Incidence and survival patterns of rare anal canal neoplasms using the surveillance epidemiology and end results registry.

Small cell, neuroendocrine tumors, and melanoma of the anus are rare. Limited data exist on the incidence and management for these rare tumors. A large, prospective, population-based database was used to determine incidence and survival patterns of rare anal neoplasms. The Surveillance, Epidemiology and End Results registry was queried to identify patients diagnosed with anal canal neoplasms. Incidence and survival patterns were evaluated with respect to age, sex, race, histology, stage, and therapy. We identified 7078 cases of anal canal neoplasms: melanoma (n = 149), neuroendocrine (n = 61), and small cell neuroendocrine (n = 26). Squamous cell carcinoma (SCC) (n = 6842) served as the comparison group. Anal melanoma (AM) demonstrated the lowest survival rate at 2.5 per cent. Neuroendocrine tumors (NETs) demonstrated similar survival as SCC (10-year survival for regional disease of 25 and 22.3%, respectively). Ten-year survival of small cell NETs resembled AM (5.3 vs 2.5%). Age 60 years or older, sex, black race, stage, and surgery were independent predictors of survival. This study presents the largest patient series of rare anal neoplasms. NETs of the anal canal demonstrate similar survival patterns to SCC, whereas small cell NETs more closely resemble AM. Accurate histologic diagnosis is vital to determine treatment and surgical management because survival patterns can differ among rare anal neoplasms.

Understanding the limits of large datasets.

Many health professionals use large datasets to answer behavioral, translational, or clinical questions. Understanding the impact of missing data in large databases, such as disease registries, can avoid erroneous interpretations of these data. Using the California Cancer Registry, the authors selected seven common cancers, seven sociodemographic and clinical variables, and the top three reporting sources, as examples of the type of data that would be deemed critical to most studies. The gender variable had no missing data, followed by age (<0.1 % missing), ethnicity (1.7 %), stage (9.8 %), differentiation (39.1 %), and birthplace (41.1 %). Reports from hospitals and clinics had the lowest percentages of missing data. Users of large datasets should anticipate the limitations of missing data to prevent methodological flaws and misinterpretations of research findings. Knowledge of what and how much data may be missing in large datasets can help prevent errors in research conclusions, while better guiding treatment modalities and public health policies and programs.

Penile Kaposis sarcoma in the state of California.

INTRODUCTION: Penile Kaposi's sarcoma (PKS) is a rare and poorly characterized disease. Kaposi's sarcoma is common in HIV disease and is an AIDS-defining illness. This study aimed to review epidemiologic characteristics and changes in the incidence of PKS using a total population-based database. MATERIALS AND METHODS: Data from the California Cancer Registry (CCR) were reviewed for the years 1988-2004, identifying all cases of penile cancer. Tumors were classified by histology and stage. Annual age-adjusted incidence and actuarial survival rates were calculated for the overall population and subdivided histology. RESULTS: From 1988-2004, 2870 cases of penile cancer were identified. Squamous cell carcinoma accounted for 87% of all penile cancer (n = 2507), and PKS was the second most common, accounting for 4.6% (n = 132). Patients diagnosed with PKS demonstrated a significantly lower mean age (years) than the overall cohort (43.7 versus 62.6, p < .0001). The incidence of PKS peaked in 1992 with a subsequent dramatic decline, the same year as incident AIDS cases. The percentage of all penile cancer comprised by PKS dropped from 7.4% in the 1988-1995 cohort to 1.7% in the 1995-2004 cohort (p < 0.0001). Patients diagnosed with PKS demonstrated a significantly lower 5 (32.8% versus 76.6%, p < .0001) and 10 year (29.5% versus 69.6%, p < .0001) relative overall survival than those with squamous cell carcinoma. CONCLUSION: PKS is the second most frequent malignancy of the penis, occurring at a younger age and portending a worse prognosis than other forms of penile cancer. The proportion of PKS tumors has declined in recent years, reflecting improvements in HIV treatment that occurred during the study period.

Adenoid cystic breast carcinoma: is axillary staging necessary in all cases? Results from the California Cancer Registry.

