Cancer patient survival: Surveillance, Epidemiology, and End Results Program, 1973-79.

Data from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute were used in the evaluation of cancer patient survival experience for almost 10% of the U.S. population. This first report contains actuarial (life table) survival analysis on 368,263 patients with first primary cancer diagnosed in 1973-79 from nine SEER areas: the entire States of Connecticut, Iowa, New Mexico, Utah, and Hawaii and the metropolitan areas of Atlanta, Detroit, San Francisco, and Seattle. Both observed and relative survival rates were shown for whites and blacks, sex, age, primary site, and time period (each yr, 1973-78). The largest racial difference in survival was for cancer of the corpus uteri: 87% 5-year relative survival rate for white females versus only 54% for black females. Survival rates varied considerably by primary site. For most sites, as age increased the relative and observed survival rates decreased. Analysis of relative survival rates by ech year of diagnosis, 1973-78, and for each year following diagnosis suggested increasing rates for cancers of the colon, lung, and prostate gland, whereas there were no definite increases for cancers of the female breast and corpus uteri. A dramatic increase in survival from acute lymphocytic leukemia was found for children under 15 years of age, with the 4-year relative survival rate increasing from 51% among those diagnosed in 1973-75 to 65% for those diagnosed in 1976-78.

Cancer patient survival among ethnic groups in the United States.

Data from the Surveillance, Epidemiology and End Results Program of the National Cancer Institute were used in the evaluation of cancer patient survival experience for 8 racial-ethnic groups in the U.S. population--Anglos, Hispanics, blacks, American Indians, Chinese, Japanese, Filipinos, and Hawaiians. This report contains an actuarial (life table) survival analysis on 402,752 patients with first primary cancer diagnosed in 1973-79 and followed through December 31, 1981. Relative and observed survival rates are shown for each sex separately by primary site. Survival rates for females exceeded those for males for each primary site except for gallbladder and urinary bladder. The primary site having the highest survival rate among each group studied was the thyroid gland with a 5-year relative rate of 91% for all races combined. Rates were uniformly low among each group for cancers of the esophagus, liver, and pancreas. Survival rates for Hispanics were almost identical to those for Anglos; the largest differences were found for bladder (73% for Anglos vs. 64% for Hispanics), Hodgkin's disease (70% for Anglos vs. 61% for Hispanics), and ovary (35% for Anglos vs. 42% for Hispanics). For many primary sites Japanese experienced the highest survival rates and American Indians the lowest. In comparison to Anglos, Japanese had higher survival for cancers of the stomach, colon, prostate gland, and breast. The higher survival for stomach and breast cancers persisted even when controlling for age of patient and stage of disease at diagnosis. Survival rates for blacks were much lower than those for whites for cancers of the corpus uteri and urinary bladder. Survival rates for Chinese and Hawaiians were roughly comparable to those for Anglos, whereas survival rates for Filipinos tended to be similar to those for blacks.

Increasing annual incidence of primary malignant brain tumors in the elderly.

Between 1973 and 1985, total age-adjusted cancer incidence in the United States (all races, men and women) rose by 10.7%, with an average annual percentage change of +0.9%. Analysis of reported age-specific incidence of primary malignant brain tumors over the same years demonstrates that incidence rates increased dramatically between 1973/1974 and 1985. In 1985, incidence rates for persons aged 75-79, 80-84, and 85 years of age and over were 187%, 394%, and 501%, respectively, of rates in 1973/1974. Similar increases were found in both men and women, analyzed separately and combined. Average annual percentage changes in primary brain tumor incidence were +7.0%, +20.4%, and +23.4% in these age ranges, respectively. Reported incidence in younger persons varied little over the same period of time. The most common histologic type of primary brain tumor in the elderly was of glial origin, predominantly the glioblastoma multiforme and astrocytoma. These tumors are highly malignant and invariably fatal. Two possible causes may explain the increased incidence in the elderly: the introduction and extensive use of x-ray computed tomography since 1973 and/or a true increase in incidence occurring independently of diagnostic advances.

Inflammatory breast cancer: the experience of the surveillance, epidemiology, and end results (SEER) program.

