Journal of Cancer Epidemiology http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Epidemic of Non-Hodgkin Lymphoma in New Zealand Remains Unexplained Tue, 01 Apr 2014 09:47:32 +0000 http://www.hindawi.com/journals/jce/2014/315378/ Background. Non-Hodgkin lymphoma (NHL) incidence rates have increased considerably in New Zealand. Methods. Incidence and mortality rates for NHL from 1981 to 2010 were calculated. Trends in age-specific rates were analysed and age-period-cohort models fitted to explore generation-specific changes in incidence and mortality. Results. NHL incidence increased by 67% for men and 74% for women between the 1981–1985 and 2006–2010 time periods in New Zealand. For women born about 1936 and men born about 1946, NHL incidence and mortality have diverged suggesting an improved prognosis for recent generations. Conclusion. The strong generation effects suggest that an exposure before 25 years of age is of major importance in determining the lifetime risk of NHL in New Zealand. NHL incidence rates in New Zealand will continue to increase in the future and probably more in females than males, as generations with increased risk age. Current hypotheses for the cause of NHL do not explain the trends observed. A decline in the prevalence of a protective factor may have also contributed to these trends. Examination of trends for subtypes of NHL and innovative testable hypotheses that may explain these trends are needed. Brian Cox, Chih-Wei Liu, Mary J. Sneyd, and Claire M. Cameron Copyright © 2014 Brian Cox et al. All rights reserved. Cancer Risks for Relatives of Children with Cancer Thu, 27 Mar 2014 13:47:32 +0000 http://www.hindawi.com/journals/jce/2014/806076/ We determined the extent and distribution of cancers in relatives of 379 children newly diagnosed with cancer. Family history was collected from 1,337 first-degree and 3,399 second-degree relatives and incidence compared with national age- and gender-specific rates. Overall, 14 children (3.7%) had a relative with a history of childhood cancer and 26 children (6.9%) had a first-degree relative with a history of cancer, with only one of these having an identifiable familial cancer syndrome. There was a higher than expected incidence of childhood cancer among first-degree relatives (parents and siblings) (standardized incidence ratio (SIR) 1.43; 95% CI 0.54–5.08). There was also a higher than expected incidence of adult cancers among first-degree relatives (SIR 1.45; 95% CI 0.93–2.21), particularly in females (SIR 1.82; 95% CI 1.26–3.39). The increased family cancer history in first-degree females was largely attributable to an effect in mothers (SIR 1.78; 95% CI 1.27–3.33). The gender-specific association was reflected in higher than expected incidence rates of breast cancer in both mothers (SIR 1.92; 95% CI 0.72–6.83) and aunts (SIR 1.64; 95% CI 0.98–2.94). These findings support the hypothesis that previously undetected familial cancer syndromes contribute to childhood cancer. John A. Heath, Elizabeth Smibert, Elizabeth M. Algar, Gillian S. Dite, and John L. Hopper Copyright © 2014 John A. Heath et al. All rights reserved. A Population-Based Study of Childhood Cancer Survivors’ Body Mass Index Thu, 09 Jan 2014 13:47:50 +0000 http://www.hindawi.com/journals/jce/2014/531958/ Background. Population-based studies are needed to estimate the prevalence of underweight or overweight/obese childhood cancer survivors. Procedure. Adult survivors (diagnosed ≤20 years) were identified from the linked Utah Cancer Registry and Utah Population Database. We included survivors currently aged ≥20 years and ≥5 years from diagnosis , and a comparison cohort selected on birth year and sex . BMI was calculated from driver license data available from 2000 to 2010. Multivariable generalized linear regression models were used to calculate prevalence relative risks (RR) and 95% confidence intervals (95% CI) of BMI outcomes for survivors and the comparison cohort. Results. Average time since diagnosis was 18.5 years , and mean age at BMI for both groups was 30.5 (survivors , comparison ). Considering all diagnoses, survivors were not at higher risk for being underweight or overweight/obese than the comparison. Male central nervous system tumor survivors were overweight (, 95% CI 1.01–1.23) more often than the comparison. Female survivors, who were diagnosed at age 10 and under, had a 10% higher risk of being obese than survivors diagnosed at ages 16–20 . Conclusion. While certain groups of childhood cancer survivors are at risk for being overweight/obese, in general they do not differ from population estimates. Echo L. Warner, Mark Fluchel, Jennifer Wright, Carol Sweeney, Kenneth M. Boucher, Alison Fraser, Ken R. Smith, Antoinette M. Stroup, Anita Y. Kinney, and Anne C. Kirchhoff Copyright © 2014 Echo L. Warner et al. All rights reserved. Breast Cancer Pathology, Receptor Status, and Patterns of Metastasis in a Rural Appalachian Population Thu, 09 Jan 2014 13:42:15 +0000 http://www.hindawi.com/journals/jce/2014/170634/ Breast cancer patients in rural Appalachia have a high prevalence of obesity and poverty, together with more triple-negative phenotypes. We reviewed clinical records for tumor receptor status and time to distant metastasis. Body mass index, tumor size, grade, nodal status, and receptor status were related to metastatic patterns. For 687 patients, 13.8% developed metastases to bone () or visceral sites (). Metastases to viscera occurred within five years, a latent period which was shorter than that for bone (). More women with visceral metastasis presented with grade 3 tumors compared with the bone and nonmetastatic groups (). There were 135/574 women (23.5%) with triple-negative breast cancer, who presented with lymph node involvement and visceral metastases (68.2% versus 24.3%; ). Triple-negative tumors that metastasized to visceral sites were larger (). Developing a visceral metastasis within 10 years was higher among women