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Biomedical subjects

S L Glaser

Publications and source records attributed to S L Glaser.

At least 19 recordsLinked to original sources
PubMed2001

Expert review of the diagnosis and histologic classification of Hodgkin disease in a population-based cancer registry: interobserver reliability and impact on incidence and survival rates.

BACKGROUND: The reliability of Hodgkin disease (HD) diagnosis and histologic classification is an ongoing concern but has not been evaluated in a population-based case series in 20 years. Yet, diagnostic error in cancer registry data used in surveying HD occurrence may produce statistics that misrepresent incidence, mortality, or survival. METHODS: Uniform pathology review was attempted for all 395 women ages 19--79 years with incident HD reported to a population-based cancer registry in 1988--94. Agreement between original registry and review diagnoses was measured with positive predictive values and kappa statistics. Incidence rates and survival probabilities were computed based on registry and review diagnoses. RESULTS: Registry and review diagnosis agreed for 245 of the 362 reviewed cases. Positive predictive values varied by histologic subtype (nodular sclerosis, 95%; lymphocyte predominance, 69%; mixed cellularity, 58%; lymphocyte depletion, 0%; not otherwise specified, 40%), but agreement was good overall (kappa, 0.66, 95% confidence interval, 0.56--0.76). Eleven patients were determined not to have HD; all were older than age 44 years. Hodgkin disease incidence rates differed for original and review diagnoses only in older women, for whom registry rates slightly overestimated incidence. Five-year survival rates did not differ for registry and review data overall or by age group. CONCLUSIONS: For most adult women patients, the diagnosis of HD was confirmed on review, reflecting the very good agreement between registry and review diagnoses for nodular sclerosis, the most common subtype. Thus, cancer registry statistics for this time period can provide accurate estimates of disease patterns for HD overall and for the nodular sclerosis variant. For other histologic subtypes, rates may be unreliable, and HD occurrence overall may be less dependable in populations with larger proportions of these subtypes.

Adult↗
PubMed2001

Epstein-Barr virus and survival after Hodgkin disease in a population-based series of women.

BACKGROUND: Epstein-Barr virus (EBV) positive Hodgkin disease (HD), as defined by the presence of EBV genes or gene products in the malignant cells, differs epidemiologically from EBV negative HD. However, survival patterns for EBV-defined HD have not been well studied. To determine if EBV status influenced survival time after HD, the authors investigated a large, population-based series of female patients. METHODS: For 311 female patients living in the Greater San Francisco Bay Area who were aged 19-79 years with HD diagnosed between mid-1988 and 1994, histopathologically rereviewed archived biopsy specimens were assayed for EBV with immunohistochemistry and in situ hybridization. The 53 subjects with EBV positive and the 258 with EBV negative HD were observed for vital status through 1998; overall survival was analyzed with Kaplan-Meier and Cox proportional hazards regression methods. RESULTS: Epstein-Barr virus positive HD patients were older, received diagnosis at a later stage, and were less likely to have nodular sclerosis histology than EBV negative patients. Deaths were reported for 21 (40%) EBV positive and 37 (14%) EBV negative patients. No survival differences were observed between EBV positive and negative women aged 19-44 years, but survival was significantly poorer in women aged 45-79 years with EBV positive HD. Regression analysis confirmed this strong negative effect of EBV positive status on survival (hazard ratio for death, 3.0; 95% confidence interval, 1.5-6.2) as unrelated to age, stage at diagnosis, or tumor histology. CONCLUSIONS: This study found a marked survival disadvantage for EBV positive HD in older but not young adult women. These findings suggest influences of both EBV status and age on HD survival, as well as pathogenesis.

Adult↗
PubMed2001

Age-specific survival after Hodgkin's disease in a population-based cohort (United States).

OBJECTIVE: To examine risk factors for disease-specific survival in young and older adults diagnosed with Hodgkin's disease (HD) in a representative case series of adequate size for detecting effect modification by age group. METHODS: For 5630 young adults (ages 15-44) and 2424 older adults (ages 45 and older) diagnosed with HD and reported to the population-based Surveillance, Epidemiology, and End Results program of the National Cancer Institute between 1983 and 1995, Kaplan-Meier survival curves were constructed and Cox proportional hazards regression used to evaluate the influences of age, sex, race/ethnicity, histologic subtype, Ann Arbor stage at diagnosis, and calendar year on hazard of disease-specific death. RESULTS: The effects of most previously studied risk factors for HD death were different for young and older adults. Age was not associated with disease-specific survival in young adults, but in older adults, 1-year increases in age elevated the relative hazard of HD death by 4 6%. Male sex was related to outcome in young but not older adults, and Ann Arbor stage and B-symptom status exhibited markedly different relationships to survival by age. Older adult patients with and without B-symptoms had different hazards of mortality and had to be assessed separately. CONCLUSIONS: Factors associated with disease-specific survival were different for young and older adults with HD. These findings provide further support for two etiologically and clinically distinct disease entities.

