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S S Devesa

Publications and source records attributed to S S Devesa.

At least 37 records · Page 2Linked to original sources
PubMed1999

Using a mixed effects model to estimate geographic variation in cancer rates.

Commonly used methods for depicting geographic variation in cancer rates are based on rankings. They identify where the rates are high and low but do not indicate the magnitude of the rates nor their variability. Yet such measures of variability may be useful in suggesting which types of cancer warrant further analytic studies of localized risk factors. We consider a mixed effects model in which the logarithm of the mean Poisson rate is additive in fixed stratum effects (e.g., age effects) and in logarithms of random relative risk effects associated with geographic areas. These random effects are assumed to follow a gamma distribution with unit mean and variance 1/alpha, similar to Clayton and Kaldor (1987, Biometrics 43, 671-681). We present maximum likelihood and method-of-moments estimates with standard errors for inference on alpha -1/2, the relative risk standard deviation (RRSD). The moment estimates rely on only the first two moments of the Poisson and gamma distributions but have larger standard errors than the maximum likelihood estimates. We compare these estimates with other measures of variability. Several examples suggest that the RRSD estimates have advantages compared to other measures of variability.

Biometry↗
PubMed1998

Changing patterns in the incidence of esophageal and gastric carcinoma in the United States.

BACKGROUND: Incidence rates for esophageal adenocarcinoma previously were reported to be increasing rapidly, especially among white males. Rates for gastric cardia adenocarcinoma also were observed to be rising, although less rapidly. In this article, the authors update the incidence trends through 1994 and further consider the trends by age group. METHODS: Surveillance, Epidemiology, and End Results (SEER) program data were used to calculate age-adjusted incidence rates for esophageal carcinoma by histologic type and gastric adenocarcinoma by anatomic subsite. RESULTS: Among white males, the incidence of adenocarcinoma of the esophagus rose > 350% since the mid-1970s, surpassing squamous cell carcinoma around 1990. Rates also rose among black males, but remained at much lower levels. To a lesser extent, there were continuing increases in gastric cardia adenocarcinoma among white and black males, which nearly equaled the rates for noncardia tumors of the stomach in white men. The upward trend for both tumors was much greater among older than younger men. Although the incidence also rose among females, rates remained much lower than among males. CONCLUSIONS: Previously reported increases of esophageal adenocarcinoma are continuing, most notably among white males. Cigarette smoking may contribute to the trend through an early stage carcinogenic effect, along with obesity, which may increase intraabdominal pressure and predispose to gastroesophageal reflux disease. Further research into esophageal and gastric cardia adenocarcinoma is needed to clarify the risk factors and mechanisms responsible for the upward trends as well as the racial and gender disparities in incidence.

Adenocarcinoma↗
PubMed1998

Waldenström's macroglobulinemia: incidence patterns in the United States, 1988-1994.

BACKGROUND: There are few data describing the epidemiologic aspects of Waldenström's macroglobulinemia (WM), a rare lymphoplasmaproliferative disorder. METHODS: The authors evaluated the incidence of WM reported in 11 population-based cancer registries in the U.S. RESULTS: A total of 624 cases were diagnosed between January 1, 1988 (when WM became reportable) and December 31, 1994. Age-adjusted incidence rates for WM (per 1 million person-years at risk) were 3.4 among males and 1.7 among females. The rates increased sharply with age, from 0.1 at age < 45 years to 36.3 at age 75+ years (males) and from 0.1 at age < 45 years to 16.4 at age 75+ years (females). The rates for WM were comparable to those for hairy cell leukemia, but considerably lower than those for multiple myeloma or chronic lymphocytic leukemia. Some geographic variation was evident, with age-adjusted rates among white males ranging from 2.2-7.8 across registries. There was no significant change in rates over the 7-year study period (P > 0.05). The markedly higher rates for WM among whites than blacks stand in contrast to multiple myeloma, which occurs twice as often among blacks. CONCLUSIONS: This survey provides new data regarding the incidence patterns of WM in the U.S. However, further epidemiologic studies with biomarkers are needed to define the environmental, genetic, immunologic, and viral determinants of this rare but distinctive disorder.

Adult↗
PubMed1998

Rising incidence of biliary tract cancers in Shanghai, China.

