Living near a freeway is associated with lower bone mineral density among Mexican Americans.

UNLABELLED: We hypothesized that chronic exposures to traffic combustion products may lower bone mineral density (BMD). We found that proximity to freeways was associated with reduced BMD. Our findings suggest that traffic-related pollution may contribute to the occurrence of osteopenia and osteoporosis. INTRODUCTION: Adults residing in rural areas have been linked with higher BMD. We aimed to determine if this difference is due in part to air pollution by examining the relationships between traffic metrics and ambient air pollution with total body and pelvic BMD. METHODS: Mexican American adults (n = 1,175; mean 34 years; 72 % female) who had participated in the BetaGene study of air pollution, obesity, and insulin resistance were included in this analysis. Total body and pelvic BMD were estimated using dual-energy X-ray absorptiometry. Traffic and ambient air pollutant exposures were estimated at residences using location and ambient monitoring data. Variance component models were used to analyze the associations between residential distance to the nearest freeway and ambient air pollutants with BMD. RESULTS: Residential proximity to a freeway was associated with lower total body BMD (p-trend = 0.01) and pelvic BMD (p-trend = 0.03) after adjustment for age, sex, weight, and height. The adjusted mean total body and pelvic BMD in participants living within 500 m of a freeway were 0.02 and 0.03 g/cm(2) lower than participants living greater than 1,500 m from a freeway. These associations did not differ significantly by age, sex, or obesity status. Results were similar after further adjustment for body fat and weekly physical activity minutes. Ambient air pollutants (NO2, O3, and PM2.5) were not significantly associated with BMD. CONCLUSIONS: Traffic-related exposures in overweight and obese Mexican Americans may adversely affect BMD. Our findings indicate that long-term exposures to traffic may contribute to the occurrence of osteoporosis and its consequences.

Family history and risk of breast cancer in hispanic and non-hispanic women: the New Mexico Women's Health Study.

OBJECTIVES: Many epidemiologic studies have demonstrated that an increased risk of breast cancer is associated with positive family history of this disease. Little information had been available on the relationship of breast cancer risk with family history in Hispanic women. To investigate the association of family history of breast cancer on the risk of breast cancer, we examined the data from the New Mexico Women's Health Study (NMWHS), a statewide case-control study. METHODS: In this study 712 women (332 Hispanics and 380 non-Hispanic whites) with breast cancer and 844 controls (388 Hispanics and 456 non-Hispanic whites) were included. Conditional logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval (95% CI). adjusted for sociodemographic, medical, and reproductive factors. RESULTS: We found an increased risk in women with a history of breast cancer in one or more first-degree or second-degree relatives (OR= 1.5, 95% CI 1.2-1.9), first-degree relatives (OR= 1.3, 95% CI 1.0-1.8) and second-degree relatives (OR = 1.6, 95% CI 1.2-2.2). Hispanic women had higher risk estimates for a positive family history (OR= 1.7, 95% CI 1.1-2.5) than non-Hispanic white women (OR= 1.4, 95% CI 1.0-2.0); however, the differences were not statistically significant. In both ethnic groups a higher risk was observed in premenopausal women compared with postmenopausal women and women diagnosed with breast cancer before age 50 years compared with older women. CONCLUSIONS: The results indicate that Hispanic women with a family history of breast cancer are at increased risk of breast cancer.

Patterns of mammography use among Hispanic, American Indian, and non-Hispanic White women in New Mexico, 1994-1997.

For screening efforts to maximally reduce mortality in the general population, a large proportion of women need to utilize mammography routinely. To investigate utilization of mammography in a community setting, the authors used population-based data collected by the New Mexico Mammography Project for residents of the Albuquerque, New Mexico, metropolitan area for the period 1994-1997. The authors computed screening rates and the proportion of women who routinely use mammography. The utilization of mammography was low. Only 50% of the women aged 50-74 years were screened each year. Less than one third of women aged 40-49 years or 75 years and older were screened annually. The percentage of women who routinely used mammography on an annual or biennial basis was low in all age groups, especially among Hispanics and American Indians. Women aged 50-74 years had the highest percentage of routine annual mammography use, ranging from 30% in non-Hispanic Whites to 20% in Hispanics. Current utilization of mammography in community-based screening efforts is unlikely to achieve a potential 30% reduction in breast cancer mortality. Interventions are needed to increase the routine use of mammography.

