Trends in cancer incidence and mortality in the United States, 1969-76.

Trends in cancer incidence and mortality in the United States were analyzed over the period 1969 through 1976. The greatest increase in incidence among whites occurred for lung cancer among females (almost 9%/yr), whereas the incidence of cancer of the uterine corpus increased 6% per year. Cancer of the cervix showed the greatest decrease in incidence, an average of 6% per year. Stomach cancer incidence and mortality showed a substantial decline for each sex, and rectal cancer incidence increased for each sex whereas mortality declined. The incidence of cancer of the female breast increased 1.8% per year without inclusion of the rates for 1974 and 1975, when an unusually large increase occurred. Cancer mortality data were presented for the total United States on the basis of data from the National Center for Health Statistics. Emphasis was focused on the comparability of cancer incidence data over the time period studied, given the fact that cancer incidence was measured by the Third National Cancer Survey for the period 1969-71 and by the Surveillance, Epidemiology, and End Results Program for the period 1973-76. Each survey covered approximately 10% of the U.S. population but had four geographic areas in common. Investigation of the comparability of these two surveys revealed that the incidence rates for whites were sufficiently comparable to permit an analysis of trends in cancer incidence over the entire period 1969-1976. Such comparability was not found for blacks. Therefore, cancer incidence data are presented only for whites, but cancer mortality data are presented for both whites and blacks.

Association of cancer sites with tobacco and alcohol consumption and socioeconomic status of patients: interview study from the Third National Cancer Survey.

From personal interviews obtained for 7,518 incident cases of invasive cancer from the population-based Third National Cancer Survey, the quantitative lifetime use of cigarettes, cigars, pipes, unsmoked tobacco, wine, beer, hard liquor, and combined alcohol were recorded, as well as education and family income level. In an initial screening analysis of these data, Mantel-Haenszel 2 X 2 contingency tabulations and multiple regression analyses were used to compare each specific cancer site with controls from other sites to test for associations with the "exposure variables." Significant positive associations with cigarette smoking were found for cancers of the lung, larynx, oral cavity, esophagus, stomach, pancreas, bladder, kidney, and uterine cervix. Other forms of tobacco were associated with cancers of the oral cavity, larynx, lung, and cervix. Consumption of wine, beer, hard liquor, and all combined showed positive associations with neoplasms of the oral cavity larynx, esophagus, colon, rectum, breast, and thyroid gland. College educaton and high income both showed positive associations with cancers of the breast, thyroid gland, uterine corpus, and melanomas in males. These same indicators of high socioeconomic status showed inverse associations with invasive neoplasms of the uterine cervix, lung, lip-tongue, and colon in females. College attendance (but not income) showed an inverse association with stomach cancer and positive association with pancreatic cancer in males. Still other tumor sties showed "suggestive" associations with each of these exposure variables. In the analyses producing these results, age, race, sex, smoking, drinking, education, income, parity, foreign birth, marital status, and geographic location were used as stratification variables separately or in combination when appropriate to assess and control for their potentially confounding affects and to examine results in different strata to assess interaction.

Changes in lung cancer incidence and mortality rates among Americans: 1969--78.

Cancer incidence data from two large cancer surveys and cancer mortality data for the entire United States were used to estimate trends in lung cancer incidence and mortality rates among whites for specific age groups during the 10 years 1969--78. Data for the Third National Cancer Survey were from 1969 to 1971; data for the Surveillance, Epidemiology, and End Results Program were from 1973 to 1978. For both incidence and mortality, the rates for women increased much more rapidly than the rates for men, except in the oldest age group (greater than or equal to 85). For both men and women, there was a striking similarity between the average annual percent changes for age-specific incidence rates and those for age-specific mortality rates. For the first time women and men had a similar incidence rate for the youngest (35--44) age group in 1978. If these trends continue, the data suggest that the total incidence rates for men and women will be equal by the year 2000.

Socioeconomic factors and cancer incidence among blacks and whites.

