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14 Background: Cancer patients often have multiple chronic conditions and require complex care coordination. We compared older (ages 66+) cancer patients’ reports of their healthcare experiences based on level of multimorbidity. Methods: Data from the SEER-CAHPS combines cancer registry (Surveillance, Epidemiology, and End Results; SEER), patient experiences (Consumer Assessment of Healthcare Providers and Systems; CAHPS) and Medicare claims data. Multimorbidity was captured as: (1) the National Cancer Institute-Combined Comorbidity Index (NCCI, 16 Charlson conditions diagnosed ≤12 months prior to cancer); and (2) a Multimorbidity Burden Index (MBI), which categorizes conditions based on the impact to cancer treatment (no comorbidity, low/medium, and high). Outcomes were CAHPS patient experience measures: Doctor Communication, Getting Care Quickly, Getting Needed Care, Obtaining Prescription Drugs, Customer Service, and ratings of Overall Care, Personal Doctor, and Specialist. Multivariable linear regression provided associations of each multimorbidity measure with CAHPS measures controlling for standard case mix adjustors, years from diagnosis to survey and diagnostic stage. Results: The study cohort included 9305 cancer patients (53% male, 84% Non-Hispanic White, average age 77, average time from diagnosis 29 months), with a distribution of NCCI conditions as: 0 (cancer only), 73%; 1, 17%; ≥2, 10%. Cancer patients with NCCI = 0 and those with MBI = no comorbidity rated their Personal Doctor more negatively than those with any comorbidities ( p < 0.02). Those with NCCI ≥ 2 or MBI = low/medium reported better Doctor Communication ( p < 0.04). Those with high MBI rated their specialist physician better than those with no multimorbidity ( p = 0.04), and those with low/medium MBI reported better experiences Getting Care Quickly ( p = 0.02). No other associations were significant. Conclusions: Cancer patients with multimorbidity report better communication with their doctor and care = by = personal doctors and specialists. Increased attention to the care experiences of cancer patients with multimorbidity may lead to insights and interventions that benefit all cancer patients.

BACKGROUND: Cancer diagnosis and treatment of a parent has considerable impact on the lives of their minor children, family caregivers, and patients themselves. Understanding the number and characteristics of the population of cancer survivors with children younger than 18 years of age would help to better target services for these survivors and their children and to stimulate and inform research on these understudied families. METHODS: This study identified adults with a history of cancer (n = 13,385) who participated in the United States National Health Interview Survey (NHIS) between 2000 and 2007. The authors examined the prevalence and characteristics of survivors residing with their minor children, both in the total sample and among survivors diagnosed within the last 2 years. RESULTS: Among these adult survivors, 18.3% (95%CI, 16.3-20.5) of those recently diagnosed and 14.0% (95%CI 13.3-14.8) of the total sample reported living with a minor child. Most of these survivors were female (78.9%), married (69.8%), and younger than age 50 years (85.8%). Of the 3193 identified children of survivors, 30.5% were younger than age 6 years at the time of their parent's cancer diagnosis; 33.4% were born after the diagnosis. By using population-based weights, the authors estimated that 1.58 million US cancer survivors reside with their minor children, representing 2.85 million children. Furthermore, an estimated 562,000 US minor children are living with a parent in the early phases of cancer treatment and recovery. CONCLUSIONS: There is a large population of families for whom cancer may pose special challenges and for whom assessment of needs and referral to resources are essential. Cancer 2010. Published 2010 by the American Cancer Society.

BACKGROUND: This paper examines the prevalence of cancer screening use as reported in 2005 among US adults, focusing on differences among historically underserved subgroups. We also examine trends from 1992 through 2005 to determine whether differences in screening use are increasing, staying the same, or decreasing. METHODS: Data from the National Health Interview Surveys between 1992 and 2005 were analyzed to describe patterns and trends in cancer screening practices, including Papanicolaou test, mammography, prostate-specific antigen, and colorectal screening. Logistic regression was used to report 2005 data for population subgroups defined by several demographic and socioeconomic characteristics. RESULTS: Rates of use for cancer tests are rising only for colorectal cancer, due largely to the increase in colorectal endoscopy screening. Use of all the modalities was strongly influenced by contact with a physician and by having health insurance coverage. CONCLUSIONS: There remain large gaps in use for all screening modalities by education, income, usual source of care, health insurance, and recent physician contact. These specific populations would benefit from interventions to overcome these barriers to screening. Cancer 2010. Published 2010 by the American Cancer Society.

Background: In the United States, prostate cancer incidence is higher among black than among white males, with a higher proportion of blacks diagnosed with advanced-stage cancer. Methods: Prostate cancer incidence (1999-2001) and census tract data were obtained for 66,468 cases in four states that account for 20% of U.S. blacks: Georgia, Florida, Alabama, and Tennessee. Spatial clusters of localized-stage prostate cancer incidence were detected by spatial scan. Clusters were examined by relative risk, population density, and socioeconomic and racial attributes. Results: Overall prostate cancer incidence rates were higher in black than in white men, and a lower proportion of black cases were diagnosed with localized-stage cancer. Strong associations were seen between urban residence and high relative risk of localized-stage cancer. The highest relative risks generally occurred in clusters with a lower percent black population than the national average. Conversely, of eight nonurban clusters with significantly elevated relative risk of localized-disease, seven had a higher proportion of blacks than the national average. Furthermore, positive correlations between percent black population and relative risk of localized-stage cancer were seen in Alabama and Georgia. Conclusion: Association between urban residence and high relative risk of localized-stage disease (favorable prognosis) persisted after spatial clusters were stratified by percent black population. Unexpectedly, seven of eight nonurban clusters with high relative risk of localized-stage disease had a higher percentage of blacks than the U.S. population. Impact: Although evidence of racial disparity in prostate cancer was found, there were some encouraging findings. Studies of community-level factors that might contribute to these findings are recommended. Cancer Epidemiol Biomarkers Prev; 19(6); 1460–7. ©2010 AACR.

6529Background: The proliferation of next-generation sequencing (NGS) tests provides an opportunity to advance oncology care. However, there are limited data about when and how NGS tests are used a...

BACKGROUND: The number of adult survivors of childhood cancer in the United States is increasing because of effective treatments and improved survival. The purpose of this study was to use a national, population-based sample to estimate the burden of illness in adult survivors of childhood cancer. METHODS: A total of 410 adult survivors of childhood cancer and 294,641 individuals without cancer were identified from multiple years of the National Health Interview Survey. Multiple measures of burden, general health, and lost productivity were compared using multivariate regression analyses including: logistic, polytomous logit, proportional odds, and linear models. RESULTS: Controlling for the effects of age, sex, race/ethnicity, and survey year, adult survivors of childhood cancer reported poorer outcomes across the majority of general health measures and productivity measures than individuals without cancer. Survivors were more likely to report their health status as fair or poor (24.3% vs 10.9%; P < .001); having any health limitation in any way (12.9% vs 3.4%; P < .001); being unable to work because of health problems (20.9% vs 6.3%; P < .001); and being limited in the amount/kind of work because of health problems (30.9% vs 10.6%; P < .001). When categorized by time since diagnosis, cancer survivors had poor health outcomes in every time interval, with the greatest limitations in the initial 4 years after diagnosis and 30 or more years after diagnosis. CONCLUSIONS: Across multiple measures, adult survivors of childhood cancers have poorer health outcomes and more health limitations than similar individuals without cancer. Cancer 2010. Published 2010 by the American Cancer Society.

