27 results on '"Feuer, Eric J"'
Search Results
2. Impact of Reduced Tobacco Smoking on Lung Cancer Mortality in the United States During 1975–2000
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Moolgavkar, Suresh H., Holford, Theodore R., Levy, David T., Kong, Chung Yin, Foy, Millenia, Clarke, Lauren, Jeon, Jihyoun, Hazelton, William D., Meza, Rafael, Schultz, Frank, McCarthy, William, Boer, Robert, Gorlova, Olga, Gazelle, G. Scott, Kimmel, Marek, McMahon, Pamela M., de Koning, Harry J., and Feuer, Eric J.
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- 2012
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3. Projections of the Cost of Cancer Care in the United States: 2010–2020
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Mariotto, Angela B., Robin Yabroff, K., Shao, Yongwu, Feuer, Eric J., and Brown, Martin L.
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- 2011
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4. Productivity Costs of Cancer Mortality in the United States: 2000–2020
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Bradley, Cathy J., Yabroff, K. Robin, Dahman, Bassam, Feuer, Eric J., Mariotto, Angela, and Brown, Martin L.
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- 2008
5. Estimates and Projections of Value of Life Lost From Cancer Deaths in the United States
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Yabroff, K. Robin, Bradley, Cathy J., Mariotto, Angela B., Brown, Martin L., and Feuer, Eric J.
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- 2008
6. Re: Trends in Use of Adjuvant Multi-Agent Chemotherapy and Tamoxifen for Breast Cancer in the United States: 1975–1999
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Mariotto, Angela, Feuer, Eric J., and Abrams, Jeffrey
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- 2003
7. Trends in Use of Adjuvant Multi-Agent Chemotherapy and Tamoxifen for Breast Cancer in the United States: 1975–1999
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Mariotto, Angela, Feuer, Eric J., Harlan, Linda C., Wun, Lap-Ming, Johnson, Karen A., and Abrams, Jeffrey
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- 2002
8. Impact of Reporting Delay and Reporting Error on Cancer Incidence Rates and Trends
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Clegg, Limin X., Feuer, Eric J., Midthune, Douglas N., Fay, Michael P., and Hankey, Benjamin F.
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- 2002
9. Overdiagnosis Due to Prostate-Specific Antigen Screening: Lessons From U.S. Prostate Cancer Incidence Trends
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Etzioni, Ruth, Penson, David F., Legler, Julie M., Tommaso, Dante di, Boer, Rob, Gann, Peter H., and Feuer, Eric J.
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- 2002
10. Changing Area Socioeconomic Patterns in U.S. Cancer Mortality, 1950–1998: Part I—All Cancers Among Men
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Singh, Gopal K., Miller, Barry A., Hankey, Benjamin F., Feuer, Eric J., and Pickle, Linda W.
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- 2002
11. Cancer Surveillance Series: Interpreting Trends in Prostate Cancer—Part I: Evidence of the Effects of Screening in Recent Prostate Cancer Incidence, Mortality, and Survival Rates
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Hankey, Benjamin F., Feuer, Eric J., Clegg, Limin X., Hayes, Richard B., Legler, Julie M., Prorok, Phillip C., Ries, Lynn A., Merrill, Ray M., and Kaplan, Richard S
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- 1999
12. Cancer Surveillance Series: Interpreting Trends in Prostate Cancer—Part III:Quantifying the Link Between Population Prostate-Specific Antigen Testing and Recent Declines in Prostate Cancer Mortality
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Etzioni, Ruth, Legler, Julie M., Feuer, Eric J., Merrill, Ray M., Cronin, Kathleen A., and Hankey, Benjamin F.
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- 1999
13. Cancer Surveillance Series: Interpreting Trends in Prostate Cancer—Part II: Cause of Death Misclassification and the Recent Rise and Fall in Prostate Cancer Mortality
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Feuer, Eric J., Merrill, Ray M., and Hankey, Benjamin F.
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- 1999
14. Does Size Matter? Association Between Number of Patients Treated and Patient Outcome in Metastatic Testicular Cancer
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Feuer, Eric J., Sheinfeld, Joel, and Bosl, George J.