with triple-negative tumors. Across all breast cancer receptor subtypes, the probability of remaining distant metastasis-free was greater for brain and liver than for lung. The excess risk of metastatic spread to visceral organs in triple-negative breast cancers, even in the absence of positive nodes, was combined with the burden of larger and more advanced tumors. Linda Vona-Davis, David P. Rose, Vijaya Gadiyaram, Barbara Ducatman, Gerald Hobbs, Hannah Hazard, Sobha Kurian, and Jame Abraham Copyright © 2014 Linda Vona-Davis et al. All rights reserved. Colorectal Cancer Incidence and Mortality Disparities in New Mexico Thu, 02 Jan 2014 16:29:09 +0000 http://www.hindawi.com/journals/jce/2014/239619/ Background. Previous analyses indicated that New Mexican Hispanics and American Indians (AI) did not experience the declining colorectal cancer (CRC) incidence and mortality rates observed among non-Hispanic whites (NHW). We evaluated more recent data to determine whether racial/ethnic differences persisted. Methods. We used New Mexico Surveillance Epidemiology and End Results data from 1995 to 2009 to calculate age-specific incidence rates and age-adjusted incidence rates overall and by tumor stage. We calculated mortality rates using National Center for Health Statistics’ data. We used joinpoint regression to determine annual percentage change (APC) in age-adjusted incidence rates. Analyses were stratified by race/ethnicity and gender. Results. Incidence rates continued declining in NHW (APC −1.45% men, −1.06% women), while nonsignificantly increasing for AI (1.67% men, 1.26% women) and Hispanic women (0.24%). The APC initially increased in Hispanic men through 2001 (3.33%, ), before declining (−3.10%, ). Incidence rates declined in NHW and Hispanics aged 75 and older. Incidence rates for distant-stage cancer remained stable for all groups. Mortality rates declined significantly in NHW and Hispanics. Conclusions. Racial/ethnic disparities in CRC persist in New Mexico. Incidence differences could be related to risk factors or access to screening; mortality differences could be due to patterns of care for screening or treatment. Richard M. Hoffman, David K. Espey, Robert L. Rhyne, Melissa Gonzales, Ashwani Rajput, Shiraz I. Mishra, S. Noell Stone, and Charles L. Wiggins Copyright © 2014 Richard M. Hoffman et al. All rights reserved. Cancer Incidence and Mortality in a Cohort of US Blood Donors: A 20-Year Study Tue, 31 Dec 2013 13:53:56 +0000 http://www.hindawi.com/journals/jce/2013/814842/ Blood donors are considered one of the healthiest populations. This study describes the epidemiology of cancer in a cohort of blood donors up to 20 years after blood donation. Records from donors who participated in the Retroviral Epidemiology Donor Study (REDS, 1991–2002) at Blood Centers of the Pacific (BCP), San Francisco, were linked to the California Cancer Registry (CCR, 1991–2010). Standardized incidence ratios (SIR) were estimated using standard US 2000 population, and survival analysis used to compare all-cause mortality among donors and a random sample of nondonors with cancer from CCR. Of 55,158 eligible allogeneic blood donors followed-up for 863,902 person-years, 4,236 (7.7%) primary malignant cancers were diagnosed. SIR in donors was 1.59 (95% CI = 1.54,1.64). Donors had significantly lower mortality (adjusted HR = 0.70, 95% CI = 0.66–0.74) compared with nondonor cancer patients, except for respiratory system cancers (adjusted HR = 0.93, 95% CI = 0.82–1.05). Elevated cancer incidence among blood donors may reflect higher diagnosis rates due to health seeking behavior and cancer screening in donors. A “healthy donor effect” on mortality following cancer diagnosis was demonstrated. This population-based database and sample repository of blood donors with long-term monitoring of cancer incidence provides the opportunity for future analyses of genetic and other biomarkers of cancer. Farnaz Vahidnia, Nora V. Hirschler, Maria Agapova, Artina Chinn, Michael P. Busch, and Brian Custer Copyright © 2013 Farnaz Vahidnia et al. All rights reserved. The Impact of Adjustment for Socioeconomic Status on Comparisons of Cancer Incidence between Two European Countries Sun, 22 Dec 2013 09:10:45 +0000 http://www.hindawi.com/journals/jce/2013/612514/ Background. Cancer incidence rates vary considerably between countries and by socioeconomic status (SES). We investigate the impact of SES upon the relative cancer risk in two neighbouring countries. Methods. Data on 229,824 cases for 16 cancers diagnosed in 1995–2007 were extracted from the cancer registries in Northern Ireland (NI) and Republic of Ireland (RoI). Cancers in the two countries were compared using incidence rate ratios (IRRs) adjusted for age and age plus area-based SES. Results. Adjusting for SES in addition to age had a considerable impact on NI/RoI comparisons for cancers strongly related to SES. Before SES adjustment, lung cancer incidence rates were 11% higher for males and 7% higher for females in NI, while after adjustment, the IRR was not statistically significant. Cervical cancer rates were lower in NI than in RoI after adjustment for age (IRR: 0.90 (0.84–0.97)), with this difference increasing after adjustment for SES (IRR: 0.85 (0.79–0.92)). For cancers with a weak or nonexistent relationship to SES, adjustment for SES made little difference to the IRR. Conclusion. Socioeconomic factors explain some international variations but also obscure other crucial differences; thus, adjustment for these factors should not become part of international comparisons. David W. Donnelly, Avril Hegarty, Linda Sharp, Anne-Elie Carsin, Sandra Deady, Neil McCluskey, Harry Comber, and Anna Gavin Copyright © 2013 David W. Donnelly et al. All rights reserved. Cancer Mortality among Asians and Pacific Islanders in New York City, 2001–2010 Thu, 12 Dec 2013 10:33:09 +0000 http://www.hindawi.com/journals/jce/2013/986408/ Asians and Pacific Islanders’ (APIs) leading