Bio

Academic Appointments


Administrative Appointments


  • Consulting Associate Professor, Dept. of Health Research and Policy, Stanford (2005 - Present)
  • Steering Committee, California Teachers Study (2006 - Present)
  • Scientific Communications Advisor, Cancer Prevention Institute of California (2011 - Present)

Professional Education


  • Ph.D, Univ. of California, Berkeley, Epidemiology (1999)
  • MPH, Tulane University, Epidemiology (1996)
  • BS, Duke University, Biology (1995)

Research & Scholarship

Current Research and Scholarly Interests


Breast cancer: This research area involves descriptive work to describe geographic and temporal variations in incidence especially in the Bay Area, and analytic efforts to uncover possible immunologic and infectious causes. Dr. Clarke was among the first to note and report on the unprecedented decline in breast cancer incidence that occurred in mid-2002. Dr. Clarke recently completed two population-based case-control studies to explore environmental factors associated with immune system development (as identified by the “hygiene hypothesis” literature for asthma and allergy development). With colleagues, she is also investigating associations of breast cancer with immune genes, human herpesviruses, and other markers of immune function and infection.

Lymphoid malignancies: this research area emphasizes population-based study of the causes and outcomes of Hodgkin lymphoma (HL) and the many subtypes of non-Hodgkin lymphoma (NHL). Her dissertation research described patient survival after HL in the general population and with respect to a certain molecular marker (Epstein-Barr virus in HL tumor cells). With Dr. Sally Glaser, she has examined reproductive, infectious, social class and other risk factors for Hodgkin lymphoma in a population-based case control study of women. In addition to descriptive efforts to describe NHL incidence, she has conducted methodologic studies to improve the surveillance and study of NHL subtypes, which has been challenged by changing classifications over time and by inability to separate HIV-related from –unrelated forms. She is a co-leader of the Pathology Working Group of the NCI-backed International Interlymph Consortium.

Cancer surveillance: As co-Investigator for the Greater Bay Area Cancer Registry, part of the NCI SEER and California Cancer Registry programs, Dr. Clarke monitors changes in cancer incidence and survival patterns among various population subgroups, particularly those defined by geography, race/ethnicity and socioeconomic status. In particular, she has examined cancer incidence survival patterns jointly by racial/ethnic and socioeconomic characteristics. Recent work with Dr. Susan Swetter at Stanford also emphasizes melanoma incidence, especially how possible underreporting by physicians may have led to underestimates of the burgeoning melanoma epidemic. She is also working on methodologies for cancer surveillance research, an emerging subdiscipline of epidemiology concerned with the analysis of cancer registry and other routinely collected health data. An ARRA funded proposal with Dr. Matt Kreuter at Washington University focuses on better means of visually displaying cancer registry data.

Patientcentric epidemiology: traditional methods for recruitment and data collection as part of population-based research emphasize the preferences and convenience of researchers, when it should be the other way around. With multidisciplinary colleagues in marketing, information technology, communications, and graphic design, we are working on new methodologies for recruitment, data collection, and other aspects of the research "user experience".

Publications

Journal Articles


  • Reply to survival after lumpectomy and mastectomy for early stage invasive breast cancer: The effect of age and hormone receptor status CANCER Hwang, E. S., Clarke, C. A., Gomez, S. L. 2013; 119 (17): 3254-3255

    View details for DOI 10.1002/cncr.28181

    View details for Web of Science ID 000323255600025

    View details for PubMedID 23824869

  • Melanoma Survival Disadvantage in Young, Non-Hispanic White Males Compared With Females JAMA DERMATOLOGY Gamba, C. S., Clarke, C. A., Keegan, T. H., Tao, L., Swetter, S. M. 2013; 149 (8): 912-920

    Abstract

    IMPORTANCE Worse survival among patients with melanoma has been demonstrated in middle-aged and older men compared with women, but few studies have explored survival differences by sex in adolescents and young adults, in whom melanoma is the third most common cancer. Focusing on sex disparities in survival among younger individuals may provide further evidence of biological rather than behavioral factors that affect melanoma outcome. OBJECTIVE To determine whether long-term survival varies between white male and female adolescents and young adults with melanoma (15 to 39 years of age at diagnosis) in the United States. DESIGN, SETTING, AND PARTICIPANTS Population-based cohort with a mean follow-up of 7.5 years of 26 107 non-Hispanic white adolescents and young adults with primary invasive melanoma of the skin diagnosed from January 1, 1989, through December 31, 2009, and reported to the Surveillance, Epidemiology, and End Results network of cancer registries. MAIN OUTCOME AND MEASURE Melanoma-specific survival. RESULTS There were 1561 melanoma-specific deaths in the study population. Although adolescent and young adult males accounted for fewer overall melanoma cases (39.8%) than females, they comprised 63.6% of melanoma-specific deaths. Adolescent and young adult males were 55% more likely to die of melanoma than age-matched females after adjustment for tumor thickness, histologic subtype, presence and extent of metastasis, and anatomical location (hazard ratio, 1.55; 95% CI, 1.39-1.73). Males were also more likely to die within each age range assessed (eg, 15-24, 25-29, 30-34, and 35-39 years), and even those with thin melanomas (≤1.00 mm) were twice as likely to die as age-matched females (hazard ratio, 1.95; 95% CI, 1.57-2.42). Adjustment for health insurance and socioeconomic status in a subanalysis did not significantly alter these results. CONCLUSIONS AND RELEVANCE Male sex is associated with worse survival among white adolescents and young adults with melanoma after controlling for thickness and other prognostic factors. Continued public health efforts are necessary to raise awareness of the outcome of melanoma in young men. Further investigation of possible biological mechanisms that account for these sex differences is merited.

    View details for DOI 10.1001/jamadermatol.2013.4408

    View details for Web of Science ID 000323721400005

    View details for PubMedID 23804160

  • Risk of lymphoma subtypes after solid organ transplantation in the United States BRITISH JOURNAL OF CANCER Clarke, C. A., Morton, L. M., Lynch, C., Pfeiffer, R. M., Hall, E. C., Gibson, T. M., Weisenburger, D. D., Martinez-Maza, O., Hussain, S. K., Yang, J., Chang, E. T., Engels, E. A. 2013; 109 (1): 280-288

    Abstract

    Background:Solid organ transplant recipients have high risk of lymphomas, including non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL). A gap in our understanding of post-transplant lymphomas involves the spectrum and associated risks of their many histologic subtypes.Methods:We linked nationwide data on solid organ transplants from the US Scientific Registry of Transplant Recipients (1987-2008) to 14 state and regional cancer registries, yielding 791 281 person-years of follow-up for 19 distinct NHL subtypes and HL. We calculated standardised incidence ratios (SIRs) and used Poisson regression to compare SIRs by recipient age, transplanted organ, and time since transplantation.Results:The risk varied widely across subtypes, with strong elevations (SIRs 10-100) for hepatosplenic T-cell lymphoma, Burkitt's lymphoma, NK/T-cell lymphoma, diffuse large B-cell lymphoma, and anaplastic large-cell lymphoma (both systemic and primary cutaneous forms). Moderate elevations (SIRs 2-4) were observed for HL and lymphoplasmacytic, peripheral T-cell, and marginal zone lymphomas, but SIRs for indolent lymphoma subtypes were not elevated. Generally, SIRs were highest for younger recipients (<20 years) and those receiving organs other than kidneys.Conclusion:Transplant recipients experience markedly elevated risk of a distinct spectrum of lymphoma subtypes. These findings support the aetiologic relevance of immunosuppression for certain subtypes and underscore the importance of detailed haematopathologic workup for transplant recipients with suspected lymphoma.British Journal of Cancer advance online publication, 11 June 2013; doi:10.1038/bjc.2013.294 www.bjcancer.com.

    View details for DOI 10.1038/bjc.2013.294

    View details for Web of Science ID 000321702400036

    View details for PubMedID 23756857

  • Plasma Cell Neoplasms in US Solid Organ Transplant Recipients. American journal of transplantation Engels, E. A., Clarke, C. A., Pfeiffer, R. M., Lynch, C. F., Weisenburger, D. D., Gibson, T. M., Landgren, O., Morton, L. M. 2013; 13 (6): 1523-1532

    Abstract

    Transplant recipients have elevated risk for plasma cell neoplasms (PCNs, comprising multiple myeloma and plasmacytoma), but little is known about risk factors in the transplant setting. Through linkage of the US solid organ transplant registry with 15 state/regional cancer registries, we identified 140 PCNs in 202?600 recipients (1987-2009). PCN risk was 1.8-fold increased relative to the general population (standardized incidence ratio [SIR] 1.80, 95%CI 1.51-2.12). Among cases, 102 were multiple myeloma (SIR 1.41) and 38 were plasmacytoma (SIR 7.06). PCN incidence increased with age, but due to the rarity of PCNs in younger people in the general population, SIRs were highest in younger transplant recipients (p?=?0.03). PCN risk was especially high in recipients who were Epstein-Barr virus (EBV) seronegative at transplantation (SIR 3.93). EBV status was known for 18 tumors, of which 7 (39%) were EBV positive. Following liver transplantation, PCN risk was higher in recipients with cholestatic liver disease (SIR 2.78); five of these cases had primary biliary cirrhosis (PBC). A role for primary EBV infection after transplantation is supported by the increased PCN risk in young EBV seronegative recipients and the presence of EBV in tumors. PBC may be another risk factor, perhaps by causing chronic immune activation.

    View details for DOI 10.1111/ajt.12234

    View details for PubMedID 23635036

  • Male Breast Cancer According to Tumor Subtype and Race A Population-Based Study CANCER Chavez-MacGregor, M., Clarke, C. A., Lichtensztajn, D., Hortobagyi, G. N., Giordano, S. H. 2013; 119 (9): 1611-1617

    Abstract

    Breast cancer occurs rarely in men. To the authors' knowledge, no population-based estimates of the incidence of human epidermal growth factor receptor 2 (HER2)-positive breast cancer or of the distribution of breast cancer subtypes among male breast cancer patients have been published to date. Therefore, the objective of the current study was to explore breast tumor subtype distribution by race/ethnicity among men in the large, ethnically diverse population of California.This study included men who were diagnosed with invasive breast cancer between 2005 and 2009 with known estrogen receptor (ER) and progesterone receptor (PR) (together, hormone receptor [HR]) status and HER2 status reported to the California Cancer Registry. Among the men with HR-positive tumors, survival probabilities between groups were compared using log-rank tests.Six hundred six patients were included. The median age at diagnosis was 68 years. Four hundred ninety-four men (81.5%) had HR-positive tumors (defined as ER-positive and/or PR-positive and HER2-negative). Ninety men (14.9%) had HER2-positive tumors, and 22 (3.6%) had triple receptor-negative (TN) tumors. Among the patients with HR-positive tumors, non-Hispanic black men and Hispanic men were more likely to have PR-negative tumors than non-Hispanic white men. No statistically significant differences in survival were observed according to tumor subtype (P = .08). Differences in survival according to race/ethnicity were observed among all patients (P = .087) and among those with HR-positive tumors (P = .0170), and non-Hispanic black men had poorer outcomes.In this large, representative cohort of men with breast cancer, the distribution of tumor subtypes was different from that reported for women and varied by patient race/ethnicity. Non-Hispanic black men were more likely to have TN tumors and ER-positive/PR-negative tumors than white men.

    View details for DOI 10.1002/cncr.27905

    View details for Web of Science ID 000318115000003

    View details for PubMedID 23341341

  • Burkitt lymphoma risk in US solid organ transplant recipients AMERICAN JOURNAL OF HEMATOLOGY Mbulaiteye, S. M., Clarke, C. A., Morton, L. M., Gibson, T. M., Pawlish, K., Weisenburger, D. D., Lynch, C. F., Goodman, M. T., Engels, E. A. 2013; 88 (4): 245-250

    Abstract

    Case reports of Burkitt lymphoma (BL) in transplant recipients suggest that the risk is markedly elevated. Therefore, we investigated the incidence of BL in 203,557 solid organ recipients in the U.S. Transplant Cancer Match Study (1987-2009) and compared it with the general population using standardized incidence ratios. We also assessed associations with demographic and clinical characteristics, and treatments used to induce therapeutic immunosuppression. BL incidence was 10.8 per 100,000 person-years, representing 23-fold (95% confidence interval (CI) 19-28) greater risk than in the general population, and it peaked 3-8 years after the time of transplantation. In adjusted analyses, BL incidence was higher in recipients transplanted when <18 vs. ?35 years (incidence rate ratio [IRR] 3.49, 95% CI 2.08-5.68) and in those transplanted with a liver (IRR 2.91, 95% CI 1.68-5.09) or heart (IRR 2.39, 95% CI 1.30-4.31) compared with kidney. BL incidence was lower in females than males (IRR 0.45, 95% CI 0.28-0.71), in blacks than whites (IRR 0.33, 95% CI 0.12-0.74), in those with a baseline Epstein-Barr virus (EBV)-seropositive versus EBV-seronegative status (IRR 0.34, 95% CI 0.13-0.93), and in those treated with azathioprine (IRR 0.56, 95% CI 0.34-0.89) or corticosteroids (IRR 0.48, 95% CI 0.29-0.82). Tumors were EBV-positive in 69% of 32 cases with results. EBV positivity was 90% in those aged <18 years and 59% in those aged 18+ years. In conclusion, BL risk is markedly elevated in transplant recipients, and it is associated with certain demographic and clinical features. EBV was positive in most but not all BL cases with results.

    View details for DOI 10.1002/joh.23385

    View details for Web of Science ID 000316808800001

    View details for PubMedID 23386365

  • Rituximab use and survival after diffuse large B-cell or follicular lymphoma: a population-based study LEUKEMIA & LYMPHOMA Keegan, T. H., Moy, L. M., Foran, J. M., Alizadeh, A. A., Chang, E. T., Shema, S. J., Schupp, C. W., Clarke, C. A., Glaser, S. L. 2013; 54 (4): 743-751

    Abstract

    To determine whether reported socioeconomic disparities in survival might be related to treatment, we examined patient and tumor characteristics associated with receipt of rituximab and survival in the National Cancer Institute's Patterns of Care Studies (2003 and 2008) for patients with diffuse large B-cell (DLBCL) and follicular (FL) lymphoma. Patients with DLBCL (n = 1192) were less likely to receive rituximab if they were older, black or Asian, lacked private medical insurance, had impaired performance status, had no lactate dehydrogenase measurements or were diagnosed with stage I disease. Patients with FL (n = 476) were less likely to receive rituximab if they were unmarried or non-Hispanic white. Receipt of rituximab did not differ by neighborhood median income. Treatment with rituximab was associated with better survival for patients with DLBCL, but not patients with FL. Lower rituximab use in patients with DLBCL without private insurance suggests that previously identified socioeconomic disparities in survival may, in part, be explained by receipt of rituximab.

    View details for DOI 10.3109/10428194.2012.727415

    View details for Web of Science ID 000315898100015

    View details for PubMedID 22957852

  • Survival after lumpectomy and mastectomy for early stage invasive breast cancer: the effect of age and hormone receptor status. Cancer Hwang, E. S., Lichtensztajn, D. Y., Gomez, S. L., Fowble, B., Clarke, C. A. 2013; 119 (7): 1402-1411

    Abstract

    Randomized clinical trials (RCT) have demonstrated equivalent survival for breast-conserving therapy with radiation (BCT) and mastectomy for early-stage breast cancer. A large, population-based series of women who underwent BCT or mastectomy was studied to observe whether outcomes of RCT were achieved in the general population, and whether survival differed by surgery type when stratified by age and hormone receptor (HR) status.Information was obtained regarding all women diagnosed in the state of California with stage I or II breast cancer between 1990 and 2004, who were treated with either BCT or mastectomy and followed for vital status through December 2009. Cox proportional hazards modeling was used to compare overall survival (OS) and disease-specific survival (DSS) between BCT and mastectomy groups. Analyses were stratified by age group (< 50 years and ? 50 years) and tumor HR status.A total of 112,154 women fulfilled eligibility criteria. Women undergoing BCT had improved OS and DSS compared with women with mastectomy (adjusted hazard ratio for OS entire cohort = 0.81, 95% confidence interval [CI] = 0.80-0.83). The DSS benefit with BCT compared with mastectomy was greater among women age ? 50 with HR-positive disease (hazard ratio = 0.86, 95% CI = 0.82-0.91) than among women age < 50 with HR-negative disease (hazard ratio = 0.88, 95% CI = 0.79-0.98); however, this trend was seen among all subgroups analyzed.Among patients with early stage breast cancer, BCT was associated with improved DSS. These data provide confidence that BCT remains an effective alternative to mastectomy for early stage disease regardless of age or HR status.

    View details for DOI 10.1002/cncr.27795

    View details for PubMedID 23359049

  • Re: Age-Specific Incidence of Breast Cancer Subtypes: Understanding the Black-White Crossover Response JNCI-JOURNAL OF THE NATIONAL CANCER INSTITUTE Clarke, C. A., Lacey, J. V. 2013; 105 (5): 369-370

    View details for DOI 10.1093/jnci/djt002

    View details for Web of Science ID 000315937500010

    View details for PubMedID 23586090

  • Evidence of Gene-Environment Interactions between Common Breast Cancer Susceptibility Loci and Established Environmental Risk Factors PLOS GENETICS Nickels, S., Truong, T., Hein, R., Stevens, K., Buck, K., Behrens, S., Eilber, U., Schmidt, M., Haeberle, L., Vrieling, A., Gaudet, M., Figueroa, J., Schoof, N., Spurdle, A. B., Rudolph, A., Fasching, P. A., Hopper, J. L., Makalic, E., Schmidt, D. F., Southey, M. C., Beckmann, M. W., Ekici, A. B., Fletcher, O., Gibson, L., Silva, I. d., Peto, J., Humphreys, M. K., Wang, J., Cordina-Duverger, E., Menegaux, F., Nordestgaard, B. G., Bojesen, S. E., Lanng, C., Anton-Culver, H., Ziogas, A., Bernstein, L., Clarke, C. A., Brenner, H., Mueller, H., Arndt, V., Stegmaier, C., Brauch, H., Bruening, T., Harth, V., Mannermaa, A., Kataja, V., Kosma, V., Hartikainen, J. M., Lambrechts, D., Smeets, D., Neven, P., Paridaens, R., Flesch-Janys, D., Obi, N., Wang-Gohrke, S., Couch, F. J., Olson, J. E., Vachon, C. M., Giles, G. G., Severi, G., Baglietto, L., Offit, K., John, E. M., Miron, A., Andrulis, I. L., Knight, J. A., Glendon, G., Mulligan, A. M., Chanock, S. J., Lissowska, J., Liu, J., Cox, A., Cramp, H., Connley, D., Balasubramanian, S., Dunning, A. M., Shah, M., Trentham-Dietz, A., Newcomb, P., Titus, L., Egan, K., Cahoon, E. K., Rajaraman, P., Sigurdson, A. J., Doody, M. M., Guenel, P., Pharoah, P. D., Schmidt, M. K., Hall, P., Easton, D. F., Garcia-Closas, M., Milne, R. L., Chang-Claude, J. 2013; 9 (3)

    Abstract

    Various common genetic susceptibility loci have been identified for breast cancer; however, it is unclear how they combine with lifestyle/environmental risk factors to influence risk. We undertook an international collaborative study to assess gene-environment interaction for risk of breast cancer. Data from 24 studies of the Breast Cancer Association Consortium were pooled. Using up to 34,793 invasive breast cancers and 41,099 controls, we examined whether the relative risks associated with 23 single nucleotide polymorphisms were modified by 10 established environmental risk factors (age at menarche, parity, breastfeeding, body mass index, height, oral contraceptive use, menopausal hormone therapy use, alcohol consumption, cigarette smoking, physical activity) in women of European ancestry. We used logistic regression models stratified by study and adjusted for age and performed likelihood ratio tests to assess gene-environment interactions. All statistical tests were two-sided. We replicated previously reported potential interactions between LSP1-rs3817198 and parity (Pinteraction = 2.4 × 10(-6)) and between CASP8-rs17468277 and alcohol consumption (Pinteraction = 3.1 × 10(-4)). Overall, the per-allele odds ratio (95% confidence interval) for LSP1-rs3817198 was 1.08 (1.01-1.16) in nulliparous women and ranged from 1.03 (0.96-1.10) in parous women with one birth to 1.26 (1.16-1.37) in women with at least four births. For CASP8-rs17468277, the per-allele OR was 0.91 (0.85-0.98) in those with an alcohol intake of <20 g/day and 1.45 (1.14-1.85) in those who drank ? 20 g/day. Additionally, interaction was found between 1p11.2-rs11249433 and ever being parous (Pinteraction = 5.3 × 10(-5)), with a per-allele OR of 1.14 (1.11-1.17) in parous women and 0.98 (0.92-1.05) in nulliparous women. These data provide first strong evidence that the risk of breast cancer associated with some common genetic variants may vary with environmental risk factors.

    View details for DOI 10.1371/journal.pgen.1003284

    View details for Web of Science ID 000316866700004

    View details for PubMedID 23544014

  • Incidence of Non-Small-Cell Lung Cancer among California Hispanics According to Neighborhood Socioeconomic Status JOURNAL OF THORACIC ONCOLOGY Wong, M. L., Clarke, C. A., Yang, J., Hwang, J., Hiatt, R. A., Wang, S. 2013; 8 (3): 287-294

    Abstract

    Lung cancer incidence is associated with markers of lower socioeconomic status (SES) in whites, blacks, and Asians but with markers of higher SES in Hispanics. The magnitude and etiology of this positive gradient in Hispanics remain undefined. We examined non-small-cell lung cancer (NSCLC) incidence and ever-smoking rates among California Hispanics according to measures of SES.We computed neighborhood (n)SES-specific incidence rates by sex and race or ethnicity for 74,179 NSCLC cases in the California Cancer Registry, 1998-2002. Associations between nSES and NSCLC incidence were examined, using incidence rate ratios and linear trend tests, and stratified by age, stage, and histology. Ever-smoking rates among Hispanics were obtained from California Health Interview Survey 2001 data, and odds ratios for ever-smoking were calculated for measures of SES and acculturation.Compared with the lowest nSES quintile, the NSCLC incidence in the highest quintile was 1.86 and 1.18 times higher for Hispanic women and men, respectively. The positive nSES gradients remained significant for all ages, stages, and nonsquamous histologies in women, and only for older age, local or regional stages, and adenocarcinoma histology in men. Ever-smoking rates were associated with English-speaking households and U.S.-born status for Hispanic women and low education and U.S.-born status for Hispanic men.For California Hispanics, higher nSES was strongly associated with increased NSCLC incidence in women, but weakly associated in men, and ever-smoking rates were strongly correlated with increased acculturation. This finding may portend an increasing burden of NSCLC in Hispanic women, given future trends in acculturation and SES.

    View details for DOI 10.1097/JTO.0b013e31827bd7f5

    View details for Web of Science ID 000316205600012

    View details for PubMedID 23399956

  • Anthropometric, behavioral, and female reproductive factors and risk of multiple myeloma: a pooled analysis. Cancer causes & control : CCC Wang, S. S., Voutsinas, J., Chang, E. T., Clarke, C. A., Lu, Y., Ma, H., West, D., Lacey, J. V., Bernstein, L. 2013

    Abstract

    BACKGROUND: Risk of developing multiple myeloma (MM) rises with age and is greater among men and blacks than among women and whites, respectively, and possibly increased among obese persons. Other risk factors remain poorly understood. By pooling data from two complementary epidemiologic studies, we assessed whether obesity, smoking, or alcohol consumption alters MM risk and whether female reproductive history might explain the lower occurrence of MM in females than in males. METHODS: The Los Angeles County MM Case-Control Study (1985-1992) included 278 incident cases and 278 controls, matched on age, sex, race, and neighborhood of residence at case's diagnosis. We estimated MM risk using conditional logistic regression to calculate odds ratios (ORs) and 95 % confidence intervals (CIs). In the prospective California Teachers Study (CTS), 152 women were diagnosed with incident MM between 1995 and 2009; we calculated hazard ratios using Cox proportional hazards analysis. Data from the two studies were pooled using a stratified, nested case-control sampling scheme (10:1 match) for the CTS; conditional logistic regression among 430 cases and 1,798 matched controls was conducted. RESULTS: Obesity and smoking were not associated with MM risk in the individual or combined studies. Alcohol consumption was associated with decreased MM risk among whites only (pooled OR = 0.66, 95 % CI = 0.49-0.90) for ever versus never drinking. Higher gravidity and parity were associated with increased MM risk, with pooled ORs of 1.38 (95 % CI = 1.01-1.90) for ?3 versus 1-2 pregnancies and 1.50 (95 % CI = 1.09-2.06) for ?3 versus 1-2 live births. CONCLUSIONS: Female reproductive history may modestly alter MM risk, but appears unlikely to explain the sex disparity in incidence. Further investigation in consortial efforts is warranted.