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- 1999
15. The lifetime risk of developing breast cancer
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Feuer, Eric J., Wun Lap-Ming, Boring, Catherine C., Flanders, W. Dana, Timmel, Marilyn J., and Tong, Tony
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Breast cancer -- Risk factors ,Disease susceptibility -- Research ,Health - Abstract
Background: The lifetime risk of developing breast cancer in U.S. women, often quoted as one in nine, is a commonly cited cancer statistic. However, many estimates have used cancer rates derived from total rather than the cancer-free population and have not properly accounted for multiple cancers in the same individual. Purpose: Our purpose was to provide a revised method for calculating estimates of the lifetime risk of developing breast cancer and to aid in interpretation of the estimates. Methods: A multiple decrement life table was derived by applying age-specific incidence and mortality rates from cross-sectional data to a hypothetical cohort of women. Incidence, mortality, and population data from 1975-1988 were used, representing the geographic areas of the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program. The incidence rates reflected only the First breast primary cancer; mortality rates reflected causes other than breast cancer. The population denominator used in calculating incidence rates was adjusted to reflect only those women without previously diagnosed breast cancers in the hypothetical cohort. Results: Our calculations showed an overall lifetime risk for developing invasive breast cancer of approximately one in eight with use of 1987-1988 SEER data, although up to age 85, it was still the commonly quoted one in nine. Conclusion: Our estimate was calculated assuming constant age-specific rates derived from 1987-1988 SEER data. Because incidence and mortality rates change over time, conditional risk estimates over the short term (10 or 20 years) may be more reliable. A large portion of the rise in the lifetime risk of breast cancer estimated using 1975-1977 data (one in 10.6) to an estimate using 1987-1988 data (one in eight) may be attributed to 1) early detection of prevalent cases due to increased use of mammographic screening and 2) lower mortality due to causes other than breast cancer. A common misperception is that the lifetime risk estimate assumes that all women live to a particular age (e.g., 85 or 95). In fact, the calculation assumes that women can die from causes other than breast cancer at any possible age. Cutting off the lifetime risk calculation at age 85 assumes that no women develop breast cancer after that age. While the lifetime risk of developing breast cancer rose over the period 1976-1977 to 1987-1988, the lifetime risk of dying of breast cancer increased from one in 30 to one in 28, reflecting generally flat mortality trends.
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- 1993
16. Changing trends in U.S. prostate cancer incidence rates
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Merrill, Ray M., Potosky, Arnold L., and Feuer, Eric J.
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Prostate cancer -- Demographic aspects ,Health - Published
- 1996
17. Cancer Surveillance Series: Interpreting Trends in Prostate Cancer--Part III: Quantifying the Link Between Population Prostate-Specific Antigen Testing and Recent Declines in Prostate Cancer Mortality
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Etzioni, Ruth, Legler, Julie M., Feuer, Eric J., Merrill, Ray M., Cronin, Kathleen A., and Hankey, Benjamin F.
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Prostate-specific antigen ,Prostate cancer -- Patient outcomes ,Health - Abstract
Background: The objective of this study was to investigate the circumstances under which dissemination of prostate-specific antigen (PSA) testing, beginning in 1988, could plausibly explain the declines in prostate cancer mortality observed from 1992 through 1994. Methods: We developed a computer simulation model by use of information on population-based PSA testing patterns, cancer detection rates, average lead time (the time by which diagnosis is advanced by screening), and projected decreased risk of death associated with early diagnosis of prostate cancer through PSA testing. The model provides estimates of the number of deaths prevented by PSA testing for the 7-year period from 1988 through 1994 and projects what prostate cancer mortality for these years would have been in the absence of PSA testing. Results: Results were generated by assuming a level of screening efficacy similar to that hypothesized for the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial. Under this assumption, the projected mortality in the absence of PSA testing continued the increasing trend observed before 1991 only when it was assumed that the mean lead time was 3 years or less. Projected mortality trends in the absence of PSA screening were not consistent with pre-1991 increasing trends for lead times of 5 years and 7 years. Conclusions: When screening is assumed to be at least as efficacious as hypothesized in the PLCO trial, it is unlikely that the entire decline in prostate cancer mortality can be explained by PSA testing based on current beliefs concerning lead time. Only very short lead times,would produce a decline in mortality of the magnitude that has been observed. [J Natl Cancer Inst 1999;91:1033-9]
