We extend a prior analysis on the relation between poverty and cancer incidence in a sample of 2.90 million cancers diagnosed in 16 US states plus Los Angeles over the 2005–2009 period by ...additionally considering stage at diagnosis. Recognizing that higher relative disparities are often found among less‐common cancer sites, our analysis incorporated both relative and absolute measures of disparities. Fourteen of the 21 cancer sites analyzed were found to have significant variation by stage; in each instance, diagnosis at distant stage was more likely among residents of high‐poverty areas. If the incidence rates found in the lowest‐poverty areas for these 21 cancer sites were applied to the entire country, 18,000 fewer distant‐stage diagnoses per year would be expected, a reduction of 8%. Conversely, 49,000 additional local‐stage diagnoses per year would be expected, an increase of 4%. These figures, strongly influenced by the most common sites of prostate and female breast, speak to the trade‐offs inherent in cancer screening. Integrating the type of analysis presented here into routine cancer surveillance activities would permit a more complete understanding of the dynamic nature of the relationship between socioeconomic status and cancer incidence.
What's new?
How does poverty impact cancer diagnoses? New data indicates that people living in poverty are more likely to be diagnosed with later‐stage cancer. Building on previous studies of socioeconomic status and cancer, this study adds information about cancer stage at diagnosis. The authors show that in poorer populations, more cancers are diagnosed at later stages, while affluent populations get many more early‐stage diagnoses. Reducing poverty, then, should help reduce the number of late‐stage, less treatable cancers.
Maps are well recognized as an effective means of presenting and communicating health data, such as cancer incidence and mortality rates. These data can be linked to geographic features like counties ...or census tracts and their associated attributes for mapping and analysis. Such visualization and analysis provide insights regarding the geographic distribution of cancer and can be important for advancing effective cancer prevention and control programs. Applying a spatial approach allows users to identify location‐based patterns and trends related to risk factors, health outcomes, and population health. Geographic information science (GIScience) is the discipline that applies Geographic Information Systems (GIS) and other spatial concepts and methods in research. This review explores the current state and evolution of GIScience in cancer research by addressing fundamental topics and issues regarding spatial data and analysis that need to be considered. GIScience, along with its health‐specific application in the spatial epidemiology of cancer, incorporates multiple geographic perspectives pertaining to the individual, the health care infrastructure, and the environment. Challenges addressing these perspectives and the synergies among them can be explored through GIScience methods and associated technologies as integral parts of epidemiologic research, analysis efforts, and solutions. The authors suggest GIScience is a powerful tool for cancer research, bringing additional context to cancer data analysis and potentially informing decision‐making and policy, ultimately aimed at reducing the burden of cancer.
The current state and evolution of geographic information science (GIScience) in cancer research is explored by addressing fundamental topics and issues regarding spatial data and analysis that need to be considered. GIScience is a powerful tool for cancer research, bringing additional context to cancer data analysis, potentially informing decision making and policy, and ultimately reducing the burden of cancer.
Background
The Centers for Disease Control and Prevention, the American Cancer Society, the National Cancer Institute, and the North American Association of Central Cancer Registries collaborate to ...provide annual updates on cancer occurrence and trends in the United States and to address a special topic of interest. Part I of this report focuses on national cancer statistics, and part 2 characterizes progress in achieving select Healthy People 2020 cancer objectives.
Methods
For this report, the authors selected objectives—including death rates, cancer screening, and major risk factors—related to 4 common cancers (lung, colorectal, female breast, and prostate). Baseline values, recent values, and the percentage change from baseline to recent values were examined overall and by select sociodemographic characteristics. Data from national surveillance systems were obtained from the Healthy People 2020 website.
Results
Targets for death rates were met overall and in most sociodemographic groups, but not among males, blacks, or individuals in rural areas, although these groups did experience larger decreases in rates compared with other groups. During 2007 through 2017, cancer death rates decreased 15% overall, ranging from −4% (rural) to −22% (metropolitan). Targets for breast and colorectal cancer screening were not yet met overall or in any sociodemographic groups except those with the highest educational attainment, whereas lung cancer screening was generally low (<10%). Targets were not yet met overall for cigarette smoking, recent smoking cessation, excessive alcohol use, or obesity but were met for secondhand smoke exposure and physical activity. Some sociodemographic groups did not meet targets or had less improvement than others toward reaching objectives.
Conclusions
Monitoring trends in cancer risk factors, screening test use, and mortality can help assess the progress made toward decreasing the cancer burden in the United States. Although many interventions to reduce cancer risk factors and promote healthy behaviors are proven to work, they may not be equitably applied or work well in every community. Implementing cancer prevention and control interventions that are sustainable, focused, and culturally appropriate may boost success in communities with the greatest need, ensuring that all Americans can access a path to long, healthy, cancer‐free lives.