    View details for PubMedID 23568533

  • Trends in the occurrence of high-grade anal intraepithelial neoplasia in San Francisco: 2000-2009. Cancer Simard, E. P., Watson, M., Saraiya, M., Clarke, C. A., Palefsky, J. M., Jemal, A. 2013

    Abstract

    Although screening of human immunodeficiency virus (HIV)-positive individuals for anal intraepithelial neoplasia (AIN; a precursor of anal cancer) has been practiced in San Francisco among HIV health care providers since the early 1990s, to the authors' knowledge no study to date has focused on evaluating recent AIN trends.Cases of high-grade AIN 3 and invasive anal cancer from 2000 to 2009 were obtained from the San Francisco/Oakland Surveillance, Epidemiology, and End Results (SEER) population-based cancer registry. Age-standardized rates of AIN 3 and anal cancer were calculated overall and by demographic characteristics (sex, race, and age group). Log-linear regression calculated annual percent change in rates during 2000 to 2009, and rate ratios (RRs) and 95% confidence intervals (95% CIs), evaluated differences in rates during 2000 through 2004 and 2005 through 2009.During 2000 through 2009, the majority of AIN 3 cases occurred among men (1152 of 1320 men; 87.3%). Rates of AIN 3 during the corresponding period increased by 11.48% per year (P?

    View details for PubMedID 23861091

  • The Epidemic of Non-Hodgkin Lymphoma in the United States: Disentangling the Effect of HIV, 1992-2009. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology Shiels, M. S., Engels, E. A., Linet, M. S., Clarke, C. A., Li, J., Hall, H. I., Hartge, P., Morton, L. M. 2013; 22 (6): 1069-78

    Abstract

    For decades, non-Hodgkin lymphoma (NHL) incidence has been increasing worldwide. NHL risk is strongly increased among HIV-infected people. Our understanding of trends in NHL incidence has been hampered by difficulties in separating HIV-infected NHL cases from general population rates.NHL incidence data during 1992-2009 were derived from 10 U.S. SEER cancer registries with information on HIV status at NHL diagnosis. The CDC estimated the number of people living with HIV in the registry areas. The proportion of NHL cases with HIV and NHL rates in the total and the HIV-uninfected populations were estimated. Time trends were assessed with Joinpoint analyses.Of 115,643 NHL cases diagnosed during 1992-2009, 5.9% were HIV-infected. The proportions of NHL cases with HIV were highest for diffuse large B-cell (DLBCL; 7.8%), Burkitt (26.9%), and peripheral T-cell lymphomas (3.2%) with low proportions (?1.1%) in the other subtypes. NHL rates in the total population increased 0.3% per year during 1992-2009. However, rates of NHL in HIV-uninfected people increased 1.4% per year during 1992-2003, before becoming stable through 2009. Similar trends were observed for DLBCLs and follicular lymphoma in HIV-uninfected people; rates increased 2.7% per year until 2003 and 1.7% per year until 2005, respectively, before stabilizing.NHL incidence rates in the United States have plateaued over the last 5-10 years, independent of HIV infection.Although the causes of the long-term increase in NHL incidence rates in the United States remain unknown, general population rates of NHL have stabilized since the early 2000s, independent of HIV. Cancer Epidemiol Biomarkers Prev; 22(6); 1069-78. ©2013 AACR.

    View details for PubMedID 23595542

  • Alcohol Consumption and Breast Cancer Risk Among Postmenopausal Women Following the Cessation of Hormone Therapy Use: The California Teachers Study CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION Horn-Ross, P. L., Canchola, A. J., Bernstein, L., Clarke, C. A., Lacey, J. V., Neuhausen, S. L., Reynolds, P., Ursin, G. 2012; 21 (11): 2006-2013

    Abstract

    Alcohol consumption increases breast cancer risk, but its effect may be modified by hormone therapy (HT) use, such that exposure to both may be synergistic. Because many women stopped taking HT after mid-2002, it is important to quantify risks associated with alcohol consumption in the context of HT cessation, as these risks may be more relevant to cancer prevention efforts today.Among 40,680 eligible postmenopausal California Teachers Study cohort participants, 660 were diagnosed with invasive breast cancer before 2010. Multivariate Cox proportional hazards regression models were used to estimate relative risks (RR) and 95% confidence intervals (CI).Increased breast cancer risk associated with alcohol consumption was observed among postmenopausal women who were current HT users [RR, 1.60; 95% confidence interval (CI), 1.13-2.26 and RR, 2.11; 95% CI, 1.41-3.15 for <20 and ?20 g/d of alcohol], with risks being similar by HT preparation. Alcohol did not increase risk among women who had stopped using HT within 3 years or 3 to 4 years before completing the follow-up questionnaire or in the more distant past. Results were similar for estrogen receptor positive (ER+) and ER+PR+ progesterone receptors positive (PR+) tumors; while power was limited, no increase in risk was observed for ER- tumors.Following the cessation of HT use, alcohol consumption is not significantly associated with breast cancer risk, although a nonsignificant increased risk was observed among women who never used HT.Our findings confirm that concurrent exposure to HT and alcohol has a substantial adverse impact on breast cancer risk. However, after HT cessation, this risk is reduced.

    View details for DOI 10.1158/1055-9965.EPI-12-0418

    View details for Web of Science ID 000310931700014

    View details for PubMedID 22832206

  • Long-Term Survivors of Gastric Cancer: A California Population-Based Study JOURNAL OF CLINICAL ONCOLOGY Kunz, P. L., Gubens, M., Fisher, G. A., Ford, J. M., Lichtensztajn, D. Y., Clarke, C. A. 2012; 30 (28): 3507-3515

    Abstract

    In the United States, gastric cancer is rapidly fatal with a 25% 5-year survival. Of the few patients who survive, little is known about their demographic, clinical, and tumor characteristics.Data regarding all cases of gastric and gastroesophageal junction (GEJ) adenocarcinoma diagnosed in California between 1988 and 2005 were obtained from the California Cancer Registry, a member of the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program. A Cox proportional hazards model was constructed to understand the independent relationships of patient demographic, disease, and treatment factors with survival.We identified 47,647 patients diagnosed with gastric or GEJ cancer. Of those, only 9,325 (20%) survived at least 3 years. Variables associated with longer survival were localized stage (hazard ratio [HR], 0.20), surgery with diagnosis in 2002 or later (HR, 0.34), surgery with diagnosis in 2001 or before (0.37), regional stage (HR, 0.53), chemotherapy (HR, 0.56), intestinal histology (HR, 0.74), well- or moderately differentiated tumors (HR, 0.76), radiation (HR, 0.80), Asian/Pacific Islander race (HR, 0.81), treatment at an academic hospital (HR, 0.85), fundus/body/antrum location (HR, 0.90), highest socioeconomic status quintile (HR, 0.91), female sex (HR, 0.92), Hispanic race (HR, 0.92), and hospital size more than 150 beds (HR, 0.94). Kaplan-Meier curves showed longer median disease-specific survival (DSS) in patients with tumors originating in the fundus/body/antrum compared with esophagus/cardia (13.4 v 10.8 months). Intestinal histology had significantly longer median DSS (28.9 months) compared with other (11.0 months) or diffuse (10.1 months) histology.Patients who survive gastric and GEJ cancer more than 3 years after diagnosis have demographic and pathologic characteristics distinct from those who do not survive.

    View details for DOI 10.1200/JCO.2011.35.8028

    View details for Web of Science ID 000309517700016

    View details for PubMedID 22949151

  • 9q31.2-rs865686 as a Susceptibility Locus for Estrogen Receptor-Positive Breast Cancer: Evidence from the Breast Cancer Association Consortium CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION Warren, H., Dudbridge, F., Fletcher, O., Orr, N., Johnson, N., Hopper, J. L., Apicella, C., Southey, M. C., Mahmoodi, M., Schmidt, M. K., Broeks, A., Cornelissen, S., Braaf, L. M., Muir, K. R., Lophatananon, A., Chaiwerawattana, A., Wiangnon, S., Fasching, P. A., Beckmann, M. W., Ekici, A. B., Schulz-Wendtland, R., Sawyer, E. J., Tomlinson, I., Kerin, M., Burwinkel, B., Marme, F., Schneeweiss, A., Sohn, C., Guenel, P., Therese Truong, T., Laurent-Puig, P., Mulot, C., Bojesen, S. E., Nielsen, S. F., Flyger, H., Nordestgaard, B. G., Milne, R. L., Benitez, J., Arias-Perez, J., Pilar Zamora, M., Anton-Culver, H., Ziogas, A., Bernstein, L., Dur, C. C., Brenner, H., Mueller, H., Arndt, V., Langheinz, A., Meindl, A., Golatta, M., Bartram, C. R., Schmutzler, R. K., Brauch, H., Justenhoven, C., Bruening, T., Chang-Claude, J., Wang-Gohrke, S., Eilber, U., Doerk, T., Schuermann, P., Bremer, M., Hillemanns, P., Nevanlinna, H., Muranen, T. A., Aittomaki, K., Blomqvist, C., Bogdanova, N., Antonenkova, N., Rogov, Y., Bermisheva, M., Prokofyeva, D., Zinnatullina, G., Khusnutdinova, E., Lindblom, A., Margolin, S., Mannermaa, A., Kosma, V., Hartikainen, J. M., Kataja, V., Chenevix-Trench, G., Beesley, J., Chen, X., Lambrechts, D., Smeets, A., Paridaens, R., Weltens, C., Flesch-Janys, D., Buck, K., Behrens, S., Peterlongo, P., Bernard, L., Manoukian, S., Radice, P., Couch, F. J., Vachon, C., Wang, X., Olson, J., Giles, G., Baglietto, L., McLean, C. A., Severi, G., John, E. M., Miron, A., Winqvist, R., Pylkas, K., Jukkola-Vuorinen, A., Grip, M., Andrulis, I. L., Knight, J. A., Mulligan, A. M., Weerasooriya, N., Devilee, P., Tollenaar, R. A., Martens, J. W., Seynaeve, C. M., Hooning, M. J., Hollestelle, A., Jager, A., Tilanus-Linthorst, M. M., Hall, P., Czene, K., Liu, J., Li, J., Cox, A., Cross, S. S., Brock, I. W., Reed, M. W., Pharoah, P., Blows, F. M., Dunning, A. M., Ghous-saini, M., Ashworth, A., Swerdlow, A., Jones, M., Schoemaker, M., Easton, D. F., Humphreys, M., Wang, Q., Peto, J., dos-Santos-Silva, I. 2012; 21 (10): 1783-1791

    Abstract

    Our recent genome-wide association study identified a novel breast cancer susceptibility locus at 9q31.2 (rs865686).To further investigate the rs865686-breast cancer association, we conducted a replication study within the Breast Cancer Association Consortium, which comprises 37 case-control studies (48,394 cases, 50,836 controls).This replication study provides additional strong evidence of an inverse association between rs865686 and breast cancer risk [study-adjusted per G-allele OR, 0.90; 95% confidence interval (CI), 0.88; 0.91, P = 2.01 × 10(-29)] among women of European ancestry. There were ethnic differences in the estimated minor (G)-allele frequency among controls [0.09, 0.30, and 0.38 among, respectively, Asians, Eastern Europeans, and other Europeans; P for heterogeneity (P(het)) = 1.3 × 10(-143)], but no evidence of ethnic differences in per allele OR (P(het) = 0.43). rs865686 was associated with estrogen receptor-positive (ER(+)) disease (per G-allele OR, 0.89; 95% CI, 0.86-0.91; P = 3.13 × 10(-22)) but less strongly, if at all, with ER-negative (ER(-)) disease (OR, 0.98; 95% CI, 0.94-1.02; P = 0.26; P(het) = 1.16 × 10(-6)), with no evidence of independent heterogeneity by progesterone receptor or HER2 status. The strength of the breast cancer association decreased with increasing age at diagnosis, with case-only analysis showing a trend in the number of copies of the G allele with increasing age at diagnosis (P for linear trend = 0.0095), but only among women with ER(+) tumors.This study is the first to show that rs865686 is a susceptibility marker for ER(+) breast cancer.The findings further support the view that genetic susceptibility varies according to tumor subtype.

    View details for DOI 10.1158/1055-9965.EPI-12-0526

    View details for Web of Science ID 000309576100022

    View details for PubMedID 22859399

  • Examining the Association Between Socioeconomic Status and Invasive Colorectal Cancer Incidence and Mortality in California CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION Steinbrecher, A., Fish, K., Clarke, C. A., West, D. W., Gomez, S. L., Cheng, I. 2012; 21 (10): 1814-1822

    Abstract

    Colorectal cancer (CRC) incidence and mortality rates vary across race/ethnicity. Socioeconomic status (SES) also influences CRC rates; however, these associations might be inconsistent across racial/ethnic groups and tumor subsite. We examined associations between area-level SES and CRC incidence and mortality in a population-based registry study of non-Hispanic Whites, African Americans, Hispanics, and Asians/Pacific Islanders from California.Data on 52,608 incident CRC cases (1998-2002) and 14,515 CRC deaths (1999-2001) aged ?50 years were obtained from the California Cancer Registry. Based on 2000 U.S. Census data, each cancer case and death was assigned a multidimensional census tract-level SES index. SES-specific quintiles of CRC incidence and mortality rates, incidence rate ratios (IRR) and mortality rate ratios, and 95% confidence intervals (CI) were estimated. Analyses were stratified by anatomical site, including left- versus right-sided tumors, race/ethnicity, and stage of disease.Overall CRC incidence and SES did not show a clear association, yet patterns of associations varied across tumor subsite and race/ethnicity. Positive associations between SES and CRC incidence were found in Hispanics [SES Q5 v. Q1: IRR = 1.54, CI = 1.39-1.69], irrespective of the subsite. For Whites [SES Q5 v. Q1: IRR = 0.80, CI = 0.77-0.83], and African Americans [SES Q5 v. Q1: IRR = 0.83, CI = 0.70-0.97] inverse associations were observed, predominantly for left-sided tumors. Mortality rates declined with increasing SES in Whites, whereas in Hispanics mortality rates significantly increased with SES.Our findings show that SES differences in CRC incidence and mortality vary considerably across anatomical subsite and race/ethnicity.Studies combining area- and individual-level SES information are warranted.

    View details for DOI 10.1158/1055-9965.EPI-12-0659

    View details for Web of Science ID 000309576100026

    View details for PubMedID 22911333

  • Age-Specific Incidence of Breast Cancer Subtypes: Understanding the BlackWhite Crossover JOURNAL OF THE NATIONAL CANCER INSTITUTE Clarke, C. A., Keegan, T. H., Yang, J., Press, D. J., Kurian, A. W., Patel, A. H., Lacey, J. V. 2012; 104 (14): 1094-1101

    Abstract

    Breast cancer incidence is higher among black women than white women before age 40 years, but higher among white women than black women after age 40 years (black-white crossover). We used newly available population-based data to examine whether the age-specific incidences of breast cancer subtypes vary by race and ethnicity.We classified 91908 invasive breast cancers diagnosed in California between January 1, 2006, and December 31, 2009, by subtype based on tumor expression of estrogen receptor (ER) and progesterone receptor (PR)-together referred to as hormone receptor (HR)-and human epidermal growth factor receptor 2 (HER2). Breast cancer subtypes were classified as ER or PR positive and HER2 negative (HR(+)/HER2(-)), ER or PR positive and HER2 positive (HR(+)/HER2(+)), ER and PR negative and HER2 positive (HR(-)/HER2(+)), and ER, PR, and HER2 negative (triple-negative). We calculated and compared age-specific incidence rates, incidence rate ratios, and 95% confidence intervals by subtype and race (black, white, Hispanic, and Asian). All P values are two-sided.We did not observe an age-related black-white crossover in incidence for any molecular subtype of breast cancer. Compared with white women, black women had statistically significantly higher rates of triple-negative breast cancer at all ages but statistically significantly lower rates of HR(+)/HER2(-) breast cancers after age 35 years (all P < .05). The age-specific incidence of HR(+)/HER2(+) and HR(-)/HER2(+) subtypes did not vary markedly between white and black women.The black-white crossover in breast cancer incidence occurs only when all breast cancer subtypes are combined and relates largely to higher rates of triple-negative breast cancers and lower rates of HR(+)/HER2(-) breast cancers in black vs white women.

    View details for DOI 10.1093/jnci/djs264

    View details for Web of Science ID 000306969100011

    View details for PubMedID 22773826

  • Gastric Cancer Incidence among Hispanics in California: Patterns by Time, Nativity, and Neighborhood Characteristics CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION Chang, E. T., Gomez, S. L., Fish, K., Schupp, C. W., Parsonnet, J., DeRouen, M. C., Keegan, T. H., Clarke, C. A., Glaser, S. L. 2012; 21 (5): 709-719

    Abstract

    Better understanding about gastric cancer incidence patterns among Hispanics by birthplace, socioeconomic status (SES), and acculturation can improve preventive strategies and disease models.Incidence rates, rate ratios, and estimated annual percent change (EAPC) in rates of anatomic and histologic subtype-specific gastric cancer were calculated by age, sex, and nativity among Hispanics using California Cancer Registry data from 1988 through 2004. Incidence rates in 1998 to 2002 were compared by neighborhood SES and Hispanic enclave status according to 2000 US Census data.Incidence rates of diffuse gastric cancer increased from 1988 through 2004 among foreign-born Hispanic men (EAPC: 3.5%, 95% CI: 1.5%-5.5%) and U.S.-born Hispanic women (EAPC: 3.0%, 95% CI: 0.7%-5.3%). During the same time period, incidence rates of intestinal gastric cancer declined significantly and both cardia and noncardia gastric cancer were steady or declined among foreign-born and U.S.-born Hispanic men and women. Noncardia and both intestinal and diffuse gastric cancer were more common in foreign-born than U.S.-born Hispanic men and women, and in those from lower SES, higher enclave neighborhoods. By contrast, among younger and middle-aged Hispanic men, cardia tumors were more common in the U.S.-born than the foreign-born, and in higher SES, lower enclave neighborhoods.Varying gastric cancer risk factors among Hispanic subgroups and increasing rates of diffuse gastric cancer in foreign-born Hispanic men and U.S.-born Hispanic women merit further investigation to identify separate disease etiologies.Age, sex, birthplace, SES, and acculturation modify gastric cancer incidence in Hispanics and should be considered when examining disease risk and prevention.

    View details for DOI 10.1158/1055-9965.EPI-11-1208

    View details for Web of Science ID 000303908200004

    View details for PubMedID 22374991

  • 19p13.1 Is a Triple-Negative-Specific Breast Cancer Susceptibility Locus CANCER RESEARCH Stevens, K. N., Fredericksen, Z., Vachon, C. M., Wang, X., Margolin, S., Lindblom, A., Nevanlinna, H., Greco, D., Aittomaki, K., Blomqvist, C., Chang-Claude, J., Vrieling, A., Flesch-Janys, D., Sinn, H., Wang-Gohrke, S., Nickels, S., Brauch, H., Ko, Y., Fischer, H., Schmutzler, R. K., Meindl, A., Bartram, C. R., Schott, S., Engel, C., Godwin, A. K., Weaver, J., Pathak, H. B., Sharma, P., Brenner, H., Mueller, H., Arndt, V., Stegmaier, C., Miron, P., Yannoukakos, D., Stavropoulou, A., Fountzilas, G., Gogas, H. J., Swann, R., Dwek, M., Perkins, A., Milne, R. L., Benitez, J., Pilar Zamora, M., Arias Perez, J. I., Bojesen, S. E., Nielsen, S. F., Nordestgaard, B. G., Flyger, H., Guenel, P., Therese Truong, T., Menegaux, F., Cordina-Duverger, E., Burwinkel, B., Marme, F., Schneeweiss, A., Sohn, C., Sawyer, E., Tomlinson, I., Kerin, M. J., Peto, J., Johnson, N., Fletcher, O., dos Santos Silva, I., Fasching, P. A., Beckmann, M. W., Hartmann, A., Ekici, A. B., Lophatananon, A., Muir, K., Puttawibul, P., Wiangnon, S., Schmidt, M. K., Broeks, A., Braaf, L. M., Rosenberg, E. H., Hopper, J. L., Apicella, C., Park, D. J., Southey, M. C., Swerdlow, A. J., Ashworth, A., Orr, N., Schoemaker, M. J., Anton-Culver, H., Ziogas, A., Bernstein, L., Dur, C. C., Shen, C., Yu, J., Hsu, H., Hsiung, C., Hamann, U., Duennebier, T., Ruediger, T., Ulmer, H. U., Pharoah, P. P., Dunning, A. M., Humphreys, M. K., Wang, Q., Cox, A., Cross, S. S., Reed, M. W., Hall, P., Czene, K., Ambrosone, C. B., Ademuyiwa, F., Hwang, H., Eccles, D. M., Garcia-Closas, M., Figueroa, J. D., Sherman, M. E., Lissowska, J., Devilee, P., Seynaeve, C., Tollenaar, R. A., Hooning, M. J., Andrulis, I. L., Knight, J. A., Glendon, G., Mulligan, A. M., Winqvist, R., Pylkas, K., Jukkola-Vuorinen, A., Grip, M., John, E. M., Miron, A., Alnaes, G. G., Kristensen, V., Borresen-Dale, A., Giles, G. G., Baglietto, L., McLean, C. A., Severi, G., Kosel, M. L., Pankratz, V. S., Slager, S., Olson, J. E., Radice, P., Peterlongo, P., Manoukian, S., Barile, M., Lambrechts, D., Hatse, S., Dieudonne, A., Christiaens, M., Chenevix-Trench, G., Beesley, J., Chen, X., Mannermaa, A., Kosma, V., Hartikainen, J. M., Soini, Y., Easton, D. F., Couch, F. J. 2012; 72 (7): 1795-1803

    Abstract

    The 19p13.1 breast cancer susceptibility locus is a modifier of breast cancer risk in BRCA1 mutation carriers and is also associated with the risk of ovarian cancer. Here, we investigated 19p13.1 variation and risk of breast cancer subtypes, defined by estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER2) status, using 48,869 breast cancer cases and 49,787 controls from the Breast Cancer Association Consortium (BCAC). Variants from 19p13.1 were not associated with breast cancer overall or with ER-positive breast cancer but were significantly associated with ER-negative breast cancer risk [rs8170 OR, 1.10; 95% confidence interval (CI), 1.05-1.15; P = 3.49 × 10(-5)] and triple-negative (ER-, PR-, and HER2-negative) breast cancer (rs8170: OR, 1.22; 95% CI, 1.13-1.31; P = 2.22 × 10(-7)). However, rs8170 was no longer associated with ER-negative breast cancer risk when triple-negative cases were excluded (OR, 0.98; 95% CI, 0.89-1.07; P = 0.62). In addition, a combined analysis of triple-negative cases from BCAC and the Triple Negative Breast Cancer Consortium (TNBCC; N = 3,566) identified a genome-wide significant association between rs8170 and triple-negative breast cancer risk (OR, 1.25; 95% CI, 1.18-1.33; P = 3.31 × 10(-13)]. Thus, 19p13.1 is the first triple-negative-specific breast cancer risk locus and the first locus specific to a histologic subtype defined by ER, PR, and HER2 to be identified. These findings provide convincing evidence that genetic susceptibility to breast cancer varies by tumor subtype and that triple-negative tumors and other subtypes likely arise through distinct etiologic pathways.

