Biomedical subjects

Holly L Howe

Publications and source records attributed to Holly L Howe.

At least 19 recordsLinked to original sources

PubMed2006

Method to assess identifiability in electronic data files.

The authors developed the Record Uniqueness (RU) software program to assess electronic data files for risk of confidentiality breach based on unique combinations of key variables. The underlying methodology utilized by the RU program generates a frequency distribution for every variable selected for analysis and for all combinations of the variables selected. In addition, the program provides the regression coefficient that designates the relative contribution of each variable to the unique records on the data file. The authors used RU to evaluate a North American Association of Central Cancer Registries research data set with 4.67 million cases from 34 population-based cancer registries for 1995-2001. To illustrate the process and utility of RU, they describe the evaluation process of the confidentiality risk of adding a county-based socioeconomic measure to the research file. The RU method enables one to be assured of record confidentiality, provides flexibility to adjust record uniqueness thresholds for different users or purposes of data release, and facilitates good stewardship of confidential data balanced with maximum use and release of information for research. RU is a useful data tool that can quantify the risk of confidentiality breach of electronic health databases, including reidentifiability of cases through triangulation of information or linkage with other electronic databases.

Confidentiality↗

PubMed2006

Annual report to the nation on the status of cancer, 1975-2003, featuring cancer among U.S. Hispanic/Latino populations.

BACKGROUND: The American Cancer Society, Centers for Disease Control and Prevention, National Cancer Institute, and North American Association of Central Cancer Registries collaborate annually to provide U.S. cancer information, this year featuring the first comprehensive compilation of cancer information for U.S. Latinos. METHODS: Cancer incidence was obtained from 90% of the Hispanic/Latino and 82% of the U.S. populations. Cancer deaths were obtained for the entire U.S. population. Cancer screening, risk factor, incidence, and mortality data were compiled for Latino and non-Latino adults and children (incidence only). Long-term (1975-2003) and fixed-interval (1995-2003) trends and comparative analyses by disease stage, urbanicity, and area poverty were evaluated. RESULTS: The long-term trend in overall cancer death rates, declining since the early 1990s, continued through 2003 for all races and both sexes combined. However, female lung cancer incidence rates increased from 1975 to 2003, decelerating since 1991 and breast cancer incidence rates stabilized from 2001 to 2003. Latinos had lower incidence rates in 1999-2003 for most cancers, but higher rates for stomach, liver, cervix, and myeloma (females) than did non-Latino white populations. Latino children have higher incidence of leukemia, retinoblastoma, osteosarcoma, and germ-cell tumors than do non-Latino white children. For several common cancers, Latinos were less likely than non-Latinos to be diagnosed at localized stages. CONCLUSIONS: The lower cancer rates observed in Latino immigrants could be sustained by maintenance of healthy behaviors. Some infection-related cancers in Latinos could be controlled by evidence-based interventions. Affordable, culturally sensitive, linguistically appropriate, and timely access to cancer information, prevention, screening, and treatment are important in Latino outreach and community networks.

Adolescent↗

PubMed2006

Patterns of cancer incidence among US Hispanics/Latinos, 1995-2000.

OBJECTIVE: Current and comprehensive data on cancer incidence in US Latinos has been limited. METHODS: Using a standardized approach to uniformly assign Hispanic/Latino race/ethnicity to cancer records, data from 15 central cancer registries, representing more than 85% of the US Latino population, were included in the analysis. Average annual age-adjusted incidence rates and standard errors were calculated for Hispanic, non-Hispanic white and non-Hispanic black males and females. To compare cancer incidence among Hispanic and non-Hispanic populations, standardized incidence ratios (SIRs) also were calculated. RESULTS: Latino populations had overall lower incidence for all cancers combined and the four leading cancers (breast, prostate, lung and colorectal) than non-Hispanic populations, however, cancers of lesser impact in non-Hispanic populations (liver, gallbladder, stomach, penis and cervix) were more commonly diagnosed among Latinos. CONCLUSIONS: Understanding the patterns of cancer incidence in this diverse racial/ethnic minority group can serve to both stimulate research into the unique behaviors, exposures and genetics that drive cancer risk among Latinos and to direct prevention and control efforts tailored to this population.

Black or African American↗

PubMed2005

Annual report to the nation on the status of cancer, 1975-2002, featuring population-based trends in cancer treatment.

