News

2022

Systemic and Structural Racism with Breast Biopsy DelaysExternal Web Site Policy

June 23, 2022 – JAMA Network

When cancer is diagnosed in its early stages, it is usually easier to treat and results in better outcomes for the patient, such as a higher survival rate and fewer complications from treatment. Screening mammography can detect breast cancer in early stages. However, even if a potential cancer is detected, there may be delays between detection and diagnosis that can result in later-stage disease.

In a study partially funded by the Surveillance Research Program (SRP), researchers examined the cases of over 45,000 women who had mammograms that required biopsy follow-up visits. They compared these cases with demographic, socioeconomic, and residential data for the women to understand whether systemic racism influenced biopsy delays. The investigators found that, compared to White women, Asian, Black, and Hispanic women had an increased risk of not having a biopsy within 30 to 60 days after their suspicious mammogram. Black women also had a risk of no follow-up biopsy within 90 days. The researchers suggest that systemic racism—which includes factors such as health insurance coverage and reimbursement policies—in addition to structural racism outside the health care system, may have contributed to their findings.

New study finds over 18 million cancer survivors in US in 2022External Web Site Policy

June 23, 2022 – American Cancer Society

Every three years, the American Cancer Society and National Cancer Institute collaborate on a report to better understand the population of cancer survivors in the United States. Two DCCPS scientists—Dr. Theresa Devasia and Dr. Angela Mariotto—contributed to this study, which also included data from the Surveillance, Epidemiology, and End Results (SEER) Program and other cancer registries.

The investigators found that over 18 million Americans with a history of cancer were alive on January 1, 2022. Among men, the three cancers with the most cases were prostate (3.5 million cases), melanoma of the skin (760,000 cases), and colon and rectum (726,000 cases). Among women, the three most common cancers were breast (4 million cases), uterine (891,000 cases), and thyroid (823,000 cases). Overall, two-thirds of cancer survivors were 65 years or older and more than half of survivors were diagnosed in the last 10 years.

The investigators also explored racial disparities and examined whether COVID-19 negatively affected cancer care. The investigators found that Black patients had lower 5-year survival rates than White patients for most cancers. This disparity is likely driven by unequal access to care as well as a lack of diversity in the health care workforce and in clinical trials. About one in four cancer patients experienced treatment delays due to the COVID-19 pandemic and many survivors experienced reduced contact with health care providers. Cancer survivors also delayed their own care during the pandemic, either for fear of contracting COVID-19 or because of financial difficulties.

Veterans more likely to develop regional and distant melanomaExternal Web Site Policy

May 17, 2022 – Journal of the American Academy of Dermatology

Melanoma is the fifth most common cancer in the United States. When melanoma is diagnosed at the localized stage, meaning the disease has not spread from where it first developed, the five-year survival rate is 99.5%. This survival rate means that over 99% of people diagnosed with localized melanoma will not have died from the disease five years after diagnosis (excluding the risk of death from other causes). However, the survival rate drops for melanoma diagnosed at regional and distant stages.

Cancer cases among veterans may be underrepresented in SEER data, as the Veterans Health Administration—which provides cancer care to many veterans—has often been underrepresented in national datasets. Compared to the rest of the population, veterans are exposed to higher levels of ultraviolet (UV) and ionizing radiation—major risk factors for melanoma—during service. Researchers from Harvard Medical School analyzed data from SEER and the Veterans Affairs Cancer Registry (VACR) to compare the statistics for melanoma among veterans to melanoma among the general population.

The researchers found that, compared with patients in SEER, veterans in VACR were more likely to be diagnosed with advanced-stage disease and those younger than 80 years were also less likely to survive 5 years. However, the researchers also found that new immunotherapy treatments for melanoma increased the survival rate for veterans more than they did for the general population.

SEER study explores uterine cancer mortality by stage, subtype, race, and ethnicityExternal Web Site Policy

May 5, 2022 – JAMA Network

Cancer health disparities are differences between population groups on cancer measures such as incidence, prevalence, mortality, and survival. For example, the mortality rate for uterine cancer is twice as high for Black women compared to White women. However, previous studies of uterine cancer have not investigated stage- and subtype-specific mortality rates stratified by race and ethnicity. A recent publication in JAMA Oncology from the National Cancer Institute’s Division of Cancer Epidemiology and Genetics used data from the Surveillance, Epidemiology, and End Results (SEER) Program to explore these mortality rates.

The investigators analyzed de-identified uterine cancer incidence data from 2000 to 2017 and mortality data from 2010 to 2017. Stage and subtype data were included as well. Overall, the uterine cancer mortality rate increased by 1.8% per year from 2010 to 2017. While the mortality rate for the nonendometrioid subtype—which is more aggressive—increased by 2.7% per year over the same period, the mortality rate for the less-aggressive endometrioid subtype remained stable.

Disparities emerge with the analysis of uterine cancer mortality by race and ethnicity. The mortality rate for uterine cancer overall (both subtypes combined), as well as the nonendometrioid subtype, was twice as high for Black women compared to other racial and ethnic groups. For both subtypes, the mortality rate was higher for Black women across all stages compared to other racial and ethnic groups. Between 2010 and 2017, mortality rates for the nonendometrioid subtype increased fastest for Hispanic women, followed by Black, Asian, and White women. The rising rates of this subtype may explain rising uterine cancer mortality overall; however, the disparities experienced by Black women are due to more than higher rates of aggressive disease. The investigators call for further research into the nonendometrioid subtype, treatment and screening strategies, and mitigation of factors at the health care system and patient levels that contribute to uterine cancer disparities.

Study uses SEER data to estimate breast cancer overdiagnosis rate from mammographyExternal Web Site Policy

April, 2022 – Annals of Internal Medicine

The United States Preventive Services Task Force currently recommends screening mammography every two years (biennially) for women between 50 and 74 years old who are at average risk of breast cancer. Overdiagnosis—the detection of a cancer that would not cause symptoms or death—is a known side-effect of this screening strategy, which can lead to unnecessary or harmful treatments. However, the overdiagnosis rate for breast cancer detected with mammography is not well known; previous estimates vary from 0% to over 50%.

