Age 65 represents a transition point where most U.S. residents begin Medicare coverage. We examined whether or not delays in medical care near this age extend to cancer diagnosis. We calculated single-year-of-age cancer incidence rates by site and stage for the most common cancer sites (i.e., prostate, female breast, lung, and colorectal) for the 2000-2010 period using data from the SEER 18 registries, and we used Poisson regression to identify a possible age-65 effect. The analysis was repeated on comparable Canadian data. Cancer rates at age 65 were found to be as much as 15% above expected in the U.S. data, with the age-65 effect strongly associated with site- and stage-specific survival. A smaller association was seen in the Canadian data. We found strong evidence that diagnosis of less severe cancers spikes at age 65. Delay of medical care prior to this age has complex policy implications.
Abstract Background/Objective: Many Hispanic or Latino/a individuals (hereafter Hispanic) reside in ethnic enclaves. Hispanic enclaves are places characterized by high prevalence of Hispanic individuals, immigrants, individuals who speak Spanish, and/or ethnic-specific businesses. This population-based study of Hispanic women with breast cancer examines how residence in Hispanic enclaves is associated with late stage diagnosis. Methods: We used data from population-based cancer registries in four states (CA, NJ, NY, TX) to identify Hispanic women with breast cancer diagnosed between 2000-2017. Hispanic enclaves were defined using principal components analysis of four census tract-level variables: percent Hispanic, percent foreign-born Hispanic residents, percent with limited English and percent linguistically isolated and speaking Spanish. All census tracts in the four states were classified into quintiles of ethnic enclave score (pooled across all four states). Using log binomial regression with clustering by census tract, we examined associations of enclave residence (in quintiles) on late stage (regional or distant) compared to early stage (in-situ or localized) diagnosis; we fit unadjusted and adjusted models with age, year of diagnosis, insurance type, state, metropolitan/non-metropolitan census tract residence, and census tract percent poverty as covariates. Results: Among 165,226 Hispanic women, 35.1% were diagnosed at late stage. Two-thirds of women resided in census tracts with the highest ethnic enclave scores: 25.3% in Q4 and 43.6% in Q5. The percent late stage varied by ethnic enclave quintile (29.5% in Q1 to 37.9% in Q5; Chi-square across all quintiles p<0.01. Residence in the highest (Q5) compared to lowest (Q1) enclave quintile was associated with increased risk of late-stage diagnosis in the unadjusted model (RR=1.28 95% CI: 1.24-1.33) and in the fully adjusted model (RR=1.11; 95% CI: 1.07-1.15). Conclusions: Enhanced understanding of the features of ethnic enclaves that may contribute to later stage at breast cancer diagnosis among Hispanic women is important to inform future outreach and intervention. Additional analyses will assess potential for moderation by poverty and will examine whether results vary by enclave characteristics such as the predominant ethnic group (e.g., Mexican, Puerto Rican) or enclave transitions between 2000-2010 (never, former, persistent, emerging enclave). Citation Format: Sandi L. Pruitt, Aniruddha B. Rathod, Kathryn L. Shahan, Alison J. Canchola, Francis P. Boscoe, Kevin A. Henry, Robert A. Hiatt, Amy E. Hughes, Katherine Lin, Dan Meltzer, Paulo S. Pinheiro, Antoinette M. Stroup, Hong Zhu, Scarlett L. Gomez, Salma Shariff-Marco. Residence within Hispanic ethnic enclaves is associated with later stage breast cancer diagnosis among Hispanic women in four U.S. states [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B093.
A study in this journal found evidence of variation in cancer registry data quality according to the residence of the patient.1 Patients from more affluent areas were more likely to have information on tumour stage and tumour grade recorded than those in less affluent areas. No relation was found among cases registered by death certificate only. The authors surmised that these differences could result from differences in the degree of investigation accorded to patients of different backgrounds, or to some other aspect of the data collection process.