BACKGROUND: The American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR) collaborate annually to provide information on cancer rates and trends in the United States. This year's report updates statistics on the 15 most common cancers in the five major racial/ethnic populations in the United States for 1992-2002 and features population-based trends in cancer treatment. METHODS: The NCI, the CDC, and the NAACCR provided information on cancer cases, and the CDC provided information on cancer deaths. Reported incidence and death rates were age-adjusted to the 2000 U.S. standard population, annual percent change in rates for fixed intervals was estimated by linear regression, and annual percent change in trends was estimated with joinpoint regression analysis. Population-based treatment data were derived from the Surveillance, Epidemiology, and End Results (SEER) Program registries, SEER-Medicare linked databases, and NCI Patterns of Care/Quality of Care studies. RESULTS: Among men, the incidence rates for all cancer sites combined were stable from 1995 through 2002. Among women, the incidence rates increased by 0.3% annually from 1987 through 2002. Death rates in men and women combined decreased by 1.1% annually from 1993 through 2002 for all cancer sites combined and also for many of the 15 most common cancers. Among women, lung cancer death rates increased from 1995 through 2002, but lung cancer incidence rates stabilized from 1998 through 2002. Although results of cancer treatment studies suggest that much of contemporary cancer treatment for selected cancers is consistent with evidence-based guidelines, they also point to geographic, racial, economic, and age-related disparities in cancer treatment. CONCLUSIONS: Cancer death rates for all cancer sites combined and for many common cancers have declined at the same time as the dissemination of guideline-based treatment into the community has increased, although this progress is not shared equally across all racial and ethnic populations. Data from population-based cancer registries, supplemented by linkage with administrative databases, are an important resource for monitoring the quality of cancer treatment. Use of this cancer surveillance system, along with new developments in medical informatics and electronic medical records, may facilitate monitoring of the translation of basic science and clinical advances to cancer prevention, detection, and uniformly high quality of care in all areas and populations of the United States.

Age Distribution↗

PubMed2005

Women with multiple primary breast cancers diagnosed within a five year period, 1994-1998.

INTRODUCTION: Women diagnosed with a primary breast cancer are at higher risk for a second primary. Few studies have focused on a comparison of women with single breast primary cancers and women with multiple primary breast cancers. The 1994-1998 NAACCR dataset aggregated from high quality registries representing more than one-third of the US population provides a unique opportunity to examine the incidence of multiple primary breast cancers in a large population. MATERIALS AND METHODS: Using this multi-registry dataset, we describe the incidence pattern of malignant synchronous (within 2 months) and short-term metachronous (from 3 to 60 months) multiple primaries and single primary breast cancers by demographic and tumor characteristics. RESULTS: Synchronous multiple primary tumors were more similar in age, stage, and tumor grade to single breast tumors than they were to short-term metachronous tumors. The short-term metachronous tumors did not resemble either the synchronous tumors or the single primaries. DISCUSSION: These findings may indicate that while synchronous multiple primaries may have treatment implications different from single primaries, their etiology may be similar to single breast primaries. Further, they may actually be multi-centric single primaries. The two-month interval between multiple primaries is arbitrary and may not distinguish between the synchronous tumors and those occurring within 12 months of the index tumor. The rules for defining and counting breast primaries have implications for interpretation of incidence rates and temporal trends. These data also suggest the need for standard definitions for multiple primary breast tumors among clinicians, pathologists, and surveillance epidemiologists.

Adolescent↗

PubMed2005

Racial and ethnic disparities in breast cancer rates by age: NAACCR Breast Cancer Project.

OBJECTIVE: To examine age-specific rates of breast cancer incidence among racial and ethnic groups in the United States. METHODS: Subjects were 363,801 women diagnosed with invasive breast cancer diagnosed during 1994--1998 and reported in the North American Association of Central Cancer Registries (NAACCR) data set. Variables analyzed included race, ethnicity, 5-year age group (from 10 years through 85+years), and stage at time of diagnosis (localized, regional, distant). Incidence rates per 100,000 women were calculated for each 5--year age group and stratified by stage. Rate ratios and 95% confidence intervals were calculated by comparing each racial group with whites and Hispanics with non-Hispanics. RESULTS: Black women experience significantly higher breast cancer incidence up to the age of 40 years and significantly lower incidence after age 50 compared with white women of the same ages. This is called the 'crossover' effect. This shifting burden of higher incidence occurs at ages 35--39 for localized stage and at ages 55--59 for regional stage. For distant stage, black women of all ages experience higher incidence compared with white women. Similar crossover effects do not exist for American Indian (AI) or Asian/Pacific Islander (API) women compared with white women. Both AI and API women have significantly lower incidence of breast cancer compared with white women, and Hispanic women have significantly lower incidence compared with non-Hispanic women. CONCLUSIONS: This study highlights racial and ethnic differences in breast cancer incidence rates among US women. The crossover effect between black and white women, particularly the lower incidence of localized stage disease diagnosed in older black women, is a significant phenomenon that may be associated with screening practices, and has implications for public health planning and cancer control initiatives to reduce racial/ethnic disparities.

