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December 16, 2021 – JAMA Network Tweet
Oropharyngeal cancer, or cancer in the middle part of the throat behind the mouth, can affect the base of the tongue, tonsils, soft palate, uvula, and more. Human papillomavirus (HPV) is believed to cause most oropharyngeal cancer cases, but other risk factors include smoking and heavy alcohol use.
Researchers at UTHealth in Houston, Texas used the National Program of Cancer Registries (NPCR) and the Surveillance, Epidemiology, and End Results (SEER) Program to examine de-identified oropharyngeal cancer data by demographics, tumor stage, and geography between 2001 and 2017. In this time frame, the researchers studied over 260,000 total cases of oropharyngeal cancer, with the incidence rate increasing by 2.7% each year for men. Cases diagnosed in the regional stage, where the cancer has spread to nearby tissues, increased by 3.1% for men. Incidence also increased by 3% per year for men over 65 years old. Over 50% of diagnoses occurred in the Southeast and Midwest, increasing by over 3.5% a year for men and over 2% for women living in these regions.
However, the investigators found incidence rates decreased for men and women younger than 45. The introduction of the HPV vaccine, decreasing smoking rates, fewer sexual partners, or some combination of these factors may be responsible for this decrease. Based on these findings, the researchers call for more studies on prevention, screening, and detection to understand and combat the rise in oropharyngeal cancer.
December 3, 2021 – Society of Urologic Oncology Tweet
240,000 men are diagnosed with prostate cancer each year, making it the second most common cancer in the United States. When diagnosed at either the localized or regional stages, prostate cancer has a nearly 100% 5-year survival rate. In distant stages, also known as metastatic disease, the 5-year survival rate drops to about 30%.
In 2008, the United State Preventive Services Task Force (USPSTF), which issues screening recommendations for various diseases, recommended against routine screening for prostate cancer for men over 75 years old. In 2012, the USPSTF issued new recommendations for men between the ages of 55 and 69. In the recommendations, the USPSTF states the potential harms of screening, rejects routine screening, and emphasizes that men between 55 and 69 should decide if screening is right for them after talking with their clinicians.
Researchers from the University of California Los Angeles used the Surveillance, Epidemiology, and End Results (SEER) Program to explore the impacts of these screening guidelines on metastatic prostate cancer incidence between 2004 and 2018. They found incidence rates of metastatic prostate cancer remained stable from 2004 to 2010 in men between the ages of 45 and 74. However, between 2010 and 2018, the incidence rate of metastatic disease for this age group increased by 5.3%. In men older than 75, the incidence rate for metastatic prostate cancer had decreased from 2004 to 2010 but then rebounded by 6.5% between 2010 and 2018. The researchers note these increases correlate with changes in screening guidelines issued by the USPSTF . NCI, ACS, CDC, and NAACCR found similar results as part of their Annual Report to the Nation on the Status of Cancer from 2018.
October 26, 2021 – JNCI: Journal of the National Cancer Institute Tweet
The Annual Report to the Nation (ARN) is a collaboration between the American Cancer Society, National Cancer Institute, Centers for Disease Control and Prevention, and North American Association of Central Cancer Registries. Earlier this year, the ARN released part one of its report detailing cancer statistics in the United States. Part two of the report examines how much cancer care costs patients. The report calculated cancer cost a total of $21.1 billion in 2019, which includes out-of-pocket costs and time costs.
The report examined two different groups: adults 65 and older and adults between 18 and 64 years old. In the first year after a cancer diagnosis, adults 65 and older spent approximately $2,700 in out-of-pocket costs, while younger patients spent $5,900. Patients who were diagnosed with localized cancer had lower costs compared to patients with regional and distant cancers. However, the report also details how end-of-life care is most expensive, regardless of the cancer’s stage at diagnosis.
Cancer treatment cost US patients an estimated $16.22 billion. The cancers with the highest total cost, which also reflects their high prevalence, are breast ($3.14 billion), prostate ($2.26 billion), colorectal ($1.46 billion), and lung ($1.35 billion). Time-costs associated with cancer treatment are estimated to be $4.87 billion, with younger patients bearing higher time-costs compared to adults 65 and older. By combining these two, the report arrives at a total cost for cancer of $21.1 billion in 2019.
August 24, 2021 – American Cancer Society Journals Tweet
In a study published by the American Cancer Society, Kimberly D. Miller and colleagues explored brain and central nervous system tumors reported between 2008 and 2017 in collaboration with the Central Brain Tumor Registry of the United States (CBTRUS), which compiles brain and central nervous system cancer data from the NCI’s Surveillance, Epidemiology, and End Results (SEER) Program and the CDC’s National Program of Cancer Registries (NPCR). The researchers also utilized SEER*Stat software to calculate incidence and survival rates for malignant and nonmalignant brain tumors and other central nervous system tumors across ages, sexes, races, and ethnicities during this period.
The researchers found the risk for developing brain tumors increases with age, but that overall incidence for malignant brain tumors decreased by 0.8% from 2008 to 2017. However, while the incidence rate for all ages combined decreased, malignant brain tumor incidence increased in children and adolescents from 0.5% to 0.7%. Men and non-Hispanic Whites have the highest incidence rate for malignant brain tumors, while women and non-Hispanic Blacks have the highest incidence rate of nonmalignant tumors. Five-year survival rates, which measure how many study participants are alive five years after diagnosis, are high across all ages for all nonmalignant brain tumors. However, the five-year survival rate for malignant tumors varies dramatically for each specific subtype. For example, glioblastoma, which accounts for half of the malignant brain tumor diagnoses, has the lowest survival rate across all age groups. The survival rates are not uniform either; black children have lower survival rates for diffuse astrocytomas and embryonal tumors.
The authors call for more resources for cancer registries that collect and report data on brain and central nervous system tumors. They note that much more research is needed to advance understanding of the causes of brain tumors and explain the wide variation in occurrence, survival, and racial disparities.
Hispanic men are more likely to receive amputation to treat cancer in feet, according to analysis of SEER data
August 24, 2021 – Journal of Surgical Oncology Tweet
Researchers at the University of California-Davis used the Surveillance, Epidemiology, and End Results (SEER) Program to study foot cancer reported from 1975 to 2017. Because these cancers are rare—only 514 patients participated in the study during this 42-year window—the researchers believe they are the first to study foot cancers using population-based data. These cancers can affect the bones, cartilage, and/or marrow of the feet, and treatment options typically include surgery, radiation, and/or chemotherapy.
The investigators found that age could predict the five- and ten-year survival rates for these patients, with survival rates decreasing for those over 65 years old. They also found Hispanic men were more likely to receive amputation to treat their cancer compared to patients of other racial and ethnic groups. The investigators suggest this may be due to higher rates of osteosarcoma in Hispanics. However, they also suggest disparities issues, like socioeconomic factors and insurance coverage, may be related to higher rates of amputation within this group.
CISNET Study Supports Early Breast Cancer Screening in Childhood Cancer Survivors Not Treated With Radiation
August 18, 2021 – JNCI Tweet
Experts recommend female childhood cancer survivors who received chest radiation as part of their treatment begin breast cancer screening earlier than the general population. However, there are no particular recommendations for childhood survivors treated without chest radiation. A recent study published in the Journal of the National Cancer Institute examined the potential clinical benefits and cost-effectiveness of early breast cancer screening among childhood cancer survivors treated without chest radiation.
Using data from the Childhood Cancer Survivor Study, researchers adapted two CISNET breast cancer simulation models and SEER- Medicare data to reflect the elevated risks of breast cancer and competing mortality among leukemia and sarcoma survivors. Researchers compared joint digital mammography screening with MRI starting at 25, 30, 35, or 40 years of age.
According to the simulation, 36.3% to 43.4% of survivors will develop breast cancer in their lifetime. Without screening, the estimated lifetime risk of dying from breast cancer is 6.8% to 7.0%. Based on this study, screening at 25 to 40 years of age could reduce up to 64% of breast cancer deaths. However, starting screening before age 40 is not cost-effective.
The investigators highlight the importance of early breast cancer screening among childhood cancer survivors treated without chest radiation. Screening experts can consider these findings to update screening guidelines and improve follow-up care for all childhood cancer survivors.
July 28, 2021 – JNCI Tweet
Mammography is the gold standard for breast cancer screening. However, women at higher risk for breast cancer often require more sensitive Magnetic Resonance Imaging (MRI) screening. While the Affordable Care Act mandates insurance providers waive cost-sharing for preventative services like mammography, there is no such provision for breast MRI screenings.
A study funded by the NCI’s Surveillance Research Program (SRP) explored these financial burdens associated with breast cancer screening. The investigators analyzed de-identified insurance claim data and calculated the out-of-pocket costs for women who received mammography or breast MRI screenings between 2008 and 2017.
The percentage of women who had zero out-of-pocket costs for mammography screening increased from 81.9% in 2009 to 96.8% in 2017. However, the percentage of women who had zero out-of-pocket costs for breast MRI screening decreased from 43.1% to 26.2% over the same period. Worse still, women with high-deductible insurance plans who received breast MRI screening are more likely to have double the out-of-pocket cost compared to women who received the same service with standard deductible insurance ($545 vs $251). These costs varied geographically as well, with women in the South receiving larger invoices.
The investigators point out the vicious cycle in these trends. Over 25% of the women in this study paid $376 or more for screenings. Given that 40% of American households cannot cover an unexpected $400 expense, according to a study from the Federal Reserve, these high costs can increase financial burdens or outright block access to service for especially at-risk women.
July 26, 2021 – Cancer Tweet
There will be more than an estimated 88,000 new adolescent and young adult (AYA) cancer cases in the US in 2021. The AYA population includes individuals who are ages 15 to 39 years. Cancer, a journal sponsored by the American Cancer Society, has published a July 2021 study on cancer survival among the AYA population. Dr. Denise Riedel Lewis and colleagues from the National Cancer Institute (NCI) examined US mortality data to determine which cancer types had the highest mortality rates among AYAs. Then, with data from the Surveillance, Epidemiology and End Results (SEER) Program, they evaluated incidence, and survival rates and trends for 9 cancer types with the highest mortality from 1975-2016.
The authors found that mortality rates were highest for 9 AYA cancer types, including female breast cancer, brain and other nervous system cancers, cervical cancer, colon and rectum cancer, ovarian cancer, lung cancer, acute myeloid leukemia, non-Hodgkin lymphoma, and bone, joint, and soft tissue sarcomas. The team examined survival improvement and determined that brain, colon and rectum, lung, acute myeloid leukemia, and non-Hodgkin lymphoma cancers had significant improvement in 5-year relative survival. Female breast, cervical, ovarian, and bone and joint sarcoma cancers showed little to no improvement in survival. Females had higher 5-year relative survival for all cancer types compared to males, and 5-year relative survival for all cancer types was greater than 80 percent for all race/ethnic groups except for black non-Hispanics, who had a 5-year relative survival of nearly 75 percent.
Dr. Lewis and colleagues concluded by saying "our examination of survival trends among AYAs diagnosed with cancer in the United States shows progress in some cancer types.” Explanations for progress in individual cancers include uptake of prevention, advances in diagnosis and treatment and containment of risk factors. Though it may not be evident due to rising incidence rates, five-year survival rates for certain cancer types among AYAs are steadily improving. Continued research is necessary to monitor survival rates for female breast, cervical, ovarian, and bone and joint sarcoma cancers, which show little improvement at this time.
July 14, 2021 – JNCI Tweet
The COVID-19 pandemic created disruptions across nearly every aspect of life in the United States. Some of these disruptions were highly visible, such as cancelled graduations or delayed weddings, while others were more inconspicuous, such as missed routine doctor visits. During the first six months of the pandemic, public health measures barred elective medical procedures, which included screening mammography for breast cancer. Other services, such as diagnostic mammography and chemotherapy for early-stage patients, were reduced or delayed as well.
Investigators at the University of Wisconsin-Madison explored the potential long-term impact of these disruptions on breast cancer mortality over the next ten years. Using data from the National Cancer Institute Cancer Intervention and Surveillance Modeling Network (CISNET) and models of breast cancer incidence and mortality, the researchers estimated a 0.52% increase in breast cancer deaths by 2030 due to these disruptions. Many of these deaths may be attributed to delayed screening and diagnosis.
If these screening and diagnosis disruptions continued for a full year, the investigators projected a 1% increase in breast cancer deaths by 2030. However, the investigators attributed the overall small increase (0.52%) to the rapid implementation of new screening and diagnostic strategies in the wake of the pandemic. The investigators noted that the increase in breast cancer deaths can be mitigated if health care systems ensure prompt access to screening, diagnostic, and treatment procedures as well as prioritize women who missed their routine mammography during the pandemic.
July 8, 2021 – Axios Tweet
Overall cancer death rates decreased from 2014 to 2018, with the largest drops seen in lung cancer and melanoma, according to the Annual Report to the Nation on the Status of Cancer. The report, which is produced with collaboration from the National Cancer Institute, Centers for Disease Control and Prevention, American Cancer Society, and North American Association of Central Cancer Registries, also examines specific types of cancers and their trends over this period. While overall cancer death rates have decreased across all types combined, the improvements in death rates seen in previous annual reports stagnated for some of the most common cancers like colorectal, breast, and prostate cancer.
Marisa Fernandez in Axios summarized these findings and provided context given the ongoing COVID-19 pandemic. Fernandez quotes an NCI model that projects an additional 10,000 deaths over the next decade due to pandemic-related disruptions in screening and treatment for breast and colorectal cancers. Despite the disruptions, Dr. Ned Sharpless, NCI director, issued a statement in the Axios article indicating the findings are proof of scientific advancement and improvement of outcomes at the population level. Dr. Sharpless added further improvements are achievable by “[addressing] obesity, which has the potential to overtake tobacco use to become the leading modifiable factor associated with cancer.”
July 6, 2021 – Cancer Today Tweet
Cancer communication can be hard to digest. The medical terminology and numbers swimming across the page certainly don’t make the process of sharing information any easier. Dr. Kathy Cronin, Deputy Associate Director of the Surveillance Research Program (SRP) at the National Cancer Institute (NCI), notes to Cancer Today magazine that cancer survival statistics are “important to people who are diagnosed so they know what their prognosis is.”
Resources like the Surveillance, Epidemiology and End Results (SEER) Program help cancer patients, caregivers, researchers, and others explore a broad range of cancer data like incidence, mortality, survival, prevalence, and stage at diagnosis rates. Some of SEER’s most requested calculations are 5-year relative survival rates. Relative survival help others determine the number of people who are expected to survive the effects of their cancer, excluding the risk of non-cancer related causes of death, for a pre-determined number of years. The relative survival rates are calculated by using the percent of patients with the disease who are still alive at the end of the period of time and dividing it by the percent of people in the general population of the same sex and age who are alive at the end of the same time period.
A person’s prognosis can be affected by individual cancer patient factors such as diet and exercise, smoking status, access to care, and other demographics. Survival rates are one of the ways to summarize the bigger picture of the cancer burden in a given population, fulfilling the NCI mission to support cancer research across the nation, advance scientific knowledge, and help all people live longer, healthier lives.
July, 2021 – Radiology Society of North America Tweet
In 2018, there were an estimated 235,081 women living with ovarian cancer in the United States. Ovarian cancer is currently the 5th most common cancer diagnosis for women. Siqi Hu, a PhD candidate and the lead author of an April 2021 ovarian cancer study, has been doing research at the University of Utah and Huntsman Cancer Institute, which is one of the Surveillance, Epidemiology, and End Results cancer registries for the National Cancer Institute (NCI). The study explored the correlation between ovarian cancer, mental health, and mortality rates. Dr. Hu and colleagues analyzed data from 1,689 ovarian cancer patients from 1996-2012 and compared them to 7,038 women without cancer.
The research team found that compared to the general population, patients with ovarian cancer were 3 times more likely to receive a mental illness diagnosis in the first two years after their cancer diagnosis. The risk of depression after receiving an ovarian cancer diagnosis was 3.11 times higher in the first two years and 1.67 times higher 2-5 years after diagnosis. The risk of anxiety disorders among ovarian cancer survivors is 3.54 times higher in the first two years after diagnosis and 1.86 times higher 2-5 years after diagnosis. Heightened rates of depression and anxiety also lead to higher mortality rates in ovarian cancer patients. Ovarian cancer patients with a mental health diagnosis were 1.8 times more likely to die when compared to those who did not have a mental health diagnosis.
The author indicates that mental health screenings and services are needed during and after ovarian cancer diagnoses. Mental health screenings may help patients and providers identify signs of depression and anxiety throughout the course of treatment, and increased support could help aid in increasing survivorship rates of ovarian cancer patients.
June 23, 2021 – MedPage Today Tweet
Kristin Jenkins, Contributing Writer for MedPage Today, highlighted the Surveillance, Epidemiology, and End Results (SEER) Program’s Cancer Stat Facts Sheet on childhood leukemia in a recent article for the Clinical Challenges section. The fact sheet, which focuses on data from patients aged 0 to 19, includes a declining death rate over the last few decades and a five-year survival rate of 85.3%. These statistics are for childhood leukemia overall, meaning all subtypes combined. For pediatric acute myeloid leukemia (AML), the prolonged event-free survival rate now exceeds 70%, up from below 50% around 1990. However, as outlined in MedPage Today, anywhere from 20 to 40% of pediatric AML patients experience relapse, with up to 70% of this subset not surviving the intense chemotherapy and stem cell transplant treatment regimens. Novel therapies in early-stage clinical trials show promise for these patients. Ms. Jenkins’ article is a prime example of how analyzing cancer surveillance data can help researchers pinpoint both areas of progress and those in need of advancements to improve treatment outcomes. SEER supports cancer research through providing high quality, population-based data as a public service.
Note: SEER also has a Stat Facts page on Acute Myeloid Leukemia, which includes statistics by age group.
June 22, 2021 – Stat Tweet
In late August 2020, “Black Panther” star Chadwick Boseman died of stage IV colon cancer at the age of 43. His death came as a shock, as he kept his diagnosis of stage III colon cancer in 2016 private. Boseman’s battle with cancer reflects a growing trend with the disease, as its incidence and mortality rates rise among younger people. African American men especially appear at risk of the disease, according to several new studies.
A study published in the American Journal for Cancer Research identified 232 counties in the contiguous United States to be “hot spots” for early-onset colorectal cancer mortality. The study, which used Surveillance, Epidemiology, and End Results (SEER) data combined with data from the Centers for Disease Control, examined the outcomes of over 32,000 White, Black, and Hispanic men diagnosed with early-onset colorectal cancer between 1999 and 2016. The South contains an overwhelming majority, 92%, of these hotspot counties. Within these counties, later-stage and metastatic colon cancer diagnoses were more likely and survivability decreased. Non-Hispanic Black men in these areas demonstrate a 31% increased risk of death from colorectal cancer compared to Non-Hispanic White men living in the same area.
These researchers also examined early-onset colorectal cancer in women for similar geographic hot spots in a publication in Clinical and Translational Gastroenterology. In this study, which also used SEER data and similar analyses to the previous study, 191 hot spot counties were identified, with 101 of them located in the South. Compared to the male-centric study, this study found more hot spots for women in the Midwest and Northeast. The investigators examined community health behaviors, such as smoking, obesity, and physical inactivity, and found them to be positively correlated with early-onset colorectal cancer.
Neither of these studies presents causality. However, both studies illuminate cancer disparities for future investigation and raise awareness of a growing problem facing younger people. To further emphasize this point, a recent related publication in JAMA Network Open used data from the SEER program, combined with population projections from the US Census Bureau, to predict that colon cancer will be the leading cause of cancer-related death in adults aged 20 to 49 by 2030.
Racial and ethnic disparities in pediatric cancer incidence among children and young adults in the United States by single year of age
June 21, 2021 – American Cancer Society Journals Tweet
Averaging or grouping data together can be an effective strategy for analysis and interpretation of large sets of data. However, as shown in a recent study published in Cancer, making data less granular through these methods may obscure important details or trends.
Researchers at the University of Minnesota used data from the Surveillance, Epidemiology, and End Results (SEER) Program to examine cancer incidence rates from birth to 39 years old. Instead of grouping ages into ranges, which can be a convenience for large datasets, the investigators explored cancer rates by individual ages (1 year old, 2 years old, etc.) and by racial and ethnic groups.
The investigators found Black children and young adults have a substantially lower risk of acute lymphoid leukemia when compared to White children and young adults. However, Black children and young adults are at increased risk for non-Hodgkin lymphoma starting at age 28 and for a rare kidney tumor before age 5. Hispanic children are at higher risk for Hodgkin lymphoma from birth through 9 years compared to White children. Beyond 9 years of age, Hispanics demonstrate a lower risk for Hodgkin lymphoma. Asian and Pacific Islanders, and American Indian and Alaska Natives groups were found to have lower rates for many types of childhood cancers.
The investigators hope further research into these incidence rates will help explain the cancer risk disparities observed in children and young adults of different racial and ethnic groups.
