Therese A. Dolecek

Epidemiologic and Molecular Prognostic Review of Glioblastoma

Glioblastoma multiforme (GBM) is the most common and aggressive primary central nervous system malignancy with a median survival of 15 months. The average incidence rate of GBM is 3.19/100,000 population, and the median age of diagnosis is 64 years. Incidence is higher in men and individuals of white race and non-Hispanic ethnicity. Many genetic and environmental factors have been studied in GBM, but the majority are sporadic, and no risk factor accounting for a large proportion of GBMs has been identified. However, several favorable clinical prognostic factors are identified, including younger age at diagnosis, cerebellar location, high performance status, and maximal tumor resection. GBMs comprise of primary and secondary subtypes, which evolve through different genetic pathways, affect patients at different ages, and have differences in outcomes. We report the current epidemiology of GBM with new data from the Central Brain Tumor Registry of the United States 2006 to 2010 as well as demonstrate and discuss trends in incidence and survival. We also provide a concise review on molecular markers in GBM that have helped distinguish biologically similar subtypes of GBM and have prognostic and predictive value. Cancer Epidemiol Biomarkers Prev; 23(10); 1985–96. ©2014 AACR.

Age, gender, and racial differences in incidence and survival in primary CNS lymphoma

Background:Primary central nervous system lymphoma (PCNSL) is a rare subtype of extranodal non-Hodgkin lymphoma that accounts for ∼4% of newly diagnosed central nervous system (CNS) tumours. The objective of this study was to analyse the epidemiology, incidence, and outcome of these rare tumours.Methods:Primary brain and CNS lymphoma cases were identified from the Surveillance, Epidemiology, and End Results (SEER) research data sets for the years 1980–2008 for analysis of trends in incidence and survival. SEER*Stat v. 7.0.4 software was used to analyse the data.Results:The overall incidence rate of PCNSL was 0.47 per 100 000 person-years. The incidence was significantly higher in males compared with females, blacks aged 0–49 years at diagnosis compared with whites, and whites aged 50 years and older at diagnosis compared with blacks. After a significant decline in incidence between 1995 and 1999, incidence rates rose slightly; those aged 75+ years at diagnosis had the most dramatic increase in incidence rates over time. Five-year survival rates were significantly higher in whites compared with blacks aged 0–49 years at diagnosis, but was primarily driven by white women aged 0–49 years.Conclusion:There is an increase in incidence of PCNSL in the elderly, and elderly blacks have lower incidence compared with white population. Survival remains poor and is negatively dominated by factors associated with HIV infection and advanced age.

Toward determining the lifetime occurrence of metastatic brain tumors estimated from 2007 United States cancer incidence data

Few population estimates of brain metastasis in the United States are available, prompting this study. Our objective was to estimate the expected number of metastatic brain tumors that would subsequently develop among incident cancer cases for 1 diagnosis year in the United States. Incidence proportions for primary cancer sites known to develop brain metastasis were applied to United States cancer incidence data for 2007 that were retrieved from accessible data sets through Centers for Disease Control and Prevention (CDC Wonder) and Surveillance, Epidemiology, and End Results (SEER) Program Web sites. Incidence proportions were identified for cancer sites, reflecting 80% of all cancers. It was conservatively estimated that almost 70 000 new brain metastases would occur over the remaining lifetime of individuals who received a diagnosis in 2007 of primary invasive cancer in the United States. That is, 6% of newly diagnosed cases of cancer during 2007 would be expected to develop brain metastasis as a progression of their original cancer diagnosis; the most frequent sites for metastases being lung and bronchus and breast cancers. The estimated numbers of brain metastasis will be expected to be higher among white individuals, female individuals, and older age groups. Changing patterns in the occurrence of primary cancers, trends in populations at risk, effectiveness of treatments on survival, and access to those treatments will influence the extent of brain tumor metastasis at the population level. These findings provide insight on the patterns of brain tumor metastasis and the future burden of this condition in the United States.

