The effect of body mass index and weight change on epithelial ovarian cancer survival in younger women: a long-term follow-up study.

OBJECTIVE: The objective of this study was to assess the relationship between body mass index (BMI) and epithelial ovarian cancer survival among young women. METHODS: We conducted a cohort analysis of 425 women aged 20-54 years with incident epithelial ovarian cancer enrolled during 1980-1982 in Cancer and Steroid Hormone (CASH), a population-based, case-control study. Participants' vital status was ascertained though linkage with the Surveillance, Epidemiology and End Results (SEER) program. Using Cox proportional hazards models, we estimated adjusted hazard ratios (HR) and 95% confidence intervals (CI) for the association between survival and usual adult BMI, BMI at age 18, and weight change from age 18 to adult. RESULTS: During a follow-up of up to 17 years, 215 women died. Compared to women with an adult BMI in the lowest quartile (<20.7), women in the second (20.8-22.5), third (22.6-24.9), and fourth (≥25.0) quartiles were not at increased risk for death (HR 1.2, 95% CI 0.8-1.8; HR 1.1, 95% CI 0.7-1.6; and HR 0.9, 95% CI 0.6-1.4, respectively) (p trend=0.6). Similarly, neither age 18 BMI nor weight change were associated with ovarian cancer survival. CONCLUSIONS: Although elevated BMI is associated with increased ovarian cancer risk among young women, we found no evidence of its association with ovarian cancer survival in this population.

Geographic variation in trends and characteristics of teen childbearing among American Indians and Alaska Natives, 1990-2007.

To study teen birth rates, trends, and socio-demographic and pregnancy characteristics of AI/AN across geographic regions in the US. The birth rate for US teenagers 15-19 years reached a historic low in 2009 (39.1 per 1,000) and yet remains one of the highest teen birth rates among industrialized nations. In the US, teen birth rates among Hispanic, non-Hispanic black, and American Indian/Alaska Native (AI/AN) youth are consistently two to three times the rate among non-Hispanic white teens. Birth certificate data for females younger than age 20 were used to calculate birth rates (live births per 1,000 women) and joinpoint regression to describe trends in teen birth rates by age (<15, 15-17, 18-19) and region (Aberdeen, Alaska, Bemidji, Billings, California, Nashville, Oklahoma, Portland, Southwest). Birth rates for AI/AN teens varied across geographic regions. Among 15-19-year-old AI/AN, rates ranged from 24.35 (California) to 123.24 (Aberdeen). AI/AN teen birth rates declined from the early 1990s into the 2000s for all three age groups. Among 15-17-year-olds, trends were approximately level during the early 2000s-2007 in six regions and declined in the others. Among 18-19-year-olds, trends were significantly increasing during the early 2000s-2007 in three regions, significantly decreasing in one, and were level in the remaining regions. Among AI/AN, cesarean section rates were lower in Alaska (4.1%) than in other regions (16.4-26.6%). This is the first national study to describe regional variation in AI/AN teen birth rates. These data may be used to target limited resources for teen pregnancy intervention programs and guide research.

Oral contraceptive formulation and risk of breast cancer.

BACKGROUND: While evidence on the association between oral contraceptive (OC) use and breast cancer generally suggests little or no increased risk, the question of whether breast cancer risk varies by OC formulation remains controversial. Few studies have examined this issue because large samples and extensive OC histories are required. STUDY DESIGN: We used data from a multicenter, population-based, case-control investigation. Women aged 35-64 years were interviewed. To explore the association between OC formulation and breast cancer risk, we used conditional logistic regression to derive adjusted odds ratios, and we used likelihood ratio tests for heterogeneity to assess whether breast cancer risk varied by OC formulation. Key OC exposure variables were ever use, current or former use, duration of use and time since last use. To strengthen inferences about specific formulations, we restricted most analyses to the 2282 women with breast cancer and the 2424 women without breast cancer who reported no OC use or exclusive use of one OC. RESULTS: Thirty-eight formulations were reported by the 2674 women who used one OC; most OC formulations were used by only a few women. We conducted multivariable analyses on the 10 formulations that were each used by at least 50 women and conducted supplemental analyses on selected formulations of interest based on recent research. Breast cancer risk did not vary significantly by OC formulation, and no formulation was associated with a significantly increased breast cancer risk. CONCLUSIONS: These results add to the small body of literature on the relationship between OC formulation and breast cancer. Our data are reassuring in that, among women 35-64 years of age, we found no evidence that specific OC formulations increase breast cancer risk.