cause of death is cancer. We compared APIs’ age-adjusted cancer mortality rates to other racial/ethnic groups and by API subgroup (i.e., Chinese, Koreans, Asian Indians, and Filipinos) using New York City (NYC) Mortality data and Census Bureau population estimates for 2001–2010. While other racial/ethnic groups’ overall cancer mortality rates declined in NYC during the last decade, APIs remained stable. APIs overall had the lowest mortality rates for more common cancer types (i.e., lung, colorectal, breast, and prostate), but the highest mortality rates for certain less common cancers (i.e., nasopharyngeal, stomach, and liver). Chinese New Yorkers’ lung cancer death rates were very high compared to other APIs and comparable to non-Hispanic whites (47.1/100,000 versus 49.5/100,000, resp.). Chinese men had much higher nasopharyngeal cancer mortality rates (4.5/100,000 versus 0.3/100,000 for non-Hispanic whites). Korean men had the highest liver and stomach cancer mortality rates (25.3/100,000 and 27.7/100,000, resp., versus 7.9/100,000 and 6.0/100,000 for non-Hispanic whites). Analysis of cancer rates by API subgroup provides the detailed information needed to plan cancer prevention efforts. These findings warrant consideration of targeted cancer mortality prevention efforts for affected subgroups, including hepatitis vaccination, screening, and treatment; smoking cessation; and cancer screening. Vivian Huang, Wenhui Li, Josephine Tsai, and Elizabeth Begier Copyright © 2013 Vivian Huang et al. All rights reserved. Sleep Duration and Breast Cancer Phenotype Mon, 04 Nov 2013 14:26:50 +0000 http://www.hindawi.com/journals/jce/2013/467927/ Emerging evidence suggests that short sleep is associated with an increased risk of cancer; however, little has been done to study the role of sleep on tumor characteristics. In this study, we evaluated the relationship between sleep duration and tumor phenotype in 972 breast cancer patients. Sleep duration was inversely associated with tumor grade (univariate ), particularly in postmenopausal women (univariate ). This association did not reach statistical significance after adjustments for age, race, body mass index, hormone replacement therapy use, alcohol consumption, smoking, and physical activity in the entire study sample (), but it remained statistically significant () among post-menopausal patients. We did not observe a statistically significant association between sleep duration and stage at diagnosis, ER, or HER2 receptor status. These results present a modest association between short duration of sleep and higher grade breast cancer in post-menopausal women. Further work needs to be done to validate these findings. Ali Khawaja, Santosh Rao, Li Li, and Cheryl L. Thompson Copyright © 2013 Ali Khawaja et al. All rights reserved. Trends in Breast Cancer Incidence Rates by Age and Stage at Diagnosis in Gharbiah, Egypt, over 10 Years (1999–2008) Thu, 24 Oct 2013 16:06:56 +0000 http://www.hindawi.com/journals/jce/2013/916394/ Background. This study was undertaken to evaluate trends in breast cancer incidence in Egypt from 1999 to 2008 and to make projections for breast cancer occurrence for the years 2009–2015. Patients and Methods. We utilized joinpoint regression and average annual percent change (AAPC) measures with 95% confidence intervals (CI) to describe the trends in breast cancer incidence rates from the Gharbiah Cancer Registry by age and stage at diagnosis and to estimate expected breast cancer caseloads for 2009–2015. Results. From 1999 to 2008, the AAPC in breast cancer incidence rates in Gharbiah significantly increased among women 50 years and older and among localized tumors (AAPC %, 95% CI, 3.1% to 8.0%). Our results predict a significant increase in breast cancer caseloads from 2009 to 2015 among women aged 30–39 (AAPC %, 95% CI, 0.9% to 1.1%) and among women aged 40–49 years (AAPC %, 95% CI, 1.0% to 2.6%). Conclusion. These results have important implications for allocating limited resources, managing treatment needs, and exploring the consequences of prior interventions and/or changing risk factors in Egypt and other developing countries at the same stages of demographic and health transitions. Kelly A. Hirko, Amr S. Soliman, Ahmed Hablas, Ibrahim A. Seifeldin, Mohamed Ramadan, Mousumi Banerjee, Joe B. Harford, Robert M. Chamberlain, and Sofia D. Merajver Copyright © 2013 Kelly A. Hirko et al. All rights reserved. Patterns of Pelvic Radiotherapy in Patients with Stage II/III Rectal Cancer Wed, 02 Oct 2013 09:48:58 +0000 http://www.hindawi.com/journals/jce/2013/408460/ High-level evidence supports adjuvant radiotherapy for rectal cancer. We examined the influence of sociodemographic factors on patterns of adjuvant radiotherapy for resected Stage II/III rectal cancer. Methods. Patients undergoing surgical resection for stage II/III rectal cancer were identified in SEER registry. Results. A total of 21,683 patients were identified. Majority of patients were male (58.8%), white (83%), and with stage III (54.9%) and received radiotherapy (66%). On univariate analysis, male gender, stage III, younger age, year of diagnosis, and higher socioeconomic status (SES) were associated with radiotherapy. Radiotherapy was delivered in 84.4% of patients 50; however, only 32.8% of those are 80 years. Logistic regression demonstrated a significant increase in the use of radiotherapy in younger patients who are 50 (OR, 10.3), with stage III (OR, 1.21), males (OR, 1.18), and with higher SES. Conclusions. There is a failure to conform to standard adjuvant radiotherapy in one-third of patients, and this is associated with older age, stage II, area-level of socioeconomic deprivation, and female sex. Timothy L. Fitzgerald, Emmanuel Zervos, and Jan H. Wong Copyright © 2013 Timothy L. Fitzgerald et al. All rights reserved. Epidemiological Study of the Incidence of Cancers Eligible for Proton or Carbon Ions Therapy: Methodology and Results of Recruitment Estimation