May, 2021 – Annals of Internal Medicine Tweet
Mammograms can identify both potential tumors as well as breast cancer risk factors, such as dense breasts. According to the Centers for Disease Control and Prevention, approximately half of women aged 40 or older have dense breasts. However, women may not know if they have this risk factor until later in life because the U.S. Preventive Services Task Force (USPSTF) recommends that screening mammography begins at age 50 and continues biennially for women of average risk.
Using data from the Surveillance, Epidemiology, and End Results (SEER) Program, researchers supported by the NCI’s Surveillance Research Program (SRP) at the University of Texas MD Anderson Cancer Center modeled outcomes and costs associated with new and existing mammography screening strategies. The researchers found a new strategy that may be more cost-efficient than the current USPSTF guidelines. This strategy involves a baseline mammogram at age 40, followed either by annual screening for women between 40 and 75 years old with dense breasts or biennial screening for women in the same age range without dense breasts. The researchers also suggest earlier screening may promote more patient-physician communication, which may facilitate lifestyle changes to reduce risk.
Evaluation of Racial/Ethnic Differences in Treatment and Mortality Among Women With Triple-Negative Breast Cancer
May 13, 2021 – JAMA Oncology Tweet
According to a study published in JAMA Oncology and reported on Cancer Network, non-Hispanic African American women with nonmetastatic triple-negative breast cancer (TNBC) fared worse when compared with White women with the same diagnosis. Specifically, the risk of breast cancer mortality was significantly higher for African American women, even after accounting for sociodemographic and county-level factors.
The population-based, retrospective study used the Surveillance, Epidemiology, and End Results (SEER) database to examine outcomes of 23,123 women who received a nonmetastatic (stage I to stage III) TNBC diagnosis between January 1, 2010 and December 31, 2015. Within this group, 5881 (25.3%), were African American and 17,332 (74.7%) were White. The analysis continued through either the date of death, date of last contact, or December 31, 2016, whichever came first.
Compared to White women in this dataset, African American women were younger at diagnosis, more likely to be insured through Medicaid, and more likely to live in deprived and urban counties. African American women in this group also presented with larger and more aggressive tumors. While most patients received surgery, chemotherapy, and/or radiation therapy, African American women were found to have lower odds of receiving surgery and chemotherapy compared with White women. Neither group was more likely to receive radiation therapy. The investigators found African American women had a lower 5-year survival rate (76.9%) compared to White women (82.9%).
The investigators suggest these disparities may be due to discriminatory practices in the health care system, unsatisfying communication with clinicians, increased travel and financial burdens, and treatment at underfunded and safety net hospitals. They propose future studies on these factors, as well as tumor biology and microenvironment, to fully understand and remediate the observed disparities.
May, 2021 – Radiology Society of North America Tweet
Breast cancer mortality rates for US women overall have been steadily declining since 1989. However, this may no longer be the case for US women under the age of 40, according to a recent study. R. Edward Hendrick and colleagues analyzed US breast cancer incidence and mortality rates among women ages 20-79 years.
The study authors utilized the National Cancer Institute’s (NCI) Surveillance, Epidemiology, and End Results (SEER) Program to examine delay-adjusted invasive breast cancer incidence rates by race, age, and stage, and Joinpoint software to study breast cancer mortality trends. The study population was split into three groups: 20-79 years of age, 20-39 years of age, and 40-69 years of age. Overall breast cancer mortality rates decreased 1.5%-3.4% from 1989-2010 for women in all age groups combined. However, after the year 2010 mortality rates for women younger than 40 showed no significant change in either direction. Alarmingly, late-stage breast cancer incidence rates in women 20-39 years of age increased by more than 4% after the year 2000. This increase might have contributed to the plateau in mortality. The authors emphasize the need for future research on the potential causes for changes in breast cancer trends among women under 40.
May, 2021 – Cancer Epidemiology, Biomarkers & Prevention Tweet
In a study recently published in Cancer Epidemiology, Biomarkers, & Prevention, Dr. Don C. Codipilly and colleagues from the Mayo Clinic examined esophageal adenocarcinoma cases in individuals under the age of 50, ages 50-79, and over the age of 70 using Surveillance, Epidemiology, and End Results (SEER) data from the National Cancer Institute (NCI). The study team also analyzed disease stage, incidence rates, and survival trends of esophageal adenocarcinoma cancer in three different time periods: 1975-1989, 1990-1999, and 2000-2015. While analyzing the data the research team made a startling discovery; incidence rates for adenocarcinoma of the esophagus have been increasing among individuals under the age of 50. Adenocarcinoma is a type of esophageal cancer that begins in the glandular cells of the esophagus and forms in the lower part of the stomach.
Esophageal cancer is the 11th deadliest cancer in the US, with a 5-year relative survival rate of 19.9%. This means that out of 100 people with this cancer, about 20 will not die of their cancer 5 years after their diagnosis. This excludes the risk of dying from other causes. Though esophageal cancer is uncommon it is still rising in incidence especially among younger patients, and the disease is also being diagnosed in later stages for patients under 50. The study authors suggest current diagnostic and management strategies need to be reassessed if we want to decrease the esophageal cancer burden in the US for patients suffering from this disease.
March 5, 2021 – Breast Cancer Research and Treatment Tweet
The United States Preventive Services Task Force (USPSTF) currently recommends that women aged 50 to 74 years old should receive biennial screening mammography, notably excluding women 75 and older. These guidelines, last updated in 2016, are currently under review and may be updated this year. In conflict with USPSTF’s current recommendation, the American Cancer Society advises older women to continue receiving regular screening if they are in good health.
In a recent publication in Epidemiology, researchers at Emory University and Dr. Erica Breslau from the National Cancer Institute’s Division of Cancer Control and Population Sciences reviewed breast cancer incidence and screening mammography data for women over age 65. The study included data from the Surveillance, Epidemiology, and End Results (SEER) Program, and the researchers used SEER*Stat for part of their analysis.
Dr. Breslau and colleagues found that breast cancer incidence is highest for women between 70 and 74 years old. However, women between 75 and 79 years old had a higher incidence of breast cancer than women between 65 and 69 years old. Women 75 and older are also at higher risk of advanced stage or metastatic cancer. Nearly half of the women over 77 years old received a screening mammography in the last two years, according to the study. The investigators suggest future studies into the systemic reasons related to the discrepancy between screening guidelines and practice.
February 24, 2021 – JAMA Internal Medicine Tweet
According to a recent study in JAMA Internal Medicine using real-world data, COVID-19 antibodies may form a resistance against re-infection. The article is the result of a collaborative effort between the National Cancer Institute (NCI), HealthVerity, Aetion, Inc., and five commercial labs, including Quest and LabCorp. NCI researchers applied their expertise in serology (usually in terms of how the immune system relates to cancer) to its role in SARS-CoV-2 infection. The study team included Dr. Ned Sharpless, Director of the NCI, Dr. Doug Lowy, NCI Deputy Director, and Dr. Lynne Penberthy, Associate Director of the NCI’s Surveillance Research Program (SRP).
The study team examined a data set with clinical information from over 3 million individuals to determine separate antibody indexes. Approximately 88.3% had a negative antibody index; 11.6% had a positive antibody index. Among those who were positive for antibodies, only 0.3% were reinfected with the COVID-19 virus, while 3% of those who were negative for antibodies were re-infected. Study authors were able to conclude that those with a presence of antibodies were much less likely to test positive for up to 6 months or more. Dr. Sharpless stated that it is incredibly rare to get re-infected and those who do are often asymptomatic. Investigators also noted that COVID-19 antibodies work similarly to the vaccine, however, the antibodies do not have a clear window of protection against the virus.
The NCI authors and their collaborators have uncovered new information regarding COVID-19 antibodies. The researchers’ findings will help to further the scientific community’s understanding of COVID-19 and support the development of strategies to fight against it.
December 21, 2020—Clinical and Translational Gastroenterology Tweet
The December 2020 version of the Clinical and Translational Gastroenterology Journal features a study from Vanderbilt University’s Dr. Andreana Holowaytj and colleagues. The investigative team examined colorectal cancer mortality rates among women under the age of 50 in counties across the United States. The study is the first of its kind within the United States to examine rates of colorectal mortality rates by geographical area. The study team utilized the National Cancer Institute’s (NCI) Surveillance, Epidemiology and End Results (SEER) Program in order to examine data results of women in the United States, from the ages of 15-49, who were diagnosed with colorectal cancer between 1999 and 2016. The authors linked the SEER data with information from the CDC, American Community Survey, and County Health Rankings databases. According to the results, colorectal cancer mortality rates are increasing among adults under the age of 50 especially within specific counties across the United States, labelled as ‘hot spots.’ On average, every 1 out of 16 counties that were examined were labelled as a hot spot for colorectal cancer mortality; overall, out of the 3,108 counties that were examined, 191 qualify as hot spots. 52.9% of those hot spots are in Southern counties, and non-Hispanic and Black individuals represent an average of 19.3% of the population in those hot spot counties. Adverse characteristics that were common within these hot spot counties were low fertility rates and a lack of physical fitness; 5% of women in these counties experienced live births in the past year and nearly 25% of adults reported a lack of physical activity in their leisure time. Some of the high population counties that had high mortality rates for this particular study were Miami-Dade County, Cook County (Chicago), Fulton County (Atlanta), New Castle County (Wilmington, Del.), Fairfield County (Bridgeport, Conn.), St. Louis County, Bergen County (New Jersey suburbs of New York metropolitan area), Queens County (Queens borough of New York), Mecklenburg County (Charlotte, N.C.), Hamilton County (Cincinnati, Ohio), Tulsa County, and Philadelphia County.
The study team’s research has drawn attention to the fact that cancer intervention strategies, such as behavioral health interventions for physical activity, will play an integral part in constructing positive change towards cancer outcomes. Strategies like these will help to decrease the cancer burden in hot spot communities and other communities across the United States. In addition, more research must be done to further understand colorectal cancer incidence and mortality rates among women of all backgrounds and in specific geographic regions.
December 7, 2020—MedPage Today Tweet
According to a study in MedPage Today, incidence rates of anal cancer are on the rise especially for women over the age of 45. Dr. Anas Raed of Augusta University in Georgia and colleagues discovered the trend while using the National Cancer Institute’s (NCI) Surveillance, Epidemiology and End Results (SEER) Program. While analyzing the SEER data, Dr. Raed’s team was able to uncover the annual percentage change (APC) of anal cancer rates over time; the team specifically looked at rates of anal cancer in the U.S. population in those above and below the age of 50. The investigative team categorized the data by histology, gender, and race. Incidence rates for anal cancer grew from 2001 to 2016, particularly among women. Men account for 37.5% of anal cancer diagnoses, while women account for 62.5%. For women, Caucasians have the highest incidence rates for anal cancer, representing 86.7% of cases, followed by African Americans at 10.9%; the remaining 2.4% fell into the ‘other’ race category. Women ages 55 to 59 experienced the highest number of new diagnoses and women above the age of 45 reportedly had a higher-than-average APC. Through his research, Dr. Raed draws attention to our country’s increased need for cancer screenings and other preventive measures. While anal cancer is uncommon, it is preventable. The human papillomavirus (HPV) vaccine, if it is administered to men and women prior to sexual activity, has proven to be effective against anal cancer. However, more than 50% of adults in the U.S. are not vaccinated against HPV, which leads to an increased risk for anal cancer.
By the end of 2020, a projected 5,900 women will have been diagnosed with anal cancer and 810 women will have died from it. According to Raed, there is no current explanation for the sudden rise in anal cancer or the racial and gender disparities the disease has, however, more than 90% of anal cancer cases have been linked to HPV. With anal cancer cases on the rise in even the most developed countries, we must find innovative ways to prevent and treat this disease. While routine screening and monitoring will play an important part in decreasing anal cancer diagnoses, patients and providers will have to work together to decrease anal cancer rates. Patients, especially those who are at high risk of being diagnosed with anal cancer, and their doctors must continue to educate themselves on preventive cancer measures to reduce anal cancer diagnoses over time.
December 3, 2020 – Health Day Tweet
When examining cancer trends in US Adolescents and Young Adults (AYAs), Penn State’s Alyssa R. Scott and colleagues made a grim discovery: cancer rates have increased by 30% from 1973-2015, a 42-year timespan, among the AYA population. The study team, comprised of researchers from 5 different academic research facilities, used Surveillance, Epidemiology, and End Results (SEER) data from the National Cancer Institute (NCI) to conduct their analysis. The data included patient demographics, the frequency of cancer types, and cancer incidence trends over time. All individuals included in the data set were ages 15-39; 59.1% of the study population identified as female and 79.9% identified as white.
Overall rates of cancer have increased among AYAs, and many different cancer types are contributing to the rising trend. While kidney cancer has increased the most for the combined male and female AYA population, the next most common cancers vary by sex. Females tend to have higher rates of breast (25%), thyroid (17%), cervical and uterine (12%) cancer diagnoses, while males have higher rates of testicular (19%), melanoma (10%), and Non-Hodgkin Lymphoma (10%) cancer diagnoses. The rise in diagnostic imaging, poor diet, insufficient exercise, obesity, UV tanning exposure, substance abuse, and risky sexual behavior in the AYA population may contribute to a large portion of cancer diagnoses in this group. This includes new cases of colorectal cancer, which are also on the rise.
AYA cancer patients often have unique concerns when facing a cancer diagnosis. This population is much more likely to struggle with treatment due to early life transitions such as school, work, and potential fertility concerns. While the risk of cancer in the AYA population remains low, this is still a growing health concern in the US.
Researchers Say Younger Indian And Pakistani Women Could Benefit from Culturally Targeted Breast Cancer Screening
October 25, 2020—International Journal of Cancer Tweet
The International Journal of Cancer recently published an article featuring Cancer Intervention and Surveillance Modeling Network (CISNET) Investigators from Rutgers University. Dr Jaya M. Satagopan led the breast cancer study alongside 5 other scientists. The investigative team worked to analyze data regarding breast cancer rates among women of Indian and Pakistani descent. Breast cancer rates within these ethnic groups increase as they age before decreasing after the age of 46. Since the South Asian population is one of the largest growing populations within the United States, the findings of this study have drawn attention to one of cancer research’s current issues-- breast cancer rates among minority women. Breast cancer rates for South Asian women are high due to a myriad of factors, including lack of support from friends and family, lack of transportation to and from appointments, preserving cultural modesty, and spiritual doctrine which states that cancer is a punishment for past misdeeds. Due to these factors, women within this group have reported under average mammogram screenings and as a result are often diagnosed with breast cancer in later stages when compared to non-Hispanic white women.
The research team utilized the National Cancer Institute’s (NCI) Surveillance, Epidemiology, and End Results (SEER) Program for breast cancer incidence rates, disease characteristics, treatment methods, and survival information for those over the age of 18 from the years 1990-2016. The team then compared this information to data from 1990-2014 for 4,900 women of Pakistani and Indian descent vs. 482,250 non-Hispanic white women who had breast cancer from the years 2000-2016. Ultimately, the authors found that more research needed to be done to understand the unique characteristics relating to Indian and Pakistani women. The investigative team’s conclusion also indicates that women of Indian and Pakistani descent would benefit from breast cancer screening and prevention interventions within their communities. Future research on the unique set of factors for breast cancer screening, diagnosis, and survival rates for women of Indian and Pakistani descent would benefit the field of cancer surveillance.
NCI CISNET Researchers Discover Breast Cancer Screenings Among Childhood Cancer Survivors 25-30 Years of Age May Cut Breast Cancer Mortality by 50%
September 1, 2020—Annals of Internal Medicine Tweet
In a recent study published in Annals of Internal Medicine, a group of NCI-sponsored investigators from the Cancer Intervention and Surveillance Modeling Network (CISNET) examined the clinical benefits, harms, and cost-effectiveness of breast cancer screening for survivors of childhood cancer treated with chest radiation. The researchers focused on the Childhood Cancer Survivor Study and other published data including women aged 20 years with a history of chest radiotherapy. The research team examined 4 outcome measures in order to ensure study effectiveness: breast cancer deaths averted, false-positive screening results, benign biopsy results, and incremental cost-effectiveness ratios (ICERs). The study authors found that the lifetime risk of breast cancer deaths with no screening is 10%-11% across models. Annual breast MRI and mammography prevent the most deaths, between 56% and 71%; annual MRI without mammography prevents 56%-62% of breast cancer related deaths.
The NCI CISNET consortium utilizes scientific modeling to improve and increase comprehension of the impact that cancer control interventions have on population level trends, specifically those dealing with incidence and mortality rates. CISNET researchers found that early initiation (ages 25-30) of annual breast cancer screenings with MRI, with or without mammography, may reduce breast cancer mortality by 50% in childhood cancer survivors. Future research teams can use findings from this study to further analyze and model trends for breast and other cancers among this population.
August 13, 2020—New England Journal of Medicine Tweet
As part of a groundbreaking study recently published in the New England Journal of Medicine (NEJM), Dr. Nadia Howlader, National Cancer Institute (NCI) Deputy Director Dr. Doug Lowy, and other NCI and non-federal researchers analyzed lung cancer mortality by subtype using data from the Surveillance, Epidemiology, and End Results (SEER) Program. The authors found that non-small cell lung cancer (NSCLC) mortality rates fell from both 2006 to 2013 and from 2013 to 2016. Over a 7-year timespan, 2006 to 2013, NSCLC rates fell by 2.3% each year. The following years, 2013 to 2016, displayed more dramatic trends; NSCLC rates decreased by 6.3% each year. This corresponds to the time period in which NSCLC treatment advances became available.
Unlike death certificates, records from the SEER Program include subtype information. The researchers were able to calculate incidence-based mortality by subtype using the SEER data. They also used Joinpoint software in their analysis. The mortality rate for NSCLC, the most common type of lung cancer (representing 76% of US cases), is decreasing faster than the incidence rate. Survival rates from NSCLC have also improved over time. Investigators believe that a sharp decline in NSCLC mortality rates was caused, in part, by new treatment advances and approved therapies that became available during this time. Other possible reasons include a continued decline in smoking. For small-cell lung cancer, the decreases in incidence and mortality were similar, and survival did not improve. Advancements in treatment for this subtype are slower but in progress, and so any effect in rates is not yet discernible. Findings from this study will help future research teams further analyze and model US lung cancer rates and trends by subtype.
NCI Director Dr. Norman Sharpless cites CISNET model in new editorial warning of dire consequences for cancer outcomes due to the COVID-19 pandemic
June 19, 2020—Science Tweet
In an editorial published in Science, National Cancer Institute (NCI) Director Dr. Norman Sharpless warns of substantial consequences for cancer outcomes due to the COVID-19 pandemic. The NCI director utilized Cancer Intervention and Surveillance Modeling Network (CISNET)* modeling which projected almost 10,000 excess deaths from breast and colorectal cancer in the next ten years associated with delays in the screening and diagnosis of these two cancers Dr. Sharpless cautions that not only has the COVID-19 pandemic caused delays in screening, diagnosis and treatment, but also an “unprecedented interruption” to cancer research. These projections are based on a conservative estimate that does not consider variables such as other cancer types or regional variations; Dr. Sharpless warns that postponing procedures and ignoring potentially fatal non-COVID-19 conditions such as cancer may produce a new public health crisis in the coming years. He calls for immediate action by clinicians, researchers, and the federal government to alleviate the impact of delayed diagnosis and postponed research.
*CISNET is a collaborative consortium of simulation modelers, funded by the Surveillance Research Program of the Division of Cancer Control and Population Sciences, which provide a link between complex evidence and actionable public health strategies.
Researchers utilize SEER data in new study analyzing medical care costs associated with cancer survivorship in the United States
June 10, 2020—Cancer Epidemiology Biomarkers and Prevention (CEBP) Tweet
In a recent study published in CEBP Dr. Angela Mariotto of the Surveillance Research Program, along with a team of researchers, project the national costs of cancer-related care to increase more than 30% from 2015 to 2030. Utilizing the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER)-Medicare database the team analyzed data from cancer survivors aged 65 and older who had been diagnosed between 2000 and 2012. Dr. Mariotto and colleagues used claims data from 2007-2013 from the Centers for Medicare and Medicaid to estimate costs of care by cancer site, phase of care, and stage at diagnosis. By combining per-patient phase-specific attributable costs with prevalence projections the researchers estimated national costs of care from 2015 to 2030. They found that per patient per year costs varied by cancer site, phase and stage at diagnosis and end-of-life costs were highest, at around $105,000 per patient per year. While in 2015 national cancer care cost was $183 billion, the authors estimate the cost of care will increase 34% to $246 billion in 2030 due solely to population aging and growth (under the assumption of constant cost, incidence, and survival). Studies such as this, quantifying and projecting costs, are important to increase awareness of the high costs of cancer care and to better plan resource allocation. Importantly, the per patient phase of care cancer-attributable cost estimates by site and stage are key inputs to cost-effectiveness analyses which are vital to inform changes in health care policies.
