Overview of latest SEER data and the impact of COVID on cancer incidence trends and reportingSEER*Stat Tools Webinar Series
Discussion of challenges in reporting cancer incidence and trends with the 2020 COVID data point, covering examples in SEER*Explorer and the monthly trends before and after the stay-at-home orders were issued.
SEER*Stat Tools Webinars
A series of webinars highlighting SEER data, software and web tools, and statistical methods.
SEER data helps estimate US population living with metastatic prostate cancer
February 15, 2023 – American Association for Cancer Research Tweet
The number of people alive ever diagnosed with cancer is called “cancer prevalence,” and includes people who were recently diagnosed, in treatment, cured, or whose cancer returned. When cancer is diagnosed, cancer registries will gather information about the disease’s stage. However, these registries will not follow up about that cancer’s progression to later stages or its return after treatment. This means the population of metastatic cancer survivors—people living the most advanced stage disease—may not be accurately represented in current cancer data. For diseases like prostate cancer, the most common invasive cancer affecting men in the US, cancer registries are likely underestimating the true number of metastatic cancer survivors.
Researchers at NCI’s Division of Cancer Control and Population Sciences (DCCPS), including Drs. Theresa Devasia and Angela Mariotto of the Surveillance Research Program, used SEER prostate cancer and mortality data together with modeling to estimate the number of men living with metastatic prostate cancer in the United States. In 2018, the investigators found about 120,400 men were living with metastatic prostate cancer in the US, which is almost 4% of the entire population of US prostate cancer survivors. Of this group of metastatic prostate cancer survivors, about 45% were diagnosed with metastatic prostate cancer, while the other 55% were diagnosed with earlier stages and later progressed to metastatic disease. By 2030, the researchers predict 208,500 men will be living with metastatic prostate cancer, due to projected improvements in treatments and survival.
Researchers use SEER to study risk of bladder cancer from prostate cancer treatment
November 30, 2022 – Society of Urologic Oncology Tweet
Treatment options for prostate cancer include surgical removal of the prostate, radiation therapy, chemotherapy, and more. Depending on the individual case, some treatment options may be combined, such as surgery and radiation. Several options for radiation therapy exist, from brachytherapy, in which a small radioactive emitter is implanted near the tumor, to external beam radiation therapy, where a machine focuses a ray of radiation on the tumor. But exposure to radiation, even as part of therapy, can also be a risk factor for other types of cancers. Researchers from UC Davis Health used data from the Surveillance, Epidemiology, and End Results (SEER) Program to study if patients with prostate cancer who received radiation therapy were at a higher risk for bladder cancer compared to patients who received surgical treatment.
The researchers used de-identified data from over 418,000 patients diagnosed with prostate cancer between 2000 and 2019. Compared to patients who were treated for prostate cancer with surgery, patients who received either brachytherapy or external beam radiation therapy were 2.4 to 2.5 times more likely, respectively, to be diagnosed with bladder cancer. Patients who received surgery and followed up with external beam radiation therapy were 1.45 times more likely to be diagnosed with bladder cancer. While the risk of bladder cancer diagnosis increased with radiation therapy, the stage of the bladder cancer did not.
Models using SEER data identify patients at low-risk of death from localized melanoma
November 7, 2022 – ACS Journal Tweet
Early-stage cancers, even though they have the highest survival rates, can still be deadly. But for some patients, these early-stage cancers will not cause symptoms or death during the patient’s lifetime because either the tumor does not grow or it grows extremely slowly. Overdiagnosis happens when doctors screen for cancer and find these very slow-growing tumors that would not cause harm if left untreated. To treat all patients better, researchers and doctors need more data and tools to help them separate diagnosed cancers that need treatment from those cancers that might not.
Researchers led by Megan Eguchi, MPH, at the UCLA David Geffen School of Medicine used Surveillance, Epidemiology, and End Results (SEER) Program data to develop predictive models that could identify patients at very-low risk of dying from melanoma. The researchers analyzed the data of de-identified patients diagnosed with localized (or stage I) melanoma from 2010 to 2011. Their models included factors like sex, age, and melanoma tumor characteristics.
The study population was 11,594 patients and the overall mortality rate was 2.5% over seven years. However, 25% of the patients in this study—typically younger patients with melanomas that do not go deep into the skin—had a risk of death of less than 1% during the same seven-year period. The researchers also found that a small group of patients in this study who were older and had thicker and deeper melanomas had more than 20% risk of death over seven years. The researchers suggest reclassifying the very low-risk melanomas to something other than cancer and reevaluating treatment options for both low and high-risk patients.
Changes in childhood cancer treatment associated with reduced breast cancer risk later in life
October 13, 2022 – JAMA Oncology Tweet
To make the best decisions for cancer patients in the long-run, medical professionals need to understand factors like the effectiveness and long-term risks of a treatment. These decisions matter since cancer survivors are already at higher risk of developing and dying from new cancers later in life. If a treatment increases that risk even more, it may not be the right option for a patient. In a recent JAMA Oncology publication, researchers led by Dr. Tara Henderson at the University of Chicago Comer Children’s Hospital explored how treatments received for childhood cancer influenced the risk of developing female breast cancer later in life.
The researchers used childhood cancer data and data from the Surveillance, Epidemiology, and End Results (SEER) Program to track how childhood cancer diagnoses made from 1970 to 1990—a time of changes in radiation and chemotherapy treatments—affected the risk of developing breast cancer later in life. As an example, over this timeframe, radiation therapy used to treat childhood Hodgkin lymphoma became less frequent, used lower doses, and exposed less tissue to radiation. Did these changes mean a lowered risk for breast cancer later in life?
