Publications by authors named "Amy R Kahn"

29 Publications

  • Page 1 of 1

Racial Disparities in Children, Adolescents, and Young Adults with Hodgkin Lymphoma Enrolled in the New York State Medicaid Program.

J Adolesc Young Adult Oncol 2021 Oct 8. Epub 2021 Oct 8.

Center for Oncology Hematology Outcomes Research and Training (COHORT) and Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, California, USA.

We examined the impact of race/ethnicity and age on survival in a publicly insured cohort of children and adolescent/young adults (AYA; 15-39 years) with Hodgkin lymphoma, adjusting for chemotherapy using linked Medicaid claims. We identified 1231 Medicaid-insured patients <1-39 years diagnosed with classical Hodgkin lymphoma between 2005 and 2015, in the New York State Cancer Registry. Chemotherapy regimens were based on contemporary therapeutic regimens. Cox proportional hazards regression models quantified associations of patient, disease, and treatment variables with overall survival (OS) and disease-specific survival (DSS), and are presented as hazard ratios (HR) with confidence intervals (95% CIs). At median follow-up of 6.6 years,  = 1108 (90%) patients were alive; 5-year OS was 92% in children <15 years. In multivariable models, Black (vs. White) patients had 1.6-fold increased risk of death (HR: 1.58, 95% CI: 1.02-2.46;  = 0.042). Stage III/IV (vs. I/II) was associated with 1.9-fold increased risk of death (HR: 1.86, 95% CI: 1.25-2.78;  = 0.002) and treatment at a non-National Cancer Institute (NCI) affiliate was associated with worse DSS (HR: 2.71, 95% CI: 1.47-4.98;  = 0.001). In this Medicaid-insured cohort of children and AYAs with Hodgkin lymphoma, Black race/ethnicity remained associated with inferior OS in multivariable models adjusted for disease, demographic, and treatment data. Further work is needed to identify dimensions of health care access not mediated by insurance, as findings suggest additional factors are contributing to observed cancer disparities in vulnerable pediatric and AYA populations.
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http://dx.doi.org/10.1089/jayao.2021.0131DOI Listing
October 2021

Temporal association of prostate cancer incidence with World Trade Center rescue/recovery work.

Occup Environ Med 2021 10 10;78(10):699-706. Epub 2021 Sep 10.

Department of Epidemiology & Population Health, Division of Biostatistics, Albert Einstein College of Medicine, Bronx, New York, USA

Background: The World Trade Center (WTC) attacks on 11 September 2001 created a hazardous environment with known and suspected carcinogens. Previous studies have identified an increased risk of prostate cancer in responder cohorts compared with the general male population.

Objectives: To estimate the length of time to prostate cancer among WTC rescue/recovery workers by determining specific time periods during which the risk was significantly elevated.

Methods: Person-time accruals began 6 months after enrolment into a WTC cohort and ended at death or 12/31/2015. Cancer data were obtained through linkages with 13 state cancer registries. New York State was the comparison population. We used Poisson regression to estimate hazard ratios and 95% CIs; change points in rate ratios were estimated using profile likelihood.

Results: The analytic cohort included 54 394 male rescue/recovery workers. We observed 1120 incident prostate cancer cases. During 2002-2006, no association with WTC exposure was detected. Beginning in 2007, a 24% increased risk (HR: 1.24, 95% CI 1.16 to 1.32) was observed among WTC rescue/recovery workers when compared with New York State. Comparing those who arrived earliest at the disaster site on the morning of 11 September 2001 or any time on 12 September 2001 to those who first arrived later, we observed a positive, monotonic, dose-response association in the early (2002-2006) and late (2007-2015) periods.

Conclusions: Risk of prostate cancer was significantly elevated beginning in 2007 in the WTC combined rescue/recovery cohort. While unique exposures at the disaster site might have contributed to the observed effect, screening practices including routine prostate specific antigen screening cannot be discounted.
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http://dx.doi.org/10.1136/oemed-2021-107405DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8458078PMC
October 2021

Cancer Incidence in World Trade Center Rescue and Recovery Workers: 14 Years of Follow-Up.

J Natl Cancer Inst 2021 Sep 9. Epub 2021 Sep 9.

Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.

Background: Statistically significantly increased cancer incidence has been reported from 3 cohorts of World Trade Center (WTC) disaster rescue and recovery workers. We pooled data across these cohorts to address ongoing public concerns regarding cancer risk 14 years after WTC exposure.

Methods: From a combined deduplicated cohort of 69 102 WTC rescue and recovery workers, a sample of 57 402 workers enrolled before 2009 and followed through 2015 was studied. Invasive cancers diagnosed in 2002-2015 were identified from 13 state cancer registries. Standardized incidence ratios (SIRs) were used to assess cancer incidence. Adjusted hazard ratios (aHRs) were estimated from Cox regression to examine associations between WTC exposures and cancer risk.

Results: Of the 3611 incident cancers identified, 3236 were reported as first-time primary (FP) cancers, with an accumulated 649 724 and 624 620 person-years of follow-up, respectively. Incidence for combined FP cancers was below expectation (SIR = 0.96, 95% confidence interval [CI] = 0.93 to 0.99). Statistically significantly elevated SIRs were observed for melanoma-skin (SIR = 1.43, 95% CI = 1.24 to 1.64), prostate (SIR = 1.19, 95% CI = 1.11 to 1.26), thyroid (SIR = 1.81, 95% CI = 1.57 to 2.09), and tonsil (SIR = 1.40, 95% CI = 1.00 to 1.91) cancer. Those arriving on September 11 had statistically significantly higher aHRs than those arriving after September 17, 2001, for prostate (aHR = 1.61, 95% CI = 1.33 to 1.95) and thyroid (aHR = 1.77, 95% CI = 1.11 to 2.81) cancers, with a statistically significant exposure-response trend for both.

Conclusions: In the largest cohort of 9/11 rescue and recovery workers ever studied, overall cancer incidence was lower than expected, and intensity of WTC exposure was associated with increased risk for specific cancer sites, demonstrating the value of long-term follow-up studies after environmental disasters.
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http://dx.doi.org/10.1093/jnci/djab165DOI Listing
September 2021

Cancer survival among World Trade Center rescue and recovery workers: A collaborative cohort study.

Am J Ind Med 2021 10 19;64(10):815-826. Epub 2021 Jul 19.

Department of Hematology and Oncology, Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, New York, USA.

Background: World Trade Center (WTC)-exposed responders may be eligible to receive no-cost medical monitoring and treatment for certified conditions, including cancer. The survival of responders with cancer has not previously been investigated.