Background: Although family history of cancer is widely ascertained in research and clinical care, little is known about assessment methods, accuracy, or other quality measures. Given its widespread use in cancer screening and surveillance, better information is needed about the clarity and accuracy of family history information reported in the general population. Methods: This telephone survey in Connecticut examined coherence and completeness of reports from 1,019 respondents about 20,504 biological relatives. Results: Of 2,657 cancer reports, 97.7% were judged consistent with malignancy (versus benign or indeterminate conditions); 79% were site specific, 10.1% had unspecified cancer sites, and 8.6% had “ill-defined” sites. Only 6.1% of relatives had unknown histories. Unknown histories and ambiguous sites were significantly higher for second-degree relatives. The adjusted percentage of first-degree relative reports with ambiguous sites increased with decreasing education and African-American race of survey respondents, and with deceased vital status of relatives. Ambiguous second-degree relative reports were also associated with deceased vital status and with male gender of respondents. Conclusions: These findings suggest that family history of cancer reports from the general population are generally complete and coherent. Impact: Strategies are needed to improve site specificity and thus maximize the utility of such information in primary care settings. Cancer Epidemiol Biomarkers Prev; 19(3); 799–810

Data are limited regarding cancer risk in human immunodeficiency virus (HIV)-infected persons with modest immunosuppression, before the onset of acquired immunodeficiency syndrome (AIDS). For some cancers, risk may be affected by highly active antiretroviral therapy (HAART) widely available since 1996. We linked HIV/AIDS and cancer registries in Colorado, Florida and New Jersey. Standardized incidence ratios (SIRs) compared cancer risk in HIV-infected persons (initially AIDS-free) during the 5-year period after registration with the general population. Poisson regression was used to compare incidence across subgroups, adjusting for demographic factors. Among 57,350 HIV-infected persons registered during 1991-2002 (median CD4 count 491 cells/mm(3)), 871 cancers occurred during follow-up. Risk was elevated for Kaposi sarcoma (KS, SIR 1,300 [n = 173 cases]), non-Hodgkin lymphoma (NHL, 7.3 [n = 203]), cervical cancer (2.9 [n = 28]) and several non-AIDS-defining malignancies, including Hodgkin lymphoma (5.6 [n = 36]) and cancers of the lung (2.6 [n = 109]) and liver (2.7 [n = 14]). KS and NHL incidence declined over time but nonetheless remained elevated in 1996-2002. Incidence increased in 1996-2002 compared to 1991-1995 for Hodgkin lymphoma (relative risk 2.7, 95%CI 1.0-7.1) and liver cancer (relative risk infinite, one-sided 95%CI 1.1-infinity). Non-AIDS-defining cancers comprised 31.4% of cancers in 1991-1995, versus 58.0% in 1996-2002. For KS and NHL, risk was inversely related to CD4 count, but these associations attenuated after 1996. We conclude that KS and NHL incidence declined markedly in recent years, likely reflecting HAART-related improvements in immunity, while incidence of some non-AIDS-defining cancers increased. These trends have led to a shift in the spectrum of cancer among HIV-infected persons.

Although breast and cervical cancer screening rates for Asian American (AA) women are the lowest of any ethnic group in California, few causes for this are known. The authors used the 2001 California Health Interview Survey, conducted in five Asian languages, to conduct the first evaluation of Pap and mammography screening rates for a representative sample of 2,239 AA women. Wide variations in screening rates were found among the seven different subgroups of AA women studied: adjusted Pap test use ranged from 81% (Filipina Americans) to 61% (Vietnamese Americans). Mammography rates ranged from 78% (Japanese Americans) to 53% (Korean Americans). Disaggregating the AA data and using separate multivariate logistic regressions revealed that different factors were independently associated with the low screening rates for each subgroup. The measurement of additional contextual information is needed to identify structural barriers and community resources to provide clearer guidance for the design of effective screening promotion programs for AA subpopulations.

BACKGROUND Timely screening with mammography can prevent a substantial number of deaths from breast cancer. The objective of this brief was to ascertain whether recent use of mammography has dropped nationally. METHODS The authors assessed the trend in mammography rates from 1987 through 2005. Then, they used the 2000 and 2005 National Health Interview Survey (NHIS) estimates to characterize trends and current patterns in mammography use. RESULTS After robust, rapid increases in reported use of mammography by women in the U.S. since 1987, estimates from the 2005 NHIS showed a decline compared with 2000 (from 70% to 66%). Although it was small, this decline may be cause for concern, because it signals a change in direction. CONCLUSIONS This report establishes for the nation what already has been observed in some local data. The results confirmed that the use of mammography may be falling. This change needs to be monitored carefully and also may call for intervention. Cancer 2007. Published 2007 by the American Cancer Society

Background: Although recent trends in the use of recommended breast and cervical cancer screening have been well documented in the USA, little is known about trends in the prevalence of abnormal screening results. Methods: Trends in abnormal screening results for mammography and Papanicolaou (Pap) smear were assessed descriptively using data from the 1987 and 2000 National Health Interview Surveys. Estimates were stratified by sociodemographic characteristics of the populations who reported ever receiving screening. All comparisons were evaluated with two-sided tests of statistical significance. Results: The age-standardized prevalence of abnormal Pap smears increased from 12.9% (95% confidence interval [CI] 12.1–13.8%) of women ever screened in 1987 to 20.3% (95% CI 19.5–21.0%) in 2000, and the age-standardized prevalence of abnormal mammogram results increased from 18.8% (95% CI 17.0–20.7%) to 21.6% (95% CI 20.5–22.7%) of women ever screened over the same period. Among women aged 40 years and older who reported ever receiving both a Pap smear and a mammogram, 29.6% (95% CI: 27.3–32.2%) in 1987 and 35% (95% CI: 33.8–36.2%) in 2000 reported either an abnormal Pap smear or an abnormal mammogram. In 2000, abnormal screening results were positively associated with reported frequency of recent screening ( P Conclusions: A substantial portion of women in the USA reporting cancer screening also report having had abnormal results, although the magnitude of trends between 1987 and 2000 vary by screening test. Additional research is needed to assess the relative contributions of changes in classification of test results, test characteristics and changes in underlying screening histories to increases in abnormal screening results.

Objectives. We examined cancer screening and risk factor patterns in California using 4 different statistical tabulations of American Indian and Alaska Native (AIAN) populations. Methods. We used the 2001 California Health Interview Survey to compare cancer screening and risk factor data across 4 different tabulation approaches. We calculated weighted prevalence estimates by gender and race/ethnicity for cancer screening and risk factors, sociodemographic characteristics, and access to care variables. We compared AIAN men and women with members of other racial groups and examined outcomes among AIAN men and women using the 4 tabulation methods. Results. Although some differences were small, in general, screening and risk factor rates among American Indians/Alaska Natives were most similar to rates among Whites when the most inclusive multiracial tabulation approach was used and least similar when the more exclusive US census “single-race” approach was used. Conclusions. Racial misclassification and undercounting are among the most difficult obstacles to obtaining accurate and informative data on the AIAN population. Our analysis suggests some guidelines for overcoming these obstacles.

