Targeting the underserved for breast and cervical cancer screening: the utility of ecological analysis using the National Health Interview Survey.

Objectives: This study tested the utility of ecological variables created from the National Health Interview Survey (NHIS) for strategic targeting of health services for the underserved.

Methods: Ecological variables were created using the 1989-1991 survey years of the NHIS public use data files. Segments, the NHIS secondary sampling units, permit computation of secondary sampling characteristics by percentage Black, percentage Hispanic, percentage below poverty, percentage unemployed, median education, median income, median age, and percentage residing in the United States for 5 years or less.

Improving question wording in surveys of culturally diverse populations.

Purpose: The purpose of this paper is to briefly describe a theoretical model articulating cognitive theory and sources of potential response bias resulting from racial or ethnic cultural experience to survey questions that deal with health behavior. The theory components are then evaluated using questions obtained from national health surveys conducted by the National Center for Health Statistics and Centers for Disease Control and Prevention. The analysis explores the effects of four cognitive tasks involved in responding to questions as specified by the model: question interpretation, information retrieval from memory, judgment formation, and response editing.

Who participates in cardiovascular disease risk factor screenings? Experience with a religious organization-based program.

Adult members who declined participation in cardiovascular disease risk factor screenings offered at religious organizations were randomly selected and asked to participate in screenings at their homes. Relationships between screening participation and sociodemographic, behavioral, and physiological measures were examined. Age, knowledge of cardiovascular disease risk factors, body mass index, current smoking status, previous report of elevated blood pressure, current diastolic blood pressure measurement, frequency of worship service attendance, and residential distance from the religious organization screening site were important predictors of screening response.

Who in America is trying to lose weight?

Objectives: To describe the characteristics and weight-loss methods of persons who are trying to lose weight; to compare the knowledges and practices regarding weight loss between those persons trying to lose weight and those not trying to lose weight; and to evaluate trends in these knowledges and practices between 1985 and 1990.

Design: Large (approximately 120,000 persons per year), nationally representative random sample of the U.S.

Does cancer survival differ for older patients?

The relation of age to 5-year relative survival rates was examined for leading sites of cancer resulting in death among 127,554 patients; data from 1978 to 1982 were studied for four areas of the Surveillance, Epidemiology and End Results program of the National Cancer Institute. Overall and stage-stratified relative survival rates declined with advancing patient age for cancer of the lung, prostate, pancreas, bladder, oral cavity, uterus, cervix, ovary, and large bowel (women only). In men, this trend was not explained by age differences in stage of diagnosis, whereas, among women, age was associated with more advanced disease for most sites examined.

Stage at diagnosis in breast cancer: race and socioeconomic factors.

Cancer incidence data from three US metropolitan areas were coupled with census tract indicators of education and income. The data suggest that both Black and White cancer patients living in census tracts with lower median education/income values are diagnosed in later disease stages than are patients in tracts with higher median education/income values. Within education and income strata, Black women had a less favorable stage of disease at diagnosis than Whites.

Representativeness of the surveillance, epidemiology, and end results program data: recent trends in cancer mortality rates.

Background: Mortality, incidence, and survival rates are the primary measures used by the National Cancer Institute (NCI) to monitor cancer in the United States. The Surveillance, Epidemiology, and End Results (SEER) data system collects data on all cancers diagnosed among residents in geographically defined populations, which comprise about 10% of the U.S.

Projections of the incidence of non-Hodgkin's lymphoma related to acquired immunodeficiency syndrome.

Advances in antiretroviral therapy and treatment or prophylaxis against opportunistic infection have resulted in prolongation of the survival of patients with acquired immunodeficiency syndrome (AIDS). Previous research has demonstrated an association between AIDS and risk of non-Hodgkin's lymphoma (NHL). In addition to the approximately 3% of individuals found to have NHL at the time of AIDS onset, others continue to develop NHL following AIDS diagnosis.

Socioeconomic factors and cancer incidence among blacks and whites.

Findings from previous studies suggest that differences in socioeconomic status may be responsible for some, if not all, of the elevated incidence of cancer among blacks as compared with whites. Using incidence data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program, we tested this hypothesis by correlating black and white cancer incidence rates in three US metropolitan areas between 1978 and 1982 with data from the 1980 census on socioeconomic status within individual census tracts. The study analyzed data on the incidence of cancer at all sites combined (greater than 100 cancer sites) and at seven major sites separately.

Increasing incidence of cancers associated with the human immunodeficiency virus epidemic.

We examined data from San Francisco and other areas participating in the Surveillance, Epidemiology, and End Results (SEER) Program to determine the effect of the human immunodeficiency virus (HIV) epidemic on cancer incidence between 1973 and 1987. In this period, non-Hodgkin's lymphoma incidence has increased over 10-fold and Kaposi's sarcoma incidence has increased over 5000-fold in single San Francisco men 20 to 49 years of age. Increases in non-Hodgkin's lymphoma have been restricted to high-grade and diffuse large-cell (intermediate-grade) histological types.

Current status of prostate cancer in North American black males.

The National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program is used to examine the most recent data available to draw inferences about black and white males in the United States with prostate cancer. Findings include a continuing rise in the incidence of prostate cancer which, as of 1985 SEER data, is 50% higher in the black male population than in white males. With the exception of minor fluctuations over the last 17 years, the mortality rate for black males demonstrates an upward trend.

Rise in prostatic cancer incidence associated with increased use of transurethral resection.

We examined the association between prostatic cancer incidence rates and the rates of transurethral prostatectomy to explore reasons for the nationally reported dramatic increases in incidence rates of prostatic cancer from 1973 through 1986. There was a strong correlation between both incidence of all stages of prostatic cancer combined and of localized disease and the increasing use of transurethral resection, a common surgical procedure usually performed to relieve urinary obstruction due to benign enlargement of the prostate. Our analyses suggest that increased detection of existing tumors via transurethral resection was the primary reason for the observed increase in incidence rates of prostatic cancer.