Adenoid cystic carcinoma (ACC) is an uncommon type of breast cancer. There are limited data about its epidemiology, tumor characteristics, and outcomes. Using a large, population-based data base, this study aimed to identify specific characteristics of patients with adenoid cystic breast cancer, investigate its natural history, and determine its long-term prognosis. The California Cancer Registry, a population-based registry, was reviewed from the years 1988 to 2006. The data were analyzed with relation to patient age, tumor size and stage, and overall survival. Relative cumulative actuarial survival was determined using the Berkson-Gage life table method. A total of 244 cases of invasive adenoid cystic cancer were identified in women during this time period. The patients' median age was 61.9 years. Most cases were diagnosed in non-Hispanic White women (82%, n = 200), followed by African American (6%, n = 15), Asian/Pacific-Islander (5.7%, n = 14) and Hispanic women (4.4%, n = 12). The remainder of the patients was of unknown or other ethnicity. Tumors were between 1 and 140 mm in size. At the time of diagnosis, 92% (n = 225) of patients had localized disease, 5% (n = 12) of patients had regional disease, and even fewer (n = 7) had either distant or unknown staged disease. Lymph node involvement was not present in any tumors smaller than 1.4 cm. The relative cumulative survival of patients with adenoid cystic breast carcinoma was 95.6% at 5 years and 94.9% at 10 years. ACC of the breast is a rare disease with an overall good prognosis. Knowing that this cancer usually presents as localized disease, with lymph node involvement seen only with larger tumors, can help clinicians plan the operative management of these tumors.

Prostate cancer postoperative nomogram scores and obesity.

PURPOSE: Nomograms are tools used in clinical practice to predict cancer outcomes and to help make decisions regarding management of disease. Since its conception, utility of the prostate cancer nomogram has more than tripled. Limited information is available on the relation between the nomograms' predicted probabilities and obesity. The purpose of this study was to examine whether the predictions from a validated postoperative prostate cancer nomogram were associated with obesity. METHODS: We carried out a cross-sectional analysis of 1220 patients who underwent radical prostatectomy (RP) in southern California from 2000 to 2008. Progression-free probabilities (PFPs) were ascertained from the 10-year Kattan postoperative nomogram. Multivariable logistic regression models estimated odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: In the present study, aggressive prostate cancer (Gleason ≥7), but not advanced stage, was associated with obesity (p = 0.01). After adjusting for age, black race, family history of prostate cancer and current smoking, an inverse association was observed for 10-year progression-free predictions (OR = 0.50; 95% CI = 0.28-0.90) and positive associations were observed for preoperative PSA levels (OR = 1.23; 95% CI = 1.01-1.50) and Gleason >7 (OR = 1.45; 95% CI = 1.11-1.90). CONCLUSION: Obese RP patients were more likely to have lower PFP values than non-obese patients, suggesting a higher risk of experiencing prostate cancer progression. Identifying men with potentially higher risks due to obesity may improve disease prognosis and treatment decision-making.

Racial/ethnic differences in early detection of breast cancer: a study of 250,985 cases from the California Cancer Registry.

AIMS: This study analyzed early breast cancer detection rates as a surrogate for breast cancer mortality rates. Stage at diagnosis was broken down by race/ethnicity and year of diagnosis for the cases of female breast cancer in the California Cancer Registry from 1988 to 2002. METHODS: A quarter million cases of breast cancer in women > or =50 years of age recorded in the California Cancer Registry over the period 1988-2002 were classified as early (in situ and localized stages) or late (regional and distant stages). The increases in the percent of cases that were early were studied by 3-year periods over this interval. In addition to the total group, data were broken down by race/ethnicity. The 3-year periods were used to compensate for small numbers of cases in some of the nonwhite groups. RESULTS: The proportion of early stage female breast cancers reached a plateau at 70% in the mid-1990s. African American and Hispanic women's screening rates reached a plateau at a considerably lower rate. Only Pacific Islander/Asian American women demonstrated a sustained rise in the percent of early breast cancers detected through 2002, eventually nearing the rate of early detection set by white women. CONCLUSIONS: The plateaus observed suggest that focused interventions continue to be needed for all women, especially for African American and Hispanic women if the American Cancer Society's 2015 goals are to be achieved.

Squamous cell carcinoma of the breast: a review of 177 cases.