Objectives To describe the implementation of the Multifactor Screener in the 2000 National Health Interview Survey (NHIS); to provide intake estimates for fruits and vegetables, fiber, and percentage of energy from fat by various demographic and behavioral characteristics; and to discuss the strengths and weaknesses of the method. Design/subjects The 2000 NHIS was conducted in 38,632 households in a clustered sample representative of the 48 contiguous states in the United States. The Cancer Control Module was administered to adults (18 years and older) and included 17 dietary intake questions. Analyses After excluding individuals with missing data or unlikely values on the diet questions, we computed individual intake of servings of fruits and vegetables, percentage of energy from fat, and grams of fiber. We estimated median intakes and distributions of intakes using adjusted variance estimates. We present bivariate relationships between diet and demographics and diet and behavioral characteristics in almost 30,000 adults in the United States. Results In general, intakes of these dietary factors were closer to recommendations among well-educated individuals, those engaged in other healthful behaviors, and underweight and normal weight individuals. Latinos had higher intakes of fruits and vegetables (men: 6 servings; women: 4.8 servings) and fiber (men: 23 g; women: 17 g), and generally a lower percentage of energy intake from fat (men: 33.7%; women: 32.1%) than did non-Latino whites (men: 5.4 servings; women: 4.5 servings; men: 19 g; women: 14 g; men: 33.9%; women: 32.0%) and non-Latino blacks (men: 5.4 servings; women: 4.4 servings; men: 19 g; women: 13 g; men: 34.7%; women: 33.5%). The strengths and limitations of the short dietary assessment method are discussed. Conclusions The Multifactor Screener in NHIS, when used in conjunction with external reference data, provides reasonable estimates for three dietary factors and suggests relationships between intakes and other characteristics that are consistent with other data. Thus, these NHIS estimates could provide useful national benchmarks for local surveys using the same instrument.

Purpose: Anatomic pulmonary resection includes surgical procedures such as pneumonectomy, lobectomy, and segmentectomy, in contrast to non-anatomic pulmonary surgical procedures such as wedge resection. National Comprehensive Cancer Network guidelines for non-small cell lung cancer (NSCLC) indicate that anatomic pulmonary resection is preferred when surgery is indicated. The purpose of the current study is to describe racial-ethnic disparities in the receipt of anatomic pulmonary resection among NSCLC patients. Methods: We analyzed Surveillance, Epidemiology, and End Results (SEER) patients linked with Medicare claims, first diagnosed in 2000-2011. We required patients to have NSCLC as their first malignancy and covered by fee-for-service with continuous Part A and B Medicare from 12 months before to 4 months after first diagnosis. We categorized stage using American Joint Committee on Cancer 6th Edition. We excluded patients who were age ≤65 years; diagnosed at occult stage or stage 0; diagnosed at death; had unknown race, census tract poverty, urban-rural status, month of diagnosis, or month of death; or were enrolled in a health maintenance organization at any time from 12 months before to 4 months after diagnosis. We used SEER race to classify cases as: non-Hispanic whites; non-Hispanic blacks; Hispanics of white or black race (hereafter referred to as Hispanics), and Asian or Pacific Islanders. We reserved cases with American Indian or Alaska Native race for a future, separate analysis because numbers were smaller compared to other racial-ethnic groups. We defined anatomic pulmonary resection to include pneumonectomy, lobectomy, and segmentectomy. We identified receipt of anatomic pulmonary resection from the month of diagnosis to 4 months after first NSCLC diagnosis using Healthcare Common Procedure Coding System and International Classification of Disease 9th edition Clinical Modification codes. We used multiple variable logistic regression to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for receipt of anatomic pulmonary resection by males, and separately by females, adjusting for age at diagnosis, racial-ethnic group, mediastinal exploration, stage, histology, census tract poverty, SEER region, year of diagnosis, and comorbidity. Results: Our study cohort included 99,766 NSCLC cases, with similar proportions of males (51.2%) and females (48.8%). Overall, 23.2% (n=23,105) received anatomic pulmonary resection, but receipt varied by racial-ethnic group. Compared to non-Hispanic black men, anatomic resection procedures were more commonly received by men who were non-Hispanic white (aOR, 1.93; 95% CI, 1.70-2.19), Hispanic (aOR, 1.82; 95% CI, 1.49-2.22), or Asian or Pacific Islander (aOR, 2.06; 95% CI, 1.71-2.49). Compared to non-Hispanic black females, anatomic resection procedures also were more commonly received by females who were non-Hispanic white (aOR, 1.39; 95% CI, 1.23-1.57), Hispanic (aOR, 1.46; 95% CI, 1.20-1.79) or Asian or Pacific Islander (aOR, 1.42; 95% CI, 1.16-1.73). Conclusions: Non-Hispanic black men diagnosed with NSCLC from 2000-2011 were less likely to receive anatomic pulmonary resection than non-Hispanic white, Hispanic, or Asian or Pacific Islander men. Non-Hispanic black females also were less likely to receive anatomic pulmonary resection, but the differences in aORs by race were smaller among females than among males. Citation Format: Thomas B. Richards, Serban Negoita, Timothy S. McNeel, Dylan L. Holt, Marie Topor, S Jane Henley, Arica White, Jun Li, Chunyu Li. Racial-ethnic disparities in receipt of anatomic pulmonary resection in non-small cell lung cancer, SEER Medicare, 2000-2011. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr PR06.

BACKGROUND. The results of several studies conducted in the United States show no association between intake of 100 percent fruit juice and early childhood caries (ECC). The authors examined this association according to poverty and race/ethnicity among U.S. preschool children. METHODS. The authors analyzed data from the 1999–2004 National Health and Nutrition Examination Survey (NHANES) for 2,290 children aged 2 through 5 years. They used logistic models for caries (yes or no) to assess the association between caries and intake of 100 percent fruit juice, defined as consumption (yes or no), ounces (categories) consumed in the previous 24 hours or usual intake (by means of a statistical method from the National Cancer Institute). RESULTS. The association between caries and consumption of 100 percent fruit juice (yes or no) was not statistically significant in an unadjusted logistic model (odds ratio [OR], 0.76; 95 percent confidence interval [CI], 0.57–1.01), and it remained nonsignificant after covariate adjustment (OR, 0.89; 95 percent CI, 0.63–1.24). Similarly, models in which we evaluated categorical consumption of 100 percent juice (that is, 0 oz; > 0 and ≤ 6 oz; and > 6 oz), unadjusted and adjusted by covariates, did not indicate an association with ECC. CONCLUSIONS. Our study findings are consistent with those of other studies that show consumption of 100 percent fruit juice is not associated with ECC. PRACTICAL IMPLICATIONS. Dental practitioners should educate their patients and communities about the low risk of developing caries associated with consumption of 100 percent fruit juice. Limiting consumption of 100 percent fruit juice to 4 to 6 oz per day among children 1 through 5 years of age should be taught as part of general health education.