Cancers of the biliary tract, including cancers of the gallbladder, extra-hepatic bile ducts, and ampulla of Vater, are relatively uncommon malignancies. From 1972 to 1994, biliary tract cancer was the most rapidly rising malignancy in Shanghai, China, with a 119% increase in men and 124% in women. The increase in incidence was seen for all 3 subsites, both sexes, and all age groups. Future studies are needed to identify reasons for the large increases in these rates.

Age Factors↗
PubMed1998

Contamination of poliovirus vaccines with simian virus 40 (1955-1963) and subsequent cancer rates.

CONTEXT: Poliovirus vaccine contaminated with live simian virus 40 (SV40), a macaque polyomavirus that is tumorigenic in rodents, was used extensively in the United States between 1955 and 1963. Simian virus 40 DNA has recently been detected in several rare human tumors, including ependymomas, osteosarcomas, and mesotheliomas. OBJECTIVE: To determine the risk of ependymoma, osteosarcoma, and mesothelioma among Americans who as children received SV40-contaminated poliovirus vaccine. DESIGN: Retrospective cohort study using data from the Surveillance, Epidemiology, and End Results program (1973-1993) and the Connecticut Tumor Registry (1950-1969), as well as national mortality statistics (1947-1973). SETTING: United States. PARTICIPANTS: Birth cohorts that were likely to have received SV40-contaminated poliovirus vaccine as infants, born 1956 through 1962 (60 811730 person-years of observation); as children, born 1947 through 1952 (46430953 person-years); or that were unexposed, born 1964 through 1969 (44959979 person-years). MAIN OUTCOME MEASURES: Relative risk (RR) of each cancer among exposed compared with unexposed birth cohorts. RESULTS: Age-specific cancer rates were generally low and were not significantly elevated in birth cohorts exposed to SV40-contaminated vaccine. Specifically, compared with the unexposed, the relative risk of ependymoma was not increased in the cohorts exposed as infants (RR, 1.06; 95% confidence interval [CI], 0.69-1.63), or as children (RR, 0.98; 95% CI, 0.57-1.69) nor did the exposed have an increased risk of all brain cancers. Osteosarcoma incidence also showed no relation to exposure as infants (RR, 0.87; 95% CI, 0.71-1.06) or children (RR, 0.85; 95% CI, 0.59-1.22). Last, mesotheliomas were not significantly associated with exposure, although the cohorts studied have not yet reached the age at which these tumors tend to occur. CONCLUSIONS: After more than 30 years of follow-up, exposure to SV40-contaminated poliovirus vaccine was not associated with significantly increased rates of ependymomas and other brain cancers, osteosarcomas, or mesotheliomas in the United States.

Adolescent↗
PubMed1998

Colorectal cancer incidence trends by subsite in urban Shanghai, 1972-1994.

Epidemiological characteristics of colorectal cancer may differ by particular anatomical subsite, suggesting that the subsite-specific colorectal cancers may represent different disease entities. This study explored the time trends over a 23-year period in colorectal cancer incidence at various subsites by sex and age group. Data on the incidence of colorectal cancer were obtained from a population-based cancer registry in Shanghai, People's Republic of China. Between 1972 and 1994, 30,693 patients with colorectal cancer were registered at the Shanghai Cancer Registry. The overall age-adjusted colorectal cancer incidence rates increased > 50%, or 2% per year from 1972-1977 to 1990-1994, from 14 to 22 per 100,000 among men and from 12 to 19 per 100,000 among women. The increases in rates were considerably more rapid for colon cancer, with rates approximately doubling, than they were for rectal cancer. Proximal colon cancer was more common than distal colon cancer over the whole study period, whereas rates for both cancers rose with similar annual percentage changes (> 5% per year) and across virtually all age groups. The estimated annual increases rose from 2% at ages 35-44 years to 7% at ages 75-84 years for proximal colon cancer, but they were more uniform for distal colon cancer (5-6% per year). Age-adjusted and age-specific rectal cancer rates changed little. The male:female age-adjusted rate ratio for colorectal cancer was 1.19 in 1990-1994. The ratios increased over time and varied by subsites, with ratios increasing from the proximal colon to the distal colon and to the rectum. Furthermore, men had higher rates than women for distal colon and rectal cancers at ages 55 and older, whereas women had higher rates than men at younger ages for these two cancers. Male:female rate ratios for proximal colon cancer did not vary substantially with age. The findings from this study indicate that subsite-specific incidence rates of colorectal cancer differ by sex and age and in their time trends. Cancers arising in the proximal colon, distal colon, and rectum may have somewhat different disease etiologies.