Methods: This study compared the estimated relative survival of WTC-exposed responders who developed cancer while enrolled in two WTC medical monitoring and treatment programs in New York City (WTC-MMTP responders) and WTC-exposed responders not enrolled (WTC-non-MMTP responders) to non-responders from New York State (NYS-non-responders), all restricted to the 11-southernmost NYS counties, where most responders resided. Parametric survival models estimated cancer-specific and all-cause mortality. Follow-up ended at death or on December 31, 2016.

Results: From January 1, 2005 to December 31, 2016, there were 2,037 cancer cases and 303 deaths (248 cancer-related deaths) among WTC-MMTP responders, 564 cancer cases, and 143 deaths (106 cancer-related deaths) among WTC-non-MMTP responders, and 574,075 cancer cases and 224,040 deaths (158,645 cancer-related deaths) among the NYS-non-responder population. Comparing WTC-MMTP responders with NYS-non-responders, the cancer-specific mortality hazard ratio (HR) was 0.72 (95% confidence interval [CI] = 0.64-0.82), and all-cause mortality HR was 0.64 (95% CI = 0.58-0.72). The cancer-specific HR was 0.94 (95% CI = 0.78-1.14), and all-cause mortality HR was 0.93 (95% CI = 0.79-1.10) comparing WTC-non-MMTP responders to the NYS-non-responder population.

Conclusions: WTC-MMTP responders had lower mortality compared with NYS-non-responders, after controlling for demographic factors and temporal trends. There may be survival benefits from no-out-of-pocket-cost medical care which could have important implications for healthcare policy, however, other occupational and socioeconomic factors could have contributed to some of the observed survival advantage.
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http://dx.doi.org/10.1002/ajim.23278DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8515734PMC
October 2021

Impact of healthcare services on thyroid cancer incidence among World Trade Center-exposed rescue and recovery workers.

Am J Ind Med 2021 10 18;64(10):861-872. Epub 2021 Jul 18.

Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA.

Background: A recent study of World Trade Center (WTC)-exposed firefighters and emergency medical service workers demonstrated that elevated thyroid cancer incidence may be attributable to frequent medical testing, resulting in the identification of asymptomatic tumors. We expand on that study by comparing the incidence of thyroid cancer among three groups: WTC-exposed rescue/recovery workers enrolled in a New York State (NYS) WTC-medical monitoring and treatment program (MMTP); WTC-exposed rescue/recovery workers not enrolled in an MMTP (non-MMTP); and the NYS population.

Methods: Person-time began on 9/12/2001 or at enrollment in a WTC cohort and ended at death or on 12/31/2015. Cancer data were obtained through linkages with 13 state cancer registries. We used Poisson regression to estimate rate ratios (RRs) and 95% confidence intervals (CIs) for MMTP and non-MMTP participants. NYS rates were used as the reference. To estimate potential changes over time in WTC-associated risk, change points in RRs were estimated using profile likelihood.

Results: The thyroid cancer incidence rate among MMTP participants was more than twice that of NYS population rates (RR = 2.31; 95% CI = 2.00-2.68). Non-MMTP participants had a risk similar to NYS (RR = 0.96; 95% CI = 0.72-1.28). We observed no change points in the follow-up period.

Conclusion: Our findings support the hypothesis that no-cost screening (a benefit provided by WTC-MMTPs) is associated with elevated identification of thyroid cancer. Given the high survival rate for thyroid cancer, it is important to weigh the costs and benefits of treatment, as many of these cancers were asymptomatic and may have been detected incidentally.
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http://dx.doi.org/10.1002/ajim.23277DOI Listing
October 2021

Combining Three Cohorts of World Trade Center Rescue/Recovery Workers for Assessing Cancer Incidence and Mortality.

Int J Environ Res Public Health 2021 02 3;18(4). Epub 2021 Feb 3.

Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA.

Three cohorts including the Fire Department of the City of New York (FDNY), the World Trade Center Health Registry (WTCHR), and the General Responder Cohort (GRC), each funded by the World Trade Center Health Program have reported associations between WTC-exposures and cancer. Results have generally been consistent with effect estimates for excess incidence for all cancers ranging from 6 to 14% above background rates. Pooling would increase sample size and de-duplicate cases between the cohorts. However, pooling required time consuming steps: obtaining Institutional Review Board (IRB) approvals and legal agreements from entities involved; establishing an honest broker for managing the data; de-duplicating the pooled cohort files; applying to State Cancer Registries (SCRs) for matched cancer cases; and finalizing analysis data files. Obtaining SCR data use agreements ranged from 6.5 to 114.5 weeks with six states requiring >20 weeks. Records from FDNY ( = 16,221), WTCHR ( = 29,372), and GRC ( = 33,427) were combined de-duplicated resulting in 69,102 unique individuals. Overall, 7894 cancer tumors were matched to the pooled cohort, increasing the number cancers by as much as 58% compared to previous analyses. Pooling resulted in a coherent resource for future research for studies on rare cancers and mortality, with more representative of occupations and WTC- exposure.
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http://dx.doi.org/10.3390/ijerph18041386DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7913216PMC
February 2021

Anaplastic large cell lymphoma in human immunodeficiency virus-infected people and solid organ transplant recipients.

Br J Haematol 2021 02 8;192(3):514-521. Epub 2020 Jun 8.

Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.

Human immunodeficiency virus (HIV)-infected people and solid organ transplant recipients have elevated risk of anaplastic large cell lymphoma (ALCL). Little is known regarding ALCL risk factors in immunosuppressed populations. We used data from US cancer registries linked to HIV registries (1996-2016) and to the national transplant registry (1992-2017). ALCL risk in HIV-infected people and transplant recipients relative to the general population was calculated as a standardized incidence ratio (SIR). ALCL risk factors were evaluated using Poisson regression. We identified 121 incident ALCL cases in the HIV (n = 86) and transplant (n = 35) populations. We reviewed pathology reports for 45 cases and most (86·7%) were confirmed as ALCL. Epstein-Barr virus tested positive in 1/8 (12·5%) cases. Compared to the general population, ALCL risk was strongly elevated among HIV-infected people [SIR 5·43; 95% confidence interval (CI) 4·27-6·81] and transplant recipients (5·96; 4·03-8·49). Among HIV-infected people, ALCL incidence was strongly related to CD4 count [adjusted incidence rate ratio (aIRR) 0·15 for ≥500 vs. <200 cells/μl; P trend < 0·001]. Among transplant recipients, risk was highest within the first year (aIRR 6·82) and 10+ years post-transplant (5·99). In conclusion, ALCL risk is strongly increased in these immunosuppressed populations but may be unrelated to EBV infection based on limited reports.
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http://dx.doi.org/10.1111/bjh.16778DOI Listing
February 2021

Risk of Rare Cancers Among Solid Organ Transplant Recipients.