Thu, 20 Jun 2013 11:46:53 +0000 http://www.hindawi.com/journals/jce/2013/107646/ Context. Hadrontherapy is an innovative form of radiotherapy using beams of protons or carbon ions able to destroy some radio-resistant tumours. Because these tumours are highly specific amongst all cancerous tumours, it is impossible to determine the incidence of these diseases from surveillance registries. Goal. To assess, within the Rhône-Alpes region, the incidence of cancers being hadrontherapy indications. Method. Prospective, multicentre continuous data collection during 1 year, by practitioners participating to multidisciplinary tumor board. Tumours are inoperable, radio resistant, at primary stage of development, or locally recurrent, with low metastatic potential. Results. Study involved 27 healthcare centres, 52 groups of specialist practitioners. The estimated incidence of cancers eligible for hadrontherapy in the Rhône-Alpes region in 2010, that is, for 34 locations in all, is of 8.5/100 000 inhabitants. Appraisal of the low potential of metastatic progression is impeded, because these are rare diseases, whose outcome is unfamiliar to investigators. Conclusion. Future epidemiological studies will need to focus on prognosis and on the metastatic progression rate of these diseases. Indeed, there are few information available on this subject in the literature that could be used to improve preventive measures, medical care, and the surveillance of these rare cancers. Stéphanie Patin, Pascal Pommier, Hu Yi, Marie Hélène Baron, and Jacques Balosso Copyright © 2013 Stéphanie Patin et al. All rights reserved. Immunohistochemical Analysis of Vimentin in Oral Submucous Fibrosis Tue, 11 Jun 2013 11:16:51 +0000 http://www.hindawi.com/journals/jce/2013/549041/ Background. Oral submucous fibrosis (OSF), a precancerous condition, is characterized by abnormal accumulation of collagen fibers in oral submucosa. Vimentin is a Class 2 intermediate filament (IF) and primarily expressed in cells of mesenchymal origin. Vimentin is also found to be involved in cell growth, cell cycling, and tumour differentiation. Objective. The purpose of the study was to compare the expression of vimentin in various histological grades of OSF. Materials and Methods. To assess the immunohistochemical expression of vimentin in 20 mild cases of OSF, 20 severe cases of OSF, and ten cases of normal oral buccal mucosa. Results. The overall staining intensity of vimentin significantly increased statistically () in OSF cases over normal control. A significant increase in the staining intensity of vimentin was also noted in the fibroblasts of severe cases of OSF (). Conclusion. Considering the marked vimentin expression in the present study, future studies should include cytoskeleton IF and other filaments in the fibroblasts of OSF. Meghanand T. Nayak, Anjali Singh, Rajiv S. Desai, and S. S. Vanaki Copyright © 2013 Meghanand T. Nayak et al. All rights reserved. Worldwide Increasing Incidence of Thyroid Cancer: Update on Epidemiology and Risk Factors Tue, 07 May 2013 10:41:43 +0000 http://www.hindawi.com/journals/jce/2013/965212/ Background. In the last decades, thyroid cancer incidence has continuously and sharply increased all over the world. This review analyzes the possible reasons of this increase. Summary. Many experts believe that the increased incidence of thyroid cancer is apparent, because of the increased detection of small cancers in the preclinical stage. However, a true increase is also possible, as suggested by the observation that large tumors have also increased and gender differences and birth cohort effects are present. Moreover, thyroid cancer mortality, in spite of earlier diagnosis and better treatment, has not decreased but is rather increasing. Therefore, some environmental carcinogens in the industrialized lifestyle may have specifically affected the thyroid. Among potential carcinogens, the increased exposure to medical radiations is the most likely risk factor. Other factors specific for the thyroid like increased iodine intake and increased prevalence of chronic autoimmune thyroiditis cannot be excluded, while other factors like the increasing prevalence of obesity are not specific for the thyroid. Conclusions. The increased incidence of thyroid cancer is most likely due to a combination of an apparent increase due to more sensitive diagnostic procedures and of a true increase, a possible consequence of increased population exposure to radiation and to other still unrecognized carcinogens. Gabriella Pellegriti, Francesco Frasca, Concetto Regalbuto, Sebastiano Squatrito, and Riccardo Vigneri Copyright © 2013 Gabriella Pellegriti et al. All rights reserved. Disruptions in Liver Function among Cancer Patients and Patients Treated with Tyrosine Kinase Inhibiting Drugs: Comparisons of Two Population-Based Databases Sun, 21 Apr 2013 10:49:12 +0000 http://www.hindawi.com/journals/jce/2013/358285/ Liver toxicity is a recognized adverse event associated with small molecule tyrosine kinase inhibitors (TKIs). Electronic Medical Record (EMR) databases offer the most precise data to investigate the rate of liver function test (LFT) elevations; however, they can be limited in sample size and costly to access and analyze. Health insurance claims databases often contain larger samples sizes but may lack key health information. We evaluated the feasibility of utilizing a large claims database to calculate incidence rates (IRs) of LFT elevations among a general cohort of cancer patients and a cohort of patients treated with TKIs by comparing the results to a “gold standard” oncology-specific EMR database. IRs for the TKI cohorts were very similar between the two databases; however, IRs were higher in the EMR database for the cancer cohorts. Possible explanations for these differences include lack of specificity when defining a cancer case, poor capture of laboratory data, or inaccurate assessment of person-time in the insurance