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- 1999
18. Accelerating Progress to Reduce the Cancer Burden through Prevention and Control in the US.
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Goddard KAB, Feuer EJ, Umar A, and Castle PE
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Improvements in cancer prevention and control are poised to be main contributors in reducing the burden of cancer in the US. We quantify top opportunities to accelerate progress using projected life years gained (LYG) and deaths averted as measures. We project that over the next 25 years, realistic gains from tobacco control can contribute 0.4 to 17 million additional LYG per intervention and 8.4 million additional LYG from improving uptake of screening programs over the lifetime of 25 annual cohorts. Additional opportunities include addressing modifiable risk factors (excess weight, alcohol consumption), improving methods to prevent or treat oncogenic infections, and reducing cancer health disparities. Investment is needed in the pipeline of new preventive agents and technologies for early detection to continue progress. There is also a need for additional research to improve the access to and uptake of existing and emerging interventions for cancer prevention and control and to address health disparities. These gains are undeniably within our power to realize for the US population., (Published by Oxford University Press 2024.)
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- 2024
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19. Assessing racial, ethnic, and nativity disparities in US cancer mortality using a new integrated platform.
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Yu M, Liu L, Gibson JT, Campbell D, Liu Q, Scoppa S, Feuer EJ, and Pinheiro PS
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- Humans, United States epidemiology, Male, Female, Middle Aged, Aged, Adult, Emigrants and Immigrants statistics & numerical data, Mortality trends, Mortality ethnology, Health Status Disparities, Racial Groups statistics & numerical data, Neoplasms mortality, Neoplasms ethnology, Ethnicity statistics & numerical data
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Background: Foreign-born populations in the United States have markedly increased, yet cancer trends remain unexplored. Survey-based Population-Adjusted Rate Calculator (SPARC) is a new tool for evaluating nativity differences in cancer mortality., Methods: Using SPARC, we calculated 3-year (2016-2018) age-adjusted mortality rates and rate ratios for common cancers by sex, age group, race and ethnicity, and nativity. Trends by nativity were examined for the first time for 2006-2018. Traditional cancer statistics draw populations from decennial censuses. However, nativity-stratified populations are from the American Community Surveys, thus involve sampling errors. To rectify this, SPARC employed bias-corrected estimators. Death counts came from the National Vital Statistics System., Results: Age-adjusted mortality rates were higher among US-born populations across nearly all cancer types, with the largest US-born, foreign-born difference observed in lung cancer among Black women (rate ratio = 3.67, 95% confidence interval [CI] = 3.37 to 4.00). The well-documented White-Black differences in breast cancer mortality existed mainly among US-born women. For all cancers combined, descending trends were more accelerated for US-born compared with foreign-born individuals in all race and ethnicity groups with changes ranging from -2.6% per year in US-born Black men to stable (statistically nonsignificant) among foreign-born Black women. Pancreas and liver cancers were exceptions with increasing, stable, or decreasing trends depending on nativity and race and ethnicity. Notably, foreign-born Black men and foreign-born Hispanic men did not show a favorable decline in colorectal cancer mortality., Conclusions: Although all groups show beneficial cancer mortality trends, those with higher rates in 2006 have experienced sharper declines. Persistent disparities between US-born and foreign-born individuals, especially among Black people, necessitate further investigation., (Published by Oxford University Press 2024.)
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- 2024
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20. Interpreting cancer incidence trends: challenges due to the COVID-19 pandemic.