Recent trends in cutaneous melanoma incidence and death rates in the United States, 1992-2006.

BACKGROUND: Increasing cutaneous melanoma incidence rates in the United States have been attributed to heightened detection of thin (≤ 1-mm) lesions. OBJECTIVE: We sought to describe melanoma incidence and mortality trends in the 12 cancer registries covered by the Surveillance, Epidemiology, and End Results program and to estimate the contribution of thin lesions to melanoma mortality. METHODS: We used joinpoint analysis of Surveillance, Epidemiology, and End Results incidence and mortality data from 1992 to 2006. RESULTS: During 1992 through 2006, melanoma incidence rates among non-Hispanic whites increased for all ages and tumor thicknesses. Death rates increased for older (>65 years) but not younger persons. Between 1998 to 1999 and 2004 to 2005, melanoma death rates associated with thin lesions increased and accounted for about 30% of the total melanoma deaths. LIMITATIONS: Availability of long-term incidence data for 14% of the US population was a limitation. CONCLUSIONS: The continued increases in melanoma death rates for older persons and for thin lesions suggest that the increases may partly reflect increased ultraviolet radiation exposure. The substantial contribution of thin lesions to melanoma mortality underscores the importance of standard wide excision techniques and the need for molecular characterization of the lesions for aggressive forms.

Recent changes in the trends of teen birth rates, 1981-2006.

PURPOSE: To explore trends in teen birth rates by selected demographics. METHODS: We used birth certificate data and joinpoint regression to examine trends in teen birth rates by age (10-14, 15-17, and 18-19 years) and race during 1981-2006 and by age and Hispanic origin during 1990-2006. Joinpoint analysis describes changing trends over successive segments of time and uses annual percentage change (APC) to express the amount of increase or decrease within each segment. RESULTS: For teens younger than 18 years, the decline in birth rates began in 1994 and ended in 2003 (APC: -8.03% per year for ages 10-14 years; APC: -5.63% per year for ages 15-17 years). The downward trend for 18- and 19-year-old teens began earlier (1991) and ended 1 year later (2004) (APC: -2.37% per year). For each study population, the trend was approximately level during the most recent time segment, except for continuing declines for 18- and 19-year-old white and Asian/Pacific Islander teens. The only increasing trend in the most recent time segment was for 18- and 19-year-old Hispanic teens. During these declines, the age distribution of teens who gave birth shifted to slightly older ages, and the percentage whose current birth was at least their second birth decreased. CONCLUSIONS: Teen birth rates were generally level during 2003/2004-2006 after the long-term declines. Rates increased among older Hispanic teens. These results indicate a need for renewed attention to effective teen pregnancy prevention programs in specific populations.

Influence of reproductive factors on mortality after epithelial ovarian cancer diagnosis.