claims database. This study suggests that insurance claims data may provide reliable results when investigating liver toxicities associated with oncology drug exposure; however, there are limitations when assessing laboratory outcomes for cohorts defined solely by disease status. Sarah H. Landis, Beth L. Nordstrom, Leah B. Sansbury, Sumitra Shantakumar, Samantha A. St. Laurent, Kathy H. Fraeman, and Jeanenne J. Nelson Copyright © 2013 Sarah H. Landis et al. All rights reserved. Body Fat and Breast Cancer Risk in Postmenopausal Women: A Longitudinal Study Sun, 07 Apr 2013 15:26:45 +0000 http://www.hindawi.com/journals/jce/2013/754815/ Associations between anthropometric indices of obesity and breast cancer risk may fail to capture the true relationship between excess body fat and risk. We used dual-energy-X-ray-absorptiometry- (DXA-) derived measures of body fat obtained in the Women’s Health Initiative to examine the association between body fat and breast cancer risk; we compared these risk estimates with those for conventional anthropometric measurements. The study included 10,960 postmenopausal women aged 50–79 years at recruitment, with baseline DXA measurements and no history of breast cancer. During followup (median: 12.9 years), 503 incident breast cancer cases were diagnosed. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated using Cox proportional hazards models. All baseline DXA-derived body fat measures showed strong positive associations with breast cancer risk. The multivariable-adjusted HR for the uppermost quintile level (versus lowest) ranged from 1.53 (95% CI 1.14–2.07) for fat mass of the right leg to 2.05 (1.50–2.79) for fat mass of the trunk. Anthropometric indices (categorized by quintiles) of obesity (BMI (1.97, 1.45–2.68), waist circumference (1.97, 1.46–2.65), and waist : hip ratio (1.91, 1.41–2.58)) were all strongly, positively associated with risk and did not differ from DXA-derived measures in prediction of risk. Thomas E. Rohan, Moonseong Heo, Lydia Choi, Mridul Datta, Jo L. Freudenheim, Victor Kamensky, Heather M. Ochs-Balcom, Lihong Qi, Cynthia A. Thomson, Mara Z. Vitolins, Sylvia Wassertheil-Smoller, and Geoffrey C. Kabat Copyright © 2013 Thomas E. Rohan et al. All rights reserved. Epidemiology of Thyroid Cancer in an Area of Epidemic Thyroid Goiter Mon, 04 Mar 2013 08:50:26 +0000 http://www.hindawi.com/journals/jce/2013/584768/ The aim of this study was to analyze and describe the epidemiological characteristics and trends of thyroid cancer in the province of Sassari (Sardinia, Italy), an area with epidemic thyroid goiter, in the period 1992–2010. Data were obtained from the local tumor registry which makes part of a wider registry web, coordinated today by the Italian Association for Tumor Registries. An increasing trend in the incidence of thyroid cancer in the province of Sassari was evidenced. This trend seems to follow the general worldwide trend and does not seem to be related to the high incidence of thyroid goiter in the area. The frequencies of the different histological subtypes were similar to those reported in numerous national and international reports. Women are affected earlier than men and, therefore, suffer greater professional, economic, and social impacts. Overall mortality is low and a relative 5-year survival is excellent, especially in comparison to other malignancies. Antonio Cossu, Mario Budroni, Panagiotis Paliogiannis, Giuseppe Palmieri, Fabrizio Scognamillo, Rosaria Cesaraccio, Federico Attene, Mario Trignano, and Francesco Tanda Copyright © 2013 Antonio Cossu et al. All rights reserved. Individual and Neighborhood Socioeconomic Status and Healthcare Resources in Relation to Black-White Breast Cancer Survival Disparities Wed, 20 Feb 2013 16:02:29 +0000 http://www.hindawi.com/journals/jce/2013/490472/ Background. Breast cancer survival has improved significantly in the US in the past 10–15 years. However, disparities exist in breast cancer survival between black and white women. Purpose. To investigate the effect of county healthcare resources and SES as well as individual SES status on breast cancer survival disparities between black and white women. Methods. Data from 1,796 breast cancer cases were obtained from the Surveillance Epidemiology and End Results and the National Longitudinal Mortality Study dataset. Cox Proportional Hazards models were constructed accounting for clustering within counties. Three sequential Cox models were fit for each outcome including demographic variables; demographic and clinical variables; and finally demographic, clinical, and county-level variables. Results. In unadjusted analysis, black women had a 53% higher likelihood of dying of breast cancer and 32% higher likelihood of dying of any cause () compared with white women. Adjusting for demographic variables explained away the effect of race on breast cancer survival (HR, 1.40; 95% CI, 0.99–1.97), but not on all-cause mortality. The racial difference in all-cause survival disappeared only after adjusting for county-level variables (HR, 1.27; CI, 0.95–1.71). Conclusions. Improving equitable access to healthcare for all women in the US may help eliminate survival disparities between racial and socioeconomic groups. Tomi F. Akinyemiju, Amr S. Soliman, Norman J. Johnson, Sean F. Altekruse, Kathy Welch, Mousumi Banerjee, Kendra Schwartz, and Sofia Merajver Copyright © 2013 Tomi F. Akinyemiju et al. All rights reserved. Serum Lipid Profiles and Cancer Risk in the Context of Obesity: Four Meta-Analyses Sun, 20 Jan 2013 14:28:39 +0000 http://www.hindawi.com/journals/jce/2013/823849/ The objective here was to summarize the evidence for, and quantify the link between, serum markers of lipid metabolism and risk of obesity-related cancers. PubMed and Embase were searched using predefined inclusion criteria to conduct meta-analyses on the association between serum levels of TG, TC, HDL, ApoA-I, and risk of 11 obesity-related cancers. Pooled relative risks (RRs) and 95% confidence intervals were estimated using random-effects analyses. 