Part II of the Annual Report to the Nation characterizes progress in achieving select Healthy People 2020 cancer‐related objectives. This report shows that Healthy People 2020 objectives for reducing death from 4 major cancer types (lung, colorectal, female breast, and prostate) have been met overall; however, improvement is still needed to achieve health equity and to meet other Healthy People 2020 objectives related to these cancers, including increasing cancer screening, smoking cessation, and physical activity and reducing cigarette smoking, secondhand smoke exposure, obesity, and excessive alcohol use.
Background:The diversity among Hispanics/Latinos, defined by geographic origin (e.g., Mexico, Puerto Rico, Cuba), has been
neglected when assessing cancer morbidity. For the first time in the United ...States, we estimated cancer rates for Cubans,
Mexicans, Puerto Ricans, and other Latinos, and analyzed changes in cancer risk between Hispanics in their countries of origin,
U.S. Hispanics in Florida, and non-Hispanic Whites in Florida.
Methods: Florida cancer registry (1999-2001) and the 2000 U.S. Census population data were used. The Hispanic Origin Identification
Algorithm was applied to establish Hispanic ethnicity and subpopulation.
Results: The cancer rate of 537/100,000 person-years (95% confidence interval, 522.5-552.5) for Hispanic males in Florida
was lower than Whites (601; 595.4-606.9). Among women, these rates were 376 (365.6-387.1) and 460 (455.6-465.4), respectively.
Among Florida Hispanics, Puerto Ricans had the highest rates, followed by Cubans. Mexicans had the lowest rates. Rates for
Hispanics in Florida were at least 40% higher than Hispanics in their countries of origin, as reported by the IARC.
Conclusion: Substantial variability in cancer rates occurs among Hispanic subpopulations. Cubans, unlike other Hispanics,
were comparable with Whites, especially for low rates of cervical and stomach cancers. Despite being overwhelmingly first
generation in the U.S. mainland, Puerto Ricans and Cubans in Florida showed rates of colorectal, endometrial, and prostate
cancers similar to Whites in Florida. Because rates are markedly lower in their countries of origin, the increased risk for
cancer among Cubans, Mexicans, and Puerto Ricans who move to the United States should be further studied. (Cancer Epidemiol
Biomarkers Prev 2009;18(8):2162–9)
Background
With access to cancer care services limited because of coronavirus disease 2019 control measures, cancer diagnosis and treatment have been delayed. The authors explored changes in the ...counts of US incident cases by cancer type, age, sex, race, and disease stage in 2020.
Methods
Data were extracted from selected US population‐based cancer registries for diagnosis years 2015–2020 using first‐submission data from the North American Association of Central Cancer Registries. After a quality assessment, the monthly numbers of newly diagnosed cancer cases were extracted for six cancer types: colorectal, female breast, lung, pancreas, prostate, and thyroid. The observed numbers of incident cancer cases in 2020 were compared with the estimated numbers by calculating observed‐to‐expected (O/E) ratios. The expected numbers of incident cases were extrapolated using Joinpoint trend models.
Results
The authors report an O/E ratio <1.0 for major screening‐eligible cancer sites, indicating fewer newly diagnosed cases than expected in 2020. The O/E ratios were lowest in April 2020. For every cancer site except pancreas, Asians/Pacific Islanders had the lowest O/E ratio of any race group. O/E ratios were lower for cases diagnosed at localized stages than for cases diagnosed at advanced stages.
Conclusions
The current analysis provides strong evidence for declines in cancer diagnoses, relative to the expected numbers, between March and May of 2020. The declines correlate with reductions in pathology reports and are greater for cases diagnosed at in situ and localized stage, triggering concerns about potential poor cancer outcomes in the coming years, especially in Asians/Pacific Islanders.
Plain Language Summary
To help control the spread of coronavirus disease 2019 (COVID‐19), health care organizations suspended nonessential medical procedures, including preventive cancer screening, during early 2020.
Many individuals canceled or postponed cancer screening, potentially delaying cancer diagnosis.
This study examines the impact of the COVID‐19 pandemic on the number of newly diagnosed cancer cases in 2020 using first‐submission, population‐based cancer registry database.
The monthly numbers of newly diagnosed cancer cases in 2020 were compared with the expected numbers based on past trends for six cancer sites.
April 2020 had the sharpest decrease in cases compared with previous years, most likely because of the COVID‐19 pandemic.
This analysis provides strong evidence for sharp declines in the numbers of new cancer cases diagnosed between March and May of 2020. The declines are correlated with reductions in pathology reports and are more substantial for cases diagnosed at in situ and localized stage, triggering concerns for potential poor cancer outcomes in certain demographic subgroups in the coming years.
Purpose
To describe and elucidate rates in breast cancer incidence by subtype in the federally designated Mississippi Delta Region, an impoverished region across eight Southern/Midwest states with a ...high proportion of Black residents and notable breast cancer mortality disparities.