May 28, 2020—Lancet Tweet
In a recent study published in Lancet, a group of researchers – including Dr. Donna Rivera of the National Cancer Institute’s Surveillance Research Program – examined the impact of COVID-19 on patients with cancer. The study found the primary outcome of mortality increased in patients with cancer compared to the general population. Using logistic regression analysis, the authors analyzed the association between 30-day all-cause mortality and potential prognostic variables in a cohort of 928 patients with current or former cancer from the United States, Canada, and Spain diagnosed with COVID-19. While half of the 928 current and former cancer patients with concomitant COVID-19 were hospitalized, 13% had a mortality outcome within 30 days of diagnosis with COVID-19, which is higher than the percentage that is reported for the general population. The authors found significant associations between 30-day all-cause mortality and a number of general factors including increasing age, male sex, former smoking status, and comorbidities. However, factors such as recent cancer treatment, which researchers may hypothesize would increase risk, were not found to have a signification association. The authors advise that some of their observations should be interpreted cautiously and conclude continued long-term research, with larger sample sizes, and clinical trials need to be conducted to truly understand the effects of COVID-19 on cancer patients.
Researchers utilize SEER data in new study identifying 232 US counties as “hotspots” for early onset colorectal cancer with worse survival among men
May 1, 2020—American Journal of Cancer Research Tweet
While overall incidence rates for colorectal cancer have decreased in recent years, there has been a significant increase in incidence and mortality rates in younger adults aged 20-49. In a new study published in the American Journal of Cancer Research, researchers identified 232 “hotspots” or counties with high early-onset colorectal cancer (EOCRC) mortality rates in the United States. Using data from the Centers from Disease Control and Prevention from 1999-2017 linked to data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program for men aged 15-49 with colorectal cancer, the team used a generalized R2 to estimate the total variance of EOCRC survival. Compared to other counties, the identified “hotspots” had risk factors that have been linked to poorer health outcomes, such as: higher poverty rates (26.57%), greater prevalence of adult obesity (34.94%), higher adult smoking rates (23.97%), higher uninsured rates (20.06%), and fewer primary care physicians (58.28 per 100,000 population). The researchers concluded that these hotspot counties had significantly worse survival rates among men – particularly Non-Hispanic Black men. As one of the first studies to define geographic hotspots for EOCRC, the authors called for further research in colorectal-related health behaviors among Non-Hispanic Black men and young adults under 50 to improve cancer screening, early detection, and treatment.
Researchers utilize SEER data in study estimating excess mortality in people with cancer and multimorbidity in the COVID-19 emergency
April 2020—ResearchGate Tweet
In a first-of-its-kind study published in ResearchGate*, researchers found the majority of patients who have cancer, or are suspected of having cancer, are not accessing health care services due to the COVID-19 pandemic. Utilizing population-based health records from 3,862,012 adults in England along with data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program for US cases, the authors estimated one-year mortality rates for 24 cancer sites and 40 comorbid non-cancer conditions, all of which are considered high risk by the Centers for Disease Control and Prevention (CDC) during the COVID-19 emergency.
The researchers found major declines in chemotherapy attendance and early diagnosis referrals. They acknowledge that the decline in chemotherapy attendance may be due to capacity or resource reallocation. However, they assert that multimorbidity must be considered when prioritizing chemotherapy to protect the most vulnerable cancer patients. Through modeling, the researchers found that one year from now there could be 6,270 excess deaths among cancer patients in the UK and 33,890 excess deaths in the US. The report concludes that rapid, frequent reporting of cause-specific excess mortality, urgent referrals for cancer diagnosis, and treatment statistics are critically needed to protect — and inform optimal delivery of care to — this vulnerable population.
*Please note: This report was published on ResearchGate as a preprint and has not undergone peer review.
Researchers utilize SEER data in an assessment of enrollment characteristics for Children’s Oncology Group (COG) upfront therapeutic clinical trials
April 23, 2020—PLOS One Tweet
In a recent article published in PLOS One, researchers found that the number of children with cancer enrolled in clinical trials has significantly decreased in the United States. Dr. Kelly Faulk and colleagues analyzed cancer cases using incidence data and population estimates from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program and cases from the Children’s Oncology Group (COG). The analysis included 2004-2015 incidence data for ages 0 to 29; the team compared SEER cases to COG data from patients enrolled in upfront (newly diagnosed disease) therapeutic trials.
Based on the data, 19.9% of cancer patients in the US aged 0-19 enrolled in COG trials between 2004-2015, a decrease from 26.8% between 2000-2003. While childhood cancer incidence has risen over the last several decades, enrollment in clinical trials has decreased from 40-70% in the 1990s to approximately 20-25% in the 2000s. Faulk and her colleagues found no significant racial, ethnic, or county-level socioeconomic disparities in enrollment; however adolescents and young adults (AYAs) and young patients with solid and central nervous system tumors were under-enrolled. The authors explained that this decrease in young patients enrolled in clinical trials may partly be due to increased treatment development. However, it could also be due to a variety of different issues, including ensuring trials availability, poor physician referral rates, and a variety of psychosocial factors such as informed consent concerns. The researchers concluded that future efforts should further assess enrollment rates over time. More studies with this focus will help maintain an emphasis on COG trials, which will continue to provide treatment advances and improved outcomes for cancer patients.
Request for Information: Tools and Solutions for Improving the Acquisition of Electronic Pathology and Radiology Reports for National Cancer Surveillance
March 19, 2020—American Journal of Public Health Tweet
In a recent study published in the American Journal of Public Health, researchers utilized data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program to review melanoma incidence and mortality among whites in the United States. The authors found that overall mortality rates increased by 7.5% between 1986 to 2013 and decreased by 17.9% from 2013 to 2016, with a significantly sharp decline among men 50 years or older. The researchers conclude the introduction of new therapies for melanoma was associated with a significant reduction in mortality, and future research should focus on the continued development of effective treatments with a focus on reducing the number of patients with advanced disease.
March 17, 2020—Cancer Tweet
In a recent study published in Cancer, researchers utilized data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program to understand the relationship between enclave residence and breast cancer survival. The researchers conducted parallel analyses of California and Texas cancer registry data for adult Latinas diagnosed with breast cancer from 1996 to 2005 with follow-up through 2014. The authors found an association between improved survival and residence in more distinct ethnic neighborhoods, proving that enclaves are protective.
Prior studies have shown mixed results for whether being foreign-born was associated with survival outcomes. In this study, foreign-born Latinas had worse breast cancer-specific and all-cause survival. The authors conclude future studies should prioritize historically underserved populations and focus on the impact of residence within culturally distinct enclaves on health outcomes.
March 5, 2020—American Cancer Society Journals Tweet
In a recent report published in American Cancer Society Journals, researchers analyzed data from the National Cancer Insitute’s Surveillance, Epidemiology, and End Results (SEER) Program (in combination with additional data sources) to summarize colorectal cancer (CRC) incidence and mortality trends. Researchers estimated in 2020, 147,950 individuals will be diagnosed with CRC and 53,200 will die from the disease. From this estimate, approximately 17,930 cases and 3,640 deaths will occur in individuals aged younger than 50 years.
From 2011-2016, CRC incidence rates declined by 3.3% annually in individuals 65+ years and by 1% annually in those 50-64 years, yet incidence rates increased by ~2% annually among individuals younger than 50 years. Similarly, from 2008-2017, CRC death rates declined by 3% annually in individuals aged 65+ years and by 0.6% annually in individuals aged 50-64 years, yet death rates increased by 1.3% annually in those aged younger than 50 years.
Researchers concluded a substantial proportion of CRC cases could be further prevented through screening and surveillance. In The Washington Times, National Cancer Institute’s Dr. Kathy Cronin commented “Screening for colorectal cancer can identify and remove polyps before they progress to cancer… This is different than other cancer sites where screening detects early-stage cancer.” Screening uptake remains low in many states, among individuals without health insurance, among those aged 45 to 54 years, and who have a family history of the disease.
CISNET Researchers Utilize SEER Data in Study Projecting Time to Elimination of Cervical Cancer in the USA
February 10, 2020—The Lancet Public Health Tweet
The Cancer Intervention and Surveillance Modeling Network (CISNET) recently published an assessment of the potential elimination of cervical cancer in the United States in the journal The Lancet Public Health. The researchers used two independently-developed cervical cancer models, the Harvard and Policy-1 Cervix, to estimate changes over time in the incidence of human papillomavirus (HPV)-induced cervical cancer in the US. The models projected cervical cancer to decrease to less than four new cases per 100,000 women by the year 2038 according to the Harvard model, and by 2046 according to the Policy1-Cervix model.
Through analysis the researchers found scaling up screening coverage could expedite the time to elimination of cervical cancer, whereas scaling up vaccination coverage had little effect. The authors conclude the key to elimination of cervical cancer for all women lies in targeting under-screened and under-vaccinated populations.
January 31, 2020—JAMA Tweet
In a recent study published in JAMA, researchers used Surveillance, Epidemiology, and End Results (SEER) Program data to examine the incidence rate of colorectal cancer in Americans ages 30-60 years by 1-year age increments. Researchers hypothesized the colorectal cancer burden may be underestimated in those younger than 50 years, as screening for colorectal cancer traditionally beings at age 50. Through analyses of 170,434 colorectal cancer cases, researchers concluded a significant incidence rate increase of 46.1% between the ages of 49 and 50, of which, 92.9% of cases were invasive. Steep incidence increases for those 49-50 years were seen in both men and women, white and black populations, colon and rectal cancers, and across geographical regions. Researchers concluded additional studies could be conducted to estimate the effects of screening at an earlier age or to determine the proportion of cases diagnosed at age 50 through screening vs diagnostic testing.
January 22, 2020—The American Cancer Society Tweet
The American Cancer Society (ACS) recently published an article with the latest data and new estimates of cancer incidence and mortality in the United States. The authors used incidence data through 2016 from the Surveillance, Epidemiology, and End Results (SEER) database, a major initiative of the National Cancer Institute (NCI).
The researchers highlight positive news: overall cancer deaths declined by 29% between 1991 and 2017. This decrease translates into an estimated 2.9 million fewer cancer deaths than would have occurred if the increasing trends before 1991 had continued. The authors attribute this progress to long-term declines in mortality rates for lung, colorectal, breast, and prostate cancer. Researchers found the largest ever single-year drop in overall cancer mortality from 2016 to 2017, when overall mortality dropped 2.2%.
Overall cancer incidence in men declined from 2007 to 2014 but stabilized through 2016. The authors suggest that this trend may reflect lower incidence of colorectal cancer and stabilizing rates of prostate cancer. However, the ACS article referenced the 2018 Annual Report to the Nation: Part II, which highlighted recent changes in prostate cancer trends. In this article, NCI’s Serban Negoita and colleagues indicated that the overall decline in prostate cancer incidence masks an increase in distant stage diagnoses since around 2010.
The overall cancer incidence rate in women has remained generally stable over the past few decades. The authors suggest that this may be due to declines in rates for lung and colorectal cancer along with increasing or stable rates for other common cancers.
Though incidence rates for many cancers are stable, obesity-related cancers are increasing. The authors report that a majority (71%) of cancers of the kidney, pancreas, liver, oral cavity and pharynx, and melanoma of the skin are potentially preventable through limiting exposure to avoidable risk factors. For example, obesity, excess alcohol consumption, cigarette smoking, and hepatitis B and C viruses are risk factors for these cancers, so risk reduction strategies can help decrease the risk of these cancers.
Although research and treatment breakthroughs, advancing immunotherapies, and targeted therapies have helped contribute to decreases in cancer mortality, progress has been slowing for cancers that can be detected through early screening (breast cancer, prostate cancer, colorectal cancer). Among preventable cancers, there are significant racial and geographic disparities that still exist. The authors suggest that increased investment in cancer control interventions and basic and clinical research is needed to further advance and improve cancer surveillance and accelerate progress against cancer.
Researchers utilize SEER data in new study quantifying association between insurance status and detection of early-stage breast cancer
January 9, 2020—JAMA Oncology Tweet
In a recent study published in JAMA Oncology, researchers found that insurance and access to care contribute to disparities in early detection of breast cancer. Utilizing data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program, researchers conducted a retrospective, cross-sectional study of 177,075 women aged 40-64 years who received a diagnosis of stage I to stage III breast cancer between January 1, 2010 and December 31, 2016.
Through statistical analysis, the researchers found insurance coverage mediates nearly half of the increased risk for late-stage breast cancer diagnosis seen among racial and ethnic minority women in the United States. The investigators recognize that it is important to note that insurance alone will not eliminate racial and ethnic disparities in breast cancer, however quantifying the association between insurance and breast cancer stage is pivotal to potential public health policy changes. The authors suggest future studies continue to examine both the direct and indirect costs of disparities in health insurance on patients, families, and society as whole.
December 16, 2019—Cancer Tweet
In a recent study published in Cancer, researchers found that while breast cancer remains the most common cause of death within the first five years of diagnosis, other non-breast cancer causes of death (primarily heart and cerebrovascular disease) represent a significant number of deaths among patients. Utilizing the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program, researchers included data from 754,270 US breast cancer cases (2000-2015) in the study. Researchers calculated standardized mortality ratios for cause of death in the study population using the SEER*Stat software.
Although breast cancer was the most common cause of death initially after diagnosis, over time the proportion of non-breast cancer related causes increased. Deaths from cardiovascular disease, cerebrovascular diseases, and COPD became the most common as time passed after breast cancer diagnosis. Researchers found that non-breast cancer causes of death accounted for about half of deaths within 5-10 years of diagnosis and about 60% of deaths beyond 10 years since diagnosis. Researchers concluded that breast cancer survivors should receive specifically tailored counseling regarding their future health risks.
Researchers find Lower Rates of Cancer and All-Cause Mortality in an Adventist Cohort Compared with a US Census Population
December 3, 2019—Cancer Tweet
Gary Fraser and colleagues recently published a paper in Cancer comparing all-cause mortality and cancer incidence between American Seventh-Day Adventists and nonsmokers in the general population. Seventh-Day Adventists are a health-oriented religious population in which most members avoid caffeine, follow a vegetarian diet, and do not drink alcohol or smoke.
The researchers used data from the Adventist Health Study 2 (AHS-2) and from nonsmokers in the US Census through the nationally representative National Longitudinal Mortality Study (NLMS). They also used the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database and the linkage of the two, SEER-NLMS. The team obtained mortality data for both studies from the National Death Index. The researchers conducted their analyses by using proportional hazards regression adjusting for age, sex, race, smoking history, and education.
The NLMS and SEER-NLMS analysis included de-identified data for individuals alive in January 2002 without a cancer diagnosis who were non-Hispanic whites or non-Hispanic blacks aged 25 years or older. Eligible individuals completed the Current Population Survey Tobacco Use Supplement and were either former or never cigarette smokers. The team selected these factors to make the study populations as similar as possible. The AHS-2 analysis included de-identified data beginning in 2002, and both studies included data through 2011.
The researchers found that all-cause mortality, cancer mortality, cancer incidence, and breast, colorectal, and lung cancer cases were significantly lower in the AHS-2 population. The black population of the AHS-2 study also had a significantly lower all-cause mortality and all-cancer incidence than those for the black NLMS populations. Among males, AHS-2 blacks survived longer than their white NLMS counterparts. The researchers concluded that these significantly lower rates of all-cause mortality and cancer incidence among Adventists may suggest lifestyle and diet effects on cancer and cancer etiology.
November 25, 2019—European Heart Journal Tweet
Mallika Mitra of CNBC recently reported on an article published in the European Heart Journal. Researchers, Kathleen Sturgeon and team, found that cancer patients have a higher risk of dying from cardiovascular disease (heart disease and stroke), with 10% of cancer patients dying from cardiovascular disease, not cancer itself.
Cardiovascular disease and cancer are both leading causes of death in the U.S. and the world. With advancements in research and cancer-specialized medical care, cancer survivorship is increasing among patients. However, there are complexities that come with cancer-specialized care. The researchers of this study wanted to explore the risk cancer survivors may face when cardiovascular disease is overlooked during their cancer treatment.
The researchers used data from the Surveillance, Epidemiology, and End Results (SEER) Program to analyze patients with invasive cancer, who were diagnosed between 1973 to 2015, and their cause of death. The team analyzed over three million cancer cases among 28 cancer sites. In 2012, 61% of cancer patients who died from cardiovascular disease were diagnosed with breast, prostate, or bladder cancer. However, all cancer sites have increased risk of dying from cardiovascular disease, and this will increase as cancer survivorship improves in the coming years.
Researchers use SEER data to estimate incidence trends in late-stage head and neck cancers by race and sex
November 13, 2019—Cancer Tweet
In a recent study published in Cancer, researchers used Surveillance, Epidemiology, and End Results (SEER) data to estimate the incidence of, and risk of, late-stage head and neck cancer (HNC) by race and sex. Dr. Adam Thompson-Harvey and colleagues analyzed a total of 57,118 patients with stage IV HNC between 2004 and 2015). Stage IV HNC incidence rates were highest among black patients compared to other racial groups, and blacks were 39% more likely to be diagnosed with late-stage disease. Researchers also concluded incidence rates were greater in males compared to females.
The overall age-adjusted incidence rate (AAIR) of stage IV HNC increased 26.1% from 2004-2015. By race, late-stage HNC incidence (2004-2015) decreased significantly in black patients but increased significantly in white patients. Approximately 50% of patients were diagnosed with oropharyngeal cancer, which had the highest average AAIR for stage IV HNC. Oropharyngeal cancer is most common among whites, particularly white males. Researchers estimated 75% of oropharyngeal cancer cases are associated with HPV, a factor to consider in improving early detection.
The Cost-Effectiveness of Different Lung Cancer Screening Strategies
November 5, 2019—Annals of Internal Medicine Tweet
Abraham Kim, a staff writer for AuntMinnie, recently reported on an article published in the Annals of Internal Medicine in November. Recommendations regarding the maximum age when to stop screening for lung cancer vary across different sources. The researchers, Steven Criss and team, used SEER-Medicare data to compare the cost-effectiveness of different stopping ages for lung cancer screening.
The researchers compared the recommended maximum ages according to the U.S. Preventive Services Task Force (USPSTF, 80 years), the Centers for Medicare & Medicaid Services (CMS, 77 years), and the National Lung Screening Trial (NLST, 74 years). They used four independently developed microsimulation models to evaluate health and cost outcomes. The models simulated individual-level lung cancer histories, including age and stage at diagnosis, whether screening was performed, histologic subtype, rate of disease progression, and other unique factors. The team ran all four models across the screening strategies of USPSTF, CMS, and NLST. According to the results, all three strategies were cost-effective, with NLST and CMS having higher probabilities of being cost-effective (98% and 77%, respectively).
November 1, 2019—ATS: Annals of the American Thoracic Society Tweet
The Cancer Intervention and Surveillance Modeling Network (CISNET) Lung Working Group recently shared its findings on disparities in lung cancer treatment in the U.S. in the Annals of the American Thoracic Society. The purpose of this study was twofold: to assess the level of adherence to the minimal lung cancer treatment guidelines recommended by the National Comprehensive Cancer Network, and to assess disparities by racial or ethnic group and age across all clinical subgroups. The researchers assessed levels of adherence and disparities in receipt of treatment guidelines by evaluating logistic regression models, which included 441,812 lung cancer cases from the National Cancer Database (diagnosed between 2010-2014). These results were then assessed for generalizability to the U.S. population through comparison of baseline characteristics to a lung cancer cohort from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program. The researchers found that elderly, non-Hispanic Blacks, and Hispanic lung cancer patients are less likely than non-Hispanic Whites to receive guideline-concordant treatment. The authors conclude that their results suggest there is room for improvement in the uptake of treatment guideline adherence to reduce disparities.
November, 2019—American Lung Association Tweet
In the recent "State of Lung Cancer" report from the American Lung Association, researchers used Surveillance, Epidemiology, and End Results (SEER) Program data along with other data sources to examine various lung cancer trends, measures, and outcomes. Over the last decade, lung cancer incidence rates have decreased 19% and the five-year survival rate has increased 26%. Despite these improvements, lung cancer remains the leading cause of cancer death in the United States. Survival rates are five times greater when cases are diagnosed early, however only 21.5% of cases are diagnosed at this stage. The report also highlighted the importance of lung cancer screening via low-dose CT scans for those at high risk, though only 4.2% of eligible individuals were screened in 2018. These measures, in addition to several other measures (e.g., treatment, Medicaid coverage of screening, and risk factor exposure), vary by state. To see how your state compares to the US rates, please visit the full report.