Researchers funded by the Division of Cancer Control and Population Sciences (DCCPS) Healthcare Delivery Research Program (HDRP) used de-identified data from the Breast Cancer Surveillance Consortium (BCSC) and the Surveillance, Epidemiology, and End Results (SEER) Program to estimate the breast cancer overdiagnosis rate. The researchers developed a model from these data, which includes factors such as age-specific incidence, mammogram sensitivity, time from development of cancer to detection with clinical symptoms or signs, and the chance that a cancer will not grow. The researchers’ model predicts that 15% (about 1 in 7) of all breast cancer cases detected with biennial mammography in women from age 50 to 74 years are overdiagnosed, meaning the cancer either grew too slowly to cause problems or the patient died of causes unrelated to breast cancer. The model estimates that the overdiagnosis rate increases from about 12% at age 50 (first screen) to about 24% at age 74 (final screen). With this information, the researchers call for continued discussion and shared decision making about the benefits and risks of mammography screening.

SRP-funded study explores quality of life for breast cancer patients who undergo breast conservation or mastectomyExternal Web Site Policy

April 13, 2022 – JAMA Network

Treatment options for women with early-stage breast cancer include breast conservation surgery with radiation therapy or mastectomy—removal of the entire breast—without radiation therapy. Both options give the patient a similar likelihood of survival and a similar risk of recurrent disease. Researchers at the University of Texas MD Anderson Cancer Center, with partial funding from the Surveillance Research Program, studied whether a patient’s long-term quality of life and satisfaction with their breasts depended on their choice of breast cancer treatment.

The researchers surveyed patients in the Texas Cancer Registry who were diagnosed with stage 0 to stage II breast cancer between 2006 and 2008 and who received either breast-conserving surgery with radiation therapy or mastectomy and breast reconstruction without radiation therapy. The researchers asked these patients about their satisfaction with their breasts after treatment, as well as their physical, psychosocial, and sexual well-being. Between the two treatment options, satisfaction with breasts and reported physical well-being did not significantly differ. Patients who chose mastectomy and breast reconstruction without radiation therapy reported worse psychosocial and sexual well-being than patients who chose breast conservation with radiation therapy.

Compared with White patients, American Indian/Alaskan Native, Asian American/Pacific Islander, and Hispanic patients reported worse physical well-being. American Indian/Alaskan Native patients also reported lower breast satisfaction and psychosocial and sexual well-being. Patients who are younger, received less education, and have lower socioeconomic status also reported lower quality of life after treatment. The researchers point to these disparities as an opportunity to enhance equity in quality of life for breast cancer patients.

Uterine cancer mortality rates rise, now equal ovarian cancer mortality ratesExternal Web Site Policy

March, 2022 – Obstetrics & Gynecology

The most common cancers that affect the female reproductive system are uterine cancer and ovarian cancer. Researchers from the American Cancer Society used de-identified data from the Surveillance, Epidemiology, and End Results (SEER) Program to examine racial and ethnic disparities in the mortality rates for these cancers from 1990 to 2019.

Uterine cancer mortality rates declined between 1990 and 1997 from 4.3 deaths to 4.0 deaths per 100,000 women and then increased to 5.1 deaths per 100,000 in 2019. The ovarian cancer mortality rate decreased from 9.3 deaths per 100,000 women in 1990 to 6.0 deaths per 100,000 in 2019. While overall mortality rates for these two cancers are now similar, racial disparities in the uterine cancer mortality rate have emerged. Until 2005, mortality rates for uterine cancer were similar across races and ethnicities. After 2005, the uterine cancer mortality rate for Black women increased to 9.1 cases per 100,000 women in 2019, which is twice as high as the mortality rate for White women.

Lung Cancer Screening Guidelines Save LivesExternal Web Site Policy

March 30, 2022 – British Medical Journal

The leading risk factor for lung cancer is smoking. Pack-years are how medical professionals measure smoking history, where one pack-year equals smoking a pack of cigarettes each day for a year or two packs a day for half a year. In 2013, the United States Preventive Services Task Force (USPSTF) recommended lung cancer screening for people between 55 and 80 years old with a 30 pack-year smoking history. Researchers from the Massachusetts General Hospital used cancer databases, including the Surveillance, Epidemiology, and End Results (SEER) Program, to understand whether these screening guidelines increased the number of early-stage diagnoses and patient survival.

The investigators found that stage 1 diagnoses of non-small cell lung cancer (NSCLC) increased by 3.9% each year from 2014 to 2018 for patients between 55-80 years old. Patient survival increased as well, from a median of over 18 months in 2013 to over 28 months in 2018. They estimate that the increased patient survival resulting from more diagnoses at earlier stages saved over 10,000 lives between 2014 and 2018.

The researchers also highlight outstanding cancer health disparities. In 2018, Non-Hispanic White patients and patients with higher education and income were more likely to be diagnosed at stage 1 than at stage 4. Meanwhile, non-White patients and patients living in lower income and less educated regions were more likely to be diagnosed with stage 4 lung cancer. The 2021 update to the USPSTF’s lung cancer screening guidelines may reduce this disparity, as more women and racial minorities are now eligible for screening.

Breast cancer screening strategies for women with high-risk genetic mutationsExternal Web Site Policy

February 17, 2022 – Jama Network

The United States Preventive Services Task Force (USPSTF) recommends screening mammography every two years for women between 50 and 74 years old who are at average risk of breast cancer. The risk of developing breast cancer is greater than average for women who have genetic mutations such as BRCA1/2, ATM, CHEK2, and PALB2. Previous studies using simulation modeling estimated that magnetic resonance imaging (MRI) screening for women with BRCA1/2 mutations reduces breast cancer mortality. The National Comprehensive Cancer Network recommends that women and their clinicians consider adding annual MRI to mammography beginning at age 40 for women with the ATM or CHEK2 mutations and at age 30 for women with the PALB2 mutation. Although these more intensive screening strategies may benefit women with these mutations, an optimal screening strategy has not been established.