The current status of inflammatory breast cancer (IBC) among U.S. females was reviewed with the use of data abstracted from medical records of patients diagnosed with breast cancer between 1975 and 1981 in nine geographic areas covered by the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program. Patients were selected on the basis of reported clinical and pathologic features of IBC and were divided into 3 groups: I) both clinical and pathologic features of IBC; II) clinical features without pathologic confirmation; and III) pathologic evidence only. The age distribution of pathologically defined IBC, in general, showed younger ages than those for other breast cancers in both the white and black populations. Further analysis was restricted to white females due to the relatively small numbers of black and other nonwhite patients with IBC. The disease presentations of both clinically and pathologically defined IBC were similar with regard to the likelihood of the presence of metastases at initial staging. Survival was evaluated by comparison of patients with nonmetastatic (MO) disease. Three years after diagnosis, the relative survival rates among patients in groups I, II, and III were observed to be 34, 60, and 52%, respectively. Survival of patients with all other types of breast cancer was 90% at 3 years. The management of IBC appeared to differ from the treatment of other forms of breast cancer; chemotherapy was given more frequently as the first course of cancer-directed therapy in white SEER females with evidence of MO IBC compared with the group with MO non-IBC. When all possible combinations of initial therapy were considered, the treatment for IBC was more variable than the treatment for non-IBC.

Leukemia following chemotherapy for breast cancer.

Leukemia following chemotherapy for breast cancer was studied among patients diagnosed during 1973-1985 within the population-based tumor registries in the Surveillance, Epidemiology, and End Results Program. Among 13,734 women given initial chemotherapy, 24 developed acute nonlymphocytic leukemia (ANLL) compared to 2.1 expected based on general population rates (observed/expected = 11.5; 95% confidence interval = 7.4-17.1). Overall, 58 excess ANLL occurred per 100,000 women-years at risk for patients treated with chemotherapy. The cumulative incidence was 0.7% at 10 years. Risk remained high over all periods of observation up to 9 years after treatment. Among 7974 women treated only with surgery during 1973 and 1974, a period before the widespread use of adjuvant chemotherapy for breast cancer, ANLL was not significantly increased (observed = 7, expected = 5.1). A case-control study was then conducted in Connecticut to evaluate in more detail the risk associated with adjuvant chemotherapy in the general population. Among 20 cases (17 incident leukemias and 3 deaths due to preleukemia) and 60 matched controls, alkylating agents were linked to an 11.9-fold risk of ANLL and preleukemia (95% confidence interval = 2.6-55). Chemotherapy regimens including melphalan were related to a higher risk of leukemic conditions than those including cyclophosphamide. These data suggest that women in the general population treated with adjuvant chemotherapy for breast cancer are at an increased risk of leukemia, that the risk remains high among long-term survivors, and that risk differs by type of alkylating agent administered.

Improved survival among children with acute leukemia in the United States.

Statistically significant increases in 3- and 5-year survival rates were observed for white children under 15 years of age diagnosed with acute lymphocytic leukemia (ALL) from 1973-1976 to 1977-1980 in 9 geographic areas of the United States. Survival for the cohort diagnosed in 1977-1980 was 78% at 3 years, 68% at 5 years, and 42% at 10 years from diagnosis. For the cohort diagnosed in 1981-1984, however, slight but not significant decreases in survival rates were seen. Improvements in 3- and 5-year survival for children with acute granulocytic leukemia (AGL) were found between the cohort diagnosed in 1973-1976 as compared to 1977-1980, but these rates stabilized as well in the 1980s. While the age-adjusted incidence rate for all childhood leukemias fluctuated slightly between 1973 and 1985, age-adjusted mortality continued to decline, dropping from 2.5 per 100,000 white population under 15 years of age in 1973 to 1.4 per 100,000 in 1985, an average annual decrease of approximately 4%.

The accuracy of liver cancer as the underlying cause of death on death certificates.

Studies of liver cancer mortality are subject to confusion attributable to the changes in categories by which liver cancer is identified in successive revisions of the International Classification of Diseases. To determine the effects of these changes, diagnoses of 2,388 cases of primary liver cancer in the years 1973-80 were compared to the underlying causes of death recorded on the death certificates, using data from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. Results showed that only 53 percent of the deaths were attributed on death certificates to primary liver cancer. In a reverse comparison of 2,977 death certificates from the years 1973-85 with an underlying cause of death of primary liver cancer, 83 percent had been diagnosed as liver cancer. However, among the certificates that specified cancer of the liver, not specified as primary or secondary, as the cause of death, only 40 percent had been diagnosed originally as liver cancer. The mortality of liver cancer can be either underestimated or overestimated depending on which disease classification categories are used.

Cancer in the aged. An epidemiologic perspective on treatment issues.