Uranium mining and lung cancer among Navajo men in New Mexico and Arizona, 1969 to 1993.

Navajo men who were underground miners have excess risk of lung cancer. To further characterize the long-term consequences of uranium mining in this high-risk population, we examined lung cancer incidence among Navajo men residing in New Mexico and Arizona from 1969 to 1993 and conducted a population-based case-control study to estimate the risk of lung cancer for Navajo uranium miners. Uranium mining contributed substantially to lung cancer among Navajo men over the 25-year period following the end of mining for the Navajo Nation. Sixty-three (67%) of the 94-incident lung cancers among Navajo men occurred in former uranium miners. The relative risk for a history of mining was 28.6 (95% confidence interval, 13.2-61.7). Smoking did not account for the strong relationship between lung cancer and uranium mining. The Navajo experience with uranium mining is a unique example of exposure in a single occupation accounting for the majority of lung cancers in an entire population.

A population-based survey of prostate cancer testing in New Mexico.

Prostate cancer screening has increased dramatically in the past decade, but few studies have looked at population-based testing rates and the factors that influence testing. The objectives of our study were to estimate prostate cancer testing rates for New Mexican men 50 years or older and to identify patient factors associated with testing. We surveyed men using random-digit dialing. Subjects completed a 32-item questionnaire asking about prostate cancer testing; demographics; cancer knowledge, attitudes, and beliefs; health behaviors; and risks for prostate cancer. Associations between patient factors and testing were analyzed with multivariate logistic regression. Two hundred thirty-nine subjects (36% response rate) completed the survey; 95% had heard of prostate cancer and nearly 90% felt that testing was important. Forty-eight percent had been tested, most within the past year. Significant predictors for testing included receiving regular health care (odds ratio = 2.15, 95% CI = 1.07-4.33), being retired (OR = 2.49, 95 CI = 1.18-5.28), and having been diagnosed with prostatic hyperplasia (OR = 3.14, 95% CI = 1.30-7.59). Prostate cancer testing occurred frequently among New Mexican men. The study variables that were the most significant predictors of testing were all markers for access to health care.

Trends in incidence and treatment for ductal carcinoma in situ in Hispanic, American Indian, and non-Hispanic white women in New Mexico, 1973-1994.

BACKGROUND: Incidence rates of ductal carcinoma in situ (DCIS) breast carcinoma and the use of breast-conserving surgery (BCS) for its treatment show substantial geographic and ethnic variations nationwide. To the authors' knowledge, few studies have investigated incidence rates and treatment patterns in Hispanics and American Indians. METHODS: The authors used data from the population-based New Mexico Tumor Registry to describe trends in DCIS incidence rates between 1973-1994 and investigate patient and physician characteristics related to BCS in a multiethnic population between 1985-1994. Multiple logistic regression was used to evaluate patient and physician factors related to receiving BCS. RESULTS: Incidence rates for DCIS in Hispanics were approximately 50% lower compared with non-Hispanic whites. American Indians had the lowest incidence rate. Beginning in 1985, incidence rates for Hispanics and non-Hispanic whites showed a 21% annual increase. Between 1990-1994, incidence rates in American Indians increased more than twofold. BCS increased 5.8% per year between 1985-1994, with 50% of Hispanic and non-Hispanic white patients treated with BCS in 1994. The strongest factor associated with receiving BCS was geographic location of treatment (P < 0.001). The odds of receiving BCS were 5.8 times higher in the northern third of the state compared with the southern third. No significant variation in BCS was found by ethnicity, rural/urban residency, socioeconomic status, or physician characteristics. CONCLUSIONS: Incidence rates for DCIS increased substantially in all three ethnic groups. The use of BCS was associated most strongly with the location of treatment, most likely reflecting differences in physician practices and treatment recommendations. Further research is needed to investigate the increasing incidence rates of DCIS and the determinants of BCS for the treatment of DCIS.