The researchers found that, with each passing decade from 1970 to 1990, the rate of new breast cancer diagnoses declined in childhood cancer survivors. The researchers associated this decline with reductions in both radiation treatments and radiation dosages used. However, during this time, certain chemotherapy treatments were used more often for childhood cancer patients. The researchers found the rate of breast cancer cases increased over the decades for these survivors who only received certain chemotherapy treatments and not radiation therapy. The researchers call for more studies into the long-term risks for breast cancer for treatments used after the year 2000.
Lung cancer rates decrease in people living with HIV, according to SEER data
October, 2022 – The Lancet Tweet
Infection with the human immunodeficiency virus (HIV) makes a person more vulnerable to other infections, diseases, and cancers according to the National Cancer Institute (NCI). However, advances in treatments for HIV, in addition to extending lifetimes, may help lower the risk of cancer. Investigators, including researchers at the NCI’s Division of Cancer Epidemiology and Genetics, used data from the Surveillance, Epidemiology, and End Results (SEER) Program and the HIV/AIDS Cancer Match study to explore how rates of lung cancer in HIV-positive people have changed from 2001 to 2016.
The investigators found that rates of lung cancer in HIV-positive people decreased by 6% each year from 2001 to 2016. However, compared with the rest of the population, rates of lung cancer were 48% higher for HIV-positive people between 2013 and 2016. Smoking is one of the primary risk factors for lung cancer, and the researchers note smoking rates in HIV-positive people are higher than the general population. However, the decreased immunity and increased inflammation associated with HIV infection may also be responsible for these higher overall risks. They add that the risk of lung cancer for this group will continue to increase with age as more HIV-positive people live longer due to effective HIV treatment programs. The investigators call for more prevention and early detection strategies to reduce lung cancer disparities for people living with HIV.
Oral Anticancer Medication Costs Increasing for Medicare Beneficiaries
September 13, 2022 – JCO Oncology Practice Tweet
Targeted oral anticancer medicines are therapies that patients can take at home, instead of at a hospital, to treat cancer. According to the National Cancer Institute (NCI), these medications target proteins in cancer cells that affect how the cell grows, divides, and spreads. In a recent JCO Oncology Practice publication, researchers at the University of Texas MD Anderson—who were partially funded by NCI’s Surveillance Research Program—explored how costs for these medications changed from 2011 to 2016.
The researchers used the Surveillance, Epidemiology, and End Results (SEER) – Medicare linked dataset to study the trends in costs of targeted oral anticancer medicines from 2011 to 2016. This linked dataset combines SEER’s cancer data, such as new case rates, survival, and mortality, with Medicare’s cost information for health services. From the entire de-identified SEER-Medicare dataset, the researchers studied only those patients who met all the following criteria: 1) aged 65 or older, 2) diagnosed with cancer between 2011 and 2016, 3) enrolled in Medicare Part D coverage, 4) did not receive low-income subsidies, and 5) received oral anticancer therapy.
The investigators found rates of patients treated with these medications more than doubled between 2011 and 2016, from 3.6% to 8.9%. The number of patients taking these medications who reached catastrophic Medicare coverage after meeting an out-of-pocket spending threshold (for example, $4,850 out-of-pocket in 2016) increased from 54.6% to 60.3%. In this coverage phase, Medicare will pay 95% of the cost of the drug for the rest of the year. However, even after receiving catastrophic coverage, average patient out-of-pocket costs increased from $596 in 2011 to $2,549 in 2016. The investigators call for caps on patient out-of-pocket drug spending and control of drug prices.
Costs of cancer increased for first year of diagnosis between 2009-2016
September 13, 2022 – Journal of the National Cancer Institute Tweet
A cancer diagnosis can be a long-term burden for patients on multiple fronts, including both health and finances. According to the 2021 Annual Report to the Nation on the Status of Cancer, the total cost of cancer in 2019 was $21 billion. Costs related to cancer are expected to increase with both growing and aging populations in the United States. To understand how those costs might increase in the future, researchers at the University of Texas MD Anderson Cancer Center, partially funded by NCI’s Surveillance Research Program, studied trends in total and out-of-pocket costs for privately-insured and nonelderly breast, colorectal, lung, and prostate cancer patients between 2009 and 2016 who were within their first year since diagnosis.
From a de-identified dataset representing approximately 28% of Americans with employer-sponsored private insurance, the investigators found 105,255 cases of breast cancer, 23,571 cases of colorectal cancer, 11,321 cases of lung cancer, and 59,197 cases of prostate cancer were diagnosed between 2009 and 2016. The average total cost—the sum of insurance and out-of-pocket payments—increased by 29% for breast cancer, 11% for lung cancer, and 4% for prostate cancer during this period. The out-of-pocket costs paid by patients with these four cancers increased to over $6,000, which is more than a 15% increase from 2009 to 2016. The researchers note that in 2018, 40% of adults had high-deductible employee-based health insurance and some deductibles were as high as $6,750. A cancer diagnosis, especially for those with high-deductible insurance plans, could bring financial hardship. The investigators call for changes to cost-sharing in insurance to address rising cancer costs.
SEER*Stat Tools Webinars
A series of webinars highlighting SEER data, software and web tools, and statistical methods.
Toward Precision Cancer Surveillance Blog
Featuring current initiatives of the Surveillance Research Program.