Are Benign and Borderline Brain Tumors Underreported?

BACKGROUND: Primary benign and borderline (BB) brain tumors have been reportable since 2004 by population-based cancer registries in the United States. Because these tumors often are diagnosed clinically at nonhospital settings, underreporting is a big concern. Despite this, the magnitude and geographic variations in underreporting are unknown. The objectives of this study are to assess variations in BB brain tumor incidence rate by registry and trend in comparison to malignant brain tumors, as well as to identify the factors associated with the completeness of BB brain tumor reporting. METHODS: North American Association of Central Cancer Registries (NAACCR) Cancer in North America (CINA) Deluxe 1995­2012 Analytic File, which included data from 47 US population-based cancer registries, was used. Age-adjusted incidence rate and average annual percent change (APC) were calculated. Correlation coefficients were used to assess the relationships between incidence rates and clinical factors. RESULTS: The overall age-adjusted incidence rate was 14.2 per 100,000 for BB brain tumors and 6.6 per 100,000 for malignant brain tumors. The age-adjusted incidence rates of BB brain tumors varied by registry from 9.8 per 100,000 to 19.9 per 100,000, whereas the variations in malignant brain tumors were much smaller from 4.1 per 100,000 to 7.7 per 100,000. BB brain tumor cases were more likely than malignant brain tumors to be diagnosed through radiography without microscopic confirmation or surgery. Overall, the BB brain tumor incidence rate significantly increased by 2.3% per year from 2004 to 2012. In contrast, incidence rates of malignant brain tumors significantly decreased by 0.9% per year in the same period. Higher BB brain tumor incidence rates were significantly associated with higher proportions of cases without microscopic confirmation or surgery. These associations were not observed for malignant brain tumors. CONCLUSIONS: Incidence rates of BB brain tumors varied substantially across 47 US registries and were higher than those of malignant brain tumors in the United States. The variations in incidence rate of BB brain tumors may be largely attributable to difference in identifying clinically diagnosed cases. The increasing incidence rate of BB brain tumors may reflect improved case ascertainment rather than a biological trend. Key words:

Racial and Ethnic Disparities in the Incidence and Trends of Soft Tissue Sarcoma Among Adolescents and Young Adults in the United States, 1995-2008.

PURPOSE: The aim of this study was to examine racial/ethnic disparities in the incidence rates and trends of soft tissue sarcoma (STS) by gender, age, and histological type among adolescents and young adults (AYAs) aged 15-29 years. METHODS: The 1995-2008 incidence data from 25 population-based cancer registries, covering 64% of the United States population, were obtained from the North American Association of Central Cancer Registries. The Surveillance, Epidemiology and End Results AYA site recode and International Classification of Diseases for Oncology, 3rd Edition, were adopted to categorize STS histological types and anatomic groups. Age-adjusted incidence rates and average annual percent change (AAPC) were calculated. RESULTS: The incidence of all STSs combined was 34% higher in males than females (95% CI: 1.28, 1.39), 60% higher among blacks than whites (95% CI: 1.52, 1.68), and slightly higher among Hispanics than whites. Compared with whites, blacks had significantly higher incidence of fibromatous neoplasms, and Hispanics had significantly higher incidence of liposarcoma. Whites were more likely to be diagnosed with synovial sarcoma than blacks. Black and Hispanic males had significantly higher Kaposi sarcoma incidence than white males. The AAPC of all STSs combined showed a significant decrease from 1995 to 2008 (AAPC=-2.1%; 95% CI: -3.2%, -1.0%). However, after excluding Kaposi sarcoma, there was no significant trend. CONCLUSION: The incidence rates of STS histological types in AYAs vary among racial/ethnic groups. The declining trends of STS are due mainly to decreasing incidence of Kaposi sarcoma in all races/ethnicities. Research to identify factors associated with racial/ethnic disparities in AYA STS is necessary.

Influence of socioeconomic status and hospital type on disparities of lymph node evaluation in colon cancer patients.

BACKGROUND: A minimum of 12 dissected lymph nodes (LNs) has been recommended as a consensus guideline for resections in colon cancer patients. This study assessed the influence of both socioeconomic status (SES) and hospital type on compliance with this colon LN dissection guideline and examined the time trend for ≥12 LNs dissected. METHODS: Stage I to III incident colon cancer cases diagnosed from 1996 to 2007 were obtained from the Louisiana Tumor Registry. A composite census tract-level SES score was created to serve as a surrogate for individual-level SES. Hospitals performing colon resections were categorized into 5 groups according to the Commission on Cancer Accreditation Program. Multiple logistic regression analyses were used. RESULTS: Of 10,460 colon cancer cases diagnosed during the study period, 43.9% had ≥12 LNs dissected. Patients residing in less affluent SES areas were less likely to receive a dissection of ≥12 nodes than those residing in more affluent areas. SES was no longer significant after adjusting for race, sex, age, stage, grade, anatomic subsite, diagnosis year, and hospital type. In contrast, hospital type was significantly associated with the number of LNs dissected, even after adjusting for other factors. Patients diagnosed from 2002 to 2007 were twice as likely (95% confidence interval, 1.84-2.17) to have ≥12 LNs dissected than those diagnosed from 1996 to 2001 after adjustment. CONCLUSIONS: In Louisiana, hospital type is an independent significant predictor of adequate LN evaluation for colon cancer. Training and education are needed to reduce this disparity in the facilities with consistently lower LN yield in their dissections.