    View details for DOI 10.1158/0008-5472.CAN-11-3364

    View details for Web of Science ID 000302551800022

    View details for PubMedID 22331459

  • Genome-wide association analysis identifies three new breast cancer susceptibility loci NATURE GENETICS Ghoussaini, M., Fletcher, O., Michailidou, K., Turnbull, C., Schmidt, M. K., Dicks, E., Dennis, J., Wang, Q., Humphreys, M. K., Luccarini, C., Baynes, C., Conroy, D., Maranian, M., Ahmed, S., Driver, K., Johnson, N., Orr, N., Silva, I. d., Waisfisz, Q., Meijers-Heijboer, H., Uitterlinden, A. G., Rivadeneira, F., Hall, P., Czene, K., Irwanto, A., Liu, J., Nevanlinna, H., Aittomaki, K., Blomqvist, C., Meindl, A., Schmutzler, R. K., Mueller-Myhsok, B., Lichtner, P., Chang-Claude, J., Hein, R., Nickels, S., Flesch-Janys, D., Tsimiklis, H., Makalic, E., Schmidt, D., Bui, M., Hopper, J. L., Apicella, C., Park, D. J., Southey, M., Hunter, D. J., Chanock, S. J., Broeks, A., Verhoef, S., Hogervorst, F. B., Fasching, P. A., Lux, M. P., Beckmann, M. W., Ekici, A. B., Sawyer, E., Tomlinson, I., Kerin, M., Marme, F., Schneeweiss, A., Sohn, C., Burwinkel, B., Guenel, P., Truong, T., Cordina-Duverger, E., Menegaux, F., Bojesen, S. E., Nordestgaard, B. G., Nielsen, S. F., Flyger, H., Milne, R. L., Rosario Alonso, M., Gonzalez-Neira, A., Benitez, J., Anton-Culver, H., Ziogas, A., Bernstein, L., Dur, C. C., Brenner, H., Mueller, H., Arndt, V., Stegmaier, C., Justenhoven, C., Brauch, H., Bruening, T., Wang-Gohrke, S., Eilber, U., Doerk, T., Schuermann, P., Bremer, M., Hillemanns, P., Bogdanova, N. V., Antonenkova, N. N., Rogov, Y. I., Karstens, J. H., Bermisheva, M., Prokofieva, D., Khusnutdinova, E., Lindblom, A., Margolin, S., Mannermaa, A., Kataja, V., Kosma, V., Hartikainen, J. M., Lambrechts, D., Yesilyurt, B. T., Floris, G., Leunen, K., Manoukian, S., Bonanni, B., Fortuzzi, S., Peterlongo, P., Couch, F. J., Wang, X., Stevens, K., Lee, A., Giles, G. G., Baglietto, L., Severi, G., McLean, C., Alnaes, G. G., Kristensen, V., Borrensen-Dale, A., John, E. M., Miron, A., Winqvist, R., Pylkas, K., Jukkola-Vuorinen, A., Kauppila, S., Andrulis, I. L., Glendon, G., Mulligan, A. M., Devilee, P., Van Asperen, C. J., Tollenaar, R. A., Seynaeve, C., Figueroa, J. D., Garcia-Closas, M., Brinton, L., Lissowska, J., Hooning, M. J., Hollestelle, A., Oldenburg, R. A., van den Ouweland, A. M., Cox, A., Reed, M. W., Shah, M., Jakubowska, A., Lubinski, J., Jaworska, K., Durda, K., Jones, M., Schoemaker, M., Ashworth, A., Swerdlow, A., Beesley, J., Chen, X., Muir, K. R., Lophatananon, A., Rattanamongkongul, S., Chaiwerawattana, A., Kang, D., Yoo, K., Noh, D., Shen, C., Yu, J., Wu, P., Hsiung, C., Perkins, A., Swann, R., Velentzis, L., Eccles, D. M., Tapper, W. J., Gerty, S. M., Graham, N. J., Ponder, B. A., Chenevix-Trench, G., Pharoah, P. D., Lathrop, M., Dunning, A. M., Rahman, N., Peto, J., Easton, D. F. 2012; 44 (3): 312-U120

    Abstract

    Breast cancer is the most common cancer among women. To date, 22 common breast cancer susceptibility loci have been identified accounting for ?8% of the heritability of the disease. We attempted to replicate 72 promising associations from two independent genome-wide association studies (GWAS) in ?70,000 cases and ?68,000 controls from 41 case-control studies and 9 breast cancer GWAS. We identified three new breast cancer risk loci at 12p11 (rs10771399; P = 2.7 × 10(-35)), 12q24 (rs1292011; P = 4.3 × 10(-19)) and 21q21 (rs2823093; P = 1.1 × 10(-12)). rs10771399 was associated with similar relative risks for both estrogen receptor (ER)-negative and ER-positive breast cancer, whereas the other two loci were associated only with ER-positive disease. Two of the loci lie in regions that contain strong plausible candidate genes: PTHLH (12p11) has a crucial role in mammary gland development and the establishment of bone metastasis in breast cancer, and NRIP1 (21q21) encodes an ER cofactor and has a role in the regulation of breast cancer cell growth.

    View details for DOI 10.1038/ng.1049

    View details for Web of Science ID 000300843600018

    View details for PubMedID 22267197

  • Nativity and papillary thyroid cancer incidence rates among Hispanic women in California CANCER Horn-Ross, P. L., Chang, E. T., Clarke, C. A., Keegan, T. H., Rull, R. P., Thu Quach, T., Gomez, S. L. 2012; 118 (1): 216-222

    Abstract

    Overall, the incidence of papillary thyroid cancer in Hispanic women residing in the United States (US) is similar to that of non-Hispanic white women. However, little is known as to whether rates in Hispanic women vary by nativity, which may influence exposure to important risk factors.Nativity-specific incidence rates among Hispanic women were calculated for papillary thyroid cancer using data from the California Cancer Registry (CCR) for the period 1988-2004. For the 35% of cases for whom birthplace information was not available from the CCR, nativity was statistically imputed based on age at Social Security number issuance. Population estimates were extracted based on US Census data. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were also estimated.In young (age <55 years) Hispanic women, the incidence of papillary thyroid cancer among US-born women (10.65 per 100,000) was significantly greater than that for foreign-born women (6.67 per 100,000; IRR, 1.60 [95% CI, 1.44-1.77]). The opposite pattern was observed in older women. The age-specific patterns showed marked differences by nativity: among foreign-born women, rates increased slowly until age 70 years, whereas among US-born women, incidence rates peaked during the reproductive years. Incidence rates increased over the study period in all subgroups.Incidence rates of papillary thyroid cancer vary by nativity and age among Hispanic women residing in California. These patterns can provide insight for future etiologic investigations of modifiable risk factors for this increasingly common and understudied cancer.

    View details for DOI 10.1002/cncr.26223

    View details for Web of Science ID 000298549700027

    View details for PubMedID 21692062

  • Occurrence of breast cancer subtypes in adolescent and young adult women BREAST CANCER RESEARCH Keegan, T. H., DeRouen, M. C., Press, D. J., Kurian, A. W., Clarke, C. A. 2012; 14 (2)

    Abstract

    Breast cancers are increasingly recognized as heterogeneous based on expression of receptors for estrogen (ER), progesterone (PR), and human epidermal growth factor receptor 2 (HER2). Triple-negative tumors (ER-/PR-/HER2-) have been reported to be more common among younger women, but occurrence of the spectrum of breast cancer subtypes in adolescent and young adult (AYA) women aged between 15 and 39 years is otherwise poorly understood.Data regarding all 5,605 AYA breast cancers diagnosed in California during the period 2005 to 2009, including ER and PR status (referred to jointly as hormone receptor (HR) status) and HER2 status, was obtained from the population-based California Cancer Registry. Incidence rates were calculated by subtype (triple-negative; HR+/HER2-; HR+/HER2+; HR-/HER2+), and logistic regression was used to evaluate differences in subtype characteristics by age group.AYAs had higher proportions of HR+/HER2+, triple-negative and HR-/HER2+ breast cancer subtypes and higher proportions of patients of non-White race/ethnicity than did older women. AYAs also were more likely to be diagnosed with stage III/IV disease and high-grade tumors than were older women. Rates of HR+/HER2- and triple-negative subtypes in AYAs varied substantially by race/ethnicity.The distribution of breast cancer subtypes among AYAs varies from that observed in older women, and varies further by race/ethnicity. Observed subtype distributions may explain the poorer breast cancer survival previously observed among AYAs.

    View details for DOI 10.1186/bcr3156

    View details for Web of Science ID 000304771800030

    View details for PubMedID 22452927

  • Body size and the risk of postmenopausal breast cancer subtypes in the California Teachers Study cohort. Cancer causes & control : CCC Canchola, A. J., Anton-Culver, H., Bernstein, L., Clarke, C. A., Henderson, K., Ma, H., Ursin, G., Horn-Ross, P. L. 2012

    Abstract

    PURPOSE: To evaluate how the association between body size and breast cancer risk varies by tumor receptor subtype, host factors, and other exposures among women in the California Teachers Study cohort. METHODS: Among 52,642 postmenopausal women, 2,321 developed invasive breast cancer with known estrogen- and progesterone-receptor status (1,652 ER+PR+, 338 ER+PR-, and 312 ER-PR-) between 1995 and 2007. In a subset of 35,529 with waist circumference data, 1,377 developed invasive breast cancer with known ERPR status (991 ER+PR+, 208 ER+PR-, 169 ER-PR-) between 1997 and 2007. Multivariate Cox regression was performed to estimate relative risks (RR) and 95% confidence intervals (CI). RESULTS: Obesity, adult weight gain of ?40 pounds, greater abdominal adiposity, and greater height increased the risk of ER+PR+ breast cancer. The increased risk associated with postmenopausal obesity was limited to those who did not use hormone therapy (HT) at cohort entry (RR = 1.37; 95% CI, 1.05-1.78 for BMI ? 30 vs. < 25 kg/m(2); p-interaction = 0.14) and those who were not overweight or obese at age 18 (p-interaction = 0.06). The increased risk associated with greater abdominal adiposity was limited to those who were not also overweight or obese (p-interaction = 0.01). Neither obesity, abdominal adiposity, nor height was associated with the risk of ER-PR- tumors. CONCLUSIONS: The effects of body size on postmenopausal breast cancer risk differed by hormone receptor subtype, and among women with ER+PR+ tumors, by HT use and early adult body size.

    View details for PubMedID 22286371

  • Comparison of 6q25 breast cancer hits from Asian and European Genome Wide Association Studies in the Breast Cancer Association Consortium (BCAC). PloS one Hein, R., Maranian, M., Hopper, J. L., Kapuscinski, M. K., Southey, M. C., Park, D. J., Schmidt, M. K., Broeks, A., Hogervorst, F. B., Bueno-de-Mesquita, H. B., Muir, K. R., Lophatananon, A., Rattanamongkongul, S., Puttawibul, P., Fasching, P. A., Hein, A., Ekici, A. B., Beckmann, M. W., Fletcher, O., Johnson, N., dos Santos Silva, I., Peto, J., Sawyer, E., Tomlinson, I., Kerin, M., Miller, N., Marmee, F., Schneeweiss, A., Sohn, C., Burwinkel, B., Guénel, P., Cordina-Duverger, E., Menegaux, F., Truong, T., Bojesen, S. E., Nordestgaard, B. G., Flyger, H., Milne, R. L., Perez, J. I., Zamora, M. P., Benítez, J., Anton-Culver, H., Ziogas, A., Bernstein, L., Clarke, C. A., Brenner, H., Müller, H., Arndt, V., Stegmaier, C., Rahman, N., Seal, S., Turnbull, C., Renwick, A., Meindl, A., Schott, S., Bartram, C. R., Schmutzler, R. K., Brauch, H., Hamann, U., Ko, Y., Wang-Gohrke, S., Dörk, T., Schürmann, P., Karstens, J. H., Hillemanns, P., Nevanlinna, H., Heikkinen, T., Aittomäki, K., Blomqvist, C., Bogdanova, N. V., Zalutsky, I. V., Antonenkova, N. N., Bermisheva, M., Prokovieva, D., Farahtdinova, A., Khusnutdinova, E., Lindblom, A., Margolin, S., Mannermaa, A., Kataja, V., Kosma, V., Hartikainen, J., Chen, X., Beesley, J., Lambrechts, D., Zhao, H., Neven, P., Wildiers, H., Nickels, S., Flesch-Janys, D., Radice, P., Peterlongo, P., Manoukian, S., Barile, M., Couch, F. J., Olson, J. E., Wang, X., Fredericksen, Z., Giles, G. G., Baglietto, L., McLean, C. A., Severi, G., Offit, K., Robson, M., Gaudet, M. M., Vijai, J., Alnæs, G. G., Kristensen, V., Børresen-Dale, A., John, E. M., Miron, A., Winqvist, R., Pylkäs, K., Jukkola-Vuorinen, A., Grip, M., Andrulis, I. L., Knight, J. A., Glendon, G., Mulligan, A. M., Figueroa, J. D., García-Closas, M., Lissowska, J., Sherman, M. E., Hooning, M., Martens, J. W., Seynaeve, C., Collée, M., Hall, P., Humpreys, K., Czene, K., Liu, J., Cox, A., Brock, I. W., Cross, S. S., Reed, M. W., Ahmed, S., Ghoussaini, M., Pharoah, P. D., Kang, D., Yoo, K., Noh, D., Jakubowska, A., Jaworska, K., Durda, K., Zlowocka, E., Sangrajrang, S., Gaborieau, V., Brennan, P., McKay, J., Shen, C., Yu, J., Hsu, H., Hou, M., Orr, N., Schoemaker, M., Ashworth, A., Swerdlow, A., Trentham-Dietz, A., Newcomb, P. A., Titus, L., Egan, K. M., Chenevix-Trench, G., Antoniou, A. C., Humphreys, M. K., Morrison, J., Chang-Claude, J., Easton, D. F., Dunning, A. M. 2012; 7 (8)

    Abstract

    The 6q25.1 locus was first identified via a genome-wide association study (GWAS) in Chinese women and marked by single nucleotide polymorphism (SNP) rs2046210, approximately 180 Kb upstream of ESR1. There have been conflicting reports about the association of this locus with breast cancer in Europeans, and a GWAS in Europeans identified a different SNP, tagged here by rs12662670. We examined the associations of both SNPs in up to 61,689 cases and 58,822 controls from forty-four studies collaborating in the Breast Cancer Association Consortium, of which four studies were of Asian and 39 of European descent. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI). Case-only analyses were used to compare SNP effects in Estrogen Receptor positive (ER+) versus negative (ER-) tumours. Models including both SNPs were fitted to investigate whether the SNP effects were independent. Both SNPs are significantly associated with breast cancer risk in both ethnic groups. Per-allele ORs are higher in Asian than in European studies [rs2046210: OR (A/G) = 1.36 (95% CI 1.26-1.48), p = 7.6 × 10(-14) in Asians and 1.09 (95% CI 1.07-1.11), p = 6.8 × 10(-18) in Europeans. rs12662670: OR (G/T) = 1.29 (95% CI 1.19-1.41), p = 1.2 × 10(-9) in Asians and 1.12 (95% CI 1.08-1.17), p = 3.8 × 10(-9) in Europeans]. SNP rs2046210 is associated with a significantly greater risk of ER- than ER+ tumours in Europeans [OR (ER-) = 1.20 (95% CI 1.15-1.25), p = 1.8 × 10(-17) versus OR (ER+) = 1.07 (95% CI 1.04-1.1), p = 1.3 × 10(-7), p(heterogeneity) = 5.1 × 10(-6)]. In these Asian studies, by contrast, there is no clear evidence of a differential association by tumour receptor status. Each SNP is associated with risk after adjustment for the other SNP. These results suggest the presence of two variants at 6q25.1 each independently associated with breast cancer risk in Asians and in Europeans. Of these two, the one tagged by rs2046210 is associated with a greater risk of ER- tumours.

    View details for PubMedID 22879957

  • Spectrum of Cancer Risk Among US Solid Organ Transplant Recipients JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Engels, E. A., Pfeiffer, R. M., Fraumeni, J. F., Kasiske, B. L., Israni, A. K., Snyder, J. J., Wolfe, R. A., Goodrich, N. P., Bayakly, A. R., Clarke, C. A., Copeland, G., Finch, J. L., Fleissner, M. L., Goodman, M. T., Kahn, A., Koch, L., Lynch, C. F., Madeleine, M. M., Pawlish, K., Rao, C., Williams, M. A., Castenson, D., Curry, M., Parsons, R., Fant, G., Lin, M. 2011; 306 (17): 1891-1901

    Abstract

    Solid organ transplant recipients have elevated cancer risk due to immunosuppression and oncogenic viral infections. Because most prior research has concerned kidney recipients, large studies that include recipients of differing organs can inform cancer etiology.To describe the overall pattern of cancer following solid organ transplantation.Cohort study using linked data on solid organ transplant recipients from the US Scientific Registry of Transplant Recipients (1987-2008) and 13 state and regional cancer registries.Standardized incidence ratios (SIRs) and excess absolute risks (EARs) assessing relative and absolute cancer risk in transplant recipients compared with the general population.The registry linkages yielded data on 175,732 solid organ transplants (58.4% for kidney, 21.6% for liver, 10.0% for heart, and 4.0% for lung). The overall cancer risk was elevated with 10,656 cases and an incidence of 1375 per 100,000 person-years (SIR, 2.10 [95% CI, 2.06-2.14]; EAR, 719.3 [95% CI, 693.3-745.6] per 100,000 person-years). Risk was increased for 32 different malignancies, some related to known infections (eg, anal cancer, Kaposi sarcoma) and others unrelated (eg, melanoma, thyroid and lip cancers). The most common malignancies with elevated risk were non-Hodgkin lymphoma (n = 1504; incidence: 194.0 per 100,000 person-years; SIR, 7.54 [95% CI, 7.17-7.93]; EAR, 168.3 [95% CI, 158.6-178.4] per 100,000 person-years) and cancers of the lung (n = 1344; incidence: 173.4 per 100,000 person-years; SIR, 1.97 [95% CI, 1.86-2.08]; EAR, 85.3 [95% CI, 76.2-94.8] per 100,000 person-years), liver (n = 930; incidence: 120.0 per 100,000 person-years; SIR, 11.56 [95% CI, 10.83-12.33]; EAR, 109.6 [95% CI, 102.0-117.6] per 100,000 person-years), and kidney (n = 752; incidence: 97.0 per 100,000 person-years; SIR, 4.65 [95% CI, 4.32-4.99]; EAR, 76.1 [95% CI, 69.3-83.3] per 100,000 person-years). Lung cancer risk was most elevated in lung recipients (SIR, 6.13 [95% CI, 5.18-7.21]) but also increased among other recipients (kidney: SIR, 1.46 [95% CI, 1.34-1.59]; liver: SIR, 1.95 [95% CI, 1.74-2.19]; and heart: SIR, 2.67 [95% CI, 2.40-2.95]). Liver cancer risk was elevated only among liver recipients (SIR, 43.83 [95% CI, 40.90-46.91]), who manifested exceptional risk in the first 6 months (SIR, 508.97 [95% CI, 474.16-545.66]) and a 2-fold excess risk for 10 to 15 years thereafter (SIR, 2.22 [95% CI, 1.57-3.04]). Among kidney recipients, kidney cancer risk was elevated (SIR, 6.66 [95% CI, 6.12-7.23]) and bimodal in onset time. Kidney cancer risk also was increased in liver recipients (SIR, 1.80 [95% CI, 1.40-2.29]) and heart recipients (SIR, 2.90 [95% CI, 2.32-3.59]).Compared with the general population, recipients of a kidney, liver, heart, or lung transplant have an increased risk for diverse infection-related and unrelated cancers.

    View details for Web of Science ID 000296376200023

    View details for PubMedID 22045767

  • Cigarette Smoking, Passive Smoking, and Non-Hodgkin Lymphoma Risk: Evidence From the California Teachers Study AMERICAN JOURNAL OF EPIDEMIOLOGY Lu, Y., Wang, S. S., Reynolds, P., Chang, E. T., Ma, H., Sullivan-Halley, J., Clarke, C. A., Bernstein, L. 2011; 174 (5): 563-573

    Abstract

    Epidemiologic studies conducted to date have shown evidence of a causal relation between smoking and non-Hodgkin lymphoma (NHL) risk. However, previous studies did not account for passive smoking exposure in the never-smoking reference group. The California Teachers Study collected information about lifetime smoking and household passive smoking exposure in 1995 and about lifetime exposure to passive smoking in 3 settings (household, workplace, and social settings) in 1997-1998. Multivariable-adjusted relative risks and 95% confidence intervals were estimated by fitting Cox proportional hazards models with follow-up through 2007. Compared with never smokers, ever smokers had a 1.11-fold (95% confidence interval (CI): 0.94, 1.30) higher NHL risk that increased to a 1.22-fold (95% CI: 0.95, 1.57) higher risk when women with household passive smoking were excluded from the reference category. Statistically significant dose responses were observed for lifetime cumulative smoking exposure (intensity and pack-years; both P 's for trend = 0.02) when women with household passive smoking were excluded from the reference category. Among never smokers, NHL risk increased with increasing lifetime exposure to passive smoking (relative risk = 1.51 (95% CI: 1.03, 2.22) for >40 years vs. ?5 years of passive smoking; P for trend = 0.03), particularly for follicular lymphoma (relative risk = 2.89 (95% CI: 1.23, 6.80); P for trend = 0.01). The present study provides evidence that smoking and passive smoking may influence NHL etiology, particularly for follicular lymphoma.

    View details for DOI 10.1093/aje/kwr127

    View details for Web of Science ID 000294356800009

    View details for PubMedID 21768403

  • Oral contraceptives, menopausal hormone therapy use and risk of B-cell non-Hodgkin lymphoma in the California Teachers Study INTERNATIONAL JOURNAL OF CANCER Lu, Y., Wang, S. S., Sullivan-Halley, J., Chang, E. T., Clarke, C. A., Henderson, K. D., Ma, H., Duan, L., Lacey, J. V., Deapen, D., Bernstein, L. 2011; 129 (4): 974-982

    Abstract

    We examined oral contraceptive (OC) and menopausal hormonal therapy (MHT) use in relation to risk of B-cell non-Hodgkin lymphoma (NHL). Women under age 85 years participating in the California Teachers Study with no history of hematopoietic cancer were followed from 1995 through 2007. A total of 516 of 114,131 women eligible for OC use analysis and 402 of 54,758 postmenopausal women eligible for MHT use analysis developed B-cell NHL. Multivariable adjusted and age stratified Cox proportional hazards models were fit to estimate relative risks (RRs) and 95% confidence intervals (95% CI). Ever versus never OC use was marginally associated with lower B-cell NHL risk, particularly among women first using OCs before age 25 years (RR=0.72, 95% CI=0.51-0.99); yet, no duration-response effect was observed. No association was observed for ever versus never MHT use among postmenopausal women (RR=1.05, 95% CI=0.83-1.33) overall or by formulation (estrogen alone, ET, or estrogen plus progestin, EPT). Among women with no MHT use, having bilateral oophorectomy plus hysterectomy was associated with greater B-cell NHL risk than having natural menopause (RR=3.15, 95% CI=1.62-6.13). Bilateral oophorectomy plus hysterectomy was not associated with risk among women who used ET or EPT. These results indicate that exogenous hormone use does not strongly influence B-cell NHL risk.

    View details for DOI 10.1002/ijc.25730

    View details for Web of Science ID 000292508000023

    View details for PubMedID 20957632

  • Adulthood residential ultraviolet radiation, sun sensitivity, dietary vitamin D, and risk of lymphoid malignancies in the California Teachers Study BLOOD Chang, E. T., Canchola, A. J., Cockburn, M., Lu, Y., Wang, S. S., Bernstein, L., Clarke, C. A., Horn-Ross, P. L. 2011; 118 (6): 1591-1599

    Abstract

    To lend clarity to inconsistent prior findings of an inverse association between ultraviolet radiation (UVR) exposure and risk of lymphoid malignancies, we examined the association of prospectively ascertained residential ambient UVR exposure with risk of non-Hodgkin lymphomas (NHLs), multiple myeloma (MM), and classical Hodgkin lymphoma in the California Teachers Study cohort. Among 121 216 eligible women, 629 were diagnosed with NHL, 119 with MM, and 38 with Hodgkin lymphoma between 1995-1996 and 2007. Cox proportional hazards regression was used to estimate incidence rate ratios (RRs) with 95% confidence intervals (CIs). Residential UVR levels within a 20-km radius were associated with reduced risk of overall NHL (RR for highest vs lowest statewide quartile of minimum UVR [? 5100 vs < 4915 W-h/m(2)], 0.58; 95% CI, 0.42-0.80), especially diffuse large B-cell lymphoma (RR, 0.36; 95% CI, 0.17-0.78) and chronic lymphocytic leukemia/small lymphocytic lymphoma (RR, 0.46; 95% CI, 0.21-1.01), and MM (RR for maximum UVR, 0.57; 95% CI, 0.36-0.90). These associations were not modified by skin sensitivity to sunlight, race/ethnicity, body mass index, or neighborhood socioeconomic status. Dietary vitamin D also was not associated with risk of lymphoid malignancies. These results support a protective effect of routine residential UVR exposure against lymphomagenesis through mechanisms possibly independent of vitamin D.

    View details for DOI 10.1182/blood-2011-02-336065

    View details for Web of Science ID 000293787300026

    View details for PubMedID 21622649

  • Increases in Melanoma Among Adolescent Girls and Young Women in California Trends by Socioeconomic Status and UV Radiation Exposure ARCHIVES OF DERMATOLOGY Hausauer, A. K., Swetter, S. M., Cockburn, M. G., Clarke, C. A. 2011; 147 (7): 783-789

    Abstract

    During the past 3 decades in the United States, melanoma incidence among non-Hispanic white girls and women aged 15 to 39 years has more than doubled. To better understand which specific subpopulations of girls and women experienced this increase and thereby to target public health interventions, we assessed the relationship between melanoma incidence and small-area level measures of socioeconomic status (SES) and UV radiation (UV-R) exposure.Longitudinal study of California Cancer Registry, US Census, and National Oceanic and Atmospheric Administration data from pericensal periods January 1, 1988, through December 31, 1992, and January 1, 1998, through December 31, 2002.State of California.A total of 3800 non-Hispanic white girls and women aged 15 to 39 years, in whom 3842 melanomas were diagnosed.Incidence rates per 100 000 person-years and rate ratios according to SES quintiles and UV-R exposure tertiles.Whereas melanoma rates increased over time for all SES categories, only changes among the highest 3 categories achieved statistical significance. UV radiation was significantly and positively associated with melanoma incidence only among adolescent girls and young women in the 2 highest quintiles ranked by SES, which suggests that SES is not a proxy for UV-R exposure. Those living in neighborhoods with the highest SES and UV-R categories had 80.0% higher rates of melanoma than those in neighborhoods in the lowest categories (rate ratio, 1.80; 95% confidence interval, 1.13-3.01).Understanding the ways that SES and UV-R exposure work together to influence melanoma incidence is important for planning effective prevention and educational efforts. Interventions should target adolescent girls and young women living in high SES and high UV-R neighborhoods because they have experienced a significantly greater increase in disease burden.