October 22, 2019—Cancer Tweet
Judith Malmgren, PhD and co-authors reported a retrospective analysis of improved breast cancer survival in the journal Cancer.The researchers measured breast cancer outcome disparity by comparing data from the Surveillance, Epidemiology, and End Results (SEER) 9 registry grouping by region and an institutional cohort (IC) with de novo metastatic breast cancer (MBC) . De novo MBC is defined as breast cancer that is first diagnosed at stage IV; when breast cancer is initially diagnosed and treated at the localized stage but then after a period of remission returns and spreads to other parts of the body, it is defined as recurrent MBC. In their previous study, they observed breast cancer-specific survival (BCSS) rates for both de novo and recurrent MBC in their IC of patients in the Seattle-Puget Sound registry. In this study, they compared the 1999-2011 five-year survival percentages for de novo MBC between 1) SEER 9 without Seattle-Puget Sound region (26%), 2) SEER 9 Seattle-Puget Sound region only (35%), and 3) IC Seattle-Puget Sound (56%). Even though the overall survival improved at the same time new treatments were introduced, regional disparities clearly exist. Some of the authors provided their individual takes on the regional results. Dr. Malmgren stated, “Work to identify specific patient and treatment factors associated with better survival is ongoing.” Study author, Musa Mayer, stated, “[This study] documents worsening disparities with regard to access, adherence, and socioeconomic status.” And Shirley Mertz, Chair of the Metastatic Breast Cancer Alliance, spoke to how important it is for breast cancer organizations and advocates to continue efforts to ensure newly diagnosed MBC patients are knowledgeable about their cancer subtype and have affordable access to the newest treatments for the disease. Study author, Dr. Kaplan, concluded that it is also important to begin researching treatment to de novo MBC versus recurrent MBC.
Researchers use SEER-Medicare linked data to assess racial disparities in the treatment and outcomes of patients with multiple myeloma
October 17, 2019—ASH Publications
In a recent study, researchers analyzed the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database to evaluate racial disparities in the treatment and outcomes of white, African American, and Hispanic multiple myeloma (MM) patients. The analysis included a total of 4,830 patients with a confirmed MM diagnosis. To measure treatment, the study authors evaluated use of novel therapy (lenalidomide, pomalidomide, bortezomib, and carfilzomib) and autologous stem cell transplant (ASCT). Additional outcome measures included hospitalization frequency, overall survival, myeloma-specific survival (MSS), and health care costs.
Researchers concluded African American and Hispanic patients received novel MM therapies later compared to white patients. Within 6 months of MM diagnosis, the use of novel therapies in all three cohorts increased, though this trend was more defined in whites compared to African Americans. Additionally, Hispanics were less likely to receive ASCT compared to whites, and no significant difference was observed in African Americans compared to whites. The rate of ASCT within 1 year of MM diagnosis increased in white and African American patients, but not Hispanic patients.
While the median overall survival was similar in the three cohorts, the median MSS was significantly longer for African Americans than whites. After adjustment, African Americans experienced a lower risk of death from MM compared to whites. Lastly, medical costs were comparable in African Americans and whites with MM, but greater in Hispanics. Researchers hypothesized this was driven by higher hospitalization costs in Hispanics.
October 3, 2019—The New England Journal of Medicine Tweet
In a recent article published in The New England Journal of Medicine, researchers utilized data to examine patterns of incidence and mortality for various cancers. This study included 40 years of incidence data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program from 1975 through 2015 for selected cancers in the United States.
The researchers illustrate mortality and incidence trends using a pair of graphics for each cancer site. The first depicts absolute rates over time, age-adjusted to the U.S 2000 standard population; the second depicts the relative rates over time using the 1975 rates as the reference group. Through the creation and analysis of these graphed trends, the team observed a decline in cancer mortality rates over time. Through further analysis, they determined that the biggest single component of this decline was the decline in lung cancer rates, and in conjunction the decline in cigarette smoking. The authors state that the primary goal of this article was to enable medical readers to interpret trends of population-based cancer burden, while providing insight into occurrence, overdiagnosis, and treatment advances. The team concludes that while current system-level efforts of cancer-surveillance are robust, more work needs to be done to ensure the acquisition of population-based data on cancer burden is an attribute of a well-functioning health care system.
September 30, 2019—JNCI: Journal of the National Cancer Institute Tweet
The Cancer Intervention and Surveillance Modeling Network (CISNET) Lung Working Group recently shared its findings on risk-based lung cancer screening strategies in the Journal of the National Cancer Institute. The researchers used four independent natural-history models to perform a comparative study evaluating long-term effects of selecting individuals for lung cancer screening through risk-prediction models. The researchers found that screening someone based on their lung cancer risk could prevent considerably more lung cancer deaths than current screening recommendations, however, this form of screening could also lead to over-diagnosis. Due to these findings, the authors call for researchers to investigate the cost-effectiveness of risk-based screening and to explore plausible screening techniques that could result in lower over-diagnosis rates in high risk individuals.
Researchers use SEER data in Cost Analysis of Intensive Medical Services for Patients with Terminal Cancer
September 27, 2019— JAMA Tweet
In a recent study published in JAMA, investigators examine costs associated with intensive medical care services in the last months of life. Risha Gidwani-Marszowski, Steven Asch, Vincent Mor, and their team analyzed data from the Veterans Health Administration data and the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. The analysis included statistics from fiscal years 2010 to 2014 for patients who were veterans, aged 66 or older, and were continuously enrolled in fee-for-service Medicare in the 12 months prior to death.
The authors found that patients with terminal cancer continue to receive costly intensive medical treatment despite guidelines from prominent organizations. Agencies such as the National Academy of Medicine and the American Society of Clinical Oncology (ASCO) provide recommendations to reduce intensive medical treatment at the end of life, emphasize palliative care, and promote efforts to reduce suffering in patients with terminal diseases.
The researchers determined that receiving medically intensive services in the last months of life was associated with substantial costs to beneficiaries and their families. The authors emphasized that physicians and families should consider beneficiary and health system financial consequences when weighing medical care options. They concluded that there is a need for further support to improve the value of cancer care for patients with terminal illness.
Researchers Utilize SEER Data in Study Reporting Rising Incidence of Prostate Cancer in Young Adult Men
September 25, 2019—Cancer Tweet
In a recent study published in Cancer, researchers described the increasing incidence of prostate cancer worldwide. Utilizing data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program alongside the Institute for Health Metrics and Evaluation Global Burden of Disease database, Salinas and colleagues reported an increase in prostate cancer incidence among adolescent and young adult (AYA) men. According to the data, the global incidence of prostate cancer has increased in all groups aged 15 to 40 years and increased at a steady rate averaging 2% per year since 1990.
The authors recognize there are several factors that could contribute to this increasing incidence, including, but not limited to, improved recognition (better detection of early stage cancers that were previously undiagnosed), screening practices, overdiagnosis, racial/ethnic shifts, societal factors, exposures, and increasing obesity among AYAs. Men as young as 17 are experiencing an increase in prostate cancer in much of the world, presenting at a more advanced stage, and ultimately having worse survival outcomes than middle-aged and older men. Salinas and colleagues conclude that there is much research to be done in understanding why this increase is occurring and the biological factors that differentiate these AYA cancers from those in older men.
Screening for Pancreatic Cancer in High-Risk Individuals: The USPSTF’s Reaffirmation Recommendation Statement
August 19, 2019—Medscape Tweet
Helen Leask, a contributor for Medscape, recently reported on editorials challenging the recent recommendation statement from the US Preventive Task Force (USPSTF) against screening for pancreatic cancer in asymptomatic adults. The USPSTF recommendation statement and all editorials were published in the Journal of the American Medical Association in August. The researchers highlighted the 5-year survival rate of pancreatic cancer to make their respective points, using data from NCI’s Surveillance, Epidemiology, and End Results (SEER) Program. Though pancreatic cancer is not common, it has a relatively low survival rate that decreases over the cancer’s progression.
Contrary to the USPSTF recommendation statement, researchers have found evidence that screening pancreatic cancer in high-risk individuals would do more GOOD than harm. Despite the low overall prevalence of this cancer, high-risk populations may include individuals with precursor lesions that lead to pancreatic cancer within three to five years (such as pancreatic intraepithelial neoplasia [PanIN], intraductal papillary mucinous neoplasms [IPMNs], and mucinous cystic neoplasms [MCNs]). With continued research, the USPSTF may support screening for pancreatic cancer.
August 14, 2019—JAMA Network Open Tweet
Stirred by recent evidence of an association between obesity and certain cancers, Dr. Siran Koroukian, Weichuan Dong, and Nathan Berger explore which subgroups of the population are most affected by obesity-associated cancers (OACs) in a recent article published by JAMA Network Open. To gain a better understanding of how these obesity-associated cancers (OACs) and age interact, these experts conducted a cross-sectional, population-based study using data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program.
The researchers analyzed over 6 million cancer patients both with and without OACs between 2000 to 2016. In this period, the percentage of people with incident OACs increased in younger than expected age groups: across all races, people between the ages of 50 and 64 are at greater risk of developing OACs. Specifically, these OACs increased substantially for liver and thyroid cancers regardless of sex and race/ethnicity, in gallbladder and other biliary cancers for non-Hispanic black men and women and Hispanic men, and for uterine cancers in Hispanic women between 50-64.
These findings have important public health implications; the population could benefit from interventions to reduce the burden of OACs in younger age groups. The authors suggest crafting interventions to reduce obesity and implementing individualized screening programs.
August 7, 2019—CA: A Cancer Journal for Clinicians Tweet
The "oldest old", adults 85 years and older, are the fastest growing age group in the United States. While their numbers may be growing, little is known about their cancer burden. In an article published in CA: A Cancer Journal for Clinicians, a group of researchers combined data from NCI’s Surveillance, Epidemiology, and End Results (SEER) Program with National Program of Cancer Registries data, as provided by the North American Association of Central Cancer Registries (NAACCR). The authors found, while cancer trends in the “oldest old” are generally similar to those aged 65-84, they documented unexpectedly high rates of screening. This is an alarming finding, as the harms of screening often outweigh the benefits for many people 85 and older. Coupled with documented undertreatment of otherwise fit seniors and over treatment of vulnerable individuals, the researchers are calling for improved cancer care for this complex population. The authors conclude that due to a rapid growth in the population of the oldest old, there is an urgent need to develop a comprehensive evidence base to drive treatment decisions of these patients.
Researchers Utilize SEER Data in Study Finding Genetics May Play a Role in Behavioral Melanoma Protection
August 2, 2019—Genetics in Medicine Tweet
The current evidence of predictive genetic testing increasing preventive behaviors against cancer has been mixed. However, there has been some initial evidence of improvement in risk-reduction behaviors relating to familial melanoma; predictive testing for the CDKN2A/p16 pathogenic variant, which if present could make someone thirty five times more likely to develop melanoma, could increase the uptake of sun exposure protective behaviors. In a recent article published in Genetics in Medicine, Dr. Tammy Stump and her colleagues investigate whether disclosure of a CDKN2A pathogenic variant promotes reductions in sun exposure. The researchers utilized data from the Utah Cancer Registry, which is part of the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program. Through a prospective, nonequivalent control group design, the team found that genetic counseling about highly elevated melanoma risk (both with and without test reporting) led to sustained reductions in sun exposure. The authors conclude further researchers may examine what motivates long-term reductions in sun exposure, as well as specific barriers and facilitators to sun protection in order to improve melanoma risk education.
Elderly HIV-infected cancer patients may experience elevated mortality rates compared to HIV-uninfected patients
August 1, 2019—JAMA Oncology Tweet
In a recent study published in JAMA Oncology, researchers used Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data to compare cancer-specific mortality rates in HIV-infected and HIV-uninfected patients with cancer, adjusting for cancer treatment. The study team selected a total of 308,268 patients (ages 65 and older) diagnosed (1996-2012) with nonadvanced cancer (colorectum, lung, prostate, or breast), with a subset of 288 HIV-infected patients. HIV-infected patients were more likely to be younger and nonwhite compared to HIV-uninfected patients.
After adjusting for stage-appropriate treatment, the overall mortality rate was greater in HIV-infected patients in three of the four cancers identified (colorectum, prostate, and breast) compared to HIV-uninfected patients. Additionally, HIV-infected prostate and breast cancer patients experienced higher rates of cancer-specific mortality and relapse or death. Researchers hypothesized these outcomes may be influenced by HIV-associated immunosuppression.
Derivation and Validation of a Risk Assessment Model for Immunomodulatory Drug–Associated Thrombosis Among Patients With Multiple Myeloma (XML)
July, 2019—Journal of the National Comprehensive Cancer Network Tweet
Patients with multiple myeloma (MM) often receive immunomodulatory drugs that are associated with an increased risk of venous thromboembolism (VTE). To assist in the prevention and risk communication of this complication, experts from the International Myeloma Working Group proposed a new risk assessment model for immunomodulatory drug-associated thrombosis. To validate this risk assessment model, Dr. Ang Li and colleagues conducted research recently featured in the Journal of the National Comprehensive Cancer Network. In this study, they validate the VTE risk assessment tool using the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER)- Medicare database. In this retrospective cohort study, the researchers analyzed data from 2,397 patients and used the Veterans Health Administration database for an external comparison cohort. The researchers found that their final model, named the "SAVED" score, had greater discriminative power than the more complex VTE recommendations currently in the National Comprehensive Cancer Network Guidelines. The team concluded that the SAVED model, with only 5 clinical variables, allows clinicians to identify patients at the highest risk for VTE. They are “hopeful that this tool will aid in informed decision making between providers and patients with MM regarding VTE risk…”. The researchers encourage future prospective studies to find the best VTE prevention strategy.
Researchers Use SEER Data in Recent Study Analyzing Trends in Diagnosis of Colorectal Cancer Before Age 50 in the US
July 22, 2019—Cancer Tweet
In a recent article published in Cancer, Dr. John Virostko, and colleagues, conducted a retrospective study utilizing NCI’s Surveillance, Epidemiology, and End Results (SEER) data to compare to the National Cancer Data Base (NCDB) data from 2004-2015. Using this data, the researchers assessed changes in the proportion of cases of colorectal cancer (CRC) diagnosed before age fifty. Researchers examined the NCDB data to determine whether recent trends seen in CRC diagnosis before age fifty matched those found in SEER data. They also compared clinical characteristics of CRC tumors among age groups to determine whether younger patients had differences in presentation.
Dr. Virostko, and his colleagues discovered a trend toward a higher proportion of diagnoses of CRC before age fifty; the mean age at diagnosis for both colon and rectal cancer in the United States has significantly decreased over the past decade. This finding, coupled with the proportion of cases continuing to increase with no signs of plateauing, is part of a growing collection of data in support of adjusting screening guidelines. While the researchers found a significant drop in the age of diagnosis of CRC, the causes are less clear. The authors recommend further research in this area to identify the main causes of this significant drop in age of diagnosis.
Researchers use SEER-Comparison of Cancer Burden and Nonprofit Organization Funding Reveals Disparities in Funding Across Cancer Types
July 18, 2019—Medscape Tweet
Dr. Veronica Hackethal, a contributor for Medscape, recently reported on an article published in the Journal of the National Comprehensive Cancer Network in July. Dr. Suneel Kamath and colleagues investigated the distribution of funding for nonprofit organizations (NPOs) classified by the type of cancer they support. The researchers utilized data from NCI’s Surveillance, Epidemiology, and End Results (SEER) Program, which contains data such as annual incidence, mortality, and person-years of life lost by cancer type. They compared SEER data with annual reports, Form 990 tax records, and the websites of 172 NPOs.
The researchers found that cancers with the largest total annual revenue were breast cancer ($460 million; 33.2%), leukemia ($201 million; 14.5%), pediatric cancers ($177 million; 12.8%), and lymphoma ($145 million; 10.5%). However, other common or highly lethal diseases, such as lung, colorectal, pancreatic, ovarian, and endometrial cancers, are underfunded compared to their burden on society. Dr. Kamath also pointed out that cancers with strongly associated with high-risk, stigmatizing behaviors (e.g., smoking, alcohol, intravenous drug use, sex, tanning beds) are more likely to be poorly funded. As the researchers conclude, their goal was not to divert funding away from any disease, but to educate the public and increase funding for diseases that do not receive enough support.
Researchers use SEER data to estimate risk of infection-related solid cancers in non-Hodgkin lymphoma survivors
July 9, 2019—Blood Advances Tweet
In a recent study published in Blood Advances, researchers used Surveillance, Epidemiology, and End Results (SEER) Program data to estimate non-Hodgkin lymphoma (NHL) survivors’ risk of developing secondary primary infection-related solid cancers. Researchers analyzed de-identified data from a total of 127,044 survivors (at least 1 year after diagnosis; diagnosed 2000-2014) among the 4 most common NHL subtypes:
- Diffuse large B-cell lymphoma (DLBCL)
- Follicular lymphoma (FL)
- Chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL)
- Marginal zone lymphoma (MZL)
Researchers concluded risk for developing subsequent infection-related cancers differs by both NHL subtype and second primary cancer type. Compared to the general population, DLBCL and MZL survivors experienced greater risk for developing stomach, liver, and anal cancers, but CLL/SLL and FL survivors did not have an increased risk. Researchers found these patterns to be consistent with shared infectious etiologies and the following associations: stomach cancer and Helicobacter pylori infection; liver cancer and hepatitis C virus infection; and anal cancer and HIV infection. In contrast to these findings, researchers concluded risks for oropharyngeal/tonsil and cervical cancers were not significantly elevated among survivors of any NHL subtype.
Association Between Androgen Deprivation Therapy Use and Diagnosis of Dementia in Men With Prostate Cancer
July 3, 2019—JAMA Network Tweet
In a recent study published in JAMA Network, researchers analyzed the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database to determine if androgen deprivation therapy (ADT) exposure is associated with diagnosis of Alzheimer disease or dementia among elderly men with prostate cancer. While ADT has proven benefits, such as reducing the likelihood of cancer progression and/or cancer mortality, there are concerns regarding the association between ADT exposure and cognitive dysfunction. The retrospective cohort study included a total of 154,089 men, aged 66 years and older, diagnosed with prostate cancer between 1996-2003. 62,330 men received ADT within 2 years of prostate cancer diagnosis. Researchers concluded patients with prostate cancer exposed to ADT were more likely to be diagnosed with Alzheimer disease or dementia compared to those not exposed to ADT. The authors noted a dose-response relationship as well: prolonged ADT exposure (8+ doses) was associated with a significantly higher hazard of both Alzheimer disease and dementia compared to those receiving fewer doses.
Rates of Active Surveillance in Intermediate-Risk Prostate Cancer Patients Nearly Double, Researchers Find
June 24, 2019—Renal & Urology News Tweet
Natasha Persaud, a contributor for Renal & Urology News, recently reported on an article published in the journal Cancer. Dr. Vinayak Muralidhar and colleagues utilized the Prostate with Watchful Waiting database from the Surveillance, Epidemiology, and End Results (SEER) Program. This database contains records of watchful waiting cases, also known as active surveillance (AS) cases. Oncologists employ AS for patients who are diagnosed with low-risk or intermediate-risk prostate cancer, and AS has become the standard way to manage low-risk prostate cancer.
Using SEER data, the researchers in this study identified 52,940 men with intermediate-risk prostate cancer who were under AS from 2010 through 2015. They also identified a comparison cohort of 45,915 men with low-risk prostate cancer. Through statistical analyses and time trend assessments, the researchers identified an increase in the rates of AS: AS nearly doubled from 3.7% to 7.3% between 2010 through 2015. When comparing between favorable and unfavorable intermediate-risk prostate cancer, AS usage increased for both groups: 7.2% to 14.9% and 2.2% to 3.8%, respectively. The mean age of patients managed with AS decreased from 69.9 to 67.9 years. The authors also found that for men over the age of 70, the rates significantly increased from 7.2% to 11.7%. Prostate cancer-specific mortality was similar between AS and other treatment options for patients with low-risk and favorable intermediate-risk disease. However, AS yielded a higher mortality rate for individuals with unfavorable intermediate-risk prostate cancer.
The researchers concluded that factors associated with AS include favorable risk disease; black race; higher socioeconomic status; older age; and diagnosis in the West, Northwest, or Midwest regions. They also recommended additional research to further examine the safety and efficacy of AS for men with intermediate-risk prostate cancer.
Researchers Use SEER Data in Recent Study Analyzing Birthplace and Geographical Disparities in Breast Cancer for Women of African Descent
June 13, 2019—U.S. News & World Report Tweet
U.S. News & World Report recently highlighted an important paper, published in the journal Cancer, that used Surveillance, Epidemiology, and End Results (SEER) Program data. The researchers built upon their previous research in which they utilized SEER data to identify breast cancer subtype patterns between United States-born, Eastern-African-born, and Western-African-born black women in the United States. In this previous study, the researchers found similar subtype patterns between US-born and Western-African-born black women in the United States, however, these were significantly different from Eastern-African-born black women.
Expounding on these previous findings, cancer epidemiologist Dr. Hyuna Sung and her colleagues from the American Cancer Society used data from the National Program of Cancer Registries and US Cancer Statistics to identify non‐Hispanic black women who were born in the United States, East Africa, West Africa, or the Caribbean and were diagnosed with invasive breast cancer from 2010 through 2015. The research team identified 65,211 cases that fit the inclusion criteria and used these cases to analyze and report on geographical differences in the prevalence of triple-negative and hormone-receptor-negative breast cancer. The researchers found that compared with US-born black women, the prevalence rate ratio of triple-negative breast cancer was 0.92 among Western-African-born, 0.87 among Caribbean-born, and 0.53 among Eastern-African-born black women. This means that US-born and Western-African-born black women have a much higher likelihood of developing aggressive breast cancer.
