John L. Young

Access to Pediatric Cancer Care by Age, Race, and Diagnosis, and Outcomes of Cancer Treatment in Pediatric and Adolescent Patients in the State of Georgia

PURPOSE There have been concerns among pediatric oncologists that adolescent and minority patients are not getting adequate access to care. This study examines access to cancer care and survival outcomes based on age, race, and type of cancer in patients in Georgia. PATIENTS AND METHODS We performed a retrospective review of 1,751 cancer patients aged 0 to 19 years, diagnosed between 1998 and 2002, in the Georgia Comprehensive Cancer Registry, which identified patients who were treated at one of five Georgia pediatric cancer centers (Childrens Oncology Group [COG] members) at any point in their treatment. Data were further analyzed for age at diagnosis, race, county of residence, and 5-year survival. RESULTS Eighty-seven percent of patients aged 0 to 14 years and 36% of those aged 15 to 19 years were treated at a COG institution. Twenty-five percent of all patients were of African descent, with 75.4% of black versus 70.3% of white patients (age 0 to 19 years) treated at a COG institution (P < .01); 97.1% of other minorities were treated at a COG institution (P < .05). The 5-year actuarial survival rates for more pediatric-specific cancers were significantly lower in all leukemias (75.1% v 46.4%; P = .0015), and acute lymphoblastic leukemia specifically (86.3% v 53.3%; P < .05) for patients not treated at a COG institution. Actuarial survival rates were much lower for blacks than whites in all cancers as a whole (70% v 82%; P < .001) and for many specific subtypes. CONCLUSION Adolescent-aged patients are less likely to be referred to a COG institution, potentially exposing them to worse outcomes in some cancer subtypes. Reassuringly, minority populations are receiving adequate access to pediatric cancer care; unfortunately their survival rates are lower.

Stage at diagnosis of ovarian cancer in the United States, 1992-1997.

Received March 18, 2002; revision received September 25, 2002; accepted January 15, 2003. In the early stages of epithelial ovarian cancer, symptoms typically are mild or nonspecific (e.g., abdominal discomfort, bloating, or back pain) and therefore are difficult to distinguish from symptoms of other common illnesses. Approximately 95% of women who are diagnosed and treated with localized disease that has not spread beyond the ovary survive for 5 years, but only about 25% of women with ovarian cancer are diagnosed at this early stage. Five-year survival decreases to approximately 28% when distant spread has occurred, and 75% of women with surgically staged ovarian cancer are diagnosed with metastatic disease that has this poor prognosis. This purpose of the current article is to describe the stage at diagnosis of ovarian cancer among white, black, Asian and Pacific Islander, American Indian, and Hispanic women in the United States from 1992 through 1997 using a comparable staging system. Cancer stage describes the extent of the malignant process— higher values denote greater disease severity. Although all staging systems are inherently imperfect attempts to categorize complex biologic processes, they are nonetheless necessary for statistical analysis of cancer cases with similar prognostic characteristics; for instance, disease stage at diagnosis influences treatment options. In the United States, the systems most often used for the clinical staging of ovarian cancers are the FIGO (International Federation of Gynecology and Obstetrics) system and the American Joint Committee on Cancer TNM system. Not all population-based cancer registries collect data regarding each of the specific components of the TNM or FIGO system. However, all registries do use a summary stage variable, developed by the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program, to group cases into one of five categories: in situ, localized, regional, distant, and unknown. Although the FIGO and SEER Summary Stage systems are not directly interconvertible, what follows is a general translation. In situ cancer is confined to the ovary without stromal invasion or penetration of the basement membrane. Diagnosis of an in situ cancer can only be made microscopically. Localized ovarian cancer has infiltrated the epithelium, but invasion has not spread beyond the ovary (FIGO Stages IA and IB). Regional cancer has spread beyond the ovary by direct extension to adjacent tissue and/or regional lymph node involvement (FIGO Stages IC, IIA–C). Distant or metastatic ovarian cancer includes tumor cells that have broken away from the primary tumor and have begun to grow in a new, remote location beyond the pelvis (FIGO Stages IIIA–C, IV). Some registries collect disease stage information directly, whereas others derive the categories by aggregating specific descrip2648

Ovarian cancer in children and young adults in the United States, 1992–1997

Received March 18, 2002; revision received September 25, 2002; accepted January 15, 2003. Ovarian cancer in children and young adults is rare. As a consequence, little descriptive or analytic research regarding ovarian cancer has been conducted in this age group. The types of ovarian cancer that occur in girls and young women before the age of 25 years are different from those diagnosed in older women. Key developmental events and anatomic features differentiate various subtypes of ovarian tumors. The majority of ovarian tumors occurring in girls between the ages of birth and 19 years are of a nonepithelial origin, similar to other malignancies diagnosed in this age group. The two major histologic categories of nonepithelial ovarian cancers are sex cord-stromal tumors and germ cell tumors. The pathology and classification of ovarian tumors are reviewed elsewhere. The purpose of this study was to describe the incidence of ovarian cancer among girls and young women (ages birth–24 years) by histology, race, ethnicity, and stage. The cases were selected from women and children diagnosed with ovarian cancer between 1992 and 1997 in selected areas of the U.S.

