Monique N. Hernandez

Trends in Colorectal Cancer Among Hispanics by Stage and Subsite Location: 1989–2006

OBJECTIVES:Hispanic colorectal cancer (CRC) rates historically have been lower than for non-Hispanic Whites in the United States and in Florida. The aim of this study is to understand CRC trends in Florida Hispanics and non-Hispanic Whites.METHODS:Using a cross-sectional study design, all invasive CRCs diagnosed among Florida residents between 1989 and 2006 were accessed from the Florida Cancer Data System (FCDS). These cases were analyzed by Hispanic and non-Hispanic White ethnic identification. The Hispanic Origin Identification Algorithm was applied to the FCDS data to identify Hispanic subjects. Primary cancer site and histology data were organized according to SEER (Surveillance Epidemiology and End Results) categories. Joinpoint regression was used to generate incidence trends by stage and subsite location.RESULTS:Rates of CRC incidence were higher for Florida Hispanics compared with non-Hispanic Whites since the mid 1990s. There was a consistent significant increase in the incidence of distant stage CRC in Hispanics (annual percent change (APC) of 1.26 and 0.90 in males and females), whereas rates in non-Hispanics decreased significantly during the same time period (APC −1.36 and −1.28, respectively). Similar trends were found in distant-stage right-sided CRC. Among right-sided CRCs, local stage incidence rate increased for both non-Hispanic Whites and Hispanics, whereas the incidence rate for regional stage decreased for both racial/ethnic groups.CONCLUSIONS:Trends for distant-stage CRC are increasing among Florida Hispanics. This is a particular public health concern given that CRC is a cancer for which screening modalities exist and could imply a concomitant increase in CRC-related mortality among Florida Hispanics. Lower rates of CRC screening in Hispanics are documented at the state level, relative to non-Hispanic Whites. Screening programs targeting the Florida Hispanic population are warranted.

Factors Associated With Receipt of Radiation Therapy for Rectal Cancer.

Purpose: Appropriate treatment for cancer is vital to increasing the likelihood of survival; however, for rectal cancer, there are demonstrated disparities in receipt of treatment by race/ethnicity and socioeconomic status. We evaluated factors associated with receipt of appropriate radiation therapy for rectal cancer using data from the Florida Cancer Data System that had been previously enriched with detailed treatment information collected from a Centers for Disease Control and Prevention Comparative Effectiveness Research study. This treatment information is not routinely available in cancer registry data and represents a unique data resource. Materials and Methods: Using multivariable regression, we evaluated factors associated with receiving radiation therapy among rectal cancer cases stage II/III. Our sample (n=403) included cases diagnosed in Florida in 2011 who were 18 years and older. Cases clinically staged as 0/I/IV were excluded. Results: Older age (odds ratio=0.96; 95% confidence interval, 0.94-0.97), the presence of one or more comorbidities (0.61; 0.39-0.96), and receipt of surgical intervention (0.44; 0.22-0.90) were associated with lack of radiation. Conclusions: In this cohort of patients, sociodemographic factors such as race/ethnicity, insurance status, and socioeconomic status, did not influence the receipt of radiation. Further research is needed, however, to understand why aging, greater comorbidity, and having surgery present a barrier to radiation therapy, particularly given that it is a well-tolerated treatment in most patients.

New Strategies Immediately Needed for Molecular Marker Reporting in Colorectal Cancer

≤2 cm diameter. Th ere was no signifi cant postembolization syndrome in patients who were initially treated with TACE. In fact, 3 patients of 122 in the TACE group presented with fever >38.0 °C, alleviated with symptomatic treatments without prolonged hospitalization. Th e rate of postembolization fever in our study (2.5%) was much lower than that in prior studies (20.6–75%) ( 4,5 ). Finally, owing to the inhomogeneous and less predictable spread of ethanol, pecutaneous ethanol injection (PEI) may not be as eff ective for local tumor control compared with RFA even when the size of hepatocellular carcinomas is <2 cm ( 6 ). Even though PEI can be used in treating hepatocellular carcinomas in RFA-high-risk locations, PEI may cause major biliary complications for treating hepatocellular carcinomas adjacent to the portal vein ( 6 ). Although we cannot agree with Dr Lo that TACE cannot be a good alternative to RFA, we agree with Dr Lo that TACE should only be reserved for patients with hepatocellular carcinoma ≤2 cm, which is not accessible by RFA.