The researchers concluded that the prevalence of triple-negative breast cancer among black women in the United States varies significantly by birthplace, especially among Eastern-African-born black women. Based on these results, considering geographic origin in future studies is important for researchers to consider as they work to characterize breast cancer subtypes, communicate risk, and conduct interventions for women of African descent both in the United States and abroad. Therefore, the researchers encourage complete collection of birthplace information to reflect the diverse black population in cancer research.
June 11, 2019—Wiley Online Library Tweet
In a recent article, National Cancer Institute’s Dr. Angela Mariotto and colleagues analyzed incidence and survival data from three sources (The Surveillance, Epidemiology, and End Results (SEER) cancer registries, The Centers for Disease Control and Prevention's National Center for Health Statistics, and The US Census Bureau) to summarize current cancer prevalence and estimate future cancer prevalence in the United States. In 2019, the three most prevalent cancers in males were prostate, colon and rectum, and melanoma of the skin. In females, the three most prevalent cancers (2019) were breast, uterine corpus, and colon and rectum. Researchers estimated the number of cancer survivors in the US would increase by more than 5 million by 2030 (from 16.9 million (January 1, 2019) to 22.1 million by January 1, 2030). The authors hypothesize this growth in cancer survivorship is the result of a growing and aging population, as well as advances in early detection and treatment. Given this estimated projection and the various physical, financial, and other types of challenges that may come with survivorship, researchers concluded it is crucial to increase efforts to help cancer survivors live longer and healthier lives.
June 3, 2019—JAMA Oncology Tweet
In a recent study published in JAMA Oncology, researchers examine age disparities in Randomized Control Trials (RCTs) by using data from ClinicalTrials.gov and the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database. Dr. Ethan Ludmir and colleagues retroactively analyzed 302 randomized clinical trials (RCTs) comprising of 262,354 participants with oncology-related therapeutic interventions between 1994 and 2015. Using SEER data, they calculated population-level median ages of patients with the same disease site and at the same time of RCT enrollment. The authors used this data to examine differences in the median ages between RCT enrollees and cancer-specific national averages.
Trial participants were significantly younger than the overall population with the same disease, and these age disparities increased in RCTs over time. Across all trials, RCT participants were aged an average of 6.49 years less than population-level median ages. Industry-funded trials and trials testing targeted therapies had even larger age disparities: for industry-funded trials, participants were 6.84 years younger than national median ages while non-industry-funded trials averaged at 4.72 years younger than the national median for the same cancer site. The authors suggest that restrictions in enrollment criteria based on performance status or age cutoffs are associated with these age disparities. Goals for future studies and trials should include improving equitable representation and the generalizability of RCTs for underrepresented age groups.
May 23, 2019—JAMA Otolaryngology Tweet
Dr. Z. Jason Qian and colleagues used Surveillance, Epidemiology, and End Results (SEER) data to examine the trends in U.S. pediatric thyroid cancer incidence from 1973 to 2013. The researchers report that from 1973 to 2006, the annual percent change in pediatric thyroid cancer incidence increased 1.1%, and this number increased to 9.5% per year from 2006 to 2013. The authors suggest a couple of explanations for this marked increase, including increased screening and diagnostic practices or a true increase in incidence associated with environmental exposures such as medical radiation. Further research may help clarify these alarming incidence trends, learn more about pediatric thyroid cancer risk factors, and help to structure prevention efforts more effectively.
Hysterectomy-Corrected Uterine Cancer Incidence Trends Reveal Racial Disparities and Rising Rates of Nonendometrioid Cancers
May 22, 2019—Journal of Clinical Oncology Tweet
Ashley Taylor, a contributor of Cancer Today Magazine, recently reported on an article published in the Journal of Clinical Oncology in May. National Cancer Institute (NCI) research fellow Dr. Megan Clarke, along with her colleagues, challenge the idea that obesity is to blame for the rising rates of uterine cancer. The research team instead suggests the recent increases in incidence have been primarily driven by rising rates of aggressive nonendometrioid subtypes that are not linked to obesity or hormonal risk factors. The researchers utilized data from NCI’s Surveillance, Epidemiology, and End Results (SEER) Program which compiles and analyzes data from cancer registries covering approximately 35% of the US population.
The researchers in this study estimated hysterectomy-corrected, age-standardized uterine cancer rates from 2000-2015 using SEER data. The authors concluded that the hysterectomy-corrected uterine cancer incidence rates have been significantly increasing by approximately 1% per year from 2003-2015, with the most rapid rate of increase in Hispanic, Asian, and Black women. In addition, they concluded that along with higher incidence of non-endometrioid cancers, black women also had significantly lower expected 5-year survival rates regardless of stage at diagnosis.
These findings are in line with previous reports of strong racial disparities in both biologic and care-related factors among black women. More studies need to be done to better understand the underlying factors that predispose women to uterine cancer subtypes.
May 22, 2019—Journal of Clinical Oncology Tweet
Dr. Megan Clarke and her colleagues from NCI used data from the Surveillance, Epidemiology, and End Results (SEER) database to examine trends in uterine cancer incidence and mortality rates for women aged 30 to 79 from 2000 to 2015. The researchers analyzed trends among all women and then by race and ethnicity, geographic region, and histologic subtype, accounting for hysterectomy prevalence. They also estimated five-year relative survival rates to compare disparities among these groups.
Among all women, the incidence of aggressive, nonendometrioid cancers has been increasing, and endometrioid carcinoma rates have also been rising among non-Hispanic blacks, Hispanics, and Asians/Pacific Islanders. In 2007, overall incidence rates among non-Hispanic blacks surpassed those of non-Hispanic whites. Besides being at a higher risk for uterine cancer, the researchers identified non-Hispanic blacks as those with the lowest survival rates regardless of stage at diagnosis or histologic subtype. More research is needed to address the increasing rates of uterine cancer and to learn more about disproportionate burden of this disease to communities of African descent.
Scientists Use SEER Data to Examine Trends in Incidence and Stage at Diagnosis of Colorectal Cancer for Adults Aged 40-49
May 21, 2019—JAMA Tweet
In a recent study published in JAMA, researchers used data from the Surveillance, Epidemiology, and End Results (SEER) Program to assess trends in incidence and stage at diagnosis of colorectal cancer. Dr. Reinier Meester and colleagues focused their study on adults aged 40 through 49 years with a colorectal cancer diagnosis between 1975 and 2015. The researchers found that the incidence of colorectal cancer in the United States is increasing among adults aged 40-49. Across localized, regional, and distant stages, trends in colorectal cancer incidence followed a similar pattern in which there was a decrease in incidence from 1975 until 1995 followed by a significant increase through 2015. The authors report that this increase in incidence does not represent a shift in age at diagnosis attributable to earlier detection or by a decrease in unstaged cases.
The researchers also report that the colorectal cancer stage at diagnosis has differed significantly in trends over the past twenty years. Localized colorectal cancer incidence did not change significantly since 1995, while regional colorectal cancer incidence decreased by 3.4% and distant colorectal cancer incidence increased significantly from 21.7% to 26.6%. This means that colorectal cancer is being diagnosed at later stages, which hinders treatment options and length of survival. In light of this study, future interventions and research should focus on colorectal cancer prevention and earlier screening efforts.
May 20, 2019—JAMA Tweet
In a recent article in Forbes.com, contributor Bruce Lee highlights Bob Griese’s contributions to sports and his efforts to fight skin cancer. Hall of Fame quarterback Griese, a survivor of melanoma, works to spread the news that skin cancer is preventable and treatable. He is currently involved in melanoma awareness and fundraising efforts, including participating in health fairs that provide free skin cancer screenings. In the article, Lee includes melanoma incidence and mortality data from the Surveillance, Epidemiology, and End Results (SEER) Program to emphasize how common melanoma is among all cancers. Echoing Griese, Lee stresses the importance of awareness and screening practices and shares skin cancer prevention tips from the American Academy of Dermatology, including seeking shade, wearing protective clothing, regularly applying and reapplying sunscreen, performing regular skin self-exams, and avoiding tanning beds.
Researchers using SEER-Medicare conclude elderly cancer survivors may be at risk for brain metastases
May, 2019—Cancer Epidemiology, Biomarkers & Prevention Tweet
In a recent study published in American Association for Cancer Research, researchers analyzed Surveillance, Epidemiology, and End Results (SEER) Program data to calculate the incidence proportion (IP) of synchronous brain metastases (SBM) and lifetime brain metastases (LBM) in patients diagnosed with breast, lung, or skin cancer. SBM is defined by brain metastases diagnosed during primary cancer staging workup, whereas LBM is brain metastases diagnosed later in life, following primary cancer staging (studied using SEER-Medicare data). IP was calculated for each primary cancer: For breast cancers, SBM IP=0.3%, and LBM IP=1.8%; brain metastases rates were lower among patients with localized breast tumors (compared to a cancer that had already metastasized) and rates were higher for triple-negative breast cancer (compared to other molecular subtypes). For lung cancers, SBM IP=9.6%, and LBM IP=13.5%; rates were higher in small cell and non-small cell lung carcinomas (compared to adenocarcinomas). Finally, for melanoma, SBM IP=1.1%, and SBM IP=3.6%; rates were lowest among patients with localized disease, and highest in those with distant disease. Researchers concluded understanding a patient’s risk for brain metastasis after primary diagnosis could influence screening and surveillance guidelines.
Study of natural language processing for genomic biomarkers in Stage IV non-small-cell lung cancer included data from SEER registries
May 6, 2019—JCO Clinical Cancer Informatics Tweet
In a recent study published in JCO Clinical Cancer Informatics, researchers analyzed data from two Surveillance, Epidemiology, and End Results (SEER) registries in the development and validation of a natural language processing (NLP) algorithm. SEER data does not include epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) mutation tests, yet the detection of these genomic abnormalities can guide the choice of initial therapy in stage IV non–small-cell lung cancer (NSCLC). In the study, electronic pathology (e-path) reports from two SEER registries (Seattle-Puget Sound and Kentucky) helped develop, train, and validate the NLP algorithm. Two medical oncologists also manually reviewed the reports to help generate gold-standard data sets. The NLP algorithm demonstrated high internal validity (ranging from 0.95 to 1.00) and high internal accuracy for the ascertainment of EGFR and ALK test information. However, external validity was lower, and researchers concluded future research could improve the algorithm.
Trends in cervical cancer vary depending on age, race/ethnicity, histological subtype, and stage at diagnosis
April 16, 2019—Preventive Medicine Tweet
In a recent study published in Preventive Medicine, researchers used Surveillance, Epidemiology, and End Results (SEER) Program data in combination with the U.S. Cancer Statistics Incidence Analytic Database to analyze trends in cervical cancer incidence rates in the United States by age, race/ethnicity, histological subtype, and stage at diagnosis. Incidence rates (1999-2015) for cervical squamous cell carcinoma (SCC), the most common type of cervical cancer, continuously decreased in all racial/ethnic groups except among non-Hispanic whites, whose rates stabilized in the 2010s. Incidence rates (2002-2015) for cervical adenocarcinomas among non-Hispanic whites increased, with a steeper increase in middle aged women in more recent years. However, among other racial/ethnic subgroups, incidence rates (1999-2015) for cervical adenocarcinoma decreased or remained stable. Finally, incidence rates of distant stage cervical SCC and adenocarcinoma increased in several age groups among non-Hispanic whites. Researchers highlighted the importance of increasing uptake of screening and HPV vaccination to reverse the increasing adenocarcinoma trend and to accelerate the declining SCC trend.
April 13, 2019—Journal of Health Economics Tweet
In a recent study, researchers used Surveillance, Epidemiology, and End Results (SEER) Program data, in combination with a multitude of other data sources, to examine the health and economic effects of conflict between social schedules and biological needs (also referred to as ‘social jetlag’). The authors classified counties on the eastern side of a time zone boundary as ‘late sunset’ counties because the onset of daylight is generally delayed by an hour. Researchers found this discontinuity in the timing of natural light to have significant effects on health outcomes typically associated with circadian rhythms disruptions and sleep deprivation (obesity, diabetes, cardiovascular diseases; and colorectal, prostate, and breast cancers). The authors assigned health index scores based on these outcomes; late sunset counties had scores .3 standard deviations lower than counties on the other side of the time zone border.
April 9, 2019—Journal of Clinical Oncology Tweet
In a recent study published in the Journal of Clinical Oncology, lead author Allison Kurian of Stanford along with NCI researchers (Dr. Nadia Howlader, Dr. Angela Mariotto, and Dr. Lynne Penberthy) and colleagues found ovarian and breast cancer patients were undertested for genetic mutations. The analysis included Surveillance, Epidemiology and End Results (SEER) Program data for women 20 years or older diagnosed with breast or ovarian cancer in California and Georgia between 2013 and 2014. The authors linked the SEER data to results from germline cancer genetic testing laboratories. In ovarian cancer patients, 30.9% of women had genetic testing, with rates being lower in blacks and uninsured. Similarly, 24.1% of breast cancer patients had genetic testing, and this rate of testing decreased with increasing age at diagnosis. Among women who underwent genetic testing for all genes indicated in current guidelines, approximately 8% of breast cancer patients and 15% of ovarian cancer patients were identified as carriers of pathogenic variant. These mutations are important to detect as they guide the care that the patient receives: for example, secondary screening or risk-reducing surgery.
March 6, 2019—Nature Medicine Tweet
A recent article published in Nature Medicine outlined the challenges and difficulties associated with collecting data on metastatic cancer. For example, even if a patient is recorded as having metastatic cancer at the time of diagnosis, crucial information such as when the secondary tumor developed, or its location, may still be missing. The Surveillance, Epidemiology, and End Results (SEER) Program is leading efforts to help reduce this burden and improve the process of gathering information about metastases. Dr. Lynne Penberthy, the Associate Director of the Surveillance Research Program at the National Cancer Institute, explained that one way the SEER Program is attempting to close these gaps is through the use of machine learning. SEER researchers plan to use machine learning to search patient’s medical files (doctors’ notes, pathology reports, radiology reports, etc.) for key words that could indicate metastases such as ‘bone’ or ‘spread.’ However, the collection of this data is only half the battle; next, researchers and clinicians will need to determine how and when to record metastases so that registries are consistent, reliable, and uniform. The SEER Program is currently working with groups from various countries to develop a standard method of recording data that could be implemented across the world.
February 15, 2019—Cancer Therapy Advisor Tweet
In a study presented at the 2019 Genitourinary Cancers Symposium, Dr. Ray-Zack and colleagues compared two treatment methods for muscle-invasive bladder cancer. In particular, they studied survival outcomes and cost of treatment for radical cystectomy and trimodal therapy. The researchers used data from the linked SEER-Medicare database and analyzed about 3,000 bladder cancer cases among patients aged 66 years or older and who were diagnosed from 2002 through 2011; 25 percent of them had undergone trimodal therapy, while 75 percent of them had undergone radical cystectomy. Based on the results, patients who underwent trimodal therapy had significantly decreased cancer-specific survival. Median total costs over six months were also significantly higher for trimodal therapy compared to radical cystectomy. Due to these findings, the researchers suggest that radical cystectomy is a better treatment method compared to trimodal therapy for patients with muscle-invasive bladder cancer.
Recent trends in localized prostate cancer management: active surveillance increases, treatment decreases
February 11, 2019—JAMA Tweet
In a study recently published in JAMA, researchers from Dana-Farber Cancer Institute used Surveillance, Epidemiology, and End Results (SEER) data to examine US trends in management strategies for localized (low-risk) prostate cancer. There are two common approaches to management of low-risk prostate cancer: treatment (most commonly radical prostatectomy, followed by radiotherapy) or active surveillance/watchful waiting (AS/WW). Researchers used the SEER Prostate Active Surveillance/Watchful Waiting database to analyze data for men with localized prostate cancer (2010-2015) and a known management type. Overall, men diagnosed in 2015 had significantly lower rates of low-risk disease compared to men diagnosed in 2010 (24.5% vs 34.2%, respectively). From 2010 to 2015, AS/WW management strategy increased from 14.5% to 42.1%, while radical prostatectomy and radiotherapy both decreased. This trend coincides with the 2010 national guidelines, which advocated for AS/WW in low-risk prostate cancer patients.
February 11, 2019—HealthDay News Tweet
In a study published in Cancer, researchers investigated the fall in breast cancer mortality rates since 1990, after it increased steadily from 1975 to 1990. Dr. Edward Hendrick and colleagues used mortality and population data from the Surveillance, Epidemiology, and End Results (SEER) Program and included women aged 40 to 84 years old. The study also references work done by the Cancer Intervention and Surveillance Modeling Network (CISNET), a consortium of investigators sponsored by the National Cancer Institute. The researchers found that in 2012, the number of averted breast cancer deaths ranged from about 21,00 to 34,000 averted deaths. In 2015, there were between 24,000 to 39,000 averted deaths, and, in 2018, there were an estimated 27,000 to 46,000 averted deaths. Cumulatively, an estimated 384,000 to 614,000 breast cancer deaths were averted from 1989 to 2018. Due to these findings, the team suggests that these deaths were averted due to screening mammography and improved treatment.
February 3, 2019—The Lancet Tweet
In a recent study published in The Lancet Public Health, researchers from the American Cancer Society and National Cancer Institute analyzed U.S. cancer incidence trends for 30 common cancers. The team used Surveillance, Epidemiology, and End Results (SEER) Program data from people aged 25-84 years diagnosed with invasive cancers from 01/01/1995-12/31/2014. After grouping the incidence data by 5-year age groups, the authors calculated the age-specific average annual percent change. Between 1995-2014, incidence increased for six (multiple myeloma, colorectal, uterine corpus, gallbladder, kidney, and pancreatic cancer) out of 12 obesity-related cancers in young adults (25-49 years old). Additionally, this increase became steeper, and of greater magnitude, in successively younger generations. Researchers have hypothesized this trend may be influenced by the increasing obesity rates in the United States. In contrast to the obesity-related cancers, during the same time period, incidence increased in only two (gastric non-cardia cancer and leukemia) of the remaining 18 cancers in young adults.
January 28, 2019—JNCI Tweet
In a recent study published in Journal of the National Cancer Institute, researchers investigated lung cancer risk by linking California and Hawaii Surveillance, Epidemiology, and End Results Program (SEER) data to the existing Multiethnic Cohort Study (MEC) data. The cohort included five racial/ethnic populations: African Americans, Japanese Americans, Latinos, Native Hawaiians, and whites. The original MEC study found that African Americans and Native Hawaiians had the highest lung cancer risk compared to other races in the cohort. In the updated analysis, researchers included 11 years of additional follow-up, additional questionnaire data, and biomarker data for a subset of current smokers. With these updates and the use of SEER data, the researchers identified 3,014 additional lung cancer cases. Racial differences in the updated analysis were consistent with earlier patterns as demonstrated in the MEC. Specifically, at lower smoking intensity, African Americans and Native Hawaiians had higher risk of smoking-related lung cancer than other races in the cohort. Additionally, African American smokers had the lowest quitting rates, while Japanese Americans had the highest quitting rates. Finally, the biomarker data showed that African Americans uptake greater amounts of nicotine per cigarette compared to the other races. Researchers concluded this biomarker data only explained a portion of the racial differences in the risk of lung cancer, and therefore additional study of other biomarkers is necessary.
January 25, 2019—OncLive Tweet
In a study commissioned by the Leukemia & Lymphoma Society, researchers aimed to identify the total healthcare allowed spending, defined as amounts paid by insurance payers and patients combined, and patient out-of-pocket costs before and after the diagnosis of a blood cancer. The researchers cited the SEER database, including that blood cancer-related deaths decreased by more than 2 percent from 2011 to 2015, to emphasize the need to understand healthcare cost burdens faced by blood cancer survivors. This longitudinal study included 2,332 patients who were diagnosed in 2014 with one of five blood cancer categories – acute leukemia, chronic leukemia, lymphoma, multiple myeloma, and bone marrow disorders – and who were covered by commercial insurance. The researchers found that one year after diagnosis, the average annual allowed spending per patient was $156,000. High spending persisted beyond the first year, and allowed spending did not return to pre-diagnosis levels ($1,600 per month or lower pre-diagnosis compared to between $3,500 to $4,500 per month in the third year after diagnosis). The researchers also found that: 1) services that drive total allowed spending differ from those that drive patient out-of-pocket costs; 2) very high spending occurs immediately after diagnosis, largely due to inpatient hospital costs; and 3) patient out-of-pocket costs are high and are impacted by plan type and month of diagnosis. Due to these findings, the researchers suggest that some patients, including those with high-deductible plans, will face financial toxicity and that insurance payers could help alleviate this issue by providing financial counseling to such individuals. Additionally, it is important to work toward solutions that address the unsustainable cost of care for blood cancer patients.