Adolescent↗
PubMed2001

Epidemiologic trends in HIV-associated lymphomas.

Infection with HIV increases the risk of developing non-Hodgkin lymphoma and, to a lesser extent, Hodgkin disease. The introduction of highly active antiretroviral therapy (HAART) in 1996 changed the natural history of HIV disease, but the HIV-infected population also has changed in composition. Accordingly, the epidemiology of HIV-associated lymphomas now differs from that observed in the first 15 years of the HIV epidemic. In populations with access to HAART, reductions in lymphoma risk have been reported for NHL and suggested for Hodgkin disease, but long-term risks are as yet unknown. Lymphomas are increasingly common cancers in persons with HIV and are fatal in most patients, warranting continued attention to their incidence and etiology.

Antiretroviral Therapy, Highly Active↗
PubMed2000

Epstein-barr virus-associated malignancies: epidemiologic patterns and etiologic implications.

Epstein-Barr virus (EBV), a ubiquitous B-lymphotrophic herpesvirus, has been found in the tumor cells of a heterogeneous group of malignancies (Burkitt's lymphoma, lymphomas associated with immunosuppression, other non-Hodgkin's lymphomas, Hodgkin's disease, nasopharyngeal carcinoma, gastric adenocarcinoma, lymphoepithelioma-like carcinomas, and immunodeficiency-related leiomyosarcoma). As the epidemiologic characteristics of these cancers have not been considered together, this review seeks to relate their incidence patterns and risk factors to EBV biology and virus-host interaction in an attempt to help elucidate factors involved in EBV-related carcinogenesis. We include a brief review of EBV virology and primary infection to provide a biologic context for considering the epidemiology, summarize the most salient epidemiologic features of each malignancy, synthesize epidemiologic data by risk factor to uncover commonalities and informative contrasts across the diseases, and propose hypotheses regarding etiologic mechanisms, based on the possible effect of the risk factors at various stages in the viral life cycle.

Animals↗
PubMed1999

Comparison of methods for classifying Hispanic ethnicity in a population-based cancer registry.

The accuracy of ethnic classification can substantially affect ethnic-specific cancer statistics. In the Greater Bay Area Cancer Registry, which is part of the Surveillance, Epidemiology, and End Results (SEER) Program and of the statewide California Cancer Registry, Hispanic ethnicity is determined by medical record review and by matching to surname lists. This study compared these classification methods with self-report. Ethnic self-identification was obtained by surveying 1,154 area residents aged 20-89 years who were diagnosed with cancer in 1990 and were reported to the registry as being Hispanic or White non-Hispanic. Predictive value positive, sensitivity, and relative bias were used to assess the accuracy of Hispanic classification by medical record and surname. Among those persons classified as Hispanic by either or both of these sources, only two-thirds agreed (predictive value positive = 66%), and many self-identified Hispanics were classified incorrectly (sensitivity = 68%). Classification based on either medical record or surname alone had a lower sensitivity (59% and 61%, respectively) but a higher predictive value positive (77% and 70%, respectively). Ethnic classification by medical record alone resulted in an underestimate of Hispanic cancer cases and incidence rates. Bias was reduced when medical records and surnames were used together to classify cancer cases as Hispanic.

California↗
PubMed1998

Absence of Epstein-Barr virus EBER-1 transcripts in an epidemiologically diverse group of breast cancers.

Epstein-Barr virus (EBV), a ubiquitous herpesvirus associated with certain lymphomas and carcinomas, has been identified within the malignant cells of a small proportion of breast tumors. As breast cancer is a very common malignancy in women, a pathogenetic role of EBV for even a subgroup of patients could have important implications for etiology and prevention. Therefore, we attempted to confirm the EBV-breast cancer association by exploring it in a representative case series stratified by characteristics that modify breast cancer risk. We studied a sample of 97 female and 28 male patients identified from a US population-based cancer registry. Patients were selected randomly within age, sex, ethnicity and tumor estrogen-receptor status groups. With their archived tumor tissues, we examined EBV presence using in situ hybridization for the EBER-1 transcript. In the 107 technically adequate specimens, we did not detect this viral transcript in any tumors, including one from a woman who also had an EBER-positive nasopharyngeal carcinoma. Our uniformly negative findings are extremely unlikely to have occurred by chance and cannot be attributed to selective sampling, as our study group included persons at diverse risk for breast cancer. We conclude that the EBV EBER-1 transcript is not commonly expressed in breast cancer, based on a broadly representative case series, though we cannot exclude an association of EBV within a particular population subgroup.