The incidence of malignant non-carcinomas of the female breast

AbstractObjective: Demographic and tumor characteristics of all malignant non-carcinomas of the breast, including the lymphomas and myelomas, are the focus of this investigation. Methods: Twenty-six US population-based registries identified 363,801 newly diagnosed malignant breast cancers among women during the time period 1994–1998. Of these, 4625 (1.3%) were reported simply as cancer, NOS; 357,775 (98.3%) were of epithelial origin (carcinomas or adenocarcinomas); and the remaining 1401 (0.4%) were non-epithelial in origin. All but nine of the non-epithelial breast cancers were some form of soft tissue sarcoma. Results: The most common non-epithelial cancer was malignant phyllodes tumor, which accounted for 61% of these diagnoses. In addition to the 363,801 malignant cancers classified to the breast, another 613 tumors arose in the breast but were classified as myelomas or lymphomas; two as solitary myelomas, two as Hodgkin lymphoma and the remaining 609 as non-Hodgkin lymphoma. Principal conclusions: The median age of females with a non-epithelial cancer (53) was 10 years younger than that of women with an epithelial cancer. The age-adjusted incidence rate per 100,000 females was 0.51 for non-epithelial cancers compared to 127.05 for epithelial cancers. Adding the myelomas and lymphomas, which are traditionally included with the hematopoietic cancers, to the incidence rates for breast cancer would increase the rate by less than 0.2 per 100,000.

A vision for cancer incidence surveillance in the United States.

A comprehensive framework for cancer surveillance should span the entire lifespan and be capable of providing information on risk, burden, disparity, cost, cancer care, survival, and death. Cancer incidence, the point in the continuum when an individual is diagnosed with cancer, has a strong, well-developed system to produce information about newly diagnosed cancer cases. However, in the future, this system must be enhanced and integrated with other cancer surveillance networks and other systems to provide timely information on the burden of newly diagnosed patients with respect to various cross-cutting population characteristics (e.g., social, economic, race/ethnic, urbanicity, or access to care) to define, monitor, and reduce incidence and various disparities noted among population groups. Collaboration in data collection, standard setting, surveillance activities, research, education and training, data use, and advocacy among all registries and national programs will be important to the continued success of the cancer incidence surveillance system. The cancer registry is an integral part of the infrastructure to reduce the burden of cancer, including the numbers of newly diagnosed cases.

Racial/ethnic diversity in children's oncology clinical trials: ten years later.

During the past 50 years, clinical trials have led to dramatic improvement in pediatric cancer survival. Prior studies have shown that racial/ethnic and age groups have not been enrolled proportionally. Whites, Hispanics, and adolescents are under‐represented and black children are over‐represented. This study identifies the current racial/ethnic/age/sex representation in pediatric (ages birth to 19 years) cancer treatment trials.

Invasion characteristics of oral tongue cancer: frequency of reporting and effect on survival in a population-based study.

The 2000 College of American Pathologists (CAP) guidelines recommend that a characterization of carcinomas of the upper aerodigestive tract, including tongue cancer, should include depth of invasion (DI) and the presence of lymphovascular invasion (LVI) or perineural invasion (PNI).

Assessment of a commercial searchable population directory as a means of selecting controls for case-control studies.

We explored the feasibility of using SalesGenie®, a commercially available database, as a potential alternative to traditional methods of selecting controls for population-based case-control studies. An attractive feature of this particular database is that it permits a search within specific age ranges, geographic locations, and household income. Information on 1,068 cases reported to the California Cancer Registry between 2001 and 2005 was entered manually into the SalesGenie Web-based search engine. The frequency of Registry-to-SalesGenie matches was then compared with the frequency of matching the registry data to the California Department of Motor Vehicles (DMV) records. Our findings indicate that the SalesGenie database is currently less comprehensive than DMV records. Nevertheless, Web-based population data sources may provide a potential alternative for population-based studies when used in conjunction with other methods, particularly in states where DMV records are not accessible to researchers.