J Natl Cancer Inst 2021 02;113(2):199-207

Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.

Background: Immunosuppressed solid organ transplant recipients (SOTRs) have elevated rates of certain rare cancers caused by viruses. Evaluating risk of rare cancers among SOTRs may provide etiological clues for additional cancers linked to poor immunity and viral infections.

Methods: We performed a cohort study of 262 455 SOTRs (1987-2014) from the US SOTR registry linked to 17 population-based cancer registries. First cancers in SOTRs were categorized using an established classification scheme based on site and histology. Standardized incidence ratios (SIRs) compared risk in SOTRs with the general population. We used Poisson regression to calculate incidence rate ratios according to immune-related SOTR characteristics, including time since transplant (ie, duration of immunosuppression). All statistical tests were 2-sided.

Results: We examined 694 distinct cancer subtypes, with 33 manifesting statistically significantly elevated SIRs (Bonferroni P < 7.2 × 10-5). All 33 are rare (incidence <6 per 100 000 person-years) and several have known viral etiology (eg, Merkel cell carcinoma: SIR = 24.7, 95% confidence interval [CI] = 20.8 to 29.1). Additional cancers that were increased include squamous cell carcinomas of the lip (SIR range = 18.3-19.8), eye and adnexa (SIR = 13.8, 95% CI = 7.9 to 22.3), salivary gland (SIR = 9.3, 95% CI = 6.1 to 13.5), and nasal cavity and sinuses (SIR = 4.5, 95% CI = 2.8 to 6.8); sebaceous adenocarcinoma (SIR = 34.3, 95% CI = 26.3 to 44.0); malignant fibrous histiocytoma (15.4); and subtypes of bladder, kidney, lung, and colon cancer (SIR range = 3.2-13.3). Incidence of several cancers increased over time since transplant (Ptrend < .05), including squamous cell carcinomas of the lip, salivary gland, and anogenital sites.

Conclusions: SOTRs experience elevated rates of several rare cancers. Because some of these cancers exhibit aggressive behavior with poor outcomes, it is important to further characterize the role of immunity and the potential involvement of oncogenic viruses to improve prevention and treatment.
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http://dx.doi.org/10.1093/jnci/djaa078DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7850530PMC
February 2021

Risk of lip cancer after solid organ transplantation in the United States.

Am J Transplant 2019 01 5;19(1):227-237. Epub 2018 Sep 5.

Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.

Solid organ transplant recipients have an increased risk of lip cancer, but the reasons are uncertain. Using data from the Transplant Cancer Match Study, we describe the epidemiology of lip cancer among 261 500 transplant recipients in the United States. Two hundred thirty-one lip cancers were identified, corresponding to elevated risks for both invasive and in situ lip cancers (standardized incidence ratios of 15.3 and 26.2, respectively). Invasive lip cancer incidence was associated with male sex (adjusted incidence rate ratio [aIRR] 2.01, 95% CI 1.44-2.82), transplanted organ (0.33, 0.20-0.57, for liver transplants and 3.07, 1.96-4.81, for lung transplants, compared with kidney transplants), and racial/ethnic groups other than non-Hispanic whites (0.09, 0.04-0.2). In addition, incidence increased with age and during the first 3 years following transplant, and was higher in recipients prescribed cyclosporine/azathioprine maintenance therapy (aIRR 1.79, 95% CI 1.09-2.93, compared with use of tacrolimus/mycophenolate mofetil) and following a diagnosis of cutaneous squamous cell carcinoma (4.21, 2.69-0.94). The elevation in lip cancer incidence is consistent with an effect of immunosuppression. Notably, the very strong associations with white race and history of prior skin cancer point to an important role for ultraviolet radiation exposure, and cyclosporine and azathioprine may contribute as photosensitizing or DNA damaging agents.
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http://dx.doi.org/10.1111/ajt.15052DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6310619PMC
January 2019

Cancer Risk in Older Persons Living With Human Immunodeficiency Virus Infection in the United States.

Clin Infect Dis 2018 06;67(1):50-57

Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, Maryland.

Background: Cancer risk is increased in persons living with human immunodeficiency virus (HIV) (PLWH). Improved survival has led to an aging of PLWH. We evaluated the cancer risk in older PLWH (age ≥50 years).

Methods: We included data from the HIV/AIDS Cancer Match Study (1996-2012) and evaluated risks of Kaposi sarcoma (KS), non-Hodgkin lymphoma (NHL), Hodgkin lymphoma, and cervical, anal, lung, liver, oral cavity/pharyngeal, breast, prostate, and colon cancers in older PLWH with risk in the general population by calculating standardized incidence ratios (SIRs) and excess absolute risks (EARs). Cancer risk by time since HIV diagnosis was estimated using Poisson regression.

Results: We identified 10371 cancers among 183542 older PLWH. Risk was significantly increased for KS (SIR, 103.34), NHL (3.05), Hodgkin lymphoma (7.61), and cervical (2.02), anal (14.00), lung (1.71), liver (2.91), and oral cavity/pharyngeal (1.66) cancers, and reduced for breast (0.61), prostate (0.47), and colon (0.63) cancers. SIRs declined with age for all cancers; however, EARs increased with age for anal, lung, liver, and oral cavity/pharyngeal cancers. Cancer risk was highest for most cancers within 5 years after HIV diagnosis; risk decreased with increasing time since HIV diagnosis for KS, NHL, lung cancer, and Hodgkin lymphoma.

Conclusions: Cancer risk is elevated among older PLWH. Although SIRs decrease with age, EARs are higher for some cancers, reflecting a greater absolute excess in cancer incidence among older PLWH. High risk in the first 5 years after HIV diagnosis for some cancers highlights the need for early HIV diagnosis and rapid treatment initiation.
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http://dx.doi.org/10.1093/cid/ciy012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6248478PMC
June 2018

Contribution of solid organ transplant recipients to the pediatric non-hodgkin lymphoma burden in the United States.

Cancer 2017 Dec 31;123(23):4663-4671. Epub 2017 Jul 31.

Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland.

Background: Pediatric solid organ transplant recipients have a 100 to 200 times higher risk of non-Hodgkin lymphoma (NHL) than the general pediatric population. Consequently, transplant-related NHL may contribute considerably to the pediatric NHL burden in the United States.

Methods: A cohort study using a linkage between the US transplant registry and 16 cancer registries was conducted. Cancer incidence rates were calculated for people less than 20 years old in the transplant and general populations. Rates were applied to transplant registry and US census data to estimate pediatric NHL counts for transplant recipients and the general population.