Adult↗
PubMed1997

Non-Hodgkin's lymphoma among people with AIDS: incidence, presentation and public health burden. AIDS/Cancer Study Group.

We describe the anatomic and histologic presentation and prognosis of non-Hodgkin's lymphoma (NHL) among people with AIDS (PWA) and determine their contribution to the NHL burden. We linked AIDS and cancer registries in selected areas of the United States and compared NHL sites and histologies in PWA and non-PWA, after adjusting for age, sex and ethnicity. Among 51,033 PWA, we found 2,156 cases of NHL (4.3%). Half of NHL cases occurring post-AIDS were not reported to AIDS registries. NHL was part of an AIDS-defining condition for 3.2% of all PWA; the relative risk of NHL with 3.5 years of another AIDS diagnosis was 165-fold compared to non-PWA within the cancer surveillance system. Of NHLs, 39% were high grade (vs. 12% among non-PWA), 60% were nodal (vs. 74% among non-PWA) and 15% had brain primaries (vs. 1% among non-PWA). Excluding brain sites, extranodal sites were still 20% more common than expected. Relative risk was elevated for all histologic types, with the risk ranging from 652-fold for high-grade diffuse immunoblastic tumors and 261-fold for Burkitt's lymphomas to 113 for intermediate-grade lymphoma to 14-fold for low-grade lymphoma. Survival among PWA with NHL was poor, and tumor grade had little impact. In high-risk AIDS areas, AIDS-related NHLs constitute a major share of the NHL burden. We conclude that NHL risk is considerably under-estimated in AIDS registry data. The major differences between PWA and non-PWA were the high frequency of brain lymphoma and the increase in high-grade lymphomas in PWA. However, the grade of NHL did not influence the prognosis among PWA with lymphoma. The increasing risk of NHL in PWA has contributed substantially to the general increase in NHL rates in the United States since 1981.

Adolescent↗
PubMed1997

The epidemiology of non-Hodgkin's lymphoma: comparison of nodal and extra-nodal sites.

International population-based cancer incidence data, coded according to the International Classification of Diseases for Oncology (WHO, 1990), were used to describe geographical patterns of incidence of extra-nodal non-Hodgkin's lymphomas. Incidence data from the USA were also used to describe age and sex distribution of lymphomas at different extranodal sites. The percentage of all non-Hodgkin's lymphomas coded as being of extra-nodal origin is between 25% and 35% in most countries, with the stomach, skin and small intestine being the most common extra-nodal sites. In general, the pattern of incidence rates for extra-nodal lymphomas tends to reflect that of other lymphomas. For example, the age incidence curve of each site-specific extra-nodal lymphoma is similar to that of nodal lymphomas, and in countries where total lymphoma incidence is high the incidence of lymphomas at each extra-nodal site also tends to be relatively high. Although specific factors are known to increase the risk of lymphomas at certain anatomical sites, these data suggest that the aetiology of extra-nodal lymphomas is not entirely independent from that of nodal lymphomas.

Adult↗
PubMed1997

Socioeconomic status and breast cancer mortality, 1989 through 1993: an analysis of education data from death certificates.

OBJECTIVES: This study examined whether more highly educated women were at greater risk of dying of breast cancer during 1989 through 1993. METHODS: Breast cancer mortality rates were calculated through death certificates and Current Population Survey data. RESULTS: Breast cancer mortality rates were highest among women with 12 and with 16 or more years of education. Non-Hispanic Black women had the highest mortality rates and Asian women the lowest. Positive relationships between mortality and education were found for Hispanic women as well as non-Hispanic Black and Asian women. CONCLUSIONS: The previously seen positive relationship between breast cancer mortality and education was found among US women of color but not non-Hispanic White women.

Breast Neoplasms↗
PubMed1996

Laterality of breast cancer in the United States.