January 15, 2019—The Philadelphia Inquirer Tweet
In a study published in Nature Communications, researchers aimed to identify cancer types with the highest risk of suicide. Dr. Nicholas Zaorsky and colleagues used SEER data from patients who were diagnosed with cancer between 1973 and 2014; the study included more than 8.6 million patients. In this retrospective study, the authors found that the risk of suicide among cancer patients is four times that of the general population. The patients at highest risk of suicide were predominantly male, white, and/or diagnosed with Hodgkin lymphoma or cancer of the bladder, head and neck, lung, or testes. Most suicides occurred in adults older than age 50 years and who had been diagnosed with prostate, lung, colorectum, or bladder cancer. Due to these findings, the researchers suggest that suicide prevention strategies should be targeted toward cancer patients at highest risk of suicide. Providers should follow related guidelines from institutions such as the American College of Surgeons Committee on Cancer or American Society of Clinical Oncology.
January 14, 2019—Reuters Health Tweet
In a study published in JAMA Internal Medicine, researchers aimed to quantify the complication rates and costs associated with invasive diagnostic procedures for lung abnormalities provided in the community setting compared to the clinical trial setting. The National Cancer Institute’s Surveillance Research Program funded this retrospective cohort study. It included more than 344,000 patients aged 55 to 77 years who underwent invasive diagnostic procedures between 2008 and 2013. The authors found that the complication rates for procedures provided in the community setting were two times higher in both younger and older age groups than those reported in a clinical trial called the National Lung Screening Trial (22.2% and 23.8% compared to 9.8% and 8.5%, respectively). The average costs of complications were $6,320 for minor complications and $56,845 for major complications. Due to these findings, the researchers suggest that both physicians and patients should be aware of and consider in their shared decision-making process the potential risk of complications and related costs for lung cancer screening.
January 8, 2019—Wiley Online Library Tweet
In a recent study published in CA: A Cancer Journal for Clinicians, American Cancer Society researchers summarized recent cancer incidence and mortality trends. Sources such as the Surveillance, Epidemiology, and End Results (SEER) Program, the National Center for Health Statistics (NCHS), and the National Program of Cancer Registries (NPCR) were all included in the analysis. The SEER Program provided the only source of historic population-based incidence data (1975-2015). Researchers concluded the cancer incidence rate (2006‐2015) declined approximately 2% per year in men, and remained stable in women. However, over this time, incidence rates increased for melanoma and cancers of the thyroid, breast, uterus, pancreas, and liver (liver cancer incidence rising the fastest compared to all other cancers for men and women). Regarding mortality, the overall cancer death rate (2007‐2016) declined in both men and women (1.8% per year in men; 1.4% per year in women). From 1991 to 2016, cancer death rates fell a total of 27%. Researchers have long attributed this tremendous decline in cancer mortality to reductions in smoking, advancements in early detection, and improved medical advances. The team from ACS also highlighted the growing socioeconomic inequalities: mortality rates for preventable cancers were disproportionately higher in the poorest counties compared to the most affluent counties.
January 7, 2019—HealthDay News Tweet
In a study published in Cancer, researchers investigated suicide risk within the year after a cancer diagnosis. Dr. Ahmad Samir Alfaar and colleagues used SEER data on patients who were diagnosed with cancer between 2000 and 2014; the study included more than 4.6 million patients. In this retrospective study, the authors found that suicide risk increased significantly in the first year after a diagnosis of cancer in comparison with the general population. The suicide risk increased the most for patients diagnosed with pancreatic or lung cancers. There was also a significant increase in suicide risk for patients diagnosed with colorectal cancer. Suicide risk did not increase significantly for patients diagnosed with breast or prostate cancers. Essentially, suicide rates were higher for cancers with a poor prognosis. Due to these findings, the researchers suggest that it is important for healthcare providers to screen newly diagnosed patients for their risk of suicide and ensure that patients have access to social and emotional support.
Researchers use SEER-Medicare to evaluate factors associated with discontinuation of follow-up care in early-stage breast cancer patients
January 1, 2019—Journal of Oncology Practice Tweet
In a recent study published in Journal of Oncology Practice, researchers used Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data to analyze factors associated with follow-up care among women with early-stage breast cancer. The study team included data for patients diagnosed with stage I or II breast cancer between 2002 and 2007 who underwent surgery with follow-up through 2012. In the first year after diagnosis, 85.8% of patients saw a medical oncologist and 71.9% of patients saw a radiation oncologist in addition to their surgeon. Within the first five years after diagnosis, 21% of patients discontinued seeing any oncology provider. Factors associated with greater likelihood of discontinuation of physician visits were: increasing age, stage I cancer (vs stage II), low-grade tumors, and patients with hormone receptor-negative tumors. Researchers also concluded that race, socioeconomic status, and marital status were not associated with discontinuation of physician follow-up.
December 27, 2018—JAMA Oncology Tweet
An estimated 1 in 17 cancers diagnosed in the United States between 2011 and 2015 in adults 30 years or older can be attributed to excess body weight (EBW). In a recent article published in JAMA Oncology, researchers analyzed data from the Surveillance, Epidemiology, and End Results (SEER) Program and National Program of Cancer Registries (NCPR) to estimate the EBW-related cancer burden by state. Between 2011 and 2015, 4.7% of cancers in men, and 9.6% of cancers in women were attributable to EBW. The percent of obesity-related cancers varied by state, with rates for men and women being highest in the District of Columbia (population attributable fraction (PAF) = 8.3%) and lowest in Hawaii (PAF = 5.9%). Overall, 13 different cancer types are associated with EBW. As prevalence of obesity has increased over the past 40 years, researchers suspect the burden of EBW will increase over time. Researchers highlighted the importance of obesity prevention through healthy diet, exercise, and policy change.
December 20, 2018—NCI Press Release Tweet
In a study published in JAMA Oncology, researchers at the National Cancer Institute investigated the levels of risk that patients who receive chemotherapy for solid tumors face for certain complications, including therapy-related myelodysplastic syndrome or acute myeloid leukemia (tMDS/AML). Dr. Lindsay Morton and colleagues used SEER-Medicare data for patients, ages 66-84, who: (1) were diagnosed with their first primary solid cancer during 2000 to 2013, (2) received initial chemotherapy for that cancer during that time frame, and (3) survived one year or more without developing a second cancer. The study authors found that cancer patients with 22 of the 23 solid cancers studied and who were treated with chemotherapy were at increased risk for developing tMDS/AML. The risk ranged from a 1.5- to 10-fold increased risk for the complications. Additionally, the team found that the risk for tMDS/AML was greatest following chemotherapy for bone, soft tissue, and testis cancer, which were typically diagnosed in younger patients. Due to these findings, the researchers suggest efforts be continued to reduce treatment-related adverse effects, especially for solid cancer patients with a favorable prognosis. Effective and less toxic chemotherapy treatments also need to be developed.
Multigene panel testing vs BRCA1/2-only testing: No substantial difference in patient cancer-related
December 19, 2018—JCO Precision Oncology Tweet
In a recent study published in JCO Precision Oncology, researchers found that multigene panel (MGP) testing after breast cancer diagnosis was not associated with increased cancer-related worry when compared to BRCA1/2-only testing. The research team used Surveillance, Epidemiology, and End Results (SEER) Program data from women ages 20-79 years old who were diagnosed with stages 0 to II breast cancer in the Georgia or Los Angeles County SEER registries. Study participants completed a survey which measured worry about future cancer: impact of cancer worry was the primary outcome, and frequency of cancer worry was also measured. Then the investigators merged survey responses with SEER clinical data and genetic testing information from laboratories. Approximately 60% of the sample received BRCA1/2-only testing, and 40% received MGP testing. A minority of participants reported significant cancer worry after treatment (approximately 11% reported high impact of cancer worry and 15% reported high frequency of cancer worry). In sum, researchers concluded that cancer worry (impact and frequency) did not differ by the type of genetic testing performed.
December 18, 2018—JAMA Tweet
According to a recent study published in JAMA, black men with Gleason 6 disease were twice as likely to die from prostate cancer compared to nonblack men. Researchers analyzed data for men diagnosed with localized prostate cancer from 2010 to 2015 in the Surveillance, Epidemiology, and End Results (SEER) Prostate Active Surveillance/Watchful Waiting (AS/WW) database and investigated mortality by Gleason score and race. No significant racial difference was found in Gleason 7 to 10 disease. Racial disparities were most notable in patients with Gleason 6 disease (considered to be a low-grade disease): prostate cancer mortality was higher in black patients (0.40%) compared to nonblack patients (0.22%). Low-grade prostate cancer may be more aggressive in black men compared to nonblack men. Lead author Brandon Mahal, MD suspects several factors are also involved, highlighting the importance of further studies in this area.
December 13 10, 2018—Idaho State Journal Tweet
Cancer Data Registry of Idaho, one of the newest participants in the SEER Program, released promising new data from 2016 and 2017. According to an article in the Idaho State Journal article, the state’s preliminary report from 2017 has its lowest rate of new cancer cases so far this century. Dr. Daniel Miller, a radiation oncologist, noted that most of the rates are similar to national data. Specifically, breast cancer was the most common new diagnosis among all types of cancer, and lung cancer was the deadliest type of cancer in Idaho. Dr. Miller also reported that Idaho now has better systemic treatment options, helping reduce mortality rates as well.
December 3, 2018—The Washington Post Tweet
If you are widowed, divorced, or unmarried, you may be getting less aggressive cancer treatment, says a Washington Post article. The author, Joan DelFattore, PhD, analyzed findings from 59 studies that used SEER data; she found that significant differences exist in treatment rates between married and unmarried patients. Dr. DelFattore says a proposed explanation that single patients do not get aggressive treatments like surgery because they refuse it does not hold up to scrutiny. Instead, she suggests that a stereotyped portrayal of unmarried adults linked to physician prescribing practices may play a role. For example, a physician who believes unmarried patients are less prepared to handle aggressive treatments due to a lack of social support may prescribe milder treatment instead. The author suggests that caution should be taken when conflating unmarried status with factors like depression and social isolation because 1) the majority of unmarried people are not depressed and 2) marriage is not the only source of social support. To avoid potential fallacies, physicians can ask patients about nontraditional support before determining treatment, talk about their treatment decision-making, or frame discussions in terms of what the patient actually needs. An interdisciplinary team approach that combines physicians’ oncology expertise with social scientists’ understanding of discrepancies based on marital status may also be beneficial.
December 7, 2018—CDC Tweet
Although incidence and mortality rates are decreasing for a majority of cancers nationwide, uterine cancer rates are increasing. In a recent article published in the Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report (MMWR), S. Jane Henley and colleagues analyzed Surveillance, Epidemiology, and End Results (SEER) Program data to assess recent trends in uterine cancer incidence and mortality by race and ethnicity. Researchers found that overall uterine cancer incidence rates increased 0.7% per year (1999-2015), and mortality rates increased 1.1% per year (1999–2016). Black women were disproportionately affected: compared to rates for other racial/ethnic groups, incidence, mortality, and rates of distant stage cancers were high among black women. White women had the same incidence rate but a lower mortality rate. One possible explanation for the increase in incidence is the nation’s high prevalence of obesity: women who are overweight or obese are between two to four times as likely to develop uterine cancer compared to women with healthy weight.
October 10, 2018—NBC Los Angeles Tweet
California is experiencing an accelerated reduction in smoking rates compared to the rest of the country due to their long-standing tobacco control initiatives. In a recent study published in Cancer Prevention Research, Dr. John Pierce and colleagues examined the differences in smoking behavior trends in California and the United States to help inform lung cancer research. Investigators analyzed data from the National Health Interview Survey (NHIS) and the Surveillance, Epidemiology, and End Results (SEER) Program to assess smoking initiation, intensity, and quitting behaviors. Researchers found that Californians aged 18-35 smoked at lower rates than national levels, and of those who smoked, they smoked fewer cigarettes and had higher quit rates by age 35. They also found that annual lung cancer mortality in California declined faster, and by 2013 was 28% lower than in the rest of the United States. Authors concluded that because of California’s major tobacco control initiatives, the lung cancer mortality gap between California and the rest of the country will continue to widen. Additionally, researchers suggest that California’s approach to target smoking behaviors should direct cessation programs for the nation to help reduce lung cancer deaths.
August 23, 2018—The Washington Post Tweet
The Centers for Disease Control and Prevention (CDC) recently published a Morbidity and Mortality Weekly Report (MMWR) summarizing trends in human papillomavirus (HPV) associated cancers between 1999-2015. The CDC analyzed data from its National Program of Cancer Registries (NPCR) and the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program. The researchers found that HPV-associated cancers rose from 30,115 incident cases in 1999, to 43,371 incident cases in 2015. Specifically, rates of oropharyngeal squamous cell carcinoma (SCC), anal SCC, and vulvar SCC all increased from 1999-2015. Hypothesized reasons for these rate increases include changes in sexual behaviors and lack of recommended screening for these specific HPV-associated cancers. In contrast, rates of cervical carcinoma and vaginal SCC have decreased over the same time period. The combination of recommendations for cervical cancer screenings and an overall increase in HPV vaccination rates is thought to have influenced these declining rates. Although HPV vaccination initiation rates have increased an average of 5.1% each year since 2013, only 53% of girls and 44% of boys receive all recommended doses. Due to these findings, the authors suggest improving vaccination coverage and conducting further research to understand the progression from HPV infection to cancer.
July 23, 2018—Reuters Health Tweet
In a study published in Cancer, researchers found that the financial toxicity that many cancer patients face is not being sufficiently addressed by health care providers. Those with cancer face financial burdens through disruptions in employment, out-of-pocket costs associated with care, and more. Dr. Reshma Jagsi, Dr. Kevin C. Ward, Paul H. Abrahamse, and colleagues surveyed patients with early-stage breast cancer as identified through the sampling of two Surveillance, Epidemiology, and End Results (SEER) Program regions. Responses were collected from 370 surgeons, 306 medical oncologists, 169 radiation oncologists, and 2,502 patients. Of the medical oncologists, 50.9% of respondents reported that someone in their practice often discusses the financial burdens with their patients, along with 15.6% of surgeons and 43.2% of radiation oncologists. However, a lower percentage of responding medical providers are truly aware of the out-of-pocket costs, and patients are still left with unmet needs for engagement with physicians regarding financial concerns. The authors believe that more clinician engagement and communication regarding financial toxicity is necessary to help patients combat financial burdens in addition to battling cancer itself.
July 3, 2018—Reuters Health Tweet
In a study published in JAMA Surgery, researchers found that genetic testing after a breast cancer diagnosis varies due to differences among surgeon attitudes. Genetic testing helps to inform treatment decisions, as well as risk reduction decisions. Dr. Steven J. Katz, Irina Bondarenko, Dr. Kevin C. Ward and colleagues performed an analysis using data from the Surveillance, Epidemiology, and End Results (SEER) Program, surveys of patients and surgeons, and testing information from laboratories. The team surveyed 5,080 women who were treated for early-stage breast cancer. Of these patients, 35% had an elevated risk of carrying a genetic mutation, yet only 27% of the study patients received genetic testing. In addition, only 52% of women at a higher risk of carrying genetic mutations received genetic testing. Due to these results, the authors believe that outreach to surgeons is necessary to build a consensus regarding approaches to genetic risk evaluation and results management.
June 10, 2018—U.S. News Tweet
The National Cancer Institute led this year’s Annual Report to the Nation on the Status of Cancer, published last month in Cancer. Dr. Serban Negoita of NCI’s Data Quality, Analysis and Interpretation Branch is the lead author of Part II of the report, which contains updated prostate cancer trends. Staff Writer for U.S. News & World Report Michael O. Shroeder highlights findings from this section, including that age-adjusted prostate cancer death rates have remained stable at around 19 per 100,000 persons in recent years. Researchers also found that although the incidence of prostate cancer is declining, the rate of late-stage prostate cancer increased between 2010-2014. These findings open further discussion on the benefits and risks of screening, as well as the importance of “watchful waiting” after a man is diagnosed with prostate cancer. This entails closely monitoring the cancer, yet only taking treatment action when necessary.
June 7, 2018—Wiley Online Library Tweet
In a study published in Cancer, researchers found that although patients with cancer in rural areas reported more timely care than those diagnosed in urban areas, racial/ethnic minorities in rural areas reported barriers to accessing such care. Dr. Michelle A. Mollica, Dr. Kathryn E. Weaver, Timothy S. McNeel, and Dr. Erin E. Kent examined SEER-CAHPS data and a total of 6,826 surveys of patients with breast, lung, colorectal, or prostate cancers. The SEER-CAHPS dataset is a resource used for quality of care research based on a collaboration between the NCI’s Surveillance, Epidemiology, and End Results (SEER) cancer registry data and the Centers for Medicare & Medicaid Services’ (CMS) Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) patient surveys. The authors found that although patients who live in rural areas report more timely care than those in urban areas overall, discrepancies may be found regarding access and race/ethnicity. More specifically, patients who identified as non-Hispanic black and Hispanic rated their care as lower in rural areas compared with urban areas. Accessing care in rural areas may be more difficult for racial/ethnic minorities, and more research should examine specific barriers that could otherwise ensure equitable access.
May 10, 2018—Jama Oncology Tweet
A recent study published in JAMA Oncology found that while multigene testing is becoming more common for breast cancer patients than the older two-gene BRCA1/2 test, there has not been an increase in prophylactic surgery. Researchers led by Dr. Allison W. Kurian from Stanford University’s School of Medicine analyzed SEER data from 1,316 women in Georgia and Los Angeles who were diagnosed with early stage breast cancer between 2013 and 2015. BRCA1/2 mutations were still the most common result associated with prophylactic mastectomies; 79% of women with BRCA mutations underwent prophylactic mastectomies, compared to 35.3% with no mutations. Patients with other known pathogenic variants, and a variant of unknown significance (VUS), decided to undergo prophylactic surgery at rates of 37.6% and 30.2%, respectively. Unlike the BRCA1/2-only test, multigene testing is more common after surgery. Dr. Kurian says results from multigene sequencing need to be addressed earlier to better guide surgical decisions. The study also found that a VUS is higher in black and Asian patients at 44.5% and 50.9%, respectively, compared to white patients at 23.7%. Dr. Kurian went on to say that additional research should be done since VUS rates among racial-ethnic minorities are significantly higher.
April 18, 2018—Jama Dermatology Tweet
In a recent study published in JAMA Dermatology, Dr. Giorgos Karakousis and Cimarron Sharon of the University of Pennsylvania found that there is a correlation between the stage melanoma skin cancer is diagnosed and relationship status. The researchers analyzed SEER data from 52,063 patients diagnosed with melanoma between 2010-2014, looking specifically at tumor stage at diagnosis and marital status. It was determined that 46% of patients diagnosed at stage 1 of the disease were married, followed by 43% who were never married, 39% who were divorced, and 32% who were widowed. The study authors also found that patients who had never been married were 12% more likely to be diagnosed at late stage disease; divorced patients were 34% more likely and widowed patients were nearly 3 times more likely to be diagnosed with late stage disease. One hypothesis is that a spouse helps detect new or changing moles and is also likely to encourage visits to have moles examined. Dr. Karakousis says that everyone should get skin exams routinely, and that dermatologists should suggest more frequent visits for patients without spouses.
March 27, 2018—ABC News Tweet
At the 49th Society of Gynecologic Oncology Annual Meeting, researchers from the Department of Obstetrics and Gynecology at the University of Alabama at Birmingham proposed an update to screening guidelines for cervical cancer, citing their recent study; using SEER data and the National Cancer Database (NCDB), Dr. Sarah Dilley and colleagues found that between 2000-2014, about 1 in every 5 new cervical cancer cases were among women 65 years old and older. Currently, the U.S. Preventive Services Task Force (USPSTF) recommends only women between the ages of 21-65 get tested for cervical cancer by Pap smear and HPV testing. Dr. Dilley noted that the population of women over 65 is increasing due to longer life expectancy, and suggested that governing bodies such as the USPSTF reconsider changing screening guidelines to include this expanding age group.
March 30, 2018—Health Day Editor Tweet
The overall lung cancer mortality has declined steadily in the United States since 1990, however the decrease in deaths among women did not start until the mid-2000s. In a recent study published in Cancer Epidemiology, Biomarkers & Prevention, researchers examined county-level changes in lung cancer-related deaths among women between 1990-1999 and 2006-2015. Katherine Ross and colleagues used the SEER*Stat database to obtain lung cancer-related death rates and the SEER*Stat software to compute age-standardization, absolute change, and relative change calculations. They identified two distinct clusters of counties in Appalachia and the Midwest (Hotspot 1) and the northern Midwest (Hotspot 2) where death rates among women increased. From 1990-1999 to 2006-2015, lung cancer-related death rates increased 13% in Hotspot 1 and 7% in Hotspot 2, while rates decreased 6% in the rest of the United States. Researchers speculate that the excess burden of lung cancer deaths in these hotspots relates to lower cigarette taxes in the regions, as well as a lack of comprehensive smoke-free air laws. Due to these findings, researchers suggest the implementation of targeted tobacco control programs at the county, state, and federal level to reduce smoking prevalence and prevent the widening of geographic inequity for lung cancer-related death.