Methods
Cancer registry data from seven LMDR states (Missouri was not included because of permission issues) were used to explore breast cancer incidence differences by subtype between the LMDR’s Delta and non-Delta Regions and between White and Black women within the Delta Region (2012–2014). Overall and subtype-specific age-adjusted incidence rates and rate ratios were calculated. Multilevel negative binomial regression models were used to evaluate how individual-level and area-level factors, like race/ethnicity and poverty level, respectively, affect rates of breast cancers by subtype.
Results
Women in the Delta Region had higher rates of triple-negative breast cancer, the most aggressive subtype, than women in the non-Delta (17.0 vs. 14.4 per 100,000), but the elevated rate was attenuated to non-statistical significance in multivariable analysis. Urban Delta women also had higher rates of triple-negative breast cancer than non-Delta urban women, which remained in multivariable analysis. In the Delta Region, Black women had higher overall breast cancer rates than their White counterparts, which remained in multivariable analysis.
Conclusion
Higher rates of triple-negative breast cancer in the Delta Region may help explain the Region’s mortality disparity. Further, an important area of future research is to determine what unaccounted for individual-level or social area-level factors contribute to the elevated breast cancer incidence rate among Black women in the Delta Region.
Epidemiologists are gradually incorporating spatial analysis into health-related research as geocoded cases of disease become widely available and health-focused geospatial computer applications are ...developed. One health-focused application of spatial analysis is cluster detection. Using cluster detection to identify geographic areas with high-risk populations and then screening those populations for disease can improve cancer control. SaTScan is a free cluster-detection software application used by epidemiologists around the world to describe spatial clusters of infectious and chronic disease, as well as disease vectors and risk factors. The objectives of this article are to describe how spatial analysis can be used in cancer control to detect geographic areas in need of colorectal cancer screening intervention, identify issues commonly encountered by SaTScan users, detail how to select the appropriate methods for using SaTScan, and explain how method selection can affect results. As an example, we used various methods to detect areas in Florida where the population is at high risk for late-stage diagnosis of colorectal cancer. We found that much of our analysis was underpowered and that no single method detected all clusters of statistical or public health significance. However, all methods detected 1 area as high risk; this area is potentially a priority area for a screening intervention. Cluster detection can be incorporated into routine public health operations, but the challenge is to identify areas in which the burden of disease can be alleviated through public health intervention. Reliance on SaTScan's default settings does not always produce pertinent results.
Cancer risk varies by geography. Epidemiologists can apply a spatial approach to recognize geographic patterns
and test associations in order to postulate about community health and etiologic ...pathways, and to determine public health
action. Geospatial applications are valuable tools to evaluate geographic differences, which are often drive by social disparities. However, relevant conclusions hinge on data limitations, including data quality.
Recording address is critical for a geographic information system (GIS) and geospatial studies of cancer surveillance data.
Address is used to geocode cases, as well as to append census and other data to a cancer case. New North American
Association of Central Cancer Registries (NAACCR) tract-level codes are derived based on the geocoded address at diagnosis
(Address at DX) and have enabled significant national-level research on the association of cancer and socioeconomic
status.
•There is no Delta Region/non-Delta Region difference in breast cancer staging.•Delta Region women have higher rates of HR- cancers across stages.•Regional stage differences are explained by ...multilevel sociodemographic factors.•Black women in the Delta Region have higher rates of late-stage breast cancers.
To evaluate disparities in breast cancer stage by subtype (categorizations of breast cancer based upon molecular characteristics) in the Delta Regional Authority (Delta), an impoverished region across eight Lower Mississippi Delta Region (LMDR) states with a high proportion of Black residents and high breast cancer mortality rates.
We used population-based cancer registry data from seven of the eight LMDR states to explore breast cancer staging (early and late) differences by subtype between the Delta and non-Delta in the LMDR and between White and Black women within the Delta. Age-adjusted incidence rates and rate ratios were calculated to examine regional and racial differences. Multilevel negative binomial regression models were constructed to evaluate how individual-level and area-level factors affect rates of early- and late-stage breast cancers by subtype.
For all subtypes combined, there were no Delta/non-Delta differences in early and late stage breast cancers. Delta women had lower rates of hormone-receptor (HR+)/human epidermal growth factor 2 (HER2-) and higher rates of HR-/HER2- (the most aggressive subtype) early and late stage cancers, respectively, but these elevated rates were attenuated in multilevel models. Within the Delta, Black women had higher rates of late-stage breast cancer than White women for most subtypes; elevated late-stage rates of all subtypes combined remained in Black women in multilevel analysis (RR = 1.10; 95% CI = 1.04–1.15).
Black women in the Delta had higher rates of late-stage cancers across subtypes. Culturally competent interventions targeting risk-appropriate screening modalities should be scaled up in the Delta to improve early detection.
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