Breast cancer laterality of over 250,000 cases from the Surveillance, Epidemiology, and End Results (SEER) program in the United States was studied in relation to gender, race, tumor stage, histology, age at diagnosis, year of diagnosis, estrogen receptor status, and marital status. The data, which include all invasive and in situ breast cancer cases in the SEER program during the years 1973-92, confirm results from other studies of an overall five percent excess of left-sided disease in women. The excess occurs for all races and stages of disease, and for invasive disease, the excess increases with age. There was no significant variation in the laterality of invasive disease over time, though for in situ tumors, the left-sided excess was significantly greater during the years 1978-82 than in other periods. No excess of left-sided breast cancer was observed among men. There is no evidence that detection bias plays a major role, and although the left breast is slightly larger, on average, than the right, there is little evidence that breast size is associated with breast cancer risk. The reason for the left-sided excess among women remains unclear.

Adolescent↗
PubMed1996

Underreporting and misclassification of urinary tract cancer cases on death certificates.

We compared the diagnoses for decreased cases with urinary tract cancer reported to the Surveillance, Epidemiology, and End Results (SEER) program with their underlying cause of death reported on death certificates. Deaths for a substantial proportion of cases were ascribed to noncancer causes (bladder, 48%; kidney, 28%; renal pelvis, 37%; and other urinary tract, 38%), which decreased with advancing stage at diagnosis and increased with length of survival. In general, cancer deaths were more likely to be recorded to the predominant subsite within an organ. Only 5.5% of renal pelvis cancer patients were recorded to have died of their illness, whereas 33.7% of their deaths were reported as due to kidney cancer. On the other hand, over 85% of urinary tract cancer deaths reported on the death certificates were confirmed by SEER diagnosis, although the extent of agreement varied by stage at diagnosis and age at death for kidney and renal pelvis cancers.

Adult↗
PubMed1995

Graphical presentation of trends in rates.

A variety of graphical approaches have been used to visually portray and analyze temporal trends, especially annual rates of change, in disease rates. In reviewing their own work, the authors have found that they could improve on their graphical presentations by choosing an arithmetic or logarithmic scale according to the research question being addressed, by selecting scaling ratios of the axes that allow one to detect specific rates of change, and by using uniform scaling ratios to facilitate comparisons across graphs. Different presentations of the same data can result in different impressions. The authors used rates over a 40-year period to illustrate the concepts involved and to investigate the portrayal of various rates of change. These principles extend to the plotting of odds ratios or relative risks, where the choice of an arithmetic rather than a logarithmic axis also can result in a misleading plot. The authors conclude that a graph should be designed and studied with care, clearly reflect the truth, convey information, and make a point without overemphasizing. For the particular problem addressed here, displaying temporal trends in disease rates, they see advantages in justifiable uniformity. Attention to plotting techniques in the epidemiologic and medical literature should be encouraged.

Epidemiologic Methods↗
PubMed1995

Recent cancer trends in the United States.

BACKGROUND: Cancer incidence rates have been reported to be increasing in the United States, although trends vary according to form of cancer. PURPOSE: We identify the cancers accounting for the rising incidence, quantify the changes that have occurred from the mid-1970s to the early 1990s, and contrast incidence and mortality trends to provide clues to the determinants of the temporal patterns. METHODS: Sex-, race-, and age-specific and age-adjusted incidence rates for the 5-year periods 1987-1991 versus 1975-1979 were calculated for 28 cancers among men and 30 cancers among women using data from the Surveillance, Epidemiology, and End Results (SEER) Program of cancer registration covering about 10% of the U.S. population. Similar rates were computed using national mortality data. Cancers were ranked according to the change in incidence rates over the two periods. RESULTS: Age-adjusted incidence rates for all cancers combined increased by 18.6% among males and 12.4% among females from 1975-1979 to 1987-1991, due largely to rising rates for prostate cancer among men and for breast and lung cancers among women. National mortality rates for all cancers combined rose less steeply, 3% and 6% among men and women, respectively, driven mostly by continuing increases in lung cancer mortality, while death rates for the majority of the cancers were steady or declining. Total cancer incidence rose at all ages, but with different tumors responsible for the increases at different ages: leukemia and brain/nervous system cancer among children; testicular cancer, nonmelanoma skin cancer (largely Kaposi's sarcoma), non-Hodgkin's lymphoma, and melanoma among young and middle-aged adults; and prostate, breast, and lung cancers among older individuals. In contrast, mortality rates for all cancers combined declined among both males and females under age 55 years, increasing only among older persons. CONCLUSIONS: Trends in cancer incidence and mortality differ. For most cancers, incidence rates are rising, while mortality rates are generally stable or declining. IMPLICATIONS: Much of the recent increase in cancer incidence can be explained by known factors. Improved detection appears to account for most of the increases in breast cancer among women and prostate cancer among men. On the other hand, cigarette smoking is the major determinant of the rise in lung cancer among women, acquired immunodeficiency syndrome has led to increases in non-Hodgkin's lymphoma and Kaposi's sarcoma among young and middle-aged men, and sunlight exposure patterns have affected the trends in melanoma. Some trends remain unexplained, however, and may reflect changing exposures to carcinogens yet to be identified and clarified.