Preventive health care among rural American Indians in New Mexico.

BACKGROUND: Incidence of and mortality from cardiovascular disease, cancer, diabetes, and other chronic diseases are rapidly increasing among American Indians; however, the utilization of preventive services for these conditions is not well characterized in these ethnic groups. METHODS: We interviewed 1,273 American Indian adults in New Mexico, ages 18 years and older, by telephone regarding routine health checks, including blood pressure, blood cholesterol, mammograms, clinical breast exams, Pap smears, influenza and pneumonia vaccinations, and diabetes using items from the CDC Behavioral Risk Factor Surveillance System. RESULTS: We found that utilization of preventive service was surprisingly high among rural American Indians. Routine health checks and blood pressure checks within the past year were reported by more than 70% of the population. Blood cholesterol checks (41.1%) and pneumonia vaccinations (30.7%) were less commonly reported. Utilization of cancer screening for the most common women's cancers was also high. Most women reported ever having a Pap smear test (88.3%), a clinical breast examination (79.5%), and a mammogram (75.6%). The prevalence of diagnosed diabetes (8.8% overall and 26.4% for ages 50 years and older) greatly exceeds the nationwide prevalence. CONCLUSIONS: The utilization of preventive services delivered by a unique governmental partnership is high among American Indians in New Mexico and, except for cholesterol screening, is comparable with rates for the U.S. population. Because cardiovascular disease is on the rise, more attention to preventive services in this arena is warranted. The high and increasing prevalence of diagnosed diabetes suggests that aggressive diabetes screening and interventions are needed.

Effects of age, breast density, ethnicity, and estrogen replacement therapy on screening mammographic sensitivity and cancer stage at diagnosis: review of 183,134 screening mammograms in Albuquerque, New Mexico.

PURPOSE: To examine how common patient factors affect screening mammographic sensitivity and cancer stage at diagnosis. MATERIALS AND METHODS: The authors used a population-based database of 183,134 screening mammograms and a statewide tumor registry to identify 807 breast cancers detected at screening mammography. RESULTS: Sensitivity varied significantly with ethnicity, use of estrogen replacement therapy, mammographic breast density, and age. Sensitivity was 54% (13 of 24) in women younger than 40 years, 77% (121 of 157) in women aged 40-49 years, 78% (224 of 286) in women aged 50-64 years, and 81% (277 of 340) in women older than 64 years. Sensitivity was 68% (162 of 237) for dense breasts and 85% (302 of 356) for nondense breasts and 74% (180 of 244) in estrogen replacement therapy users and 81% (417 of 513) in nonusers. Sensitivity was most markedly reduced with the combination of dense breasts and estrogen replacement therapy use; there was little difference when only one factor was present. Median cancer size and the percentage of early cancers showed little change with any factors. CONCLUSION: Age is a minor determinant of mammographic sensitivity in women aged 40 years or older. Sensitivity is substantially decreased with the combination of higher breast density and estrogen replacement therapy use. There was not a notable shift in cancer outcomes in the groups with lower mammographic sensitivity. These data do not support different screening recommendations in women aged 40-49 years or in estrogen replacement therapy users.

Health-related quality of life for rural American Indians in New Mexico.

OBJECTIVES: To determine health-related quality of life for rural American Indians using an economical telephone surveillance system. DESIGN: We interviewed 618 American Indians by telephone about health-related quality of life using an adaptation of the Behavioral Risk Factor Surveillance System questionnaire. RESULTS: A smaller proportion of rural New Mexico American Indians (50.7%) reported their general health as 'excellent' or 'very good' compared to the overall New Mexico (58.2%) and US populations (57.9%). American Indians reported a mental health limitation more frequently than the New Mexico and the US populations. However, 13% fewer rural New Mexico American Indians reported a limitation in usual activities. Most limitations were due to musculoskeletal conditions or diabetes mellitus. Survey respondents were found to be representative of the rural American Indian population as reported by the 1990 US Census Bureau by tribal group affiliation and age, but were not representative by income, education, and gender. CONCLUSIONS: Health-related quality of life for rural American Indians differs little from that of other New Mexicans and the general US population; however, when physical and mental health was rated as poor, fewer American Indians reported a limitation in usual activities. A telephone survey focusing on New Mexico American Indians is an efficient method by which to conduct surveillance of health-related quality of life.