Comparisons of directly coded SEER Summary Stage 2000 and Collaborative Staging Derived SEER Summary Stage 2000.

This study assessed comparability of the directly coded Summary Stage 2000 and the Collaborative Stage (CS) Derived Summary Stage 2000 (SS2000) using 2001-2004 data from 40 population-based cancer registries in the United States that met the high quality criteria. The likelihood ratio test was employed to determine whether stage differences between 2003 (pre-CS) and 2004 (CS) were attributable to 2001-2004 linear trends, decreases in percentage of unknown stage cases, or both. Statistically significant differences in stage distribution between 2003 and 2004 were observed for 30 out of the 34 cancer sites. For 4 cancer sites, the differences were attributable to 2001-2004 linear trends of stage distribution. For 8 cancer sites, the differences were attributable to decreases in percentage of unknown stage cases alone or in combination with the temporal trends of stage distribution. For the remaining 18 cancer sites, either (1) no linear trends of stage distribution were identified or (2) the combination of the decline in cases with unknown stage plus linear trends did not explain the stage differences between 2003 and 2004. By comparing the SS2000 and CS manuals, we found differences in coding definitions for direct extension and/or lymph node involvement for all cancer sites except cancers of the breast, cervix, and cranial nervous and other nervous system. Evidence showed that the stage differences between 2003 and 2004 may be attributable in part to the implementation of the CS System for some cancer sites.

Incidence of esophageal and gastric cancers among Hispanics, non-Hispanic whites and non-Hispanic blacks in the United States: subsite and histology differences.

OBJECTIVE: We examined subsite- and histology-specific esophageal and gastric cancer incidence patterns among Hispanics/Latinos and compared them with non-Hispanic whites and non-Hispanic blacks. METHODS: Data on newly diagnosed esophageal and gastric cancers for 1998-2002 were obtained from 37 population-based central cancer registries, representing 66% of the Hispanic population in the United States. Age-adjusted incidence rates (2000 US) were computed by race/ethnicity, sex, anatomic subsite, and histology. The differences in incidence rates between Hispanics and non-Hispanics were examined using the two-tailed z-statistic. RESULTS: Squamous cell carcinoma accounted for 50% and 57% of esophageal cancers among Hispanic men and women, respectively, while adenocarcinoma accounted for 43% among Hispanic men and 35% among Hispanic women. The incidence rate of squamous cell carcinoma was 48% higher among Hispanic men (2.94 per 100,000) than non-Hispanic white men (1.99 per 100,000) but about 70% lower among Hispanics than non-Hispanic blacks, for both men and women. In contrast, the incidence rates of esophageal adenocarcinoma were lower among Hispanics than non-Hispanic whites (58% lower for men and 33% for women) but higher than non-Hispanic blacks (70% higher for men and 64% for women). Cardia adenocarcinoma accounted for 10-15% of gastric cancers among Hispanics, and the incidence rate among Hispanic men (2.42 per 100,000) was 33% lower than the rate of non-Hispanic white men (3.62 per 100,000) but 37% higher than that of non-Hispanic black men. The rate among Hispanic women (0.86 per 100,000), however, was 20% higher than that of non-Hispanic white women (0.72 per 100,000) and 51% higher than for non-Hispanic black women. Gastric non-cardia cancer accounted for approximately 50% of gastric cancers among Hispanics (8.32 per 100,000 for men and 4.90 per 100,000 for women), and the rates were almost two times higher than for non-Hispanic whites (2.95 per 100,000 for men and 1.72 per 100,000 for women) but about the same as the non-Hispanic blacks. CONCLUSION: Subsite- and histology-specific incidence rates of esophageal and gastric cancers among Hispanics/Latinos differ from non-Hispanics. The incidence rates of gastric non-cardia cancer are almost two times higher among Hispanics than non-Hispanic whites, both men and women. The rates of gastric cardia cancer are lower among Hispanics than non-Hispanic whites for men but higher for women. The rates of esophageal and gastric cardia adenocarcinomas are higher among Hispanics than non-Hispanic blacks.

Initial treatment patterns for clinically localized prostate cancer and factors associated with the treatment in Louisiana.

