Barry A. Miller

Annual report to the nation on the status of cancer, 1975–2004, featuring cancer in American Indians and Alaska Natives

The American Cancer Society, the Centers for Disease Control and Prevention, the National Cancer Institute, and the North American Association of Central Cancer Registries collaborate annually to provide updated information on cancer occurrence and trends in the U.S. The 2007 report features a comprehensive compilation of cancer information for American Indians and Alaska Natives (AI/AN).

Annual report to the nation on the status of cancer, 1975–2003, featuring cancer among U.S. Hispanic/Latino populations

The American Cancer Society, Centers for Disease Control and Prevention, National Cancer Institute, and North American Association of Central Cancer Registries collaborate annually to provide U.S. cancer information, this year featuring the first comprehensive compilation of cancer information for U.S. Latinos.

Persistent area socioeconomic disparities in U.S. incidence of cervical cancer, mortality, stage, and survival, 1975–2000†

Temporal cervical cancer incidence and mortality patterns and ethnic disparities in patient survival and stage at diagnosis in relation to socioeconomic deprivation measures have not been well studied in the United States. The current article analyzed temporal area socioeconomic inequalities in U.S. cervical cancer incidence, mortality, stage, and survival.

Cancer Incidence Trends Among Asian American Populations in the United States, 1990–2008

BACKGROUND National cancer incidence trends are presented for eight Asian American groups: Asian Indians/Pakistanis, Chinese, Filipinos, Japanese, Kampucheans, Koreans, Laotians, and Vietnamese. METHODS Cancer incidence data from 1990 through 2008 were obtained from 13 Surveillance, Epidemiology, End Results (SEER) registries. Incidence rates from 1990 through 2008 and average percentage change were computed using SEER*Stat and Joinpoint software. The annual percentage change (APC) in incidence rates was estimated with 95% confidence intervals (95% CIs) calculated for both the rate and APC estimates. Rates for non-Hispanic whites are presented for comparison. RESULTS Prostate cancer was the most common malignancy among most groups, followed by lung, colorectal, liver, and stomach cancers. Breast cancer was generally the most common cancer in women, followed by colorectal and lung cancers; liver, cervix, thyroid, and stomach cancers also ranked highly. Among men, increasing trends were observed for prostate (Asian Indians and Pakistanis: APC 1990-2003 = 2.2, 95% CI = 0.3 to 4.1; Filipinos: APC 1990-1994 = 19.0, 95% CI = 4.5 to 35.4; Koreans: APC 1990-2008 = 2.9, 95% CI = 1.8 to 4.0), colorectal (Koreans: APC 1990-2008 = 2.2, 95% CI = 0.9 to 3.5), and liver cancers (Filipinos: APC 1990-2008 = 1.6, 95% CI = 0.4 to 2.7; Koreans: APC 1990-2006 = 2.1, 95% CI = 0.4 to 3.7; Vietnamese: APC 1990-2008 = 1.6, 95% CI = 0.3 to 2.8), whereas lung and stomach cancers generally remained stable or decreased. Among women, increases were observed for uterine cancer (Asian Indians: APC 1990-2008 = 3.0, 95% CI = 0.3 to 5.8; Chinese: APC 2004-2008 = 7.0, 95% CI = 1.4 to 12.9; Filipina: APC 1990-2008 = 3.0, 95% CI = 2.4 to 3.7; Japanese: APC 1990-2008 = 1.1, 95% CI = 0.1 to 2.0), colorectal cancer (Koreans: APC 1990-2008 = 2.8, 95% CI = 1.7 to 3.9; Laotians: APC: 1990-2008 = 5.9, 95% CI = 4.0 to 7.7), lung cancer (Filipinas: APC 1990-2008 = 2.1, 95% CI = 1.4 to 2.8; Koreans: APC 1990-2008 = 2.1, 95% CI = 0.6 to 3.6), thyroid cancer (Filipinas: APC 1990-2008 = 2.5, 95% CI = 1.7 to 3.3), and breast cancer in most groups (APC 1990-2008 from 1.2 among Vietnamese and Chinese to 4.7 among Koreans). Decreases were observed for stomach (Chinese and Japanese), colorectal (Chinese), and cervical cancers (Laotians and Vietnamese). CONCLUSIONS These data fill a critical knowledge gap concerning the cancer experience of Asian American groups and highlight where increased preventive, screening, and surveillance efforts are needed-in particular, lung cancer among Filipina and Korean women and Asian Indian/Pakistani men, breast cancer among all women, and liver cancer among Vietnamese, Laotian, and Kampuchean women and Filipino, Kampuchean, and Vietnamese men.