Reproductive risk factors for breast cancer in Hispanic and non-Hispanic white women: the New Mexico Women's Health Study.

The authors conducted a population-based case-control study of breast cancer in Hispanic women in New Mexico. Hispanic and non-Hispanic white women with incident breast cancer, aged 30-74 years and diagnosed between 1992 and 1994, were identified by the New Mexico Tumor Registry. Controls were selected using random digit dialing and frequency matched by ethnicity, age, and region. Information on reproductive history, lactation, and other risk factors was collected through in-person interviews; 719 Hispanics and 836 non-Hispanic whites were included in the analysis. Conditional logistic regression was used to estimate relative risk of breast cancer for reproductive factors and to assess ethnic differences in effects. Older age at first full-term birth was associated with breast cancer among Hispanics; the odds ratio for women aged 27 years and older at first full-term birth compared with women 18 years or younger was 2.26 (95% confidence interval 1.17-4.38) compared with 1.60 (95% confidence interval 0.86-3.01) for non-Hispanic whites. Higher parity was associated with reduced risk of breast cancer for non-Hispanic whites, but not Hispanics (p < 0.008). Longer lactation was associated with reduced risk in premenopausal Hispanic women and premenopausal and postmenopausal non-Hispanic white women. Reproductive factors explained 17% of the ethnic difference in breast cancer incidence for postmenopausal women and none of the difference for premenopausal women.

Non-ceremonial tobacco use among southwestern rural American Indians: the New Mexico American Indian Behavioural Risk Factor Survey.

OBJECTIVES: To ascertain non-ceremonial tobacco use among rural American Indians in New Mexico (United States). DESIGN: A geographically targeted telephone survey. SETTING: Rural New Mexico. PARTICIPANTS: American Indian residents aged 18 years and older. MAIN OUTCOME MEASURES: Prevalence of ever-smokers and current smokers of cigarettes and ever-users and current users of smokeless tobacco, number of cigarettes smoked, and prevalence of cigarette smoking quitting behaviour. RESULTS: Of the 1266 respondents, 38.5% (95% confidence interval (CI) = 34.5% to 42.1%) reported ever smoking, and 16.3% (95% CI = 13.5% to 19.0%) reported being current smokers. Current smokers averaged 7.6 (95% CI = 6.0 to 9.3) cigarettes per day. Current smoking prevalence was highest among men and lowest among college graduates. Prevalence of smokeless tobacco use was 24.1% for ever-use and 7.2% for current use and showed a strong male predominance of use. CONCLUSIONS: The prevalence of current smokers among rural American Indians in New Mexico was lower than among American Indians of other regions in the United States, all New Mexicans, and the national population as a whole. Although smoking prevalence was lower among American Indians in New Mexico, variation by sex and education followed the same patterns as reported among American Indians of other regions.

Trends in the survival of American Indian, Hispanic, and Non-Hispanic white cancer patients in New Mexico and Arizona, 1969-1994.