Adult↗
PubMed1998

Adjustment of cancer incidence rates for ethnic misclassification.

Although ethnic population counts measured by the United States Census are based on self-identification, the same is not necessarily true of cases reported to cancer registries. The use of different ethnic classification methods for numerators and denominators may therefore lead to biased estimates of cancer incidence rates. The extent of such misclassification may be assessed by conducting an ethnicity survey of cancer patients and estimating the proportion misclassified using double sampling models that account for sample stratification. For two ethnic categories, logistic regression may be used to model self-identified ethnicity as a function of demographic variables and the fallible classification method. Incidence rates then may be adjusted for misclassification using regression results to estimate the number of cancer cases of a given age, sex, and site in each self-identified ethnic group. An example is given using this method to estimate ethnic misclassification of San Francisco Bay area Hispanic cancer patients diagnosed in 1990. Results suggest that the number of cancer cases reported as Hispanic is an underestimate of the number of cases self-identified as Hispanic, resulting in an underestimate of Hispanic cancer rates.

Data Interpretation, Statistical↗
PubMed1998

Accuracy of racial classification of Vietnamese patients in a population-based cancer registry.

Racial classification of Asian subgroups is increasingly important for health statistics, given the growing Asian-American populations. This study reports the reliability of racial classification of Vietnamese in population-based cancer registry data from northern California. From the Greater Bay Area Cancer Registry, we selected 2240 persons diagnosed with cancer in 1989-1992 and whom the registry considered Vietnamese by birthplace and/or registry race and/or surname, or who were Southeast Asian or Chinese by race. One thousand ninety persons (49%) were interviewed. Sensitivity and predictive value positive, and cancer incidence rates, were calculated using different combinations of the classification factors (birthplace, registry race, and name). By registry-reported race alone, 74% of those the registry classified as Vietnamese agreed with this classification on interview, while 90% of those identifying themselves as Vietnamese were so classified. With classification based on 2 of 3 factors, 78% of those classified as Vietnamese agreed, and 91% of self-reported Vietnamese were correctly classified. Misclassification was associated with age, sex, year of immigration, education, and language use. Registry-based annual age-adjusted all-site cancer incidence rates per 100,000 for Vietnamese were 287.7 for males and 221.3 for females. Rates adjusted for self-reported ethnicity were 242.8 (male) and 213.7 (female). Registry classification of Vietnamese is currently problematic. Approximately 20% of cancer cases classified as Vietnamese are probably not Vietnamese. The higher incidence rates for Vietnamese in the United States than in Vietnam partly may reflect such classification error.

Adult↗
PubMed1997

Epstein-Barr virus-associated Hodgkin's disease: epidemiologic characteristics in international data.

Hodgkin's disease (HD) has long been suspected to have an infectious precursor, and indirect evidence has implicated Epstein-Barr virus (EBV), a ubiquitous herpesvirus, as a causal agent. Recent molecular studies using EBER in situ hybridization or latency membrane protein-I (LMP-I) immunohistochemistry have identified EBV latent infection in up to 50% of HD tumors. However, the epidemiologic features of these cases have not been examined in detail. To explore the epidemiology of EBV-positive HD so as to understand the role of EBV in HD etiology more clearly, this project accumulated patient data from 14 studies that had applied these EBV assays to HD tumors. With information on age at diagnosis, sex, ethnicity, histologic subtype, country of residence, clinical stage and EBV tumor status from 1,546 HD patients, we examined risk for EBV-positive disease using logistic regression. Forty percent of subjects had EBV-positive tumors, and EBV prevalence varied significantly across groups defined by the study variables. Odds ratios (OR) for EBV-associated HD were significantly elevated for Hispanics vs. whites (OR = 4.1), mixed cellularity vs. nodular sclerosis histologic subtypes (OR = 7.3, 13.4, 4.9 for ages 0-14, 15-49, 50+ years), children from economically less-developed vs. more-developed regions and young adult males vs. females (OR = 2.5). These findings suggest that age, sex, ethnicity and the physiologic effects of poverty may represent biologic modifiers of the EBV association and confirm that this association is strongly but variably linked to histologic subtype. The data augment biologic evidence that EBV is actively involved in HD pathogenesis in some cases but describe epidemiologic complexity in this process.

