- Email: [email protected]
Alcohol Use, Folate Intake, Liver Disease, and Hepatocellular Carcinoma
662
Abstracts / Annals of Epidemiology 22 (2012) 661e680
common in women in all ethnic groups (female/male rate ratio [FMRR] from 1.2 to 2.8), but bile duct and ampulla of Vater were more common in men (FMRR from 0.57 to 0.86). Gallbladder cancer rates generally declined among all racial/ethnic and gender groups (APC from -0.4% to e 3.8%) except blacks, while rates of extra hepatic bile duct cancer rose, with the most rapid increase among Asian/PI females (APC: 3.8%). In contrast, ampulla of Vater cancer rates decreased among Asian/PI females (APC: -2.7%) but remained stable for the other groups. Conclusion: In addition to confirming that biliary tract cancer incidence patterns differ by subsite, this study provides novel evidence that both the incidence and the temporal trends differ by racial/ethnic group in the United States. These differences may help guide future etiologic studies.
P03. Survival After Bone Metastases in Cancer Patients in Denmark V.M. Chia, C.F. Christiansen, K. Cetin, C. Sværke, J.B. Jacobsen, H.T. Sørensen. Amgen, Thousand Oaks, CA, Aarhus University Hospital, Denmark Purpose: To estimate survival after bone metastasis (BM) in cancer patients by primary tumor type. Methods: All adult residents of Denmark diagnosed with cancer from January 1994-December 2003 and with a diagnosis of BM on or after the date of the primary cancer diagnosis were identified and followed for death through 2009. Primary tumor types were identified by ICD-10 codes in the Danish Cancer Registry. BM and other metastases were identified by ICD- 10 codes in the National Registry of Patients, and deaths were identified through the Civil Registration System. 1-, 3- and 5-year survival (%) was estimated for each tumor type. Survival estimates were also assessed separately for BM only vs. those with BM plus other metastases. Results: 8,642 cancer patients with BM were identified. The majority of patients with BM had prostate (40%), breast (26%), or lung (18%) as the primary cancer type. The remainder included kidney (5%), bladder (3%), colon (2%), or rectum (2%); multiple myeloma (2%); or non-Hodgkin's lymphoma (NHL) (1%) as the primary cancer type. 1-year survival was lowest in lung cancer patients (7.5%) and highest among those who had cancers of the prostate (34.9%), breast (51.5%), or kidney (28.0%) and in those with multiple myeloma (63.7%) or NHL (52.5%). For most cancer types, survival was better in those with BM who had no other metastases. Conclusion: This nationwide study in Denmark demonstrates that BM can occur secondary to a range of primary cancer types, and survival after BM can vary widely but is longer than one year for many patients.
P04-S. Geographic Variation of Benign Lung Disease in the US: Implications for Lung Cancer Screening S.A. Deppen, S. Phillips, M.C. Aldrich, Y. Shyr, E.L. Grogan. Purpose: Recent success of the National Lung Screening Trial has driven a number of clinical and patient advocate groups to propose guidelines for lung cancer screening with low dose CT scans. However, the false positive rate was 96% and 24% of lung surgeries resulted in benign disease in the trial. If prevalence of benign disease differs across the country, then a nationwide screening regimen may have geographically varying success. Methods: We examined the period prevalence of benign disease identified by lung surgery in a retrospective cohort being evaluated for lung cancer. The National Inpatient Sample from 2009 was used to determine lung surgery by region of the country and by treating hospital urban level. Lung surgery and primary diagnosis of benign disease were determined by ICD-9CM codes. Diseases not arising from a lung nodule or mass and patients under age 18 were excluded. Benign disease prevalence was compared between hospital regions and between level of urbanization. Results: An estimated 55,855 patients had a lung operation for known or suspected lung cancer. Among these, 7,856 (14%) resulted in a benign diagnosis. Benign disease prevalence varied significantly (chi-square p < 0.001) across geographic regions from 13%, 15%, 11%, to 17% for the West, Northeast, South and Mid-West respectively. Hospitals in the most rural areas had similar benign disease prevalence (13%) when compared to urban hospitals (14%; p < 0.42). Conclusion: Benign disease diagnosed by lung surgery varies by geographic region. Geographic variation in benign disease may have implications for lung cancer screening and diagnosis.
P05. Access Perspective
to
Mammography
in
the
South:
a
Spatial
J.M. Eberth, L. Elting, K. Eschbach, J. Morris, M.D.M. Hossain, H. Nguyen. Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX Purpose: Mammography can detect breast cancer at an early stage when treatment is most effective. Utilization varies across racial/ethnic groups, income levels, and geographic areas, and access is a contributing factor. The purpose of this study was to describe the distribution of mammography facilities in the south, examine the spatial accessibility of those facilities to women aged 40 and over, and determine where additional capacity is needed to meet the Healthy People 2020 mammography screening objective. Methods: After geocoding and mapping the locations of FDA-certified mammography facilities, we calculated spatial accessibility using the twostep floating catchment area method, which accounts for the locations of mammography facilities (addresses), populations (population-weighted block group centroids), and the travel times between them. The resulting access index is then compared to the threshold needed to achieve the Healthy People 2020 objective of 81% screening coverage (.68 machines/ 10,000 women for biennial screening). Results: Preliminary results show inadequate mammography capacity in many suburban and rural areas throughout the south. The number of mammography facilities is also decreasing over time. A map displaying variation in access over space and time will be presented at the meeting. Conclusion: Our study provides geographically-specific data that can assist in the placement of new facilities, addition of mammography machines, and routing of mobile mammography units.