BACKGROUND: The burden of cancer mortality falls disproportionately on cancer patients belonging to ethnic minority groups. In the U.S., African American, Hispanic, and American Indian cancer patients are diagnosed at a more advanced stage and receive less appropriate treatment, resulting in poorer outcomes and higher mortality, than white cancer patients. The authors hypothesized that cancer control strategies based on earlier detection and more effective treatment may be most effective in increasing survival in groups with more advanced disease at diagnosis, less appropriate treatment, and lower survival. METHODS: Data collected by the New Mexico Tumor Registry, a member organization of the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute, afforded the authors an opportunity to investigate this hypothesis by studying trends in cancer survival for American Indians, Hispanics, and non-Hispanic whites. The authors examined temporal trends and ethnic disparities in survival for in situ and invasive incident cancer cases at 25 sites diagnosed from 1969 through 1994 in New Mexico residents and in American Indians residing in Arizona. RESULTS: The distribution of stage became more favorable and the percentage of patients receiving appropriate treatment increased for all three ethnic groups during the study period. Survival improved for patients with cancer at most sites in each ethnic group; however, because the increase in survival was greater for non-Hispanic whites than for American Indians or Hispanics, the number of sites associated with disparities in survival among non-Hispanic whites, American Indians, and Hispanics increased. Differences in the distribution of age, gender, stage at diagnosis, histologic grade, and treatment did not completely explain the improved survival or the ethnic disparities regarding survival. CONCLUSIONS: Increased cancer control efforts were associated with earlier diagnosis, more patients receiving appropriate therapy, and improved survival for non-Hispanic whites, American Indians, and Hispanics. However, the improvement was greatest for non-Hispanic whites, and disparities in survival results for the different ethnic groups widened over the period of study. Cancer control strategies need to address the specific social, cultural, and biologic prognostic factors that affect different ethnic groups if disparities in outcomes are to be reduced.

Increasing incidence of colon and rectal cancer among Hispanics and American Indians in New Mexico (United States), 1969-94.

OBJECTIVES: This study evaluates time trends in colon and rectal cancer incidence and mortality among the three major race/ethnic groups (Hispanics, American Indians, and non-Hispanic Whites) in New Mexico (United States). METHODS: We used data from the New Mexico Tumor Registry (NMTR) and computed average annual age-standardized incidence and mortality rates. Colon cancer incidence rates were further examined by anatomical subsite. Estimated annual percent change (EAPC) in incidence and mortality over time were computed using Poisson regression. RESULTS: Invasive colorectal cancer incidence rates increased from 1969-89 in all three race/ethnic groups, but decreased among non-Hispanic Whites in 1990-94, while rates continued to increase among minority populations, especially among minority men. Over the 26-year period, EAPC in colon cancer incidence among men was 3.6 percent for Hispanics, 4.7 percent for American Indians, and 0.7 percent for non-Hispanic Whites. Right-sided colon cancers were more common among American Indian women, and among all women aged 65 years and older. Mortality rates decreased steadily among non-Hispanic Whites over the study period, especially among women. CONCLUSIONS: Studies are needed to identify important modifiable risk factors and to develop strategies to increase the use of colorectal cancer screening-procedures among the minority populations.

Validity and reproducibility of a food frequency questionnaire among Hispanic and non-Hispanic white women in New Mexico.

The purpose of this study was to assess the validity and reproducibility of an interviewer-administered, semi-quantitative food frequency questionnaire (FFQ) among 132 volunteer New Mexico Hispanic (H) and non-Hispanic white (NHW) women, aged 35-74 years, with (n = 47) and without (n = 85) a breast cancer history, and to add to the limited data presently available on the performance of FFQs among different ethnic groups. Validity was measured at one month and six months from baseline against four-day food records, and reproducibility was tested by comparing FFQs. Unadjusted validity correlation coefficients were highest at one month, ranging from 0.38 (polyunsaturated and monounsaturated fat) to 0.57 (calcium); energy-adjusted correlation coefficients were highest at six months, ranging from 0.15 (polyunsaturated fat) to 0.68 (calcium). Energy-adjusted correlation coefficients were statistically significant by ethnicity for vitamins A and C, protein, carotene and calcium, and by case status for saturated fat, folate, fiber, and vitamins A and E. Reproducibility correlation coefficients (unadjusted) ranged from 0.40 (polyunsaturated fat) to 0.71 (carbohydrate, retinol); energy-adjusted correlation coefficients ranged from 0.42 (vitamin E) to 0.78 (fiber), and differed significantly by ethnicity for saturated fat and retinol, and by case status for carbohydrate. Overall, our FFQ has comparable characteristics to other FFQs and is suitable for use with New Mexico's H and NHW women.

Prostate cancer in American Indians, New Mexico, 1969 to 1994.