Findings from previous studies suggest that differences in socioeconomic status may be responsible for some, if not all, of the elevated incidence of cancer among blacks as compared with whites. Using incidence data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program, we tested this hypothesis by correlating black and white cancer incidence rates in three US metropolitan areas between 1978 and 1982 with data from the 1980 census on socioeconomic status within individual census tracts. The study analyzed data on the incidence of cancer at all sites combined (greater than 100 cancer sites) and at seven major sites separately. As in other studies, income and educational levels served as surrogates for socioeconomic status. The present study also used census-tract data on population density as a surrogate factor. Each of these measures of socioeconomic status was analyzed independently. Before correlation with census-tract data, age-adjusted data on cancer incidence showed statistically significant elevated risks among blacks for cancer at all sites combined and at four of the seven separate sites; whites showed an elevated risk for cancer at two sites. Cancer at only one site, the colon, showed no significant association with race. When age-adjusted incidence data were correlated with socioeconomic status, the comparative black-white risks changed: Whites showed an elevated risk of cancer at all sites combined and at three of the seven separate sites; blacks maintained their elevated risk at three sites. These findings suggest that the disproportionate distribution of blacks at lower socioeconomic levels accounts for much of the excess cancer burden among blacks. They also suggest that for both blacks and whites unidentified racial factors, which may be either cultural or genetic and which are not closely linked to socioeconomic status, may play a role in the incidence of some cancers.

Rise in prostatic cancer incidence associated with increased use of transurethral resection.

We examined the association between prostatic cancer incidence rates and the rates of transurethral prostatectomy to explore reasons for the nationally reported dramatic increases in incidence rates of prostatic cancer from 1973 through 1986. There was a strong correlation between both incidence of all stages of prostatic cancer combined and of localized disease and the increasing use of transurethral resection, a common surgical procedure usually performed to relieve urinary obstruction due to benign enlargement of the prostate. Our analyses suggest that increased detection of existing tumors via transurethral resection was the primary reason for the observed increase in incidence rates of prostatic cancer. However, analyses of mortality trends, particularly among nonwhites, and laboratory studies of the histologic nature of clinically asymptomatic tumors suggest that part of the increase may reflect changes in the real risk of prostatic cancer.

Representativeness of the surveillance, epidemiology, and end results program data: recent trends in cancer mortality rates.

BACKGROUND: Mortality, incidence, and survival rates are the primary measures used by the National Cancer Institute (NCI) to monitor cancer in the United States. The Surveillance, Epidemiology, and End Results (SEER) data system collects data on all cancers diagnosed among residents in geographically defined populations, which comprise about 10% of the U.S. population. This data system is the major component of the NCI system for tracking these rates. Thus, it is important to assess the degree to which SEER data are representative of the entire U.S. population. PURPOSE: National data on mortality, but not on incidence or survival, are available from the National Center for Health Statistics. These data provide a census against which mortality data from the subset of the SEER regions may be compared. METHODS: Multivariate regression analyses of age-adjusted mortality rates from 1975 to 1988, computed for the SEER areas and for the entire United States, were performed for race- and sex-specific data from 15 cancer sites. Representativeness was evaluated by testing for differences in trends and levels between the data from the U.S. population and those from the SEER Program. RESULTS: Data from the SEER regions reflected the correct direction of trend for all sites, although some race-, sex-, and site-specific differences existed for the magnitude of the trends and levels of mortality when compared with data from the U.S. population. CONCLUSIONS: The demonstration that data from the SEER population do occasionally yield mortality rates that differ from those for the entire U.S. population suggests that data from the SEER coverage population are, in some cases, not representative of the greater U.S. population. IMPLICATIONS: This issue is of particular relevance to the interpretation of incidence measures, computed from the SEER data, for which there is no national database. Future efforts should be directed at a better understanding of how the SEER population differs from the U.S. population so that SEER rates can be adjusted to be more nationally representative.

Projections of the incidence of non-Hodgkin's lymphoma related to acquired immunodeficiency syndrome.

Advances in antiretroviral therapy and treatment or prophylaxis against opportunistic infection have resulted in prolongation of the survival of patients with acquired immunodeficiency syndrome (AIDS). Previous research has demonstrated an association between AIDS and risk of non-Hodgkin's lymphoma (NHL). In addition to the approximately 3% of individuals found to have NHL at the time of AIDS onset, others continue to develop NHL following AIDS diagnosis. Data from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute demonstrated a sharply increasing incidence of NHL among men in the age range 20-49 years since 1983 in the United States. Based on new data on the risk of NHL following AIDS diagnosis, on estimates of improved survival following AIDS diagnosis, and on projections of future AIDS incidence, we considered four sets of assumptions and estimated the number of AIDS-related NHL cases in 1992 to be between 2900 and 9800. Three of these projections were higher than the estimate of 4700 cases obtained by linear extrapolation of SEER incidence trends. These projections of AIDS-related NHL incidence suggest that between 8% and 27% of all NHL cases that occur in the United States in 1992 will arise as a consequence of infection with the human immunodeficiency virus (HIV), imposing a substantial health care burden. More research into the pathogenesis of lymphoma and new approaches to antiretroviral and antilymphoma therapy will be necessary to prevent and treat this formidable complication of infection with HIV.