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Mariotto AB, Feuer EJ, Howlader N, Chen HS, Negoita S, and Cronin KA
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- Humans, United States epidemiology, Incidence, Pandemics, SEER Program, COVID-19 epidemiology, Thyroid Neoplasms epidemiology
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The considerable deficit in cancer diagnoses in 2020 due to COVID-19 pandemic disruptions in health care can pose challenges in the estimation and interpretation of long-term cancer trends. Using Surveillance, Epidemiology, and End Results (SEER) (2000-2020) data, we demonstrate that inclusion of the 2020 incidence rates in joinpoint models to estimate trends can result in a poorer fit to the data and less accurate or less precise trend estimates, providing challenges in the interpretation of the estimates as a cancer control measure. To measure the decline in 2020 relative to 2019 cancer incidence rates, we used the percent change of rates in 2020 compared with 2019. Overall, SEER cancer incidence rates dropped approximately 10% in 2020, but for thyroid cancer the decrease was as large as 18% after adjusting for reporting delay. The 2020 SEER incidence data are available in all SEER released products, except for joinpoint estimates of trends and lifetime risk of developing cancer., (Published by Oxford University Press 2023.)
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- 2023
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21. Disparities of National Lung Cancer Screening Guidelines in the US Population.
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Han SS, Chow E, Ten Haaf K, Toumazis I, Cao P, Bastani M, Tammemagi M, Jeon J, Feuer EJ, Meza R, and Plevritis SK
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- Black or African American statistics & numerical data, Age Factors, Aged, Aged, 80 and over, Cohort Studies, Early Detection of Cancer standards, Female, Humans, Lung Neoplasms epidemiology, Lung Neoplasms ethnology, Male, Middle Aged, Practice Guidelines as Topic, Prevalence, Randomized Controlled Trials as Topic, Risk Factors, Sex Factors, Smoking epidemiology, United States epidemiology, White People statistics & numerical data, Early Detection of Cancer statistics & numerical data, Guideline Adherence statistics & numerical data, Healthcare Disparities statistics & numerical data, Lung Neoplasms diagnosis
- Abstract
Background: Current US Preventive Services Task Force (USPSTF) lung cancer screening guidelines are based on smoking history and age (55-80 years). These guidelines may miss those at higher risk, even at lower exposures of smoking or younger ages, because of other risk factors such as race, family history, or comorbidity. In this study, we characterized the demographic and clinical profiles of those selected by risk-based screening criteria but were missed by USPSTF guidelines in younger (50-54 years) and older (71-80 years) age groups., Methods: We used data from the National Health Interview Survey, the CISNET Smoking History Generator, and results of logistic prediction models to simulate lifetime lung cancer risk-factor data for 100 000 individuals in the 1950-1960 birth cohorts. We calculated age-specific 6-year lung cancer risk for each individual from ages 50 to 90 years using the PLCOm2012 model and evaluated age-specific screening eligibility by USPSTF guidelines and by risk-based criteria (varying thresholds between 1.3% and 2.5%)., Results: In the 1950 birth cohort, 5.4% would have been ineligible for screening by USPSTF criteria in their younger ages but eligible based on risk-based criteria. Similarly, 10.4% of the cohort would be ineligible for screening by USPSTF in older ages. Notably, high proportions of blacks were ineligible for screening by USPSTF criteria at younger (15.6%) and older (14.2%) ages, which were statistically significantly greater than those of whites (4.8% and 10.8%, respectively; P < .001). Similar results were observed with other risk thresholds and for the 1960 cohort., Conclusions: Further consideration is needed to incorporate comprehensive risk factors, including race and ethnicity, into lung cancer screening to reduce potential racial disparities., (© The Author(s) 2020. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
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- 2020
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22. A Comparative Modeling Analysis of Risk-Based Lung Cancer Screening Strategies.