As patients receiving surgery are more likely to have their tumours …
Malignant pleural mesothelioma (MPM) is a rare and aggressive malignancy with a dismal prognosis. We aimed to identify predictors of survival among male and female MPM patients in the United States.We identified MPM cases reported by 18 cancer registries in the Surveillance, Epidemiology, and End Results Program (2000-2017). We applied a random survival forest (RSF) algorithm to identify and rank the importance of 10 variables at patient, cancer, and area level in predicting all-cause survival overall and by female and male subgroups.Approximately 91.4% (n = 11,160) of the MPM patients had died, with better survival among females than males (11.7% vs 7.8%). The median follow-up time was 7 months (interquartile range, 2-17 months). A majority of the patients were male (78.6%), non-Hispanic White (81.8%), and residing in metropolitan counties with a population greater than 1 million (63.7%). The top 3 factors for predicting overall MPM survival were age, histological type, and cancer-directed surgery status. Except for age, the relative ranking of covariates varied by the 3 sample groups. Stage ranked fifth in predicting female survival, while it was replaced by metastasis status for male and overall patients. Race/ethnicity was not a good predictor for survival among MPM patients overall or the male subgroup, but ranked sixth for predicting survival among females. Median household income was not a good predictor for survival among females.We demonstrated that RSF successfully identified predictors of MPM survival. RSF is a viable complement to the commonly used Cox proportional hazard model and a viable alternative, particularly when the proportional hazard assumption is unmet. RSF also identified differences between the sexes, which may help explain the sex differences in MPM survival rates.
Geographic visualization, sometimes called cartographic visualization, is a form of information visualization in which principles from cartography, geographic information systems (GIS), exploratory data analysis (EDA), and information visualization more generally are integrated in the development and assessment of visual methods that facilitate the exploration, analysis, synthesis, and presentation of georeferenced information. The authors report on development and use of one component of a prototype GVis environment designed to facilitate exploration, by domain experts, of time series multivariate georeferenced health statistics. Emphasis is on how manipulable dynamic GVis tools may facilitate visual thinking, pattern noticing, and hypothesis generation. The prototype facilitates the highlighting of data extremes, examination of change in geographic patterns over time, and exploration of similarity among georeferenced variables. A qualitative exploratory analysis of verbal protocols and transaction logs is used to characterize system use. Evidence produced through the characterization highlights differences among experts in data analysis strategies (particularly in relation to the use of attribute "focusing" combined with time series animation) and corresponding differences in success at noticing spatiotemporal patterns.
These are the raw American Community Survey files compiled in support of a paper to be published in Spatial and Spatiotemporal Epidemiology. More information to be added soon.
This file contains measured and modeled breast cancer rates by stage and median household income percentile in New York State, 2006-2015. It accompanies the book chapter, "Spatial and Contextual Analyses of Stage at Diagnosis" by Francis Boscoe and Lindsey Hutchison, in Geospatial Approaches to Energy Balance and Breast Cancer. D Berrigan, NA Berger, eds. Berlin: Springer, 2018.. 4,835 census tracts in New York State were divided into percentiles based on median household income, using data from the 2006-2010 and 2011-2015 editions of American Community Survey Table S1903. Census tracts are defined here: https://figshare.com/articles/Population_Estimates_by_Census_Tract_New_York_State_by_Age_and_Sex_1990-2016_/6813029 58 of the 4,893 census tracts in this file did not have households (primarily college campuses, prisons, and military bases) and thus had no reported median household income and were excluded, leaving 4,835. 200,022 cases of breast cancer diagnosed among New York State residents from 2006-2015 were assigned an income percentile. Cases diagnosed between 2006-2010 were assigned based on the 2006-2010 edition of ACS Table S1903 and cases diagnosed between 2011-2015 were assigned based on the 2011-2015 edition. Directly-adjusted incidence rates were calculated for all cancers and for those diagnosed at in situ, local, regional, and distant stage, using the SEER Summary Stage 2000 staging system.