Cancer incidence and mortality trends among whites in the United States, 1947-84.

Cancer incidence trends from the late 1940s to 1983-84 were assessed among white residents of five geographic areas (Atlanta, Connecticut, Detroit, Iowa, San Francisco-Oakland) by means of data derived from several National Cancer Institute surveys, the Connecticut Tumor Registry, and the Surveillance, Epidemiology, and End Results Program. Incidence trends were compared with mortality trends for the entire United States and for the same five study areas. This study documented rising incidence and mortality rates for four cancers: lung cancer, melanoma of the skin, multiple myeloma, and non-Hodgkin's lymphomas. Increases in lung cancer continued through the early 1980s, but the rate of increase has been moderating during recent years, particularly among males and at younger ages for whom recent declines are evident. Overall, lung cancer incidence rates increased more than 220 and 400% among males and females, respectively. Although much rarer than lung cancer, melanoma of the skin and multiple myeloma increased greatly until the early 1980s among both males and females. The overall rate of increase in melanoma incidence among males was greater than that for lung cancer, and the rate of increase in multiple myeloma mortality among females was exceeded only by that for lung cancer. Increases of 70-120% were observed for non-Hodgkin's lymphomas. Increases in incidence and mortality rates for pancreatic cancer were apparent during the early years but less conspicuous in recent years. Laryngeal and kidney cancer rates generally increased substantially, although the changes were not remarkable for laryngeal cancer mortality among males and kidney cancer mortality among females. The rates for cancers of the mouth and pharynx increased among females but not males. Prostate, colon, and bladder cancer incidence rates increased more than 65% among males, whereas mortality rates changed only moderately. The incidence of thyroid cancer increased more than 75% among both sexes until the late 1970s, but mortality rates have declined during the period of study. Breast cancer incidence increased 30%, whereas mortality rates remained remarkably constant. The incidence of corpus uteri cancer increased dramatically during the mid-1970s and decreased substantially thereafter; these changes were not reflected in the mortality rates, which continually declined during the entire time period. The incidence of testicular cancer increased more than 90% and that of Hodgkin's disease did not change greatly; however, mortality rates for both cancers declined more than 50% since the late 1960s and early 1970s.(ABSTRACT TRUNCATED AT 400 WORDS)

The incidence of retinoblastoma in the United States: 1974 through 1985.

We have estimated the incidence of retinoblastoma in the United States from data available form the Surveillance, Epidemiology, and End Results program of the National Cancer Institute, Bethesda, Md (1974 through 1985). The larger number of cases available (220) compared with those of previous US population-based studies enabled us to evaluate change in incidence over time and to more precisely estimate incidence according to various demographic characteristics. The incidence of retinoblastoma has been almost uniform form 1974 to 1985. The average annual incidence of retinoblastoma was 5.8 per million for children younger than 10 years and 10.9 per million for children younger than 5 years. There was no difference in the incidence of retinoblastoma by either sex or race. The overall 5-year cumulative survival rate was 91% (95% confidence interval, 87% to 95%). The data indicate a worsening survival with increasing age at diagnosis, through age 2 years, but a less clear relationship of survival with diagnosis beyond age 2 years.

Estimating cancer mortality rates from SEER incidence and survival data.

A method to estimate site-specific cancer mortality rates using Surveillance, Epidemiology, and End Results (SEER) Program incidence and survival data is proposed, calculated, and validated. This measure, the life table-derived mortality rate (LTM), is the sum of the product of the probability of being alive at the beginning of an interval times the probability of dying of the cancer of interest during the interval times the annual age-adjusted incidence rate for each year that data have been collected. When the LTM is compared to death certificate mortality rates (DCM) for organ sites with no known misclassification problems, the LTM was within 10 percent of the death certificate rates for 13 of 14 organ sites. In the sites that have problems with the death certificate rates, there were major disagreements between the LTM and DCM. The LTM was systematically lower than the DCM for sites if there was overreporting on the death certificates, and the LTM was higher than the DCM for sites if there was underreporting. The limitations and applications of the LTM are detailed.