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Ten Haaf K, Bastani M, Cao P, Jeon J, Toumazis I, Han SS, Plevritis SK, Blom EF, Kong CY, Tammemägi MC, Feuer EJ, Meza R, and de Koning HJ
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- Aged, Aged, 80 and over, Early Detection of Cancer, Female, Humans, Male, Middle Aged, Models, Statistical, Risk Assessment, Risk Factors, Smoking epidemiology, Lung Neoplasms diagnosis, Lung Neoplasms epidemiology
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Background: Risk-prediction models have been proposed to select individuals for lung cancer screening. However, their long-term effects are uncertain. This study evaluates long-term benefits and harms of risk-based screening compared with current United States Preventive Services Task Force (USPSTF) recommendations., Methods: Four independent natural history models were used to perform a comparative modeling study evaluating long-term benefits and harms of selecting individuals for lung cancer screening through risk-prediction models. In total, 363 risk-based screening strategies varying by screening starting and stopping age, risk-prediction model used for eligibility (Bach, PLCOm2012, or Lung Cancer Death Risk Assessment Tool [LCDRAT]), and risk threshold were evaluated for a 1950 US birth cohort. Among the evaluated outcomes were percentage of individuals ever screened, screens required, lung cancer deaths averted, life-years gained, and overdiagnosis., Results: Risk-based screening strategies requiring similar screens among individuals ages 55-80 years as the USPSTF criteria (corresponding risk thresholds: Bach = 2.8%; PLCOm2012 = 1.7%; LCDRAT = 1.7%) averted considerably more lung cancer deaths (Bach = 693; PLCOm2012 = 698; LCDRAT = 696; USPSTF = 613). However, life-years gained were only modestly higher (Bach = 8660; PLCOm2012 = 8862; LCDRAT = 8631; USPSTF = 8590), and risk-based strategies had more overdiagnosed cases (Bach = 149; PLCOm2012 = 147; LCDRAT = 150; USPSTF = 115). Sensitivity analyses suggest excluding individuals with limited life expectancies (<5 years) from screening retains the life-years gained by risk-based screening, while reducing overdiagnosis by more than 65.3%., Conclusions: Risk-based lung cancer screening strategies prevent considerably more lung cancer deaths than current recommendations do. However, they yield modest additional life-years and increased overdiagnosis because of predominantly selecting older individuals. Efficient implementation of risk-based lung cancer screening requires careful consideration of life expectancy for determining optimal individual stopping ages., (© The Author(s) 2019. Published by Oxford University Press.)
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- 2020
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23. Expected Monetary Impact of Oncotype DX Score-Concordant Systemic Breast Cancer Therapy Based on the TAILORx Trial.
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Mariotto A, Jayasekerea J, Petkov V, Schechter CB, Enewold L, Helzlsouer KJ, Feuer EJ, and Mandelblatt JS
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- Adult, Aged, Breast Neoplasms diagnosis, Breast Neoplasms etiology, Breast Neoplasms therapy, Combined Modality Therapy, Female, Health Care Costs, Humans, Middle Aged, Neoplasm Staging, Precision Medicine, Prognosis, Recurrence, SEER Program, Biomarkers, Tumor, Breast Neoplasms epidemiology
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Background: TAILORx demonstrated that women with node-negative, hormone receptor-positive, HER2-negative breast cancers and Oncotype DX recurrence scores (RS) of 0-25 had similar 9-year outcomes with endocrine vs chemo-endocrine therapy; evidence for women aged 50 years and younger and RS 16-25 was less clear. We estimated how expected changes in practice following the trial might affect US costs in the initial 12 months of care (initial costs)., Methods: Data from Surveillance, Epidemiology, and End Results (SEER), SEER-Medicare, and SEER-Genomic Health Inc datasets were used to estimate Oncotype DX testing and chemotherapy rates and mean initial costs pre- and post-TAILORx (in 2018 dollars), assuming all women received Oncotype DX testing and score-suggested therapy posttrial. Sensitivity analyses tested the impact on costs of assumptions about compliance with testing and score-suggested treatment and estimation methods., Results: Pretrial mean initial costs were $2.816 billion. Posttrial, Oncotype DX testing costs were projected to increase from $115 to $231 million and chemotherapy use to decrease from 25% to 17%, resulting in initial care costs of $2.766 billion, or a net savings of $49 million (1.8% decrease). A small net savings was seen under most assumptions. The one exception was if all women aged 50 years and younger with tumors with RS 16-25 elected to receive chemotherapy, initial care costs could increase by $105 million (4% increase)., Conclusions: Personalizing breast cancer treatment based on tumor genetic profiles could result in small cost decreases in the initial 12 months of care. Studies are needed to evaluate the long-term costs and nonmonetary benefits of personalized cancer care., (© The Author(s) 2019. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
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- 2020
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24. Annual Report to the Nation on the Status of Cancer, Featuring Cancer in Men and Women Age 20-49 Years.