Supplemental Digital Content is available in the text., Background: The population-based Surveillance, Epidemiology, and End Results (SEER) registries collect information on first-course treatment, including surgery, chemotherapy, radiation therapy, and hormone therapy. However, the SEER program does not release data on chemotherapy or hormone therapy due to uncertainties regarding data completeness. Activities are ongoing to investigate the opportunity to supplement SEER treatment data with other data sources. Methods: Using the linked SEER-Medicare data, we examined the validity of the SEER data to identify receipt of chemotherapy and radiation therapy among those aged 65 and older diagnosed from 2000 to 2006 with bladder, female breast, colorectal, lung, ovarian, pancreas, or prostate cancer and hormone therapy among men diagnosed with prostate cancer at age 65 or older. Treatment collected by SEER was compared with treatment as determined by Medicare claims, using Medicare claims as the gold standard. The κ, sensitivity, specificity, positive predictive values, and negative predictive values were calculated for the receipt of each treatment modality. Results: The overall sensitivity of SEER data to identify chemotherapy, radiation, and hormone therapy receipt was moderate (68%, 80%, and 69%, respectively) and varied by cancer site, stage, and patient characteristics. The overall positive predictive value was high (>85%) for all treatment types and cancer sites except chemotherapy for prostate cancer. Conclusions: SEER data should not generally be used for comparisons of treated and untreated individuals or to estimate the proportion of treated individuals in the population. Augmenting SEER data with other data sources will provide the most accurate treatment information.

Introduction Healthy People (HP) is the US program that formulates and tracks national health objectives for the nation. The National Health Interview Survey (NHIS) is a designated data source for setting and evaluating several HP targets in cancer. We used data from the 2008 and 2010 NHIS to provide a benchmark for national performance toward meeting HP 2020 cancer-related objectives. Methods HP 2020 cancer screening, provider counseling, and health care access objectives were selected. For each objective, NHIS measures for the overall population and several sociodemographic subgroups were calculated; the findings were compared with established HP 2020 targets. Results From 2008 to 2010, rates of breast and cervical cancer screening declined slightly while colorectal cancer screening rates increased by 7 percentage points. Rates of cancer screening and provider counseling were below HP targets. Meeting HP targets seems less likely for subgroups characterized by low income, no health insurance, or no usual source of care. Meeting HP targets for access to health services will require an increase of 18 percentage points in the proportion of persons under age 65 with health insurance coverage and an increase of 10 percentage points in the proportion aged 18 to 64 with a usual source of care. Conclusion Whether HP objectives for cancer screening and health care access are met may depend on implementation of health care reform measures that improve access to and coordination of care. Better integration of clinical health care and community-based efforts for delivering high-quality screening and treatment services and elimination of health disparities are also needed.

Researchers are using diagnosis codes from health claims to identify metastatic disease in cancer patients. The validity of this approach has not been established.We used the linked 2005-2007 Surveillance, Epidemiology and End Results (SEER)-Medicare data to assess the validity of metastasis codes at diagnosis from claims compared with stage reported by SEER cancer registries. The cohort included 80,052 incident breast, lung, and colorectal cancer patients aged 65 years and older. Using gold-standard SEER data, we evaluated sensitivity, specificity, positive predictive value, and negative predictive value of claims-based stage, survival by stage classification, and patient factors associated with stage misclassification using multivariable regression.For patients with a registry report of distant metastatic cancer, the sensitivity, specificity, and positive predictive value of claims never simultaneously exceeded 80% for any cancer: lung (42.7%, 94.8%, and 88.1%), breast (51.0%, 98.3%, and 65.8%), and colorectal (72.8%, 93.8%, and 68.5%). Misclassification of stage from Medicare claims was significantly associated with inaccurate estimates of stage-specific survival (P .001). In adjusted analysis, patients who were older, black, or living in low-income areas were more likely to have their stage misclassified in claims.Diagnosis codes in Medicare claims have limited validity for inferring cancer stage and metastatic disease.

Background Access to health care, particularly effective primary and secondary preventive care, is critical for cancer survivors, in order to minimize the adverse sequelae of cancer and its treatment. Purpose The goal of the study was to evaluate the association between cancer survivorship and access to primary and preventive health care. Methods Cancer survivors ( n =4960) and individuals without a cancer history ( n =64,431) aged ≥18 years, from the 2008–2010 Medical Expenditure Panel Survey (MEPS), were evaluated. Multiple measures of access and preventive services use were compared. The association between cancer survivorship and access and preventive services was evaluated with multivariate logistic regression models, stratified by age group (18–64 years and ≥65 years), controlling for the effects of age, gender, race/ethnicity, education, marital status, and comorbidities. Data were analyzed in 2013. Results Cancer survivors aged ≥65 years had equivalent or greater access and preventive services use than individuals without a cancer history, in adjusted analyses. However, among those aged 18–64 years with private health insurance, cancer survivors were more likely than other individuals to have a usual source of care and to use preventive services, whereas uninsured or publicly insured cancer survivors were generally less likely to have a usual source of care and to use preventive services than were uninsured or publicly insured adults without a cancer history. Conclusions Although access and preventive care use in cancer survivors is generally equivalent or greater compared to that of other individuals, disparities for uninsured and publicly insured cancer survivors aged 18–64 years suggest that improvements in survivor care are needed.

Background/Aims Researchers are increasingly using diagnosis codes from administrative claims for cancer patients to identify metastatic disease at initial diagnosis or recurrence. The validity of metastasis codes on claims has not been established in population-based data. We used SEER cancer registry linked to Medicare claims to assess the completeness and validity of metastasis codes from Medicare claims for the four most common cancers in the U.S.