Adolescent↗

PubMed2005

A national framework for cancer surveillance in the United States.

Enhancements to cancer surveillance systems are needed for meeting increased demands for data and for developing effective program planning, evaluation, and research on cancer prevention and control. Representatives from the American Cancer Society, Centers for Disease Control and Prevention, National Cancer Institute, National Cancer Registrars Association, and North American Association of Central Cancer Registries have worked together on the National Coordinating Council for Cancer Surveillance to develop a national framework for cancer surveillance in the United States. The framework addresses a continuum of disease progression from a healthy state to the end of life and includes primary prevention (factors that increase or decrease cancer occurrence in healthy populations), secondary prevention (screening and diagnosis), and tertiary prevention (factors that affect treatment, survival, quality of life, and palliative care). The framework also addresses cross-cutting information needs, including better data to monitor disparities by measures of socioeconomic status, to assess economic costs and benefits of specific interventions for individuals and for society, and to study the relationship between disease and individual biologic factors, social policies, and the environment. Implementation of the framework will require long-term, extensive coordination and cooperation among these major cancer surveillance organizations.

American Cancer Society↗

PubMed2004

Annual report to the nation on the status of cancer, 1975-2001, with a special feature regarding survival.

BACKGROUND: The American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR) collaborate annually to provide updated information regarding cancer occurrence and trends in the U.S. This year's report features a special section on cancer survival. METHODS: Information concerning cancer cases was obtained from the NCI, CDC, and NAACCR and information concerning recorded cancer deaths was obtained from the CDC. The authors evaluated trends in age-adjusted cancer incidence and death rates by regression models and described and compared survival rates over time and across racial/ethnic populations. RESULTS: Incidence rates for all cancers combined decreased from 1991 through 2001, but stabilized from 1995 through 2001 when adjusted for delay in reporting. The incidence rates for female lung cancer decreased (although not statistically significant for delay adjusted) and mortality leveled off for the first time after increasing for many decades. Colorectal cancer incidence rates also decreased. Death rates decreased for all cancers combined (1.1% per year since 1993) and for many of the top 15 cancers occurring in men and women. The 5-year relative survival rates improved for all cancers combined and for most, but not all, cancers over 2 diagnostic periods (1975-1979 and 1995-2000). However, cancer-specific survival rates were lower and the risk of dying from cancer, once diagnosed, was higher in most minority populations compared with the white population. The relative risk of death from all cancers combined in each racial and ethnic population compared with non-Hispanic white men and women ranged from 1.16 in Hispanic white men to 1.69 in American Indian/Alaska Native men, with the exception of Asian/Pacific Islander women, whose risk of 1.01 was similar to that of non-Hispanic white women. CONCLUSIONS: The continued measurable declines for overall cancer death rates and for many of the top 15 cancers, along with improved survival rates, reflect progress in the prevention, early detection, and treatment of cancer. However, racial and ethnic disparities in survival and the risk of death from cancer, and geographic variation in stage distributions suggest that not all segments of the U.S. population have benefited equally from such advances.

American Cancer Society↗

PubMed2004

Variation in breast cancer counts using SEER and IARC multiple primary coding rules.

OBJECTIVE: To determine breast cancer case counts, on a given data set, using both Surveillance, Epidemiology, and End Results (SEER) program and International Agency for Research on Cancer (IARC) multiple primary coding rules and to describe differences, if any, by age at diagnosis, histology, stage at diagnosis, laterality, and grade. METHODS: SEER and IARC multiple primary coding rules were applied to a dataset provided by the North American Association of Central Cancer Registries. Only registries whose data met high quality data standards for the time period studied (1994-1998) and whose permission was obtained were included. Percentage differences were calculated using IARC counts as the base. RESULTS: Using IARC multiple primary rules resulted in 2.4% fewer cases. Among females, the highest percent changes by category were: age group - 80-84 year-olds (3.4%); histology - inflammatory breast cancer (4.6%); stage - distant (3.1%); grade - well differentiated (3.0%). Among males, the highest percent changes by category were: age group - 80-84 year-olds (1.7%); histology - for intraductal and lobular breast carcinoma in combination (4.8%); stage - distant (3.0%); grade - well differentiated (1.8%). Overall differences were generally unaffected when examined by laterality. CONCLUSION: Breast cancer case counts are dependent on the multiple primary coding rules used.

Age Factors↗

PubMed2004

The incidence of malignant non-carcinomas of the female breast.