28 studies were included. Associations between abnormal lipid components and risk of obesity-related cancers when using clinical cutpoints (; ; ; ) were apparent in all models. RRs were 1.18 (95% CI: 1.08–1.29) for TC, 1.20 (1.07–1.35) for TG, 1.15 (1.01–1.32) for HDL, and 1.42 (1.17–1.74) for ApoA-I. High levels of TC and TG, as well as low levels of HDL and ApoA-I, were consistently associated with increased risk of obesity-related cancers. The modest RRs suggest serum lipids to be associated with the risk of cancer, but indicate it is likely that other markers of the metabolism and/or lifestyle factors may also be involved. Future intervention studies involving lifestyle modification would provide insight into the potential biological role of lipid metabolism in tumorigenesis. Jennifer C. Melvin, Lars Holmberg, Sabine Rohrmann, Massimo Loda, and Mieke Van Hemelrijck Copyright © 2013 Jennifer C. Melvin et al. All rights reserved. Undertreated Breast Cancer in the Elderly Thu, 10 Jan 2013 08:23:44 +0000 http://www.hindawi.com/journals/jce/2013/893104/ The effect of undertreatment with adjuvant hormonal therapy, chemotherapy, or radiation was studied in elderly women with breast cancer. A prospectively maintained database was used to identify women undergoing potentially curative surgery between 1978 and 2012. The presentation, pathologic findings, treatment, and outcomes of 382 women over 70 were compared to the findings in 2065 younger patients. Subsequently, conventionally treated and undertreated elderly patients were identified and their characteristics and outcomes were compared. Both young and old patients presented most frequently with mammographic findings, but older patients presented more frequently with mammographic masses while younger patients presented more frequently with mammographic calcifications. Cancers of older patients were significantly more favorable than cancers in younger patients: smaller, with more infiltrating lobular, fewer ductal carcinoma in situ, and more frequently estrogen receptor positive and fewer were poorly differentiated. Elderly patients had less axillary sampling, fewer mastectomies, less adjuvant radiation therapy, and more hormonal therapy. Fifty-one percent of the 382 elderly patients were undertreated by conventional criteria. Undertreated patients were more frequently in situ, better differentiated, smaller, and more often estrogen receptor positive. Forty-four percent of the undertreated patients died during followup without disease recurrence. Despite undertreatment, local and distant disease-free survival was comparable to patients who were not undertreated. Manmeet Kaur Malik, Paul Ian Tartter, and Rachel Belfer Copyright © 2013 Manmeet Kaur Malik et al. All rights reserved. Accuracy of Self-Reported Breast Cancer Information among Women from the Ontario Site of the Breast Cancer Family Registry Mon, 17 Dec 2012 07:54:28 +0000 http://www.hindawi.com/journals/jce/2012/310804/ Obtaining complete medical record information can be challenging and expensive in breast cancer studies. The current literature is limited with respect to the accuracy of self-report and factors that may influence this. We assessed the agreement between self-reported and medical record breast cancer information among women from the Ontario site of the Breast Cancer Family Registry. Women aged 20–69 years diagnosed with incident breast cancer 1996–1998 were identified from the Ontario Cancer Registry, sampled on age and family history. We calculated kappa statistics, proportion correct, sensitivity, specificity, and positive and negative predictive values and conducted unconditional logistic regression to examine whether characteristics of the women influenced agreement. The proportions of women who correctly reported having received a broad category of therapy (hormone therapy, chemotherapy, radiation, or surgery) as well as sensitivity and specificity were above 90%, and the kappa statistics were above 0.80. The specific type of hormonal or chemotherapy was reported with low-to-moderate agreement. Aside from recurrence, no factors were consistently associated with agreement. Thus, most women were able to accurately report broad categories of treatment but not necessarily specific treatment types. The finding of this study can aid researchers in the use and design of self-administered treatment questionnaires. Andriana Barisic, Gord Glendon, Nayana Weerasooriya, Irene L. Andrulis, and Julia A. Knight Copyright © 2012 Andriana Barisic et al. All rights reserved. Uptake and Tolerance of Chemotherapy in Elderly Patients with Small Cell Lung Cancer and Impact on Survival Thu, 29 Nov 2012 15:29:19 +0000 http://www.hindawi.com/journals/jce/2012/708936/ The treatment of elderly cancer patients is complicated by many factors. We sought to assess the uptake and tolerance of chemotherapy among patients 75 years and older diagnosed with small cell lung cancer (SCLC) in years 2004–2008 in Alberta, Canada, and assess their survival. All patients who met the above criteria and had an oncologist-consult were included. Data were obtained from the Alberta Cancer Registry and chart review. A total of 171 patients were included in the study, 117 (68%) of whom began chemotherapy. Of those, 52% completed all cycles, 66% did not have any dose reductions, and 31% completed all cycles at the recommended dose. The risk of death for patients who did not complete all cycles of chemotherapy was 2.72 (95% CI: 1.52–4.87) and for those who completed all cycles but with a reduced dose was 1.02 (95% CI: 0.57–1.82) relative to those who completed chemotherapy at full dose after adjusting for several demographic/clinical factors. Our results suggest that a significant proportion of elderly patients are able to tolerate chemotherapy and receive a survival benefit from it while those who experience toxicity may receive