March 15, 2018—The New York Times Tweet
Blacks comprise only 12% of the total population in the United States, yet have the highest cancer mortality rates and shortest survival of all racial/ethnic groups for most cancers. In a recent report, researchers from the American Cancer Society (ACS) analyzed cancer incidence, mortality, and survival data from a combination of sources, including the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program, to describe the disproportionate burden of cancer among blacks. Additionally, ACS’ Carol DeSantis and colleagues reviewed data on cancer risk factors, such as the use of tobacco and chronic human papillomavirus (HPV) infection, which may increase a person’s lifetime risk of developing cancer. For men, researchers found that incidence rates for all cancers combined were 12% higher for blacks than whites, and mortality rates were 27% higher for black men. For women, they found that blacks had a lower risk of cancer diagnosis but a higher risk of death than whites. Most significantly, despite lower incidence rates, black women with uterine and breast cancer had morality rates that were 42% and 92% higher than white women, respectively. Due to these findings, continuing to address the complex socioeconomic factors that lead to cancer disparities is necessary to create better outcomes for all populations.
March 12, 2018—Health Day Editor Tweet
In a recent study published in Cancer, researchers investigated whether socioeconomic status is predictive of survival among patients with squamous cell carcinoma of the anus (SCCA). Dr. Daniel Becker and colleagues used SEER-18 data on SCCA diagnoses between 2004-2013 and median household income (MHI) data collected by the American Community Survey. The study authors found that socioeconomic status does predict survival outcomes in patients with SCCA, with lower survival associated with patients living in lower MHI areas compared to patients living in higher MHI areas. The team also found that the risk of cancer death was higher among patients who were black, diagnosed at an earlier year, diagnosed with more advanced cancer, male, of older age, or unmarried. Due to these findings, the researchers suggest that one’s social environment plays a significant role in cancer outcomes. Anal cancer can be highly treatable and curable, and policy interventions and increased awareness, resources, and access to care could reduce cancer mortality in groups at higher risk for SCCA.
January 31, 2018—JAMA Dermatology Tweet
A recent study published in JAMA Dermatology found that rates of melanoma decreased significantly in younger white adults (men age <45 and women age <35), but increased in older white adults (men age >54 years and women age >44 years). Dawn Holman and colleagues from the Division of Cancer Prevention and Control at the CDC used both NCI’s SEER data and the CDC’s National Program of Cancer Registries in the 10-year study, and found that melanoma incidence ranged from 2.0 per 100,000 to 198.3 per 100,000 in white Americans ages 15-24 and 85 years old and older, respectively. Less exposure to UV radiation through indoor tanning and the decline in sunburn cases in recent years among teenagers and young adults are contributing factors to the decline. For older adults, age is a major determining factor in developing melanoma. According to Holman, the upswing in melanoma cases could be directly linked to older patients being more aware of melanoma and practicing total-body skin exams to monitor the disease. Doctors are encouraged to inform patients about using protective clothing, seeking shade, and using sunscreen with SPF 15+ to protect their skin from the sun.
January 9, 2018—UPI Tweet
In the United States, breast cancer mortality has steadily declined over the years, yet it is unclear to what extent advances in screening and treatment have contributed to the observed population-level mortality decline. In a recent study published in JAMA, Dr. Sylvia Plevritis and colleagues analyzed the impact of improved screening and adjuvant treatment on the reduction in breast cancer mortality by molecular subtype based on estrogen-receptors (ERs) and human epidermal growth factor receptor 2 (ERBB2). Researchers projected breast cancer mortality trends, for women aged 30 to 79, using six independent, simulated Cancer Intervention and Surveillance Network (CISNET) models. The National Cancer Institute sponsors CISNET. Overall, advances in screening and treatment reduced breast cancer mortality by 37% in 2000 and 49% in 2012. Researchers also found that declines in mortality rates differed by molecular subtype. Due to these findings, study investigators suggest continued use of model-based approaches to evaluate population-level progress in the reduction of breast cancer and the dissemination of molecularly targeted therapies, as well as tailored prevention and early detection methods for breast cancer molecular subtypes to reduce the burden of disease.
January 4, 2018—TIME Health Tweet
The American Cancer Society (ACS) recently published their annual report, which compiles the most recent data on cancer incidence, mortality, and survival in the United States. ACS’s Rebecca Siegel and colleagues projected cancer incidence and mortality rates using data from the Surveillance, Epidemiology, and End Results (SEER) Program, the National Program of Cancer Registries (NPCR), the North American Association of Central Cancer Registries (NAACCR), and the National Center for Health Statistics (NCHS). Researchers estimated that there would be 1,735,350 new cancer cases and 609,640 cancer deaths in the United States in 2018. They also found that the combined cancer death rate dropped 26% between 1991 and 2015, which translates to approximately 2.4 million fewer cancer deaths. This observed decline was the result of a combination of factors, including the reduction in smoking rates and improved treatment options. However, investigators continued to find substantial racial, socioeconomic, and geographic disparities in cancer incidence and mortality. Due to these findings, researchers suggest delivering a broader application of existing cancer control knowledge across all segments of the population, with an emphasis on disadvantaged groups, to reduce cancer disparities and burden.
December 11, 2017—Newsweek Tweet
In a study published in the Journal of the National Cancer Institute, researchers examined recent trends of women with breast cancer who use chemotherapy treatment. This study was conducted because little is known about changes in chemotherapy use and oncologists’ recommendations in recent years. The authors of this retrospective study looked at female patients from the SEER registries of Georgia and Los Angeles County who had been diagnosed between 2013-2015 with stages 0-II and estrogen receptor-positive breast cancer. Dr. Allison Kurian and colleagues surveyed more than 5,000 of these women and over 500 oncologists who treated them. The researchers found that chemotherapy use declined from 35 percent to 21 percent between 2013-2015. Additionally, while 45 percent of the oncologists recommended their patients get chemotherapy in 2013, this number declined to 32 percent in 2015. If a patient decided against her oncologist’s chemotherapy recommendation, oncologists were more likely to order tumor genetic tests to understand the likelihood of the patient having a recurrence of cancer. Due to these findings, the study authors suggest that oncologists are attempting to be more selective in their recommendations for chemotherapy use and to spare patients from toxicity when possible. Future studies will be needed to confirm the quality of this approach to breast cancer.
December 5, 2017—HealthDay News Tweet
In a recent study published in JAMA Oncology, researchers used the California Cancer Registry (CCR) to analyze cancer survival trends from January 1997 to December 2014 by health insurance status for the five most common cancers in California: melanoma, breast, prostate, lung, and colorectal. The National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program supported the collection of cancer incidence data used in this study. Dr. Libby Ellis and colleagues found that compared to those with private insurance, those with public insurance and those who were uninsured had higher mortality rates and were more likely to have advanced stage disease at diagnosis. The largest survival disparities were among men with melanoma; mortality was 92% higher for men who were uninsured and 37% higher for those with public insurance. The team also found significant disparities by insurance status for patients with breast, prostate, lung, and colorectal cancer. Due to these findings, researchers emphasize the need for all patients to have access to health insurance that covers all aspects of care, including prevention, early detection, and timely treatment. Having appropriate and quality healthcare will help reduce the growing survival disparities seen among cancer patients.
December 5, 2017—HealthDay News Tweet
Researchers from the University of Kentucky examined the association between lung cancer incidence rates and the strength of smoke-free laws. Lung cancer is the leading cause of cancer-related death in the United States. Cigarette smoking and secondhand smoke exposure cause most lung cancers; reducing smoking and exposure could prevent many deaths from this disease. Dr. Ellen Hahn and colleagues used data from the Kentucky Cancer Registry, a SEER registry, and looked at cases of lung cancers newly diagnosed from 1995 to 2014. The team analyzed more than 80,000 cases by county-level characteristics, including the strength of smoke-free laws in the county from 1995 to 2014, the average annual adult smoking rate, and other population demographics. Individuals living in counties with comprehensive smoke-free laws were about 8 percent less likely than those living in counties without smoke-free protections to be diagnosed with lung cancer. There was not a significant difference in lung cancer incidence between counties with moderate or weak laws and counties without smoke-free laws. Due to these findings, the study authors suggest that local government may be key in preventing lung cancer by passing comprehensive smoke-free laws that cover all workers and the public with few or no exceptions.
November 28, 2017—The ASCO Post Tweet
In a recent study published in Cancer Epidemiology, Biomarkers & Prevention, researchers examined the risks of aging-related diseases, such as heart disease and diabetes, among thyroid cancer survivors. In the United States, thyroid cancer is the most rapidly increasing cancer. It is one of the most common cancers among people under age 40 and has high survival. Dr. Mia Hashibe and colleagues looked at 3,706 thyroid cancer cases diagnosed between 1997 to 2012 and used SEER data from the Utah Cancer Registry. These cases were matched to 15,587 cancer-free individuals who served as controls in the study. The researchers found that both younger and older thyroid cancer survivors had an increased risk for aging-related diseases. However, those survivors younger than age 40 had a higher risk for cardiomyopathy, hypertension, nutritional deficiencies, and osteoporosis compared to older survivors. Due to these findings, the study authors suggest that further studies are needed to assess how to reduce the increased risks of these long-term health effects.
November 22, 2017—HealthDay News Tweet
Advances in cancer care, such as improvements in cancer treatment and the expansion of screening efforts, have allowed patients to live longer. As a result, the number of cancer survivors in the United States has grown rapidly, yet there is inadequate research about the risk of developing future cancer among survivors. In a recent study published in JAMA Oncology, researchers examined the prevalence of prior cancer among 740,900 persons newly diagnosed with cancer between January 2009 and December 2013. Dr. Caitlin Murphy and colleagues identified cases using the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program of cancer registries. They evaluated the prevalence of prior cancer by age (<65 years vs ≥ 65 years) and incident cancer type, finding that a considerable proportion of newly diagnosed cancer patients had survived a previous cancer. The overall prevalence of prior cancer ranged from 3.5% to 36.9% depending on age and incident cancer type. Many prior cancers also occurred at a different cancer site. For those over age 65, 25.2% had a previous history of cancer compared to 11% of those under age 65. For all ages, prior cancer was most prevalent among incident myeloid and monocytic leukemia; 24.8% for those under age 65 and 36.9% for those over age 65. However, these figures may be a significant underestimation because cancer registries only capture cases in which the second primary cancer occurred in the same state. Cancer registries do not currently share data about primary cancer cases that occurred in two different states. Due to these findings, and the growing cancer survivor population, researchers signify the importance of understanding the nature and impact of prior cancer to improve disease outcomes and patient experience, and to help shape the direction of future research.
National Cancer Institute Awards Dr. Ruth Etzioni 5-Year Grant to Fill Gaps in Cancer-Recurrence Data
November 10, 2017—The ASCO Post Tweet
The National Cancer Institute (NCI) awarded Ruth Etzioni, PhD, a five-year grant to create an approach to identify metastatic cancer recurrence. This is an area that the NCI has pinpointed as a gap in cancer surveillance. The Surveillance, Epidemiology, and End Results (SEER) Program currently does not collect information in metastatic cancer recurrence, but does provides detailed information about cancer diagnosis, primary treatment information, and survival. Through this award, Dr. Etzioni, a biostatician at Fred Hutchinson Cancer Research Center’s Public Health Sciences Division, will use cancer records from the Puget Sound SEER Registry’s Fred Hutch–housed Cancer Surveillance System and other health data to create an algorithm that can be used to predict metastatic recurrence. This algorithm will then be tested within the Kentucky Cancer Registry to see how the results match up against gold-standard recurrence data gleaned from the electronic health records of the University of Kentucky. According to Dr. Etzioni, cancer recurrence data is necessary to understand the burden of cancer and to study the effectiveness of cancer treatments outside of controlled clinical trials.
October 3, 2017—The Washington Post Tweet
Breast cancer is the most common invasive cancer in the United States, with 252,710 new cases expected in 2017. In a recent study, researchers from the American Cancer Society (ACS) provided an overview of breast cancer incidence, mortality, survival, and screening by race, ethnicity, and state between 1975 and 2015. They used combined data from the Centers for Disease Control and Prevention’s National Program of Cancer Registries (NPCR) and the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program. ACS’ Carol DeSantis and colleagues computed calculations with NCI’s SEER*Stat software, finding that overall breast cancer mortality rates dropped 39% since 1989, after increasing 0.4% per year from 1975-1989. This translates to 322,600 averted breast cancer deaths in the United States. However, a woman still has roughly a 1-in-8 chance of developing breast cancer in her lifetime, and not all women have benefited equally from improvements over time. Black women continue to have higher mortality rates, are more likely to have advanced stage disease, and are younger at age of diagnosis. Furthermore, investigators found that there is significant variation in breast cancer screening, incidence, and mortality rates by state. A complex interaction of socioeconomic, structural, and biological factors contributes to the disparities seen in breast cancer. Due to these findings, researchers suggest improving access to care in all states, for all populations, to help eliminate breast cancer disparities and enhance outcomes.
October 3, 2017—HealthDay News Tweet
Researchers from the Centers for Disease Control and Prevention (CDC) and National Cancer Institute (NCI) examined trends in cancers that are associated with being overweight or obese. These include cancers of the breast, colon and rectum, endometrium, esophagus, gallbladder, gastric cardia, kidney, liver, ovary, pancreas, and thyroid, in addition to meningioma and multiple myeloma. Between 2013-2014, about one-third of adults in the United States were overweight and about one-third were obese. Dr. C. Brooke Steele and colleagues used cancer incidence data between 2005-2014 from SEER and the CDC’s National Program of Cancer Registries. They found that being overweight or obese was associated with 40 percent of all cancers diagnosed in 2014, or about 631,000 cancer cases. Cancers related to being overweight or obese were more likely to affect older people, females, and non-Hispanic white and black adults. Incidence rates for these cancers increased between 2005-2014 among people ages 20-74 and decreased among those 75 years old and older. Due to these findings, the researchers concluded that the burden of cancers associated with being overweight and obese is high in the United States and that this burden might be reduced with cancer prevention efforts such as maintaining a healthy diet and staying active.
September 25, 2017—Reuters Health Tweet
In a study published in JAMA, researchers examined how much influence surgeons have on patients’ choices to receive contralateral prophylactic mastectomy (CPM), removal of both breasts when cancer is found in only one. CPM rates have increased over the last decade. Surgeons play a large role in advising newly diagnosed breast cancer patients on treatment decisions, and little is known regarding how much their influence contributes to these rates. Dr. Steven Katz and colleagues surveyed 5,080 women from the SEER registries of Georgia and Los Angeles County who had early-stage breast cancer and received surgical treatment in 2013 to 2015. They found that surgeons’ attitudes were strongly linked to whether their patients received CPM. Surgeons who least favored breast conserving therapy (BCT) and were more willing to perform CPM had a 34 percent CPM rate, whereas surgeons who favored BCT and were less willing to perform CPM had a 4 percent CPM rate. Due to these findings, the researchers suggest that surgeons influence the likelihood that a newly diagnosed breast cancer patient will receive CPM. Patients should discuss their options thoroughly to make informed decisions that meet their goals and values.
September 18, 2017—Reuters Tweet
More than 40% of people living with human immunodeficiency syndrome (HIV) in the United States smoke cigarettes, which twice exceeds the prevalence in the general population. In a recent study published in JAMA Internal Medicine, researchers projected cumulative lung cancer mortality rates, by age 80, among people living with HIV who smoked cigarettes and were adherent on antiretroviral (ART) medication. In this study, supported by the National Cancer Institute, Dr. Krishna Reddy and colleagues used the Cost-Effectiveness of Preventing AIDS Complications (CEPAC)-U.S. model to estimate the odds of dying from lung cancer based on smoking status and starting HIV care at age 40. Researchers found that those living with HIV who consistently followed ART, but continued to smoke, were 6 to 13 times more likely to die from lung cancer than from AIDS-related causes. Cumulative lung cancer mortality for men who smoked at heavy, moderate, and light rates was 28.9%, 23.0%, and 18.8%, respectively. For women, the rates were slightly lower at 27.8%, 20.9%, and 16.6%. The respective rates for those who quit smoking decreased to 7.9%, 6.1%, and 4.3% for men, and 7.5%, 5.2%, and 3.7% for women. For those who had never smoked the cumulative lung cancer mortality was just 1.2%. Due to these findings, and the high prevalence of smoking in this population, researchers suggest that smoking for individuals in this group is a greater threat to health than HIV itself, and that smoking cessation should be a priority in HIV care.
September 13, 2017—Reuters Health Tweet
In a study published in The Lancet, researchers from the St. Jude Children’s Research Hospital examined the cumulative burden of chronic health conditions (CHCs) experienced by long-term survivors of childhood cancer. According to SEER, 10-year survival for childhood cancer is now more than 80 percent, and so the population of its survivors continues to increase. Dr. Nickhill Bhakta and colleagues looked at 168 CHCs among 3,010 childhood cancer survivors over age 18 who were treated at St. Jude Children’s Research Hospital. They found that nearly all survivors (99.9 percent) had experienced at least one CHC by age 50, compared with 96 percent of age-matched peers in the community. Childhood cancer survivors had an average of 17.1 CHCs per person, including 4.7 serious conditions, compared to an average of 9.2 CHCs (2.3 of them serious) in the comparison group. Lung function disorders, second cancers, and spinal disorders were more likely to occur in childhood cancer survivors. Due to these findings, the researchers suggest that the burden of CHCs in childhood cancer survivors is substantial and that this information can inform clinical guidelines and health services planning for this population.
PSA screening for prostate cancer saves lives after all, study says
September 5, 2017—LA Times Tweet
In a study published in Annals of Internal Medicine, researchers from the NCI-sponsored Cancer Intervention and Surveillance Modeling Network (CISNET) Prostate Working Group (PWG) reexamined data from two conflicting clinical trials on screening men for prostate cancer: – the United States’ Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, and the European Randomized Study of Screening for Prostate Cancer. PLCO found that screening men over 55 years of age with the prostate-specific antigen (PSA) did not decrease mortality, while the European study found that mortality decreased by 20%. In this recent study, Ruth Etzioni, along with other CISNET PWG investigators, found that screening men over 55 years old reduced mortality by 25% to 32%. Dr. Sam Chang, a urological surgeon with Vanderbilt University, says that PSA screening is useful for patients and physicians to make decisions about future care. He also acknowledges that in the last 5 to 10 years, doctors have learned more about the harms of over-treatment, which can lead to impotence, incontinence, and difficulties with bowel movements. In April 2017, the U.S. Preventative Services Task Force (USPSTF) suggested that men ages 55-69 discuss the risks and benefits of testing with their doctors.
August 21, 2017—Reuters Tweet
In a recent study published in Cancer, researchers projected that annual mammograms beginning at age 40 for women of average risk would decrease breast cancer deaths by 40%. Dr. Elizabeth Arleo, a radiologist at Weill Cornell Medicine and New York Presbyterian, and colleagues used six Cancer Intervention and Surveillance Modeling Network (CISNET) models to compare three current, conflicting recommendations on mammography. The American Cancer Society (ACS) suggests beginning annual screening at 45, and then every other year by 55; the U.S. Preventative Services Task Force (USPSTF) suggests every two years, beginning at age 50. According to the computer models, death rates decreased by 31% and 23% when following recommendations from the ACS and the USPSTF, respectively. Dr. Otis Brawley, chief medical officer of the ACS, says that starting annual screening at age 40 will lead to more false positives and unnecessary biopsies. However, both the ACS and USPSTF agree that women should get screened earlier if they are at increased risk of breast cancer.
August 17, 2017—The ASCO Post Tweet
Researchers from Yale University investigated hospice enrollment, intensive care unit (ICU) admission, and chemotherapy administration for older patients with Acute Myeloid Leukemia (AML) to better understand end-of-life health care use in this population. Study investigators treated hospice enrollment as appropriate end-of-life care, while they considered ICU admissions and chemotherapy as potentially aggressive. In this retrospective study, funded by the National Cancer Institute (NCI), Dr. Rong Wang and colleagues used SEER-Medicare data to classify 13,156 patients, aged 66 or older, who were diagnosed with AML between 1999 and 2011, and died before December 31, 2012. Of the 13,156 patients, 5,847 (44.4%) enrolled in hospice care. Among those who enrolled in hospice, most entered within 3 or 7 days of death, 28.8% and 47.3%, respectively. Hospice enrollment increased continually between 1999 and 2012, mainly due to an increase in enrollment within 7 days of death. Additionally, the research team found that compared to their white counterparts, nonwhite male patients were more likely to receive chemotherapy or spend time in the ICU at the end of life instead of enrolling in hospice. Based on these findings, the researchers concluded that hospice care is underused, and improving culturally-sensitive care could help reduce the racial disparities seen among AML patients at the end of life. The researchers suggest further exploration into the reasons for low hospice use to improve end-of-life care for patients with AML.
