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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.

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 . . .

The Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database may provide insights into the comparative effectiveness of oncological treatments for elderly individuals who are underrepresented in clinical trials. To evaluate the suitability of SEER-Medicare data for assessing the effectiveness of adding a drug to an existing treatment regimen on the overall survival of elderly patients with cancer. This comparative effectiveness study analyzed SEER-Medicare data from 9549 individuals who received a new diagnosis of stage II colorectal cancer (2008-2012) and 940 patients who received a new diagnosis of advanced pancreatic adenocarcinoma (2007-2012), with follow-up to December 31, 2013 (SEER-Medicare data released in 2015). Two (hypothetical) target trials were designed and emulated based on 2 existing randomized clinical trials: (1) adjuvant fluorouracil after curative surgery for individuals with stage II colorectal cancer and (2) erlotinib added to gemcitabine for individuals with advanced pancreatic adenocarcinoma. Data were analyzed January 2018 to March 2019. The following treatment strategies were compared: (1) fluorouracil initiation vs no initiation within 3 months of tumor resection and (2) erlotinib initiation vs no initiation within 12 weeks of gemcitabine initiation. All-cause mortality within 60 months of baseline for the fluorouracil trial and within 72 weeks for the erlotinib trial. Compared with 3293 individuals in the existing fluorouracil trial, 9549 eligible individuals included in the present analyses were more likely to have colon cancer (8565 [90%] vs 2291 [71%]) and were older (median [interquartile range], 79 [73-84] vs 63 [56-68] years). The 5-year risk difference for initiation vs noninitiation of fluorouracil after surgery was -3.8% (95% CI, -14.8% to 12.6%), and the mortality hazard ratio (HR) was 0.95 (95% CI, 0.85-1.04). Compared with 569 individuals in the existing erlotinib trial, 940 eligible patients included in the present analysis were older (median [range], 74 [66-93] vs 64 [36-92] years) and more likely to be male (547 [58%] vs 298 [52%]). The 1-year risk difference for initiation vs noninitiation of erlotinib was 4.7% (95% CI, -9.4% to 18.0%), and the corresponding mortality HR was 1.04 (95% CI, 0.86-1.42). In naive analyses, the mortality HR estimate was 1.14 (95% CI, 0.95-1.36) for the fluorouracil emulation and 0.68 (95% CI, 0.54-0.87) for the erlotinib emulation. The present estimates were similar to those from randomized clinical trials that studied adding the same cancer drugs to existing regimens. The published HR was 1.02 (95% CI, 0.70-1.48) in the fluorouracil trial for individuals aged 70 or older and 0.96 (95% CI, 0.74-1.24) in the erlotinib trial for individuals aged 65 years or older. The SEER-Medicare database may be adequate for studying the real-world effectiveness of adding a drug to treatment regimens used for elderly individuals with cancer.

Background: Colorectal cancer is relatively frequent among adults of working age, yet few studies have examined treatment, outcomes, and costs for people under 65 years of age with this disease. Objective: The objective of this study was to compare the initial treatments, survival, cancer-related medical costs, and overall medical costs for working-aged persons with colorectal cancer in 2 large health insurance plans in Washington State, one a preferred provider organization (PPO) and the other a group model health maintenance organization (HMO). Study Population: This study consisted of patients, aged 20-64 years, diagnosed with colorectal cancer in both health plans from 1996 to 1998. For each cancer case, up to 5 control subjects, matched on age and sex, were selected for the analysis. Methods: We calculated unadjusted, attributable, and overall medical costs using the Kaplan-Meier sample average estimator. We calculated relative mortality rates using Cox regression. We used propensity scores to adjust overall costs and survival for potential confounding factors. Results: Two hundred ten persons in the PPO and 136 persons in the HMO, aged 20-64 years, were diagnosed with cancer over the observation period and included in this study. Patients in the PPO were more likely to have local excision of their tumor (16% compared with 11%) and were less likely to receive chemotherapy (48% compared with 60%). The overall medical costs for the cancer cases were $46,000 in the HMO and $46,400 in the PPO (95% confidence interval for the difference: -$19,300 to 20,100). The cancer-attributable medical costs over 2 years were $40,400 in the HMO and $44,300 in the PPO (95% confidence interval for the difference: -$17,400 to 25,200). Survival was similar in the 2 health plans: the hazard ratio was 0.89 for those enrolled in the PPO (95% confidence interval: 0.50 to 1.59). Adjustment for potential confounding factors altered the results little. Conclusions: There were differences in the initial treatment of the patients in each health plan, but costs and survival were not significantly different between the 2 plans.