P06-S. Alcohol Use, Folate Hepatocellular Carcinoma
Intake,
Liver
Disease,
and
E.C. Persson,1 L. Schwartz,1 Y. Park,1 A.R. Hollenbeck,2 B.I. Graubard,1 N.D. Freedman,1 K.A. McGlynn1. 1 DCEG, NCI, NIH, Rockville, MD, 2 AARP, Washington DC Purpose: Excessive alcohol intake increases the risk of liver disease and hepatocellular carcinoma (HCC). Alcohol consumption can also inhibit the absorption of folate. In contract, high folate intake has been inversely associated with liver damage and HCC. To examine whether high folate intake altered the relationship between alcohol and liver disease mortality or HCC incidence, we analyzed data from the NIH-AARP Cohort Study. Methods: Alcohol consumption and folate intake were determined by a food-frequency questionnaire. For analysis, alcohol intake was categorized into drinks/day and daily folate intake was categorized into tertiles. Adjusted hazard ratios and 95% confidence intervals were calculated using Cox proportional hazards regression. Results: Liver disease mortality and HCC incidence were significantly associated with intake of >3 drinks/day. Neither outcome was associated with folate intake. Folate had no effect on the relationship between alcohol and liver disease mortality, but significantly affected the relationship between alcohol and HCC. High alcohol consumption increased the risk of HCC only among persons whose folate intake was in the lower two tertiles. Conclusion: Liver disease mortality was associated with increased alcohol consumption, regardless of folate intake. HCC incidence was associated with increased alcohol consumption only among persons with folate intake in the lower two tertiles, suggesting that high folate intake may ameliorate the effects of alcohol consumption on the development of HCC.
P07. Mediators in the Survival Disparity Between Black and White Women With Ovarian Cancer C.E. Peterson, F.G. Davis, G.H. Rauscher, T.P. Johnson, C.V. Kirschner, R.E. Barrett, S. Kim. Purpose: This study examines whether factors related to socioeconomic environment (SE), tumor characteristics, and risk factors associated with longer lifetime ovulation and higher gonadotropin levels are mediators of the racial disparity in ovarian cancer survival.
Abstracts / Annals of Epidemiology 22 (2012) 661e680
common in women in all ethnic groups (female/male rate ratio [FMRR] from 1.2 to 2.8), but bile duct and ampulla of Vater were more common in men (FMRR from 0.57 to 0.86). Gallbladder cancer rates generally declined among all racial/ethnic and gender groups (APC from -0.4% to e 3.8%) except blacks, while rates of extra hepatic bile duct cancer rose, with the most rapid increase among Asian/PI females (APC: 3.8%). In contrast, ampulla of Vater cancer rates decreased among Asian/PI females (APC: -2.7%) but remained stable for the other groups. Conclusion: In addition to confirming that biliary tract cancer incidence patterns differ by subsite, this study provides novel evidence that both the incidence and the temporal trends differ by racial/ethnic group in the United States. These differences may help guide future etiologic studies.
P03. Survival After Bone Metastases in Cancer Patients in Denmark V.M. Chia, C.F. Christiansen, K. Cetin, C. Sværke, J.B. Jacobsen, H.T. Sørensen. Amgen, Thousand Oaks, CA, Aarhus University Hospital, Denmark Purpose: To estimate survival after bone metastasis (BM) in cancer patients by primary tumor type. Methods: All adult residents of Denmark diagnosed with cancer from January 1994-December 2003 and with a diagnosis of BM on or after the date of the primary cancer diagnosis were identified and followed for death through 2009. Primary tumor types were identified by ICD-10 codes in the Danish Cancer Registry. BM and other metastases were identified by ICD- 10 codes in the National Registry of Patients, and deaths were identified through the Civil Registration System. 1-, 3- and 5-year survival (%) was estimated for each tumor type. Survival estimates were also assessed separately for BM only vs. those with BM plus other metastases. Results: 8,642 cancer patients with BM were identified. The majority of patients with BM had prostate (40%), breast (26%), or lung (18%) as the primary cancer type. The remainder included kidney (5%), bladder (3%), colon (2%), or rectum (2%); multiple myeloma (2%); or non-Hodgkin's lymphoma (NHL) (1%) as the primary cancer type. 1-year survival was lowest in lung cancer patients (7.5%) and highest among those who had cancers of the prostate (34.9%), breast (51.5%), or kidney (28.0%) and in those with multiple myeloma (63.7%) or NHL (52.5%). For most cancer types, survival was better in those with BM who had no other metastases. Conclusion: This nationwide study in Denmark demonstrates that BM can occur secondary to a range of primary cancer types, and survival after BM can vary widely but is longer than one year for many patients.