Squamous cell carcinoma (SCC) of the breast is an uncommon breast neoplasm. There are limited data about its epidemiology and few studies focusing on outcomes. This study aims to identify specific characteristics of patients with breast SCC, investigate its natural history, and determine its long-term prognosis. One hundred and seventy-seven cases of SCC of the breast were identified in the California Cancer Registry from the years 1988 to 2006. At the time of diagnosis, 53 per cent of patients had localized disease, 32 per cent of patients had regional lymph node or locally advanced disease, and 8 per cent of patients had distant disease. The relative cumulative survival of patients was 68.1 per cent at 5 years and 60.2 per cent at 10 years. This is significantly worse than the relative cumulative survival of patients with all other invasive breast tumors during the same time period. Squamous cell carcinoma of the breast is a rare and aggressive disease, and it has significantly worse prognosis than other nonsquamous cell tumors of the breast. Clinicians should be aware of the aggressive nature of the tumor when counseling patients.

Renal tumors in the second decade of life: results from the California Cancer Registry.

BACKGROUND: Renal tumors are rare in adolescents and young adults. The aim of this study was to characterize the histologic condition, epidemiology, and survival of renal tumors in patients aged 11 to 20 years old using a large, population-based database. METHODS: The California Cancer Registry was reviewed from the years 1988 to 2004. All renal tumors in patients aged 11 to 20 years old were identified. The data were analyzed with relation to patient age, sex and ethnicity, tumor histologic examination, and actuarial mortality rates. RESULTS: Seventy-seven primary renal malignancies were identified. Thirty-nine (51%) were renal cell carcinoma, 23 (30%) were Wilms' tumor, and 15 (20%) were other tumor types. The mean age of the patients with renal cell carcinoma was 16.7 years old, which was significantly older than the Wilms' tumor patients (13.9 years; P < .01). The 5-year cumulative survival rate of patients with renal cell carcinoma was 54%, which was worse than that of Wilms' tumor patients (77%). CONCLUSION: Primary renal malignancies are uncommon in the second decade of life. The most common tumor type in this age-group is renal cell carcinoma followed by Wilms' tumor. Patients with renal cell carcinoma tend to be older and have a lower survival than patients with other kidney tumors.

Renal cell carcinoma in the pediatric population: Results from the California Cancer Registry.

BACKGROUND: Renal cell carcinoma (RCC) is a rare disease in children and adolescents. This study aimed to review epidemiologic characteristics and survival for pediatric RCC patients using a large, population-based database. PROCEDURE: The California Cancer Registry (CCR) was reviewed from 1988 to 2004. All cases of RCC in patients younger than 21 years were identified and annual age-adjusted incidence rates were determined for the overall population and subdivided by ethnicity. Tumors were classified by stage and grade, and actuarial mortality rates were calculated. RESULTS: From 1988 to 2004, 43 cases of RCC were identified in patients younger than 21 years, accounting for 4.3% of all renal tumors in this age group. The overall annual age-adjusted incidence was 0.01/100,000 with the tumor more common in non-Hispanic blacks (0.03/100,000) compared to non-Hispanic whites (0.01/100,000), Hispanics (<0.01/100,000), and non-Hispanic Asians/Pacific Islanders (<0.01/100,000). The mean age at presentation was 15.4 years (SD 4.03, SE 0.615). RCC was identified more frequently in females (58.14%). At the time of presentation, 53.49% of tumors were localized, 20.93% were regionally advanced, and 25.58% were metastatic. The observed actuarial survival at 5 and 10 years was 61% (+/-15.7%). CONCLUSION: Pediatric RCC is an uncommon and aggressive tumor that occurs most frequently in children in the second decade of life, more often in females and blacks. The epidemiological characteristics of this tumor differ from adult RCC and Wilms tumor, suggesting its distinctive biology and potential need for alternative treatment strategies.

Racial/ethnic and gender disparities in renal cell carcinoma incidence and survival.

