Human papillomavirus (HPV) is a major risk factor for specific cancers of the head and neck, particularly malignancies of the tonsil and base of the tongue. However, the role of HPV in the ...development of laryngeal cancer has not been definitively established. We conducted a population-based, cancer registry study to evaluate and characterize the genotype-specific prevalence of HPV in invasive laryngeal cancer cases diagnosed in the U.S.
The presence of genotype-specific HPV DNA was evaluated using the Linear Array HPV Genotyping Test and the INNO-LiPA HPV Genotyping Assay in formalin-fixed paraffin embedded tissue from 148 invasive laryngeal cancer cases diagnosed in 1993-2004 within the catchment area of three U.S. SEER cancer registries.
HPV DNA was detected in 31 of 148 (21%) invasive laryngeal cancers. Thirteen different genotypes were detected. Overall, HPV 16 and HPV 33 were the most commonly detected types. HPV was detected in 33% (9/27) of women compared with 18% (22/121) of men (p = 0.08). After adjustment for age and year of diagnosis, female patients were more likely to have HPV-positive laryngeal tumors compared to males (adjusted OR 2.84, 95% CI 1.07-7.51). Viral genotype differences were also observed between the sexes. While HPV 16 and 18 constituted half of HPV-positive cases occurring in men, among women, only 1 was HPV 16 positive and none were positive for HPV 18. Overall 5-year survival did not vary by HPV status.
HPV may be involved in the development of a subset of laryngeal cancers and its role may be more predominant in women compared to men.
Background
Previous research suggests that Adventists, who often follow vegetarian diets, live longer and have lower risks for many cancers than others, but there are no national data and little ...published comparative data for black subjects.
Methods
This study compared all‐cause mortality and cancer incidence between the nationally inclusive Adventist Health Study 2 (AHS‐2) and nonsmokers in US Census populations: the National Longitudinal Mortality Study (NLMS) and its Surveillance, Epidemiology, and End Results substudy. Analyses used proportional hazards regression adjusting for age, sex, race, cigarette smoking history, and education.
Results
All‐cause mortality and all‐cancer incidence in the black AHS‐2 population were significantly lower than those for the black NLMS populations (hazard ratio HR for mortality, 0.64; 95% confidence interval CI, 0.59‐0.69; HR for incidence, 0.78; 95% CI, 0.68‐0.88). When races were combined, estimated all‐cause mortality was also significantly lower in the AHS‐2 population at the age of 65 years (HR, 0.67; 95% CI, 0.64‐0.69) and at the age of 85 years (HR, 0.78; 95% CI, 0.75‐0.81), as was cancer mortality; this was also true for the rate of all incident cancers combined (HR, 0.70; 95% CI, 0.67‐0.74) and the rates of breast, colorectal, and lung cancers. Survival curves confirmed the mortality results and showed that among males, AHS‐2 blacks survived longer than white US subjects.
Conclusions
Substantially lower rates of all‐cause mortality and cancer incidence among Adventists have implications for the effects of lifestyle and perhaps particularly diet on the etiology of these health problems. Trends similar to those seen in the combined population are also found in comparisons of black AHS‐2 and NLMS subjects.
In comparison with a national census population, all‐cause and cancer mortality rates and incidence rates for many cancers are substantially lower in a national Seventh‐Day Adventist population. This is also true for a comparison of black census subjects and black Adventist subjects.
Background
The accuracy of cancer survival statistics relies on the quality of death linkages and follow-up information collected by population-based cancer registries. Methodological issues on ...survival data by race-ethnicity in the United States, in particular for Hispanics and Asians, have not been well studied and may undermine our understanding of survival disparities.
Methods
Based on Surveillance, Epidemiology, and End Results (SEER)-18 data, we analyzed existing biases in survival statistics when comparing the four largest racial-ethnic groups in the United States, whites, blacks, Hispanics and Asians. We compared the “reported alive” method for calculation of survival, which is appropriate when date of last alive contact is available for all cases, with the “presumed alive” method used when dates of last contact are unavailable. Cox regression was applied to calculate the likelihood of incomplete follow-up (those with less than 5 years of vital status information) according to racial-ethnic group and stage of diagnosis. Finally, potentially missed deaths were estimated based on the numbers of cases with incomplete follow-up for highly fatal cancers.
Results
The presumed alive method overestimated survival compared with the reported alive method by as much as 0.9–6.2 percentage points depending on the cancer site among Hispanics and by 0.4–2.7 percentage points among Asians. In SEER data, Hispanics and Asians are more likely to have incomplete follow-up than whites or blacks. The assumption of random censoring across race-ethnicity is not met, as among non-white cases, those who have a worse prognosis are more likely to have incomplete follow-up than those with a better prognosis (P < .05). Moreover, death ascertainment is not equal across racial-ethnic groups. Overall, 3% of cancer deaths were missed among Hispanics and Asians compared with less than 0.5% among blacks and whites.
