Thomas B. Richards

Using population‐based cancer registry data to assess the burden of human papillomavirus‐associated cancers in the United States: Overview of methods

Increased attention to human papillomavirus (HPV)‐associated cancers in light of the recent release of an HPV vaccine, as well as increased availability of cancer registry data that now include reporting from a large proportion of the US population, prompted the current assessment of HPV‐associated cancers. This article describes methods used to assess the burden of HPV‐associated cervical, vulvar, vaginal, penile, anal, and oral cavity/oropharyngeal cancers in the United States during 1998 through 2003 using cancer registry data, and it provides a brief overview of the epidemiology of these cancers. Cancer 2008;113(10 suppl):2841–54. Published 2008 by the American Cancer Society.

Cervical cancer incidence in a prevaccine era in the United States, 1998-2002.

OBJECTIVE: To report the incidence of cervical cancer by geography, race or ethnicity, and histology. METHODS: We examined combined data from the National Program of Cancer Registries and the Surveillance, Epidemiology, and End Results Program covering 87% of the U.S. population. We calculated the age-adjusted incidence of cervical cancer by age, race or ethnicity, histology, and stage by region or state. RESULTS: Rates of invasive cancer per 100,000 females declined from 10.2 in 1998 to 8.5 in 2002. Incidence rates by state ranged from 6.6 to 12.3 per 100,000. Rates were especially high among Hispanic women aged 40 years or older (26.5 or more) and African-American women aged older than 50 years (23.5 or more). Rates of squamous cell carcinoma were significantly higher among African-American and Hispanic women than among their white counterparts. In contrast, rates of adenocarcinoma (18% of all cases) were significantly lower among African-American women than in white women (rate ratio 0.88, P<.05). Rates of adenocarcinoma were significantly higher among Hispanic women than among non-Hispanics (rate ratio 1.71, P<.05). Although no regional differences were noted for adenocarcinoma, rates of squamous cell carcinoma were higher in the South than in other regions. CONCLUSION: Despite intense screening in the past decade, higher rates of cervical cancer persist among women in the South and women who are African American or Hispanic. This information could guide more focused interventions to increase access to screening with cervical cytology as well as vaccination against human papillomavirus. LEVEL OF EVIDENCE: III

Cervical cancer screening among women in metropolitan areas of the United States by individual-level and area-based measures of socioeconomic status, 2000 to 2002

Background: Few studies have examined cancer screening among women residing in metropolitan areas in relation to both individual-level and area-based measures of socioeconomic status (SES). To learn more, we examined self-reported rates of Papanicolaou (Pap) testing among women living in metropolitan areas in relation to individual-level measures of SES (household income and education), and area-based measures of SES (percentage of residents living in poverty, percentage with low education, and percentage working class). Methods: Data were obtained from women who were interviewed by telephone during 2000 and 2002 as part of the Behavioral Risk Factor Surveillance System (BRFSS). Self-reported county of residence was used to classify respondents as residents of metropolitan statistical areas. Only BRFSS respondents who resided in 35 metropolitan statistical areas with a population of ≥1.5 million in 2000 were included in this analysis. Analyses were limited to women ages ≥18 years with no history of hysterectomy (n = 49,231). Area-based measures of SES were obtained by using county-level information from the 2000 U.S. Census. Results: Only 75.4% [95% confidence interval (95% CI), 73.8-77.1%] of 3,947 women ages ≥18 years who had a reported household income of <

Cancer in Appalachia, 2001–2003

15,000 per year had received a Pap test in the previous 3 years, compared with 92.2% (95% CI, 91.2-93.1%) of 18,698 women with a household income of ≥

Breast, cervical, and colorectal carcinoma screening in a demographically defined region of the southern U.S.†

50,000. Overall, 77.5% (95% CI, 75.7-79.3%) of women without a high school education had received a Pap test compared with 91.7% (91.0-92.3%) of college graduates. In multivariate analysis, we also found education level to be positively associated with Pap testing rates, especially among women residing in areas where a relatively low percentage of residents had a low education level (P < 0.0001). Conclusions: Individual-level measures of SES may be modified by county-level measures of SES. Analyses of cancer screening rates by measures of income, educational attainment, and other factors may help health officials to better direct their finite resources to areas of greatest need. (Cancer Epidemiol Biomarkers Prev 2006;15(11):2154–9)

Not-so-strange bedfellows : Models of interaction between managed care plans and public health agencies

Researchers have not been able to examine cancer incidence rates in Appalachia because high‐quality data have not been uniformly available across the region. This study is the first to report cancer incidence rates for a large proportion of the Appalachian population and describe the differences in incidence rates between Northern, Central, and Southern Appalachia.