Researchers used validated simulation models developed by the Cancer Intervention and Surveillance Modeling Network (CISNET) to assess the benefits (e.g., breast cancer mortality reduction) and harms (e.g., false-positive screenings) of various mammography and MRI screening strategies for women with the ATM, CHEK2, and PALB2 genetic variants. The models estimated that screening women who have these mutations with annual mammography starting at age 40 would result in 36% fewer breast cancer deaths compared to no screening. Beginning annual MRI screening for these same women between ages 30 to 35, followed by annual mammography and MRI screening starting at age 40, was estimated to reduce breast cancer mortality by over 50%. The authors concluded that this strategy likely provides the best balance of benefits and harms. The researchers estimated that women younger than 40 who have these genetic mutations and are already screened with MRI would not benefit from mammography.

Cancer Mortality Disparities Persist for Black Men and WomenExternal Web Site Policy

February 10, 2022 – American Cancer Society

Health disparities are the adverse effects on groups of people who have systematically experiences greater obstacles to health based on numerous characteristics historically linked to discrimination or exclusion. Cancer health disparities are differences between population groups on cancer measures such as incidence, prevalence, mortality, and survival. Systemic racism and low socioeconomic status, which translate to unequal access to health care, drive many of these disparities. Researchers at the American Cancer Society used de-identified data from the NCI’s Surveillance, Epidemiology, and End Results (SEER) Program along with data from the CDC’s National Program of Cancer Registries (NPCR), National Center for Health Statistics (NCHS), and nation population-based surveys to explore cancer health disparities between Black and White Americans.

Cancer incidence rates for Black men decreased by about 2% per year from 2009 to 2018, largely due to decreases in smoking. However, compared to White men, Black men have a 6% higher incidence rate for the most common cancers. Meanwhile, Black women have an 8% lower overall cancer incidence rate compared to White women.

Disparities emerge from cancer mortality data. Black men have a 19% higher mortality rate compared to White men for all cancers combined. For specific cancers, such as myeloma, stomach, and prostate, the mortality rate for Black men is twice as high as the mortality rate for White men. Compared to White women, Black women have a 12% higher mortality rate for all cancers combined. Black women are twice as likely to die from uterine cancer and 41% more likely to die from breast cancer compared to White women. The 5-year relative survival rate, which measures how many patients have not died from their cancer five years after diagnosis, is lower in Black persons for every stage of diagnosis for most cancers. The researchers call for more investigation on systemic racism’s influence on health care and for the development of mechanisms to mitigate disparities.

Radioactive Iodine Treatment for Pediatric and Young Adult Thyroid Cancer Increases Risk for New CancersExternal Web Site Policy

January 19, 2022 – Journal of Clinical Oncology

Thyroid cancer is one of the most common cancers diagnosed in adolescents and young adults. If the cancer has not spread outside the thyroid gland, it is sometimes treated with radioactive iodine. When thyroid cancer tumors are small and have not spread, previous studies showed radioactive iodine treatment did not help patient survival and increased the patient’s risk of developing other cancers such as leukemia. Researchers at the National Cancer Institute’s Division of Cancer Epidemiology and Genetics used Surveillance, Epidemiology, and End Results (SEER) Program data to study whether thyroid cancer survivors younger than 45 years old who were treated with radioactive iodine are at increased risk of developing new cancers.

Nearly half of the 36,000 de-identified patients in this study who had nonmetastatic thyroid cancer were treated with radioactive iodine. The researchers found patients in that group who survived for five years or longer were 23% more likely to develop another cancer, such as uterine, breast, kidney, and lung. Thyroid cancer survivors treated with radioactive iodine were also 51% more likely to develop leukemias, lymphomas, or myeloma. The investigators call for renewed evaluation of the risks and benefits of radioactive iodine treatment in young people, as their longer lifespans translate to overall higher risks for new cancer development.

Cancer mortality drops 32% over 28 years according to American Cancer SocietyExternal Web Site Policy

January 12, 2022 – American Cancer Society

The American Cancer Society recently published its annual Cancer Statistics and Cancer Facts and Figures reports to highlight progress made against cancer and predict new cancer cases and deaths in 2022. According to the report, which used data from the Surveillance, Epidemiology, and End Results (SEER) Program, the overall US cancer mortality rate in 2019 decreased by 32% from its peak in 1991, from 215 cancer deaths per 100,000 people to 146 cancer deaths per 100,000 people. The report attributes this decline to the reduction in smoking and advances in early detection and treatment for some cancers. The lower death rate equates to 3.5 million fewer deaths from cancer between 1991 and 2019.

Lung cancer, while still responsible for most cancer deaths in the United States, saw improvement in incidence, mortality, and survival rates. From 2009 to 2018, the lung cancer Incidence rate decreased by 3% per year for men and 1% per year for women. Between 2015 and 2019, the mortality rate for lung cancer decreased by over 5% each year for men and over 4% each year for women. The percentage of people living at least 3 years after diagnosis increased from 19% in 2001 to 31% in 2017. The investigators point to more diagnoses at a localized disease stage, increased lung cancer screening eligibility and access, and decreased smoking rates as reasons for the improvements.

Despite the progress in many cancer burden measures, the report also highlights concerning trends. For example, although Black women have lower incidence of breast cancer than White women, their breast cancer mortality rate is 41% higher. Cervical cancer, which can be prevented with the human papillomavirus (HPV) vaccine and detected at early stages with screening, remains the second leading cause of cancer death in women between 20 and 39 years old. The proportion of prostate cancer cases diagnosed at the distant stage increased from 3.9% to 8.2% between 2007 and 2018.