This study investigated treatment patterns among Louisiana residents diagnosed with clinically localized prostate cancer in 2001 and factors that may be associated with the treatment. The differences in the initial treatment between 1997 and 2001 were also examined. The data were collected from hospital medical records, supplemented by information from freestanding radiation centers and physicians' offices. We assessed the associations of initial treatment with demographic factors such as age, race, health insurance status, type of healthcare facility, area of residence, county poverty, and clinical factors such as Gleason score, PSA, and comorbidity in univariate and logistic multivariate regression analyses. Our study found that patients clinically diagnosed with localized prostate cancer in 2001 received the following treatments: radical prostatectomy (41.4%), radiation (29.7%), hormone (16.2%), or watchful waiting (11.9%). White patients, older patients, patients with private insurance and patients diagnosed or treated in hospitals were more likely (p < 0.05) to receive aggressive therapy (i.e., radical prostatectomy or radiation) than others after controlling for the demographic and clinical factors. Poverty level and comorbidity were inversely associated with receiving aggressive therapy in univariate analysis. But after adjusting for other factors, these associations were no longer statistically significant. Patients with elevated PSA and high Gleason scores were less likely to receive radical prostatectomy even after the adjustment. From 1997 to 2001, utilization of radiation and hormonal therapies increased, and watchful waiting decreased among newly diagnosed prostate cancer patients. Utilization of radical prostatectomy showed no significant change over time.

Treatment patterns for stage III colon cancer and factors related to receipt of postoperative chemotherapy in Louisiana.

This study examined treatment patterns among Louisiana residents diagnosed with stage III colon cancer in 2001 and factors that may be related to the receipt of chemotherapy. The data were collected from hospital medical records, supplemented by information from physician offices. We examined the association of chemotherapy with race (whites and blacks), gender, health insurance status (private versus public/none), hospital type (hospitals with a cancer program approved by the Commission on Cancer of the American College of Surgeons [COC hospital] versus other hospitals [non-COC hospital]), comorbidity, area of residence (rural versus urban), and level of poverty of the area (high poverty versus low poverty) in univariate analyses and logistic multivariate regression models. Our study found that all patients received cancer-directed surgery, and 66% received postoperative chemotherapy. The percentages of patients receiving chemotherapy were similar among race/gender groups. Patient age and hospital type were significantly associated with the receipt of chemotherapy even adjusting for other factors studied. The percentage of patients who received chemotherapy decreased with advancing age, and patients who were diagnosed at COC hospitals had a higher likelihood of receiving chemotherapy than their counterparts diagnosed at non-COC hospitals. Poverty and comorbidity were inversely associated (statistically significant) with the receipt of chemotherapy in univariate analysis. After adjusting for other factors, these associations were no longer significant. Although patients with private insurance were more likely to have chemotherapy than those with public insurance or no insurance, the difference was not significant. No difference was found in the receipt of chemotherapy between rural and urban patients.

Patterns of treatment for ductal carcinoma in situ of the breast in Louisiana, 1988-1999.

Data from numerous studies show that lumpectomy (breast-conserving therapy) plus radiation therapy provides survival equivalent to that following mastectomy (either modified radical or radical mastectomy) for patients with ductal carcinoma in situ (DCIS). According to the data from the National Cancer Data Base and the Surveillance Epidemiology End Results (SEER) Program, use of lumpectomy among female DCIS patients has increased dramatically over the last decade. This study examined population-based trends in treatment for DCIS among Louisiana women and compared the trends with the SEER data. Our data revealed that the percentage of the DCIS patients who received a lumpectomy increased from 34.3% in 1988-1991 to 53.7% in 1996-1999 in Louisiana (p<0.05) while DCIS patients who received a modified radical mastectomy decreased from 51.7% to 26.1% (p<0.05). Increasing use of lumpectomy was seen across all races, age groups, rural/urban areas, and poverty-level areas. Utilization of lumpectomy was about the same for white and African-American women but varied by age group, rural/urban area, and poverty level. Female DCIS patients residing in rural areas or high poverty level areas were less likely to receive a lumpectomy than those residing in urban or affluent areas. Among the patients who had a lumpectomy, 34.4% received post-lumpectomy radiotherapy in the first study period (1988-1991) and 49.7% in the last study period (1996-1999). In Louisiana, utilization of post-lumpectomy radiotherapy decreased with advancing age. Despite the increase in use of lumpectomy, its utilization remained approximately 10% lower than in the SEER areas throughout the study period. A similar deficit was observed for post-lumpectomy radiation therapy.

Childhood cancer in Louisiana 1988-1996.

Utilizing data from the Louisiana Tumor Registry, cancer incidence among children younger than 15 years of age is presented by major cancer type, according to the primarily histology-based International Classification of Childhood Cancer scheme. Cases include those diagnosed and/or treated at any hospitals and medical facilities in Louisiana, St. Jude Children's Research Hospital in Memphis, M.D. Anderson in Houston, and from neighboring states. Rates were age-adjusted, presented as rates per million, and were compared to the combined rates of the Surveillance, Epidemiology, and End Results (SEER) Program. The significance of rate differences were assessed at 0.05 level. From 1988-1996, about 125 children were diagnosed with cancer each year. In general, rates are higher in younger than older children, males than females, and white children than African-American children. The five most common childhood cancers are: leukemias (28% of total cases), central nervous system malignancies (22%), lymphomas (13%), renal tumors (8.4%), and soft tissue sarcomas (7.6%). Major findings of these cancers and their associated risk factors are presented.