Results: During 1990-2012, an estimated 22,270 NHLs were diagnosed in US children and adolescents; they included 628 cases diagnosed in transplant recipients. Thus, 2.82% of pediatric NHL diagnoses in the general population (95% confidence interval [CI], 2.45%-3.19%) occurred in transplant recipients. Among transplant recipients, the most common subtypes were diffuse large B-cell lymphoma (DLBCL; 64.5% of cases) and Burkitt lymphoma (BL; 8.6%). For DLBCL and BL, transplant recipients contributed 7.62% (95% CI, 6.35%-8.88%) and 0.87% (95% CI, 0.51%-1.23%) of diagnoses, respectively. The proportion of NHLs that occurred in transplant recipients was highest among children less than 5 years old (4.46%; 95% CI, 3.24%-5.69%) and in more recent calendar years (3.73% in 2010-2012; 95% CI, 2.07%-5.39%). DLBCL patterns were similar, with transplant recipients contributing 19.78% of cases among children less than 5 years old (95% CI, 12.89%-26.66%) and 11.4% of cases in 2010-2012 (95% CI, 5.54%-17.28%).

Conclusions: Among children and adolescents, solid organ transplant recipients contribute a substantial fraction of NHL diagnoses, particularly DLBCL diagnoses. This fraction has increased over time. Prevention efforts targeted toward this group could reduce the overall pediatric NHL burden. Cancer 2017;123:4663-4671. © 2017 American Cancer Society.
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http://dx.doi.org/10.1002/cncr.30923DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5693631PMC
December 2017

Cancer Risk After Pediatric Solid Organ Transplantation.

Pediatrics 2017 May;139(5)

Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland.

Background: The effects of pediatric solid organ transplantation on cancer risk may differ from those observed in adult recipients. We described cancers in pediatric recipients and compared incidence to the general population.

Methods: The US transplant registry was linked to 16 cancer registries to identify cancer diagnoses among recipients <18 years old at transplant. Standardized incidence ratios (SIRs) were estimated by dividing observed cancer counts among recipients by expected counts based on the general population rates. Cox regression was used to estimate the associations between recipient characteristics and non-Hodgkin's lymphoma (NHL) risk.

Results: Among 17 958 pediatric recipients, 392 cancers were diagnosed, of which 279 (71%) were NHL. Compared with the general population, incidence was significantly increased for NHL (SIR = 212, 95% confidence interval [CI] = 188-238), Hodgkin's lymphoma (SIR = 19, 95% CI = 13-26), leukemia (SIR = 4, 95% CI = 2-7), myeloma (SIR = 229, 95% CI = 47-671), and cancers of the liver, soft tissue, ovary, vulva, testis, bladder, kidney, and thyroid. NHL risk was highest during the first year after transplantation among recipients <5 years old at transplant (SIR = 313), among recipients seronegative for Epstein-Barr virus (EBV) at transplant (SIR = 446), and among intestine transplant recipients (SIR = 1280). In multivariable analyses, seronegative EBV status, the first year after transplantation, intestine transplantation, and induction immunosuppression were independently associated with higher NHL incidence.

Conclusions: Pediatric recipients have a markedly increased risk for many cancers. NHL constitutes the majority of diagnosed cancers, with the highest risk occurring in the first year after transplantation. NHL risk was high in recipients susceptible to primary EBV infection after transplant and in intestine transplant recipients, perhaps due to EBV transmission in the donor organ.
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http://dx.doi.org/10.1542/peds.2016-3893DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5404730PMC
May 2017

Ten-year cancer incidence in rescue/recovery workers and civilians exposed to the September 11, 2001 terrorist attacks on the World Trade Center.

Am J Ind Med 2016 09;59(9):709-21

World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, Long Island City, New York.

Background: Cancer incidence in exposed rescue/recovery workers (RRWs) and civilians (non-RRWs) was previously reported through 2008.

Methods: We studied occurrence of first primary cancer among World Trade Center Health Registry enrollees through 2011 using adjusted standardized incidence ratios (SIRs), and the WTC-exposure-cancer association, using Cox proportional hazards models.

Results: All-cancer SIR was 1.11 (95% confidence interval (CI) 1.03-1.20) in RRWs, and 1.08 (95% CI 1.02-1.15) in non-RRWs. Prostate cancer and skin melanoma were significantly elevated in both populations. Thyroid cancer was significantly elevated only in RRWs while breast cancer and non-Hodgkin's lymphoma were significantly elevated only in non-RRWs. There was a significant exposure dose-response for bladder cancer among RRWs, and for skin melanoma among non-RRWs.

Conclusions: We observed excesses of total and specific cancers in both populations, although the strength of the evidence for causal relationships to WTC exposures is somewhat limited. Continued monitoring of this population is indicated. Am. J. Ind. Med. 59:709-721, 2016. © 2016 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/ajim.22638DOI Listing
September 2016

Effects of the length of central cancer registry operations on identification of subsequent cancers and on survival estimates.

Cancer Epidemiol 2016 10 26;44:52-58. Epub 2016 Jul 26.

Bureau of Cancer Epidemiology, New York State Department of Health, Albany, NY, United States.

Background: Population-based cancer survival analyses have traditionally been based on the first primary cancer. Recent studies have brought this practice into question, arguing that varying registry reference dates affect the ability to identify earlier cancers, resulting in selection bias. We used a theoretical approach to evaluate the extent to which the length of registry operations affects the classification of first versus subsequent cancers and consequently survival estimates.

Methods: Sequence number central was used to classify tumors from the New York State Cancer Registry, diagnosed 2001-2010, as either first primaries (value=0 or 1) or subsequent primaries (≥2). A set of three sequence numbers, each based on an assumed reference year (1976, 1986 or 1996), was assigned to each tumor. Percent of subsequent cancers was evaluated by reference year, cancer site and age. 5-year relative survival estimates were compared under four different selection scenarios.

Results: The percent of cancer cases classified as subsequent primaries was 15.3%, 14.3% and 11.2% for reference years 1976, 1986 and 1996, respectively; and varied by cancer site and age. When only the first primary was included, shorter registry operation time was associated with slightly lower 5-year survival estimates. When all primary cancers were included, survival estimates decreased, with the largest decreases seen for the earliest reference year.

Conclusions: Registry operation length affected the identification of subsequent cancers, but the overall effect of this misclassification on survival estimates was small. Survival estimates based on all primary cancers were slightly lower, but might be more comparable across registries.
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http://dx.doi.org/10.1016/j.canep.2016.07.010DOI Listing
October 2016

Melanoma Risk and Survival among Organ Transplant Recipients.