P04-S. Geographic Variation of Benign Lung Disease in the US: Implications for Lung Cancer Screening S.A. Deppen, S. Phillips, M.C. Aldrich, Y. Shyr, E.L. Grogan. Purpose: Recent success of the National Lung Screening Trial has driven a number of clinical and patient advocate groups to propose guidelines for lung cancer screening with low dose CT scans. However, the false positive rate was 96% and 24% of lung surgeries resulted in benign disease in the trial. If prevalence of benign disease differs across the country, then a nationwide screening regimen may have geographically varying success. Methods: We examined the period prevalence of benign disease identified by lung surgery in a retrospective cohort being evaluated for lung cancer. The National Inpatient Sample from 2009 was used to determine lung surgery by region of the country and by treating hospital urban level. Lung surgery and primary diagnosis of benign disease were determined by ICD-9CM codes. Diseases not arising from a lung nodule or mass and patients under age 18 were excluded. Benign disease prevalence was compared between hospital regions and between level of urbanization. Results: An estimated 55,855 patients had a lung operation for known or suspected lung cancer. Among these, 7,856 (14%) resulted in a benign diagnosis. Benign disease prevalence varied significantly (chi-square p < 0.001) across geographic regions from 13%, 15%, 11%, to 17% for the West, Northeast, South and Mid-West respectively. Hospitals in the most rural areas had similar benign disease prevalence (13%) when compared to urban hospitals (14%; p < 0.42). Conclusion: Benign disease diagnosed by lung surgery varies by geographic region. Geographic variation in benign disease may have implications for lung cancer screening and diagnosis.
P05. Access Perspective
to
Mammography
in
the
South:
a
Spatial
J.M. Eberth, L. Elting, K. Eschbach, J. Morris, M.D.M. Hossain, H. Nguyen. Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX Purpose: Mammography can detect breast cancer at an early stage when treatment is most effective. Utilization varies across racial/ethnic groups, income levels, and geographic areas, and access is a contributing factor. The purpose of this study was to describe the distribution of mammography facilities in the south, examine the spatial accessibility of those facilities to women aged 40 and over, and determine where additional capacity is needed to meet the Healthy People 2020 mammography screening objective. Methods: After geocoding and mapping the locations of FDA-certified mammography facilities, we calculated spatial accessibility using the twostep floating catchment area method, which accounts for the locations of mammography facilities (addresses), populations (population-weighted block group centroids), and the travel times between them. The resulting access index is then compared to the threshold needed to achieve the Healthy People 2020 objective of 81% screening coverage (.68 machines/ 10,000 women for biennial screening). Results: Preliminary results show inadequate mammography capacity in many suburban and rural areas throughout the south. The number of mammography facilities is also decreasing over time. A map displaying variation in access over space and time will be presented at the meeting. Conclusion: Our study provides geographically-specific data that can assist in the placement of new facilities, addition of mammography machines, and routing of mobile mammography units.
P06-S. Alcohol Use, Folate Hepatocellular Carcinoma
Intake,
Liver
Disease,
and
E.C. Persson,1 L. Schwartz,1 Y. Park,1 A.R. Hollenbeck,2 B.I. Graubard,1 N.D. Freedman,1 K.A. McGlynn1. 1 DCEG, NCI, NIH, Rockville, MD, 2 AARP, Washington DC Purpose: Excessive alcohol intake increases the risk of liver disease and hepatocellular carcinoma (HCC). Alcohol consumption can also inhibit the absorption of folate. In contract, high folate intake has been inversely associated with liver damage and HCC. To examine whether high folate intake altered the relationship between alcohol and liver disease mortality or HCC incidence, we analyzed data from the NIH-AARP Cohort Study. Methods: Alcohol consumption and folate intake were determined by a food-frequency questionnaire. For analysis, alcohol intake was categorized into drinks/day and daily folate intake was categorized into tertiles. Adjusted hazard ratios and 95% confidence intervals were calculated using Cox proportional hazards regression. Results: Liver disease mortality and HCC incidence were significantly associated with intake of >3 drinks/day. Neither outcome was associated with folate intake. Folate had no effect on the relationship between alcohol and liver disease mortality, but significantly affected the relationship between alcohol and HCC. High alcohol consumption increased the risk of HCC only among persons whose folate intake was in the lower two tertiles. Conclusion: Liver disease mortality was associated with increased alcohol consumption, regardless of folate intake. HCC incidence was associated with increased alcohol consumption only among persons with folate intake in the lower two tertiles, suggesting that high folate intake may ameliorate the effects of alcohol consumption on the development of HCC.
P07. Mediators in the Survival Disparity Between Black and White Women With Ovarian Cancer C.E. Peterson, F.G. Davis, G.H. Rauscher, T.P. Johnson, C.V. Kirschner, R.E. Barrett, S. Kim. Purpose: This study examines whether factors related to socioeconomic environment (SE), tumor characteristics, and risk factors associated with longer lifetime ovulation and higher gonadotropin levels are mediators of the racial disparity in ovarian cancer survival.