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Ward EM, Sherman RL, Henley SJ, Jemal A, Siegel DA, Feuer EJ, Firth AU, Kohler BA, Scott S, Ma J, Anderson RN, Benard V, and Cronin KA
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- Adolescent, Adult, Aged, Brain Neoplasms epidemiology, Breast Neoplasms epidemiology, Breast Neoplasms ethnology, Child, Child, Preschool, Female, Humans, Incidence, Infant, Infant, Newborn, Male, Middle Aged, Mortality trends, Neoplasms ethnology, Neoplasms mortality, Puerto Rico epidemiology, Registries statistics & numerical data, Sex Distribution, United States epidemiology, United States ethnology, Young Adult, Neoplasms epidemiology
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Background: The American Cancer Society, Centers for Disease Control and Prevention, National Cancer Institute, and North American Association of Central Cancer Registries provide annual updates on cancer occurrence and trends by cancer type, sex, race, ethnicity, and age in the United States. This year's report highlights the cancer burden among men and women age 20-49 years., Methods: Incidence data for the years 1999 to 2015 from the Centers for Disease Control and Prevention- and National Cancer Institute-funded population-based cancer registry programs compiled by the North American Association of Central Cancer Registries and death data for the years 1999 to 2016 from the National Vital Statistics System were used. Trends in age-standardized incidence and death rates, estimated by joinpoint, were expressed as average annual percent change., Results: Overall cancer incidence rates (per 100 000) for all ages during 2011-2015 were 494.3 among male patients and 420.5 among female patients; during the same time period, incidence rates decreased 2.1% (95% confidence interval [CI] = -2.6% to -1.6%) per year in men and were stable in females. Overall cancer death rates (per 100 000) for all ages during 2012-2016 were 193.1 among male patients and 137.7 among female patients. During 2012-2016, overall cancer death rates for all ages decreased 1.8% (95% CI = -1.8% to -1.8%) per year in male patients and 1.4% (95% CI = -1.4% to -1.4%) per year in females. Important changes in trends were stabilization of thyroid cancer incidence rates in women and rapid declines in death rates for melanoma of the skin (both sexes). Among adults age 20-49 years, overall cancer incidence rates were substantially lower among men (115.3 per 100 000) than among women (203.3 per 100 000); cancers with the highest incidence rates (per 100 000) among men were colon and rectum (13.1), testis (10.7), and melanoma of the skin (9.8), and among women were breast (73.2), thyroid (28.4), and melanoma of the skin (14.1). During 2011 to 2015, the incidence of all invasive cancers combined among adults age 20-49 years decreased -0.7% (95% CI = -1.0% to -0.4%) among men and increased among women (1.3%, 95% CI = 0.7% to 1.9%). The death rate for (per 100 000) adults age 20-49 years for all cancer sites combined during 2012 to 2016 was 22.8 among men and 27.1 among women; during the same time period, death rates decreased 2.3% (95% CI = -2.4% to -2.2%) per year among men and 1.7% (95% CI = -1.8% to -1.6%) per year among women., Conclusions: Among people of all ages and ages 20-49 years, favorable as well as unfavorable trends in site-specific cancer incidence were observed, whereas trends in death rates were generally favorable. Characterizing the cancer burden may inform research and cancer-control efforts., (© The Author(s) 2019. Published by Oxford University Press.)
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- 2019
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25. Effects of Radiotherapy in Early-Stage, Low-Recurrence Risk, Hormone-Sensitive Breast Cancer.