    View details for DOI 10.1001/archdermatol.2011.44

    View details for Web of Science ID 000292840700003

    View details for PubMedID 21422322

  • Lymphoid Malignancies in US Asians: Incidence Rate Differences by Birthplace and Acculturation CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION Clarke, C. A., Glaser, S. L., Gomez, S. L., Wang, S. S., Keegan, T. H., Yang, J., Chang, E. T. 2011; 20 (6): 1064-1077

    Abstract

    Malignancies of the lymphoid cells, including non-Hodgkin lymphomas (NHL), HL, and multiple myeloma, occur at much lower rates in Asians than other racial/ethnic groups in the United States. It remains unclear whether these deficits are explained by genetic or environmental factors. To better understand environmental contributions, we examined incidence patterns of lymphoid malignancies among populations characterized by ethnicity, birthplace, and residential neighborhood socioeconomic status (SES) and ethnic enclave status.We obtained data about all Asian patients diagnosed with lymphoid malignancies between 1988 and 2004 from the California Cancer Registry and neighborhood characteristics from U.S. Census data.Although incidence rates of most lymphoid malignancies were lower among Asian than white populations, only follicular lymphoma (FL), chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), and nodular sclerosis (NS) HL rates were statistically significantly lower among foreign-born than U.S.-born Asians with incidence rate ratios ranging from 0.34 to 0.87. Rates of CLL/SLL and NS HL were also lower among Asian women living in ethnic enclaves or lower SES neighborhoods than those living elsewhere.These observations support strong roles of environmental factors in the causation of FL, CLL/SLL, and NS HL.Studying specific lymphoid malignancies in U.S. Asians may provide valuable insight toward understanding their environmental causes.

    View details for DOI 10.1158/1055-9965.EPI-11-0038

    View details for Web of Science ID 000291308600003

    View details for PubMedID 21493873

  • Papillary thyroid cancer incidence rates vary significantly by birthplace in Asian American women CANCER CAUSES & CONTROL Horn-Ross, P. L., McClure, L. A., Chang, E. T., Clarke, C. A., Keegan, T. H., Rull, R. P., Quach, T., Gomez, S. L. 2011; 22 (3): 479-485

    Abstract

    To investigate how birthplace influences the incidence of papillary thyroid cancer among Asian American women.Birthplace- and ethnic-specific age-adjusted and age-specific incidence rates were calculated using data from the California Cancer Registry for the period 1988-2004. Birthplace was statistically imputed for 30% of cases using a validated imputation method based on age at Social Security number issuance. Population estimates were obtained from the US Census. Incidence rate ratios (IRR) and 95% confidence intervals (CI) were estimated for foreign-born vs. US-born women.Age-adjusted incidence rates of papillary thyroid cancer among Filipina (13.7 per 100,000) and Vietnamese (12.7) women were more than double those of Japanese women (6.2). US-born Chinese (IRR = 0.48, 95% CI: 0.40-0.59) and Filipina women (IRR = 0.74, 95% CI: 0.58-0.96) had significantly higher rates than those who were foreign-born; the opposite was observed for Japanese women (IRR = 1.55, 95% CI: 1.17-2.08). The age-specific patterns among all foreign-born Asian women and US-born Japanese women showed a slow steady increase in incidence until age 70. However, among US-born Asian women (except Japanese), substantially elevated incidence rates during the reproductive and menopausal years were evident.Ethnic- and birthplace-variation in papillary thyroid cancer incidence can provide insight into the etiology of this increasingly common and understudied cancer.

    View details for DOI 10.1007/s10552-010-9720-5

    View details for Web of Science ID 000288542400015

    View details for PubMedID 21207130

  • Dietary phytocompounds and risk of lymphoid malignancies in the California Teachers Study cohort CANCER CAUSES & CONTROL Chang, E. T., Canchola, A. J., Clarke, C. A., Lu, Y., West, D. W., Bernstein, L., Wang, S. S., Horn-Ross, P. L. 2011; 22 (2): 237-249

    Abstract

    We examined whether dietary intake of isoflavones, lignans, isothiocyanates, antioxidants, or specific foods rich in these compounds is associated with reduced risk of B-cell non-Hodgkin lymphoma (NHL), multiple myeloma (MM), or Hodgkin lymphoma (HL) in a large, prospective cohort of women.Between 1995-1996 and 31 December 2007, among 110,215 eligible members of the California Teachers Study cohort, 536 women developed incident B-cell NHL, 104 developed MM, and 34 developed HL. Cox proportional hazards regression, with age as the time scale, was used to estimate adjusted rate ratios (RRs) with 95% confidence intervals (CIs) for risk of lymphoid malignancies.Weak inverse associations with risk of diffuse large B-cell lymphoma were observed for isothiocyanates (RR for ?12.1 vs. <2.7 mcM/day = 0.67, 95% CI: 0.43-1.05) and an antioxidant index measuring hydroxyl radical absorbance capacity (RR for ?2.2 vs. <0.9 ?M Trolox equiv/g/day = 0.68, 95% CI: 0.42-1.10; p (trend) = 0.08). Risk of other NHL subtypes, overall B-cell NHL, MM, or HL was not generally associated with dietary intake of isoflavones, lignans, isothiocyanates, antioxidants, or major food sources of these compounds.Isoflavones, lignans, isothiocyanates, and antioxidant compounds are not associated with risk of most B-cell malignancies, but some phytocompounds may decrease the risk of selected subtypes.

    View details for DOI 10.1007/s10552-010-9692-5

    View details for Web of Science ID 000286465000009

    View details for PubMedID 21107674

  • The Expanding Melanoma Burden in California Hispanics Importance of Socioeconomic Distribution, Histologic Subtype, and Anatomic Location CANCER Pollitt, R. A., Clarke, C. A., Swetter, S. M., Peng, D. H., Zadnick, J., Cockburn, M. 2011; 117 (1): 152-161

    Abstract

    The incidence patterns and socioeconomic distribution of cutaneous melanoma among Hispanics are poorly understood.The authors obtained population-based incidence data for all Hispanic and non-Hispanic white (NHW) patients who were diagnosed with invasive cutaneous melanoma from 1988 to 2007 in California. By using a neighborhood-level measure of socioeconomic status (SES), the variables investigated included incidence, thickness at diagnosis, histologic subtype, anatomic site, and the relative risk (RR) for thicker (>2 mm) versus thinner (? 2 mm) tumors at diagnosis for groups categorized by SES.Age-adjusted melanoma incidence rates per million were higher in NHWs (P < .0001), and tumor thickness at diagnosis was greater in Hispanics (P < .0001). Sixty-one percent of melanomas in NHWs occurred in the High SES group. Among Hispanics, only 35% occurred in the High SES group; and 22% occurred in the Low SES group. Lower SES was associated with thicker tumors (P < .0001); this association was stronger in Hispanics. The RR of thicker tumors versus thinner tumors (? 2 mm) in the Low SES group versus the High SES group was 1.48 (95% confidence interval [CI], 1.37-1.61) for NHW men and 2.18 (95% CI, 1.73-2.74) for Hispanic men. Patients with lower SES had less of the superficial spreading melanoma subtype (especially among Hispanic men) and more of the nodular melanoma subtype. Leg/hip melanomas were associated with higher SES in NHW men but with lower SES in Hispanic men.The socioeconomic distribution of melanoma incidence and tumor thickness differed substantially between Hispanic and NHW Californians, particularly among men. Melanoma prevention efforts targeted to lower SES Hispanics and increased physician awareness of melanoma patterns among Hispanics are needed.

    View details for DOI 10.1002/cncr.25355

    View details for Web of Science ID 000285368300021

    View details for PubMedID 20737564

  • Alcohol Consumption Over Time and Risk of Lymphoid Malignancies in the California Teachers Study Cohort AMERICAN JOURNAL OF EPIDEMIOLOGY Chang, E. T., Clarke, C. A., Canchola, A. J., Lu, Y., Wang, S. S., Ursin, G., West, D. W., Bernstein, L., Horn-Ross, P. L. 2010; 172 (12): 1373-1383

    Abstract

    Several previous studies found inverse associations between alcohol consumption and risk of non-Hodgkin lymphoma (NHL) and multiple myeloma. However, most studies were retrospective, and few distinguished former drinkers or infrequent drinkers from consistent nondrinkers. Therefore, the authors investigated whether history of alcohol drinking affected risks of NHL and multiple myeloma among 102,721 eligible women in the California Teachers Study, a prospective cohort study in which 496 women were diagnosed with B-cell NHL and 101 were diagnosed with multiple myeloma between 1995-1996 and December 31, 2007. Incidence rate ratios and 95% confidence intervals were estimated using Cox proportional hazards regression. Risk of all types of B-cell NHL combined or multiple myeloma was not associated with self-reported past consumption of alcohol, beer, wine, or liquor at ages 18-22 years, at ages 30-35 years, or during the year before baseline. NHL subtypes were inconsistently associated with alcohol intake. However, women who were former alcohol drinkers at baseline were at elevated risk of overall B-cell NHL (rate ratio = 1.46, 95% confidence interval: 1.08, 1.97) and follicular lymphoma (rate ratio = 1.81, 95% confidence interval: 1.00, 3.28). The higher risk among former drinkers emphasizes the importance of classifying both current and past alcohol consumption and suggests that factors related to quitting drinking, rather than alcohol itself, may increase B-cell NHL risk.

    View details for DOI 10.1093/aje/kwq309

    View details for Web of Science ID 000285193200008

    View details for PubMedID 20952595

  • InterLymph hierarchical classification of lymphoid neoplasms for epidemiologic research based on the WHO classification (2008): update and future directions BLOOD Turner, J. J., Morton, L. M., Linet, M. S., Clarke, C. A., Kadin, M. E., Vajdic, C. M., Monnereau, A., Maynadie, M., Chiu, B. C., Marcos-Gragera, R., Costantini, A. S., Cerhan, J. R., Weisenburger, D. D. 2010; 116 (20): E90-E98

    Abstract

    After publication of the updated World Health Organization (WHO) classification of tumors of hematopoietic and lymphoid tissues in 2008, the Pathology Working Group of the International Lymphoma Epidemiology Consortium (InterLymph) now presents an update of the hierarchical classification of lymphoid neoplasms for epidemiologic research based on the 2001 WHO classification, which we published in 2007. The updated hierarchical classification incorporates all of the major and provisional entities in the 2008 WHO classification, including newly defined entities based on age, site, certain infections, and molecular characteristics, as well as borderline categories, early and "in situ" lesions, disorders with limited capacity for clinical progression, lesions without current International Classification of Diseases for Oncology, 3rd Edition codes, and immunodeficiency-associated lymphoproliferative disorders. WHO subtypes are defined in hierarchical groupings, with newly defined groups for small B-cell lymphomas with plasmacytic differentiation and for primary cutaneous T-cell lymphomas. We suggest approaches for applying the hierarchical classification in various epidemiologic settings, including strategies for dealing with multiple coexisting lymphoma subtypes in one patient, and cases with incomplete pathologic information. The pathology materials useful for state-of-the-art epidemiology studies are also discussed. We encourage epidemiologists to adopt the updated InterLymph hierarchical classification, which incorporates the most recent WHO entities while demonstrating their relationship to older classifications.

    View details for DOI 10.1182/blood-2010-06-289561

    View details for Web of Science ID 000284359400002

    View details for PubMedID 20699439

  • Interaction of Area-Level Socioeconomic Status and UV Radiation on Melanoma Occurrence in California CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION Clarke, C. A., Moy, L. M., Swetter, S. M., Zadnick, J., Cockburn, M. G. 2010; 19 (11): 2727-2733

    Abstract

    Melanoma incidence has been correlated strongly and positively with both socioeconomic status (SES) and lower latitude and other measures of ambient UV radiation (UVR). However, because high-SES populations may be colocated in areas of high UVR, we assessed their joint influences on melanoma occurrence to better target subpopulations for melanoma education and screening.We obtained from the California Cancer Registry information regarding 23,564 incident cases of invasive cutaneous melanoma among non-Hispanic white residents between January 1, 1998, and December 31, 2002. We geocoded each case based on residence at diagnosis and linked previously tested neighborhood measures of SES and average annual UVR to calculate age-adjusted incidence rates, rate ratios, and the corresponding 95% confidence intervals. Poisson regression was used to calculate multivariately adjusted rate ratios.UVR was significantly and positively associated with melanoma incidence only among persons living in the top 40% of California neighborhoods ranked by SES. People in neighborhoods of the highest SES and UVR categories had 60% higher rates of melanoma than those from neighborhoods in the lowest categories (rate ratio, 1.60; 95% confidence interval, 1.02-2.51).Our findings indicate that UVR and SES interact to influence melanoma occurrence and suggest that socioeconomic gradients in melanoma incidence are not explained entirely by UVR.Cancer prevention and early detection educational efforts should be targeted to high-SES groups in areas of high UVR exposure. Contextual measures of both SES and UVR should be considered important determinants of melanoma occurrence in future studies.

    View details for DOI 10.1158/1055-9965.EPI-10-0692

    View details for Web of Science ID 000283991600005

    View details for PubMedID 20978173

  • Menopausal Hormone Therapy and Subsequent Risk of Specific Invasive Breast Cancer Subtypes in the California Teachers Study CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION Saxena, T., Lee, E., Henderson, K. D., Clarke, C. A., West, D., Marshall, S. F., Deapen, D., Bernstein, L., Ursin, G. 2010; 19 (9): 2366-2378

    Abstract

    Although it is well established that combined estrogen-progestin therapy (EPT) increases breast cancer risk, questions remain regarding the effect of different formulations of hormones, whether certain women are at particularly high risk, and whether risk varies by tumor subtype.We investigated hormone therapy (HT) use in relation to breast cancer risk in the California Teachers Study cohort; after a mean follow-up of 9.8 years, 2,857 invasive breast cancers were diagnosed.Compared with women who had never used HT, women who reported 15 or more years of estrogen therapy (ET) use had a 19% greater risk of breast cancer (95% confidence interval, 1.03-1.37), whereas women using EPT for 15 or more years had an 83% greater risk (95% confidence interval, 1.48-2.26). Breast cancer risk was highest among women using continuous combined EPT regimens. Risks associated with EPT and ET use were increased with duration of HT use for women with a body mass index (BMI) of <29.9 kg/m(2) but not for women with BMI of >or=30 kg/m(2). Elevated risks associated with EPT and ET use were confined to tumors that were positive for both estrogen and progesterone receptors and those that were HER2+ but were slightly diminished for HER2- tumors.Breast cancer risks increased with longer duration of ET and EPT use, and risks were highest for continuous-combined EPT use. Furthermore, risks varied by BMI and tumor subtype.These findings underscore the need for personalized risk-benefit discussions with women contemplating HT use.

    View details for DOI 10.1158/1055-9965.EPI-10-0162

    View details for Web of Science ID 000281683800028

    View details for PubMedID 20699377

  • Meat Consumption, Nonsteroidal Anti-Inflammatory Drug Use, and Mortality among Colorectal Cancer Patients in the California Teachers Study CANCER PREVENTION RESEARCH Zell, J. A., Ziogas, A., Bernstein, L., Clarke, C. A., Deapen, D., Largent, J. A., Neuhausen, S. L., Stram, D. O., Ursin, G., Anton-Culver, H. 2010; 3 (7): 865-875

    Abstract

    A low-meat diet and regular use of nonsteroidal anti-inflammatory drugs (NSAID) have been associated with decreased mortality among colorectal cancer (CRC) patients. Here, we investigated the association between prediagnosis usual meat consumption and CRC-specific mortality, and whether meat consumption modifies the previously noted association between NSAID use and CRC-specific mortality among women in the California Teachers Study cohort. Women joining the California Teachers Study in 1995-1996 without prior CRC diagnosis, diagnosed with incident CRC during follow-up through December 2007, were eligible for inclusion. Meat intake (frequency and serving size) and NSAID use (aspirin or ibuprofen use) were ascertained via self-administered questionnaires before diagnosis. Vital status and cause of death were determined by linkage with mortality files. Multivariable Cox proportional hazards regression models were used to estimate hazard ratios for death and 95% confidence intervals. Prediagnosis meat consumption was not associated with CRC-specific mortality among 704 CRC patients (and 201 CRC-specific deaths), comparing patients in the lowest consumption tertile (0-5.4 medium-sized servings/wk) to those in the higher consumption tertiles. Regular NSAID use (1-3 times/wk, 4-6 times/wk, daily) versus none was associated with decreased CRC-specific mortality among patients in the lowest meat consumption tertile (hazard ratio, 0.22; 95% CI, 0.06-0.82), but not among patients in the higher meat intake tertiles. The previously observed mortality risk reduction among female CRC patients associated with regular NSAID use was restricted to patients who reported low meat intake before diagnosis. These findings have implications for CRC survivorship and tertiary CRC prevention.

    View details for DOI 10.1158/1940-6207.CAPR-09-0262

    View details for Web of Science ID 000279556900009

    View details for PubMedID 20551290

  • Parents' Ages at Birth and Risk of Adult-onset Hematologic Malignancies Among Female Teachers in California AMERICAN JOURNAL OF EPIDEMIOLOGY Lu, Y., Ma, H., Sullivan-Halley, J., Henderson, K. D., Chang, E. T., Clarke, C. A., Neuhausen, S. L., West, D. W., Bernstein, L., Wang, S. S. 2010; 171 (12): 1262-1269

    Abstract

    Although advanced parental age at one's birth has been associated with increased risk of breast and prostate cancers, few studies have examined its effect on adult-onset sporadic hematologic malignancies. The authors examined the association of parents' ages at women's births with risk of hematologic malignancies among 110,999 eligible women aged 22-84 years recruited into the prospective California Teachers Study. Between 1995 and 2007, 819 women without a family history of hematologic malignancies were diagnosed with incident lymphoma, leukemia (primarily acute myeloid leukemia), or multiple myeloma. Multivariable-adjusted Cox proportional hazards models provided estimates of relative risks and 95% confidence intervals. Paternal age was positively associated with non-Hodgkin lymphoma after adjustment for race and birth order (relative risk for age > or =40 vs. <25 years = 1.51, 95% confidence interval: 1.08, 2.13; P-trend = 0.01). Further adjustment for maternal age did not materially alter the association. By contrast, the elevated non-Hodgkin lymphoma risk associated with advanced maternal age (> or =40 years) became null when paternal age was included in the statistical model. No association was observed for acute myeloid leukemia or multiple myeloma. Advanced paternal age may play a role in non-Hodgkin lymphoma etiology. Potential etiologic mechanisms include de novo gene mutations, aberrant paternal gene imprinting, or telomere/telomerase biology.

    View details for DOI 10.1093/aje/kwq090

    View details for Web of Science ID 000278435700002

    View details for PubMedID 20507900

  • Breast Cancer Incidence Patterns among California Hispanic Women: Differences by Nativity and Residence in an Enclave CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION Keegan, T. H., John, E. M., Fish, K. M., Alfaro-Velcamp, T., Clarke, C. A., Gomez, S. L. 2010; 19 (5): 1208-1218

    Abstract

    Breast cancer incidence is higher in U.S.-born Hispanic women than foreign-born Hispanics, but no studies have examined how these rates have changed over time. To better inform cancer control efforts, we examined incidence trends by nativity and incidence patterns by neighborhood socioeconomic status (SES) and Hispanic enclave (neighborhoods with high proportions of Hispanics or Hispanic immigrants).Information about all Hispanic women diagnosed with invasive breast cancer between 1988 and 2004 was obtained from the California Cancer Registry. Nativity was imputed from Social Security number for the 27% of cases with missing birthplace information. Neighborhood variables were developed from Census data.From 1988 to 2004, incidence rates for U.S.-born Hispanics were parallel but lower than those of non-Hispanic whites, showing an annual 6% decline from 2002 to 2004. Foreign-born Hispanics had an annual 4% increase in incidence rates from 1995 to 1998 and a 1.4% decline thereafter. Rates were 38% higher for U.S.- than foreign-born Hispanics, with elevations more pronounced for localized than regional/distant disease, and for women>50 years of age. Residence in higher SES and lower Hispanic enclave neighborhoods were independently associated with higher incidence, with Hispanic enclave having a stronger association than SES.Compared with foreign-born, U.S.-born Hispanic women in California had higher prevalence of breast cancer risk factors, suggesting that incidence patterns largely reflect these differences in risk factors.Further research is needed to separate the effects of individual- and neighborhood-level factors that affect incidence in this large and growing population.

    View details for DOI 10.1158/1055-9965.EPI-10-0021

    View details for Web of Science ID 000278489800009

    View details for PubMedID 20447917

  • Disparities in Breast Cancer Survival Among Asian Women by Ethnicity and Immigrant Status: A Population-Based Study AMERICAN JOURNAL OF PUBLIC HEALTH Gomez, S. L., Clarke, C. A., Shema, S. J., Chang, E. T., Keegan, T. H., Glaser, S. L. 2010; 100 (5): 861-869

    Abstract

    We investigated heterogeneity in ethnic composition and immigrant status among US Asians as an explanation for disparities in breast cancer survival.We enhanced data from the California Cancer Registry and the Surveillance, Epidemiology, and End Results program through linkage and imputation to examine the effect of immigrant status, neighborhood socioeconomic status, and ethnic enclave on mortality among Chinese, Japanese, Filipino, Korean, South Asian, and Vietnamese women diagnosed with breast cancer from 1988 to 2005 and followed through 2007.US-born women had similar mortality rates in all Asian ethnic groups except the Vietnamese, who had lower mortality risk (hazard ratio [HR] = 0.3; 95% confidence interval [CI] = 0.1, 0.9). Except for Japanese women, all foreign-born women had higher mortality than did US-born Japanese, the reference group. HRs ranged from 1.4 (95% CI = 1.2, 1.7) among Koreans to 1.8 (95% CI = 1.5, 2.2) among South Asians and Vietnamese. Little of this variation was explained by differences in disease characteristics.Survival after breast cancer is poorer among foreign- than US-born Asians. Research on underlying factors is needed, along with increased awareness and targeted cancer control.

    View details for DOI 10.2105/AJPH.2009.176651

    View details for Web of Science ID 000276828800021

    View details for PubMedID 20299648

  • Racial and social class gradients in life expectancy in contemporary California SOCIAL SCIENCE & MEDICINE Clarke, C. A., Miller, T., Chang, E. T., Yin, D., Cockburn, M., Gomez, S. L. 2010; 70 (9): 1373-1380

    Abstract

    Life expectancy, or the estimated average age of death, is among the most basic measures of a population's health. However, monitoring differences in life expectancy among sociodemographically defined populations has been challenging, at least in the United States (US), because death certification does not include collection of markers of socioeconomic status (SES). In order to understand how SES and race/ethnicity independently and jointly affected overall health in a contemporary US population, we assigned a small-area-based measure of SES to all 689,036 deaths occurring in California during a three-year period (1999-2001) overlapping the most recent US census. Residence at death was geocoded to the smallest census area available (block group) and assigned to a quintile of a multifactorial SES index. We constructed life tables using mortality rates calculated by age, sex, race/ethnicity and neighborhood SES quintile, and produced corresponding life expectancy estimates. We found a 19.6 (+/-0.6) year gap in life expectancy between the sociodemographic groups with the longest life expectancy (highest SES quintile of Asian females; 84.9 years) and the shortest (lowest SES quintile of African-American males; 65.3 years). A positive SES gradient in life expectancy was observed among whites and African-Americans but not Hispanics or Asians. Age-specific mortality disparities varied among groups. Race/ethnicity and neighborhood SES had substantial and independent influences on life expectancy, underscoring the importance of monitoring health outcomes simultaneously by these factors. African-American males living in the poorest 20% of California neighborhoods had life expectancy comparable to that reported for males living in developing countries. Neighborhood SES represents a readily-available metric for ongoing surveillance of health disparities in the US.

    View details for DOI 10.1016/j.socscimed.2010.01.003

    View details for Web of Science ID 000277500400016

    View details for PubMedID 20171001

  • Risk of second primary malignancies following cutaneous melanoma diagnosis: A population-based study JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY Spanogle, J. P., Clarke, C. A., Aroner, S., Swetter, S. M. 2010; 62 (5): 757-767

    Abstract

    Understanding risk patterns for developing a second primary malignancy (SPM) after cutaneous melanoma (CM) has implications for both research and clinical practice, including cancer screening.We sought to describe incidence patterns of SPMs occurring after CM.We calculated incidence rates and relative risks for the development of 65 different SPMs occurring in 16,591 CM survivors during 1.3 million person-years of observation in the Surveillance, Epidemiology, and End Results program data from 1973 to 2003.Compared with the general population, CM survivors had a 32% higher risk of developing any SPM and demonstrated significantly elevated risks for 13 cancers: melanoma of the skin (standardized incidence ratio [SIR] 8.99), soft tissue (SIR 2.80), melanoma of the eye and orbit (SIR 2.64), nonepithelial skin (SIR 2.31), salivary gland (SIR 2.18), bone and joint (SIR 1.70), thyroid (SIR 1.90), kidney (SIR 1.29), chronic lymphocytic leukemia (SIR 1.29), brain and nervous system (SIR 1.31), non-Hodgkin lymphoma (SIR 1.25), prostate (SIR 1.13), and female breast (SIR 1.07). Risks of second primary melanoma of the skin, melanoma of the eye and orbit, and cancers of the prostate, soft tissue, salivary gland, and bone and joint were elevated throughout the study period, implying no surveillance bias.Possible underreporting of CM incidence in cancer registries is a limitation. In addition, the lack of individual-level data in cancer registry data precludes detailed examination of coincident risk factors.Risks of particular SPMs after CM may be explained by surveillance bias or shared risk factors. However, these probably do not explain the increased risks observed for prostate, soft tissue, salivary gland, and bone and joint cancers years after CM diagnosis. Further investigation into genetic or environmental commonalities between CM and these cancers is warranted.

