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Lung-cancer incidence has been decreasing in part because of a decrease in smoking. However, the decline in population-based mortality from non–small-cell lung cancer has been greater than can be accounted for by cancer screening and a decrease in cancer incidence. Evidence indicates that advances in treatment account for the acceleration in decreased mortality.

Background Area-level measures are often used to approximate socioeconomic status (SES) when individual-level data are not available. However, no national studies have examined the validity of these measures in approximating individual-level SES. Methods Data came from ~ 3,471,000 participants in the Mortality Disparities in American Communities study, which links data from 2008 American Community Survey to National Death Index (through 2015). We calculated correlations, specificity, sensitivity, and odds ratios to summarize the concordance between individual-, census tract-, and county-level SES indicators (e.g., household income, college degree, unemployment). We estimated the association between each SES measure and mortality to illustrate the implications of misclassification for estimates of the SES-mortality association. Results Participants with high individual-level SES were more likely than other participants to live in high-SES areas. For example, individuals with high household incomes were more likely to live in census tracts ( r = 0.232; odds ratio [OR] = 2.284) or counties ( r = 0.157; OR = 1.325) whose median household income was above the US median. Across indicators, mortality was higher among low-SES groups (all p < .0001). Compared to county-level, census tract-level measures more closely approximated individual-level associations with mortality. Conclusions Moderate agreement emerged among binary indicators of SES across individual, census tract, and county levels, with increased precision for census tract compared to county measures when approximating individual-level values. When area level measures were used as proxies for individual SES, the SES-mortality associations were systematically underestimated. Studies using area-level SES proxies should use caution when selecting, analyzing, and interpreting associations with health outcomes.

Purpose: The lack of individual socioeconomic status (SES) information in cancer registry data necessitates the use of area-based measures to investigate health disparities. Concerns about confidentiality, however, prohibit publishing patients' residential locations at the subcounty level. We developed a census tract-based composite SES index to be released in place of individual census tracts to minimize the risk of disclosure. Methods: Two SES indices based on the measures identified in the literature were constructed using factor analysis. The analyses were repeated using the data from the 2000 decennial census and 2005–2009 American Community Survey to create the indices at two time points, which were linked to 2000–2009 Surveillance, Epidemiology, and End Results registry data to estimate incidence and survival rates. Results: The two indices performed similarly in stratifying census tracts and detecting socioeconomic gradients in cancer incidence and survival. The gradient in the incidence is positive for breast and prostate, and negative for lung cancers, in all races, although the level varies. The positive gradient in survival is more salient for regionalstaged breast, colorectal, and lung cancers. Conclusions: The census tract-based SES index provides a valuable tool for monitoring the disparities in cancer burdens while avoiding potential identity disclosure. This index, divided into tertiles and quintiles, is now available to the researchers on request.

Purpose Health-related quality of life (HRQOL) among older cancer survivors can be impaired by factors such as treatment, comorbidities, and social challenges. These HRQOL impairments may be especially pronounced in rural areas, where older adults have higher cancer burden and more comorbidities and risk factors for poor health. This study aimed to assess rural–urban differences in HRQOL for older cancer survivors and controls. Methods Data came from Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey (SEER-MHOS), which links cancer incidence from 18 U.S. population-based cancer registries to survey data for Medicare Advantage Organization enrollees (1998–2014). HRQOL measures were 8 standardized subscales and 2 global summary measures. We matched (2:1) controls to breast, colorectal, lung, and prostate cancer survivors, creating an analytic dataset of 271,640 participants (ages 65+). HRQOL measures were analyzed with linear regression models including multiplicative interaction terms (rurality by cancer status), controlling for sociodemographics, cohort, and multimorbidities. Results HRQOL scores were higher in urban than rural areas (e.g., global physical component summary score for breast cancer survivors: urban mean = 38.7, standard error [ SE ] = 0.08; rural mean = 37.9, SE  = 0.32; p  < 0.05), and were generally lower among cancer survivors compared to controls. Rural cancer survivors had particularly poor vitality (colorectal: p  = 0.05), social functioning (lung: p  = 0.05), role limitation-physical (prostate: p  < 0.01), role limitation-emotional (prostate: p  < 0.01), and global mental component summary (prostate: p  = 0.02). Conclusion Supportive interventions are needed to increase physical, social, and emotional HRQOL among older cancer survivors in rural areas. These interventions could target cancer-related stigma (particularly for lung and prostate cancers) and/or access to screening, treatment, and ancillary healthcare resources.

Analysis of data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registries shows that the age-adjusted incidence of breast cancer in the United States fell sharply by 6.7% in 2003, as compared with the rate in 2002. The decrease began in mid-2002 and had begun to level off by mid-2003. The authors attribute the decline to a sharp drop in the use of postmenopausal hormone-replacement therapy. The age-adjusted incidence of breast cancer in the United States fell sharply by 6.7% in 2003. The authors attribute the decline to a sharp drop in the use of postmenopausal hormone-replacement therapy. Major changes in cancer incidence and death rates, as detected in cancer-registry data, provide unique opportunities to examine questions related to the cause, prevention, detection, and treatment of cancer. In a preliminary report, we suggested that such a major change in breast-cancer incidence occurred in 2003 in the United States. 1 In contrast, the 1990s saw an increase in the annual age-adjusted incidence of breast cancer by an average of about 0.5% per year, a rise that was particularly evident among women who were 50 years of age or older 2 (Figure 1). Changes in reproductive factors, in the use of menopausal . . .