J Invest Dermatol 2015 Nov 13;135(11):2657-2665. Epub 2015 Aug 13.

Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA.

Solid organ transplant recipients, who are medically immunosuppressed to prevent graft rejection, have increased melanoma risk, but risk factors and outcomes are incompletely documented. We evaluated melanoma incidence among 139,991 non-Hispanic white transplants using linked US transplant-cancer registry data (1987-2010). We used standardized incidence ratios (SIRs) to compare incidence with the general population and incidence rate ratios (IRRs) from multivariable Poisson models to assess risk factors. Separately, we compared post-melanoma survival among transplant recipients (n=182) and non-recipients (n=131,358) using multivariable Cox models. Among transplant recipients, risk of invasive melanoma (n=519) was elevated (SIR=2.20, 95% CI 2.01-2.39), especially for regional stage tumors (SIR=4.11, 95% CI 3.27-5.09). Risk of localized tumors was stable over time after transplantation but higher with azathioprine maintenance therapy (IRR=1.35, 95% CI 1.03-1.77). Risk of regional/distant stage tumors peaked within 4 years following transplantation and increased with polyclonal antibody induction therapy (IRR=1.65, 95% CI 1.02-2.67). Melanoma-specific mortality was higher among transplant recipients than non-recipients (hazard ratio 2.98, 95% CI 2.26-3.93). Melanoma exhibits increased incidence and aggressive behavior under transplant-related immunosuppression. Some localized melanomas may result from azathioprine, which acts synergistically with UV radiation, whereas T-cell-depleting induction therapies may promote late-stage tumors. Our findings support sun safety practices and skin screening for transplant recipients.
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http://dx.doi.org/10.1038/jid.2015.312DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4640996PMC
November 2015

An automated algorithm for consolidating dates of diagnosis from multiple sources.

J Registry Manag 2013 ;40(1):36-9

Background: Multiple dates of diagnosis are often received from different reporting sources at a central cancer registry. Resolving these inconsistencies can be a labor-intensive task. To our knowledge, no algorithms for the consolidation of diagnosis dates have been published. We present such an algorithm here.

Methods: The algorithm uses a "take the best" heuristic approach, incorporating the reported dates of diagnosis, class of case, service type (a New York-specific item similar to type of reporting source), and the date of first contact. The algorithm was evaluated by comparing results to those obtained with manual review by experienced certified tumor registrars (CTRs).

Results: From a sample of 209,907 tumors with multiple diagnosis dates reported to the New York State Cancer Registry (NYSCR), the algorithm determined a single date for 94.7 percent of these, with the balance designated for manual review. Of a sample of 636 tumors that were manually reviewed to evaluate the algorithm, the algorithm obtained the same year as the CTRs for 621 tumors (97.6 percent), the same month and year for 572 tumors (89.9 percent) and the same month, year, and day for 518 tumors (81.4 percent). There was much lower agreement between the manually derived dates and the originally consolidated dates.

Conclusion: The algorithm presented here is accurate, efficient, and reliable, and hopefully will help the cancer registry community move toward standard practices for record consolidation.
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January 2014

Disentangling the effects of race/ethnicity and socioeconomic status of neighborhood in cancer stage distribution in New York City.

Cancer Causes Control 2013 Jun 16;24(6):1069-78. Epub 2013 Mar 16.

The Tisch Cancer Institute and Institute for Transitional Epidemiology, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1057, New York, NY 10029, USA.

Purpose: Stage at diagnosis is an important prognostic factor for the majority of cancers; it may be an indicator for quality of access to health care and is usually correlated with socioeconomic status (SES) and ethnicity/race. We aimed to investigate the association between stage of cancer at diagnosis with neighborhood of residence (as proxy for SES) and ethnicity/race, while controlling for each other, in selected areas of New York City (NYC).

Methods: The cancer summary data (1999-2008) were provided by the New York State Cancer Registry. Multinomial logistic regression models were applied to calculate risk estimates for being diagnosed with late- or unknown-stage (versus early-stage) cancers in two low-SES and two high-SES neighborhoods of NYC and among several ethnic/racial groups for all cancers combined and cancers of the female breast, lung, colorectum, and prostate, with additional adjustments for sex (for all cancers combined), age, and year of diagnosis.

Results: A total of 34,981 cancer cases were included in this study. There were significant and independent ethnic/racial and neighborhood disparities in stage of cancer at diagnosis of most of the cancers studied. The effect of ethnicity/race on the disparity appeared stronger than the effect of neighborhood. There was an overall decreasing trend in the proportion of late-stage cancers, particularly for colorectal cancer, and to a greater extent in the proportion of cancers without staging information.

Conclusions: In this population, ethnicity/race seems to be a stronger predictor for late stage at diagnosis than SES, stressing the need for ethnicity/race-oriented programs for cancer screening and improved access to care.
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http://dx.doi.org/10.1007/s10552-013-0184-2DOI Listing
June 2013

Association between World Trade Center exposure and excess cancer risk.

JAMA 2012 Dec;308(23):2479-88

NewYorkCityDepartmentof Health and Mental Hygiene, Long Island City, New York 11101, USA.

Context: The terrorist attacks of September 11, 2001, resulted in the release of known and suspected carcinogens into the environment. There is public concern that exposures may have resulted in increased cancers.

Objective: To evaluate cancer incidence among persons enrolled in the World Trade Center Health Registry.

Design, Setting, And Participants: Observational study of 55,778 New York State residents enrolled in the World Trade Center Health Registry in 2003-2004, including rescue/recovery workers (n = 21,850) and those not involved in rescue/recovery (n = 33,928), who were followed up from enrollment through December 31, 2008. Within-cohort comparisons using Cox proportional hazards models assessed the relationship between intensity of World Trade Center exposure and selected cancers.

Main Outcome Measures: Cases were identified through linkage with 11 state cancer registries. Standardized incidence ratios (SIRs) adjusted for age, race/ethnicity, and sex were computed with 2003-2008 New York State rates as the reference, focusing on cancers diagnosed in 2007-2008 as being most likely to be related to exposure during September 11 and its aftermath. The total and site-specific incidence rate differences (RDs) per 100,000 person-years between the study population and the New York State population in 2007-2008 also were calculated.