Purpose: Analyses of racial disparities in survival and treatment trends may be confounded by changes over time in cancer staging systems. For Surveillance, Epidemiology, and End Results (SEER) data linked with Medicare claims, non-small cell lung cancer (NSCLC) is available with American Joint Committee on Cancer (AJCC) 3rd edition stage from 2000–2003, and with AJCC 6th edition (AJCC6) stage from 2004–2011. We wanted to maximize the number of years that AJCC6 stage was available for analysis of trends. In this study, we describe the results of our methods to assign all NSCLC cases from 2000–2011 with stage group equivalent to AJCC6, and our assessment of black-white differences by stage and year following the stage reclassification. Methods: We focused on SEER-Medicare linked NSCLS cases, diagnosed 2000–2011, enrolled in Medicare during the month of diagnosis, and with SEER race coded as white or black. We used SEER Extent of Disease 1988 (10 digit) codes to assign AJCC6 to cases diagnosed 2000–2003, Collaborative Stage version 1 to assign AJCC6 to cases diagnosed 2004–2009, and Collaborative Stage version 2 to assign AJCC6 to cases diagnosed 2010–2011. To evaluate our adjusted AJCC6, we calculated the percentage point (pp) differences in the proportions of cases by stage and race between 2003 and 2004, and also for the 2000–2003, 2004–2009, and 2010–2011 sub-cohorts. In addition, we used SEER Joinpoint regression analysis to calculate annual percentage change (APC) by stage and race, including coincident and parallel pairwise comparisons by race. We defined statistical significance as p Results: Our final study cohort included 156,125 white and 16,594 black NSCLC cases. Overall from 2000 to 2011, the proportion of cases by stage was: IA (12.4%), IB (11.8%), IIA (1.2%), IIB (4.5%), IIIA (9.9%), IIIB (18.0%), and IV (41.0%); the remaining 1.2% were categorized Occult Carcinoma or Stage 0. The mean difference in proportions for stages I to IV between 2003 and 2004 was 0.3 pp, but the difference by specific stage varied up to 4.1 pp. The proportion Stage IA was higher in whites than in blacks (3.1 pp in 2000–2003; 3.7 pp in 2004–2009; and 3.5 pp in 2010–2011). The proportion Stage IV was higher in blacks than in whites (2.6 pp in 2000–2003; 3.2 pp in 2004–2009; and 3.5 pp in 2010–2011). Differences in proportions between whites and blacks for Stage IIA, IIB, and Stage IIIA were less than 1 pp for each of the three time periods. Proportions by stage for whites were greater than those for blacks for Stage IA to Stage IIB, and proportions by stage for blacks exceeded those for whites for Stage IIIB and Stage IV. The predicted proportions of white and black cases diagnosed at Stage IIIA were statistically identical. Significant changes in APCs were present among whites in Stage IA (at 2004), Stage IB (at 2006 and 2009), and Stage IV (at 2004). No statistically significant changes in APCs were detected among blacks. Conclusion: Our methods to reclassify NSCLC cases according to AJCC6 appear reasonable to support analyses that require cancer stage and race of all cohort patients diagnosed between 2000 and 2011. Some year-to-year differences are present, but they appear at most 4.1 pp between 2003 and 2004. Following the stage reclassification, our results suggest that whites were more likely to be diagnosed at a favorable stage (IA, IB, IIA, and IIB) compared with blacks, while blacks were more likely to be diagnosed at a less favorable stage (IIIB and IV) compared with whites. Citation Format: Thomas B. Richards, Serban Negoita, Timothy S. McNeel, Dylan L. Holt, Marie Topor, S Jane Henley, Arica White, Jun Li, Chunyu Li. Adjusted American Joint Committee on Cancer 6th edition stage for analysis of trends in black-white disparities in non-small cell lung cancer, SEER Medicare, 2000-2011. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B44.

Knowledge of family cancer history is essential for estimating an individual's cancer risk and making clinical recommendations regarding screening and referral to a specialty cancer genetics clinic. However, it is not clear if reported family cancer history is sufficiently accurate for this purpose.In the population-based 2001 Connecticut Family Health Study, 1019 participants reported on 20 578 first-degree relatives (FDR) and second-degree relatives (SDR). Of those, 2605 relatives were sampled for confirmation of cancer reports on breast, colorectal, prostate, and lung cancer. Confirmation sources included state cancer registries, Medicare databases, the National Death Index, death certificates, and health-care facility records. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for reports on lung, colorectal, breast, and prostate cancer and after stratification by sex, age, education, and degree of relatedness and used to estimate report accuracy. Pairwise t tests were used to evaluate differences between the two strata in each stratified analysis. All statistical tests were two-sided.Overall, sensitivity and positive predictive value were low to moderate and varied by cancer type: 60.2% and 40.0%, respectively, for lung cancer reports, 27.3% and 53.5% for colorectal cancer reports, 61.1% and 61.3% for breast cancer reports, and 32.0% and 53.4% for prostate cancer reports. Specificity and negative predictive value were more than 95% for all four cancer types. Cancer history reports on FDR were more accurate than reports on SDR, with reports on FDR having statistically significantly higher sensitivity for prostate cancer than reports on SDR (58.9% vs 21.5%, P = .002) and higher positive predictive value for lung (78.1% vs 31.7%, P.001), colorectal (85.8% vs 43.5%, P = .004), and breast cancer (79.9% vs 53.6%, P = .02).General population reports on family history for the four major adult cancers were not highly accurate. Efforts to improve accuracy are needed in primary care and other health-care settings in which family history is collected to ensure appropriate risk assessment and clinical care recommendations.

Unrealistically optimistic or pessimistic risk perceptions may be associated with maladaptive health behaviors. This study characterized factors associated with unrealistic optimism (UO) and unrealistic pessimism (UP) about breast cancer. Data from the 2005 National Health Interview Survey were analyzed (N = 14,426 women). After accounting for objective risk status, many (43.8%) women displayed UO, 12.3% displayed UP, 34.5% had accurate risk perceptions (their perceived risk matched their calculated risk), and 9.5% indicated “don’t know/no response.” Multivariate multinomial logistic regression indicated that UO was associated with higher education and never smoking. UP was associated with lower education, lower income, being non-Hispanic Black, having ≥3 comorbidities, current smoking, and being overweight. UO was more likely to emerge in younger and older than in middle-aged individuals. UO and UP are associated with different demographic, health, and behavioral characteristics. Population segments that are already vulnerable to negative health outcomes displayed more UP than less vulnerable populations.

Many older adults in the U.S. do not receive appropriate colorectal cancer (CRC) screening. Although primary care physicians' recommendations to their patients are central to the screening process, little information is available about their recommendations in relation to guidelines for the menu of CRC screening modalities, including fecal occult blood testing (FOBT), flexible sigmoidoscopy (FS), colonoscopy, and double contrast barium enema (DCBE). The objective of this study was to explore potentially modifiable physician and practice factors associated with guideline-consistent recommendations for the menu of CRC screening modalities.We examined data from a nationally representative sample of 1266 physicians in the U.S. surveyed in 2007. The survey included questions about physician and practice characteristics, perceptions about screening, and recommendations for age of initiation and screening interval for FOBT, FS, colonoscopy and DCBE in average risk adults. Physicians' screening recommendations were classified as guideline consistent for all, some, or none of the CRC screening modalities recommended. Analyses used descriptive statistics and polytomous logit regression models.Few (19.1%; 95% CI:16.9%, 21.5%) physicians made guideline-consistent recommendations across all CRC screening modalities that they recommended. In multivariate analysis, younger physician age, board certification, north central geographic region, single specialty or multi-specialty practice type, fewer patients per week, higher number of recommended modalities, use of electronic medical records, greater influence of patient preferences for screening, and published clinical evidence were associated with guideline-consistent screening recommendations (p0.05).Physicians' CRC screening recommendations reflect both overuse and underuse, and few made guideline-consistent CRC screening recommendations across all modalities they recommended. Interventions that focus on potentially modifiable physician and practice factors that influence overuse and underuse and address the menu of recommended screening modalities will be important for improving screening practice.