INTRODUCTION: Although many studies have examined the influence of reproductive factors on ovarian cancer risk, few have investigated their effect on ovarian cancer survival. We examined the prognostic influence of reproductive factors on survival after ovarian cancer diagnosis. METHODS: We conducted a longitudinal analysis of 410 women, ages 20 to 54 years, who participated in the 1980 to 1982 Cancer and Steroid Hormone study as incident ovarian cancer cases. We obtained their vital status by linking Cancer and Steroid Hormone records with Surveillance, Epidemiology, and End Results data. We used the Kaplan-Meier approach to estimate survival probabilities and Cox proportional hazards models to estimate hazard ratios (HR) and 95% confidence intervals (95% CI). RESULTS: During a median follow-up of 9.2 years, 212 women died. Of the reproductive factors examined, only age at menarche and number of lifetime ovulatory cycles (LOC) relative to age significantly predicted ovarian cancer survival. Risk for death was higher among women with highest number of LOC compared with those having fewest LOC (HR, 1.67; 95% CI, 1.20-2.33). Women with fewest LOC had the highest 15-year survival (56.7%; 95% CI, 47.8-64.6%), and women with the highest LOC had the poorest (33.3%; 95% CI, 25.3-41.5%). Women whose age at menarche was <12 years had a higher risk of death compared with women whose menses began at > or =14 years (HR, 1.51; 95% CI, 1.02-2.24). CONCLUSIONS: We found that high LOC and early age at menarche were associated with decreased survival after ovarian cancer.

Endometrial cancer risk among younger, overweight women.

OBJECTIVE: To examine the risk for endometrial cancer among overweight women using the World Health Organization's clinical definitions of obesity based on body mass index (BMI). METHODS: Conducted in the early 1980s, the Cancer and Steroid Hormone study was a multicenter, population-based, case-control study of breast, ovarian, and endometrial cancers among women aged 20-54 years. Participants for the case group (n=421) were identified through cancer registries and had histologically confirmed endometrial cancer. Participants for the control group (n=3,159) were chosen by random-digit dialing methods in the same regions as those in the case group. Those in the case and control groups responded to the same questions during in-person interviews. Unconditional logistic regression was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: The relationship between endometrial cancer and BMI (calculated as weight [kg]/[height (m)]) was modified by age at last menstrual period (LMP). Of women who were younger than 45 years at LMP, those with BMIs of at least 35.0 had a greater risk of endometrial cancer (56%, 30/54) than did those with normal BMIs (4%, 59/1,492, adjusted OR 21.7, 95% CI 11.3-41.7). Of women age 45 or older at LMP, those with BMIs of at least 35.0 also had a greater risk (40%, 24/60) than did those with normal BMIs (14%, 168/1,235, adjusted OR 3.7, 95% CI 2.0-6.6). Women younger than 45 years at LMP and those with BMIs of at least 25.0 at 18 years and as adults (25%, 31/123) had an approximately sixfold increased risk (adjusted OR 5.8, 95% CI 3.4-9.8) compared with those with normal BMIs at 18 and as adults (4%, 58/1,460). CONCLUSION: Very obese women aged 20-54 years have an elevated endometrial cancer risk, which appears heightened by early menopause. LEVEL OF EVIDENCE: II.

Health disparities among Mexican American women aged 15-44 years: National Health and Nutrition Examination Survey, 1999-2004.

OBJECTIVES: We analyzed the health of Mexican American women aged 15 to 44 years, by generation and language preference, to guide planning for reproductive health services in this growing population. METHODS: We used personal interview and medical examination data from the 1999 to 2004 National Health and Nutrition Examination Surveys. We used SUDAAN for calculating age-adjusted prevalence estimates of demographic and health characteristics. The Satterthwaite adjusted F test and Student t test were used for subgroup comparisons. RESULTS: The women had different health profiles (P < .05) by generation and language preference. Second- and later-generation women and women who used more English were more likely to be sexually active, to have been younger at first intercourse, and to have had more male sexual partners than were first-generation women and women who used more Spanish. Compared with their first-generation counterparts, second- and later-generation women drank more alcohol, were better educated, had higher incomes, and were more likely to have health insurance. Third-generation women were more likely to have delivered a low-birthweight baby than were first-generation women. CONCLUSIONS: Differences by generation and language preference suggest that acculturation should be considered when planning interventions to promote healthy reproductive behaviors among Mexican American women.

Cancer registries and monitoring the impact of prophylactic human papillomavirus vaccines: the potential role.