Uterine cancers of unspecified origin--a reassessment.

Uterine cancer ranks third in cancer incidence and fifth in cancer mortality among American women. The epidemiologic characteristics of cancer of the cervix uteri and the corpus uteri are different. When only "cancer of the uterus, not otherwise specified (NOS)" is reported, problems arise in data analysis. In this study, uterine cancer deaths from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program, 1977-79, are compared with those from three previous studies. Uterine cancer deaths certified only as uterus, NOS, on death certificates have decreased 34 percent in the past 30 years. However, even in the late seventies, 25 percent of the uterine cancer deaths were still not being specified as either cervix uteri or corpus uteri on death certificates. Following the deaths certified as cancer of uterus, NOS, back to the pertinent hospital records showed that in recent years 75 percent of these deaths were actually diagnosed as cancer of the corpus uteri, compared with 20 percent 30 years ago. The failure to assign these unspecified uterine cancers to corpus uteri indicates that mortality from cancer of the corpus uteri is still underreported. Although the reporting of the specific subsites of cancer of the uterus on death certificates has improved during the past 30 years, every effort should be made to achieve further improvement in accuracy.

Falling rates of lung cancer in men in the United States.

Lung-cancer incidence and mortality rates in the United States were calculated for the years 1973 to 1983. The historically increasing age-adjusted rates for white men levelled off in the late 1970s and fell between 1982 and 1983. These falls were seen for white men only. Both the incidence and mortality rates for women continued to rise with no hint of a reduction.

Targeting the underserved for breast and cervical cancer screening: the utility of ecological analysis using the National Health Interview Survey.

OBJECTIVES: This study tested the utility of ecological variables created from the National Health Interview Survey (NHIS) for strategic targeting of health services for the underserved. METHODS: Ecological variables were created using the 1989-1991 survey years of the NHIS public use data files. Segments, the NHIS secondary sampling units, permit computation of secondary sampling characteristics by percentage Black, percentage Hispanic, percentage below poverty, percentage unemployed, median education, median income, median age, and percentage residing in the United States for 5 years or less. These variables were analyzed with the NHIS Health Promotion and Disease Prevention 1990 supplement reporting mammogram, clinical breast examination, and Pap test use. RESULTS: Median education of areas was inversely related to never having mammograms. Areas with a high proportion (70%-100%) of Hispanic respondents also were more likely not to have mammograms. Women residing in areas with moderate or high proportions of Hispanic respondents were more likely never to have clinical breast examinations and Pap tests, as were those in areas with low income, poverty, and respondents who had resided in the United States 5 years or less. CONCLUSIONS: The new methodology of constructing ecological variables using the NHIS demonstrates an application that may help identify underserved areas or areas with underutilized services. More studies using this methodology are warranted.

Person-years of life lost due to cancer in the United States, 1970 and 1984.

The number of deaths due to cancer in the United States reached an all-time high of 453,450 deaths in 1984 and, due to the dynamics of population growth, will continue to increase if the risk of dying from cancer does not change. Between 1970 and 1984, the total Person-Years of Life Lost (PYLL), the sum of the difference between the actual age at death and the expected remaining lifetime for each person who died of cancer, increased for most cancer sites as well as for all sites combined. In 1984, 6,881,281 person-years of life were lost due to cancer deaths, up from 5,303,668 in 1970. The exceptions are those cancers for which there has been major progress in either prevention or treatment; e.g., stomach and cervix uteri (prevention) and testicular, Hodgkin's disease, leukemia, and childhood cancers (treatment). The Average Years of Life Lost (AYLL) per person dying from cancer in 1984 was generally less than in 1970. Overall, each person who died from cancer in 1984 died 15.2 years earlier than his/her life expectancy. The greatest loss was for those who died of childhood cancers (66.9 years earlier), followed by testicular cancer (35.8 years earlier). The least loss relative to the expectation of life was for those who died of prostate cancer. The 25,400 men who died from prostate cancer in 1984 died an average of nine years earlier than otherwise expected.

Population-based estimate of survival and determinants of prognosis in patients with mycosis fungoides.