Background The consumption of added sugars (eg, white sugar, brown sugar, and high-fructose corn syrup) displaces nutrient-dense foods in the diet. The intake of added sugars in the United States is excessive. Little is known about the predictors of added sugar intake. Objective To examine the independent relationships of socioeconomic status and race/ethnicity with added sugar intake, and to evaluate the consistency of relationships using a short instrument to those from a different survey using more precise dietary assessment. Design Cross-sectional, nationally representative, interviewer-administered survey. Subjects/setting Adults (aged ≥18 years) participating in the 2005 US National Health Interview Survey Cancer Control Supplement responding to four added sugars questions (n=28,948). Statistical analyses performed The intake of added sugars was estimated using validated scoring algorithms. Multivariate analysis incorporating sample weights and design effects was conducted. Least squares means and confidence intervals, and significance tests using Wald F statistics are presented. Analyses were stratified by sex and controlled for potential confounders. Results The intake of added sugars was higher among men than women and inversely related to age, educational status, and family income. Asian Americans had the lowest intake and Hispanics the next lowest intake. Among men, African Americans had the highest intake, although whites and American Indians/Alaskan Natives also had high intakes. Among women, African Americans and American Indians/Alaskan Natives had the highest intakes. Intake of added sugars was inversely related to educational attainment in whites, African Americans, Hispanic men, and American Indians/Alaskan Native men, but was unrelated in Asian Americans. These findings were generally consistent with relationships in National Health and Nutrition Examination Survey 2003-2004 (using one or two 24-hour dietary recalls). Conclusions Race/ethnicity, family income, and educational status are independently associated with intake of added sugars. Groups with low income and education are particularly vulnerable to diets with high added sugars. Differences among race/ethnicity groups suggest that interventions to reduce intake of added sugars should be tailored. The National Health Interview Survey added sugars questions with accompanying scoring algorithms appear to provide an affordable and useful means of assessing relationships between various factors and added sugars intake.

Despite its benefit, about 30% of women report that they did not have a recent mammogram. We examine impact of distance, rural-urban residence, and other characteristics on mammography screening rates.We linked data on 33,938 women aged 40-84 years from the 2003 and 2005 California Health Interview Survey with FDA data on the location of mammography facilities in California, and with socioeconomic and geographic variables from the 2000 Census. We use logistic regression models to estimate the impact of selected variables on a woman's probability of having had a recent mammogram and developed a new mapping scheme to help visualize differences in mammography use across California.Though distance to a facility did not impact a woman's probability of having had a recent mammogram, women who resided in urban areas had somewhat higher screening rates than those living in more rural areas, as displayed on our map.Our findings suggest that more research is needed on possible disparities in access to mammography between rural and non-rural areas in California. Therefore, data adequately powered to examine rural populations and to compare them with urban populations are needed.

To compare total fruit and vegetable intake in cup equivalents and its individual components among Hispanic subgroups in California.Data are from the adult portion of the 2005 California Health Interview Survey. Hispanic/Latino subjects (n=7,954) were grouped into six subcategories (Mexican, Central American, Caribbean, Spanish American, South American, and1 group). Total fruit and vegetable intake in cup equivalents was estimated from frequency responses about seven food categories. Both t test and chi(2) test were used to assess differences in sociodemographic characteristics across Hispanic subgroups. Multivariate linear regressions using SUDAAN software (Survey Data Analysis, version 9.0.1, 2005, Research Triangle Institute, Research Triangle Park, NC) were conducted to obtain means of total fruit and vegetable intake in cup equivalents and its components by Hispanic subgroups controlling for confounders.Hispanic subgroups did not differ in their intake of total fruit and vegetable intake in cup equivalents (mean 3.4 c and 2.9 c for men and women, respectively). Small but significant differences (P0.01) were found across Hispanic subgroups in individual fruit and vegetable components (green salad [women only], cooked dried beans and nonfried white potatoes) after adjusting for potential sociodemographic and acculturation confounders.Fruit and vegetable intake by Hispanic respondents did not meet the national recommendation, although their reported intake is higher compared to other race/ethnicity groups. The public health message remains the same: Increase fruit and vegetable intake. Examination of intake for subgroups of Hispanics may enhance the utility of dietary information for surveillance, program and message design, and intervention and evaluation.

Background: Population-based estimates of biological family size can be useful for planning genetic studies, assessing how distributions of relatives affect disease associations with family history and estimating prevalence of potential family support. Methods: Mean family size per person is estimated from a population-based telephone survey (n = 1,019). Results: After multivariate adjustment for demographic variables, older and non-White respondents reported greater mean numbers of total, first- and second-degree relatives. Females reported more total and first-degree relatives, while less educated respondents reported more second-degree relatives. Conclusions: Demographic differences in family size have implications for genetic research. Therefore, periodic collection of family structure data in representative populations would be useful.

Objective: To estimate health limitations and health-related quality of life (HRQL) associated with cancer and other chronic conditions in a nationally representative sample within a phase-of-care framework. Study Design and Setting: We used a nested case-control design to assess health limitations and HRQL in individuals reporting a breast, colorectal, prostate, or lung cancer diagnosis, or a diagnosis of arthritis, diabetes, heart disease, or hypertension compared with similar controls without these conditions. All subjects were selected from the 1986-1994 National Health Interview Surveys linked to mortality files in 1995, and classified into the initial, continuing, or last year of life phase of care. Health limitations and HRQL were compared for cases and controls for each condition with 2-sided statistical tests. Results: Across all conditions, individuals in the last year of life phase of care reported greater health limitations and lower HRQL, as measured by the Health Activities and Limitations Index (HALex), than did individuals in the initial and continuing phases of care. Compared with their matched controls, individuals with cancer or other chronic conditions were more likely to report health limitations and lower mean HALex values in the initial, continuing, and last year of life phases of care (P < 0.05). Conclusions: We observed greater health limitations and lower HRQL associated with cancer and other chronic diseases compared with similar individuals without these conditions. The phase-of-care framework used in this study seems to be applicable to the assessment of HRQL for cancer and other chronic diseases.

Background: Men with HIV/acquired immunodeficiency syndrome (AIDS) are reported to be at increased risk for germ cell tumors (GCT), particularly testicular seminoma. We investigated correlates of this association to improve understanding of GCTs. Methods: Testicular and extratesticular seminoma and nonseminoma cases were found by linking population-based cancer and HIV/AIDS registry data for 268,950 men who developed AIDS in 1980 to 2003. Standardized incidence ratios (SIR) with 95% confidence intervals (95% CI) were used to compare these cases with the number of cases expected in the demographically matched population. Results: Overall, seminoma risk (161 cases: SIR, 1.9; 95% CI, 1.6-2.2) was increased significantly with HIV/AIDS, whereas nonseminoma risk was not (56 cases: SIR, 1.3; 95% CI, 0.96-1.7). Extratesticular GCT risk also was increased (11 cases: SIR, 2.1; 95% CI, 1.1-3.7). Seminoma risk was elevated regardless of age, race, or HIV/AIDS transmission group. It was highest for disseminated disease (SIR, 4.7; 95% CI, 2.9-7.2) and within 9 months of AIDS onset (SIR, 7.6; 95% CI, 5.8-9.6), but it was unrelated to CD4 count and duration of HIV/AIDS. The excess risk of seminoma declined in more recent calendar periods, and it was no longer elevated (SIR, 1.4; 95% CI, 0.9-1.9) in the highly active antiretroviral treatment era. Conclusions: Men with HIV/AIDS had an increased risk of seminoma, but this risk may have attenuated with improving anti-HIV/AIDS treatments. Although detection bias could partly explain the excess of this cancer, various lines of evidence support a causal relationship. Possible mechanisms underlying this association include impaired tumor immunosurveillance or AIDS-related testicular atrophy. (Cancer Epidemiol Biomarkers Prev 2007;16(6):1266–9)

The remarkable success achieved in cervical cancer prevention is largely attributable to cervical cytology screening, also known as the Papanicolaou (Pap) test. The American Cancer Society (ACS) revised screening guidelines for Pap testing in 2002. The impact of these changes on future numbers of Pap tests has not been assessed. Using National Health Interview Survey (NHIS) data to determine historical screening patterns, we extrapolate the numbers of Pap tests that would be performed through 2010, under 5 different scenarios of implementation of screening guidelines. From 1993 to 2003, there was a steady increase in the number of Pap tests, with an estimated 65.6 million Pap tests performed in 2003. Approximately two thirds of women born after 1930 reported having been screened within the previous year, and 85% within the previous 3 years. Fifteen percent of Pap tests were performed in hysterectomized women, most of whom, according to current guidelines, should not be screened. Based on population projections, if screening behavior remains unchanged, 75 million Pap tests will be performed in 2010. Full compliance with ACS guidelines would approximately halve the total number of tests to 34 million. Potentially, with more appropriate allocation of resources according to guidelines, all women could be screened and the total number of Pap tests reduced, despite projected increases in the population.