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Jayasekera J, Schechter CB, Sparano JA, Jagsi R, White J, Chapman JW, Whelan T, Anderson SJ, Fyles AW, Sauerbrei W, Zellars RC, Li Y, Song J, Huang X, Julian TB, Luta G, Berry DA, Feuer EJ, and Mandelblatt J
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- Aged, Aged, 80 and over, Antineoplastic Agents, Hormonal therapeutic use, Breast Neoplasms genetics, Breast Neoplasms mortality, Clinical Trials as Topic, Combined Modality Therapy, Female, Humans, Middle Aged, Neoplasm Grading, Neoplasm Recurrence, Local, Neoplasm Staging, Proportional Hazards Models, Radiotherapy, Adjuvant, Breast Neoplasms diagnosis, Breast Neoplasms radiotherapy
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Background: Radiotherapy after breast conservation has become the standard of care. Prior meta-analyses on effects of radiotherapy predated availability of gene expression profiling (GEP) to assess recurrence risk and/or did not include all relevant outcomes. This analysis used GEP information with pooled individual-level data to evaluate the impact of omitting radiotherapy on recurrence and mortality., Methods: We considered trials that evaluated or administered radiotherapy after lumpectomy in women with low-risk breast cancer. Women included had undergone lumpectomy and were treated with hormonal therapy for stage I, ER+ and/or PR+, HER2- breast cancer with Oncotype scores no greater than 18. Recurrence-free interval (RFI), type of RFI (locoregional or distant), and breast cancer-specific and overall survival were compared between no radiotherapy and radiotherapy using adjusted Cox models. All statistical tests were two-sided., Results: The final sample included 1778 women from seven trials. Omission of radiotherapy was associated with an overall adjusted hazard ratio of 2.59 (95% confidence interval [CI] = 1.38 to 4.89, P = .003) for RFI. There was a statistically significant increase in any first locoregional recurrence (P = .001), but not distant recurrence events (P = .90), or breast cancer-specific (P = .85) or overall survival (P = .61). Five-year RFI rate was high (93.5% for no radiotherapy vs 97.9% for radiotherapy; absolute reduction = 4.4%, 95% CI = 0.7% to 8.1%, P = .03). The effects of radiotherapy varied across subgroups, with lower RFI rates for those with Oncotype scores of less than 11 (vs 11-18), older (vs younger), and ER+/PR+ status (vs other)., Conclusions: Omission of radiotherapy in hormone-sensitive patients with low recurrence risk may lead to a modest increase in locoregional recurrence event rates, but does not appear to increase the rate of distant recurrence or death.
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- 2018
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26. Simulation Modeling of Cancer Clinical Trials: Application to Omitting Radiotherapy in Low-risk Breast Cancer.
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Jayasekera J, Li Y, Schechter CB, Jagsi R, Song J, White J, Luta G, Chapman JW, Feuer EJ, Zellars RC, Stout N, Julian TB, Whelan T, Huang X, Shelley Hwang E, Hopkins JO, Sparano JA, Anderson SJ, Fyles AW, Gray R, Sauerbrei W, Mandelblatt J, and Berry DA
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- Adult, Aged, Breast Neoplasms diagnosis, Breast Neoplasms mortality, Breast Neoplasms therapy, Combined Modality Therapy, Female, Follow-Up Studies, Humans, Middle Aged, Models, Statistical, Neoplasm Grading, Neoplasm Recurrence, Local, Neoplasm Staging, Proportional Hazards Models, Radiotherapy, Adjuvant, Treatment Outcome, Breast Neoplasms epidemiology, Clinical Trials as Topic, Models, Theoretical
- Abstract
Background: We used two models to simulate a proposed noninferiority trial of radiotherapy (RT) omission in low-risk invasive breast cancer to illustrate how modeling could be used to predict the trial's outcomes, inform trial design, and contribute to practice debates., Methods: The proposed trial was a prospective randomized trial of no-RT vs RT in women age 40 to 74 years undergoing lumpectomy and endocrine therapy for hormone receptor-positive, human epidermal growth factor receptor 2-negative, stage I breast cancer with an Oncotype DX score of 18 or lower. The primary endpoint was recurrence-free interval (RFI), including locoregional recurrence, distant recurrence, and breast cancer death. Noninferiority required the two-sided 90% confidence interval of the RFI hazard ratio (HR) for no-RT vs RT to be entirely below 1.7. Model inputs included published data. The trial was simulated 1000 times, and results were summarized as percent concluding noninferiority and mean (standard deviation) of hazard ratios for Model GE and Model M, respectively., Results: Noninferiority was demonstrated in 18.0% and 3.7% for the two models. The respective means (SD) of the RFI hazard ratios were 1.8 (0.7) and 2.4 (0.9); most were locoregional recurrences. The mean five-year RFI rates for no-RT vs RT (SD) were 92.7% (2.9%) vs 95.5% (2.2%) and 88.4% (2.0%) vs 94.5% (1.6%). Both models showed little or no difference in breast cancer-specific or overall survival. Alternative definitions of low risk based on combinations of age and grade produced similar results., Conclusions: The proposed trial was unlikely to show noninferiority of omitting radiotherapy even using alternative definitions of low-risk, as the endpoint included local recurrence. Future trials regarding radiotherapy should address absolute reduction in recurrence and impact of type of recurrence on the patient.