OBJECTIVE: Demographic and tumor characteristics of all malignant non-carcinomas of the breast, including the lymphomas and myelomas, are the focus of this investigation. METHODS: Twenty-six US population-based registries identified 363,801 newly diagnosed malignant breast cancers among women during the time period 1994-1998. Of these, 4625 (1.3%) were reported simply as cancer, NOS; 357,775 (98.3%) were of epithelial origin (carcinomas or adenocarcinomas); and the remaining 1401 (0.4%) were non-epithelial in origin. All but nine of the non-epithelial breast cancers were some form of soft tissue sarcoma. RESULTS: The most common non-epithelial cancer was malignant phyllodes tumor, which accounted for 61% of these diagnoses. In addition to the 363,801 malignant cancers classified to the breast, another 613 tumors arose in the breast but were classified as myelomas or lymphomas; two as solitary myelomas, two as Hodgkin lymphoma and the remaining 609 as non-Hodgkin lymphoma. PRINCIPAL CONCLUSIONS: The median age of females with a non-epithelial cancer (53) was 10 years younger than that of women with an epithelial cancer. The age-adjusted incidence rate per 100,000 females was 0.51 for non-epithelial cancers compared to 127.05 for epithelial cancers. Adding the myelomas and lymphomas, which are traditionally included with the hematopoietic cancers, to the incidence rates for breast cancer would increase the rate by less than 0.2 per 100,000.

Adult↗

PubMed2004

Association between breast cancer laterality and tumor location, United States, 1994-1998.

OBJECTIVE: Cancer is more likely to be diagnosed in the left breast than the right, but the reasons are undetermined. Left-sided predominance has not been evaluated for some demographic groups or by tumor location. METHODS: Laterality was analyzed among 419,935 incident unilateral breast cancers from 26 population-based cancer registries covering 40% of the US population. Logistic regression assessed the independent contribution of race, ethnicity, age, histology, stage, and location to laterality. RESULTS: Breast cancer was about 5% more likely to be diagnosed in the left breast than the right, a finding that was generally consistent across demographic groups and tumor types. Left-sided predominance was evident among both younger (<45 years) and older women, and among men with either in situ or invasive disease. Among women, tumors in the upper-outer quadrant, where one-third of cancers are located, occurred with equal frequency in the left and right breast, while those in the lower quadrants were about 10% more likely to occur in the left breast. CONCLUSION: The observation that the left breast is at greater risk of cancer than the right may not apply to tumors arising in the upper-outer quadrant. The identification of physiologic, pathologic, or immunologic differences between the lower, but not upper, left and right breasts may assist in explaining breast cancer laterality.

Adolescent↗

PubMed2003

Annual report to the nation on the status of cancer, 1975-2000, featuring the uses of surveillance data for cancer prevention and control.

BACKGROUND: The American Cancer Society, the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR) collaborate annually to update cancer rates and trends in the United States. This report updates statistics on lung, female breast, prostate, and colorectal cancers and highlights the uses of selected surveillance data to assist development of state-based cancer control plans. METHODS: Age-adjusted incidence rates from 1996 through 2000 are from state and metropolitan area cancer registries that met NAACCR criteria for highest quality. Death rates are based on underlying cause-of-death data. Long-term trends and rates for major racial and ethnic populations are based on NCI and CDC data. Incidence trends from 1975 through 2000 were adjusted for reporting delays. State-specific screening and risk factor survey data are from the CDC and other federal and private organizations. RESULTS: Cancer incidence rates for all cancer sites combined increased from the mid-1970s through 1992 and then decreased from 1992 through 1995. Observed incidence rates for all cancers combined were essentially stable from 1995 through 2000, whereas the delay-adjusted trend showed an increase that had borderline statistical significance (P =.05). Increases in the incidence rates of breast cancer in women and prostate cancer in men offset a long-term decrease in lung cancer in men. Death rates for all cancer sites combined decreased beginning in 1994 and stabilized from 1998 through 2000, resulting in part from recent revisions in cause-of-death codes. Death rates among men continued to decline throughout the 1990s, whereas trends in death rates among women were essentially unchanged from 1998 through 2000. Analysis of state data for the leading cancers revealed mixed progress in achieving national objectives for improving cancer screening, risk factor reduction, and decreases in mortality. CONCLUSIONS: Overall cancer incidence and death rates began to stabilize in the mid- to late 1990s. The recent increase in the delay-adjusted trend will require monitoring with additional years of data. Further reduction in the burden of cancer is possible but will require the continuation of strong federal, state, local, and private partnerships to increase dissemination of evidence-based cancer control programs to all segments of the population.

Age Distribution↗

PubMed2003