Conclusions
Cancer survival studies involving Hispanics and Asians should be interpreted with caution because the current available data overtly inflates survival in these populations. Censoring is clearly nonrandom across race-ethnicity meaning that findings of Hispanic and Asian survival advantages may be biased. Problematic death linkages among Hispanics and Asians contribute to missing deaths and overestimated survival. More complete follow-up with at least 5 years of information on vital status as well as improved death linkages will decisively increase the validity of survival estimates for these growing populations.
Recent developments in genetics and molecular biology have classified breast cancer into subtypes based on tumor markers of estrogen (ER), progesterone (PR) and human epidermal growth Factor-2 ...receptors (Her-2), with the basal-like (ER−, PR−, Her2−) subtype commonly referred to as “triple negative” breast cancer (TNBC) being the most aggressive. Prior studies have provided evidence that higher socio-economic status (SES) is associated with increased breast cancer risk, likely due to hormone related risk factors such as parity and hormonal contraceptive use. However, it is unclear if the relationship between SES and overall breast cancer incidence exists within each subtype, and if this association varies by race/ethnicity. Analysis was based on data obtained from the SEER database linked to 2008–2012 American Community Survey data, and restricted to women diagnosed with breast cancer in 2010. The NCI SES census tract SES index based on measures of income, poverty, unemployment, occupational class, education and house value, was examined and categorized into quintiles. Age-adjusted incidence rate ratios were calculated comparing the lowest to the highest SES groups by subtype, separately for each race/ethnic group. We identified 47,586 women with breast cancer diagnosed in 2010. The majority was diagnosed with Her2−/HR+ tumors (73 %), while 12 % had triple negative tumors (TNBC). There was a significant trend of higher incidence with increasing SES for Her2−/HR+ (IRR Highest vs. Lowest SES: 1.32, 95 % CI 1.27–1.39; p value trend: 0.01) and Her2+/HR+ tumors (IRR Highest vs. Lowest SES: 1.46, 95 % CI 1.27–1.68; p value trend: 0.01) among White cases. There was no association between SES and incidence of HR− subtypes (Her2+/HR− or TNBC). Similar associations were observed among Black, Hispanic and Asian or Pacific Islander cases. The positive association between SES and breast cancer incidence is primarily driven by hormone receptor positive tumors. To the extent that neighborhood SES is a proxy for individual SES, future studies are still needed to identify etiologic risk factors for other breast cancer subtypes.
Hepatocellular carcinoma (HCC) has a poor prognosis and, unlike most cancers, HCC incidence and mortality rates are increasing in the United States. While risk is known to vary among different racial ...and ethnic groups, less is known about the variability of risk within these groups by neighborhood socioeconomic status (SES).
HCC cases diagnosed in the Surveillance, Epidemiology and End Results (SEER) 11 cancer registries between 1996 and 2007, and the population of the SEER 11 catchment areas was studied. Analyses were conducted to compare census tract area family poverty, educational attainment, and unemployment by race and ethnicity. A multiple linear regression model, weighted by the number of cases and the number of individuals in each census tract, with adjustment for registry, was used to calculate mean differences in area-level attributes between HCC cases and the population.
HCC cases in most racial/ethnic groups had lower mean neighborhood-level measures of SES than their referent population. An exception was seen among Hispanics. Comparing white cases with cases of other racial groups and to Hispanics, white cases lived in neighborhoods with less family poverty, fewer high-school dropouts, and lower unemployment. Compared with white cases, Asian and Pacific Islander and Hispanic cases lived in neighborhoods with a higher percentage of foreign-born population.
Low neighborhood-level SES and immigrant status may be associated with greater risk of HCC within specific racial and ethnic groups.
These findings could help to focus control resources for HCC toward the most affected communities.
Purpose
To examine patterns of de-novo metastases (mets) and association with breast cancer-specific mortality across subtypes and racial groups.
Methods
Non-Hispanic (NH) Black and NH-White patients ...ages 40 years and older with primary breast cancer (BC) between 2010 and 2015 were examined. Multilevel logistic regression and Cox proportional hazards models were used to assess (1) odds of de-novo mets to specific sites by subtype, and (2) association of subtype with risk of BC mortality among patients with de-novo mets by race.
Results
A total of 204,941 BC patients were included in analysis. The most common de-novo mets site was to the bone, and overall prevalence of de-novo mets was higher among NH-Black (6.4%) versus NH-White (4.1%) patients. The odds of de-novo mets to any site were lower for TNBC (OR 0.68, 95% CI 0.62–0.73) and HR+/HER2− (OR 0.50, 95% CI 0.47–0.53) subtypes, but higher for HR−/HER2+ (OR 1.16, 95% CI 1.06–1.28) relative to HR+/HER2+ . De-novo mets to the brain only was associated with the highest mortality risk across all subtypes, ranging from a 13-fold increase (hazard ratio 13.45, 95% CI 5.03–35.96) for HR−/HER2+ to a 39-fold increase (hazard ratio 39.04, 95% CI 26.2–58.14) for HR+/HER2−.
Conclusion
Site and fatality of de-novo mets vary by subtype and by race. This information may help improve risk stratification and post-diagnostic surveillance to ultimately reduce BC mortality.