•This is the first study in which incidence, survival, and mortality are interpreted concomitantly to evaluate progress against cancer in a specific region of Portugal, the Azores archipelago.•Much of the progress has been driven by treatment advances, as seen by survival improvements and decreases in mortality.•Incidence and mortality increased for colorectal cancer in men and lung cancer in women.•Reducing tobacco use and obesity are cancer control priorities within the region. Measuring progress against cancer is more accurate when trends in incidence, survival, and mortality are interpreted simultaneously. Our study aims to analyze how these key metrics have evolved over time in the Azores, Portugal. Data for incident cases diagnosed in 1997–2016 and followed up through December 31, 2017 were obtained from the Azores Cancer Registry. Data for cancer deaths that occurred in 1991–2016 were obtained from Statistics Portugal. To estimate temporal trends, we applied a joinpoint model to age-adjusted rates. We estimated five-year net survival within the framework of relative survival using the Pohar-Perme estimator and predicted the number of cases and deaths in 2025. In men, incidence and mortality decreased for stomach, larynx, and prostate cancer. In women, mortality decreased for breast and cervical cancer. Five-year relative survival improved for several cancers, with the most pronounced improvements for prostate cancer in men and colorectal cancer in women (24.1 and 27.9 percentage point absolute increase, respectively). Conversely, incidence and mortality increased for colorectal cancer in men and lung cancer in women. The incidence and mortality burdens are both expected to increase in 2025. Overall, progress against cancer in the Azores has been mixed, and much of the progress has been driven by advances in treatment. Statistics for lung cancer in women and colorectal cancer in men are a call to action for policymakers. Reducing tobacco use and tackling the obesity epidemic are the two public health priorities for cancer control within the region.

The 21-gene Recurrence Score assay is validated to predict recurrence risk and chemotherapy benefit in hormone-receptor-positive (HR+) invasive breast cancer. To determine prospective breast-cancer-specific mortality (BCSM) outcomes by baseline Recurrence Score results and clinical covariates, the National Cancer Institute collaborated with Genomic Health and 14 population-based registries in the the Surveillance, Epidemiology, and End Results (SEER) Program to electronically supplement cancer surveillance data with Recurrence Score results. The prespecified primary analysis cohort was 40–84 years of age, and had node-negative, HR+, HER2-negative, nonmetastatic disease diagnosed between January 2004 and December 2011 in the entire SEER population, and Recurrence Score results ( N =38,568). Unadjusted 5-year BCSM were 0.4% ( n =21,023; 95% confidence interval (CI), 0.3–0.6%), 1.4% ( n =14,494; 95% CI, 1.1–1.7%), and 4.4% ( n =3,051; 95% CI, 3.4–5.6%) for Recurrence Score <18, 18–30, and ⩾31 groups, respectively ( P <0.001). In multivariable analysis adjusted for age, tumor size, grade, and race, the Recurrence Score result predicted BCSM ( P <0.001). Among patients with node-positive disease (micrometastases and up to three positive nodes; N =4,691), 5-year BCSM (unadjusted) was 1.0% ( n =2,694; 95% CI, 0.5–2.0%), 2.3% ( n =1,669; 95% CI, 1.3–4.1%), and 14.3% ( n =328; 95% CI, 8.4–23.8%) for Recurrence Score <18, 18–30, ⩾31 groups, respectively ( P <0.001). Five-year BCSM by Recurrence Score group are reported for important patient subgroups, including age, race, tumor size, grade, and socioeconomic status. This SEER study represents the largest report of prospective BCSM outcomes based on Recurrence Score results for patients with HR+, HER2-negative, node-negative, or node-positive breast cancer, including subgroups often under-represented in clinical trials. Diagnostics: Gene test predicts death from breast cancer A common gene-panel test can help to predict the likelihood of women with breast cancer dying from the disease. Valentina Petkov at the US National Cancer Institute in Maryland and her colleagues studied a form of breast cancer that responds to hormone therapy in more than 44,500 American patients with and without spread to the lymph nodes. At diagnosis, all had taken a genomic test called Oncotype DX, which estimates the likelihood of breast-cancer recurrence on the basis of expression data from 21 genes. The team found that the test’s ‘recurrence score’ was strongly associated with the chance of death from breast cancer — independent of patient age, tumor size and tumor grade. The study provides the best evidence to date that Oncotype DX can be used to predict mortality risk, including for racial minority and other under-represented groups.