    View details for DOI 10.1016/j.jaad.2009.07.039

    View details for Web of Science ID 000277190100004

    View details for PubMedID 20223559

  • Are cancer registries unconstitutional? SOCIAL SCIENCE & MEDICINE McLaughlin, R. H., Clarke, C. A., Crawley, L. M., Glaser, S. L. 2010; 70 (9): 1295-1300

    Abstract

    Population-based cancer registration, mandated throughout the United States, is central to quantifying the breadth and impact of cancer. It facilitates research to learn what causes cancer to develop and, in many cases, lead to death. However, as concerns about privacy increase, cancer registration has come under question. Recently, its constitutionality was challenged on the basis of 1) the vagueness of statutory aims to pursue public health versus the individual privacy interests of cancer patients, and 2) the alleged indignity of one's individual medical information being transmitted to government authorities. Examining cancer registry statutes in states covered by the US National Cancer Institute's SEER Program and the US Centers for Disease Control and Prevention's National Program of Cancer Registries, we found that cancer registration laws do state specific public health benefits, and offer reasonable limits and safeguards on the government's possession of private medical information. Thus, we argue that cancer registration would survive constitutional review, is compatible with the civil liberties protected by privacy rights in the U.S., satisfies the conditions that justify public health expenditures, and serves human rights to enjoy the highest attainable standards of health, the advances of science, and the benefits of government efforts to prevent and control disease.

    View details for DOI 10.1016/j.socscimed.2010.01.032

    View details for Web of Science ID 000277500400006

    View details for PubMedID 20199835

  • Recent trends in hormone therapy utilization and breast cancer incidence rates in the high incidence population of Marin County, California BMC PUBLIC HEALTH Ereman, R. R., Prebil, L. A., Mockus, M., Koblick, K., Orenstein, F., Benz, C., Clarke, C. A. 2010; 10

    Abstract

    Recent declines in invasive breast cancer have been reported in the US, with many studies linking these declines to reductions in the use of combination estrogen/progestin hormone therapy (EPHT). We evaluated the changing use of postmenopausal hormone therapy, mammography screening rates, and the decline in breast cancer incidence specifically for Marin County, California, a population with historically elevated breast cancer incidence rates.The Marin Women's Study (MWS) is a community-based, prospective cohort study launched in 2006 to monitor changes in breast cancer, breast density, and personal and biologic risk factors among women living in Marin County. The MWS enrolled 1,833 women following routine screening mammography between October 2006 and July 2007. Participants completed a self-administered questionnaire that included items regarding historical hormone therapy regimen (estrogen only, progesterone only, EPHT), age of first and last use, total years of use, and reason(s) for stopping, as well as information regarding complementary hormone use. Questionnaire items were analyzed for 1,083 non-Hispanic white participants ages 50 and over. Breast cancer incidence rates were assessed overall and by tumor histology and estrogen receptor (ER) status for the years 1990-2007 using data from the Northern California Surveillance, Epidemiology and End Results (SEER) cancer registry.Prevalence of EPHT use among non-Hispanic white women ages 50 and over declined sharply from 21.2% in 1998 to 6.7% by 2006-07. Estrogen only use declined from 26.9% in 1998 to 22.4% by 2006-07. Invasive breast cancer incidence rates declined 33.4% between 2001 and 2004, with drops most pronounced for ER+ cancers. These rate reductions corresponded to declines of about 50 cases per year, consistent with population attributable fraction estimates for EPHT-related breast cancer. Self-reported screening mammography rates did not change during this period. Use of alternative or complementary agents did not differ significantly between ever and never hormone users. Of women who reported stopping EPHT in the past 5 years, 60% cited "health risks" or "news reports" as their primary reasons for quitting.A dramatic reduction in EPHT use was followed temporally by a significant reduction in invasive and ER+ breast cancer rates among women living in Marin County, California.

    View details for DOI 10.1186/1471-2458-10-228

    View details for Web of Science ID 000278253400003

    View details for PubMedID 20433756

  • Increasing Mastectomy Rates for Early-Stage Breast Cancer? Population-Based Trends From California JOURNAL OF CLINICAL ONCOLOGY Gomez, S. L., Lichtensztajn, D., Kurian, A. W., Telli, M. L., Chang, E. T., Keegan, T. H., Glaser, S. L., Clarke, C. A. 2010; 28 (10): E155-E157

    View details for DOI 10.1200/JCO.2009.26.1032

    View details for Web of Science ID 000276152200036

    View details for PubMedID 20159812

  • Menopausal Hormone Therapy Use and Risk of Invasive Colon Cancer The California Teachers Study AMERICAN JOURNAL OF EPIDEMIOLOGY Henderson, K. D., Duan, L., Sullivan-Halley, J., Ma, H., Clarke, C. A., Neuhausen, S. L., Templeman, C., Bernstein, L. 2010; 171 (4): 415-425

    Abstract

    Results from epidemiologic studies of hormone therapy use and colon cancer risk are inconsistent. This question was investigated in the California Teachers Study (1995-2006) among 56,864 perimenopausal or postmenopausal participants under 80 years of age with no prior colorectal cancer by using Cox proportional hazards regression. Incident invasive colon cancer was diagnosed among 442 participants. Baseline-recent hormone therapy users were at 36% lower risk for colon cancer versus baseline-never users (baseline-recent users: relative risk (RR) = 0.64, 95% confidence interval (CI): 0.51, 0.80). Results did not differ by formulation. Estimated risk was lower among baseline-recent hormone therapy users with increasing duration between 5 and 15 years of use (RR = 0.49, 95% CI: 0.35, 0.68), but the trend did not persist in the longest duration group, more than 15 years of use (RR = 0.69, 95% CI: 0.52, 0.92; P(trend) = 0.60). Long-term recreational physical activity, obesity, regular use of nonsteroidal antiinflammatory medications, and daily alcohol intake did not modify these effects; baseline-recent use was more strongly associated with colon cancer risk among women with a family history of colorectal cancer (P(heterogeneity) = 0.04). Baseline-recent hormone therapy use was inversely associated with invasive colon cancer risk among perimenopausal and postmenopausal women in the California Teachers Study.

    View details for DOI 10.1093/aje/kwp434

    View details for Web of Science ID 000274340900004

    View details for PubMedID 20067917

  • Recent breast cancer incidence trends according to hormone therapy use: the California Teachers Study cohort BREAST CANCER RESEARCH Marshall, S. F., Clarke, C. A., Deapen, D., Henderson, K., Largent, J., Neuhausen, S. L., Reynolds, P., Ursin, G., Horn-Ross, P. L., Stram, D. O., Templeman, C., Bernstein, L. 2010; 12 (1)

    Abstract

    Recent, international declines in breast cancer incidence are unprecedented, and the causes remain controversial. Few data sources can address breast cancer incidence trends according to pertinent characteristics like hormone therapy use history.We used the prospective California Teachers Study to evaluate changes in self-reported use of menopausal hormone therapy (HT) between 1995 to 1996 and 2005 to 2006 and age-adjusted breast cancer incidence among 74,647 participants aged 50 years or older. Breast cancer occurrence was determined by linkage with the California Cancer Registry.During 517,286 woman years of follow up, 565 in situ and 2,668 invasive breast cancers were diagnosed. In situ breast cancer incidence rates in this population did not change significantly from 2000 to 2002 to 2003 to 2005, whereas rates of invasive breast cancer declined significantly by 26.0% from 528.0 (95% confidence intervals (CI) = 491.1, 564.9) per 100,000 women in 2000 to 2002 to 390.6 (95% CI = 355.6, 425.7) in 2003 to 2005. The decline in invasive breast cancer incidence rates was restricted to estrogen receptor-positive tumors. In 1996 to 1999 and 2000 to 2002 invasive breast cancer incidence was higher for women who reported current HT use especially estrogen-progestin (EP) use at baseline than for never or past users; but by 2003 to 2005 rates were comparable between these groups. For women who were taking EP in 2001 to 2002,75% of whom had stopped use by 2005 to 2006, incidence had declined 30.6% by 2003 to 2005 (P = 0.001); whereas incidence did not change significantly for those who never took HT (P = 0.33).Few data resources can examine prospectively individual HT use and breast cancer diagnosis. Stable in situ breast cancer rates imply consistent levels of screening and suggest recent declines in invasive breast cancer to be explained predominantly by changes in HT use.

    View details for DOI 10.1186/bcr2467

    View details for Web of Science ID 000276986300010

    View details for PubMedID 20064209

  • Lifetime risks of specific breast cancer subtypes among women in four racial/ethnic groups BREAST CANCER RESEARCH Kurian, A. W., Fish, K., Shema, S. J., Clarke, C. A. 2010; 12 (6)

    Abstract

    Breast cancer comprises clinically distinct subtypes, but most risk statistics consider breast cancer only as a single entity. To estimate subtype-specific lifetime breast cancer risks, we took advantage of population-based data for which information regarding tumor expression of estrogen receptor (ER), progesterone receptor (PR) and HER2/neu (HER2) was newly available.We included women whose breast cancer was diagnosed in the state of California from 2006 to 2007 and was reported to the National Cancer Institute's Surveillance, Epidemiology and End Results Program (N = 40,936). We calculated absolute lifetime and age-specific probabilities (percent, 95% confidence interval) of developing breast cancer subtypes defined by ER, PR, and HER2 status - luminal (ER and/or PR-positive, HER2-negative), HER2-positive (ER and PR-positive or negative, HER2-positive), and triple-negative (ER-negative, PR-negative, and HER2-negative) - separately for white, black, Hispanic, and Asian women.The luminal breast cancer subtype predominates across racial/ethnic groups, with lifetime risk lowest in Hispanic women (4.60%, 4.41-4.80%) and highest in white women (8.10%, 7.94-8.20%). HER2-positive breast cancer varies less by race (1.56-1.91%). Lifetime risk of triple-negative breast cancer is highest in black women (1.98%, 1.80-2.17%), compared to 0.77% (0.67-0.88%) for Asians, 1.04% (0.96-1.13%) for Hispanics and 1.25% (1.20-1.30%) for whites. Across racial/ethnic groups, nearly half of all luminal breast cancers occur after age 70.These absolute risk estimates may inform health policy and resource planning across diverse populations, and can help patients and physicians weigh the probabilities of developing specific breast cancer subtypes against competing health risks.

    View details for DOI 10.1186/bcr2780

    View details for Web of Science ID 000288751500010

    View details for PubMedID 21092082

  • Hidden Breast Cancer Disparities in Asian Women: Disaggregating Incidence Rates by Ethnicity and Migrant Status AMERICAN JOURNAL OF PUBLIC HEALTH Gomez, S. L., Quach, T., Horn-Ross, P. L., Pham, J. T., Cockburn, M., Chang, E. T., Keegan, T. H., Glaser, S. L., Clarke, C. A. 2010; 100: S125-S131

    Abstract

    We estimated trends in breast cancer incidence rates for specific Asian populations in California to determine if disparities exist by immigrant status and age.To calculate rates by ethnicity and immigrant status, we obtained data for 1998 through 2004 cancer diagnoses from the California Cancer Registry and imputed immigrant status from Social Security Numbers for the 26% of cases with missing birthplace information. Population estimates were obtained from the 1990 and 2000 US Censuses.Breast cancer rates were higher among US- than among foreign-born Chinese (incidence rate ratio [IRR] = 1.84; 95% confidence interval [CI] = 1.72, 1.96) and Filipina women (IRR = 1.32; 95% CI = 1.20, 1.44), but similar between US- and foreign-born Japanese women. US-born Chinese and Filipina women who were younger than 55 years had higher rates than did White women of the same age. Rates increased over time in most groups, as high as 4% per year among foreign-born Korean and US-born Filipina women. From 2000-2004, the rate among US-born Filipina women exceeded that of White women.These findings challenge the notion that breast cancer rates are uniformly low across Asians and therefore suggest a need for increased awareness, targeted cancer control, and research to better understand underlying factors.

    View details for DOI 10.2105/AJPH.2009.163931

    View details for Web of Science ID 000275937600025

    View details for PubMedID 20147696

  • Nonsteroidal Anti-inflammatory Drugs Effects on Mortality After Colorectal Cancer Diagnosis CANCER Zell, J. A., Ziogas, A., Bernstein, L., Clarke, C. A., Deapen, D., Largent, J. A., Neuhausen, S. L., Stram, D. O., Ursin, G., Anton-Culver, H. 2009; 115 (24): 5662-5671

    Abstract

    Nonsteroidal anti-inflammatory drug (NSAID) use has been associated with a decreased colorectal cancer (CRC) risk. However, to the best of the authors' knowledge, the effects of NSAID on clinical outcomes after CRC diagnosis are not well defined. The authors investigated the association between prediagnosis NSAID use and mortality after CRC diagnosis among women in the California Teachers Study cohort.Women aged <85 years participating in the California Teachers Study, without a prior CRC diagnosis at baseline (1995-1996), and who were diagnosed with CRC during follow-up through December 2005, were eligible for analysis of the association between prediagnosis NSAID use and mortality. NSAID use (including aspirin and ibuprofen) was collected through a self-administered questionnaire. Cancer occurrence was identified through California Cancer Registry linkage. Multivariate Cox proportional hazards regression models were used to estimate hazards ratios (HR) for death and 95% confidence intervals (95% CIs).Among 621 CRC patients who were identified, 64% reported no prediagnosis regular NSAID use, 17% reported use of 1 to 6 days/week, and 20% reported daily use. A duration of NSAID use <5 years was reported by 17% of patients and a use of >or=5 years was reported by 18%. Regular prediagnosis NSAID use (1-3 days/week, 4-6 days/week, and daily) versus none was associated with improved overall survival (OS) (HR, 0.71; 95% CI, 0.53-0.95) and CRC-specific survival (HR, 0.58; 95% CI 0.40-0.84) after adjustment for clinically relevant factors. Prediagnosis NSAID use >or=5 years (vs none) was found to be associated with improved OS (HR, 0.55; 95% CI, 0.37-0.84) and CRC-specific survival (HR, 0.40; 95% CI, 0.23-0.71) in adjusted analyses.When used regularly or over a prolonged duration before CRC diagnosis, NSAIDs are associated with decreased mortality among female CRC patients.

    View details for DOI 10.1002/cncr.24705

    View details for Web of Science ID 000272545400010

    View details for PubMedID 19827153

  • Reproductive Factors and Non-Hodgkin Lymphoma Risk in the California Teachers Study PLOS ONE Prescott, J., Lu, Y., Chang, E. T., Sullivan-Halley, J., Henderson, K. D., Clarke, C. A., Ma, H., Templeman, C., Deapen, D., Bernstein, L. 2009; 4 (12)

    Abstract

    Non-Hodgkin lymphoma (NHL) is a malignancy etiologically linked to immunomodulatory exposures and disorders. Endogenous female sex hormones may modify immune function and influence NHL risk. Few studies have examined associations between reproductive factors, which can serve as surrogates for such hormonal exposures, and NHL risk by subtype.Women in the California Teachers Study cohort provided detailed data in 1995-1996 on reproductive history. Follow-up through 2007 identified 574 women with incident B-cell NHL. Hazard rate ratios (RR) and 95% confidence intervals (CI) were estimated using Cox proportional hazards models to assess associations between reproductive factors and all B-cell NHL combined, diffuse large B-cell lymphomas, follicular lymphomas, and B-cell chronic lymphocytic leukemias/small lymphocytic lymphomas. Pregnancy was marginally associated with lower risk of B-cell NHL (RR = 0.84, 95% CI = 0.68-1.04). Much of the reduction in risk was observed after one full-term pregnancy relative to nulligravid women (RR = 0.75, 95% CI = 0.54-1.06; P for trend <0.01), particularly for diffuse large B-cell lymphomas (P for trend = 0.13), but not among women who had only incomplete pregnancies. Age at first full-term pregnancy was marginally inversely associated with B-cell NHL risk overall (P for trend = 0.08) and for diffuse large B-cell lymphomas (P for trend = 0.056). Breast feeding was not associated with B-cell NHL risk overall or by subtype.Full-term pregnancy and early age at first full-term pregnancy account for most of the observed reduction in B-cell NHL risk associated with gravidity. Pregnancy-related hormonal exposures, including prolonged and high-level exposure to progesterone during a full-term pregnancy may inhibit development of B-cell NHL.

    View details for DOI 10.1371/journal.pone.0008135

    View details for Web of Science ID 000272828800026

    View details for PubMedID 19956586

  • Disparities in survival after Hodgkin lymphoma: a population-based study CANCER CAUSES & CONTROL Keegan, T. H., Clarke, C. A., Chang, E. T., Shema, S. J., Glaser, S. L. 2009; 20 (10): 1881-1892

    Abstract

    Survival after Hodgkin lymphoma (HL) is generally favorable, but may vary by patient demographic characteristics. The authors examined HL survival according to race/ethnicity and neighborhood socioeconomic status (SES), determined from residential census-block group at diagnosis. For 12,492 classical HL patients ? 15 years diagnosed in California during 1988-2006 and followed through 2007, we determined risk of overall and HL-specific death using Cox proportional hazards regression; analyses were stratified by age and Ann Arbor stage. Irrespective of disease stage, patients with lower neighborhood SES had worse overall and HL-specific survival than patients with higher SES. Patients with the lowest quintile of neighborhood SES had a 64% (patients aged 15-44 years) and 36% (? 45 years) increased risk of HL-death compared to patients with the highest quintile of SES; SES results were similar for overall survival. Even after adjustment for neighborhood SES, blacks and Hispanics had increased risks of HL-death 74% and 43% (15-44 years) and 40% and 17% (? 45 years), respectively, higher than white patients. The racial/ethnic differences in survival were evident for all stages of disease. These data provide evidence for substantial, and probably remediable, racial/ethnic and neighborhood SES disparities in HL outcomes.

    View details for DOI 10.1007/s10552-009-9382-3

    View details for Web of Science ID 000271809000010

    View details for PubMedID 19557531

  • Body Size, Recreational Physical Activity, and B-Cell Non-Hodgkin Lymphoma Risk Among Women in the California Teachers Study AMERICAN JOURNAL OF EPIDEMIOLOGY Lu, Y., Prescott, J., Sullivan-Halley, J., Henderson, K. D., Ma, H., Chang, E. T., Clarke, C. A., Horn-Ross, P. L., Ursin, G., Bernstein, L. 2009; 170 (10): 1231-1240

    Abstract

    Nutritional status and physical activity are known to alter immune function, which may be relevant to lymphomagenesis. The authors examined body size measurements and recreational physical activity in relation to risk of B-cell non-Hodgkin lymphoma (NHL) in the prospective California Teachers Study. Between 1995 and 2007, 574 women were diagnosed with incident B-cell NHL among 121,216 eligible women aged 22-84 years at cohort entry. Multivariable-adjusted relative risks and 95% confidence intervals were estimated by fitting Cox proportional hazards models for all B-cell NHL combined and for the 3 most common subtypes: diffuse large B-cell lymphoma, follicular lymphoma, and B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma. Height was positively associated with risk of all B-cell NHLs (for >1.70 vs. 1.61-1.65 m, relative risk = 1.50, 95% confidence interval: 1.16, 1.96) and chronic lymphocytic leukemia/small lymphocytic lymphoma (relative risk = 1.93, 95% confidence interval: 1.09, 3.41). Weight and body mass index at age 18 years were positive predictors of B-cell NHL risk overall. These findings indicate that greater height, which may reflect genetics, early life immune function, infectious exposures, nutrition, or growth hormone levels, may play a role in NHL etiology. Adiposity at age 18 years may be more relevant to NHL etiology than that in later life.

    View details for DOI 10.1093/aje/kwp268

    View details for Web of Science ID 000271379800005

    View details for PubMedID 19822569

  • Risk factors for surgically removed fibroids in a large cohort of teachers FERTILITY AND STERILITY Templeman, C., Marshall, S. F., Clarke, C. A., Henderson, K. D., Largent, J., Neuhausen, S., Reynolds, P., Ursin, G., Bernstein, L. 2009; 92 (4): 1436-1446

    Abstract

    To describe reproductive and lifestyle correlates of surgically confirmed fibroids.Prospective cohort study.The California Teachers Study, an ongoing prospective study of more than 133,000 female teachers and school administrators identified through the California State Teachers Retirement System.California Teachers Study cohort members, reporting no previous history of fibroids, were ascertained prospectively for surgical diagnosis of fibroids using hospital patient discharge records.Multivariable Cox proportional hazards regression methods were used to assess the association of self-reported menstrual, reproductive, and lifestyle characteristics with fibroids, using ages at the start and end of follow-up (in months) to define time on study. Hazard rate ratios, presented as relative risks (RR) with 95% confidence intervals (CI), were estimated.The strongest risk factor we identified was African-American race/ethnicity, as compared to non-Latina white women. We observed a reduced risk of fibroids for postmenopausal women in comparison to premenopausal women, but use of hormone replacement therapies (regardless of formulation) were associated with an increased risk. Other risk factors included race, a family history of fibroids, being overweight, and drinking alcohol, Smoking and diabetes were associated with a decreased risk of fibroids.These observations provide a more detailed epidemiologic profile of women with surgically managed fibroids.

    View details for DOI 10.1016/j.fertnstert.2008.08.074

    View details for Web of Science ID 000270616100052

    View details for PubMedID 19019355

  • Socioeconomic status and prostate cancer incidence and mortality rates among the diverse population of California CANCER CAUSES & CONTROL Cheng, I., Witte, J. S., McClure, L. A., Shema, S. J., Cockburn, M. G., John, E. M., Clarke, C. A. 2009; 20 (8): 1431-1440

    Abstract

    The racial/ethnic disparities in prostate cancer rates are well documented, with the highest incidence and mortality rates observed among African-Americans followed by non-Hispanic Whites, Hispanics, and Asian/Pacific Islanders. Whether socioeconomic status (SES) can account for these differences in risk has been investigated in previous studies, but with conflicting results. Furthermore, previous studies have focused primarily on the differences between African-Americans and non-Hispanic Whites, and little is known for Hispanics and Asian/Pacific Islanders.To further investigate the relationship between SES and prostate cancer among African-Americans, non-Hispanic Whites, Hispanics, and Asian/Pacific Islanders, we conducted a large population-based cross-sectional study of 98,484 incident prostate cancer cases and 8,997 prostate cancer deaths from California.Data were abstracted from the California Cancer Registry, a population-based surveillance, epidemiology, and end results (SEER) registry. Each prostate cancer case and death was assigned a multidimensional neighborhood-SES index using the 2000 US Census data. SES quintile-specific prostate cancer incidence and mortality rates and rate ratios were estimated using SEER*Stat for each race/ethnicity categorized into 10-year age groups.For prostate cancer incidence, we observed higher levels of SES to be significantly associated with increased risk of disease [SES Q1 vs. Q5: relative risk (RR) = 1.28; 95% confidence interval (CI): 1.25-1.30]. Among younger men (45-64 years), African-Americans had the highest incidence rates followed by non-Hispanic Whites, Hispanics, and Asian/Pacific Islanders for all SES levels. Yet, among older men (75-84 years) Hispanics, following African-Americans, displayed the second highest incidence rates of prostate cancer. For prostate cancer deaths, higher levels of SES were associated with lower mortality rates of prostate cancer deaths (SES Q1 vs. Q5: RR = 0.88; 95% CI: 0.92-0.94). African-Americans had a twofold to fivefold increased risk of prostate cancer deaths in comparison to non-Hispanic Whites across all levels of SES.Our findings suggest that SES alone cannot account for the greater burden of prostate cancer among African-American men. In addition, incidence and mortality rates of prostate cancer display different age and racial/ethnic patterns across gradients of SES.