PURPOSE: We used a population based cancer registry to examine trends in renal cell carcinoma incidence and survival among 4 racial/ethnic groups (white, black, Hispanic and Asian/Pacific Islander) and both genders. MATERIALS AND METHODS: Race/ethnicity, gender, age, staging, length of survival and cause of death data were analyzed using 39,434 cases of renal cell carcinoma from 1988 to 2004 from the California Cancer Registry. Annual age adjusted incidence rates and relative survival rates were calculated for the racial/ethnic and gender groups. These rates and the percent of localized cancer were plotted by year, and Microsoft Excel was used to calculate linear regression equations. Median age was also calculated. Z-tests and chi-square tests were performed to determine p values. RESULTS: An increase in renal cell carcinoma incidence was found with localized cancer accounting for most of the increase. Black patients had a significantly higher incidence rate (p <0.0001) and lower survival rate (p <0.0001) than all other races/ethnicities despite having more localized cancer (p <0.005). Black patients were also diagnosed at a younger age (p <0.0001) than their counterparts. On the other hand Asian/Pacific Islanders had a lower incidence rate (p <0.0001) and higher survival rate (p <0.05) than all other races/ethnicities. Males had approximately twice the incidence rate of females and a lower survival rate (p <0.005). CONCLUSIONS: Higher incidence rates and lower survival rates were identified among black and male patients compared to their counterparts, while Asian/Pacific Islanders showed the opposite trends. Such racial/ethnic and gender disparities in renal cell carcinoma incidence and survival may help elucidate biological, behavioral and environmental factors that can potentially be addressed.

Late age (85 years or older) peak incidence of bladder cancer.

PURPOSE: We examined the incidence rates of bladder cancer using California Cancer Registry data to determine if any trends exist. MATERIALS AND METHODS: Complete records of the 55,159 cases of invasive bladder cancer were examined from the original 92,677 bladder cancer cases recorded in the California Cancer Registry between 1988 and 2004. RESULTS: California Cancer Registry data showed a universal late age peak in age specific incidence of bladder cancer in men and women, and across ethnic boundaries. The rate of annual increase in the percent of bladder cancer in individuals 85 years or older was increasing about 10 times as rapidly as the percent of the population that was 85 years or older (slope = 0.395 vs 0.0336). Furthermore, during all 17 years the proportion of patients 85 or older with bladder cancer was about twice that of patients with other cancers regardless of gender. CONCLUSIONS: California Cancer Registry data illustrate a peak in the incidence of bladder cancer in individuals 85 years or older. However, to our knowledge there is no known explanation for this late peak in bladder cancer. With the rate of bladder cancer in the population 85 years or older increasing at a rapid pace, it is critical to encourage investigators to include this age group as they continue to search for causative factors and genetic contributors to bladder cancer as well as effective treatments.

A comparison of merkel cell carcinoma and melanoma: results from the california cancer registry.

INTRODUCTION: Melanoma and Merkel cell carcinoma (MCC) are both aggressive skin malignancies associated with immunosuppression and possible UV exposure. Both tumors get similar surgical treatment; however, MCC is a relatively rare tumor in which less is known about prognosis and clinical behavior. METHODS: The California Cancer Registry (CCR), a population-based registry, was reviewed from the years 1988-2003. Merkel cell carcinoma and melanoma were compared with relation to gender, age, ethnicity, disease stage, site, and survival. RESULTS: A total of 113,187 cases of melanoma and 1,878 cases of MCC were identified in the CCR. Though both cancers are more common in men than in women, MCC had a higher incidence in men than melanoma (63% vs 57% p < 0.005). MCC occurs in the more elderly, with 73.6% of cases occurring in people over 70 years. In contrast, 69% of melanoma cases occurred in people younger than 70 years (p < 0.005). MCC shows a predilection for the head and neck compared to melanoma (47% vs 25.8%) Additionally, melanoma occurs more frequently on the trunk than MCC (30% vs 8.7%). Finally, the 10-year cumulative survival is lower for MCC than for melanoma (17.7% vs 61.3%, p < 0.005). CONCLUSION: Many clinicians assume MCC and melanoma behave similarly. However, MCC occurs in an older population, more frequently on the head and neck, in a higher percentage of men. Additionally, MCC has a higher rate of regional metastasis and thus may have more of a benefit from regional staging procedures. Overall, MCC has a worse prognosis.

Age and time as factors in the left-to-right shift of the subsite of colorectal adenocarcinoma: a study of 213,383 cases from the California Cancer Registry.

GOALS: Using a data set of more than 200,000 cases, we can measure the effects of age, time, sex, and race/ethnicity on the shift of the site of origin of colorectal adenocarcinoma from the left to the right side. BACKGROUND: As people become older, there is a shift of the site of origin of adenocarcinoma of the colorectum from the left to the right side. Although some studies do show some relationship of this shift, in addition to age, to race/ethnicity and to sex, there are no large, total population-based data studying the effects of these factors and time trends in this shift. STUDY: 213,383 cases of adenocarcinoma of the colorectum for the years 1988 to 2003 from the California Cancer Registry have been studied. RESULTS: The left-to-right shift increases significantly with increasing age and year of diagnosis, and is greater in women than in men and is greater in whites than in other racial/ethnic groups. The time-related shift is a reflection of a lesser decrease in the incidence of colorectal adenocarcinoma on the right side than on the left. CONCLUSIONS: The most attractive hypothesis is that a greater likelihood of prior polypectomy, and thus prevention of more cancers, occurs on the left side than on the right.