Seven statistical models were independently developed to investigate the reasons for the reduction in the rate of death from breast cancer from 1975 to 2000. All models led to the conclusion that both mammographic screening and adjuvant treatment have contributed to the decrease in mortality. Seven statistical models led to the conclusion that both mammographic screening and adjuvant treatment have contributed to the reduction in the rate of death from breast cancer from 1975 to 2000. The Cancer Intervention and Surveillance Modeling Network (CISNET) is a consortium of investigators sponsored by the National Cancer Institute whose purpose is to measure the effect of cancer-control interventions on the incidence of and risk of death from cancer in the general population. This report of the CISNET Breast Cancer Working Group provides estimates of the contributions of screening mammography and adjuvant treatment to the reduction in the rate of death from breast cancer among U.S. women from 1975 to 2000. In 1975, the rate of death from breast cancer among women 30 to 79 years of age, adjusted for . . .

Purpose This analysis describes the impact of hysterectomy on incidence rates and trends in endometrioid endometrial cancer in the United States among women of reproductive age. Methods Hysterectomy prevalence for states containing Surveillance, Epidemiology, and End Results (SEER) registry was estimated using data from the Behavioral Risk Factor Surveillance System (BRFSS) between 1992 and 2010. The population was adjusted for age, race, and calendar year strata. Age-adjusted incidence rates and trends of endometrial cancer among women age 20–49 corrected for hysterectomy were estimated. Results Hysterectomy prevalence varied by age, race, and ethnicity. Increasing incidence trends were observed, and were attenuated after correcting for hysterectomy. Among all women, the incidence was increasing 1.6% annually (95% CI 0.9, 2.3) and this increase was no longer significant after correction for hysterectomy (+ 0.7; 95% CI − 0.1, 1.5). Stage at diagnosis was similar with and without correction for hysterectomy. The largest increase in incidence over time was among Hispanic women; even after correction for hysterectomy, incidence was increasing (1.8%; 95% CI 0.2, 3.4) annually. Conclusion Overall, endometrioid endometrial cancer incidence rates in the US remain stable among women of reproductive age. Routine reporting of endometrial cancer incidence does not accurately measure incidence among racial and ethnic minorities.

Diabetes prevalence and racial health disparities in the diabetic population are increasing in the US. Population‐based cancer‐specific survival estimates for cancer patients with diabetes have not been assessed. The Surveillance, Epidemiology, and End Results (SEER)‐Medicare linkage provided data on cancer‐specific deaths and diabetes prevalence among 14 separate cohorts representing 1 068 098 cancer patients ages 66 +  years diagnosed between 2000 and 2011 in 17 SEER areas. Cancer‐specific survival estimates were calculated by diabetes status adjusted by age, stage, comorbidities, and cancer treatment, and stratified by cancer site and sex with whites without diabetes as the reference group. Black patients had the highest diabetes prevalence particularly among women. Risks of cancer deaths were increased across most cancer sites for patients with diabetes regardless of race. Among men the largest effect of having diabetes on cancer‐specific deaths were observed for black men diagnosed with Non‐Hodgkin lymphoma (NHL) (HR = 1.53, 95%CI = 1.33‐1.76) and prostate cancer (HR = 1.37, 95%CI = 1.32‐1.42). Diabetes prevalence was higher for black females compared to white females across all 14 cancer sites and higher for most sites when compared to white and black males. Among women the largest effect of having diabetes on cancer‐specific deaths were observed for black women diagnosed with corpus/uterus cancer (HR = 1.66, 95%CI = 1.54‐1.79), Hodgkin lymphoma (HR = 1.62, 95%CI = 1.02‐2.56) and breast ER+ (HR = 1.39, 95%CI = 1.32‐1.47). The co‐occurrence of diabetes and cancer significantly increases the risk of cancer death. Our study suggests that these risks may vary by cancer site, and indicates the need for future research to address racial and sex disparities and enhance understanding how prevalent diabetes may affect cancer deaths. The co‐occurrence of diabetes and cancer significantly increases the risk of cancer death. Our study suggests that these risks may vary by cancer site, and indicates the need for future research to address racial and sex disparities and enhance understanding how prevalent diabetes may affect cancer deaths.

Objective This study combines population changes in hormone therapy (HT) use with reported relative risks to estimate directly the impact of reductions in HT use on US breast cancer incidence. Methods Using breast cancer incidence rates and prevalence estimates of HT use, the breast cancer incidence in HT users and non-users was derived. Attributable fraction calculations used risk data from the Million Women Survey (MWS), Collins' meta-analysis (CMA), and the initial or later data from the Women's Health Initiative (WHI) study. Results Between 2000 and 2005, HT use fell from 25.0 to 11.3%. The reported breast cancer incidence (in women aged 40-79) fell 8.8%. Derived incidence rates among non-users of HT remained unchanged (MWS or later WHI data) or slightly lower (initial WHI and CMA data), suggesting reductions in incidence are almost entirely (MWS or later WHI data) or partially (initial WHI or CMA data) due to reduced HT use. Conclusion Changes in reported breast cancer incidence may be partially or largely explained by changes in HT use in the US population.