Descriptive epidemiology of malignant and nonmalignant primary spinal cord, spinal meninges, and cauda equina tumors, United States, 2004‐2007

Primary tumors of the spinal cord, spinal meninges, and cauda equina are relatively rare, and a paucity of population‐based data exist on tumors in these sites. This study intends to augment the current literature by examining incidence of these tumors on a national level.

Prediagnosis Food Patterns Are Associated with Length of Survival from Epithelial Ovarian Cancer

BACKGROUND Dietary factors have been the focus of many studies on the etiology of ovarian cancer and may potentially affect survival. Indeed, three recent studies outside the United States have suggested that diet plays a role in ovarian cancer survival. OBJECTIVE The study purpose was to evaluate the hypothesis that women diagnosed with ovarian cancer whose reported prediagnosis food patterns more closely reflect recommendations for optimal health experience a survival advantage compared with those reporting poorer diets. DESIGN A longitudinal follow-up study design was used to examine prediagnosis usual diet effects on survival among 341 Cook County, Illinois, residents diagnosed with epithelial ovarian cancer during 1994-1998. These women participated in a previous case-control study where diet was assessed using a validated food frequency questionnaire. This diet information was categorized utilizing the Dietary Guidelines for Americans 2005. Deaths through 2005 were ascertained using a national death index search. STATISTICAL ANALYSIS Hazard ratios (HR) and 95% confidence intervals (CI) adjusting for important covariables were obtained from proportional hazards regression models to evaluate diet effects on survival from ovarian cancer. RESULTS Comparisons of high to low food group or subgroup intakes demonstrated statistically significant prediagnosis food pattern associations with survival time. Longer survival was associated with total fruits and vegetables (HR 0.61, 95% CI 0.38 to 0.98, P for trend=0.10) and vegetables separately (HR 0.66, 95% CI 0.43 to 1.01, P for trend <0.05). Subgroup analyses showed only yellow and cruciferous vegetables to significantly favor survival. Conversely, a survival disadvantage was shown for meats, not generally recommended (HR 2.28, 95% CI 1.34 to 3.89, P for trend <0.01), and specifically the red and cured/processed meats subgroups. An increased HR was also observed for the milk (all types) subgroup (HR 2.15, 95% CI 1.20 to 3.84, P for trend <0.05). CONCLUSIONS Prediagnosis adherence to diets that reflect recommendations for optimal nutrition and cancer prevention may have benefits that continue even after an ovarian cancer diagnosis.

Epidemiology of meningiomas post‐Public Law 107‐206: The Benign Brain Tumor Cancer Registries Amendment Act

The current analysis follows the implementation of Public Law 107‐260, the Benign Brain Tumor Cancer Registries Amendment Act, which mandated the collection of nonmalignant brain tumors.

Racial differences in stage at diagnosis and survival from epithelial ovarian cancer: a fundamental cause of disease approach.

Associations between race, socioeconomic status (SES) and health outcomes have been well established. One of the ways in which race and SES affect health is by influencing ones access to resources, which confers ability to avoid or mitigate adverse outcomes. The fundamental cause of disease approach argues that when a new screening tool is introduced, individuals with greater resources tend to have better access to the innovation, thus benefiting from early detection and leading to better survival. Conversely, when there is no established screening tool, racial and SES differences in early detection may be less pronounced. Most ovarian cancer is diagnosed at advanced stages, because of the lack of an effective screening tool and few early symptoms. However, once detected, racial differences may still be observed in mortality and survival outcomes. We examined the racial differences in diagnosis and survival among ovarian cancer cases diagnosed during 1994-1998, in Cook County, Illinois (N = 351). There were no racial differences in the stage at diagnosis: 51.7% of white and 52.9% of black women were diagnosed at later stages (III and IV). Only age was associated with the stage at diagnosis. Tumor characteristics also did not differ between white and black women. Compared to white women, black women were less likely to be married, less educated, more frequently used genital powder, had tubal ligation, and resided in higher poverty census tracts. As of December 31, 2005, 44.3% of white and 54.5% of black women had died of ovarian cancer. Controlling for known confounding variables, the hazard ratio for ovarian cancer death between black and white women was 2.2. The findings show that fundamental cause perspective provides a potential framework to explore subtleties in racial disparities, with which broader social causes may be accounted for in explaining post diagnosis racial differences.

