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IMPORTANCE: The COVID-19 pandemic disrupted the normal course of cancer screening and detection in the US. A nationwide analysis of the extent of this disruption using cancer registry data has not been conducted. OBJECTIVE: To assess the observed and expected cancer rate trends for March through December 2020 using data from all 50 US states and the District of Columbia. DESIGN, SETTINGS, AND PARTICIPANTS: This was a population-based cross-sectional analysis of cancer incidence trends using data on cases of invasive cancer diagnosis reported to the US Cancer Statistics from January 1, 2018, through December 31, 2020. Data analyses were performed from July 6 to 28, 2023. EXPOSURE(S): Age, sex, race, urbanicity, and state-level response to the COVID-19 pandemic at the time of cancer diagnosis. MAIN OUTCOMES AND MEASURES: Used time-series forecasting methods to calculate expected cancer incidence rates for March 1 through December 31, 2020, from prepandemic trends (January 2018-February 2020). Measured relative difference between observed and expected cancer incidence rates and numbers of potentially missed cancer cases. RESULTS: This study included 1 297 874 cancer cases reported in the US from March 1 through December 31, 2020, with an age-adjusted incidence rate of 326.5 cases per 100 000 population. Of the observed cases, 657 743 (50.7%) occurred in male patients, 757 106 (58.3%) in persons 65 years or older, and 1 066 566 (82.2%) in White individuals. Observed rates of all-sites cancer incidence in the US were 28.6% (95% prediction interval [PI], 25.4%-31.7%) lower than expected during the height of the COVID-19 pandemic response (March-May 2020); 6.3% (95% PI, 3.8%-8.8%) lower in June to December 2020; and overall, 13.0% (95% PI, 11.2%-14.9%) lower during the first 10 months of the pandemic. These differences indicate that there were potentially 134 395 (95% PI, 112 544-156 680) undiagnosed cancers during that time frame. Prostate cancer accounted for the largest number of potentially missed cases (22 950), followed by female breast (16 870) and lung (16 333) cancers. Screenable cancers saw a total rate reduction of 13.9% (95% PI, 12.2%-15.6%) compared with the expected rate. The rate of female breast cancer showed evidence of recovery to previous trends after the first 3 months of the pandemic, but levels remained low for colorectal, cervical, and lung cancers. From March to May 2020, states with more restrictive COVID-19 responses had significantly greater disruptions, yet by December 2020, these differences were nonsignificant for all sites except lung, kidney, and pancreatic cancer. CONCLUSIONS AND RELEVANCE: This cross-sectional analysis of cancer incidence trends found a substantial disruption to cancer diagnoses in the US during the first 10 months of the COVID-19 pandemic. The overall and differential findings can be used to inform where the US health care system should be looking to make up ground in cancer screening and detection.

Background: Colorectal cancer incidence rates are higher in Kentucky than in the United States in general, and there are regional variations within the state. Methods: This study investigates these variations [...]

Some evidence indicates that carotenoids may reduce the risk of bladder cancer (BC), but the association is unclear. We conducted a systematic review and meta-analysis of case-control and cohort studies investigating the relation between carotenoid intake or circulating carotenoid concentrations and BC risk in men and women. All relevant epidemiologic studies were identified by a search of PubMed and Scopus databases, and the Cochrane Library from inception to April 2019 with no restrictions. A random-effects model was used to calculate pooled RRs and their 95% CIs across studies for high compared with low categories of intake or circulating concentrations. We also performed a dose-response meta-analysis using the Greenland and Longnecker method and random-effects models. A total of 22 studies involving 516,740 adults were included in the meta-analysis. The pooled RRs of BC for the highest compared with the lowest category of carotenoid intake and circulating carotenoid concentrations were 0.88 (95% CI: 0.76, 1.03) and 0.36 (95% CI: 0.12, 1.07), respectively. The pooled RR of BC for the highest compared with lowest circulating lutein and zeaxanthin concentrations was 0.53 (95% CI: 0.33, 0.84). Dose-response analysis showed that BC risk decreased by 42% for every 1 mg increase in daily dietary β-cryptoxanthin intake (RR: 0.58; 95% CI: 0.36, 0.94); by 76% for every 1 μmol/L increase in circulating concentration of α-carotene (RR: 0.24; 95% CI: 0.08, 0.67); by 27% for every 1 μmol/L increase in circulating concentration of β-carotene (RR: 0.73; 95% CI: 0.57, 0.94); and by 56% for every 1 μmol/L increase in circulating concentrations of lutein and zeaxanthin (RR: 0.44; 95% CI: 0.28, 0.67). Dietary β-cryptoxanthin intake and circulating concentrations of α-carotene, β-carotene, and lutein and zeaxanthin were inversely associated with BC risk. The protocol was registered at PROSPERO as CRD42019133240.