2021

Identifying Equitable Screening Mammography Strategies for Black WomenExternal Web Site Policy

December, 2021 – Annals of Internal Medicine

An efficient guideline may not be equitable. Current United States Preventive Services Task Force (USPSTF) guidelines for breast cancer recommend women between 50 and 74 years old receive screening mammography every two years (biennially). However, even with these guidelines, Black women die of breast cancer at higher rates than White women. Researchers from the Cancer Intervention and Surveillance Modeling Network (CISNET) used modeling to identify new screening strategies that could address this disparity.

The researchers modeled and compared outcomes between Black and White women using several different screening strategies. They obtained race-specific breast cancer incidence rates using Surveillance, Epidemiology, and End Results (SEER) data. Applying the current USPSTF guidelines to their simulation, the researchers predicted 17.6 breast cancer deaths per 1000 people for Black women and 14.3 breast cancer deaths per 1000 people for White women. Applying a new screening strategy to their simulations, where Black women are screened biennially beginning at age 40, predicted more equitable outcomes and reduced the mortality to 15.7 breast cancer deaths per 1000 people. The researchers note that disparities in cancer treatment due to systemic racism continue to exist, so more aggressive screening strategies geared towards early detection and treatment may create the most equity in the short term.

Head and neck cancer survival outcomes worse for Black patients compared to patients in other minority groupsExternal Web Site Policy

December 23, 2021 – JAMA Network

Head and neck cancer, which includes laryngeal, oral cavity, pharyngeal, and other cancers, affected about 66,000 people in 2020. About 12% to 20% of people diagnosed with head and neck cancer belong to a racial or ethnic minority group. Previous studies demonstrated that White patients with head and neck cancer have lower mortality rates compared to Black patients, as Black patients are more likely to be diagnosed with later-stage disease and receive inadequate care. However, most studies of racial disparities for head and neck cancer have investigated Black vs White differences. They have not compared racial and ethnic minority groups with one another.

Using the Surveillance, Epidemiology, and End Results (SEER) Program, investigators used de-identified data to study survival differences for head and neck cancer patients across racial and ethnic groups. The investigators found that non-Hispanic Black patients had the lowest 5-year overall survival rate for head and neck cancer compared to Hispanic, Asian and Pacific Islander, and American Indian and Alaskan Native patients. Men had lower survival rates than women, as did patients in lower socioeconomic statuses compared to those in higher-status groups. Non-Hispanic Blacks, men, and those in lower socioeconomic statuses were also more likely to be diagnosed with later-stage disease. The investigators call for more interventions to remedy the health disparities associated with head and neck cancer.

Oropharyngeal cancer rates increased across USExternal Web Site Policy

December 16, 2021 – JAMA Network

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.

Sex, race and ethnicity, and socioeconomic status disparities with metastatic bone diseaseExternal Web Site Policy

December 10, 2021 – Wiley Online Library

Metastatic bone disease, which happens when cancer spreads from other sites in the body into a bone, can occur with almost every cancer in advanced stages. Over 250,000 people, or about 5% of all cancer patients in the United States, have metastatic bone disease. However, this group of patients accounts for over 20% of all cancer health care costs in the United States. With the increasing population of cancer survivors, which is projected to exceed 22 million in 2030, more people will be at risk for metastatic bone disease and costs will increase. Researchers at the University of California, Davis School of Medicine used data from the Surveillance, Epidemiology, and End Results (SEER) Program to analyze disparities in incidence associated with metastatic bone disease.

The investigators analyzed de-identified metastatic bone disease incidence data by sex, race and ethnicity, and socioeconomic status for some of the common cancers in the United States. Metastatic bone disease rates were higher for male lung, renal (kidney), and colon cancer patients compared to female patients with the same cancers. Rates of metastatic bone disease were higher among Non-Hispanic Black patients with lung, prostate, and breast cancers and among American Indian and Alaskan Native patients with renal and colon cancers. Patients with lower socioeconomic statuses were more likely to develop metastatic bone disease from all five studied cancers—lung, prostate, breast, colon, and renal cancers. The researchers call for allocation of public health funds towards awareness and screening for patients in these high-risk groups.

Metastatic Prostate Cancer Incidence Rates IncreaseExternal Web Site Policy

December 3, 2021 – Society of Urologic Oncology

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 2018External Web Site Policy.

HPV Vaccination Can Reduce Cervical Cancer Incidence and MortalityExternal Web Site Policy

November 29, 2021 – JAMA Network

Human papillomavirus (HPV), the most common sexually transmitted infection in the United States, has multiple high-risk variants that can cause cancer in six different parts of the body. The U.S. Advisory Committee on Immunization Practices (ACIP) issued its first HPV vaccination recommendation—for girls 11 or 12 years old—in 2006. Since the introduction of the HPV vaccine that year, multiple long-term studies have shown that the use of the vaccine is associated with decreases in incidence rates for HPV-linked cancers. However, according to researchers at St. Louis University, data concerning the vaccine’s impact on cancer mortality rates are lacking.

The investigators used de-identified data from the Surveillance, Epidemiology, and End Results (SEER) Program, along with other cancer registries and databases, to examine incidence and mortality rates for cervical cancer in women and girls between 15 and 39 years old from January 2001 to December 2017. In agreement with previous studies, the investigators found incidence rates for HPV-linked cervical cancer decreased after the vaccine was introduced. Additionally, after vaccine introduction, the researchers found the mortality rate for HPV-linked cervical cancer dropped by 43% for women and girls between the ages of 15 and 24. The investigators call for more long-term studies to build a complete picture of how many deaths are averted by the HPV vaccine.

Annual Report to the Nation finds $21 billion in cancer costs for US patientsExternal Web Site Policy

October 26, 2021 – JNCI: Journal of the National Cancer Institute

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.

SEER-Supported Research Uncovers New Racial and Ethnic Disparities in Breast CancerExternal Web Site Policy

October 20, 2021 – JAMA Network

The analysis of cancer statistics across broad racial and ethnic categories has shown that certain groups are affected by cancer more than others—known as racial disparities. However, this type of sweeping analysis can blind researchers to the diversity of subpopulations within each racial and ethnic group. Because of this blind spot, disparities within a given group (e.g., Asian American women) can exist that may otherwise go unnoticed in these larger studies.