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- 2018
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27. Annual Report to the Nation on the Status of Cancer, 1975-2014, Featuring Survival.
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Jemal A, Ward EM, Johnson CJ, Cronin KA, Ma J, Ryerson B, Mariotto A, Lake AJ, Wilson R, Sherman RL, Anderson RN, Henley SJ, Kohler BA, Penberthy L, Feuer EJ, and Weir HK
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- American Cancer Society, Centers for Disease Control and Prevention, U.S., Cross-Sectional Studies, Female, Humans, Incidence, Male, Neoplasms ethnology, Neoplasms mortality, Proportional Hazards Models, Registries, SEER Program, Sex Factors, Survival Rate, United States epidemiology, Neoplasms epidemiology
- Abstract
Background: The American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR) collaborate to provide annual updates on cancer occurrence and trends in the United States. This Annual Report highlights survival rates. Data were from the CDC- and NCI-funded population-based cancer registry programs and compiled by NAACCR. Trends in age-standardized incidence and death rates for all cancers combined and for the leading cancer types by sex were estimated by joinpoint analysis and expressed as annual percent change. We used relative survival ratios and adjusted relative risk of death after a diagnosis of cancer (hazard ratios [HRs]) using Cox regression model to examine changes or differences in survival over time and by sociodemographic factors., Results: Overall cancer death rates from 2010 to 2014 decreased by 1.8% (95% confidence interval [CI] = -1.8 to -1.8) per year in men, by 1.4% (95% CI = -1.4 to -1.3) per year in women, and by 1.6% (95% CI = -2.0 to -1.3) per year in children. Death rates decreased for 11 of the 16 most common cancer types in men and for 13 of the 18 most common cancer types in women, including lung, colorectal, female breast, and prostate, whereas death rates increased for liver (men and women), pancreas (men), brain (men), and uterine cancers. In contrast, overall incidence rates from 2009 to 2013 decreased by 2.3% (95% CI = -3.1 to -1.4) per year in men but stabilized in women. For several but not all cancer types, survival statistically significantly improved over time for both early and late-stage diseases. Between 1975 and 1977, and 2006 and 2012, for example, five-year relative survival for distant-stage disease statistically significantly increased from 18.7% (95% CI = 16.9% to 20.6%) to 33.6% (95% CI = 32.2% to 35.0%) for female breast cancer but not for liver cancer (from 1.1%, 95% CI = 0.3% to 2.9%, to 2.3%, 95% CI = 1.6% to 3.2%). Survival varied by race/ethnicity and state. For example, the adjusted relative risk of death for all cancers combined was 33% (HR = 1.33, 95% CI = 1.32 to 1.34) higher in non-Hispanic blacks and 51% (HR = 1.51, 95% CI = 1.46 to 1.56) higher in non-Hispanic American Indian/Alaska Native compared with non-Hispanic whites., Conclusions: Cancer death rates continue to decrease in the United States. However, progress in reducing death rates and improving survival is limited for several cancer types, underscoring the need for intensified efforts to discover new strategies for prevention, early detection, and treatment and to apply proven preventive measures broadly and equitably., (© The Author 2017. Published by Oxford University Press.)
- Published
- 2017
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