PURPOSE: Prostate cancer is the most frequently diagnosed cancer as well as the leading cause of cancer death among American Indian men. MATERIALS AND METHODS: To describe further the occurrence of prostate cancer among American Indian men, we examined population based incidence, treatment, survival and mortality data for American Indians in New Mexico during the 25-year period 1969 to 1994. RESULTS: Although American Indian men have a lower risk of prostate cancer than nonHispanic white men, the incidence and mortality rates are rising for American Indians, and mortality rates are now equal to those for nonHispanic white men. During the 25-year period age adjusted incidence rates for American Indians increased from 42.2/100,000 (95% confidence interval 27.1 to 57.3) to 64.6/100,000 (95% confidence interval 46.2 to 83.0). The burden of prostate cancer among American Indian men compared with nonHispanic white men was reflected in disproportionately high mortality rates in relation to incidence rates. The mortality rates were high because American Indian cases were more advanced at diagnosis, 23.3% of prostate cancers were diagnosed after distant spread had occurred compared with 11.6% for nonHispanic white men and the 5-year relative survival rate was poorer (57.1% compared with 77.6% for nonHispanic white men). CONCLUSIONS: Effective and culturally sensitive cancer control efforts for prostate cancer in American Indian communities are urgently needed.

Risk factor information found in medical records of lung and prostate cancer cases, New Mexico Tumor Registry (United States).

The conduct of public health surveillance and epidemiologic investigations would be enhanced by a cost-effective method for the collection of population-based cancer risk-factor data. We assessed the feasibility of ascertaining such data from hospital medical records during routine abstraction of information from a cancer registry. We examined the medical records of a representative sample of prostate and lung cancer cases diagnosed during 1992 and 1993 from the New Mexico (United States) Tumor Registry (NMTR) database. Registry personnel abstracted ancillary information from the medical records of 575 prostate and 273 lung cancer cases. Of medical records from 848 cases, 90 percent documented a history of tobacco use, 77 percent contained any family medical history, and 48 percent documented occupational information sufficient to allow coding into standard occupational groups. Availability of occupation and industry varied by patient ethnicity, age at diagnosis, marital status, and type of hospital, indicating the potential for bias in studies using occupational information from medical records. Our findings suggest that risk factor information abstracted from medical records may provide valuable information for public health surveillance, but is generally too incomplete to serve as a single source of exposure information for etiologic studies. Family histories in medical records may be sufficient for population-based ascertainment of affected relative pairs for genetic epidemiology studies for some cancer types.

Ethnic differences in uterine corpus cancer incidence and mortality in New Mexico's American Indians, hispanics and non-Hispanic whites.

BACKGROUND: Although ethnic and radical differences in uterine corpus cancer incidence and mortality have been reported worldwide, few published data have addressed the epidemiology of uterine cancer among US American Indians and Hispanics. METHODS: We reviewed uterine corpus cancer incidence and survival data from New Mexico's population-based cancer registry collected from 1969 to 1992, and examined State vital records data for uterine cancer deaths collected from 1958 to 1992, focusing on ethnic differences in occurrence and outcomes of uterine malignancies. RESULTS: Non-Hispanic white women had age-adjusted incidence rates that were substantially higher (20.8 per 100,000) than rates for Hispanics (10.3) and American Indians (6.0) over the 24-year period. Uterine cancer mortality rates were also higher for non-Hispanic whites and Hispanics than for American Indian women, although mortality rates were substantially lower than incidence rates. Five-year survival for uterine cancer was comparable among all groups for all stages combined (87.3% for non-Hispanic whites, 81.4% for Hispanics, and 84.6% for American Indians). CONCLUSIONS: Our population-based data show ethnic differences in uterine corpus cancer incidence rates for non-Hispanic white women that were double those for Hispanics, and triple those for American Indian women. Ethnic differences in survival were comparable. Aetiologic studies are warranted to investigate the dramatic ethnic differences in occurrence of uterine cancer.

Temporal trends in diabetes mortality among American Indians and Hispanics in New Mexico: birth cohort and period effects.