    View details for DOI 10.1007/s10552-009-9369-0

    View details for Web of Science ID 000270737900020

    View details for PubMedID 19526319

  • Obesity, waist size and prevalence of current asthma in the California Teachers Study cohort THORAX Von Behren, J., Lipsett, M., Horn-Ross, P. L., Delfino, R. J., Gilliland, F., McConnell, R., Bernstein, L., Clarke, C. A., Reynolds, P. 2009; 64 (10): 889-893

    Abstract

    Obesity is a risk factor for asthma, particularly in women, but few cohort studies have evaluated abdominal obesity which reflects metabolic differences in visceral fat known to influence systemic inflammation. A study was undertaken to examine the relationship between the prevalence of asthma and measures of abdominal obesity and adult weight gain in addition to body mass index (BMI) in a large cohort of female teachers.Prevalence odds ratios (ORs) for current asthma were calculated using multivariable linear modelling, adjusting for age, smoking and race/ethnicity.Of the 88 304 women in the analyses, 13% (n = 11,500) were obese (BMI > or = 30 kg/m(2)) at baseline; 1334 were extremely obese (BMI > or = 40 kg/m(2)). Compared with those of normal weight, the adjusted OR for adult-onset asthma increased from 1.40 (95% confidence interval (CI) 1.31 to 1.49) for overweight women to 3.30 (95% CI 2.85 to 3.82) for extremely obese women. Large waist circumference (>88 cm) was associated with increased asthma prevalence, even among women with a normal BMI (OR 1.37, 95% CI 1.18 to 1.59). Among obese women the OR for asthma was greater in those who were also abdominally obese than in women whose waist was < or = 88 cm (2.36 vs 1.57). Obese and overweight women were at greater risk of severe asthma episodes, measured by urgent medical visits and hospital admissions.This study confirms the association between excess weight and asthma severity and prevalence, and showed that a large waist was associated with increased asthma prevalence even among women considered to have normal body weight.

    View details for DOI 10.1136/thx.2009.114579

    View details for Web of Science ID 000270269700014

    View details for PubMedID 19706838

  • Second Primary Breast Cancer Occurrence According to Hormone Receptor Status JOURNAL OF THE NATIONAL CANCER INSTITUTE Kurian, A. W., McClure, L. A., John, E. M., Horn-Ross, P. L., Ford, J. M., Clarke, C. A. 2009; 101 (15): 1058-1065

    Abstract

    Contralateral second primary breast cancers occur in 4% of female breast cancer survivors. Little is known about differences in risk for second primary breast cancers related to the estrogen and progesterone receptor (hormone receptor [HR]) status of the first tumor.We calculated standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) for contralateral primary breast cancers among 4927 women diagnosed with a first breast cancer between January 1, 1992, and December 31, 2004, using the National Cancer Institute's Surveillance, Epidemiology, and End Results database.For women whose first breast tumors were HR positive, risk of contralateral primary breast cancer was elevated, compared with the general population, adjusted for age, race, and calendar year (SIR = 2.22, 95% CI = 2.15 to 2.29, absolute risk [AR] = 13 cases per 10 000 person-years [PY]), and was not related to the HR status of the second tumor. For women whose first breast tumors were HR negative, the risk of a contralateral primary tumor was statistically significantly higher than that for women whose first tumors were HR positive (SIR = 3.57, 95% CI = 3.38 to 3.78, AR = 18 per 10 000 PY), and it was associated with a much greater likelihood of an HR-negative second tumor (SIR for HR-positive second tumors = 1.94, 95% CI = 1.77 to 2.13, AR = 20 per 10 000 PY; SIR for HR-negative second tumors = 9.81, 95% CI = 9.00 to 10.7, AR = 24 per 10 000 PY). Women who were initially diagnosed with HR-negative tumors when younger than 30 years had greatly elevated risk of HR-negative contralateral tumors, compared with the general population (SIR = 169, 95% CI = 106 to 256, AR = 77 per 10 000 PY). Incidence rates for any contralateral primary cancer following an HR-negative or HR-positive tumor were higher in non-Hispanic blacks, Hispanics, and Asians or Pacific Islanders than in non-Hispanic whites.Risk for contralateral second primary breast cancers varies substantially by HR status of the first tumor, age, and race and/or ethnicity. Women with HR-negative first tumors have nearly a 10-fold elevated risk of developing HR-negative second tumors, compared with the general population. These findings warrant intensive surveillance for second breast cancers in women with HR-negative tumors.

    View details for DOI 10.1093/jnci/djp181

    View details for Web of Science ID 000268812900007

    View details for PubMedID 19590058

  • Uncovering Disparities in Survival after Non-Small-Cell Lung Cancer among Asian/Pacific Islander Ethnic Populations in California CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION Chang, E. T., Shema, S. J., Wakelee, H. A., Clarke, C. A., Gomez, S. L. 2009; 18 (8): 2248-2255

    Abstract

    Asians may have better survival after non-small-cell lung cancer (NSCLC) than non-Asians. However, it is unknown whether survival varies among the heterogeneous U.S. Asian/Pacific Islander (API) populations. Therefore, this study aimed to quantify survival differences among APIs with NSCLC. Differences in overall and disease-specific survival were analyzed in the California Cancer Registry among 16,577 API patients diagnosed with incident NSCLC between 1988 and 2007. Adjusted hazard ratios (HR) with 95% confidence intervals (95% CI) were estimated using Cox proportional hazards regression models with separate baseline hazards by disease stage. Despite better overall and disease-specific survival among APIs compared with non-Hispanic Whites, differences were evident across API populations. Among women, Japanese (overall survival HR, 1.16; 95% CI, 1.06-1.27) and APIs other than those in the six largest ethnic groups (other APIs; HR, 1.19; 95% CI, 1.07-1.33) had significantly poorer overall and disease-specific survival than Chinese. By contrast, South Asian women had significantly better survival than Chinese (HR, 0.79; 95% CI, 0.63-0.97). Among men, Japanese (HR, 1.15; 95% CI, 1.07-1.24), Vietnamese (HR, 1.07; 95% CI, 1.00-1.16), and other APIs (HR, 1.18; 95% CI, 1.08-1.28) had significantly poorer overall and disease-specific survival than Chinese. Other factors independently associated with poorer survival were lower neighborhood socioeconomic status, involvement with a non-university hospital, unmarried status, older age, and earlier year of diagnosis. APIs have significant ethnic differences in NSCLC survival that may be related to disparate lifestyles, biology, and especially health care access or use. To reduce the nationwide burden of lung cancer mortality, it is critical to identify and ameliorate hidden survival disparities such as those among APIs.

    View details for DOI 10.1158/1055-9965.EPI-09-0332

    View details for Web of Science ID 000268958600016

    View details for PubMedID 19622719

  • Increasing Burden of Melanoma in the United States JOURNAL OF INVESTIGATIVE DERMATOLOGY Linos, E., Swetter, S. M., Cockburn, M. G., Colditz, G. A., Clarke, C. A. 2009; 129 (7): 1666-1674

    Abstract

    It is controversial whether worldwide increases in melanoma incidence represent a true epidemic. Dramatic increases in incidence in the setting of relatively stable mortality trends have also been attributed to expanded skin screening and detection of biologically indolent tumors with low metastatic potential. To better understand how melanoma incidence trends varied by severity at diagnosis and factors relevant to screening access, we assessed recent United States incidence and mortality trends by histologic type, tumor thickness, and area-level socioeconomic status (SES). We obtained population-based data regarding diagnoses of invasive melanoma among non-Hispanic whites from nearly 291 million person-years of observation by the Surveillance Epidemiology and End Results (SEER) program (1992-2004). Age-adjusted incidence and mortality rates were calculated for SEER and a subset (California) for which small-area SES measure was available. Overall, melanoma incidence increased at 3.1% (P<0.001) per year. Statistically significant rises occurred for tumors of all histologic subtypes and thicknesses, including those >4 mm. Melanoma incidence rates doubled in all SES groups over a 10-year period whereas melanoma mortality rates did not increase significantly. We conclude that screening-associated diagnosis of thinner melanomas cannot explain the increasing rates of thicker melanomas among low SES populations with poorer access to screening.

    View details for DOI 10.1038/jid.2008.423

    View details for Web of Science ID 000267270300013

    View details for PubMedID 19131946

  • Recent trends in breast cancer incience in US white women by county-level urban/rural and poverty status BMC MEDICINE Hausauer, A. K., Keegan, T. H., Chang, E. T., Glaser, S. L., Howe, H., Clarke, C. A. 2009; 7

    Abstract

    Unprecedented declines in invasive breast cancer rates occurred in the United States between 2001 and 2004, particularly for estrogen receptor-positive tumors among non-Hispanic white women over 50 years. To understand the broader public health import of these reductions among previously unstudied populations, we utilized the largest available US cancer registry resource to describe age-adjusted invasive and in situ breast cancer incidence trends for non-Hispanic white women aged 50 to 74 years overall and by county-level rural/urban and poverty status.We obtained invasive and in situ breast cancer incidence data for the years 1997 to 2004 from 29 population-based cancer registries participating in the North American Association of Central Cancer Registries resource. Annual age-adjusted rates were examined overall and by rural/urban and poverty of patients' counties of residence at diagnosis. Joinpoint regression was used to assess trends by annual quarter of diagnosis.Between 2001 and 2004, overall invasive breast cancer incidence fell 13.2%, with greater reductions among women living in urban (-13.8%) versus rural (-7.5%) and low- (-13.0%) or middle- (-13.8%) versus high- (-9.6%) poverty counties. Most incidence rates peaked around 1999 then declined after second quarter 2002, although in rural counties, rates decreased monotonically after 1999. Similar but more attenuated patterns were seen for in situ cancers.Breast cancer rates fell more substantially in urban and low-poverty, affluent counties than in rural or high-poverty counties. These patterns likely reflect a major influence of reductions in hormone therapy use after July 2002 but cannot exclude possible effects due to screening patterns, particularly among rural populations where hormone therapy use was probably less prevalent.

    View details for DOI 10.1186/1741-7015-7-31

    View details for Web of Science ID 000268635200001

    View details for PubMedID 19558637

  • Improvements in Survival After Follicular Lymphoma by Race/Ethnicity and Socioeconomic Status: A Population-Based Study JOURNAL OF CLINICAL ONCOLOGY Keegan, T. H., McClure, L. A., Foran, J. M., Clarke, C. A. 2009; 27 (18): 3044-3051

    Abstract

    A recent report suggested improvements in survival after follicular lymphoma (FL), but not for all racial/ethnic groups. To better understand the reasons for these FL survival differences, we examined the joint influences of diagnostic period, race/ethnicity, and neighborhood socioeconomic status (SES) on survival in a large population-based case series.All patients (n = 15,937) diagnosed with FL between 1988 and 2005 in California were observed for vital status through November 2007. Overall and FL-specific survival were analyzed with Kaplan-Meier and Cox proportional hazards regression. Neighborhood SES was assigned from United States Census data using residence at diagnosis.Overall and FL-specific survival improved 22% and 37%, respectively, from 1988 to 1997 to 1998 to 2005, and were observed in all racial/ethnic groups. Asian/Pacific Islanders had better survival than non-Hispanic white, Hispanic, and black patients who had similar outcomes. Lower neighborhood SES was associated with worse survival in patients across all stages of disease (P for trend < .01). Patients with the lowest SES quintile had a 49% increased risk of death from all causes (hazard ratio [HR] = 1.49, 95% CI, 1.30 to 1.72) and 31% increased risk of death from FL (HR = 1.31; 95% CI, 1.06 to 1.60) than patients with the highest SES.Evolving therapies have likely led to improvements in survival after FL. Although improvements have occurred within all racial/ethnic groups, lower neighborhood SES was significantly associated with substantially poorer survival.

    View details for DOI 10.1200/JCO.2008.18.8052

    View details for Web of Science ID 000267133300026

    View details for PubMedID 19451447

  • Rapidly Increasing Trends of Melanoma in Nonwhite Populations: New Data from New Zealand CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION West, D. W., Clarke, C. A. 2009; 18 (6): 1674-1675
  • Is There a Proven Link Between Anal Cancer Screening and Reduced Morbidity or Mortality? ANNALS OF INTERNAL MEDICINE Katz, K. A., Clarke, C. A., Bernstein, K. T., Katz, M. H., Klausner, J. D. 2009; 150 (4): 283-284

    View details for Web of Science ID 000263562500013

    View details for PubMedID 19221387

  • Family history of haematopoietic malignancies and non-Hodgkin's lymphoma risk in the California Teachers Study BRITISH JOURNAL OF CANCER Lu, Y., Sullivan-Halley, J., Cozen, W., Chang, E. T., Henderson, K., Ma, H., Deapen, D., Clarke, C., Reynolds, P., Neuhausen, S. L., Anton-Culver, H., Ursin, G., West, D., Bernstein, L. 2009; 100 (3): 524-526

    Abstract

    Family history of haematopoietic malignancies appears to be a risk factor for non-Hodgkin's lymphoma (NHL), but whether risk varies by family member's gender is unclear. Among 121 216 women participating in the prospective California Teachers Study, NHL risk varied by type of haematopoietic malignancy and gender of the relative.

    View details for DOI 10.1038/sj.bjc.6604881

    View details for Web of Science ID 000263074900013

    View details for PubMedID 19156148

  • The Decline in Breast Cancer Incidence: Real or Imaginary? CURRENT ONCOLOGY REPORTS Kurian, A. W., Clarke, C. A., Carlson, R. W. 2009; 11 (1): 21-28

    Abstract

    Breast cancer is a major global problem, with nearly 1 million cases occurring each year. Over the past several decades, the disease's incidence has risen worldwide, increasing in developing and developed countries. This rise in breast cancer incidence has been attributed to changes in lifestyle and reproductive factors and to the dissemination of population-wide mammographic screening, which facilitates diagnosis. Recently, a decline in breast cancer incidence was reported in the United States and several other developed countries, and a substantial reduction in menopausal hormone therapy use was proposed as a possible cause. However, significant controversy remains as to the timing, causes, generalizability, and longevity of this reported decline in incidence.

    View details for Web of Science ID 000207843700006

    View details for PubMedID 19080738

  • Melanoma underreporting: Why does it happen, how big is the problem, and how do we fix it? JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY Cockburn, M., Swetter, S. M., Peng, D., Keegan, T. H., Deapen, D., Clarke, C. A. 2008; 59 (6): 1081-1085

    View details for DOI 10.1016/j.jaad.2008.08.007

    View details for Web of Science ID 000261141600026

    View details for PubMedID 19022107

  • Incidence of lymphoid neoplasms by subtype among six Asian ethnic groups in the United States, 1996-2004 CANCER CAUSES & CONTROL Daniel Carreon, J., Morton, L. M., Devesa, S. S., Clarke, C. A., Gomez, S. L., Glaser, S. L., Sakoda, L. C., Linet, M. S., Wang, S. S. 2008; 19 (10): 1171-1181

    Abstract

    To establish baseline data for lymphoid neoplasm incidence by subtype for six Asian-American ethnic groups.Incident rates were estimated by age and sex for six Asian ethnic groups--Asian Indian/Pakistani, Chinese, Filipino, Japanese, Korean, Vietnamese--in five United States cancer registry areas during 1996-2004. For comparison, rates for non-Hispanic Whites were also estimated.During 1996-2004, Filipinos had the highest (24.0) and Koreans had the lowest incidence (12.7) of total lymphoid neoplasms. By subtype, Vietnamese and Filipinos had the highest incidence for diffuse large B-cell lymphoma (DLBCL) (8.0 and 7.2); Japanese had the highest incidence of follicular lymphoma (2.3). Although a general male predominance of lymphoid neoplasms was observed, this pattern varied by lymphoid neoplasm subtype. Whites generally had higher rates than all Asian ethnic groups for all lymphoid neoplasms and most lymphoma subtypes, although the magnitude of the difference varied by both ethnicity and lymphoma subtype.The observed variations in incidence patterns among Asian ethnic groups in the United States suggest that it may be fruitful to pursue studies that compare Asian populations for postulated environmental and genetic risk factors.

    View details for DOI 10.1007/s10552-008-9184-z

    View details for Web of Science ID 000260766300017

    View details for PubMedID 18543071

  • Racial/ethnic variation in EBV-positive classical Hodgkin lymphoma in California populations INTERNATIONAL JOURNAL OF CANCER Glaser, S. L., Gulley, M. L., Clarke, C. A., Keegan, T. H., Chang, E. T., Shema, S. J., Craig, F. E., DiGiuseppe, J. A., Dorfman, R. F., Mann, R. B., Anton-Culver, H., Ambinder, R. F. 2008; 123 (7): 1499-1507

    Abstract

    Epstein-Barr virus (EBV) is detected in the tumor cells of some but not all Hodgkin lymphoma (HL) patients, and evidence indicates that EBV-positive and -negative HL are distinct entities. Racial/ethnic variation in EBV-positive HL in international comparisons suggests etiologic roles for environmental and genetic factors, but these studies used clinical series and evaluated EBV presence by differing protocols. Therefore, we evaluated EBV presence in the tumors of a large (n = 1,032), racially and sociodemographically diverse series of California incident classical HL cases with uniform pathology re-review and EBV detection methods. Tumor EBV-positivity was associated with Hispanic and Asian/Pacific Islander (API) but not black race/ethnicity, irrespective of demographic and clinical factors. Complex race-specific associations were observed between EBV-positive HL and age, sex, histology, stage, neighborhood socioeconomic status (SES), and birth place. In Hispanics, EBV-positive HL was associated not only with young and older age, male sex, and mixed cellularity histology, but also with foreign birth and lower SES in females, suggesting immune function responses to correlates of early childhood experience and later environmental exposures, respectively, as well as of pregnancy. For APIs, a lack of association with birth place may reflect the higher SES of API than Hispanic immigrants. In blacks, EBV-positive HL was associated with later-stage disease, consistent with racial/ethnic variation in certain cytokine polymorphisms. The racial/ethnic variation in our findings suggests that EBV-positive HL results from an intricate interplay of early- and later-life environmental, hormonal, and genetic factors leading to depressed immune function and poorly controlled EBV infection.

    View details for DOI 10.1002/ijc.23741

    View details for Web of Science ID 000258892500003

    View details for PubMedID 18646185

  • Adenomyosis and endometriosis in the California Teachers Study FERTILITY AND STERILITY Templeman, C., Marshall, S. F., Ursin, G., Horn-Ross, P. L., Clarke, C. A., Allen, M., Deapen, D., Ziogas, A., Reynolds, P., Cress, R., Anton-Culver, H., West, D., Ross, R. K., Bernstein, L. 2008; 90 (2): 415-424

    Abstract

    To evaluate the reproductive and lifestyle correlates of a surgically confirmed diagnosis of endometriosis or adenomyosis in a large prospective cohort.Collection of surgical diagnoses of endometriosis and adenomyosis during follow-up of women with no prior history of endometriosis and no prior surgery for adenomyosis.The California Teachers Study (CTS), an ongoing prospective study of female teachers and school administrators established from the rolls of the California State Teachers Retirement System.Women with surgical diagnoses of endometriosis and adenomyosis were identified from California statewide hospital patient discharge records for CTS cohort members with an intact uterus and no prior history of endometriosis. Women with an incident surgical diagnosis of endometriosis (n = 229) or adenomyosis (n = 961) were compared with disease-free women in the same age range (for endometriosis, n = 43,493; for adenomyosis, n = 79,495).None.Multivariable logistic regression methods were used to calculate prevalence odds ratios and associated 95% confidence intervals for the associations between self-reported menstrual and reproductive characteristics and either endometriosis or adenomyosis.Women surgically diagnosed with endometriosis were younger than those surgically diagnosed with adenomyosis. Factors statistically significantly associated with endometriosis were having a mother or sister with endometriosis and nulligravidity. Factors statistically significantly associated with adenomyosis were increasing parity, early menarche (

    View details for DOI 10.1016/j.fertnstert.2007.06.027

    View details for Web of Science ID 000258483800028

    View details for PubMedID 17919609

  • Dietary assessment in the California Teachers Study: reproducibility and validity CANCER CAUSES & CONTROL Horn-Ross, P. L., Lee, V. S., Collins, C. N., Stewart, S. L., Canchola, A. J., Lee, M. M., Reynolds, P., Clarke, C. A., Bernstein, L., Stram, D. O. 2008; 19 (6): 595-603

    Abstract

    To evaluate the reproducibility and validity of the food-frequency questionnaire (FFQ) used in the California Teachers Study (CTS) cohort and to use this data to quantify the effects of correcting nutrient-breast cancer relative risks for measurement error.One hundred and ninety five CTS cohort members participated in a 10-month dietary validation study that included four 24-h dietary recalls and pre- and post-study FFQs. Shrout-Fleiss intraclass correlations for reproducibility were computed. Under several standard assumptions concerning the correlations of errors in the FFQs and 24-h recalls, we calculated energy-adjusted deattenuated Pearson correlations for validity and tested for differences in validity according to a number of demographic and other risk factors. For each nutrient, we compared the performance of the FFQ versus the 24-h recalls, estimating the number of days of recalls that give equivalent information about true intake as does a single FFQ. Finally, the effects of adjustment for measurement error on risk estimates were evaluated in 44,423 postmenopausal cohort members, 1,544 of whom developed breast cancer during seven years of follow-up. Relative risks (RR) and confidence intervals (CI) were calculated using Cox proportional hazards with and without correction for measurement error.Reproducibility correlations for the nutrients ranged from 0.60 to 0.87. With a few exceptions, validity correlations were reasonably high (range: 0.55-0.85), including r = 0.74 for alcohol. Performance of the FFQ differed by age for percent of calories from fat and by body mass index and hormone therapy use for alcohol consumption. For most nutrients examined, our FFQ is comparable to two to six recalls for each subject in capturing true intake. In the measurement error-adjusted risk analyses, corrected RRs were within 13% of uncorrected values for all nutrients examined except for linoleic acid. For alcohol consumption the corrected RR (per 20 g/1,000 kcal/d) was 1.36 (95% CI: 1.03-1.51) compared to the uncorrected estimate of 1.25 (95% CI: 1.10-1.42).The FFQ dietary assessment used in the CTS is reproducible and valid for all nutrients except the unsaturated fatty acids. Correcting relative risk estimates for measurement error resulted in relatively small changes in the associations between the majority of nutrients and the risk of postmenopausal breast cancer.

    View details for DOI 10.1007/s10552-008-9124-y

    View details for Web of Science ID 000257327300006

    View details for PubMedID 18256894

  • California medicaid Enrollment and melanoma stage at diagnosis - A population-based study AMERICAN JOURNAL OF PREVENTIVE MEDICINE Pollitt, R. A., Clarke, C. A., Shema, S. J., Swetter, S. M. 2008; 35 (1): 7-13

    Abstract

    Insurance status and SES are associated with the stage of melanoma at diagnosis. However, the influence of Medicaid enrollment on melanoma stage has not been studied in detail. This study examined the effect of Medicaid enrollment status and duration on melanoma stage at diagnosis in a large, multi-ethnic California population.California Cancer Registry records were linked with statewide Medicaid enrollment files to identify 4558 men and women diagnosed with invasive cutaneous and metastatic melanoma during 1998-1999. Multivariate logistic regression was used to evaluate the association between prediagnosis Medicaid enrollment status and late-stage diagnosis and tumor depth at diagnosis.Late-stage disease was diagnosed in 27% of Medicaid and 9% of non-Medicaid melanoma patients. Those enrolled in Medicaid at diagnosis and those enrolled intermittently during the year prior to diagnosis had significantly greater covariate-adjusted odds of late-stage cancer than those not enrolled in Medicaid (OR 13.64, 95% CI=4.43, 41.98, and OR 2.77, 95% CI=1.28, 5.99, respectively). Participants continuously enrolled during the previous year were not at increased odds for late-stage disease. An increased likelihood of late-stage melanoma was also associated with low SES (p<0.05) and non-Hispanic black race/ethnicity (p<0.10) after covariate adjustment.Men and women intermittently enrolled in Medicaid or not enrolled until the month of diagnosis had a significantly increased likelihood of late-stage melanoma. Greater education and outreach, particularly in low-SES areas, are needed to improve melanoma awareness and access to screening.

    View details for DOI 10.1016/j.amepre.2008.03.026

    View details for Web of Science ID 000256996900002

    View details for PubMedID 18482824

  • Incomplete pregnancy is not associated with breast cancer risk: the California Teachers Study CONTRACEPTION Henderson, K. D., Sullivan-Halley, J., Reynolds, P., Horn-Ross, P. L., Clarke, C. A., Chang, E. T., Neuhausen, S., Ursin, G., Bernstein, L. 2008; 77 (6): 391-396

    Abstract

    Early studies of incomplete pregnancy and development of breast cancer suggested that induced abortion might increase risk. Several large prospective studies, which eliminate recall bias, did not detect associations, but this relationship continues to be debated.To further inform this important question, we examined invasive breast cancer as it relates to incomplete pregnancy, including total number of induced abortions, age at first induced abortion and total number of miscarriages among women participating in the ongoing California Teachers Study (CTS) cohort. Incomplete pregnancy was self-reported on the CTS baseline questionnaire in 1995-1996. Incident breast cancers were ascertained in 3324 women through 2004 via linkage with the California Cancer Registry.Using Cox multivariable regression, we found no statistically significant association between any measure of incomplete pregnancy and breast cancer risk among nulliparous or parous women.These results provide strong evidence that there is no relationship between incomplete pregnancy and breast cancer risk.