Persons 65 years of age and older bear the greatest burden of cancer; 55% of all malignancies occur in this age group. Sixty-seven percent of all cancer deaths occurred in this population in 1988. This article describes the magnitude of the cancer problem for this age group according to major cancers (colon, rectum, lung/bronchus, pancreas, stomach, urinary bladder, breast, and prostate). Data are cast against the demographics of aging in the United States. These facts emphasize an urgent need to concentrate more attention on problems unique to the elderly for early detection, diagnosis, and treatment. Information gaps are also identified.

Ovarian cancer in the elderly: an analysis of Surveillance, Epidemiology, and End Results Program data.

With use of a unique data set from the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute for 11,062 women diagnosed with ovarian cancer from 1973 to 1982, this study focuses on the impact of old age on this malignancy. Aspects of ovarian cancer as it pertains especially to elderly women (those 65 years or older) are examined according to age/stage relationships at initial diagnosis and age variations in treatment and survival. Elderly women are more likely than younger women to be in advanced stages of ovarian cancer at initial diagnosis, and they constitute about 42% of this group. In the stage-unknown category, over 50% are 65 years or older. Data suggest that elderly women are treated more conservatively than younger patients. The National Cancer Institute data also illustrate the increased preference to treat this neoplasm with surgical procedures and chemotherapy rather than surgical procedures and radiation. For Stages III and IV disease, 5-year relative survival rates for elderly women are almost one half of the rate observed for women under 65. Although the prognosis of patients with advanced ovarian tumors is poor for all, it is even worse as age progresses.

Breast cancer in aging women. A population-based study of contrasts in stage, surgery, and survival.

Over 43% of the newly diagnosed breast cancers in the US occur in women 65 years or older. Yet little attention is devoted to the age-associated aspects of this malignancy. This study uses data on more than 125,000 women diagnosed from 1973 to 1984 to examine the influence of advancing age on breast cancer. The National Cancer Institute's Surveillance, Epidemiology, and End Results Program provides information on disease stage, surgery, histologic type, and survival time to compare and contrast women in all age groups. Women who present initially with distant disease are more likely to be elderly. Certain surgical procedures are used less frequently for older women. No unusual age variations in histologic features are noted. Elderly women do as well as younger patients in survival time for localized and regional stages of breast cancer; for distant disease, they fare worse. Results emphasize the need to focus on elderly women for screening, early detection, diagnostic evaluation, and therapy.

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%).

Non-Hodgkin's lymphomas. Application of the International Classification of Diseases for Oncology (ICD-O) to the Working Formulation.

International Classification of Diseases for Oncology (ICD-O) code numbers for the non-Hodgkin's lymphomas (NHL) are assigned to the new Working Formulation (WF). This will facilitate the coding of NHL cases by registrars and pathologists by providing a ready means of translation of terms utilized in most of the existing classification schemes. Additional code numbers and synonyms are suggested to accommodate all of the terms in the six major classification systems currently in use and to permit the coding of immunologic cell type when appropriate tests have been performed. To demonstrate how the assignment of these code numbers can be useful, over 8000 incidence cases from the Surveillance, Epidemiology and End Results (SEER) Program (1977-1980) were coded according to the WF groups and the data analyzed. The prognostic significance of the three major groups in the WF is confirmed for each group in the SEER data and comparisons are discussed with the NCI study.

Sinais e sintomas de disfuncao temporomandibular em criancas portadoras de paralisia cerebral / Signs and symptoms of temporomandibular dysfunction in children wit cerebral palsy

O objetivo deste estudo foi analisar os sinais e sintomas de disfuncao temporomandibular em criancas portadoras de paralisia cerebral. Material e metodos: Foram avaliadas 22 criancas entre 5 e 13 anos, sendo 10 portadoras de paralisia cerebral espastica (9,1+-2,64 anos) e 12 normais (7,91+-0,99 anos). Foram colhidas informacoes sobre mastigacao, dor muscular e articular e ruidos articulares. Tambem foi determinado o indice de disfuncao clinica de Helkimo e o grau de espasticidade por meio da Escala de Espasticidade Ashworth Modificada. Resultados: os resultados indicam que nao ha diferenca significativa (p=0,231) na maxima abertura bucal entre os grupos. Contudo, no movimento lateral direito (p=0,001), no movimento lateral esquerdo (p=0,048) e na protusao (p=0,009) observou-se significativa diferenca. Conclusao: muitas criancas com paralisia cerebral nao realizaram o movimento de protrusao (50 por cento) e a lateralidade par um dos lados (40 por cento) , mas a severidade da disfuncao temporomandibular nao esta relacionada com a severidade da espasticidade