August 15, 2017—Reuters Tweet
In a study published in the Journal of the American College of Cardiology, researchers examined the risk of blood clots in arteries causing heart attacks and strokes in patients recently diagnosed with cancer. Dr. Babak Navi and colleagues used SEER-Medicare data to identify patients, aged 66 or older, with new primary diagnoses of eight common types of cancer between 2002 and 2011. The researchers then matched the patients with a cancer-free control, accounting for demographics and comorbidities, to compare their cardiovascular risks over a two-year period. The research team found that six months after diagnosis, people with cancer had a higher rate of heart attack or stroke due to blood clots than people without cancer (4.7% and 2.2%, respectively). The rate was highest in patients with lung cancer (8.3%) as well as in patients with more advanced disease. After the first six months, the differences in risk between cancer and non-cancer patients decreased, and the risk was about the same by one year after diagnosis. Based on the findings, patients with cancer have higher risks of heart attack and stroke from blood clots in the arteries in the first few months after cancer diagnosis compared to people without cancer. Researchers suggest that all cancer patients should be monitored for signs and symptoms of cardiovascular disease, and patients should also be aware of the signs and symptoms of heart attack and stroke to improve clinical outcomes.
August 9, 2017—CNN Tweet
In a recent study published in JAMA, researchers from the American Cancer Society investigated trends in colorectal cancer mortality rates. Dr. Siegel and colleagues used the SEER Program to analyze mortality data from the National Center for Health Statistics. The researchers examined colorectal cancer deaths among 20- to 54-years-olds by race between 1970-2014. They found that colorectal cancer mortality rates declined overall between 1970-2004, but then increased 1 percent annually between 2004-2014. While mortality rates have decreased since 1970 among black individuals, ages 20-54, they have increased among white individuals since 1995 for those ages 30-39 and since 2005 for those aged 40-54. These increases in mortality follow decades of decline. Due to these findings, the researchers suggest that age-appropriate colorectal cancer screening and timely follow-up of symptoms are important for detecting colorectal cancer earlier.
June 29, 2017—HealthIT Analytics Tweet
A new partnership between CancerLinQ® participating oncology practices and the NCI will increase the amount of data available to oncologists and allow participants to investigate different cancer types and their outcomes more thoroughly. CancerLinQ, a big data analytics platform, enables the comparison of data collected from electronic health records (EHRs) for cancer cases treated at participating oncology practices to similar patient populations from other participating institutions and practices. According to a news release from the American Society of Oncology (ASCO), in the first phase of CancerLinQ’s partnership with the NCI, CancerLinQ users will have access to NCI’s Surveillance, Epidemiology, and End Results (SEER) program, which is a collection of de-identified data from 18 cancer registries in the U.S. covering approximately 30% of the population. The SEER database includes information on patient demographics, primary tumor site, tumor morphology (form and structure) and stage at diagnosis, first course of treatment, and follow-up for vital status. CancerLinQ participants will be able to compare their own practice data with SEER’s regional and national data, which has the potential to enhance future clinical care. A goal of the partnership’s second phase is for CancerLinQ oncologists to upload their data into the SEER program, which will enhance the cancer surveillance mission of SEER and expand its usefulness as a population-level resource for researchers. CancerLinQ will also partner with the FDA; that partnership’s goal is to improve the use of cancer medications by creating more accurate labels that explain how therapies can be used more effectively. According to Dr. Clifford A. Hudis, CEO of ASCO, “equipping these federal organizations with such a wealth of real-world evidence for cancer care will open new possibilities for gathering important insights, enhancing research, and producing better outcomes for patients.”
June 21, 2017—Reuters Tweet
Researchers from the University of Southern California investigated the effects of particulate matter (PM) air pollution on liver cancer survival. While PM air pollution has been associated with cancer incidence and mortality in lung cancer, the liver is another organ possibly affected by PM air pollution due to its role in detoxifying this matter in the body. Dr. Sandrah Eckel and colleagues used SEER data and analyzed more than 20,000 patients in the California Cancer Registry diagnosed with liver cancer between 2000 and 2009. The researchers combined this data with air pollution statistics from the U.S. Environmental Protection Agency, looking at measurements of fine air particles with diameters of 2.5 micrometers or less (PM 2.5). According to the data, exposure to PM 2.5 after liver cancer diagnosis was associated with shortened survival, with greater effects at higher PM 2.5 concentrations. Based on this finding, the study authors suggest that relatively small reductions in high pollution levels could have significant health impacts and increase survival for non-respiratory system cancer.
June 9, 2017—HealthDay News Tweet
In a recent study published in Carcinogenesis, researchers linked the use of hair dyes and hair relaxers to an increased risk of breast cancer. Dr. Adana Llanos and colleagues looked at 4,285 black and white women, ages 20 to 75, living in New York City and New Jersey, who used hair dyes, hair relaxers, and deep conditioners using cholesterol and placenta. Of the women studied, 2,280 were breast cancer survivors. According to the results, black women who used dark brown and black hair dyes increased their overall risk of breast cancer by 51%; for estrogen receptor positive, the most common breast cancer type, risk increased by 72%. White women who use hair relaxers increased their overall risk of breast cancer by 74%. While it’s not clear why risk differs among race and darker hair colors, Llanos, lead author of the study and assistant professor at Rutgers School of Public Health, says the reason may be differences in the chemical composition and marketing of these products. According to the NCI, an estimated 12% of women in the U.S. will be diagnosed with breast cancer during their lifetime.
June 8, 2017—HealthDay News Tweet
Wealth is associated with greater longevity in the U.S., but researchers have not been able to confirm higher access to medical care as a factor of living longer. A team from The Dartmouth Institute for Health Policy and Clinical Practice analyzed the incidence and mortality rates for four major types of cancers (breast, prostate, melanoma and thyroid) in high-income (median annual income > $75,000) and low-income (median annual income < $40,000) counties that report to SEER registries. The researchers indicate that since 1975, high-income counties had greater increases in incidence for all cancer types than low-income counties. In contrast, the combined mortality from the four cancers was similar between high-income and low-income counties, implying that the underlying disease burden did not change between them. The difference in incidence rates in high-income counties could be attributed to the greater ability to pay, excessive cancer screening tests, and a fee-for-service health care system that encourages doctors to treat more. The study authors emphasized the importance of reducing the overutilization of testing to create sustainable health care.
June 7, 2017—NPR Tweet
Researchers from the Yale School of Medicine investigated mechanisms that may lead to overdiagnosis in breast cancer. The study authors used SEER data to analyze invasive breast cancers that were diagnosed in 2001 to 2013, splitting them into favorable, intermediate, and unfavorable groups based on their biologic factors such as breast cancer subtype and level of survival. The researchers found that many small tumors with favorable biologic features do not progress to large tumors during the lifetime of the patient. Based on this finding, the researchers suggest that these favorable small tumors contribute substantially to overdiagnosis. Favorable tumors in women ages 40 and over are more common than in women younger than 40 years old, likely due to different patterns of mammography use. Based on this finding, the researchers suggest that overdiagnosis is much more prevalent in older women than in younger women. They also suggest that clinicians could use tumor and patient information to identify potential cases of breast cancer overdiagnosis, which could prevent harms such as overtreatment or anxiety from cancer diagnosis.
June 7, 2017—HealthDay News Tweet
In a research study published by the American Cancer Society (ACS), the authors investigated trends in liver cancer incidence, survival, and mortality in the United States. The researchers used national data from SEER and the National Center for Health Statistics. According to ACS, liver cancer deaths have doubled since the mid-1980s and are increasing at a faster pace than any other cancer. Liver cancer is the fifth- and eighth-leading cause of cancer death in men and women, respectively; only one in five patients survives five years after diagnosis. About 60 percent of liver cancers in the United States are due to potentially modifiable risk factors. Risk factors include infection with hepatitis C virus or hepatitis B virus, obesity, diabetes, consuming alcohol, and smoking tobacco. The study authors also found racial/ethnic and geographical differences in liver cancer death rates. Due to these findings, the researchers suggest that liver cancer deaths could be prevented and health disparities reduced through improvements in vaccinations for hepatitis B virus, screening and treatment for hepatitis C virus infections, providing access to high-quality diabetes care, preventing excessive alcohol consumption, and more.
June 5, 2017—NYT Health Tweet
SEER’s own Angela Mariotto led a recent study published in Cancer Epidemiology, Biomarkers & Prevention on metastatic breast cancer survival. For women under age 49, the five-year survival rate from 1992 to 1994 was 18%. Survival between 2005 and 2012 doubled to 36%. While this type of breast cancer is currently incurable, Dr. Mariotto says that both earlier imaging and improved treatment (particularly Herceptin) contribute to the increase in five-year survival. According to the study’s calculation using SEER data, in 2017, 154,794 women are living with metastatic breast cancer in the U.S.—an increase from the 105,354 women that were living with the disease in 1990.
May 23, 2017—Health Day Editor Tweet
Researchers used SEER data to investigate the link between cancer diagnoses and suicide. Dr. Jeffrey Port, of Weill Cornell Medical Center in New York City, and colleagues analyzed data of more than 3 million patients over a 40-year period and found that cancer diagnoses of any type were associated with more than 6,600 suicides.This is 60% higher than the suicide rate in the general population. Dr. Port determined that lung cancer patients in particular were 420% more likely to commit suicide than the general population. Several factors, including guilt, feeling overwhelmed, and lack of support through support groups and marches, were associated with increased risk. According to the study, lung cancer patients who are Asian, have metastatic cancer, opt out of surgery, elderly, widowed, or men are more likely to commit suicide. Dr. Port hopes this study will help address the high levels of stress, anxiety, and depression associated with lung cancer.
May 23, 2017—Chicago Tribune Tweet
In a recent study by the American Academy of Dermatology, researchers found that people of color are diagnosed with melanoma of skin in more advanced stages and are more likely to die from the disease, even though most melanoma diagnoses are in whites. According to Dr. Arthur Rhodes, director of the Dermatology Melanoma Surveillance Clinic at Rush University Medical Center in Chicago, melanoma is 15 to 20 times more common in whites. Dr. Rhodes says that there are two common misconceptions about melanoma. One is that melanoma does not occur in individuals with darker skin tones, who don’t often go tanning. The other is that melanoma only occurs in areas of the skin that are exposed to ultraviolet radiation, either through the sun or artificially. According to SEER data, there will be approximately 87,110 new melanoma cases in 2017, and around 9,730 will die.
May 8, 2017—Reuters Tweet
In a recent study published in Cancer, researchers investigated the connection between environmental quality and cancer risk, focusing on the impact of combined environmental exposures. Dr. Jyotsna Jagai and colleagues used county data on exposure to different pollutants between 2000-2005 and data from SEER on new cancer diagnoses between 2006-2010. The study authors found that, for all counties in the study, there was an average of 451 cancer cases for every 100,000 people. Counties that had lower environmental quality had an average of 39 more cancer cases each year for every 100,000 residents compared to counties with the highest level of environmental quality. Prostate and breast cancers were found to be strongly associated with environmental quality, and counties with low environmental quality were linked to 10 more cases of these cancers for every 100,000 people. Residents living in more urbanized communities also appeared to be at greater cancer risk. Due to these findings, the researchers suggest that living in areas with higher total exposures to harmful pollutants in the air, water, and land is associated with greater likelihood of developing cancer. Additionally, improved conditions in the environment would positively impact cancer risk and health outcomes.
May, 2017—AAP News & Journals Tweet
In a study published in Pediatrics, researchers examined the cancer risks of children who receive organ transplants. It is known that people who receive organ transplants are at higher risk of cancer than the general population due to the use of immunosuppressant medicine, and that children are at higher risk for non-Hodgkin’s lymphoma (NHL) after transplantation. For this retrospective study, the researchers used data from the Scientific Registry of Transplant Recipients and SEER cancer registries. The authors reviewed 17,958 transplant cases from 1987-2011 with recipients who were less than 18 years of age. The researchers found that cancer incidence was more than 19 times higher among pediatric recipients than in the general population. NHL, which made up most diagnosed cancers, had an incidence that was 212 times higher in the transplant group than in the general population. NHL risk was highest during the first year after transplantation for recipients susceptible to Epstein-Barr virus (EBV) infection and for intestine transplant recipients. Due to these findings, the authors suggest that risk for NHL, and likely Hodgkin’s lymphoma and myeloma, are due to infection with EBV and immunosuppression. EBV prevention and control among pediatric transplant recipients may prove crucial to cancer prevention in this population.
Low Acculturated Latina Women Reported Breast Cancer Treatment Experience Differently Than Other Groups
April 27, 2017—Oncology Nurse Advisor Tweet
Researchers used SEER data to understand racial differences in patient perspectives on early-stage breast cancer treatment experiences. Dr. Steven J. Katz and colleagues conducted a survey of 5,080 women from the SEER registries of Los Angeles County and Georgia who received a diagnosis between 2013 and 2015. Low acculturated Latinas had higher rates of reporting information overload from their health care providers. However, the quality of communication with physicians before surgery was similar across all and ethnic groups.
April 24, 2017—Health Day Editor Tweet
A recent study by the Fred Hutchinson Cancer Research Center in Seattle used SEER data to determine if black men should be screened for prostate cancer earlier than men of other races. Screening for prostate cancer includes a prostate-specific antigen (PSA) blood test and a digital rectal exam to determine if the prostate gland is enlarged or if other abnormalities are present. Researchers led by Dr. Ruth Etzioni estimated the onset and development of the disease by creating three models of incidence rates and PSA screening in the U.S. The study found that 30 to 43% of black men developed preclinical (asymptomatic) prostate cancer by 85 years old. This is 28 to 56% higher than the rate for men of other races. Though men of all racial backgrounds have a similar risk of preclinical prostate cancer if they are not screened, the study determined that prostate cancer develops faster in black men, with their risk of being diagnosed with advanced-stage cancer being 44 to 75% higher than other men.
April 19, 2017—Reuters Tweet
In a study published in the Journal of Clinical Oncology, researchers examined genetic counseling and testing and the impact of results on surgical decisions—particularly, bilateral mastectomy (BLM)—for early-stage breast cancer. The study was funded by the National Cancer Institute and used SEER data. The authors of this retrospective study looked at female patients from the SEER Registries of Georgia and Los Angeles County who had been diagnosed with stages 0-II breast cancer between 2014-2015. The researchers found that out of 666 women who reported genetic testing, two-thirds were tested before they had surgery. About half the patients discussed their results with a genetic counselor, and other patients discussed their results with only their surgeons or their oncologists. Higher-risk women were more likely to have BLM if testing found a high-risk mutation, but many women also underwent BLM if they had a variant of uncertain significance (VUS) or no mutation at all. Due to these findings, the authors suggest there is a need to address challenges in personalized communication about genetic testing and that it is important for genetic tests to be ordered and interpreted by genetic counseling experts.
April 13, 2017—Reuters Health Tweet
A recent study conducted by the American Cancer Society used SEER data from 2000 through 2012 to compare cancer incidence in U.S.-born non-Hispanic Blacks to Sub-Saharan-born Blacks. Researchers, led by Dr. Stacey Fedewa, used proportional incidence ratios for the 15 most common cancer types diagnosed in African-born Blacks and compared the incidence rates of those same cancers in Blacks born in the U.S. African people were more often younger, married, uninsured, and lived in more affluent areas. It was found that African-born Blacks were more frequently diagnosed with infection-related cancers, such as liver, stomach, Kaposi sarcoma, blood cancers, such as leukemia and non-Hodgkin lymphoma, as well as prostate cancer, and thyroid cancer in women. African-born people were less likely to be diagnosed with colorectal and lung cancers. It’s noted that the likelihood of diagnosis is associated with country of origin, as well as behavioral, societal, environmental, and genetic factors.
April 4, 2017—Reuters Health Tweet
Researchers from NCI and Duke University Medical Center investigated U.S. trends in thyroid cancer incidence and mortality by tumor characteristics at diagnosis. Using SEER-9 data to complete the analysis, Dr. Cari Kitahara and colleagues found that the incidence of thyroid cancer increased annually between 1974-2013, particularly for advanced-stage papillary thyroid cancer (PTC). This subtype also had an increase in mortality over this same time period. Due to these findings, the study authors suggest that there has been a true increase in the occurrence of thyroid cancer, contradicting the idea that the rising incidence of thyroid cancer is due to overdiagnosis or increased ability to diagnose small tumors that would never cause symptoms or require treatment. The researchers also state that future studies are needed to understand what is driving these increased rates of thyroid cancer, whether it may be factors like changing environmental exposures, obesity, or smoking.
March 16, 2017—JAMA Oncology Tweet
In a recent study published in JAMA, breast cancer patients with the (HR)-negative/HER2-positive and triple negative subtypes are at an increased risk of brain metastases. The researchers, led by Dr. Ayal A. Aizer of Brigham and Women’s Hospital in Boston, used SEER data of over 231,000 patients diagnosed with invasive breast cancer between 2010 and 2013. Of this patient population, 968 patients developed brain metastases, with 11.5% having the (HR)-negative/HER2-positive subtype and 11.4% having the triple negative subtype. Often, by the time patients are diagnosed with brain metastases, surgery and radiation is needed to treat their symptoms. On average, the survival rate of breast cancer patients with brain metastasis was 10 months. The study concluded that using MRIs to screen the brain in breast cancer patients, particularly those with the (HR)-negative/HER2 positive and triple negative subtypes, is justified.
February 27, 2017—NIH Tweet
The Detroit Research on Cancer Survivors (ROCS) study involves a large population of approximately 21,000 African Americans from Detroit, which is a SEER cancer registry. The major goal of this study, which is being conducted by Wayne State University School of Medicine and the Karmanos Cancer Institute of Detroit, is to pinpoint several social and biological factors that affect cancer treatment and survival and contribute to poorer outcomes among African Americans with cancer. Being the largest study to date of African American cancer survivors, the results will be a valuable guide to various stakeholders like public health workers, clinicians, researchers, and policy makers to identify ways to reduce the cancer burden and improve cancer care for African Americans.
February 28, 2017—The New York Times Tweet
A research study from NCI and the American Cancer Society investigated colorectal cancer incidence in the U.S. between 1974-2013. The researchers used SEER data and found that while colorectal cancer incidence rates have dropped for adults age 55 years and older, it is increasing among young adults. In particular, rectal cancers are rising sharply, faster than cancers in other parts of the large intestine or colon. Compared with adults born around 1950, those born around 1990 have double the risk of colon cancer and quadruple the risk of rectal cancer. Due to these findings, the researchers suggest that certain cancer screenings before age 50 years should be considered and that further research is needed to understand why these trends are happening.
February 28, 2017—Washington Post Tweet
In a study published in JAMA, researchers investigated whether changes in historical treatment practices for chemotherapy and radiation therapy are associated with changes in cancer survivors’ risk of developing new cancers. In this retrospective study, the authors looked at cancer survivors diagnosed before age 21 at pediatric hospitals in the U.S. and Canada between 1970-1999 and whether they developed new cancers within 15 years of their original cancers. Using SEER data to calculate statistical measures of association, researchers found that the rate of new cancers fell from 2.1 percent for survivors diagnosed in the 1970s to 1.3 percent for those diagnosed in the 1990s; during this same time, the rate of pediatric cancer patients being treated with radiation therapy decreased from 77 percent to 33 percent and treatment dosages also decreased. Due to these findings, the authors suggest that reduced radiation therapy of a cancer survivor’s first cancer leads to lowered risk of new cancers.
February 7, 2017—NPR Tweet
In a recent study published in JAMA, researchers investigated breast cancer patients and their experiences with genetic counseling and testing. The study, funded in part by SEER, included more than 2,500 women with breast cancer. One-third of the participants were at high risk of having a mutation in their BRCA genes, which increases the risk of breast and ovarian cancers. The study authors found that only 39.6% of all high-risk women and 61.7% of high-risk women who received genetic testing reported having a genetic counseling session. Due to these findings, the researchers suggest there may be a gap between the need and availability of genetic counseling. Oncologists may use genetic testing and counseling to determine a patient’s treatment options and susceptibility to developing future cancers.
January 26, 2016—NIH Press Release Tweet
A research study from NIH and the University of New Mexico investigated the increase in age-adjusted death rates in the U.S. in 2015. The researchers analyzed premature death rates in the age group 25-64 for all races and used the SEER Cause of Death Recode to categorize this data for the analysis. The study found that premature death rates between 1999-2014 declined in the U.S. among Hispanics, blacks, and Asian/Pacific Islanders, likely due to public health efforts and medical advances leading to improved health outcomes in cancer, heart disease, and HIV. Premature death rates rose among whites and American Indian/Alaska Natives during this same time due to increases in drug-related accidents, suicide, and liver disease. However, overall premature mortality still remained higher for black men and women than for whites.