    View details for DOI 10.1016/j.contraception.2008.02.004

    View details for Web of Science ID 000256136200002

    View details for PubMedID 18477486

  • Dietary patterns and risk of ovarian cancer in the California Teachers Study Cohort NUTRITION AND CANCER-AN INTERNATIONAL JOURNAL Chang, E. T., Lee, V. S., Canchola, A. J., Dalvi, T. B., Clarke, C. A., Reynolds, P., Purdie, D. M., Stram, D. O., West, D. W., Ziogas, A., Bernstein, L., Horn-Ross, P. L. 2008; 60 (3): 285-291

    Abstract

    Previous studies have examined the association between individual foods or nutrients, but not overall diet, and ovarian cancer risk. To account for the clustering of foods in the diet, we investigated the association between dietary patterns and risk of ovarian cancer in the prospective California Teachers Study cohort. Of 97,292 eligible women who completed the baseline dietary assessment in 1995-1996, 311 women developed epithelial ovarian cancer on or before December 31, 2004. Based on principal components analysis, 5 major dietary patterns were identified and termed plant-based, high-protein/high-fat, high-carbohydrate, ethnic, and salad-and-wine. Multivariable Cox proportional hazards regression analysis was used to estimate associations between these dietary patterns and risk of incident ovarian cancer. Most of the dietary patterns were not significantly associated with ovarian cancer risk. However, women who followed a plant-based diet had higher risk; comparing those in the top quintile of plant-based food intake with those in the lowest quintile, the relative risk of ovarian cancer was 1.65 (95% confidence interval = 1.07-2.54; P(trend) = 0.03). Associations with the 5 dietary patterns did not vary by known ovarian cancer risk factors or other behavioral or sociodemographic characteristics. Overall, our results show no convincing associations between dietary patterns and ovarian cancer risk.

    View details for DOI 10.1080/01635580701733091

    View details for Web of Science ID 000256439800001

    View details for PubMedID 18444162

  • Re: Declines in invasive breast cancer and use of postmenopausal hormone therapy in a screening mammography population JOURNAL OF THE NATIONAL CANCER INSTITUTE Robbins, A. S., Clarke, C. A. 2007; 99 (23): 1815-1815

    View details for DOI 10.1093/jnci/djm209

    View details for Web of Science ID 000251545600014

    View details for PubMedID 18042938

  • Disparities in mammographic screening for Asian women in California: a cross-sectional analysis to identify meaningful groups for targeted intervention BMC CANCER Gomez, S. L., Tan, S., Keegan, T. H., Clarke, C. A. 2007; 7

    Abstract

    Breast cancer is the most commonly diagnosed cancer among the rapidly growing population of Asian Americans; it is also the most common cause of cancer mortality among Filipinas. Asian women continue to have lower rates of mammographic screening than women of most other racial/ethnic groups. While prior studies have described the effects of sociodemographic and other characteristics of women on non-adherence to screening guidelines, they have not identified the distinct segments of the population who remain at highest risk of not being screened.To better describe characteristics of Asian women associated with not having a mammogram in the last two years, we applied recursive partitioning to population-based data (N = 1521) from the 2001 California Health Interview Survey (CHIS), for seven racial/ethnic groups of interest: Chinese, Japanese, Filipino, Korean, South Asian, Vietnamese, and all Asians combined.We identified two major subgroups of Asian women who reported not having a mammogram in the past two years and therefore, did not follow mammography screening recommendations: 1) women who have never had a pap exam to screen for cervical cancer (68% had no mammogram), and 2) women who have had a pap exam, but have no women's health issues (osteoporosis, using menopausal hormone therapies, and/or hysterectomy) nor a usual source of care (62% had no mammogram). Only 19% of Asian women who have had pap screening and have women's health issues did not have a mammogram in the past two years. In virtually all ethnic subgroups, having had pap or colorectal screening were the strongest delineators of mammography usage. Other characteristics of women least likely to have had a mammogram included: Chinese non-U.S. citizens or citizens without usual source of health care, Filipinas with no health insurance, Koreans without women's health issues and public or no health insurance, South Asians less than age 50 who were unemployed or non-citizens, and Vietnamese women who were never married.We identified distinct subgroups of Asian women at highest risk of not adhering to mammography screening guidelines; these data can inform outreach efforts aimed at reducing the disparity in mammography screening among Asian women.

    View details for DOI 10.1186/1471-2407-7-201

    View details for Web of Science ID 000252447400001

    View details for PubMedID 17961259

  • Declines in breast cancer after the WHI: apparent impact of hormone therapy CANCER CAUSES & CONTROL Clarke, C. A., Glaser, S. L. 2007; 18 (8): 847-852

    Abstract

    Large numbers of US women stopped taking hormone therapies (HT), especially estrogen/progestin (EP) formulations, after the Women's Health Initiative trial detected elevated risks of breast cancer in EP users and was halted in July 2002. Recent reports have indicated substantial and significant declines in population-based breast cancer incidence, particularly hormone-sensitive forms, for 2003 and 2004. Are these events linked? This commentary considers the available evidence linking the mass cessation of HT in 2002 to the breast cancer incidence declines of 2003/2004 and quantifies the potential impact of the cessation on the overall burden of breast cancer in the US.

    View details for DOI 10.1007/s10552-007-9029-1

    View details for Web of Science ID 000248375100007

    View details for PubMedID 17619153

  • Regional changes in hormone therapy use and breast cancer incidence in California from 2001 to 2004 JOURNAL OF CLINICAL ONCOLOGY Robbins, A. S., Clarke, C. A. 2007; 25 (23): 3437-3439

    Abstract

    Recently, an unprecedented 1-year 7% decrease in the overall incidence of invasive female breast cancer in the United States was reported. It has been suggested that the decrease resulted from the mass cessation of estrogen-progestin hormone therapy (EPHT) in 2002. We took advantage of California's unique population-based cancer surveillance resources to assess whether regional changes in breast cancer incidence observed between 2001 and 2004 correlated with regional changes in EPHT use between 2001 and 2003.We obtained statewide cancer registry and California Health Interview Survey (CHIS) EPHT data for almost 3 million non-Hispanic white women age 45 to 74 years, residing in California's 58 counties. We examined trends in the age-adjusted incidence of invasive female breast cancer and compared these with trends in the use of EPHT, after grouping all California counties into three groups based on EPHT use in 2001. We also examined CHIS data on trends in screening mammography. Results In 2001, there were large regional differences in EPHT use and breast cancer incidence. From 2001 to 2004, incidence declined by 8.8% in the counties with the smallest EPHT reductions, by 13.9% in those with intermediate reductions, and by 22.6% in counties with the largest EPHT reductions. Between 2001 and 2003, CHIS data did not show any significant change in the proportion of women who reported having a mammogram in the previous 2 years.These data support the hypothesis that changes in EPHT use in 2002 may be responsible for significant declines in breast cancer incidence between 2002 and 2003 and sustained through 2004.

    View details for DOI 10.1200/JCO.2007.11.4132

    View details for Web of Science ID 000248744300010

    View details for PubMedID 17592152

  • A decline in breast-cancer incidence NEW ENGLAND JOURNAL OF MEDICINE Robbins, A. S., Clarke, C. A. 2007; 357 (5): 511-512

    View details for Web of Science ID 000248436300033

    View details for PubMedID 17674460

  • Pro-posed classification of lymphoid neoplasms for epidemiologic research from the Pathology Working Group of the International Lymphoma Epidemiology Consortium (InterLymph) BLOOD Morton, L. M., Turner, J. J., Cerhan, J. R., Linet, M. S., Treseler, P. A., Clarke, C. A., Jack, A., Cozen, W., Maynadie, M., Spinelli, J. J., Costantini, A. S., Ruediger, T., Scarpa, A., Zheng, T., Weisenburger, D. D. 2007; 110 (2): 695-708

    Abstract

    Recent evidence suggests that there is etiologic heterogeneity among the various subtypes of lymphoid neoplasms. However, epidemiologic analyses by disease subtype have proven challenging due to the numerous clinical and pathologic schemes used to classify lymphomas and lymphoid leukemias over the last several decades. On behalf of the International Lymphoma Epidemiology Consortium (InterLymph) Pathology Working Group, we present a proposed nested classification of lymphoid neoplasms to facilitate the analysis of lymphoid neoplasm subtypes in epidemiologic research. The proposed classification is based on the World Health Organization classification of lymphoid neoplasms and the International Classification of Diseases-Oncology, Third Edition (ICD-O-3). We also provide a translation into the proposed classification from previous classifications, including the Working Formulation, Revised European-American Lymphoma (REAL) classification, and ICD-O-2. We recommend that epidemiologic studies include analyses by lymphoma subtype to the most detailed extent allowable by sample size. The standardization of groupings for epidemiologic research of lymphoma subtypes is essential for comparing subtype-specific reports in the literature, harmonizing cases within a single study diagnosed using different systems, as well as combining data from multiple studies for the purpose of pooled analysis or meta-analysis, and will probably prove to be critical for elucidating etiologies of the various lymphoid neoplasms.

    View details for DOI 10.1182/blood-2006-11-051672

    View details for Web of Science ID 000248112400033

    View details for PubMedID 17389762

  • The burden of liver cancer in Asians and Pacific Islanders in the greater San Francisco Bay Area, 1990 through 2004 CANCER Chang, E. T., Keegan, T. H., Gomez, S. L., Le, G. M., Clarke, C. A., So, S. K., Glaser, S. L. 2007; 109 (10): 2100-2108

    Abstract

    To the authors' knowledge, no previous U.S. study has examined time trends in the incidence rate of liver cancer in the high-risk Asian/Pacific Islander population. In this study, liver cancer incidence trends were evaluated in Chinese, Filipino, Japanese, Korean, and Vietnamese men and women in the Greater San Francisco Bay Area of California between 1990 and 2004.Populations at risk were estimated by using the cohort-component demographic method. Annual percentage changes (APCs) in age-adjusted incidence rates of primary liver cancer among Asians/Pacific Islanders in the Greater Bay Area Cancer Registry were calculated by using joinpoint regression analysis.The incidence rate of liver cancer between 1990 and 2004 did not change significantly in Asian/Pacific Islander men or women overall. However, the incidence rate declined, although the decline was not statistically significant, among Chinese men (APC, -1.6%; 95% confidence interval [95% CI], -3.4-0.3%), Japanese men (APC, -4.9%; 95% CI, -10.7-1.2%), and Japanese women (APC, -3.6%; 95% CI, -8.9-2%). Incidence rates remained consistently high for Vietnamese, Korean, and Filipino men and women. Trends in the incidence rate of hepatocellular carcinoma were comparable to those for liver cancer. Although disparities in liver cancer incidence between Asians/Pacific Islanders and other racial/ethnic groups diminished between the period from 1990 through 1994 and the period from 2000 through 2004, the disparities among Asian subgroups increased.Liver cancer continues to affect Asian/Pacific Islander Americans disproportionately, with consistently high incidence rates in most subgroups. Culturally targeted prevention methods are needed to reduce the high rates of liver cancer in this growing population in the U.S.

    View details for DOI 10.1002/cncr.22642

    View details for Web of Science ID 000246252800024

    View details for PubMedID 17385214

  • Diet and risk of ovarian cancer in the California teachers study cohort AMERICAN JOURNAL OF EPIDEMIOLOGY Chang, E. T., Lee, V. S., Canchola, A. J., Clarke, C. A., Purdie, D. M., Reynolds, P., Anton-Culver, H., Bernstein, L., Deapen, D., Peel, D., Pinder, R., Ross, R. K., Stram, D. O., West, D. W., Wright, W., Ziogas, A., Horn-Ross, P. L. 2007; 165 (7): 802-813

    Abstract

    Dietary phytochemical compounds, including isoflavones and isothiocyanates, may inhibit cancer development but have not yet been examined in prospective epidemiologic studies of ovarian cancer. The authors have investigated the association between consumption of these and other nutrients and ovarian cancer risk in a prospective cohort study. Among 97,275 eligible women in the California Teachers Study cohort who completed the baseline dietary assessment in 1995-1996, 280 women developed invasive or borderline ovarian cancer by December 31, 2003. Multivariable Cox proportional hazards regression, with age as the timescale, was used to estimate relative risks and 95% confidence intervals; all statistical tests were two sided. Intake of isoflavones was associated with lower risk of ovarian cancer. Compared with the risk for women who consumed less than 1 mg of total isoflavones per day, the relative risk of ovarian cancer associated with consumption of more than 3 mg/day was 0.56 (95% confidence interval: 0.33, 0.96). Intake of isothiocyanates or foods high in isothiocyanates was not associated with ovarian cancer risk, nor was intake of macronutrients, antioxidant vitamins, or other micronutrients. Although dietary consumption of isoflavones may be associated with decreased ovarian cancer risk, most dietary factors are unlikely to play a major role in ovarian cancer development.

    View details for DOI 10.1093/aje/kwk065

    View details for Web of Science ID 000244959600010

    View details for PubMedID 17210953

  • Recent trends in breast cancer incidence among 6 Asian groups in the Greater Bay Area of Northern California INTERNATIONAL JOURNAL OF CANCER Keegan, T. H., Gomez, S. L., Clarke, C. A., Chan, J. K., Glaser, S. L. 2007; 120 (6): 1324-1329

    Abstract

    Asians and Pacific Islanders are typically aggregated in United States (US) cancer statistics even though the few studies that have considered subgroups separately have found marked differences in cancer incidence. The objective of this study was to evaluate trends in breast cancer incidence rates separately for US Chinese, Japanese, Filipino, Korean, South Asian and Vietnamese women overall and by age at diagnosis, histologic subtype and stage at diagnosis. Age-adjusted incidence rates and annual percent changes (APC) of new, primary breast cancer diagnosed in the Greater Bay Area Cancer Registry of Northern California (1990-2002) were calculated using SEER*Stat. In women under 50 years of age, annual incidence rates decreased for Japanese (APC = -4.1, p = 0.02) and Filipinas (APC = -1.9, p = 0.11), and increased or fluctuated in other subgroups over the study period. In women 50 years or older, rates of invasive breast cancer increased for most subgroups, except Filipinas (APC = -1.3, p = 0.32), and in Japanese until 1998-2000. Rates of breast cancer in situ increased in most subgroups from 1990 to 2002, as did rates of lobular breast cancer for Chinese (APC = +7.46, p < 0.01) women. In Japanese women, rates of lobular breast cancer were highest in 1995-1997 and decreased thereafter. Our data support the notion that the prevalence of established risk factors influence breast cancer incidence, as breast cancer rates increased for more recently immigrated groups and decreased among more established groups, and may suggest leads into other avenues of research, such as genetic differences, that may explain differences in incidence rates among Asian subgroups.

    View details for DOI 10.1002/ijc.22432

    View details for Web of Science ID 000244118600022

    View details for PubMedID 17163416

  • Physical activity and colon cancer risk among women in the california teachers study CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION Mai, P. L., Sullivan-Halley, J., Ursin, G., Stram, D. O., Deapen, D., Villaluna, D., Horn-Ross, P. L., Clarke, C. A., Reynolds, P., Ross, R. K., West, D. W., Anton-Culver, H., Ziogas, A., Bernstein, L. 2007; 16 (3): 517-525

    Abstract

    Existing data suggest that physical activity reduces colon cancer risk, but the association is not consistently observed in women. One potential explanation for this inconsistency is that hormone therapy, which is associated with lower colon cancer risk, acts as a modifier of the physical activity/colon cancer relationship.Participants in the California Teachers Study (N = 120,147), a prospective cohort of female teachers and administrators residing in California, ages 22 to 84 years at baseline and with no prior history of colon cancer were eligible for study. Between 1996 and 2002, 395 patients were diagnosed with invasive colon cancer. The relative risks (RR) associated with lifetime (high school through age 54 years or current age) and recent (past 3 years) strenuous and moderate recreational physical activity were estimated using Cox proportional hazards regression models.Combined lifetime moderate and strenuous recreational physical activity was only modestly associated with colon cancer risk in the cohort [>or=4 versus or=4 versus

    View details for DOI 10.1158/1055-9965.EPI-06-0747

    View details for Web of Science ID 000245093900027

    View details for PubMedID 17372247

  • Long-term recreational physical activity and risk of invasive and in situ breast cancer - The California teachers study ARCHIVES OF INTERNAL MEDICINE Dallal, C. M., Sullivan-Halley, J., Ross, R. K., Wang, Y., Deapen, D., Horn-Ross, P. L., Reynolds, P., Stram, D. O., Clarke, C. A., Anton-Culver, H., Ziogas, A., Peel, D., West, D. W., Wright, W., Bernstein, L. 2007; 167 (4): 408-415

    Abstract

    Long-term physical activity may affect breast cancer risk. Few prospective studies have evaluated in situ or invasive breast cancer risk, or breast cancer receptor subtypes, in relation to long-term activity.We examined the association between recreational physical activity and risk of invasive and in situ breast cancer in the California Teachers Study, a cohort of women established in 1995-1996. Of 110 599 women aged 20 to 79 years with no history of breast cancer followed up through December 31, 2002, 2649 were diagnosed as having incident invasive breast cancer and 593 were diagnosed as having in situ breast cancer. Information was collected at cohort entry on participation in strenuous and moderate recreational activities during successive periods from high school through the current age or age 54 years (if older at enrollment) and in the past 3 years. A summary measure of long-term activity up to the current age, or age 54 years if older, was constructed for each woman.Invasive breast cancer risk was inversely associated with long-term strenuous activity (>5 vs 5 vs

    View details for Web of Science ID 000244467000020

    View details for PubMedID 17325304

  • Lung cancer incidence in never smokers JOURNAL OF CLINICAL ONCOLOGY Wakelee, H. A., Chang, E. T., Gomez, S. L., Keegan, T. H., Feskanich, D., Clarke, C. A., Holmberg, L., Yong, L. C., Kolonel, L. N., Gould, M. K., West, D. W. 2007; 25 (5): 472-478

    Abstract

    Lung cancer is a leading cause of cancer death worldwide. Although smoking remains the predominant cause of lung cancer, lung cancer in never smokers is an increasingly prominent public health issue. However, data on this topic, particularly lung cancer incidence rates in never smokers, are limited.We reviewed the existing literature on lung cancer incidence and mortality rates among never smokers and present new data regarding rates in never smokers from the following large, prospective cohorts: Nurses' Health Study; Health Professionals Follow-Up Study; California Teachers Study; Multiethnic Cohort Study; Swedish Lung Cancer Register in the Uppsala/Orebro region; and First National Health and Nutrition Examination Survey Epidemiologic Follow-Up Study.Truncated age-adjusted incidence rates of lung cancer among never smokers age 40 to 79 years in these six cohorts ranged from 14.4 to 20.8 per 100,000 person-years in women and 4.8 to 13.7 per 100,000 person-years in men, supporting earlier observations that women are more likely than men to have non-smoking-associated lung cancer. The distinct biology of lung cancer in never smokers is apparent in differential responses to epidermal growth factor receptor inhibitors and an increased prevalence of adenocarcinoma histology in never smokers.Lung cancer in never smokers is an important public health issue, and further exploration of its incidence patterns, etiology, and biology is needed.

    View details for DOI 10.1200/JCO.2006.07.2983

    View details for Web of Science ID 000244176000003

    View details for PubMedID 17290054

  • Making sense of seasonal fluctuations in lymphoma diagnosis LEUKEMIA & LYMPHOMA Chang, E. T., Clarke, C. A., Glaser, S. L. 2007; 48 (2): 223-224

    View details for DOI 10.1080/10428190601158662

    View details for Web of Science ID 000244528300005

    View details for PubMedID 17325879

  • Wine and other alcohol consumption and risk of ovarian cancer in the California Teachers Study cohort CANCER CAUSES & CONTROL Chang, E. T., Canchola, A. J., Lee, V. S., Clarke, C. A., Purdie, D. M., Reynolds, P., Bernstein, L., Stram, D. O., Anton-Culver, H., Deapen, D., Mohrenweiser, H., Peel, D., Pinder, R., Ross, R. K., West, D. W., Wright, W., Ziogas, A., Horn-Ross, P. L. 2007; 18 (1): 91-103

    Abstract

    Whether alcohol consumption influences ovarian cancer risk is unclear. Therefore, we investigated the association between alcohol intake at various ages and risk of ovarian cancer.Among 90,371 eligible members of the California Teachers Study cohort who completed a baseline alcohol assessment in 1995-1996, 253 women were diagnosed with epithelial ovarian cancer by the end of 2003. Multivariate Cox proportional hazards regression analysis was performed to estimate relative risks (RRs) and 95% confidence intervals (CIs).Consumption of total alcohol, beer, or liquor in the year prior to baseline, at ages 30-35 years, or at ages 18-22 years was not associated with risk of ovarian cancer. Consumption of at least one glass per day of wine, compared to no wine, in the year before baseline was associated with increased risk of developing ovarian cancer: RR = 1.57 (95% CI 1.11-2.22), P (trend) = 0.01. The association with wine intake at baseline was particularly strong among peri-/post-menopausal women who used estrogen-only hormone therapy and women of high socioeconomic status.Alcohol intake does not appear to affect ovarian cancer risk. Constituents of wine other than alcohol or, more likely, unmeasured determinants of wine drinking were associated with increased risk of ovarian cancer.

    View details for DOI 10.1007/s10552-006-0083-x

    View details for Web of Science ID 000243031800009

    View details for PubMedID 17186425

  • Recent breast cancer trends among Asian/Pacific Islander, Hispanic, and African-American women in the US: changes by tumor subtype BREAST CANCER RESEARCH Hausauer, A. K., Keegan, T. H., Chang, E. T., Clarke, C. A. 2007; 9 (6)

    Abstract

    Recently, unprecedented drops in breast cancer incidence have been reported for populations of mostly White European descent. Incidence patterns in non-White racial/ethnic groups are less described. Therefore, we examined population-based breast cancer incidence trends separately for US Asian/Pacific Islander, Hispanic, African-American, and non-Hispanic White women by etiologically relevant tumor subtype characteristics, including hormone receptor status, histology, size, and in situ behavior.We obtained breast cancer data from 13 Surveillance, Epidemiology, and End Results (SEER) cancer registries to calculate age-adjusted incidence rates and trends, stratified by race/ethnicity and tumor subtype for the period 1992-2004. Detailed analyses were limited to women 50 years old or older. Joinpoint regression was used to assess incidence trends by annual quarter of diagnosis.Between 2001 and 2004, incidence rates of invasive breast cancer in women 50 years old or older declined appreciably among Asians/Pacific Islanders (-8.5%) and Hispanics (-2.9%) and were stable in African-Americans (+0.5%), reductions substantially lower than those observed among non-Hispanic Whites (-14.3%). In Asian/Pacific Islander women, perceptible but statistically nonsignificant decreases were observed for hormone receptor-positive, lobular, and small tumors only. Rates of hormone receptor-negative tumors increased among African-Americans (26.1%) and Hispanics (26.9%) during 2001-2004. Incidence trends in most groups, except African-American women, peaked between 1999 and mid-2002. Rates of in situ cancer remained stable in all groups.Recently reported reductions in breast cancer incidence varied considerably by race/ethnicity. These patterns are consistent with documented racial/ethnic differences in the prevalence and discontinuation of hormone therapy (HT) after July 2002 but do not correspond as well to patterns of mammography use in these groups. The data presented in this analysis provide further evidence that population-level HT use is a major influence on population-level rates of particular breast cancer subtypes, especially receptor-positive tumors.

    View details for DOI 10.1186/bcr1839

    View details for Web of Science ID 000253285900027

    View details for PubMedID 18162138

  • Second lymphomas and other malignant neoplasms in patients with mycosis fungoides and Sezary syndrome - Evidence from population-based and clinical cohorts ARCHIVES OF DERMATOLOGY Huang, K. P., Weinstock, M. A., Clarke, C. A., McMillan, A., Hoppe, R. T., Kim, Y. H. 2007; 143 (1): 45-50

    Abstract

    To assess risks for developing second malignancies in patients with mycosis fungoides or Sézary syndrome.Retrospective study of 2 cohorts.Nine population-based US cancer registries that constitute the Surveillance, Epidemiology, and End Results Program (SEER-9), and Stanford University referral center cohort of patients with cutaneous lymphoma. Patients with mycosis fungoides or Sézary syndrome from the SEER-9 registry diagnosed and followed up from 1984 through 2001 and from the Stanford University cohort diagnosed and followed up from 1973 through 2001.Relative risk was estimated using the standardized incidence ratio (SIR). The expected cancer incidence for both cohorts was calculated using age-, sex-, race-, and calendar year-specific SEER-9 incidence rates for the general population. Nonmelanoma skin cancers were excluded because these cancers are not routinely reported by the SEER database.In the SEER-9 cohort (n = 1798), there were 197 second instances of cancer (SIR = 1.32; 95% confidence interval [CI], 1.15-1.52) at all sites. Significantly elevated risk (P<.01) was observed for Hodgkin disease (6 cases; SIR = 17.14; 95% CI, 6.25-37.26) and non-Hodgkin lymphoma (27 cases; SIR = 5.08; 95% CI, 3.34-7.38). Elevated risk (P<.05) was also observed for melanoma (10 cases; SIR = 2.60; 95% CI, 1.25-4.79), and urinary cancer (21 cases; SIR = 1.74; 95% CI, 1.08-2.66). In the Stanford University cohort (n = 429), there were 37 second instances of cancer (SIR = 1.04; 95% CI, 0.76-1.44). Elevated risk (P<.01) was observed for Hodgkin disease (3 cases; SIR = 27.27; 95% CI, 5.35-77.54). Elevated risk (P<.05) was also observed for biliary cancer (2 cases; SIR = 11.76; 95% CI, 1.51-42.02).Updated SEER (population based) and Stanford (clinic based) data confirm the generalizability of earlier findings of increased risk of lymphoma in patients with mycosis fungoides or Sézary syndrome.