Proceedings: AACR 106th Annual Meeting 2015; April 18-22, 2015; Philadelphia, PA Background: Primary liver cancer is the sixth most common cancer worldwide, with HCC representing the majority of the cases. In the U.S., HCC rates are higher among Hispanics, Asians and blacks than among whites. Whether the higher risks are due to different distributions of risk factors is not clear. Thus, we conducted an analysis of HCC risk factors by race/ethnicity in the SEER-Medicare database for the years 2000-2009. Methods: HCC cases (n = 8,116), identified by ICD-O morphology codes 8170-8175, were compared to a 5% random sample of cancer-free persons in the SEER areas (n = 313,525). Risk factors examined included type II diabetes (DM II), obesity, hepatitis B virus (HBV), hepatitis C virus (HCV), alcohol-related disorders. Multivariate logistic regression analyses, which adjusted for age, location, gender, income and date of diagnosis as well as the other risk factors were used to compare risk factors by racial/ethnic group. Results: Risk factors by race/ethnicity | Risk factor | White | Black | Asians | Hispanics | |:----------------- | ------- | ---------------- | ------ | ---------------- | ---- | | | N 6,120 | N 668 | N 971 | N 357 | | | % | OR (95% CI) | % | OR (95% CI) | % | OR (95% CI) | % | OR (95% CI) | | Obesity | 6.3 | 1.06 (0.9-1.2) | 5.5 | 1.0 (0.7-1.5) | 0.7 | 0.2 (0.1-0.8) | 7.8 | 1.2 (0.7-1.9) | | DM II | 44.5 | 2.9 (2.8-3.1) | 41.8 | 1.3 (1.1-1.6) | 38.1 | 1.8 (1.5-2.1) | 54.6 | 2.0 (1.5-2.7) | | HBV | 1.8 | 3.8 (2.6-5.7) | 3.6 | 1.6 (0.7-3.7) | 17.7 | 17.1 (11.8-25.0) | 2.0 | 1.4 (0.2-11.1) | | HCV | 16.8 | 19.7 (17.1-22.6) | 34.0 | 36.8 (28.0-48.6) | 31.1 | 21.4 (15.4-29.9) | 22.7 | 16.0 (9.2-28.1) | | Alcohol cirrhosis | 11.4 | 4.7 (3.7-5.8) | 7.6 | 4.5 (2.4-8.5) | 4.0 | 3.8 (1.3-11.7) | 17.1 | 3.3 (1.7-6.8) | | Alcohol NOS | 13.1 | 2.7 (2.2-2.9) | 13.2 | 1.6 (1.1-2.4) | 3.7 | 2.0 (1.0-4.1) | 14.8 | 1.6 (0.8-3.0) | | Cirrhosis NOS | 33.3 | 45.5 (41.2-50.4) | 24.1 | 17.9 (12.3-25.9) | 36.8 | 36.9 (26.2-52.0) | 44.8 | 27.6 (18.9-40.3) | NOS not otherwise specified. Conclusion: Major HCC risk factor profile is differ across race/ethnical groups. While diabetes is most common risk factor overall, it is most prevalent in Hispanics. HCC related to HCV is more common in blacks and Asians, and to HBV in Asians. Citation Format: Oxana V. Makarova-Rusher, Sean F. Altekruse, Timothy S. McNeel, Barry I. Graubard, Austin G. Duffy, Susanna V. Ulahannan, Tim F. Greten, Katherine A. McGlynn. Risk factors for hepatocellular carcinoma (HCC) by race/ ethnicity in the United States. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 875. doi:10.1158/1538-7445.AM2015-875

6608 Background: Expenditures associated with cancer, its treatment, and lasting effects of treatment are increasing in the US. The purpose of this study is to estimate the prevalence of financial ...

BACKGROUND People with AIDS have heightened cancer risk from immunosuppression. HAART has been available since 1996 and has reduced AIDS-related mortality, but there are few large-scale studies on cancer trends. METHODS AIDS and cancer registries in 11 US regions (1980-2002) were used to identify cancers in 375 933 people with AIDS. Cancer risk relative to the general population was measured using the standardized incidence ratio (SIR), focusing on the 2 years after AIDS onset for those with AIDS in 1990-1995 and 1996-2002 (HAART era). Time trends were assessed with Poisson regression. RESULTS Between 1990-1995 and 1996-2002, risk declined for the two major AIDS-defining cancers: Kaposi sarcoma [(KS) n = 5131; SIR, 22 100 and 3640, respectively; P < 0.0001] and non-Hodgkin lymphoma [(NHL) n = 3412; SIR, 53.2 and 22.6, respectively; P < 0.0001]. Declines began in the 1980s, but risk fell sharply in 1996 and was stable thereafter. Risk of cervical cancer did not change (n = 64; SIR, 4.2 and 5.3, respectively; P = 0.33). Among non-AIDS malignancies, lung cancer was most common, but risk declined between 1990-1995 and 1996-2002 (n = 344; SIR, 3.3 and 2.6, respectively; P = 0.02). Risk of Hodgkin lymphoma increased substantially over the 1990-2002 period (n = 149; SIR, 8.1 and 13.6, respectively; P = 0.003). CONCLUSIONS Dramatic declines in KS and NHL were temporally related to improving therapies, especially introduction of HAART, but those with AIDS remain at marked risk. Among non-AIDS-related cancers, a recent increase in Hodgkin lymphoma was observed.

By linking HIV/AIDS and cancer surveillance data in 12 US regions, breast and reproductive cancer risks with AIDS were compared to those in the general population. Trends in standardized incidence ratios (SIRs) were assessed by CD4 count, AIDS-relative time, and calendar time. Standardized incidence ratios were indirectly adjusted for cancer risk factors using data from AIDS cohort participants and the general population. With AIDS, 313 women developed breast cancer (SIR 0.69, 95% confidence interval (CI) 0.62-0.77), 42 developed ovary cancer (SIR 1.05, 95% CI, 0.75-1.42), and 31 developed uterine corpus cancer (SIR 0.57, 95% CI, 0.39-0.81). Uterine cancer risk was reduced significantly after age 50 (SIR 0.33). Breast cancer risk was reduced significantly both before (SIR 0.71) and after (SIR 0.66) age 50, and was lower for local or regional (SIR 0.54) than distant (SIR 0.89) disease. Breast cancer risk varied little by CD4 count (Ptrend=0.47) or AIDS-relative time (Ptrend=0.14) or after adjustment for established cancer risk factors. However, it increased significantly between 1980 and 2002 (Ptrend=0.003), approaching the risk of the general population. We conclude that the cancer deficit reflected direct or indirect effects of HIV/AIDS and that anti-HIV therapy reduced these effects.