Stanford University researchers, supported by the Surveillance, Epidemiology, and End Results (SEER) Program, studied the risks and disparities associated with developing a second breast cancer for female survivors of ductal carcinoma in-situ (DCIS). For this study, they examined de-identified data from the Hawaii Tumor Registry, which included self-reported demographic information. With these data, the researchers could categorize the study participants into groups that reflect the racial and ethnic populations of Hawaii, with the top five largest groups being Native Hawaiian, White, Japanese, Chinese, and Filipino.

They found that Native Hawaiian and Filipino women DCIS survivors, as well as women who received a DCIS diagnosis before 2000, were more likely to develop both invasive ipsilateral (same breast) and invasive contralateral (opposite breast) second breast cancer. Japanese DCIS survivors and DCIS survivors under 50 years old were more likely to develop invasive ipsilateral second breast cancer. The authors suggest that these findings can guide clinical treatment and screening decisions for women who belong to these at-risk groups.

SEER-researchers find patients with lower income and those living in rural counties at higher risk of suicide following cancer diagnosisExternal Web Site Policy

October 19, 2021 – JAMA Network

Researchers at the University of Texas Health Science Center at Houston used Surveillance, Epidemiology, and End Results (SEER) data to study suicide in recently diagnosed cancer patients. They found higher rates of suicide in patients living in lower-income and rural counties, compared to patients living in higher-income and urban counties. Suicide rates were highest in the first year after cancer diagnosis and decreased over time. However, the risk of suicide for cancer patients living in the lowest-income counties remained higher 10 years after diagnosis when compared to the suicide risk for the general population. Patients who are Asian or Pacific Islander showed a consistently higher suicide risk across income levels. To address these disparities, the researchers suggest increasing mental health services for cancer patients and expanding to medical and mental health services via telemedicine.

Organ transplant patients lose lifespan with cancer diagnosis, according to SEER studyExternal Web Site Policy

September 20, 2021 – Wiley Online Library

Researchers, including Dr. Anne-Michelle Noone of the NCI’s Surveillance Research Program (SRP), examined the impacts of cancer on organ transplant recipients by analyzing data from the Surveillance, Epidemiology, and End Results (SEER) Program cancer registries. The investigators explored the outcomes of more than 200,000 organ transplant patients for 10 years after transplant receipt. Compared to a hypothetical cancer-free population, organ transplant recipients who developed cancer lost about 2% of their expected lifespan. Older patients and those who received either a heart or lung transplant saw the largest impacts on their projected lifespans. Lung cancer and non-Hodgkin lymphoma were responsible for the most years of life lost within the overall study group. The researchers suggest that the aggressive immunosuppressant therapies needed to maintain lung and heart transplants may explain higher incidence of non-Hodgkin lymphoma, a cancer that may be due to uncontrolled infections of Epstein-Barr virus. Cancer screening and lifestyle changes such as stopping smoking may reduce cancer mortality for organ transplant recipients.

Women more likely than men to be diagnosed with small papillary thyroid cancer but they have same rate at autopsy, study findsExternal Web Site Policy

August 30, 2021 – JAMA Network

Rules of thumb can be useful tools for approaching a problem or learning about new topics; in most cases, the rule of thumb will work. However, most rules have exceptions or oversimplify in ways that can create unintended consequences.

Medical students learn, as a rule of thumb, that women are more likely than men to develop thyroid cancer. Researchers used data from the Surveillance, Epidemiology, and End Results (SEER) Program, together with data from the CDC’s National Vital Statistics System (NVSS), to examine these differences in thyroid cancer diagnosis between sexes. According to their findings, women are diagnosed with small papillary thyroid cancer four times more often than men. Imaging techniques frequently find these cancers at “subclinical” stages before symptoms develop. At these stages, thyroid cancer may not require immediate treatment—but instead should undergo continued monitoring—as other aggressive treatments may do more harm than good.

The researchers also analyzed prior publications on thyroid cancer. Surprisingly, they found no disparity between sexes, with men and women at nearly equal odds of having small papillary thyroid cancer detected at autopsy. They found that more lethal or advanced thyroid cancers also have similar incidence and mortality rates for both men and women. The investigators suggest this discrepancy may be due partly to the rule of thumb on thyroid cancer taught during medical school. If doctors are more likely to screen and find cancer in women, they may be less inclined to screen men for the disease. The effect is two-fold: women may receive harmful, unnecessary treatment regimens while men may not be diagnosed until later, more lethal, stages. The investigators also suggest that the disparity could be partly explained by men not visiting the doctor as often as women.

Using SEER to explore brain cancer between 2008 to 2017External Web Site Policy

August 24, 2021 – American Cancer Society Journals

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 dataExternal Web Site Policy

August 24, 2021 – Journal of Surgical Oncology

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 RadiationExternal Web Site Policy

August 18, 2021 – JNCI

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.

Cost-Sharing and Out-of-Pocket Cost for Women Who Received MRI for Breast Cancer ScreeningExternal Web Site Policy

July 28, 2021 – JNCI

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.

AYA Cancer Survival is On the RiseExternal Web Site Policy

July 26, 2021 – Cancer

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.

COVID-19 delayed mammograms and breast cancer diagnoses may result in increased deaths by 2030External Web Site Policy

July 14, 2021 – JNCI

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.

Overall death rates decreasing, according to Annual Report to the NationExternal Web Site Policy

July 8, 2021 – Axios

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.”

Cancer Survival Statistics Made SimpleExternal Web Site Policy

July 6, 2021 – Cancer Today

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.

Mental Health Affects Ovarian Cancer Mortality RatesExternal Web Site Policy

July, 2021 – Radiology Society of North America

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.