Background: Cervical cancer mortality rates in the Appalachian population of southeastern Kentucky have been shown to be unusually high. To better understand the high cervical cancer death rate in this area, we developed a population-based cervical disease registry. Purpose: This study describes the incidence of cervical dysplasia, carcinoma in situ, and invasive cervical cancer in 1986 and 1987 among White women in a 36-county area of Appalachian Kentucky based on histologic diagnoses. Methods: We compared average annual age-adjusted incidence rates for carcinoma in situ and invasive cervical cancer in the study area with those for women in the Surveillance, Epidemiology, and End Results (SEER) Program. Results: The incidence rate of invasive cervical cancer for women in the study area (14.9 per 100 000) was nearly twice that for White women in the SEER population (7.8 per 100 000), but it was similar to that for Black women in the SEER population (15.3 per 100 000). The incidence of carcinoma in situ for women in the study population (38.2 per 100 000) was 21% higher than that for White women (31.5 per 100 000) or for Black women (31.2 per 100 000) in the SEER population. The average annual age-adjusted incidence rate for all grades of dysplasia among women in the study population was 194.6 per 100000. No comparable population-based incidence rates for dysplasia could be identified. Conclusions: Cervical cancer incidence rates are higher in Appalachian Kentucky than in the SEER population. Poverty appears to be a factor associated with these rates. Implications: Low-density populations such as those in rural Appalachia deserve greater attention in cancer control research. The population-based cervical dysplasia rates reported here may be useful for comparisons in future investigations. [J Natl Cancer Inst 84:1030, 1992]

Banks, through the careful implementation of data processing systems, can cut costs and improve customer service, according to the Data Processing Costs and Performance in Community Banks report. Comprehensive data is made available from the study on the article's topics, and in addition the research covers some issues that are not examined in the article. The survey reveals that 25 percent of the respondents presently have in-house computers.

Worldwide data for cancer survival are scarce. We aimed to initiate worldwide surveillance of cancer survival by central analysis of population-based registry data, as a metric of the effectiveness of health systems, and to inform global policy on cancer control.

The main emphasis in efforts by the Federal Reserve System (Fed) to reduce risk in its payment system has been on cutting the size and frequency of daylight overdrafts. Two main Fed concerns in risk reduction are: (1) halting the 'domino' effect that settlement failures might have, and (2) reducing the exposure of Federal Reserve Banks. Among Fed risk reduction proposals are: a 'de minimus' cap for institutions with limited overdraft activity; changes in automated clearinghouse procedures; collateralization of book entry securities; and a 25 percent cap reduction. Fed risk reduction proposals should be examined in light of possible combined effects rather than independently. About $1 to $1.2 trillion passes daily through the Fed payment system.

Appalachia is a geographic region with existing cancer disparities, yet little is known about its burden of HPV-related cancers outside of cervical cancer. We assessed the burden of HPV-related cancers in three Appalachian states and made comparisons to non-Appalachian regions. We examined 1996–2008 cancer registry data for Ohio, Kentucky, West Virginia and the Surveillance, Epidemiology and End Results (SEER) 9 program. For each gender, we calculated age-adjusted incidence rates per 100,000 population for each HPV-related cancer type (cervical, vaginal, vulvar, penile, anal and oral cavity and pharyngeal cancers) and all HPV-related cancers combined. Incidence rates among females for all HPV-related cancers combined were higher in Appalachian Kentucky [24.6 (95% CI: 23.5–25.7)], West Virginia [22.8 (95% CI: 22.0–23.6)] and Appalachian Ohio [21.9 (95% CI: 21.0–22.8)] than SEER 9 [18.8 (95% CI: 18.6–19.0)]. Similar disparities were found among females when examining cervical and vulvar cancers separately. Among males, Appalachian [21.3 (95% CI: 20.2–22.4)] and non-Appalachian [21.9 (95% CI: 21.2–22.7)] Kentucky had higher incidence rates for all HPV-related cancers combined than SEER 9 [18.3 (95% CI: 18.1–18.6)]. The incidence rate of all HPV-related cancers combined was higher among males from Appalachian Ohio compared with those from non-Appalachian Ohio [17.6 (95% CI: 16.8–18.5) vs. 16.3 (95% CI: 16.0–16.6)]. Our study suggests that HPV-related cancer disparities exist in Appalachia beyond the known high cervical cancer incidence rates. These results have important public health implications by beginning to demonstrate the potential impact that widespread HPV vaccination could have in Appalachia.