Adolescent↗
PubMed1997

Predictors of misclassification of Hispanic ethnicity in a population-based cancer registry.

PURPOSE: Hispanic ethnicity is often used as a category for calculating population-based rates or assessing risk of epidemiologic studies. However, ethnic misclassification can lead to false conclusions unless the extent of misclassification and the characteristics of those misclassified are understood. METHODS: This study explored determinants of ethnic misclassification in a sample of 1154 cancer cases in the San Francisco-Oakland cancer registry, where ethnic classification is based on surname or medical record report. We compared the following: correctly classified Hispanics, persons classified as Hispanic who self-identified as non-Hispanic, and persons classified as non-Hispanic who self-identified as Hispanic. RESULTS: Among men classified as Hispanic, those most likely to self-identify as non-Hispanic did not speak Spanish, had non-Spanish surnames, and were recent immigrants. Women misclassified as Hispanic did not speak Spanish or have Spanish maiden names, nor did they have mothers with Spanish maiden names. Persons who called themselves Hispanic, but were misclassified by the registry, were likely to be non-Spanish speaking college-education males. CONCLUSIONS: Researchers using ethnicity should be aware of how ethnicity was determined and how this classification may bias or confound their results.

Adult↗
PubMed1996

The epidemiology of Hodgkin's disease.

Much of the epidemiological heterogeneity of HD incidence reflects the behaviour of the NS subtype, at least in the USA. Incidence variation across races (except Asians) and time periods is most marked in this subtype. In young adults with HD, there is compelling evidence for social class modification of risk consistent with an infectious aetiology; limited data suggest that this effect occurs within the NS subtype, but considerable evidence indicates that it does not primarily involve EBV infection. Findings from familial aggregation studies and HLA associations point to inherited susceptibility to this subtype. Despite little sex difference for NS in young adulthood in the latest incidence data, parity nevertheless appears to be protective against this subtype for women. Therefore, the greater increase for females than males in the incidence of young-adult NS in recent years may reflect the impact of population trends towards later childbearing and lower parity. This change, as well as the concomitant smaller family sizes and growing affluence, could explain part of the burgeoning incidence of NS in young adults in the USA. These observations suggest that NS in young adults constitutes a separate disease, probably of infectious origin. The incongruous occurrence of this subtype in older adults, and the presence of EBV in some NS cases, could reflect heterogeneity within NS, for example, representing features of the cellular phase of NS (Cozen et al, 1992; Medeiros and Greiner, 1995). For the non-NS subtypes, many of the factors that predict risk of NS may also be relevant. Patterns of social class determinants in children and older adults, the age groups at risk for MC, support involvement of an infectious precursor given intense exposure, and EBV is a likely candidate, based on its high prevalence in these groups. However, little aetiological research has been directed explicitly at the non-NS subtypes. Considerable effort has gone into exploring an infectious aetiology of HD. Recently, this line of investigation has moved beyond social class determinants to molecular epidemiological studies of EBV and, to a lesser degree, other potentially involved viruses. The roles of genetic susceptibility and sex hormones also represent promising areas for exploration, particularly in their possible interaction with infectious agents and other environmental factors. Ultimately, clearer epidemiological understanding of HD will be aided by more precise classification of this disease at the molecular level.

Adult↗
PubMed1995

Biologic sex as a risk factor for Helicobacter pylori infection in healthy young adults.

Diseases associated with Helicobacter pylori infection, such as peptic ulcer disease and gastric cancer, afflict men more frequently than women. No study, however, has demonstrated any difference in sex-specific rates of H. pylori infection. In a healthy population undergoing multiphasic health evaluations in 1992-1993 as members of the Kaiser Permanente Medical Care Program of Northern California, adults aged 20-39 years were screened for antibodies to H. pylori infection using a serum enzyme-linked immunosorbent assay and were surveyed with regard to their demographic characteristics and health practices. Among 556 African-American, Hispanic, and white men and women, male sex was a significant risk factor for infection. Other risk factors included African-American race and Hispanic ethnicity, increasing age, living with children, birth in a developing country, and lower levels of income and education. Men consistently had a higher prevalence of antibodies across all strata of race/ethnicity, age, education, and income, and in multivariate analysis male sex remained significantly associated with infection (odds ratio = 2.0, 95% confidence interval 1.2-3.1). African-American race, Hispanic ethnicity, increasing age, lower levels of education, and birth in a developing country were also associated with infection in multivariate analysis. Data from previously reported seroprevalence studies support a tendency for men to have a higher risk of infection. The higher prevalence of infection among young males as observed in Northern California may account in part for the increased incidence of H. pylori-related diseases among men in later decades of life.