The non-Hodgkin lymphomas (NHL) are a heterogeneous group of hematologic malignancies arising from lymphoid tissue, with varied clinical and biological features. Many systems have been developed over time to classify NHL, reflecting increased understanding of features of different types of the disease. Some NHLs are potentially curable with chemotherapy and, less often, radiotherapy; however, treatment protocols vary by NHL subtype and continue to evolve. In addition, the clinical course and survival after NHL diagnosis vary among tumor subtypes, with the 5-year relative survival for the major NHL subtypes, ranging from 52% for the aggressive diffuse, large B-cell lymphoma (DLBCL) to approximately 75% for the more indolent follicular lymphoma (FL) and chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL). Better diagnostic and classification tools, as well as the epidemic of human immunodeficiency virus (HIV) infection can explain some increase in NHL incidence by tumor subtypes. In contrast, changes in population-level mortality patterns in NHL patients by tumor subtypes have not been systematically described. Evaluation of mortality changes due to NHL subtypes in the general population is important, since NHL encompasses a wide variety of disease subtypes for which incidence pattern varies, HIV epidemic increased incidence rates for some NHL subtypes, and treatment advances have improved survival for some, but not for all NHL subtypes. To date, little is known about how population-level mortality burden varies by tumor subtypes, the impact of HIV epidemic on the overall NHL mortality burden in the U.S. general population, or cure of disease in the modern treatment era for NHL patients. We conducted three studies to better quantify population-level mortality and cure rate in U.S. NHL patients by tumor subtypes. The study aims were to 1) to evaluate population-level mortality attributed to each of the 4 major NHL subtypes over time in the US general population, 2) to evaluate mortality burden in the U.S. adult population and its relationship with the HIV epidemic, and finally 3) to estimate proportion of DLBCL patients who may be considered cured in the modern treatment era. Results from the three studies will be a valuable resource for cancer control planners as well as treating clinicians. (Abstract shortened by ProQuest.)

In the original version of the published article, line three of the third paragraph of the methods stated “Excluding patients with micrometastatic disease, the 5-year BCSM for patients with Recurrence Score results <18 and 1–3 positive nodes (n = 2,617) was 1.3% (95% CI, 0.6–2.9%).” To improve clarity this statement has been replaced with “Excluding patients with micrometastatic disease, there were 2,617 patients with 1–3 positive nodes. Of these, 1,487 also had Recurrence Score results <18 with 5-year BCSM of 1.3% (95% CI, 0.6–2.9%).” The original version of the published article also contained an error in the second sentence of the Figure 2 legend describing the mutation status of the patient population examined. The sentence in the original published version of the article stated “Patients with HR+, HER2-positive, node-negative…” this has been changed to “Patients with HR+, HER2-negative, node-negative…”. This has been corrected in the PDF and HTML versions of this paper.

The illness cost borne by households, known as out-of-pocket expenditure, was 74% of the total health expenditure in Bangladesh in 2017. Calculating economic burden of diarrhea of low-income urban community is important to identify potential cost savings strategies and prioritize policy decision to improve the quality of life of this population. This study aimed to estimate cost of illness and monthly percent expenditure borne by households due diarrhea in a low-income urban settlement of Dhaka, Bangladesh. We conducted this study in East Arichpur area of Tongi township in Dhaka, Bangladesh from September 17, 2015 to July 26, 2016. We used the World Health Organization (WHO) definition of three or more loose stool in 24 hours to enroll patients and enrolled 106 severe patients and 158 non-severe patients from Tongi General Hospital, local pharmacy and study community. The team enrolled patients between the first to third day of the illness (≤ 72 hours) and continued daily follow-up by phone until recovery. We considered direct and indirect costs to calculate cost-per-episode. We applied the published incidence rate to estimate the annual cost of diarrhea. The estimated average cost of illness for patient with severe diarrhea was US $ 27.39 [95% CI: 24.55, 30.23] (2,147 BDT), 17% of the average monthly income of the households. The average cost of illness for patient with non-severe diarrhea was US$6.36 [95% CI: 5.19, 7.55] (499 BDT), 4% of the average monthly income of households. A single diarrheal episode substantially affects financial condition of low-income urban community residents: a severe episode can cost almost equivalent to 4.35 days (17%) and a non-severe episode can cost almost equivalent to 1 day (4%) of household’s income. Preventing diarrhea preserves health and supports financial livelihoods.

There is a paucity of recent research on direct water quantity measurement for personal and domestic hygiene. We aimed to measure the water quantity used for personal and domestic hygiene and to explore the reasons and determinants for variation of water usage. We conducted this study from September 2014 to June 2016 in a low-income urban community in Dhaka. In 12 households, the team conducted a day-long bimonthly ethnographic observation for one year to measure the volume of water used per activity per person. They conducted 28 in-depth interviews to explore the reasons for changes of water usage. Participants used a median of 75 L (61–100) of water per capita per day (LCPD) and of this 75 LCPD they used a median of 39 LCPD (26–58) for personal hygiene. Women used less water than men. Individual and social norms, beliefs, and weather determinants determined personal hygiene. Water availability determined domestic hygiene (e.g., washing dishes, toilets and bathrooms). This study helps to elucidate a range of determinants of water usage of the participants from the participants’ perspective. The quantity of water used for domestic and personal hygiene and its relationship to fecal-oral transmitted disease can be explored in future research.