Quality of race, Hispanic ethnicity, and immigrant status in population-based cancer registry data: implications for health disparity studies

Population-based cancer registry data from the Surveillance, Epidemiology, and End Results (SEER) Program at the National Cancer Institute are based on medical records and administrative information. Although SEER data have been used extensively in health disparities research, the quality of information concerning race, Hispanic ethnicity, and immigrant status has not been systematically evaluated. The quality of this information was determined by comparing SEER data with self-reported data among 13,538 cancer patients diagnosed between 1973–2001 in the SEER—National Longitudinal Mortality Study linked database. The overall agreement was excellent on race (κ = 0.90, 95% CI = 0.88–0.91), moderate to substantial on Hispanic ethnicity (κ = 0.61, 95% CI = 0.58–0.64), and low on immigrant status (κ = 0.21. 95% CI = 0.10, 0.23). The effect of these disagreements was that SEER data tended to under-classify patient numbers when compared to self-identifications, except for the non-Hispanic group which was slightly over-classified. These disagreements translated into varying racial-, ethnic-, and immigrant status-specific cancer statistics, depending on whether self-reported or SEER data were used. In particular, the 5-year Kaplan–Meier survival and the median survival time from all causes for American Indians/Alaska Natives were substantially higher when based on self-classification (59% and 140 months, respectively) than when based on SEER classification (44% and 53 months, respectively), although the number of patients is small. These results can serve as a useful guide to researchers contemplating the use of population-based registry data to ascertain disparities in cancer burden. In particular, the study results caution against evaluating health disparities by using birthplace as a measure of immigrant status and race information for American Indians/Alaska Natives.

Cancer among American Indians and Alaska Natives in the United States, 1999–2004

Cancer incidence rates vary among American Indian and Alaska Native (AI/AN) populations and often differ from rates among non‐Hispanic whites (NHWs). However, the misclassification of race for AI/AN cancer cases in central cancer registries may have led to underestimates of the AI/AN cancer burden in previous reports.

Effect of Changes in Cancer Classification and the Accuracy of Cancer Death Certificates on Trends in Cancer Mortality

Cancer mortality statistics are used extensively for studying time trends as well as for many other epidemiological studies. In studying trends especially over long periods of time and comparing them fromcountry to country,investigatorsmust take steps to ensure there are no artifacts that would raise or lower mortalitystatistics. The International Classification of Diseases (ICD) published by the World Health Organization has beenused forcodingmortalityin all countries belongingto theunited Nations since 1948 when the Sixth revision came out. It undergoes periodic revision and changes are sometimes made in categories, in indexing, or in rules that seriously affect time trends unless researchers are aware of them and make adjustments. Recently, two papers have been published on the International Comparability of Cancer Mortality Data1-* that examine the coding of the same death certificates in different countries. This subject will not be discussed here. In addition, cancer mortality may be affected by the accuracy with which the underlying cause of death (UCD) is recorded on the death certificates. Nearly ten years ago, an “Accuracy of Cancer Death Certificates” study was published basedon data from the National Cancer Institute’s (NCI) Third National Cancer Survey (TNCS).3 This current studyutilizesdata from the NCI’s Surveillance, Epidemiology and End Results (SEER) Program. The basicdifference between thesestudiesis that

Methods for improving cancer surveillance data in American Indian and Alaska Native populations.

The misclassification of race decreases the accuracy of cancer incidence data for American Indians and Alaska Natives (AI/ANs) in some central cancer registries. This article describes the data sources and methods that were used to address this misclassification and to produce the cancer statistics used by most of the articles in this supplement.

The increasing incidence of breast cancer since 1982: relevance of early detection.

Breast cancer incidence in the United States has been rising dramatically since 1982, as shown in data collected by the Surveillance, Epidemiology, and End Results (SEER) Program. In women aged 50 and older, incidence rates for in situ and localized invasive tumors have increased over the period 1982–86, while rates for regional and distant tumors have remained stable. The incidence of localized tumors <1.0 cm, 1.0–1.9 cm, and 2.0–2.9 cm in size has increased more rapidly than that of tumors 3.0 cm or more in size among women over age 50. Survival rates also have improved among cases diagnosed over this time period. These data suggest that early detection may be playing a role in the recent increase in female breast cancer incidence, though other factors cannot be ruled out. Conclusions regarding improved cancer control await confirmation by reduced breast cancer mortality.

Incidence of ovarian cancer by race and ethnicity in the United States, 1992–1997†

*This article is a US Government work and, as such, is in the public domain in the United States of America. Ovarian cancer is the fifth most common cancer among U.S. women. An estimated 23,400 new cases were expected to be diagnosed in the U.S. in 2001. As is the case for breast and endometrial cancers, ovarian cancer is more common among women in northern and central Europe, and North America compared with Africa, South America, and Asia. In the U.S., substantial racial and ethnic variations also are observed in the incidence of ovarian cancer. rates reportedly are highest among non-Hispanic white and American Indian women, and are lower among Hispanic, Native Hawaiian, and Asian women. Among white women in the U.S., there has been a gradual decline in the incidence and mortality from ovarian cancer since 1973, whereas rates among black women during this time period have been fairly stable. The epidemiology of ovarian cancer was discussed in the article by Goodman and How.