Descriptive Studies: Evaluation of demographic, temporal, and geographic variation in cancer rates may suggest clues to the roles of environmental or cultural influences; identification of population subgroups or regions at notably high or low risk may indicate areas where more intensive studies might be particularly fruitful. The Atlas of Cancer Mortality in the United States, 1950-94 was published in 1999, and the online version is available at www.nci.nih.gov/atlasplus. Users can create customized maps and have flexibility in choice of cancers, age groups, and sex and race aggregation. We have been analyzing changes in the geographic patterns of mortality for those cancers with substantial variation by area, race, and/or gender. The geographic patterns for breast cancer mortality have remained remarkably static, but are more pronounced for women older than age 50 years than for younger women. Race- and age-specific breast cancer mortality rates from 1950 through 1999 were calculated for four census regions and 508 state economic areas of the United States. We found that although rates of breast cancer still tend to be highest in the Northeast, intermediate in the West and Midwest, and lowest in the South, the underlying mortality trends suggest somewhat slower recent dissemination of effective breast cancer treatment in the South. From our collaborators in Beijing, China, we received and are analyzing mortality data for the full 27 provinces for the two time periods 1973-75 and 1990-92. In contrast to mortality data, which are limited to specifying the form of cancer, incidence data include information on histologic type of the tumor and in many instances, the subsite of origin. We have used incidence data from the Surveillance, Epidemiology, and End Results (SEER) program to investigate further the demographic patterns to discern subgroups that may be of etiologic significance. We examined breast cancer incidence rates by historical stage at diagnosis, age at diagnosis, and histology using data for 1975-2000. We also examined rates by estrogen and progesterone receptor status for more recently diagnosed cases. We analyzed for changes in the trends using piecewise regression analyses. The objective was to describe breast cancer incidence rates by tumor characteristics over a period of increasing use of estrogen-progestin therapy for treatment of symptoms of menopause. Another analysis compared the incidence patterns for breast carcinoma in situ and invasive breast carcinoma according to estrogen receptor status. During the years 1973 to 2000, carcinomas in situ rates rose 660% and invasive carcinoma rates rose 36%, with the most rapid increase occurring in women age >50 years. The age-specific incidence patterns suggested that carcinogenic events operating early in reproductive life had greater impact upon carcinoma in situ and invasive carcinoma defined by estrogen receptor negative expression than upon invasive carcinoma defined by estrogen receptor positive expression. We used data on over 400,000 breast cancer patients from the Surveillance, Epidemiology, and Ends Results (SEER) Program to calculate probabilities of death from breast cancer and all other causes combined. For patients diagnosed between 1973 and 2000 we calculated probabilities according to stage, race, and age at diagnosis; for cases diagnosed from 1990 to 2000 we also calculated some such probabilities according to tumor size and estrogen receptor status. We found that the probability of death from breast cancer versus other causes varied substantially according to stage, tumor size, estrogen receptor status, and age at diagnosis in both white and black patients. Our analysis of cervical carcinoma incidence trends during 1976-2000 by histologic type found that the overall incidence of invasive squamous cell carcinoma declined over time, and the majority of tumors that are detected currently are in situ and localized carcinomas in young women. The incidence of in situ squamous cell carcinoma increased sharply in the early 1990s. Adenocarcinoma in situ incidence rates increased, especially among young women. In black women, invasive adenocarcinoma incidence rose linearly with age. We compared relative survival rates among patients diagnosed with ovarian tumors during 1988-99 by histologic type, disease stage, tumor grade, and age, and found that survival among women with distant-stage low malignant potential tumors was not 100% and resembled the survival of women who had carcinoma exhibiting favorable prognostic features (localized stage). We analyzed data from the 2000 National Health Interview Survey regarding the use of Papanicolaou test to detect cervical cancer and its precursors. We found that, among women who had not had a hysterectomy, 83% reported having had a Pap test within the past 3 years. Women who had no contact with a primary care provider in the past year, who lacked a usual source of care, had low family income, low educational attainment, or were unmarried were unlikely to have reported a recent Pap test. The descriptive epidemiology of a number of cancers has been updated in a series of chapters, including cancers of the corpus uteri, biliary tract, kidney, and bladder, and non-Hodgkin lymphoma, multiple myeloma, and the leukemias; and cancer incidence and mortality patterns in the United States have been updated. Cancer incidence and mortality rates may be used to assess consistency with hypotheses regarding cancer etiology suggested by other scientific studies. To determine if male breast carcinogenesis was similar to its more common female counterpart, we compared incidence patterns among men and women with breast cancer. We found that gender-specific incidence trends differed, most likely reflective of female-related changes in surveillance and/or reproductive risk factors. On the other hand, similar prognostic factor profiles reflective of tumor biology, age-specific incidence rate patterns, and age-frequency distributions suggested that male breast cancer was more like postmenopausal than premenopausal female breast cancer. Record-Linkage Studies: Census and hospital discharge data from Sweden, Denmark and U.S. Veterans hospitals, linked for follow-up to cancer, mortality, and population registries where available, were used to assess cancer risk among individuals with specific medical and occupational exposures. The Danish Hospital Discharge Register was used to evaluate the potential role of tubal sterilization on subsequent cancer risk; the overall risk of ovarian, endometrial, and cervical cancers was decreased. Swedish men with benign prostatic hyperplasia (BPH) were studied to estimate their risk of subsequent prostate cancer; overall, little, if any, excess risk was apparent. However, differences in prostate cancer incidence and mortality by BPH treatment type suggested that factors related to treatment or health reasons underlying the selection of treatment may influence subsequent prostate cancer risk. A large study was initiated to assess familial aggregation of autoimmune diseases and lymphoproliferative malignancies (LP). We are studying 50,000 Swedish and 10,000 Danish cases of LP, twice that number of non-cancer controls, and all their relatives' computerized medical data (cancers and hospital diagnoses). The familial aggregation of Hodgkin lymphoma is stronger in families of affected individuals age <40 years, in males, and in siblings. The familial aggregations of chronic lymphocytic leukemia were similar in siblings and offspring, male and female.
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