The file contains the following fields: income percentile; rates for all cancers, in situ, local, regional, and distant stage; and modeled rates for all cancers, in situ, local, regional and distant stages. The modeled rates used a polynomial of order 3. The equations of the best-fit lines and r-squared values, to 4 decimal places or significant figures, are as follows: All cancers: y = 0.0001986x3 - 0.02035x2 + 1.0691x + 133.7353, r2 = 0.96 In situ: y = 0.00008906x3 - 0.007555x2 + 0.3169x + 27.5728, r2 = 0.96 Local: y = 0.0001436x3 - 0.01919x2 + 1.0526x + 58.4627, r2 = 0.94 Regional: y = -0.00001676x3 + 0.003410x2 - 0.1389x + 37.6709, r2 = 0.41 Distant: y = -0.00001724x3 + 0.002989x2 - 0.1615x + 10.0288, r2 = 0.32
Papillary thyroid cancer incidence has increased in the United States from 1978 through 2011 for both men and women of all ages and races. Overdiagnosis is partially responsible for this trend, although its magnitude is uncertain. This study examines papillary thyroid cancer incidence according to stage at diagnosis and estimates the proportion of newly diagnosed tumors that are attributable to overdiagnosis. We analyzed stage specific trends in papillary thyroid cancer incidence, 1981-2011, using the Surveillance, Epidemiology and End Results national cancer registries. Yearly changes in early and late-stage thyroid cancer incidence were calculated. We estimate that the proportion of incident papillary thyroid cancers attributable to overdiagnosis in 2011 was 5.5 and 45.5% in men ages 20-49 and 50+ and 41.1 and 60.1% in women ages 20-49 and 50+, respectively. Overdiagnosis has resulted in an additional 82,000 incident papillary thyroid cancers that likely would never have caused any clinical symptoms. The detection of early-stage papillary thyroid cancer outpaced that of late-stage disease from 1981 through 2011, in part due to overdiagnosis. Further studies into the prevention, risk stratification and optimal treatment of papillary thyroid cancer are warranted in response to these trends.
PURPOSE Despite concerns that power morcellation may adversely affect prognosis of patients with occult uterine cancer, empirical evidence has been limited and inconclusive. In this study, we aimed to determine whether uncontained power morcellation at the time of hysterectomy or myomectomy is associated with increased mortality risk in women with occult uterine cancer. METHODS By linking statewide hospital discharge records with cancer registry data in New York, we identified 843 women with occult endometrial carcinoma and 334 women with occult uterine sarcoma who underwent a hysterectomy or myomectomy for presumed benign indications during the period October 1, 2003, through December 31, 2013. Within this cohort, we compared disease-specific and all-cause mortality of women who underwent laparoscopic supracervical hysterectomy/laparoscopic myomectomy (LSH/LM), a surrogate indicator for uncontained power morcellation, with women who underwent supracervical abdominal hysterectomy and total abdominal hysterectomy (TAH), which did not involve power morcellation. Multivariable Cox regressions and propensity score method were used to adjust for patient characteristics. RESULTS Among women with occult uterine sarcoma, LSH/LM was associated with a higher risk for disease-specific mortality than TAH (adjusted hazard ratio [aHR], 2.66, 95% CI, 1.11 to 6.37; adjusted difference in 5-year disease-specific survival, −19.4%, 95% CI, −35.8% to −3.1%). In the subset of women with leiomyosarcoma, LSH/LM was associated with an increased risk for disease-specific mortality compared with supracervical abdominal hysterectomy (aHR, 3.64, 95% CI, 1.50 to 8.86; adjusted difference in 5-year disease-specific survival, −31.2%, 95% CI, −50.0% to −12.3%) and TAH (aHR, 4.66, 95% CI, 1.97 to 11.00; adjusted difference in 5-year disease-specific survival, −37.3%, 95% CI, −54.2% to −20.3%). Among women with occult endometrial carcinoma, there was no significant association between surgical approach and disease-specific mortality. CONCLUSION Uncontained power morcellation was associated with higher mortality risk in women with occult uterine sarcoma, especially in those with occult leiomyosarcoma.