Results: There were 1187 incident cancers diagnosed, with an accumulated 253,269 person-years (439 cancers among rescue/recovery workers and 748 among those not involved in rescue/recovery). The SIR for all cancer sites combined in 2007-2008 was not significantly elevated (SIR, 1.14 [95% CI, 0.99 to 1.30]; RD, 67 [95% CI, -6 to 126] per 100,000 person-years among rescue/recovery workers vs SIR, 0.92 [95% CI, 0.83 to 1.03]; RD, -45 [95% CI, -106 to 15] per 100,000 person-years among those not involved in rescue/recovery). Among rescue/recovery workers, the SIRs had significantly increased by 2007-2008 for 3 cancer sites and were 1.43 (95% CI, 1.11 to 1.82) for prostate cancer (n = 67; RD, 61 [95% CI, 20 to 91] per 100,000 person-years), 2.02 (95% CI, 1.07 to 3.45) for thyroid cancer (n = 13; RD, 16 [95% CI, 2 to 23] per 100,000 person-years), and 2.85 (95% CI, 1.15 to 5.88) for multiple myeloma (n = 7; RD, 11 [95% CI, 2 to 14] per 100,000 person-years). No increased incidence was observed in 2007-2008 among those not involved in rescue/recovery. Using within-cohort comparisons, the intensity of World Trade Center exposure was not significantly associated with cancer of the lung, prostate, thyroid, non-Hodgkin lymphoma, or hematological cancer in either group.

Conclusions: Among persons enrolled in the World Trade Center Health Registry, there was an excess risk for prostate cancer, thyroid cancer, and myeloma in 2007-2008 compared with that for New York State residents; however, these findings were based on a small number of events and multiple comparisons. No significant associations were observed with intensity of World Trade Center exposures. Longer follow-up for typically long-latency cancers and attention to specific cancer sites are needed.
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http://dx.doi.org/10.1001/jama.2012.110980DOI Listing
December 2012

The implications of age and comorbidity on survival following epithelial ovarian cancer: summary and results from a Centers for Disease Control and Prevention study.

J Womens Health (Larchmt) 2012 Sep 20;21(9):887-94. Epub 2012 Jul 20.

Amgen Inc. , One Amgen Center Drive, Thousand Oaks, CA 91320, USA.

Background: Advances in treatment have improved ovarian cancer survival for most women, although less for the elderly. We report on this disparity and add further evidence about the relationship among age, comorbidity, and survival after ovarian cancer.

Methods: To examine age and comorbidity, Centers for Disease Control and Prevention (CDC)-funded cancer registries examined 2367 women residing in New York and Northern California diagnosed with epithelial ovarian cancer (1998-2000). Subjects were identified through tumor registries, treatment data were supplemented with physician survey, and comorbidity was identified through hospital discharge database linkages. Proportional hazards modeling was used to estimate the risk of death by age and comorbidity, adjusting for clinical and sociodemographic factors.

Results: Crude survival at 1 year and 3 years was 71.9% and 50.1%, respectively. Within stage, age-specific survival rates were lower in the oldest groups, particularly for those with advanced disease. For age 75+, 3-year survival was 13% vs. 50% in those <35 (stage IV). For all stages, women without comorbidity had higher survival rates than those with comorbidity. Older age and comorbidity were both associated with advanced stage and less aggressive treatment. The adjusted risk of death was 40%, and it was 80% higher for the 65-74 and 75+ groups, respectively, compared to women 35-64 (p<0.00). Comorbidity increased the risk of death by 40% (p<0.00).

Conclusions: This study confirmed the independent adverse effects of age and comorbidity on survival following ovarian cancer. As the population ages, the co-occurrence of ovarian cancer and comorbidity will increase. Further work identifying critical conditions that impact survival could potentially inform complex treatment decisions.
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http://dx.doi.org/10.1089/jwh.2012.3781DOI Listing
September 2012

Thyroid cancer incidence in highly observant Jewish neighborhoods in metropolitan New York City.

Thyroid 2011 Nov 30;21(11):1255-61. Epub 2011 Aug 30.

New York State Cancer Registry, New York State Department of Health, Albany, New York, USA.

Background: Thyroid cancer incidence in New York State has increased rapidly in recent years, particularly in New York City and its surrounding metropolitan area. In 2007 among white non-Hispanics, incidence rates were about 40% higher in the New York City metropolitan area than in the rest of the state. Here we explore the extent to which living in neighborhoods with a high percentage of highly observant Jews may be associated with this pattern.

Methods: We identify neighborhoods with concentrations of highly observant Jewish persons based on the use of Yiddish among children and the location of Orthodox synagogues. Thyroid cancer risk is modeled as a function of living in such a neighborhood, adjusting for age, sex, and other factors. The model was repeated for small (<2 cm) and large (≥2 cm) tumors to assess the role of diagnostic improvements in driving the spatial-temporal patterns.

Results: A moderate association with thyroid cancer was found among those living in Jewish neighborhoods and downstate New York. A lesser association was found among those who live in neighborhoods of high levels of people born in Russia, Belarus, or Ukraine. Similar elevated rate ratios were seen for small and large tumors in Jewish neighborhoods, providing evidence against differences in diagnostic practices in this group. Smaller tumors were more pronounced among women and persons diagnosed more recently.

Conclusions: The associations found do not seem to be diagnostically driven, but rather due to environmental, genetic, or cultural factors in the highly observant population of New York State.
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http://dx.doi.org/10.1089/thy.2011.0091DOI Listing
November 2011

Surgical staging of early stage epithelial ovarian cancer: results from the CDC-NPCR ovarian patterns of care study.

Gynecol Oncol 2011 Apr 21;121(1):94-9. Epub 2011 Jan 21.

California Cancer Registry, Public Health Institute, Sacramento, CA, USA.

Objectives: The objectives of this study were to determine the adequacy of surgical staging performed on surgically treated epithelial ovarian cancer (EOC) patients with apparent early stage disease and to determine if receipt of surgical staging had an influence on survival.

Methods: Detailed surgical staging information was collected from medical records for 721 patients diagnosed between 1998 and 2000 with EOC. Patients resided in California or New York and were identified through population-based cancer registries.

Results: Nearly 90% of patients had removal of the omentum and evaluation of bowel serosa and mesentery but only 72% had assessment of retroperitoneal lymph nodes and the majority of patients did not receive biopsies of other peritoneal locations. Only lymph node assessment (as well as node assessment combined with washings and omentectomy) had a statistically significant association with improved survival. The 5-year survival for women with node sampling was 84.2% versus 69.6% for those without this surgical procedure, and patients who did not have lymph node assessment had nearly twice the risk of death as those who did. When patients were stratified by receipt of chemotherapy, lack of node sampling had an effect only on patients who also had no chemotherapy (adjusted HR=2.2, CI=1.0-4.5).

Conclusions: The results of this population-based study confirm the prognostic importance of surgical staging for women with EOC, and the important role of gynecologic oncologists in treating these patients. Adjuvant chemotherapy does not appear to further improve survival for those women who receive adequate surgical staging.
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http://dx.doi.org/10.1016/j.ygyno.2010.12.359DOI Listing
April 2011

Racial/ethnic and socioeconomic disparities in mortality among women diagnosed with cervical cancer in New York City, 1995-2006.