Early cancer detection among rural and urban Californians.

BACKGROUND: Since the stage of cancer detection generally predicts future mortality rates, a key cancer control strategy is to increase the proportion of cancers found in the early stage. This study compared stage of detection for members of rural and urban communities to determine whether disparities were present. METHODS: The California Cancer Registry (CCR), a total population based cancer registry, was used to examine the proportion of early stage presentation for patients with breast, melanoma, and colon cancer from 1988 to 2003. Cancer stage at time of detection for these cancers was compared for rural and urban areas. RESULTS: In patients with breast cancer, there were significantly more patients presenting at early stage in 2003 compared to 1988, but no difference in the percentage of patients presenting with early stage disease between rural and urban dwellers. There were no differences in incidence in early stage cancer incidence between these groups for melanoma patients, as well. In colorectal cancer in 1988, significantly more patients presented with early stage disease in the urban areas (42% vs 34%, p < 0.02). However, over time the rural patients were diagnosed with early stage disease with the same frequency in 2003 as 1988. CONCLUSION: This analysis demonstrates that people in rural and urban areas have their breast, melanoma or colorectal cancers diagnosed at similar stages. Health care administrators may take this information into account in future strategic planning.

Reduced mammographic screening may explain declines in breast carcinoma in older women.

OBJECTIVES: To examine whether declines in breast cancer in the oldest-old women correspond with declines in the use of cancer testing. DESIGN: Cross-sectional evaluation of three databases. SETTING: Public access data. PARTICIPANTS: Cases recorded in the California Registry and the Surveillance, Epidemiology, and End Results Program between 1988 and 1997. The study also included respondents to the 2002 Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System. MEASUREMENTS: Cancer incidence and self-reported mammography within the previous 2 years. RESULTS: Most previous analyses have combined all individuals aged 75, 80, or 85 and older. Creating separate categories for age ranges 85 to 89, 90 to 94, 95 to 99, and 100 and older suggests different incidence patterns for a variety of cancers, including mammary carcinoma in situ (CIS). Between the ages of 40 and 74, there is a significant rise in CIS. Beginning at age 75, there is a significant decline in CIS through the highest age categories. The use of mammographic screening increases between the ages of 40 and 60. Beginning at age 75, there is a significant decline in the use of mammography that parallels the decline in incident cases of CIS. CONCLUSION: There may be a substantial reservoir of undiagnosed CIS in the population. Surveillance bias might explain the decreasing incidence of CIS with advancing age in the oldest age groups. Autopsy studies are needed to estimate the true prevalence of CIS in older women.

A half century of breast cancer: one life's experience.

Over the past 50 years, great changes had occurred in the circumstances surrounding breast cancer, including clinical presentation, treatment, and outcome. Not only are patients being seen at lower stages, but over the past ten years there finally has been a drop in the mortality rate from the almost flat line from 1940 to 1990. The author has been involved personally in this half century of change, both as a participant and as an observer.

5- and 10-year survival in cancer patients aged 90 and older: a study of 37,318 patients from SEER.

BACKGROUND AND OBJECTIVES: Uncertainty exists about the value of cancer therapy in patients aged 90 years and older. Because of the relative paucity of these patients, as well as the possibility of selection bias in any one institution, the use of a large, total population-based cancer registry was employed. METHODS: The Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute (NCI) offers a large, total population-based cancer registry. It includes more than 2,000,000 cases in the nine registry data from 1973 to 1998; 37,318 of these are 90 or older and are eligible for follow-up studies. A cross-sectional study of relative survival of all these cases, along with younger age groups for comparison, was carried out. RESULTS: After the first year after diagnosis, the annual relative survival is not affected by a patient's age for up to 10 years. CONCLUSIONS: Age alone is not a contraindication to cancer treatment in the most elderly and, other than in the first year, one can expect the same relative survival in these oldest patients as one does for younger patients.