Rates of diabetes mortality are disproportionately high among ethnic minorities in the United States. To describe ethnic trends and cohort effects in diabetes mortality in New Mexico, the authors examined the trends in mortality rates for non-Hispanic whites. Hispanics, and American Indians in the state during the period 1958-1994. Age-specific rates were examined graphically to qualitatively describe the contribution of calendar period and birth cohort effects to changes in the rates. The authors also fit age-period-cohort models to these data. Age-adjusted diabetes mortality rates for American Indians and Hispanics surpassed rates for non-Hispanic whites for all but the earliest two time periods. In the 1993-1994 period, the age-adjusted mortality rate for American Indians was 3.8 times higher for men and 5.6 times higher for women than for their non-Hispanic white counterparts. Rates for American Indian men and women increased sharply over the 37-year period, by 565% and 1,105%, respectively. Mortality rates increased among Hispanics over the period of study but less rapidly than did rates among American Indians. Graphical analyses of age-specific rates were consistent with birth cohort effects among both American Indians and Hispanics and also with a period effect among American Indians. Results from age-period-cohort models indicate a birth cohort effect starting with the 1912 cohort in American Indians and the 1902 cohort in Hispanics. A period effect was present during the 1960s in American Indians. American Indians have experienced an epidemic rise in diabetes mortality in New Mexico; if current trends continue, diabetes may become the leading cause of mortality among American Indians in the state.

The New Mexico Mammography Project. Screening mammography performance in Albuquerque, New Mexico, 1991 to 1993.

BACKGROUND: This project was designed to collect and link population-based mammography and breast carcinoma data to assess the performance of community mammography screening. METHODS: Computerized data were collected from all radiology practices in Albuquerque, New Mexico. The data were linked by computer match to breast carcinomas in a statewide cancer registry. Analysis is based on 126,466 screening mammogram studies performed on 87,443 female residents of New Mexico between the ages of 35 and 84 by 5 radiology groups. Sensitivity, specificity, positive predictive value, and call back rates were calculated as indicators of the discriminative performance of mammography. Carcinoma size and stage distribution were analyzed as outcome measurements. RESULTS: The computer match linked 634 breast carcinomas to the 126,466 screening mammogram series. The community-wide sensitivity was 79.9%, and specificity was 90.5%. The predictive value of an abnormal screen was 4.3%, and that of a biopsy recommendation result was 16.9%. The call back rate was 11.4%. The median invasive breast carcinoma size was 15 mm, 20.3% of carcinomas were in situ, 18.3% were lymph node positive, and 68.1% were Stage 0 or Stage 1. CONCLUSIONS: Mass screening mammography as practiced in Albuquerque, New Mexico, is able to detect breast carcinomas at early, treatable stages. The stage distribution of carcinomas is similar to that seen in successful clinical trials. However, measures of mammography performance show lower sensitivity, more additional studies, and more biopsy recommendations in this community setting than have been reported by expert mammographers.

Ovarian cancer incidence and mortality in American Indian, Hispanic, and non-Hispanic white women in New Mexico.

Although ethnic and racial differences in ovarian cancer incidence and mortality have been reported worldwide, few published data have addressed the epidemiology of ovarian cancer among U.S. American Indians and Hispanics. We reviewed ovarian cancer incidence and survival data from New Mexico's population-based cancer registry collected from 1969 to 1992, and examined state vital records data for ovarian cancer deaths collected from 1958 to 1992, focusing on ethnic differences in occurrence and outcomes of ovarian malignancies. Non-Hispanic white women had age-adjusted incidence rates that were slightly higher (13.3/100,000) than rates for American Indians (11.4) and Hispanics (10.7) over the 24-year period. Ovarian cancer mortality rates were also higher for non-Hispanic whites than for minority women. Neither incidence rates nor mortality rates for ovarian cancer improved over the span of the study period. In addition, the stage at diagnosis did not shift substantially over time for any of the ethnic groups studied, nor did the distribution of various histopathological types shift proportionately. Only slight improvement was observed in 5-year survival over the time period of the study, with greater gains among younger (50 years old or less) versus older women. Ethnic differences in ovarian cancer incidence and mortality were apparent in our population-based data. However, our analysis indicated no reduction in ovarian cancer incidence or mortality in our state over the past quarter century and only slight improvement in 5-year survival.