , Papillomaviridae/genética , Reacción en Cadena de la Polimerasa , Prevalencia , Estados Unidos/epidemiología , Proteínas Estructurales Virales/genéticaRESUMEN
BACKGROUND: Most melanoma studies use data from the National Cancer Institute Surveillance, Epidemiology, and End Results Program or individual cancer registries. Small numbers of melanoma cases have limited in-depth analyses for all racial and ethnic groups. OBJECTIVE: We sought to describe racial and ethnic variations in melanoma incidence and survival. METHODS: Incidence for invasive melanoma and 5-year melanoma-specific survival were calculated for whites, blacks, American Indians/Alaskan Natives, Asians/Pacific Islanders (API), and Hispanics using data from 38 population-based cancer registries. RESULTS: Incidence rates of melanoma were significantly higher for females than males among whites and Hispanics under 50 years of age and APIs under 40 years of age. White and black patients were older (median age: 59-63 years) compared with Hispanics, American Indians/Alaskan Natives, and API (median age: 52-56 years). The most common histologic type was acral lentiginous melanoma among blacks and superficial spreading melanoma among all other racial and ethnic groups. Hispanics had the highest incidence rate of acral lentiginous melanoma, significantly higher than whites and API. Nonwhites were more likely to have advanced and thicker melanomas at diagnosis and lower melanoma-specific survival compared with whites. LIMITATIONS: Over 50% of melanoma cases did not have specified histology. The numbers of nonwhite patients were still relatively small despite broad population coverage (67% of United States). CONCLUSIONS: Racial and ethnic differences in age at melanoma diagnosis, anatomic sites, and histologic types suggest variations in etiologic pathways. The high percentages of advanced and thicker melanomas among nonwhites highlight the need to improve melanoma awareness for all race and ethnicity in the United States.