Adult↗
PubMed1994

Reproductive factors in Hodgkin's disease in women: a review.

Understanding of Hodgkin's disease causes continues to be elusive. The prime etiologic candidate, Epstein-Barr virus, has been detected in only a proportion of cases, and there are few other active leads. Epidemiologic data reviewed here describe sex differences in Hodgkin's disease consistent with an involvement of reproductive and thus hormonal factors in its pathogenesis in women. This hypothesis has received very little research attention. Yet, the male predominance in incidence shows variation with age, particularly around the childbearing years, that is unusual for a malignancy. Indirect evidence relating Hodgkin's disease incidence to marital status, religion, and population parity trends demonstrates lower rates in women of presumed higher parity. Two studies that examined parity found strong but opposing associations with risk of Hodgkin's disease. The role of parity is difficult to interpret because of study design differences and the likelihood of confounding by social class. However, the incidence, clinical, and experimental findings, which should not be due to social class differences between men and women, are also compatible with a protective influence of reproductive experience in Hodgkin's disease in women. Prior infection with any ubiquitous virus seems unlikely to explain the sex differences in descriptive statistics. On the whole, the evidence suggests a role of hormonal factors in the pathogenesis of Hodgkin's disease, possibly operating through an effect on the immune system, and this hypothesis may prove fruitful to explore.

Adolescent↗
PubMed1991

Black-white differences in Hodgkin's disease incidence in the United States by age, sex, histology subtype and time.

Black-white differences in Hodgkin's disease (HD) occurrence have been reported in older US mortality statistics and in limited international data, suggesting either genetic or socioeconomic determinants of susceptibility. However, there has been no evaluation with reliable data of the interracial incidence patterns by age, sex, and histologic subtype, that are prerequisite to understanding the causes of such variation. This project utilized 15 years of recent, high quality, incidence data from well-defined black and white US populations to calculate age-, sex-, and histology-specific rates of HD by race over time. Rates were somewhat lower for blacks (N = 593) than whites (N = 8,541) of both sexes, except among young boys. For blacks, age-specific incidence curves were slightly bimodal, although less than for whites; the male excess of HD was larger; and rates among women were low at all ages. For each histology subtype, blacks had lower incidence than whites; however, for the first time, nodular sclerosis was found to be the most common variant for both races. Between 1969-74 and 1980-84, HD rates declined in whites over age 55 but increased in white young adult women; among blacks, rates decreased slightly for boys and young adult men, the latter likely due to improving population enumeration. These findings confirm some interracial differences noted previously in HD. For blacks, they also reveal an incipiently bimodal age incidence and more prominent nodular sclerosis subtype occurrence that support a strong role for environmental factors in racial variation of this lymphoma.

Adolescent↗
PubMed1990

Time trends in Hodgkin's disease incidence. The role of diagnostic accuracy.

A prior study of Hodgkin's disease (HD) incidence using national cancer survey data (1969-1980) identified unprecedented rate declines among white persons older than 40 years, and rate increases among young adults aged 15 through 39. These trends could be due to improved diagnostic accuracy. To investigate this hypothesis, the authors updated incidence rates in whites by age, sex, and histologic subtype through 1984; quantified diagnostic accuracy in corresponding detail using Repository Center for Lymphoma Clinical Studies data, which include original and expert review diagnoses on lymphoma patients; and recalculated HD incidence rates (1969-1984) corrected for diagnostic error. Updated HD incidence rates through 1984 continued to decline in older adults and showed persistent increases for young adults with the nodular sclerosis (NS) histologic subtype. The percentage of original HD diagnoses confirmed on review (confirmation rate) decreased with age and increased over time; in older adults, these patterns opposed observed incidence trends. However, for young adults, confirmation rates of NS, the most common subtype at these ages, were high and changed little over time. After adjustment for diagnostic error, incidence rates for older adults were lower than previously observed and showed no secular changes. However, young adults with NS had slightly larger rate increases than in uncorrected data. Thus, contemporary changes in HD incidence for whites primarily involve growing risk to persons at the start of adult life. These patterns are compatible with trends in suspected sociodemographic risk factors that suggest an infectious etiology for HD.

Age Factors↗