Background Levels of physical activity (PA) contribute to health status and outcomes directly and indirectly via the effects of PA on obesity and other risk factors. Much past surveillance has focused on leisure-time physical activity (LTPA), but this may bias estimates of prevalence. This study explores inclusion of non–leisure-time walking and bicycling (NLTWB) used for transportation on the prevalence of adherence to PA recommendations and the magnitude of apparent disparities in adherence for California adults. Methods Results of the 2001 California Health Interview Survey, a large ( n =55,151) telephone survey were analyzed in 2005 using tabulation and logistic regression. Results Higher levels of LTPA were associated with youth, males, education, income, Pacific Islanders, and non-Hispanic (NH) whites. Inclusion of NLTWB reduced these differences for all five variables. The largest decreases in disparities in adherence occurred for race/ethnicity, education, and income, with decreases in adherence differences from ∼18% to 7% for NH white vs Latino, ∼27% to 16% for more than high school versus less than high school, and ∼25% to 11% for more than 300% versus less than 100% of poverty level. Logistic regression comparing adherence gives similar results. For example, in respondents with more than high school education versus less than high school education (referent), the odds ratio changed from 2.23 (95% confidence interval [CI]=2.0–2.4) to 1.7 (1.6–1.9) after the inclusion of NLTWB. Conclusions Assessment of PA in multiple domains is required to understand differences in total levels of PA for people with different incomes, education levels, and racial/ethnic backgrounds. Inclusion of NLTWB reduces but does not eliminate disparities in adherence to recommended levels of PA.

Purpose A population-based investigation was conducted to examine the prevalence of health behaviors (smoking, alcohol use, physical activity, and cancer screening) of cancer survivors by age, time since diagnosis, and cancer site. Understanding health behaviors of survivors is imperative, as many survivors are living longer and are at risk for cancer recurrence, second cancers, and complications from treatment. Methods Using the National Health Interview Survey, this study examined the prevalence of smoking and alcohol use as well as whether cancer survivors (n = 7,384) are meeting current recommendations for physical activity and cancer screening compared with noncancer controls (n = 121,347). Results Cancer survivors are similar to controls with respect to smoking status and alcohol consumption after adjusting for group differences. However, younger survivors (18 to 40 years) are at greater risk for continued smoking than controls. Survivors are 9% more likely to meet physical activity recommendations compared with controls. χ2 tests indicate no significant differences in smoking, alcohol consumption, and physical activity by time since diagnosis, but differences by cancer site exist. Female cancer survivors are 34% and 36% more likely to meet mammogram and Papanicolaou smear screening recommendations, respectively, compared with controls. Similar screening patterns were found for prostate-specific antigen screening in men. Conclusion This study provides benchmark approximations of the prevalence of risky health behaviors of survivors by time since diagnosis and cancer site. As part of the collective effort to reduce late effects of cancer treatment, oncologists may be in the best position to offer initial guidance for promoting healthy lifestyle behaviors among cancer survivors.

Purpose: Prostate cancer death rates are higher in blacks than whites. Using the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database, we evaluated whether racial disparities exist in the receipt of initial prostate cancer treatment. Methods: We analyzed data on prostate cancer cases diagnosed in 2004-2009 and linked with Medicare claims data from 2003-2010. We focused on cases with SEER race coded as white or black; and enrolled in both Medicare Parts A and B continuously during 12 months before diagnosis to 24 months after diagnosis, death, or December 2010, whichever was earliest. We defined prostate cancer recurrence risk categories using tumor stage, prostate specific antigen (PSA), and Gleason scores. We identified initial prostate cancer treatment using: radical prostatectomy, radiation therapy, or androgen deprivation therapy within 1 month before to 6 months after diagnosis; or evidence of active surveillance based on prostate biopsies or PSA tests from 1 to 18 months after diagnosis. We used multivariate logistic regression to determine adjusted odds ratios (OR) and 95% confidence intervals (CI). The outcome variable was receipt of initial treatment. Explanatory variables were: race; prostate cancer disease recurrence risk category; asymptomatic or symptomatic at time of first diagnosis; life expectancy from the man's age at diagnosis; comorbidity; census tract poverty; and census region. Results: Our final study cohort included 70,254 white men and 8,653 black men with prostate cancer. After adjustment for multiple variables, men were less likely to receive initial treatment if: expected survival < 5 years (OR, 0.36; 95% CI, 0.33–0.40; ref.= > 10 years); black race (OR, 0.54; 95% CI, 0.50–0.57; ref. = white); or symptomatic at time of diagnosis (OR, 0.77, 95% CI, 0.74–0.81; ref.=asymptomatic). Men were more likely to receive initial treatment if: high recurrence risk (OR, 2.75; 95% CI, 2.55–2.96; ref.= low); resided in Northeast (OR, 1.30; 95% CI 1.24–1.38; ref.= West); comorbidity score > 2 (OR, 1.24; 95% CI, 1.17–1.31; ref. = 0); or lived in a census tract with 19%). Conclusion: Low expected survival and black race were relatively important reasons that older men did not receive initial treatment for prostate cancer. Citation Format: Thomas B. Richards, Serban Negoita, Timothy S. McNeel, Jun Li, Chunyu Li. Racial disparities in receipt of initial prostate cancer treatment, SEER Medicare, 2004-2009. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr C55. doi:10.1158/1538-7755.DISP13-C55

6521 Background: Researchers are increasingly using diagnosis codes from administrative claims for cancer patients to identify metastatic disease at initial diagnosis or recurrence. However, the validity of metastasis codes on claims has not been established. We used the linked SEER -Medicare data to assess the completeness and validity of metastasis codes from Medicare claims for three common U.S. cancers. Methods: The study included 80,052 breast, lung, and colorectal cancer patients diagnosed with localized, regional, or distant disease in the SEER data between January 1, 2005 and December 31, 2007. From Medicare claims, patients were classified as having regional or distant disease at diagnosis if they had one hospital claim or two physician claims with metastasis codes within 3 months of diagnosis. Patients without claims with metastases codes were classified as having local disease. Using SEER data as the gold standard, we calculated sensitivity, specificity, positive and negative predictive values of metastasis codes on Medicare claims. We conducted multivariate logistic regression analysis to evaluate patient factors associated with stage misclassification for each cancer site. Results: For patients with distant disease per SEER data, the sensitivity and PPV of the claims to identify distant disease was: breast (50.6%, 67.3%), colorectal (72.2%, 68.8%) and lung cancer (42.1%, 88.6%). None of the measures for stage simultaneously exceeded 80% for sensitivity, specificity, and PPV for any of the cancer sites. In adjusted analysis, older, lower-income, and African American patients were more likely to have stage at diagnosis misclassified from Medicare claims. Conclusions: Use of diagnosis codes alone in Medicare claims will misclassify stage at diagnosis for cancer patients, particularly for patients with metastatic disease. Our findings also suggest that using diagnosis codes for metastasis to define recurrence in Medicare claims will be limited.