Cancer Causes Control 2010 Oct 3;21(10):1645-55. Epub 2010 Jun 3.

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.

Background: Though cervical cancer rates have declined due to Pap screening, racial and socioeconomic disparities in cervical cancer incidence and mortality persist. This study assesses the relative impact of race/ethnicity and neighborhood poverty on cervical cancer incidence and mortality in New York City (NYC).

Methods: Invasive cervical cancer cases in NYC from 1995 to 2006 were identified along with demographic and socioeconomic measures. Odds ratios (OR) of late stage diagnosis were estimated using logistic regression. Hazard ratios (HR) of death were calculated using Cox proportional hazards regression.

Results: From 1995 to 2006 cervical cancer incidence and mortality rates decreased in NYC, though black and Hispanic women had higher incidence and mortality rates than white women. Puerto Ricans (OR = 1.55, 95% CI = 1.20-2.01) and blacks (OR = 1.34, 95% CI = 1.15-1.57) were more likely to be diagnosed with late stage disease than whites. In multivariate analysis, blacks had similar mortality risk (HR 1.07, 95% CI = 0.95-1.20) to whites while Puerto Ricans had increased risk (HR = 1.31, 95% CI = 1.10-1.55), and non-Puerto Rican Hispanics (HR = 0.54, 95% CI = 0.45-0.63) and Asian/PIs (HR = 0.64, 95% CI = 0.52-0.78) had reduced risk. Women living in high poverty neighborhoods had higher mortality than women in higher income neighborhoods (HR = 1.32, 95% CI = 1.16-1.52).

Conclusions: Black and Puerto Rican women in NYC are at greatest risk of dying from cervical cancer. Race/ethnicity is predictive of late stage diagnosis, while both race/ethnicity and neighborhood poverty are important predictors of cervical cancer mortality.
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http://dx.doi.org/10.1007/s10552-010-9593-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4119171PMC
October 2010

Factors associated with initial treatment and survival for clinically localized prostate cancer: results from the CDC-NPCR Patterns of Care Study (PoC1).

BMC Cancer 2010 Apr 19;10:152. Epub 2010 Apr 19.

New York State Cancer Registry, New York State Department of Health, 150 Broadway, Suite 361, Menands, NY 12204-2719, USA.

Background: Despite the large number of men diagnosed with localized prostate cancer, there is as yet no consensus concerning appropriate treatment. The purpose of this study was to describe the initial treatment patterns for localized prostate cancer in a population-based sample and to determine the clinical and patient characteristics associated with initial treatment and overall survival.

Methods: The analysis included 3,300 patients from seven states, diagnosed with clinically localized prostate cancer in 1997. We examined the association of sociodemographic and clinical characteristics with four treatment options: radical prostatectomy, radiation therapy, hormone therapy, and watchful waiting. Diagnostic and treatment information was abstracted from medical records. Socioeconomic measures were derived from the 2000 Census based on the patient's residence at time of diagnosis. Vital status through December 31, 2002, was obtained from medical records and linkages to state vital statistics files and the National Death Index. Multiple logistic regression analysis and Cox proportional hazards models identified factors associated with initial treatment and overall survival, respectively.

Results: Patients with clinically localized prostate cancer received the following treatments: radical prostatectomy (39.7%), radiation therapy (31.4%), hormone therapy (10.3%), or watchful waiting (18.6%). After multivariable adjustment, the following variables were associated with conservative treatment (hormone therapy or watchful waiting): older age, black race, being unmarried, having public insurance, having non-screen detected cancer, having normal digital rectal exam results, PSA values above 20, low Gleason score (2-4), comorbidity, and state of residence. Among patients receiving definitive treatment (radical prostatectomy or radiation therapy), older age, being unmarried, PSA values above 10, unknown Gleason score, state of residence, as well as black race in patients under 60 years of age, were associated with receipt of radiation therapy. Overall survival was related to younger age, being married, Gleason score under 8, radical prostatectomy, and state of residence. Comorbidity was only associated with risk of death within the first three years of diagnosis.

Conclusions: In the absence of clear-cut evidence favoring one treatment modality over another, it is important to understand the factors that inform treatment selection. Since state of residence was a significant predictor of both treatment as well as overall survival, true regional differences probably exist in how physicians and patients select treatment options. Factors affecting treatment choice and treatment effectiveness need to be further explored in future population-based studies.
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http://dx.doi.org/10.1186/1471-2407-10-152DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2876077PMC
April 2010

Changes in cancer incidence patterns among a northeastern American Indian population: 1955-1969 versus 1990-2004.

J Rural Health 2009 ;25(4):378-83

Roswell Park Cancer Institute, Buffalo, NY 14263, USA.

Purpose: This manuscript examines shifts in patterns of cancer incidence among the Seneca Nation of Indians (SNI) for the interval 1955-1969 compared to 1990-2004.

Methods: A retrospective cohort design was used to examine cancer incidence among the SNI during 2 time intervals: 1955-1969 and 1990-2004. Person-years at risk were multiplied by cancer incidence rates for New York State, exclusive of New York City, over 5-year intervals. A computer-aided match with the New York State Cancer Registry was used to identify incident cancers. Overall and site-specific standardized incidence ratios (SIRs = observed/expected x 100), and 95% confidence intervals (CIs), were calculated for both time periods.

Results: During the earlier interval, deficits in overall cancer incidence were noted among males (SIR = 56, CI 36-82) and females (SIR = 71, CI 50-98), and for female breast cancers (SIR = 21, CI 4-62). During the more recent intervals, deficits in overall cancer incidence persisted among both genders (males SIR = 63, CI 52-77; females SIR = 67, CI 55-80). Deficits were also noted among males for cancers of the lung (SIR = 60, CI 33-98), prostate (SIR = 51, CI = 33-76) and bladder (SIR = 17, CI = 2-61) and among females for breast (SIR = 33, CI = 20-53) and uterus (SIR = 36, CI = 10-92). No cancer sites demonstrated increased incidence. Persons ages 60-69 years, 70-79 years, and ages 80+ years tended to exhibit deficits in overall incidence.

Conclusions: Despite marked changes over time, deficits in overall cancer incidence have persisted between the time intervals studied. Tribal-specific cancer data are important for the development and implementation of comprehensive cancer control plans which align with local needs.
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http://dx.doi.org/10.1111/j.1748-0361.2009.00247.xDOI Listing
December 2009

Fifty years of cancer in an American Indian population.