Treatment Outcomes In Children With AML Improved In Last Few Decades, NCI Analysis FindsExternal Web Site Policy

June 23, 2021 – MedPage Today

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.

Researchers use SEER Data to study colorectal cancer among young adultsExternal Web Site Policy

June 22, 2021 – Stat

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 ageExternal Web Site Policy

June 21, 2021 – American Cancer Society Journals

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.

New breast cancer screening strategies may be more cost efficientExternal Web Site Policy

May, 2021 – Annals of Internal Medicine

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 CancerExternal Web Site Policy

May 13, 2021 – JAMA Oncology

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.

Breast Cancer Mortality Rates Stopped Declining for Women Under 40External Web Site Policy

May, 2021 – Radiology Society of North America

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.

Investigators Use SEER to Identify Rising Cases of Esophageal Cancer in Individuals Under 50External Web Site Policy

May, 2021 – Cancer Epidemiology, Biomarkers & Prevention

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.

USPSTF Lung Cancer Screening Recommendations UpdatedExternal Web Site Policy

March 9, 2021 – JAMA Network

The United States Preventive Services Task Force (USPSTF) updated lung cancer screening recommendations in 2021 based on several studies from the Cancer Intervention and Surveillance Modeling Network (CISNET). The screening recommendations now apply to anyone between 50 and 80 years old who have at least a 20 pack-year smoking history and either currently smoke or quit in the last 15 years.

The CISNET studies examined factors like screening frequency and patient smoking history. Using low-dose computed tomography—a chest X-ray with a low dose of radiation—the CISNET models found annual screening prevented more lung cancer deaths than biennial (every two years) screening.

Pack-years is a measurement of smoking history, where the number of packs smoked per day is multiplied by the number of years the person smoked. For example, someone with a 10 pack-year history either smoked a pack a day for 10 years, a half-pack a day for 20 years, or two packs a day for five years. The new guidelines now apply to anyone with at least a 20 pack-year history, down from the 30 pack-year history in the 2013 guidelines.

Finally, the USPSTF lowered the recommended starting age for screening from 55 to 50. The authors suggest this change, along with the reduced smoking history threshold, may help lessen screening disparities based on sex, race, and ethnicity. According to several studies cited in the guidelines, these changes will increase the pool of eligible persons by 107% in non-Hispanic Blacks and 112% in Hispanic Whites. Almost twice as many women will now be eligible for screening.

Breast cancer data shows women over 75 receiving screening mammographyExternal Web Site Policy

March 5, 2021 – Breast Cancer Research and Treatment

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.

NCI Study Suggests COVID-19 Antibodies May Prevent ReinfectionExternal Web Site Policy

February 24, 2021 – JAMA Internal Medicine

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.

Time Trends in Receipt of Germline Genetic Testing and Results for Women Diagnosed With Breast Cancer or Ovarian Cancer, 2012-2019External Web Site Policy

February 9, 2021 – Journal of Clinical Oncology

A variant (sometimes called a mutation) is a change in a gene’s DNA sequence. Certain genetic variants are associated with an increased risk of developing cancer, meaning that people who have the variant are at higher risk than people without the variant. Germline genetic variants can be inherited, which can give the appearance that a cancer “runs in the family.” Germline genetic testing, a method for tracking and documenting inherited changes in genes that are associated with cancer development, can inform risk mitigation or future treatment strategies for these people, as well as give their family members information about their own genetic risks.

Researchers supported by the NCI and the Surveillance, Epidemiology, and End Results (SEER) Program examined how germline genetic testing was used between 2012 and 2019 for California or Georgia women diagnosed with either breast or ovarian cancer between 2013 and 2017. Of this group, 25% who were diagnosed with breast cancer and 34% who were diagnosed with ovarian cancer received genetic testing. The researchers noted that multiple-gene panel testing replaced single-gene testing during this time.

The large proportion of data from non-Hispanic White patients muddles the range of normal genetic variation among patients of other races and ethnicities. As such, patients other than non-Hispanic Whites are more likely to receive a test result indicating gene “variants of uncertain significance (VUS).” A VUS is a variant for which the association with cancer (or other disease) risk is unclear. The study authors note that it’s uncertain whether these inconclusive results for people of races and ethnicities other than non-Hispanic White translate into unnecessary preventive treatments. However, these results can make it difficult to clearly communicate with family members about their risks. The researchers note that 20 genes account for most of the variants known to raise the risk for breast and ovarian cancer, also known as pathogenic variants. They suggest more precise genetic testing panels may clarify results for everyone, especially patients who are members of racial and ethnic minority groups.

2020

SEER study finds cancer survivors are at increased risk of developing new cancersExternal Web Site Policy

December 29, 2020—JAMA Network

According to a recent study authored by the American Cancer Society using Surveillance, Epidemiology, and End Results (SEER) Program data, survivors of adult-onset cancer are at a higher risk of developing and dying from subsequent primary cancers. This means cancer survivors are at higher risk of developing tumors in previously unaffected organs and that the new cancer is not instead due to their original cancer spreading in the body, also known as metastatic cancer.

The investigators examined de-identified data for over 1.5 million cancer survivors between 20 and 84 years old who were first diagnosed with cancer between 1992 and 2011. Within this group, over 49,000 men and over 62,000 women developed subsequent primary cancers. Male survivors had an 11% higher risk and female survivors had a 10% higher risk of developing a new primary cancer when compared to the general population.

Risk factors like smoking and obesity account for a large proportion of new cancer diagnoses in cancer survivors. Smokers are at elevated risk for lung, bladder, oral, and esophageal cancers. Within the study group, these four cancers accounted for 26% to 45% of all subsequent primary cancer incidence and mortality. Colorectal, pancreatic, uterine, and liver cancers, which are associated with obesity, accounted for roughly 25% of all mortality from subsequent primary cancers. The investigators emphasize continued patient-physician communication and counseling for survivors to encourage healthy lifestyles and screening and monitoring for new cancers. They also note that these mitigation strategies may reduce the long-term economic costs associated with cancer.