a survival benefit from a reduction in chemotherapy dose as opposed to stopping treatment. Stacey Fisher, Turki M. Al-Fayea, Marcy Winget, He Gao, and Charles Butts Copyright © 2012 Stacey Fisher et al. All rights reserved. Promoting Early Presentation of Breast Cancer in Older Women: Implementing an Evidence-Based Intervention in Routine Clinical Practice Wed, 07 Nov 2012 14:29:15 +0000 http://www.hindawi.com/journals/jce/2012/835167/ Background. Women over 70 with breast cancer have poorer one-year survival and present at a more advanced stage than younger women. Promoting early symptomatic presentation in older women may reduce stage cost effectively and is unlikely to lead to overdiagnosis. After examining efficacy in a randomised controlled trial, we piloted a brief health professional-delivered intervention to equip women to present promptly with breast symptoms, as an integral part of the final invited mammogram at age ~70, in the English National Health Service Breast Screening Programme. Methods. We trained mammographers, who then offered the intervention to older women in four breast screening services. We examined breast cancer awareness at baseline and one month in women receiving the intervention, and also in a service where the intervention was not offered. Results. We trained 27 mammographers to deliver the intervention confidently to a high standard. Breast cancer awareness increased 7-fold at one month in women receiving the intervention compared with 2-fold in the comparison service (odds ratio 15.2, 95% confidence interval 10.0 to 23.2). Conclusions. The PEP Intervention can be implemented in routine clinical practice with a potency similar to that achieved in a randomised controlled trial. It has the potential to reduce delay in diagnosis for breast cancer in older women. Lindsay J. L. Forbes, Alice S. Forster, Rachael H. Dodd, Lorraine Tucker, Rachel Laming, Sarah Sellars, Julietta Patnick, and Amanda J. Ramirez Copyright © 2012 Lindsay J. L. Forbes et al. All rights reserved. The Front Line of Genomic Translation Tue, 06 Nov 2012 13:54:42 +0000 http://www.hindawi.com/journals/jce/2012/372597/ Suzanne C. O'Neill, Colleen M. McBride, Angela D. Bryan, Laura M. Koehly, and Louise Wideroff Copyright © 2012 Suzanne C. O'Neill et al. All rights reserved. Patterns of Cancer Genetic Testing: A Randomized Survey of Oregon Clinicians Wed, 24 Oct 2012 10:42:07 +0000 http://www.hindawi.com/journals/jce/2012/294730/ Introduction. Appropriate use of genetic tests for population-based cancer screening, diagnosis of inherited cancers, and guidance of cancer treatment can improve health outcomes. We investigated clinicians’ use and knowledge of eight breast, ovarian, and colorectal cancer genetic tests. Methods. We conducted a randomized survey of 2,191 Oregon providers, asking about their experience with fecal DNA, OncoVue, BRCA, MMR, CYP2D6, tumor gene expression profiling, UGT1A1, and KRAS. Results. Clinicians reported low confidence in their knowledge of medical genetics; most confident were OB-GYNs and specialists. Clinicians were more likely to have ordered/recommended BRCA and MMR than the other tests, and OB-GYNs were twice as likely to have ordered/recommended BRCA testing than primary care providers. Less than 10% of providers ordered/recommended OncoVue, fecal DNA, CYP2D6, or UGT1A1; less than 30% ordered/recommended tumor gene expression profiles or KRAS. The most common reason for not ordering/recommending these tests was lack of familiarity. Conclusions. Use of appropriate, evidence-based testing can help reduce incidence and mortality of certain cancers, but these tests need to be better integrated into clinical practice. Continued evaluation of emerging technologies, dissemination of findings, and an increase in provider confidence and knowledge are necessary to achieve this end. Summer L. Cox, Amy I. Zlot, Kerry Silvey, Debi Elliott, Tara Horn, Amber Johnson, and Richard F. Leman Copyright © 2012 Summer L. Cox et al. All rights reserved. Barriers and Facilitators for Utilization of Genetic Counseling and Risk Assessment Services in Young Female Breast Cancer Survivors Mon, 22 Oct 2012 16:21:48 +0000 http://www.hindawi.com/journals/jce/2012/298745/ Introduction. Women diagnosed with breast cancer at a young age are more likely to carry a cancer predisposing genetic mutation. Per the current NCCN recommendations, women diagnosed under age 50 should be referred to cancer genetic counseling for further risk evaluation. This study seeks to assess patient-reported barriers and facilitators to receiving genetic counseling and risk assessment among a community-based population of young breast cancer survivors (YBCS). Methods. Through the Michigan Cancer Surveillance Program, a state-based cancer registry, 488 women diagnosed with breast cancer before age 50 in 2006-2007 were identified. They received a mail survey regarding family history and facilitators and barriers to receiving genetic counseling and risk assessment. Results. Responses were received from 289 women (59.2%). One hundred twenty-two (42.2%) reported having received cancer genetic counseling. The most frequent reason identified for receiving services was to benefit their family's future. The top reasons for not attending were “no one recommended it” and “medical insurance coverage issues.” Discussion. This study is the first published report using a state cancer registry to determine facilitators and barriers to receiving genetic counseling and risk assessment among YBCS. These findings demonstrate the need for additional awareness and education about appropriate indications for genetic services. Beth Anderson, Jennifer McLosky, Elizabeth Wasilevich, Sarah Lyon-Callo, Debra Duquette, and Glenn Copeland Copyright © 2012 Beth Anderson et al. All rights reserved. Folate Intake, MTHFR Polymorphisms, and the Risk of Colorectal Cancer: A Systematic Review and Meta-Analysis Thu, 18 Oct 2012 16:19:30 +0000 