Breast cancer accounts for over 200,000 annual cases among women in the United States, and is the second leading cause of cancer-related deaths. However, few studies have investigated the association ...between breast cancer subtype and survival among African-American women. We analyzed cancer-related deaths among African-American women using data obtained from the SEER database linked to the 2000 U.S. census data. We examined distribution of baseline socio-demographic and clinical characteristics by breast cancer subtypes and used Cox proportional hazard models to determine associations between breast cancer subtypes and cancer-related mortality, adjusting for age, socio-economic status, stage at diagnosis, and treatment. Among 19,836 female breast cancer cases, 54.4 % were diagnosed with the HER2−/HR+ subtype, with the majority of those cases occurring among women ages 55 and older. However, after adjusting for age, stage, and treatment type (surgery, radiation, or no radiation and/or cancer-directed surgery), TNBC (HR 2.34; 95 % CI 1.95–2.81) and HER2+/HR− (HR 1.39, 95 % CI 1.08–1.79) cases had significantly higher hazards of cancer-related deaths compared with HER2+/HR+ cases. Adjusting for socio-economic status did not significantly alter these associations. African-American women with TNBC were more likely to have a cancer-related death than African-American women with other breast cancer subtypes. This association remained after adjustments for age, stage, treatment, and socio-economic status. Further studies are needed to identify subtype-specific risk and prognostic factors aimed at better informing prevention efforts for all women.
Racial disparities in cancer mortality still exist despite improvements in treatment strategies leading to improved survival for many cancer types. In this study, we described race/ethnic differences ...in patterns of de novo metastasis and evaluated the association between site of de novo metastasis and breast, prostate, and colorectal cancer mortality. Data were obtained from the Surveillance Epidemiology and Ends Results (SEER) database from 2010 to 2013 and included 520,147 patients ages ≥40 years with primary diagnosis of breast, colorectal, or prostate cancer. Site and frequency of de novo metastases to four sites (bone, brain, liver, and lung) were compared by race/ethnicity using descriptive statistics, and survival differences examined using extended Cox regression models in SAS 9.4. Overall, non‐Hispanic (NH) Blacks (11%) were more likely to present with de novo metastasis compared with NH‐Whites (9%) or Hispanics (10%). Among patients with breast cancer, NH‐Blacks were more likely to have metastasis to the bone, (OR: 1.25, 95% CI: 1.15–1.37), brain (OR: 2.26, 95% CI: 1.57–3.25), or liver (OR: 1.62, 95% CI: 1.35–1.93), while Hispanics were less likely to have metastasis to the liver (OR: 0.76, 95% CI: 0.60–0.97) compared with NH‐Whites. Among patients with prostate cancer, NH‐Blacks (1.39, 95% CI: 1.31–1.48) and Hispanics (1.39, 95% CI: 1.29–1.49) were more likely to have metastasis to the bone. Metastasis to any of the four sites evaluated increased overall mortality by threefold (for breast cancer and metastasis to bone) to 17‐fold (for prostate cancer and metastasis to liver). Racial disparities in mortality remained after adjusting for metastasis site in all cancer types evaluated. De novo metastasis is a major contributor to cancer mortality in USA with racial differences in the site, frequency, and associated survival.
Racial disparities in cancer mortality still exist despite improvements in treatment strategies leading to improved survival for many cancer types. Data from SEER 2010–2014 were utilized to assess racial/ethnic differences in site of de novo metastasis and relative survival associated with de novo metastasis by race/ethnicity. In conclusion, de novo metastasis is a major contributor to cancer mortality among patients with cancer in the USA.
Introduction This study estimated differences in educational disparities in mortality between ages 50–64 and 66–79 years in the U.S. and explored factors contributing to the differences. Methods ...Based on the follow-up of a nationally representative cohort in the National Longitudinal Mortality Study 2002–2011, relative differences in educational disparities (relative index of inequality) between people aged 50–64 and 66–79 years were calculated for deaths from all causes, cancer, cardiovascular disease, injuries, and other causes by sex and race/ethnicity. Analyses were conducted in 2016. Results In all racial/ethnic-, sex-, and age-specific groups, death rates were higher among the least educated than the most educated groups for all causes combined and most specific causes except for injuries in non-Hispanic blacks. Among non-Hispanic whites, the relative index of inequality for all causes combined among the younger and older age groups was 5.6 (95% CI=4.9, 6.5) and 2.8 (95% CI=2.6, 3.0), respectively. Among non-Hispanic blacks, corresponding index values were 4.1 (95% CI=3.6, 4.6) and 1.7 (95% CI=1.6, 1.8). Larger disparities in the younger age group were also observed for cardiovascular disease, cancer, and other causes among non-Hispanic whites, non-Hispanic blacks, and all races combined. Conclusions Educational disparities in mortality among non-Hispanic whites and blacks were 41%–61% lower in people aged 66–79 years than in those aged 50–64 years. Various factors may contribute to diminished disparities in the elderly, including differences in access to care, health perception, stress level, lifestyle, and health behaviors with advancing age and retirement.
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