Hot Spot Counties Have Higher Colorectal Cancer Mortality Rates for Women Ages 50 and UnderExternal Web Site Policy

December 21, 2020—Clinical and Translational Gastroenterology

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.

Antibodies from COVID-19 infection offer protection against future infectionExternal Web Site Policy

December 20, 2020—medRxiv

Patients who mounted an antibody response to a COVID-19 infection are less likely to contract the disease again months later, according to a pre-print journal article in medRxiv. The study, which includes Dr. Lynne Penberthy of the NCI Surveillance Research Program (SRP) as an author, examined de-identified data for over three million patients who received an antibody test between early January and late August 2020. 88.3% of these patients received a negative antibody result and 11.6% received a positive antibody result.

11.3% of patients who tested positive for COVID-19 antibodies received a subsequent positive diagnostic test within 30 days. However, 90 or more days after the positive antibody test, just 0.3% of antibody-positive patients received a positive COVID-19 diagnostic test. For patients who originally tested negative for COVID-19 antibodies, 3.9% received a positive diagnostic test for COVID-19 within 30 days. Ninety or more days after the initial negative antibody test, 3% of patients received a positive COVID-19 diagnostic test. The researchers point to this 10-fold difference in infection rate as evidence that COVID-19 antibodies provide protection against future infection, findings which they note are comparable to initial reports on the efficacy of mRNA vaccines.

Note: Getting vaccinated is a safe, free, and highly effective way to protect yourself against COVID-19.

According to SEER Data, Anal Cancer Incidence Rates Are on the Rise for Women Over 50External Web Site Policy

December 7, 2020—MedPage Today

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.

Cancer Cases on the Rise in US Teens and Young AdultsExternal Web Site Policy

December 3, 2020 – Health Day

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 ScreeningExternal Web Site Policy

October 25, 2020—International Journal of Cancer

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%External Web Site Policy

September 1, 2020—Annals of Internal Medicine

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.

NCI Researchers use SEER Data to Evaluate Decrease in Lung Cancer Mortality by SubtypeExternal Web Site Policy

August 13, 2020—New England Journal of Medicine

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 pandemicExternal Web Site Policy

June 19, 2020—Science

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 StatesExternal Web Site Policy

June 10, 2020—Cancer Epidemiology Biomarkers and Prevention (CEBP)

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.

Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort studyExternal Web Site Policy

May 28, 2020—Lancet

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

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 emergencyExternal Web Site Policy

April 2020—ResearchGate

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 trialsExternal Web Site Policy

April 23, 2020—PLOS One

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

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.

Researchers utilize SEER data in study comparing enclave residence and breast cancer survivalExternal Web Site Policy

March 17, 2020—Cancer

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.

Researchers use data from SEER Program to estimate colorectal cancer incidence and mortality trendsExternal Web Site Policy

March 5, 2020—American Cancer Society Journals

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 USAExternal Web Site Policy

February 10, 2020—The Lancet Public Health

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.

Researchers use SEER data to examine trends in colorectal cancer incidence ratesExternal Web Site Policy

January 31, 2020—JAMA

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.

The American Cancer Society Researchers Uses SEER Data in their "Cancer Statistics, 2020" ArticleExternal Web Site Policy

January 22, 2020—The American Cancer Society

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 cancerExternal Web Site Policy

January 9, 2020—JAMA Oncology

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.

2019

Causes of death after breast cancer diagnosis: A US population‐based analysisExternal Web Site Policy

December 16, 2019—Cancer

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 PopulationExternal Web Site Policy

December 3, 2019—Cancer

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.

Ten Percent of Cancer Patients at Higher Risk of Dying from Cardiovascular DiseaseExternal Web Site Policy

November 25, 2019—European Heart Journal

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 sexExternal Web Site Policy

November 13, 2019—Cancer

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

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).

SEER Data Used to Identify Disparities in Receiving Guideline-Concordant Treatment for Lung CancerExternal Web Site Policy

November 1, 2019—ATS: Annals of the American Thoracic Society

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.

SEER Data Used to Capture the State of Lung Cancer in the USExternal Web Site Policy

November, 2019—American Lung Association

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.

Regional Disparities in the Survival of Metastatic Breast Cancer (MBC) PatientsExternal Web Site Policy

October 22, 2019—Cancer

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.

Researchers Utilize SEER Data to illustrate Epidemiologic Signatures in Cancer SurveillanceExternal Web Site Policy

October 3, 2019—The New England Journal of Medicine

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.

A comparative modeling analysis of risk-based lung cancer screening strategiesExternal Web Site Policy

September 30, 2019—JNCI: Journal of the National Cancer Institute

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 CancerExternal Web Site Policy

September 27, 2019— JAMA

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 MenExternal Web Site Policy

September 25, 2019—Cancer

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 StatementExternal Web Site Policy

August 19, 2019—Medscape

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.

The Rise in Obesity May be Influencing Age of Cancer Diagnosis, Study FindsExternal Web Site Policy

August 14, 2019—JAMA Network Open

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.

Cancer statistics for adults aged 85 years and older, 2019External Web Site Policy

August 7, 2019—CA: A Cancer Journal for Clinicians

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 ProtectionExternal Web Site Policy

August 2, 2019—Genetics in Medicine

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 patientsExternal Web Site Policy

August 1, 2019—JAMA Oncology

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 MyelomaExternal Web Site Policy (XML)

July, 2019—Journal of the National Comprehensive Cancer Network

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 USExternal Web Site Policy

July 22, 2019—Cancer

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 TypesExternal Web Site Policy

July 18, 2019—Medscape

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

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 CancerExternal Web Site Policy

July 3, 2019—JAMA Network

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 FindExternal Web Site Policy

June 24, 2019—Renal & Urology News

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 DescentExternal Web Site Policy

June 13, 2019—U.S. News & World Report

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.

Cancer statistics and survivorship: where we are now, and where we expect to be in 2030External Web Site Policy

June 11, 2019—Wiley Online Library

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.