Mycosis fungoides is the most common cutaneous lymphoma in the US, and it is increasing rapidly in both incidence and mortality. Our knowledge of its prognosis derives primarily from case series, which are subject to possible selection bias and other limitations. The current analysis examines trends in survival and prognostic factors in data from nine population-based cancer registries in the US. Among the 650 cases followed with known dates of diagnosis and no history of prior malignancy, the median survival time was 7.8 years. Advanced age, black race, prior malignancy, and Sezary syndrome presence at the time of diagnosis were each independently associated with poor prognosis. Fatality was not influenced by sex or geographic area. There was no consistent evidence of improved survival with time over the 12-year study period.

Mycosis fungoides in the United States. Increasing incidence and descriptive epidemiology.

The etiology of mycosis fungoides is obscure, and the risk factors for its occurrence are poorly documented. This investigation uses data from nine US population-based cancer registries to investigate the descriptive epidemiology of this disorder. From 1973 through 1984, 721 newly diagnosed cases of mycosis fungoides were reported to these registries (0.29 cases per 100,000 population per year). A dramatic increase in the incidence of mycosis fungoides was noted over the period of this study. The incidence was highest among the elderly. Blacks were twice as likely to be afflicted as whites, and the incidence among men was more than twice the incidence among women. The geographic variation in incidence was associated with several demographic variables, including population density, family income, and concentration of physicians. Analysis of mortality among these patients revealed no evidence of detection bias.

Stage at diagnosis in breast cancer: race and socioeconomic factors.

Cancer incidence data from three US metropolitan areas were coupled with census tract indicators of education and income. The data suggest that both Black and White cancer patients living in census tracts with lower median education/income values are diagnosed in later disease stages than are patients in tracts with higher median education/income values. Within education and income strata, Black women had a less favorable stage of disease at diagnosis than Whites. The exception was in upper education/income levels, where the disadvantage for Blacks disappeared. These data provide additional evidence that women of low socioeconomic status could benefit from targeted screening.

Increasing incidence of cancers associated with the human immunodeficiency virus epidemic.

We examined data from San Francisco and other areas participating in the Surveillance, Epidemiology, and End Results (SEER) Program to determine the effect of the human immunodeficiency virus (HIV) epidemic on cancer incidence between 1973 and 1987. In this period, non-Hodgkin's lymphoma incidence has increased over 10-fold and Kaposi's sarcoma incidence has increased over 5000-fold in single San Francisco men 20 to 49 years of age. Increases in non-Hodgkin's lymphoma have been restricted to high-grade and diffuse large-cell (intermediate-grade) histological types. With the exceptions of non-Hodgkin's lymphoma and Kaposi's sarcoma, no other tumor has significantly increased in incidence. During 1987, we estimate that HIV-seropositive men in San Francisco had a 0.47% risk of developing non-Hodgkin's lymphoma and a 1.6% risk of developing Kaposi's sarcoma. The relative risks for non-Hodgkin's lymphoma and Kaposi's sarcoma associated with HIV infection were 104 and 40,000, respectively. For 1987, HIV was associated with 14% of all reported cancers (except non-melanoma skin cancer) in men aged 20 to 49. We expect that 1,890 to 2,730 excess cases of non-Hodgkin's lymphoma and 6,490 to 8,320 excess cases of Kaposi's sarcoma will occur in the United States in 1990.

Cancer incidence, survival, and mortality for children younger than age 15 years.

Incidence and survival data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program for the 10-year period 1973-1982 are presented. Childhood cancer incidence rates have remained relatively stable over the last decade. The overall incidence rate increased slightly from 124 to 127 per million children from 1973-1977 to 1978-1982 while rates for leukemias remained unchanged over this same time period at 38 per million for all races combined. Leukemias and lymphomas accounted for 44% of all cancers among white children and 33% among blacks. For all forms of cancer combined, the 5-year relative survival rate was 57% for both whites and blacks. The 5-year relative survival rate exceeded 80% for fibrosarcomas, retinoblastomas, Hodgkin's disease, and gonadal and germ cell tumors. Survival rates for children have shown improvement during the last decade, the most dramatic improvements occurring among patients with leukemia (15% 5-year relative survival in 1967-1973 versus 51% in 1973-1981), non-Hodgkin's lymphoma (24% versus 51%), and bone tumors (28% versus 48%).