Individual- and Neighborhood-Level Predictors of Mortality in Florida Colorectal Cancer Patients

Purpose We examined individual-level and neighborhood-level predictors of mortality in CRC patients diagnosed in Florida to identify high-risk groups for targeted interventions. Methods Demographic and clinical data from the Florida Cancer Data System registry (2007–2011) were linked with Agency for Health Care Administration and US Census data (n = 47,872). Cox hazard regression models were fitted with candidate predictors of CRC survival and stratified by age group (18–49, 50–64, 65+). Results Stratified by age group, higher mortality risk per comorbidity was found among youngest (21%), followed by middle (19%), and then oldest (14%) age groups. The two younger age groups had higher mortality risk with proximal compared to those with distal cancer. Compared with private insurance, those in the middle age group were at higher death risk if not insured (HR = 1.35), or received healthcare through Medicare (HR = 1.44), Medicaid (HR = 1.53), or the Veteran’s Administration (HR = 1.26). Only Medicaid in the youngest (52% higher risk) and those not insured in the oldest group (24% lower risk) were significantly different from their privately insured counterparts. Among 18–49 and 50–64 age groups there was a higher mortality risk among the lowest SES (1.17- and 1.23-fold higher in the middle age and 1.12- and 1.17-fold higher in the older age group, respectively) compared to highest SES. Married patients were significantly better off than divorced/separated (HR = 1.22), single (HR = 1.29), or widowed (HR = 1.19) patients. Conclusion Factors associated with increased risk for mortality among individuals with CRC included being older, uninsured, unmarried, more comorbidities, living in lower SES neighborhoods, and diagnosed at later disease stage. Higher risk among younger patients was attributed to proximal cancer site, Medicaid, and distant disease; however, lower SES and being unmarried were not risk factors in this age group. Targeted interventions to improve survivorship and greater social support while considering age classification may assist these high-risk groups.

Abstract 1883: Smoking and lung cancer in the United States: Geographic variations by state over time

Introduction: Years of research have confirmed a causal association between lung cancer and chronic exposure to tobacco products. It is estimated that active smoking is responsible for approximately 90 % of lung cancer cases. In 2009, lung cancer accounted for approximately 28% of all cancer deaths. However, there have been significant improvements in controlling population exposures to these carcinogens. Our research reviewed the implementation of smoking bans across the United States and correlated prevalence and incidence rates of lung cancers across states over the last six years. Methods: Lung cancer data were obtained from the Cancer in North America (CINA) database. Prevalence and incidence of current smokers by state, race, and gender were obtained from the CDC9s morbidity and mortality weekly report (MMWR) for the years 2004, 2006 and 2008 as well as other websites. Current smokers were defined as individuals who smoked more than 100 cigarettes in their lifetime and currently smoke every day or some days. ArcGIS 9.3 was used to spatially display tobacco and lung cancer rates by state. Visual representation of data included map series for comparisons across multiple years and graphical chart illustrations embedded in maps to show race/ethnic comparisons by state. All geographical data was analyzed at the state level. Results: Tobacco initiation was delayed among women, and country wide data demonstrated an increase in lung cancer among women and a decrease among men between 2004 and 2006. Despite a decline in incidence among men, the age-adjusted death rate for lung cancer was higher for men (67.0 per 100,000 persons) than for women (40.0 per 100,000 persons). In 2006, Kentucky (a state with a thriving tobacco industry where the only smoking related state laws prohibit smoking in government offices, universities, and the state capitol, except in designated smoking areas) had the highest age-adjusted lung cancer incidence rates in both men (124.8 per 100,000) and women (76.6 per 100,000) while Utah had the lowest age-adjusted cancer incidence rates in both men and women (32.0 per 100,000 and 24.7 per 100,000 respectively). Conclusion: The states with the lowest smoking rates are those that have implemented smoking bans in workplaces, restaurants, and bars. The decrease in smoking rates has not been evenly distributed across all sectors of society; there are notable gender and racial disparities in the number of smokers and in the number of people enrolled in smoking cessation programs. Increasing bans on public smoking, increased cost of cigarettes, and improved access to smoking cessation programs are apparently linked to decreased sales and use of tobacco products as observed at the state level. In the long term this should lead a decrease in the number of lung cancer cases associated with tobacco products. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 1883. doi:10.1158/1538-7445.AM2011-1883