The recent US Food and Drug Administration licensure of a prophylactic vaccine against oncogenic human papillomavirus (HPV) types 16 and 18, the first of its kind, poses unique challenges in postmarketing vaccine surveillance, especially in measuring vaccine effectiveness against biologic endpoints of HPV infection. Historically, the national system of population-based cancer registries in the US has provided high-quality data on cancer incidence and mortality for the most important biologic endpoints, namely, anogenital cancers and some oral cavity/oropharyngeal cancers. There also has been some data collection on cancer precursors; however, this activity has been inconsistent and of lower priority. Because effectiveness against HPV-associated cancers will not be measurable for several decades, strengthening and possibly expanding the capacity of registries to collect precancer data, which are earlier manifestations of infection, must be considered. Collecting type-specific data on HPV-associated precancers and cancers. While keeping in mind the current limitations of registry operations, they discuss resources that may be needed to implement and sustain these types of activities.

Introduction to the supplement on cancer in the American Indian and Alaska Native populations in the United States.

The collection of papers in this Supplement combines cancer incidence data from the National Program of Cancer Registries and the Surveillance, Epidemiology, and End Results program, enhanced by record linkages and geographic factors, to provide a comprehensive description of the cancer burden in the American Indian/Alaska Native population in the United States. Cancer incidence rates among this population varied widely, sometimes more than 5-fold, by geographic region.

Cancer among American Indians and Alaska Natives in the United States, 1999-2004.

BACKGROUND: Cancer incidence rates vary among American Indian and Alaska Native (AI/AN) populations and often differ from rates among non-Hispanic whites (NHWs). However, the misclassification of race for AI/AN cancer cases in central cancer registries may have led to underestimates of the AI/AN cancer burden in previous reports. METHODS: Cases diagnosed during 1999 through 2004 were identified from population-based cancer registries in the United States. Age-adjusted rates were calculated for the 25 most common sites for AI/ANs and NHWs. To minimize the misclassification of race, cancer registry records were linked with patient registration files from the Indian Health Service (IHS). Analyses were restricted to Contract Health Service Delivery Area (CHSDA) counties and were stratified by IHS region. RESULTS: In CHSDA counties, cancer incidence rates among AI/ANs varied widely by region, whereas rates among NHWs did not. For all cancer sites combined, AI/AN rates were higher than NHW rates among both males and females in the Northern and Southern Plains, and among Alaska Native Females; AI/AN rates were lower than NHW rates in the Southwest, the Pacific Coast, and the East. Lung cancer and colorectal cancer rates for AI/ANs exceeded rates for NHWs in Alaska and the Northern Plains. Rates for stomach, gallbladder, kidney, and liver cancer were higher among AI/ANs than among NHWs overall, in Alaska, in the Plains regions, and in the Southwest. CONCLUSIONS: Regional differences in cancer incidence rates among AI/AN populations were not obvious from nationwide data and highlighted opportunities for cancer control and prevention. It is unlikely that such differences are explained by race misclassification.

Breast cancer incidence among American Indian and Alaska Native women: US, 1999-2004.

BACKGROUND: Breast cancer is a leading cause of cancer morbidity and mortality among American Indian and Alaska Native (AI/AN) women. Although published studies have suggested that breast cancer rates among AI/AN women are lower than those among other racial and ethnic populations, accurate determinations of the breast cancer burden have been hampered by misclassification of AI/AN race. METHODS: Cancer incidence data from the National Program of Cancer Registries and the Surveillance, Epidemiology, and End Results Program were combined to estimate age-adjusted rates for the diagnosis years 1999 through 2004. Several steps were taken to reduce the misclassification of AI/AN race: linking cases to Indian Health Service (IHS) patient services database, restricting analyses to Contract Health Service Delivery Area counties, and stratifying results by IHS region. RESULTS: Breast cancer incidence rates among AI/AN women varied nearly 3-fold across IHS regions. The highest rates were in Alaska (134.8) and the Plains (Northern, 115.9; Southern, 115.7), and the lowest rates were in the Southwest (50.8). The rate in Alaska was similar to the rate among non-Hispanic white (NHW) women in Alaska. Overall, AI/AN women had lower rates of breast cancer than NHW women, but AI/AN women were more likely to be diagnosed with late-stage disease. CONCLUSIONS: To the authors' knowledge, this report provides the most comprehensive breast cancer incidence data for AI/AN women to date. The wide regional variation indicates an important need for etiologic and health services research, and the large percentage of AI/AN women with late-stage disease demands innovative approaches for increasing access to screening.