ABSTRACT: Context:Composed of all or a portion of 13 states, Appalachia is a heterogeneous, economically disadvantaged region of the eastern United States. While mortality from cancer in Appalachia has previously been reported to be elevated, rates of cancer incidence in Appalachia remain unreported. Purpose:To estimate Appalachian cancer incidence by stage and site and to determine if incidence was greater than that in the United States. Methods:Using 1994–1998 data from the central registries of Kentucky, Pennsylvania, and West Virginia, age‐adjusted incidence rates were calculated for the rural and nonrural regions of Appalachia. These state rates were compared to rates from the Surveillance, Epidemiology, and End Results (SEER) program for the same years by calculating the adjusted rate ratio (RR) and a 95% confidence interval (CI). Findings:Both the entire and rural Appalachian regions had an adjusted incidence rate for all cancer sites similar to the SEER rate (RR = 1.00 [95% CI, 1.00–1.01] and RR=0.99 [95% CI, 0.99–1.00], respectively). However, incidence of cancer of the lung/ bronchus, colon, rectum, and cervix in Appalachia was significantly elevated (RR = 1.22 [95% CI, 1.20–1.23], 1.13 [95% CI, 1.11–1.14], 1.19 [95% CI, 1.16–1.22], and 1.12 [95% CI, 1.07–1.17], respectively). Incidence of cancer of the lung/bronchus and cervix in rural Appalachia was even more elevated (RR = 1.34 [95% CI, 1.31–1.36] and 1.29 [95% CI, 1.21–1.38], respectively). Incidence of unstaged disease for all cancer sites in Appalachia (RR=1.06 [95% CI, 1.05–1.08]), particularly rural Appalachia (RR = 1.28 [95%CI, 1.25–1.30]), was elevated. Conclusions:Cancer incidence in Appalachia was not found to be elevated. However, incidence of cancer of the lung/bronchus, colon, rectum, and cervix was elevated in Appalachia. The rates of unstaged cancer of every examined site were elevated in rural Appalachia, suggesting a lack of access to cancer health care.

Recent attempts to measure smoking behavior using chemical tests may have been confounded by the use of smokeless tobacco. An objective measure of smokeless tobacco use is needed, particularly among adolescents who may not provide accurate self-reports of tobacco usage. Saliva cotinine was used to distinguish self-reported tobacco users from nonusers and a combination of saliva cotinine and thiocyanate (SCN) tests was used to distinguish smokers from smokeless tobacco users. The subjects were 471 students in grades 7 through 11 who lived in a high-tobacco production area. Approximately 89% of reported nonusers had no detectable cotinine and 99% of nonusers had levels <25 ng/ml. Of those who had used tobacco within the last 12 hr, 95% had detectable levels of cotinine. Samples that tested positive for cotinine were also tested for SCN. Eighty-six percent of smokers and 74% of mixed users had SCN values of >1000 µmol/liter, while only 14% of smokeless users had SCN values at that level. The combination of cotinine and SCN was effective in distinguishing smokers from smokeless users but was not effective in distinguishing mixed use from the other two types of use.

The Federal Reserve Board issued a statement on May 17, 1985 on management of risk in large-dollar payment systems. Highlights of policy in this statement are given. The Board does not condone the practice of daylight overdrafts. Actions are suggested for banks with and without daylight overdraft positions.