Seng-Jaw Soong

Factors affecting survival following local, regional, or distant recurrence from localized melanoma

Background and Objectives: Approximately one third of all melanoma patients will experience disease recurrence. Factors that affect patient survival following local, regional, or distant first recurrences of localized melanoma are the subject of this investigation.

SOCIOECONOMIC CHARACTERISTICS AND MELANOMA INCIDENCE

PURPOSE This investigation examines the relationship between socioeconomic status (SES) and melanoma incidence in counties included in the Surveillance, Epidemiology, and End Results Registry (SEER) in the United States from 1973 to 1993. METHODS Cases included whites, aged at least 15 years, with a morphologic diagnosis of malignant melanoma, residing in one of 199 counties at the time of diagnosis. County level measures of SES including median household income, percentage of high school graduates, and percentage of families below poverty were abstracted from the 1950, 1960, 1970, 1980, and 1990 U.S. Census data. The relationship between SES factors and melanoma rates was examined by hierarchical Poisson regression. RESULTS The percentage of high school graduates was significantly and positively associated with the incidence of melanoma (relative risk (RR), 1.28; 95% confidence interval (CI), 1.21-1.35), after controlling for age at diagnosis, gender, time period, latitude, and percentage of Hispanics in the county. Percentage of families below poverty was significantly inversely associated with the incidence of melanoma (RR, 0.66; 95% CI, 0.55-0.78). When education and poverty were included in the same model, both the positive effects of education (RR, 1.23; 95% CI, 1.16-1.31) and the negative effects of poverty (RR, 0.85; 95% CI, 0.74-0.98) persisted. In contrast, median household income was not associated with melanoma incidence in a similar multivariable model (RR, 1.00; 95% CI, 0.99-1.00). CONCLUSION Whether the effect of education on incidence of melanoma reflects lifestyle behaviors that modify exposure to sunlight or some other factor remains unclear. Nonetheless, the findings of this study suggest that the determinant is primarily related to education, not income.

Relationships Between Socioeconomic Status and Race-Specific Cervical Cancer Incidence in the United States, 1973-1992

The association between low socioeconomic status (SES) in minority groups and higher incidence and mortality from cervical cancer was examined using two large U.S. databases. With cases from 1973 to 1992, all registries of the Surveillance, Epidemiology, and End Results (SEER) (except Hawaii) were used to calculate incidence rates of in situ and invasive cervical cancers by race group. SES indicators were derived from the Regional Economic Information System, Department of Commerce. Higher levels of SES indicators were related to decreased risk and lower incidence of invasive cancers in all race groups, but especially white and black populations, and to increased incidence of in situ cancer in these populations. Results suggest that higher SES status is related to a decrease in invasive cervical cancer, but an increase in in situ cervical cancer in recent years. These findings may explain the racial differences in cervical cancer incidence and help target intervention programs.

Clinical outcomes of localized melanoma of the foot: A case-control study

The controversy over whether melanoma of the foot has a poorer prognosis than melanoma of the leg remains unresolved. This investigation used a case-control design to address this issue. This design consisted of a survival analysis of 119 cases with localized melanoma of the foot and 238 controls with localized melanoma of the leg that were matched on prognostic factors including tumor thickness, ulceration, surgical treatment, gender, year of diagnosis, and age. There was a statistically significant difference between the survival rates of cases and controls. The 5-year survival rate for cases was 74.3% compared to 85.2% for controls. At 10 years, the survival rate was 63.6% for cases and 77.2% for controls. Cases experienced a higher percentage of distant recurrences than controls. These results imply that patients with melanoma of the foot have a poorer survival than patients with melanoma of the leg after controlling for prognostic factors.

African American and White Differences in Nutritional Status Among Low-Income Women Attending Public Health Clinics

Information concerning nutritional status and factors influencing dietary intakes among underserved populations is scarce. To obtain this information, data on nutritional status in a group of 726 white and African American women of low education and low income who were inner-city dwellers were analyzed. Dietary habits in all subjects were characterized by high intakes of fat, saturated fat, cholesterol, and salt and low intakes of fiber and folate. A comparison of dietary intake patterns of low-income white and African American women showed a trend toward poorer dietary habits among the white women. It is suggested that differences between African Americans and whites in most nutrient intakes were due to factors such as low levels of education and income rather than racial background alone. Results imply that disease prevention and health promotion programs should include efforts to increase awareness and practice of healthy diet habits among all low-income women.

Relationships between Beer, Wine, and Spirits Consumption and Suicide Rates in U.S. States from 1977 to 1988

Relationships between alcohol consumption and suicide rates were examined through an ecological study. Data on total apparent per capita alcohol consumption, as well as beer, wine, and spirits consumption, from 1977 to 1988 in each of the fifty U.S. states and District of Columbia were compared with suicide rates. It was found that total alcohol consumption was weakly but significantly related to suicide rate by univariate analysis (r = 0.16, p < 0.01). Pearson correlation coefficients were 0.30, 0.12, and −0.01 for correlation of suicide rate with beer, wine, and spirits consumption, respectively. Over the twelve years, the magnitude of associations between total alcohol consumption and suicide varied with correlation coefficients of 0.29, 0.23, 0.09, and 0.11 for four three-year periods, 1977–79, 1980–82, 1983–85, and 1986–88, respectively. The association between beer consumption and suicide persisted over the whole period with correlation coefficients of 0.35, 0.31, 0.26, and 0.30, while that between wine and suicide did not. Associations were also examined by quartile of each alcohols consumption. Significant inverse association was found for beer as well as total consumptions at the lowest quartile. However, at the highest quartile, beer and spirits consumption showed positive association with suicide. These data suggest a “U-shaped” curve relating suicide rate to alcohol consumption. By using 1980 census data with adjustment for confounding effects of socioeconomic factors, total alcoholconsumption was found to be positively associated with suicide especially at high consumption level. At low level consumption, beer showed an inverse association with suicide after controlling for confounding effects.