Health-related quality of life in cancer survivors between ages 20 and 64 years: population-based estimates from the Behavioral Risk Factor Surveillance System.

BACKGROUND: The authors examined the health-related quality of life (HRQOL) of cancer survivors between ages 20 and 64 years by using a population-based survey of individuals who had activity limitations caused by cancer. METHODS: A population-based, cross-sectional study was conducted using the 2000 to 2002 Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System (BRFSS) to examine HRQOL among respondents who reported activity limitations because of cancer. HRQOL was measured by using the CDC's Healthy Days Measures, including self-rated health status, numbers of unhealthy physical and mental health days, and activity limitation. HRQOL was compared among the following groups: those who reported no activity limitations and those who were limited primarily by cardiovascular conditions, emotional problems, and cancer. Taylor-series linearization methods were used to calculate population-based estimates in this complex sample survey. RESULTS: Individuals between ages 20 and 64 years who were limited by cancer reported poorer HRQOL measured as higher prevalence of poor or fair self-reported health, more physically unhealthy days, more painful days, and more inadequate sleep days. Compared with the group that had no activity limitations, the individuals who had limitations were more likely to be women and to have annual household incomes<$25,000. They were more likely to be unable to work and to have health insurance. In addition, they were more likely to be former smokers and to be overweight, but they were less likely to participate in leisure-time physical activity. CONCLUSIONS: Overall, respondents between ages 20 and 64 years who reported being limited primarily by cancer reported lower HRQOL. They also reported unhealthy behaviors that were detrimental to improved HRQOL. The HRQOL and lifestyle modification needs of this population need to be examined prospectively to help decrease their burden of suffering.

Cancer in Appalachia, 2001-2003.

BACKGROUND: Researchers have not been able to examine cancer incidence rates in Appalachia because high-quality data have not been uniformly available across the region. This study is the first to report cancer incidence rates for a large proportion of the Appalachian population and describe the differences in incidence rates between Northern, Central, and Southern Appalachia. METHODS: Forty-four states and the District of Columbia provided information for the diagnosis years 2001 through 2003 from cancer registries that met high-quality data criteria. Eleven of 13 states with counties in Appalachia, covering 88% of the Appalachian population, met these criteria; Virginia and Mississippi were included for 2003 only. SEER(*)Stat was used to calculate age-adjusted rates per 100,000 population and 95% gamma confidence limits. RESULTS: Overall, cancer incidence rates were higher in Appalachia than in the rest of the US; the rates for lung, colon/rectum, and other tobacco-related cancers were particularly high. Central Appalachia had the highest rates of lung (men: 143.8; women: 75.2) and cervical cancer (11.2)-higher than the other 2 regions and the rest of the US. Northern Appalachia had the highest rates for prostate, female breast, and selected other sites, and Southern Appalachia had the lowest overall cancer incidence rates. CONCLUSIONS: Cancer incidence rates in Appalachia are higher than in the rest of the US, and they vary substantially between regions. Additional studies are needed to understand how these variations within Appalachia are associated with lifestyle, socioeconomic factors, urban/rural residence, and access to care.

Use of state cancer surveillance data to estimate the cancer burden in disaster-affected areas--Hurricane Katrina, 2005.