Patterns in lung cancer incidence rates and trends by histologic type in the United States, 2004-2009.

The “Southern Black Belt,” a term used for > 100 years to describe a subregion of the southern U.S., includes counties with high concentrations of African Americans and high levels of poverty and unemployment, and relatively high rates of preventable cancers.

Breast and cervical cancer screening practices among Hispanic and non-Hispanic women residing near the United States-Mexico border, 1999-2000.

Alliances between managed care plans and public health agencies are a growing phenomenon in local health care markets, with profound implications for health care quality, cost, and accessibility. A typology of interorganizational relations between managed care plans and local public health agencies is drawn from observations of over 60 public health jurisdictions. Relations are described along three dimensions corresponding to the strategic intent, functional operation, and structural design of each alliance type. The identified models of interaction reveal the motivations for forming alliances, the mechanics of their operation, and the possible outcomes. These alliances suggest that a wide range of interorganizational strategies is possible in order to pursue the shared interests of local public health agencies and managed care plans. Nonetheless, public health agencies may face challenges in forging managed care alliances that benefit community-wide populations and that are open to participation by the full spectrum of health care providers in the community.

Use of Lung Cancer Screening Tests in the United States: Results from the 2010 National Health Interview Survey

OBJECTIVE The examination of lung cancer by histology type is important for monitoring population trends that have implications for etiology and prevention, screening and clinical diagnosis, prognosis and treatment. We provide a comprehensive description of recent histologic lung cancer incidence rates and trends in the USA using combined population-based registry data for the entire nation. MATERIALS AND METHODS Histologic lung cancer incidence data was analyzed from CDCs National Program of Cancer Registries (NPCR) and the National Cancer Institutes Surveillance, Epidemiology and End Results (SEER) Program. Standardized rates and trends were calculated for men and women by age, race/ethnicity, and U.S. Census region. Rate ratios were examined for differences in rates between men and women, and annual percent change was calculated to quantify changes in incidence rates over time. RESULTS Trend analysis demonstrate that overall rates have decreased, but incidence has remained stable for women aged 50 or older. Adenocarcinoma and squamous cell carcinoma were the two most common histologic subtypes. Adenocarcinoma rates continued to increase in men and women, and squamous cell rates increased in women only. All histologic subtype rates for white women exceeded rates for black women. Histologic rates for black men exceeded those for white men, except for small cell carcinoma. The incidence rate for Hispanics was nearly half the rate for blacks and whites. CONCLUSION The continuing rise in incidence of lung adenocarcinoma, the rise of squamous cell cancer in women, and differences by age, race, ethnicity and region points to the need to better understand factors acting in addition to, or in synergy with, cigarette smoking that may be contributing to observed differences in lung cancer histology.

Evaluating local public health performance at a community level on a statewide basis.

This study examined the breast and cervical cancer screening practices of Hispanic and non-Hispanic women (n = 3,568) in counties that approximate the US southern border region. According to the Health Resources Services Administration (HRSA), border counties are those in which any part of the county is within 100 kilometers (62.14 miles) of the border. 1 The study used data from Behavioral Risk Factor Surveillance System (BRFSS) surveys of adults aged ≥ 18 years conducted in 1999 and 2000. The study looked at recent use of mammography and the Papanicolaou (Pap) test. Hispanic women were less likely to have had a recent mammogram or Pap test as compared with non-Hispanic women in border counties, and as compared with Hispanic and non-Hispanic women in nonborder counties of Texas, New Mexico, Arizona, and California combined, and with other women in the United States. Results underscore the need for continued efforts to ensure that medically underserved women who live in the border region have access to cancer screening services.