The incidence of retinoblastoma in the United States: 1974 through 1985.

We have estimated the incidence of retinoblastoma in the United States from data available form the Surveillance, Epidemiology, and End Results program of the National Cancer Institute, Bethesda, Md (1974 through 1985). The larger number of cases available (220) compared with those of previous US population-based studies enabled us to evaluate change in incidence over time and to more precisely estimate incidence according to various demographic characteristics. The incidence of retinoblastoma has been almost uniform form 1974 to 1985.

Estimating cancer mortality rates from SEER incidence and survival data.

A method to estimate site-specific cancer mortality rates using Surveillance, Epidemiology, and End Results (SEER) Program incidence and survival data is proposed, calculated, and validated. This measure, the life table-derived mortality rate (LTM), is the sum of the product of the probability of being alive at the beginning of an interval times the probability of dying of the cancer of interest during the interval times the annual age-adjusted incidence rate for each year that data have been collected. When the LTM is compared to death certificate mortality rates (DCM) for organ sites with no known misclassification problems, the LTM was within 10 percent of the death certificate rates for 13 of 14 organ sites.

Person-years of life lost due to cancer in the United States, 1970 and 1984.

The number of deaths due to cancer in the United States reached an all-time high of 453,450 deaths in 1984 and, due to the dynamics of population growth, will continue to increase if the risk of dying from cancer does not change. Between 1970 and 1984, the total Person-Years of Life Lost (PYLL), the sum of the difference between the actual age at death and the expected remaining lifetime for each person who died of cancer, increased for most cancer sites as well as for all sites combined. In 1984, 6,881,281 person-years of life were lost due to cancer deaths, up from 5,303,668 in 1970.

Contribution of socioeconomic status to black/white differences in cancer incidence.

Blacks and Whites have very different cancer incidence rates for many sites, but this may largely be due to the racial differences in socioeconomic status (SES). The authors tested this hypothesis by determining the effect of adjustment for SES on the black/white incidence ratios for 12 cancer sites. Race-specific census tract-level SES variables (median family income, percent below poverty level, and years of education) were obtained from the 1980 US census and applied to approximately 20,000 black and 88,000 white cancer cases from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program for the years 1978 to 1982.

Population-based estimate of survival and determinants of prognosis in patients with mycosis fungoides.

Mycosis fungoides is the most common cutaneous lymphoma in the US, and it is increasing rapidly in both incidence and mortality. Our knowledge of its prognosis derives primarily from case series, which are subject to possible selection bias and other limitations. The current analysis examines trends in survival and prognostic factors in data from nine population-based cancer registries in the US.

Mycosis fungoides in the United States. Increasing incidence and descriptive epidemiology.

The etiology of mycosis fungoides is obscure, and the risk factors for its occurrence are poorly documented. This investigation uses data from nine US population-based cancer registries to investigate the descriptive epidemiology of this disorder. From 1973 through 1984, 721 newly diagnosed cases of mycosis fungoides were reported to these registries (0.

Cancer in a group at risk of acquired immunodeficiency syndrome (AIDS) through 1984.

Using a proportional morbidity analysis method, the authors examined changes in the risk of malignancy among never-married men 20-49 years old (a surrogate population for homosexual men) in a high AIDS-risk area (City of San Francisco) and other lower AIDS-risk areas. This approach easily detected increases in Kaposi's sarcoma (odds ratio (OR) comparing 1973-1978 to 1984: 2,479-fold, proportional increase = 99.9%) and in non-Hodgkin's lymphomas (OR = 4.

Cancer incidence and mortality trends among whites in the United States, 1947-84.

Cancer incidence trends from the late 1940s to 1983-84 were assessed among white residents of five geographic areas (Atlanta, Connecticut, Detroit, Iowa, San Francisco-Oakland) by means of data derived from several National Cancer Institute surveys, the Connecticut Tumor Registry, and the Surveillance, Epidemiology, and End Results Program. Incidence trends were compared with mortality trends for the entire United States and for the same five study areas. This study documented rising incidence and mortality rates for four cancers: lung cancer, melanoma of the skin, multiple myeloma, and non-Hodgkin's lymphomas.

Cancer incidence, survival, and mortality for children younger than age 15 years.

Incidence and survival data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program for the 10-year period 1973-1982 are presented. Childhood cancer incidence rates have remained relatively stable over the last decade. The overall incidence rate increased slightly from 124 to 127 per million children from 1973-1977 to 1978-1982 while rates for leukemias remained unchanged over this same time period at 38 per million for all races combined.

Falling rates of lung cancer in men in the United States.

Lung-cancer incidence and mortality rates in the United States were calculated for the years 1973 to 1983. The historically increasing age-adjusted rates for white men levelled off in the late 1970s and fell between 1982 and 1983. These falls were seen for white men only.

Cancer trends in a population at risk of acquired immunodeficiency syndrome.

Recent case reports have suggested that the acquired immunodeficiency syndrome (AIDS) may be associated with cancers other than Kaposi's sarcoma (KS). We have used the population-based registries of the Surveillance, Epidemiology, and End Results (SEER) Program to examine these relationships on a statistical basis by comparing the morbidity odds ratio (OR) and 95% confidence interval (CI) for specific cancer sites in pre- and post-AIDS time periods. Among never-married 20- to 49-year-old men, a surrogate group representing homosexual men, significant increases in the morbidity OR's for KS between 1973-80 and 1981-82 were apparent in the San Francisco standard metropolitan statistical area (OR: 51.