PURPOSE: The objective of this study was to estimate the burden of cancer in counties affected by Hurricane Katrina using population-based cancer registry data, and to discuss issues related to cancer patients who have been displaced by disasters. METHODS: The cancer burden was assessed in 75 counties in Louisiana, Alabama, and Mississippi that were designated by the Federal Emergency Management Agency as eligible for individual and public assistance. Data from the National Program of Cancer Registries were used to determine three-year average annual age-adjusted incidence rates and case counts during the diagnosis years 2000-2002 for Louisiana and Alabama. Expected rates and counts for the most-affected counties in Mississippi were estimated by direct, age-specific calculation using the 2000-2002 county level populations and the site-, sex-, race-, and age-specific cancer incidence rates for Louisiana. RESULTS: An estimated 23,549 persons with a new diagnosis of cancer in the past year resided in the disaster-affected counties. Fifty-eight percent of the cases were cancers of the lung/bronchus, colon/rectum, female breast, and prostate. Eleven of the top 15 cancer sites by sex and black/white race in disaster counties had >50% of cases diagnosed at the regional or distant stage. CONCLUSIONS: Sizable populations of persons with a recent cancer diagnosis were potentially displaced by Hurricane Katrina. Cancer patients required special attention to access records in order to confirm diagnosis and staging, minimize disruption in treatment, and ensure coverage of care. Cancer registry data can be used to provide disaster planners and clinicians with estimates of the number of cancer patients, many of whom may be undergoing active treatment.

Annual report to the nation on the status of cancer, 1975-2004, featuring cancer in American Indians and Alaska Natives.

BACKGROUND: The American Cancer Society, the Centers for Disease Control and Prevention, the National Cancer Institute, and the North American Association of Central Cancer Registries collaborate annually to provide updated information on cancer occurrence and trends in the U.S. The 2007 report features a comprehensive compilation of cancer information for American Indians and Alaska Natives (AI/AN). METHODS: Cancer incidence data were available for up to 82% of the U.S. population. Cancer deaths were available for the entire U.S. population. Long-term (1975 through 2004) and fixed-interval (1995 through 2004) incidence and mortality trends were evaluated by annual percent change using regression analyses (2-sided P < .05). Cancer screening, risk factors, socioeconomic characteristics, incidence data, and stage were compiled for non-Hispanic whites (NHW) and AI/AN across 6 regions of the U.S. RESULTS: Overall cancer death rates decreased by 2.1% per year from 2002 through 2004, nearly twice the annual decrease of 1.1% per year from 1993 through 2002. Among men and women, death rates declined for most cancers. Among women, lung cancer incidence rates no longer were increasing and death rates, although they still were increasing slightly, were increasing at a much slower rate than in the past. Breast cancer incidence rates in women decreased 3.5% per year from 2001 to 2004, the first decrease observed in 20 years. Colorectal cancer incidence and death rates and prostate cancer death rates declined, with colorectal cancer death rates dropping more sharply from 2002 through 2004. Overall, rates for AI/AN were lower than for NHW from 1999 through 2004 for most cancers, but they were higher for cancers of the stomach, liver, cervix, kidney, and gallbladder. Regional analyses, however, revealed high rates for AI/AN in the Northern and Southern Plains and Alaska. For cancers of the breast, colon and rectum, prostate, and cervix, AI/AN were less likely than NHW to be diagnosed at localized stages. CONCLUSIONS: For all races/ethnicities combined in the U.S., favorable trends in incidence and mortality were noted for lung and colorectal cancer in men and women and for breast cancer in women. For the AI/AN population, lower overall cancer incidence and death rates obscured important variations by geographic regions and less favorable healthcare access and socioeconomic status. Enhanced tobacco control and cancer screening, especially in the Northern and Southern Plains and Alaska, emerged as clear priorities.

Oral contraceptives and the risk of death from breast cancer.