Using SEER Data to Examine Age Disparities Among Oncologic Randomized Clinical Trial ParticipantsExternal Web Site Policy

June 3, 2019—JAMA Oncology

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.

Researchers use SEER Data to Examine Pediatric Thyroid Cancer Incidence TrendsExternal Web Site Policy

May 23, 2019—JAMA Otolaryngology

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 CancersExternal Web Site Policy

May 22, 2019—Journal of Clinical Oncology

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.

SEER Data Used to Identify Racial Disparities in Nonendometrioid Cancers

May 22, 2019—Journal of Clinical Oncology

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 40-49External Web Site Policy

May 21, 2019—JAMA

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.

Football Hall of Famer Leading Skin Cancer Prevention EffortsExternal Web Site Policy

May 20, 2019—JAMA

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 metastasesExternal Web Site Policy

May, 2019—Cancer Epidemiology, Biomarkers & Prevention

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 registriesExternal Web Site Policy

May 6, 2019—JCO Clinical Cancer Informatics

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 diagnosisExternal Web Site Policy

April 16, 2019—Preventive Medicine

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.

Proximity to time zone borders may be associated with health outcomes, including breast cancerExternal Web Site Policy

April 13, 2019—Journal of Health Economics

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.

SEER researchers find low rates of genetic testing for breast and ovarian cancer patientsExternal Web Site Policy

April 9, 2019—Journal of Clinical Oncology

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.

SEER Program leads efforts in improving the process of metastatic cancer data collectionExternal Web Site Policy

March 6, 2019—Nature Medicine

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.

Radical cystectomy superior to trimodal therapy for muscle-invasive bladder cancerExternal Web Site Policy

February 15, 2019—Cancer Therapy Advisor

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 decreasesExternal Web Site Policy

February 11, 2019—JAMA

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.

Study says mammograms and improved treatment helped save up to 600,000 U.S. lives since 1989External Web Site Policy

February 11, 2019—HealthDay News

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.

Incidence for obesity-related cancers is increasing in young adultsExternal Web Site Policy

February 3, 2019—The Lancet

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.

Use of SEER Program Data in Multiethnic Cohort StudyExternal Web Site Policy

January 28, 2019—JNCI

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.

Blood cancers associated with higher treatment and out-of-pocket costsExternal Web Site Policy

January 25, 2019—OncLive

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.

Suicide risk quadruples for people with cancerExternal Web Site Policy

January 15, 2019—The Philadelphia Inquirer

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.

Lung cancer screening complications may be higher than expectedExternal Web Site Policy

January 14, 2019—Reuters Health

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.

US cancer incidence and mortality declining, socioeconomic inequalities becoming more notableExternal Web Site Policy

January 8, 2019—Wiley Online Library

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.

Suicide Risk Rises Following Cancer DiagnosisExternal Web Site Policy

January 7, 2019—HealthDay News

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 patientsExternal Web Site Policy

January 1, 2019—Journal of Oncology Practice

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.

2018

1 in 17 cancers attributable to excess body weightExternal Web Site Policy

December 27, 2018—JAMA Oncology

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.

Study finds elevated risk of certain rare blood cancers after chemotherapy for most solid tumors

December 20, 2018—NCI Press Release

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-relatedExternal Web Site Policy

December 19, 2018—JCO Precision Oncology

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.

Racial Differences in Prostate Cancer-Specific Mortality by Gleason ScoreExternal Web Site Policy

December 18, 2018—JAMA

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.

SEER’s Idaho Registry Reports Its Lowest Cancer Rate This CenturyExternal Web Site Policy

December 13 10, 2018—Idaho State Journal

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.

If you’re single with cancer, you may get less aggressive treatment than a married personExternal Web Site Policy

December 3, 2018—The Washington Post

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.

Uterine Cancer: An exception to recent cancer trends

December 7, 2018—CDC

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.

California Lung Cancer Death Rate Less than National AverageExternal Web Site Policy

October 10, 2018—NBC Los Angeles

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.

CDC Finds HPV-related Cancers, HPV Vaccinations Both GrowingExternal Web Site Policy

August 23, 2018—The Washington Post

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.

Doctors don’t always recognize ‘financial toxicity’ of cancerExternal Web Site Policy

July 23, 2018—Reuters Health

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.

Breast cancer surgeons don’t always order genetic testing for patientsExternal Web Site Policy

July 3, 2018—Reuters Health

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.

How Can Men Lower Their Risk of Dying From Prostate Cancer?External Web Site Policy

June 10, 2018—U.S. News

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.

Cancer Patients in Rural Areas Rate Timeliness, Quality of Oncologic Care HigherExternal Web Site Policy

June 7, 2018—Wiley Online Library

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.

Number of Breast Cancer Patients Receiving Multigene Sequencing May Be Increasing, Study SuggestsExternal Web Site Policy

May 10, 2018—Jama Oncology

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.

Married People May Be More Likely To Be Diagnosed With Melanoma In Its Early Stages, Study SuggestsExternal Web Site Policy

April 18, 2018—Jama Dermatology

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.

Women over 65 may benefit from cervical cancer screening, research saysExternal Web Site Policy

March 27, 2018—ABC News

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.

More Women Die of Lung Cancer in 2 U.S. 'Hot Spots'External Web Site Policy

March 30, 2018—Health Day Editor

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.

Black Cancer MattersExternal Web Site Policy

March 15, 2018—The New York Times

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.

Odds of Surviving Anal Cancer Colored by IncomeExternal Web Site Policy

March 12, 2018—Health Day Editor

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.

Good News, Bad News About Melanoma for U.S. WhitesExternal Web Site Policy

January 31, 2018—JAMA Dermatology

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.

Research: New screenings, treatments dramatically reduce breast cancer deathsExternal Web Site Policy

January 9, 2018—UPI

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.

Cancer Deaths Have Dropped 26% in Recent YearsExternal Web Site Policy

January 4, 2018—TIME Health

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.


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