Descriptive epidemiology of ependymal tumours in the United States.

Background:Ependymomas are rare primary gliomas that commonly affect both children and adults, but unique as survival is worse in children.Methods:Data on brain and central nervous system primary malignant and non-malignant ependymal tumours from the Central Brain Tumor Registry of the United States analytic data set and primary malignant ependymal tumours from the SEER 13 registries research data file were used to evaluate incidence and survival, respectively.Results:The 2004–2009 average annual age-adjusted incidence rate of ependymal tumours was 0.41/100 000. Spinal cord/cauda equina was the primary site at diagnosis for 50–60% of ependymal tumours in adult age groups in contrast to about 20% in children and adolescents. Ependymoma was the most frequent histology in all age groups; however, anaplastic ependymoma comprised about 30% in cases 0–19 years of age compared with about 3–5% in adult age groups. Overall, relative survival was favourable with rates at ∼85% and 75% at 3 and 10 years post diagnosis, respectively. However, children and adolescents, the oldest adult age group, cases diagnosed with anaplastic ependymoma and/or tumour location in a brain site had lowest survival rates.Conclusion:Paediatric cases had worse outcomes compared with adults for numerous reasons including having a higher percentage of anaplastic ependymomas and greater percentage of cases of intracranial disease.

Neighborhood Changes in Concentrated Immigration and Late Stage Breast Cancer Diagnosis

Immigrant women are at greater risk for late stage breast cancer diagnosis. The rapid increase in the US foreign-born population and new immigration patterns lead us to investigate the association between changes in immigrant population and the likelihood of distant metastasis stage at diagnosis of breast cancer among women in Cook County, Illinois. Analyses employed Illinois State Cancer Registry data for 42,714 breast cancer cases diagnosed between 1994 and 2003 in conjunction with 1990 and 2000 Census tract data. We find that concentration of and increases in immigrant populations within neighborhoods contributed to the risk of late stage breast cancer diagnosis. These findings suggest that, although some health indicators for immigrant populations have improved in recent years, important health disparities in breast cancer diagnosis still remain at the neighborhood level. They further suggest that cancer screening and follow-up resources should be directed to areas experiencing rapid increases in immigrant populations.

Impact of a False-Positive Screening Mammogram on Subsequent Screening Behavior and Stage at Breast Cancer Diagnosis

Background: Experiencing a false positive (FP) screening mammogram is economically, physically, and emotionally burdensome, which may affect future screening behavior by delaying the next scheduled mammogram or by avoiding screening altogether. We sought to examine the impact of a FP screening mammogram on the subsequent screening mammography behavior. Methods: Delay in obtaining subsequent screening was defined as any mammogram performed more than 12 months from index mammogram. The Kaplan–Meier (product limit) estimator and Cox proportional hazards model were used to estimate the unadjusted delay and the hazard ratio (HR) of delay of the subsequent screening mammogram within the next 36 months from the index mammogram date. Results: A total of 650,232 true negative (TN) and 90,918 FP mammograms from 261,767 women were included. The likelihood of a subsequent mammogram was higher in women experiencing a TN result than women experiencing a FP result (85.0% vs. 77.9%, P < 0.001). The median delay in returning to screening was higher for FP versus TN (13 months vs. 3 months, P < 0.001). Women with TN result were 36% more likely to return to screening in the next 36 months compared with women with a FP result HR = 1.36 (95% CI, 1.35–1.37). Experiencing a FP mammogram increases the risk of late stage at diagnosis compared with prior TN mammogram (P < 0.001). Conclusions: Women with a FP mammogram were more likely to delay their subsequent screening compared with women with a TN mammogram. Impact: A prior FP experience may subsequently increase the 4-year cumulative risk of late stage at diagnosis. Cancer Epidemiol Biomarkers Prev; 26(3); 397–403. ©2017 AACR.