OBJECTIVE: To examine the relationship between the use of oral contraceptives and the risk of death from breast cancer. METHODS: We used interview data from the Cancer and Steroid Hormone Study, linked to cancer registry data from the Surveillance, Epidemiology, and End Results Program, to examine the 15-year survival and prior use of oral contraceptives among 4,292 women aged 20 to 54 years when diagnosed with breast cancer from December 1, 1980, to December 31, 1982. Cox proportional hazard models were used to estimate the relative rate of death from breast cancer by oral contraceptive use. RESULTS: Duration of oral contraceptive use, time since first use, age at first use, and use of specific pill formulations were not associated with survival. For time since last use, the risk of death from breast cancer decreased significantly with increasing time since last use of oral contraceptives, but a consistent gradient effect was not observed. Adjusted hazard ratios ranged from 0.86 to 1.41 and were 1.00 or less for all recency categories except during 13 to 24 months before diagnosis; none was statistically significant. Women who were currently using oral contraceptives had an adjusted hazard ratio of 0.90 (0.68, 1.19). CONCLUSION: Overall, oral contraceptive use had neither a harmful nor a beneficial effect on breast cancer mortality. The differences between pill users and nonusers were slight, and the risk estimates were usually reduced with confidence limits that nearly always included 1.0.

Annual report to the nation on the status of cancer, 1975-2003, featuring cancer among U.S. Hispanic/Latino populations.

BACKGROUND: The American Cancer Society, Centers for Disease Control and Prevention, National Cancer Institute, and North American Association of Central Cancer Registries collaborate annually to provide U.S. cancer information, this year featuring the first comprehensive compilation of cancer information for U.S. Latinos. METHODS: Cancer incidence was obtained from 90% of the Hispanic/Latino and 82% of the U.S. populations. Cancer deaths were obtained for the entire U.S. population. Cancer screening, risk factor, incidence, and mortality data were compiled for Latino and non-Latino adults and children (incidence only). Long-term (1975-2003) and fixed-interval (1995-2003) trends and comparative analyses by disease stage, urbanicity, and area poverty were evaluated. RESULTS: The long-term trend in overall cancer death rates, declining since the early 1990s, continued through 2003 for all races and both sexes combined. However, female lung cancer incidence rates increased from 1975 to 2003, decelerating since 1991 and breast cancer incidence rates stabilized from 2001 to 2003. Latinos had lower incidence rates in 1999-2003 for most cancers, but higher rates for stomach, liver, cervix, and myeloma (females) than did non-Latino white populations. Latino children have higher incidence of leukemia, retinoblastoma, osteosarcoma, and germ-cell tumors than do non-Latino white children. For several common cancers, Latinos were less likely than non-Latinos to be diagnosed at localized stages. CONCLUSIONS: The lower cancer rates observed in Latino immigrants could be sustained by maintenance of healthy behaviors. Some infection-related cancers in Latinos could be controlled by evidence-based interventions. Affordable, culturally sensitive, linguistically appropriate, and timely access to cancer information, prevention, screening, and treatment are important in Latino outreach and community networks.

A self-assessment tool was reliable in identifying hazards in the homes of elders.

BACKGROUND AND OBJECTIVES: Falls are a leading cause of fatal and nonfatal injuries, particularly among the elderly. A reliable instrument for self-assessment of home falls hazards would facilitate screening for falls risk. This study examined the reliability of self-assessment of home falls hazards by elderly women. METHODS AND SETTING: Participants were 52 elderly women, aged 67 to 97. All evaluations were performed in the participants' homes. Home falls hazards were evaluated independently by study participants and by trained observers. RESULTS: Kappa statistics indicated good to excellent agreement for most of the environmental factors. However, observers were significantly more likely than the study participants to report certain tripping hazards, particularly objects in walkways. CONCLUSION: This home checklist is an important step towards a reliable self-report instrument for measuring home falls hazards. Self-assessment appears to be a reliable method for assessing many putative hazards of falling in the home. However, our findings raise questions regarding the reliable assessment of tripping hazards.