Age Distribution↗
PubMed1995

Lung cancer.

BACKGROUND: Lung cancer is the most common cause of cancer death in the United States, and its incidence has been rising for at least 50 years. Shifts in histologic type and differences in sex and race distribution have accompanied the increased incidence of lung malignancies. METHODS: Population-based data regarding lung cancer reported to the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program for the 15-year period 1973-1987 were analyzed. RESULTS: Results indicate that from 1973-1977 to 1983-1987, the age-adjusted rates of lung cancer increased by 30%, with the gain markedly greater in women (70%) than in men (17%). The largest percentage increases in age-adjusted rates were observed for small cell carcinoma and adenocarcinoma (approximately 60% each), with a more modest change for squamous cell carcinoma (+ 14%). For squamous cell carcinoma, the age-adjusted rates increased substantially for black (65%) and white (70%) women and only slightly for black men (10%), whereas it decreased slightly in recent years for white men. CONCLUSIONS: In recent years, adenocarcinoma has replaced squamous cell carcinoma as the most frequent histologic subtype for all sexes and races combined. These shifts in histologic types by sex and race may be related to differences in exposure to tobacco products, dietary factors, environmental or occupational carcinogens, and host characteristics. Increased use of transbronchial and needle biopsy may have also influenced these trends to some extent. Over the study period, 5-year relative survival rate did not change appreciably for lung cancer, suggesting that therapeutic advances have had little effect.

Adolescent↗
PubMed1995

Patterns of occurrence of the leukaemias.

Despite a proliferation of epidemiological studies during the past two decades, aetiologies of the leukaemias remain poorly understood, and characterisation of descriptive patterns has been limited. Recent publications of international mortality and incidence data, along with the expanding U.S. database, make a comprehensive assessment of leukaemia patterns particularly timely. Total leukaemia mortality has dramatically declined among children and increased among the elderly, while incidence has declined somewhat (for Caucasian and African-American females) or remained stable (for African-American males) during the past two decades in the United States. Population-based 5-year relative survival for total leukaemia has risen substantially among children since the mid-1970s, and improved slightly among other age groups in the U.S., where survival is consistently higher among Caucasians than African-Americans, but differs little by gender. In a detailed assessment by leukaemia subtype, some important differences in geographic, racial/ethnic, age and trend patterns are identified, suggesting that the subtypes may have different aetiologic factors. Proven and suspected risk factors cannot explain more than a small fraction of the observed geographic and temporal variation in incidence. Several noteworthy subtype-specific characteristics or trends warrant further investigation: for acute lymphoid leukaemia (ALL), increasing incidence, with higher rates in Spanish and Latino populations; for chronic lymphoid leukaemia (CLL), declining incidence, with dramatically low rates among Asians; for acute myeloid leukaemia (AML), increasing incidence among African-American males; and for chronic myeloid leukaemia (CML), declining rates among Caucasian but not among African-Americans.

Acute Disease↗
PubMed1995

Cancer patterns among women in the United States.

The American Cancer Society estimated that 576,000 invasive cancers would be diagnosed among American women in 1994 and that 255,000 women will have died of cancer during that year. Six cancers account for almost 70% of the cases in women and more than 60% of the deaths. Risk factors associated with breast, lung, colorectal, cervix uteri, corpus uteri, and ovarian cancers are presented. The patterns of occurrence in the population, time trends, survival rates, and etiologic factors vary considerably, suggesting a constellation of diseases in women. One of the most important factors influencing outcome is early diagnosis.

Adult↗