http://www.hindawi.com/journals/jce/2012/952508/ Background. The objective was to determine whether relationships exist between the methylene-tetrahydrofolate reductase (MTHFR) polymorphisms and risk of colorectal cancer (CRC) and examine whether the risk is modified by level of folate intake. Methods. MEDLINE, Embase, and SCOPUS were searched to May 2012 using the terms “folic acid,” “folate,” “colorectal cancer,” “methylenetetrahydrofolate reductase,” “MTHFR.” Observational studies were included which (1) assessed the risk of CRC for each polymorphism and/or (2) had defined levels of folate intake for each polymorphism and assessed the risk of CRC. Results. From 910 references, 67 studies met our criteria; hand searching yielded 10 studies. The summary risk estimate comparing the 677CT versus CC genotype was 1.02 (95% CI 0.95–1.10) and for 677TT versus CC was 0.88 (95% CI 0.80–0.96) both with heterogeneity. The summary risk estimates for A1298C polymorphisms suggested no reduced risk. The summary risk estimate for high versus low total folate for the 677CC genotype was 0.70 (95% CI 0.56–0.89) and the 677TT genotype 0.63 (95% CI 0.41–0.97). Conclusion. These results suggest that the 677TT genotype is associated with a reduced risk of developing CRC, under conditions of high total folate intake, and this associated risk remains reduced for both MTHFR 677 CC and TT genotypes. Deborah A. Kennedy, Seth J. Stern, Ilan Matok, Myla E. Moretti, Moumita Sarkar, Thomasin Adams-Webber, and Gideon Koren Copyright © 2012 Deborah A. Kennedy et al. All rights reserved. Challenges of the Oral Cancer Burden in India Thu, 04 Oct 2012 15:38:33 +0000 http://www.hindawi.com/journals/jce/2012/701932/ Oral cancer ranks in the top three of all cancers in India, which accounts for over thirty per cent of all cancers reported in the country and oral cancer control is quickly becoming a global health priority. This paper provides a synopsis of the incidence of oral cancer in India by focusing on its measurement in cancer registries across the country. Based on the International Classification of Disease case definition adopted by the World Health Organisation, and the International Agency for Research on Cancer, this review systematically examines primary and secondary data where the incidence or prevalence of oral cancer is known to be directly reported. Variability in age-adjusted incidence with crude incidence is projected to increase by 2030. Challenges focus on measurement of disease incidence and disease-specific risk behavior, predominantly, alcohol, and tobacco use. Future research should be aimed at improving quality of data for early detection and prevention of oral cancer. Ken Russell Coelho Copyright © 2012 Ken Russell Coelho. All rights reserved. Long-Term Survival in Young Women: Hazards and Competing Risks after Thyroid Cancer Tue, 02 Oct 2012 15:54:43 +0000 http://www.hindawi.com/journals/jce/2012/641372/ Background. Differentiated thyroid cancers (DTCs) are one of the most common and survivable cancers diagnosed in women. We examine factors associated with long-term survival and competing risks of death in women diagnosed with DTC under the age of 40 (<40) and aged 40 and older (). Methods. SEER data was used to identify DTCs diagnosed in women from 1975 to 2009. We examined overall (OS), disease-specific (DSS), other cancer (OCS), and non-cancer-related (NCS) survival using multivariate Cox proportional hazards modeling. Results. Observed survival was 97.2% for <40 () and 82.5% for (). Distant stage (, 95% CI 1.23–3.07), non-Hispanic Black (, 95% CI 1.45–2.87), being unmarried (, 95% 1.03–1.54), and subsequent primary cancers ( 95% CI 3.76–5.71) were significant for OS in women <40. Age was an effect modifier for all survival outcomes. Racial disparities in NCS were most pronounced for young non-Hispanic black women (, 95% CI 2.17–5.22). Women in both age groups were more likely to die from other causes. Conclusions. Age at diagnosis remains one of the strongest prognostic factors for thyroid cancer survival. More directed efforts to ensure effective care for comorbid conditions are needed to reduce mortality from other causes. Antoinette M. Stroup, C. Janna Harrell, and Kimberly A. Herget Copyright © 2012 Antoinette M. Stroup et al. All rights reserved. Current Understanding of Lifestyle and Environmental Factors and Risk of Non-Hodgkin Lymphoma: An Epidemiological Update Wed, 12 Sep 2012 13:46:47 +0000 http://www.hindawi.com/journals/jce/2012/978930/ The incidence rates of non-Hodgkin lymphoma (NHL) have steadily increased over the last several decades in the United States, and the temporal trends in incidence can only be partially explained by the HIV epidemic. In 1992, an international workshop sponsored by the United States National Cancer Institute concluded that there was an “emerging epidemic” of NHL and emphasized the need to investigate the factors responsible for the increasing incidence of this disease. Over the past two decades, numerous epidemiological studies have examined the risk factors for NHL, particularly for putative environmental and lifestyle risk factors, and international consortia have been established in order to investigate rare exposures and NHL subtype-specific associations. While few consistent risk factors for NHL aside from immunosuppression and certain infectious agents have emerged, suggestive associations with several lifestyle and environmental factors have been reported in epidemiologic studies. Further, increasing evidence has suggested that the effects of these and other exposures may be limited to or stronger for particular NHL subtypes. This paper examines the progress that has been made over the last twenty years in elucidating the etiology of NHL, with a primary emphasis on lifestyle factors and environmental exposures. Bryan A. Bassig, Qing Lan, Nathaniel Rothman, Yawei Zhang, and Tongzhang Zheng Copyright © 2012 Bryan A. Bassig et al. All rights reserved.