Cancer 2009 Jan;115(2):419-27

Cancer Prevention and Population Sciences, Department of Educational Affairs, Roswell Park Cancer Institute, Buffalo, New York 14263, USA.

Background: A clear understanding of cancer patterns among American Indian tribal groups has been complicated by a variety of issues. A retrospective cohort study design was applied to a Seneca Nation of Indians (SNI) cohort for the period from 1955 through 2004.

Methods: Incident cancers were identified through a computer match with the New York State Cancer Registry. Standardized incidence ratios (SIRs) and 95% confidence intervals were calculated for the overall interval as well as for each of the 5 10-year intervals. The SNI cohort consisted of 3935 men and 4193 women with a total of 120,403 person-years.

Results: Significant deficits in cancer incidence were noted among men for all sites combined (SIR, 69), and for lung (SIR, 59), prostate (SIR, 54), urinary bladder (SIR, 8), and Hodgkin lymphoma (SIR, 0); no cancer sites were identified with significantly elevated incidence. Women demonstrated significantly reduced cancer incidence for all sites combined (SIR, 70) and for breast (SIR, 39), colorectal (SIR, 72), ovary (SIR, 37), uterus (SIR, 42), bladder (SIR, 20), pancreas (SIR, 10), and non-Hodgkin lymphoma (SIR, 39); elevated incidence was noted for cancers of the lung (SIR, 139) and liver (SIR, 405).

Conclusions: To the authors' knowledge, the current study represents the most comprehensive investigation to date of cancer patterns among an American Indian tribal group and provides insights for the development of tribal cancer control programming.
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http://dx.doi.org/10.1002/cncr.24039DOI Listing
January 2009

Distribution of treatment for human papillomavirus-associated gynecologic carcinomas before prophylactic vaccine.

Cancer 2008 Nov;113(10 Suppl):2926-35

New York State Cancer Registry, New York State Department of Health, Albany, New York 12237-0679, USA.

Background: This report describes the distribution of treatment for cervix uteri, vagina, and vulva carcinomas by demographic characteristics before the widespread implementation of human papillomavirus (HPV) vaccination in the US.

Methods: The authors used data collected by the Surveillance, Epidemiology, and End Results Program from 2000 through 2004 to calculate the distribution of surgical procedures and radiotherapy by carcinoma site, disease stage, and tumor histology (squamous vs nonsquamous). For women with localized cervical carcinomas, the proportions of hysterectomy procedures were analyzed by age, race, ethnicity, marital status, and histology, including a 13-year trend analysis of hysterectomy use.

Results: Although 75% of the women with cervical carcinomas underwent hysterectomy, there were significant differences in treatment by race and ethnicity. Black women were least likely to undergo hysterectomies: The large gap between them and other racial/ethnic groups persisted throughout the study period. For all 3 carcinoma sites, both tumor histology and disease stage influenced radiotherapy modality and the extent of surgery. Nonsquamous histology, ages 30 to 64 years, Asian/Pacific Islander race, and marriage were associated positively with hysterectomy. Overall, a gradual decrease in hysterectomy use was observed over time. Hysterectomies among Hispanic white women increased slightly.

Conclusions: Cancer surveillance data suggest that treatment patterns of HPV-associated carcinomas are correlated with both clinical and demographic characteristics. The decreasing use of hysterectomy before introduction of the HPV vaccine and the vaccine's potential effect on the age-related stage distributions warrant consideration when evaluating its future impact on the delivery of care for women with HPV-associated tumors.
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http://dx.doi.org/10.1002/cncr.23751DOI Listing
November 2008

Survival difference between non-Hispanic black and non-Hispanic white women with localized breast cancer: the impact of guideline-concordant therapy.

J Natl Med Assoc 2008 May;100(5):490-8

Louisiana Tumor Registry, Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA.

Objectives: This study examined the impact of guideline-concordant therapy on the survival difference between non-Hispanic black (NHB) and non-Hispanic white (NHW) women with localized breast cancer.

Methods: Data analyzed were from the CDC's NPCR Patterns of Care study in which seven population-based state cancer registries participated. We randomly selected 2,362 women who were diagnosed with a first primary localized breast cancer in 1997. Data were abstracted from hospital records, supplemented by information from physician offices and by linkages with state vital records and the National Death Index database.

Results: NHB women were more likely than NHW women to receive breast conserving surgery without radiation therapy. In addition, the percentage of NHB women with hormone receptor-positive tumors who received hormonal therapy was lower than that of NHW women. Among those with a tumor size > 3 cm, NHB women were more likely than NHW women to receive multiagent chemotherapy. After controlling for age, the risk of dying from all causes of death was 2.35 times as high for NHB women compared to NHW women. Controlling for treatment further reduced black-white difference in survival with adjustment for sociodemographic and clinical variables.

Conclusion: NHB women were less likely than NHW women to receive guideline-concordant radiation therapy after breast conserving therapy and hormonal therapy but were more likely to receive chemotherapy. Racial differences in treatment contribute significantly to the worse survival of NHB women compared with NHW women.
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http://dx.doi.org/10.1016/s0027-9684(15)31295-5DOI Listing
May 2008

Methodologic issues in follow-up studies of cancer incidence among occupational groups in the United States.

Ann Epidemiol 2006 Mar 21;16(3):170-9. Epub 2005 Sep 21.

Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35294, USA.

Purpose: Incidence studies of occupational factors and cancer in the United States are problematic because the use of population-based registries to identify cases requires development of historical data on subjects' residences and often severely restricts the time period of follow up. This article describes procedures for addressing these challenges.

Methods: We used data from studies of cancer incidence and mortality among microelectronics industry employees to assess various methods for developing residential histories and the relative informativeness of the two studies.

Results: We developed residential histories for 98% of 99,229 mortality study subjects. Analyses making alternative assumptions about residential histories yielded standardized incidence ratios varying by at most 6%. Use of postemployment residential histories increased person-years by up to 62% and increased the observed number of cancers by up to 28%. The proportion of mortality study person-years included in the cancer incidence study ranged from 40% to 77% among work activity subcohorts. The number of observed cancer cases in the incidence study was 60% higher than the number of observed cancer deaths in the mortality study.

Conclusions: Assumptions about residential history had little impact on validity. Use of information sources with national coverage to develop residential histories increased the incidence study's precision. Despite geographic and temporal restrictions, incidence studies provide more data than mortality studies on cancers with good survival. However, the potential for selection bias in incidence studies may vary considerably among subcohorts, indicating the need for cautious interpretation of such research.
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http://dx.doi.org/10.1016/j.annepidem.2005.06.055DOI Listing
March 2006
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