    View details for Web of Science ID 000243509100006

    View details for PubMedID 17224541

  • Understanding the validity of self-reported positive family history of lymphoma in extended families to facilitate genetic epidemiology and clinical practice LEUKEMIA & LYMPHOMA Glaser, S. L., Chang, E. T., Horning, S. J., Clarke, C. A. 2007; 48 (6): 1110-1118

    Abstract

    The validity of self-reported information about familial Hodgkin lymphoma (HL), important for epidemiologic research and clinical practice, is undetermined. We attempted to validate 55 familial lymphomas previously reported by 48 subjects in a population-based case-control study of HL in women. Of 44 diagnoses (80%) reported by 40 (83%) recontacted subjects, we obtained medical documentation for 36 (82%). Twenty-nine (81%) were validated as lymphoma, with accuracy better for first-degree relatives and subjects with larger nuclear families and other family illness. Fourteen reports of familial HL were validated as lymphoma for 13 (93%) and as HL for nine (64%). Fifteen reports of familial NHL were validated as lymphoma for 10 (67%) and as NHL for 10 (67%). Thus, familial HL reported by HL patients and controls is highly likely to be lymphoma even in extended family members but less likely to be HL per se. Validity may vary with the subject's family size and medical history.

    View details for DOI 10.1080/10428190701302434

    View details for Web of Science ID 000247779100012

    View details for PubMedID 17577774

  • Medicaid status and stage at diagnosis of cervical cancer AMERICAN JOURNAL OF PUBLIC HEALTH O'Malley, C. D., Sherna, S. J., Clarke, L. S., Clarke, C. A., Perkins, C. I. 2006; 96 (12): 2179-2185

    Abstract

    We examined whether Medicaid beneficiaries are more likely to be diagnosed with late-stage cervical cancer than women not enrolled in Medicaid.Using the California Cancer Registry-Medicaid linked file, we identified 4682 women diagnosed during 1996-1999 with invasive cervical cancer. Multivariate logistic regression was used to evaluate the association between late-stage diagnosis and prediagnosis Medicaid status.Late-stage disease was diagnosed in 51% of Medicaid and 42% of non-Medicaid women. Relative to women without Medicaid coverage, adjusted odds ratios for late-stage diagnosis were 2.8 times higher among women enrolled in Medicaid at the time of their diagnosis and 1.3 times higher among those intermittently enrolled before being diagnosed. Vietnamese women were less likely than White women to have advanced disease; the adjusted odds for women in other racial/ethnic groups did not differ from those among Whites. Women of low socioeconomic status and older women were at increased risk.Women intermittently enrolled in Medicaid or not enrolled until their diagnosis were at greatest risk of a late-stage diagnosis, suggesting that more outreach to at-risk women is needed to ensure access to screening services.

    View details for DOI 10.2105/AJPH.2005.072553

    View details for Web of Science ID 000242474500017

    View details for PubMedID 17077390

  • Recent declines in hormone therapy utilization and breast cancer incidence: clinical and population-based evidence. Journal of clinical oncology Clarke, C. A., Glaser, S. L., Uratsu, C. S., Selby, J. V., Kushi, L. H., Herrinton, L. J. 2006; 24 (33): e49-50

    View details for PubMedID 17114650

  • Validity of cancer registry medicaid status against enrollment files - Implications for population-based studies of cancer outcomes MEDICAL CARE Chan, J. K., Gomez, S. L., O'Malley, C. D., Perkins, C. I., Clarke, C. A. 2006; 44 (10): 952-955

    Abstract

    Poor access to or inadequate health insurance contributes to disparities in cancer incidence and mortality. Cancer registry "payer source" data is collected by many cancer registries in the United States and has been used to compare cancer outcomes across insurance types.We evaluated the validity of cancer registry data on patient Medicaid status against enrollment data from Medi-Cal, California's Medicaid program.Data from the statewide California Cancer Registry for persons under age 65 years diagnosed with 1) any cancer in 1998 and 1999 or 2) with invasive cervical cancer between 1996 and 1999 were obtained and linked probabilistically to Medi-Cal enrollment files. We compared registry Medicaid status, determined from payer source information, against linkage results and used crosstabulations to calculate sensitivity, specificity, and positive predictive value. These measures were compared across different hospital and patient characteristics and cancer types.Cancer registry Medicaid status data had poor sensitivity (48%), good specificity (98%), and moderate positive predictive value (77%). Measures of validity did not vary substantially by cancer type, stage, patient age, sex, vital status, race/ethnicity, socioeconomic status, or diagnosing hospital size. Registry data undercounted the number of Medicaid patients by 52% and incorrectly assigned Medicaid as a payer to approximately 2% of patients.As a result of the poor validity of cancer registry Medicaid status data, caution should be used when interpreting cancer outcomes by insurance type calculated from registry payer source data. Linkage of registry data to Medicaid enrollment files represents a more accurate means of identifying Medicaid insurance status.

    View details for Web of Science ID 000241115500010

    View details for PubMedID 17001267

  • Population attributable risk of breast cancer in white women associated with immediately modifiable risk factors BMC CANCER Clarke, C. A., Purdie, D. M., Glaser, S. L. 2006; 6

    Abstract

    Estrogen/progestin replacement therapy (EPRT), alcohol consumption, physical activity, and breast-feeding duration differ from other factors associated with breast cancer in being immediately modifiable by the individual, thereby representing attractive targets for future breast cancer prevention efforts. To justify such efforts, it is vital to quantify the potential population-level impacts on breast cancer considering population variations in behavior prevalence, risk estimate, and baseline incidence.For each of these four factors, we calculated population attributable risk percents (PARs) using population-based survey (2001) and cancer registry data (1998-2002) for 41 subpopulations of white, non-Hispanic California women aged 40-79 years, and ranges of relative risk (RR) estimates from the literature.Using a single RR estimate, subpopulation PARs ranged from 2.5% to 5.6% for hormone use, from 0.0% to 6.1% for recent consumption of > or = 2 alcoholic drinks daily, and 4.6% to 11.0% for physical inactivity. Using a range of RR estimates, PARs were 2-11% for EPRT use, 1-20% for alcohol consumption and 2-15% for physical inactivity. Subpopulation data were unavailable for breastfeeding, but PARs using published RR estimates ranged from 2% to 11% for lifetime breastfeeding > or = 31 months. Thus, of 13,019 breast cancers diagnosed annually in California, as many as 1,432 attributable to EPRT use, 2,604 attributable to alcohol consumption, 1,953 attributable to physical inactivity, and 1,432 attributable to never breastfeeding might be avoidable.The relatively feasible lifestyle changes of discontinuing EPRT use, reducing alcohol consumption, increasing physical activity, and lengthening breastfeeding duration could lower population breast cancer incidence substantially.

    View details for DOI 10.1186/1471-2407-6-170

    View details for Web of Science ID 000240419200001

    View details for PubMedID 16803628

  • Body size, physical activity, and risk of Hodgkin's lymphoma in women CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION Keegan, T. H., Glaser, S. L., Clarke, C. A., Dorfman, R. F., Mann, R. B., DiGiuseppe, J. A., Chang, E. T., Ambinder, R. F. 2006; 15 (6): 1095-1101

    Abstract

    Few studies have examined the associations of body size and physical activity with the development of Hodgkin's lymphoma (HL) in women. In data from a population-based case-control study in women ages 19 to 79 years, we assessed the relation of self-report height, weight, body mass index (BMI), and strenuous physical activity to HL risk in 312 cases with diagnostic re-review and 325 random-digit dialed controls using logistic regression. Analyses were stratified by age group and tumor cell presence of EBV. After adjustment for social class measures, taller childhood and adult height were associated with higher HL risk. In women ages 19 to 44 years, HL risk was elevated for higher, but healthy, BMI values, whereas in women ages 45 to 79 years, associations with BMI were inverse. The odds of developing HL were lower with participation (versus nonparticipation) in strenuous physical activity in the past year [odds ratio (OR), 0.58; 95% confidence interval (95% CI), 0.39-0.87 in women 19-44 years; OR, 0.45; 95% CI, 0.19-1.06 in women 45-79 years] and throughout adult life, and with sports team membership (versus nonmembership) in high school and/or at ages 18 to 22 years. Results were similar in cases (n = 269) with and without tumor-cell EBV compared with controls, although the inverse association with physical activity was somewhat stronger for women with EBV-positive disease. These findings show that in women, body size and strenuous physical activity, both modifiable characteristics, are associated with HL risk in adult life possibly through immunologic, infectious, or genetic mechanisms.

    View details for DOI 10.1158/1055-9965.EPI-06-0020

    View details for Web of Science ID 000238300100007

    View details for PubMedID 16775165

  • Changes in cancer registry coding for lymphoma subtypes: Reliability over time and relevance for surveillance and study CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION Clarke, C. A., Undurraga, D. M., Harasty, P. J., Glaser, S. L., Morton, L. M., Holly, E. A. 2006; 15 (4): 630-638

    Abstract

    Because lymphoma comprises numerous histologic subtypes, understanding the reasons for ongoing increases in its incidence requires surveillance and etiologic study of these subtypes. However, this research has been hindered by many coexisting classification schemes. The Revised European American classification of Lymphoid Neoplasms (REAL)/WHO system developed in 1994 and now used in clinical settings was not incorporated into the International Classification of Diseases-Oncology (ICD-O), used by cancer registries, until the release of the third edition (ICD-O-3) in 2001. Studies including patients diagnosed before 2001 may have codes from earlier ICD-O versions that must be converted to ICD-O-3 and have higher proportions of unclassified (e.g., lymphoma and not otherwise specified) cases. To better understand (a) the agreement of computer-converted ICD-O-3 codes to ICD-O-3 codes generated directly from diagnostic pathology reports and (b) the reproducibility of unclassified status, we reviewed a population-based series of diagnostic pathology reports for lymphoma patients diagnosed before (1988-1994; n = 1,493) and after (1998-2000; n = 1,527) the REAL/WHO scheme was introduced. Overall, computer- and coder-assigned ICD-O-3 codes agreed for 77% of patients in both groups and improved slightly (82%) when codes were grouped. The most common lymphoma subtypes, diffuse large B cell and follicular, had relatively good reliability (84-89%) throughout the study period. T-cell and natural killer cell lymphomas had worse agreement than B-cell lymphomas, even when grouped. Many (42-43%) lymphomas reported as unclassifiable could be assigned a subtype upon pathology report review. These findings suggest that the study of lymphoma subtypes could be improved by (a) use of more standardized terminology in pathology reports, (b) grouping individual ICD-O-3 codes to reduce misclassification bias, and (c) routine secondary editing of unclassified lymphomas by central cancer registries.

    View details for DOI 10.1158/1055-9965.EP1-05-0549

    View details for Web of Science ID 000237045100007

    View details for PubMedID 16614102

  • Cancer surveillance research: A vital subdiscipline of cancer epidemiology CANCER CAUSES & CONTROL Glaser, S. L., Clarke, C. A., Gomez, S. L., O'Malley, C. D., Purdie, D. M., West, D. W. 2005; 16 (9): 1009-1019

    Abstract

    Public health surveillance systems relevant to cancer, centered around population-based cancer registration, have produced extensive, high-quality data for evaluating the cancer burden. However, these resources are underutilized by the epidemiology community due, we postulate, to under-appreciation of their scope and of the methods and software for using them. To remedy these misperceptions, this paper defines cancer surveillance research, reviews selected prior contributions, describes current resources, and presents challenges to and recommendations for advancing the field. Cancer surveillance research, in which systematically collected patient and population data are analyzed to examine and test hypotheses about cancer predictors, incidence, and outcomes in geographically defined populations over time, has produced not only cancer statistics and etiologic hypotheses but also information for public health education and for cancer prevention and control. Data on cancer patients are now available for all US states and, within SEER, since 1973, and have been enhanced by linkage to other population-based resources. Appropriate statistical methods and sophisticated interactive analytic software are readily available. Yet, publication of papers, funding opportunities, and professional training for cancer surveillance research remain inadequate. Improvement is necessary in these realms to permit cancer surveillance research to realize its potential in resolving the growing cancer burden.

    View details for DOI 10.1007/s10552-005-4501-2

    View details for Web of Science ID 000232139900002

    View details for PubMedID 16184466

  • Epstein-Barr virus as a marker of survival after Hodgkin's lymphoma: A population-based study JOURNAL OF CLINICAL ONCOLOGY Keegan, T. H., Glaser, S. L., Clarke, C. A., Gulley, M. L., Craig, F. E., DiGiuseppe, J. A., Dorfman, R. F., Mann, R. B., Ambinder, R. F. 2005; 23 (30): 7604-7613

    Abstract

    Epstein-Barr virus (EBV) in Hodgkin's lymphoma (HL) cells has been considered as a prognostic marker for this heterogeneous disease, but studies have yielded mixed findings, likely because of selected patient series and failure to acknowledge an effect of age on outcome. This study assessed survival after HL in a population-based cohort large enough to examine the joint effects of EBV with other factors including age, sex, and histologic subtype.Included were 922 patients with classical HL diagnosed between mid-1988 and 1997 in the Greater San Francisco Bay Area, with archived biopsy specimens assayed for EBV with immunohistochemistry and in situ hybridization. Vital status was followed through December 30, 2003 (median follow-up time, 97 months). Overall and disease-specific survival were analyzed with the Kaplan-Meier method and Cox proportional hazards regression models.In children less than 15 years old, EBV presence was suggestively associated (P = .07) with favorable survival. In adults aged 15 to 44 years, EBV did not affect HL outcome, although a protective effect was suggested. In older adults (45 to 96 years), EBV presence nearly doubled the risk of overall and HL-specific mortality but only for patients with nodular sclerosis (NS) histologic subtype (hazard ratio for death = 2.5; 95% CI, 1.5 to 4.3).In HL, EBV tumor cell presence is associated with better survival in young patients and poorer survival in older patients with NS, independent of other factors. Variation in outcome by age and histology could indicate biologically distinct disease entities. Evidence that EBV is a meaningful prognostic marker may have therapeutic relevance.

    View details for DOI 10.1200/JCO.2005.02.6310

    View details for Web of Science ID 000232935300034

    View details for PubMedID 16186595

  • Exposure to childhood infections and risk of Epstein-Barr virus-defined Hodgkin's lymphoma in women INTERNATIONAL JOURNAL OF CANCER Glaser, S. L., Keegan, T. H., Clarke, C. A., Trinh, M., Dorfman, R. F., Mann, R. B., DiGiuseppe, J. A., Ambinder, R. F. 2005; 115 (4): 599-605

    Abstract

    The role of Epstein-Barr virus (EBV) in Hodgkin's lymphoma (HL) etiology remains unresolved as EBV is detected in only some HL tumors and few studies have tried to reconcile its presence with factors suggesting viral etiology (e.g., childhood social class, infection history). In a population-based case-control study of San Francisco Bay area women, we analyzed interview data by tumor EBV status. Among 211 young adult cases, EBV-positive HL (11%) was associated with a single vs. shared bedroom at age 11 (OR = 4.0, 95% CI 1.1-14.4); risk was decreased for common childhood infections (OR = 0.3, 95% CI 0.1-1.0), including measles before age 10, but not with prior infectious mononucleosis (IM), which is delayed EBV infection. No study factors affected risk of young adult EBV-negative HL. Among 57 older adult cases, EBV-positive HL (23%) was unrelated to study factors; EBV-negative HL was associated with a single bedroom at age 11 (OR = 3.6, 95% CI 1.5-9.1) and IM in family members (OR = 3.1, 95% CI 1.1-9.0). Thus, delayed exposure to infection may increase risk of EBV-positive HL in young adults, but risk patterns differ in younger and older women for both EBV-positive and -negative HL. Late EBV infection does not appear relevant to risk, suggesting that other pathogens impact HL etiology in affluent female populations. Inconsistency of findings with prior studies may reflect failure of study risk factors to proxy meaningful exposures, risk differences by gender, or selection or misclassification bias. Null findings for EBV-negative HL indicate that etiologic models should be reconsidered for this common form.

    View details for DOI 10.1002/ijc.20787

    View details for Web of Science ID 000229082800013

    View details for PubMedID 15700307

  • Neighborhood socioeconomic status and Hodgkin's lymphoma incidence in California CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION Clarke, C. A., Glaser, S. L., Keegan, T. H., Stroup, A. 2005; 14 (6): 1441-1447

    Abstract

    Hodgkin's lymphoma occurrence has long been noted to associate with higher socioeconomic status (SES). However, the Hodgkin's lymphoma-SES association has not been examined recently or across important, possibly etiologically distinct, patient subgroups. In approximately 150 million person-years of observation in the multiethnic population of California, we examined the association of Hodgkin's lymphoma incidence with a composite measure of neighborhood-level SES in patient subgroups defined by age, sex, race/ethnicity, and Hodgkin's lymphoma histologic subtype. Using population-based cancer registry data on 3,794 Hodgkin's lymphoma patients diagnosed 1988 to 1992 and 1990 census data, we assigned a previously validated, multidimensional SES index to census block groups of patient residence. We then calculated neighborhood SES-specific incidence rates and estimated rate ratios using Poisson regression. Positive neighborhood SES gradients in Hodgkin's lymphoma incidence were observed only in young adults (ages 15-44 years at diagnosis) with nodular sclerosis Hodgkin's lymphoma and older adult (ages > or =45 years) White and Hispanic males with mixed cellularity Hodgkin's lymphoma. For young adults, associations were marked in Hispanic and Asian women, weaker in Hispanic and White men and White women, and subtle to nonexistent in Blacks and Asian men. Neighborhood SES gradients in Hodgkin's lymphoma incidence varied by age, sex, race/ethnicity, and histologic subtype, underscoring etiologic complexity in Hodgkin's lymphoma. Racial/ethnic gradients were not entirely explained by neighborhood SES. In California, etiologically relevant exposures for young adult Hodgkin's lymphoma, the most common form, could associate more with race/ethnicity or foreign birthplace than neighborhood SES and may be modified by reproductive or other sex-specific factors.

    View details for Web of Science ID 000229766600019

    View details for PubMedID 15941953

  • Impact of intercensal population projections and error of closure on breast cancer surveillance: examples from 10 California counties BREAST CANCER RESEARCH Phipps, A. I., Clarke, C. A., Ereman, R. R. 2005; 7 (5): R655-R660

    Abstract

    In 2001, data from the California Cancer Registry suggested that breast cancer incidence rates among non-Hispanic white (nHW) women in Marin County, California, had increased almost 60% between 1991 and 1999. This analysis examines the extent to which these and other breast cancer incidence trends could have been impacted by bias in intercensal population projections.We obtained population projections for the year 2000 projected from the 1990 census from the California Department of Finance (DOF) and population counts from the 2000 US Census for nHW women living in 10 California counties and quantified age-specific differences in counts. We also computed age-adjusted incidence rates of invasive breast cancer in order to examine and quantify the impact of differences between the population data sources.Differences between year 2000 DOF projections and year 2000 census counts varied by county and age and ranged from underestimates of 60% to overestimates of 64%. For Marin County, the DOF underestimated the number of nHW women aged 45 to 64 years by 32% compared to the 2000 US census. This difference produced a significant 22% discrepancy between breast cancer incidence rates calculated using the two population data sources. In Los Angeles and Santa Clara counties, DOF-based incidence rates were significantly lower than rates based on census data. Rates did not differ significantly by population data source in the remaining seven counties examined.Although year 2000 population estimates from the DOF did not differ markedly from census counts at the state or county levels, greater discrepancies were observed for race-stratified, age-specific groups within counties. Because breast cancer incidence rates must be calculated with age-specific data, differences between population data sources at the age-race level may lead to mis-estimation of breast cancer incidence rates in county populations affected by these differences, as was observed in Marin County. Although intercensal rates based on population projections are important for timely breast cancer surveillance, these rates are prone to bias due to the error of closure between population projections and decennial census population counts. Intercensal rates should be interpreted with this potential bias in mind.

    View details for DOI 10.1186/bcr1266

    View details for Web of Science ID 000232332200023

    View details for PubMedID 16168110

  • Attenuation of social class and reproductive risk factor associations for Hodgkin lymphoma due to selection bias in controls CANCER CAUSES & CONTROL Glaser, S. L., Clarke, C. A., Keegan, T. H., Gomez, S. L., Nugent, R. A., Topol, B., Stearns, C. B., Stewart, S. L. 2004; 15 (7): 731-739

    Abstract

    Hodgkin lymphoma (HL) risk has been linked with higher social class and lower parity, but our prior population-based case-control study in adult women had unexpected null findings for these variables. Because subject participation was 87% for cases but 65% for random digit-dialing (RDD) controls, we examined representativeness of our controls and the impact of detected bias on prior results.Using data from RDD enumeration, abbreviated interviews with nonparticipating controls, and the US census, we compared participating and nonparticipating RDD controls across several age groups and then recomputed odds ratios for risk factor associations adjusted for bias.The 325 RDD control participants were younger, more likely to be white, better educated, and of lower birth order and lower parity than the nonparticipants. Adjustment of odds ratios for bias strengthened previously null findings for education and for parity, breast-feeding and miscarriages in young adult women; these latter changes eliminated previously apparent age modification of risks.Selection bias in female RDD controls resulted from differential participation by socioeconomic factors, varied with age, and produced underestimations of several associations in young women, including reproductive factors. Thus, our prior conclusions of etiologic irrelevance for some study variables may have been inaccurate.

    View details for Web of Science ID 000223620900011

    View details for PubMedID 15280631

  • Population-based surveillance of HIV-associated cancers: utility of cancer registry data JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES Clarke, C. A., Glaser, S. L. 2004; 36 (5): 1083-1091

    Abstract

    Long-term cancer risks are uncertain in HIV-infected persons, particularly those using highly active antiretroviral therapy (HAART). Timely, population-based surveillance of HIV-associated malignancies in the United States has been challenging because of various data inadequacies. Cancer registries represent a resource for this surveillance, if uncertainties around accurate differentiation of HIV-associated and unassociated cancers can be resolved. To inform the utility of cancer registry data for classifying and monitoring HIV-associated cancers, the completeness and quality of cancer registry-available information about patient HIV status was assessed. For all 10,126 non-Hodgkin lymphomas (NHLs), 1497 Hodgkin lymphomas (HLs), and 895 anal cancers reported to the Greater San Francisco Bay Area registry during 1990-1998, 6 indicators of patient HIV status were retrieved from 2 cancer registry-available sources (cancer registry records, death records) and from linkage with the California AIDS registry. Cross-tabulations were used to examine the distributions of patients with evidence of positive HIV status by indicator and source. Together, 5 cancer registry-available HIV indicators identified 25% more presumed HIV-positive NHL patients and nearly 50% more HL and anal cancer patients than were detected by AIDS registry linkage. Eighty-three percent of NHL patients and at least half of HL and anal cancer patients were identified by multiple sources of HIV indicators, and most individual indicators agreed acceptably with others. However, optimal strategies for classifying HIV-associated patients differed by cancer site. At least in this region, cancer registry data represent a useful resource for monitoring HIV-associated lymphomas and anal cancer and may offer benefits over linkage-based means in the age of HAART.

    View details for Web of Science ID 000222974300012

    View details for PubMedID 15247562

  • Smoking and Hodgkin lymphoma risk in women United States CANCER CAUSES & CONTROL Glaser, S. L., Keegan, T. H., Clarke, C. A., Darrow, L. A., Gomez, S. L., Dorfman, R. F., Mann, R. B., DiGiuseppe, J. A., Ambinder, R. F. 2004; 15 (4): 387-397

    Abstract

    Smoking has received little consideration as a risk factor for Hodgkin lymphoma (HL) in women, despite recent significant findings in men and gender differences in HL incidence. We investigated the association of HL with lifetime cigarette smoking and household environmental tobacco smoke (ETS) exposure in women.In data from a population-based case-control study in women ages 19-79, we analyzed HL risk associated with self-reported smoking and household ETS exposure in 312 diagnostically re-reviewed cases and 325 random-digit dialing controls using logistic regression. Epstein-Barr virus (EBV) presence was determined in tumors of 269 cases.In 253 cases compared to 254 controls ages 19-44, risks of HL overall, and of nodular sclerosis and EBV-negative HL, were increased 50% with ETS exposure in childhood; for 11 cases of mixed cellularity (MC) HL, current smoking and adult ETS exposure also increased risk; for 24 cases of EBV-positive HL, risk was elevated for current smoking, greater smoking intensity and duration, and ETS exposure. In 59 cases and 71 controls ages 45-79, most smoking characteristics did not appear to affect risk.Apparent effects of current smoking on risks of MC HL and EBV-positive HL and of household ETS on risk of all HL in young adult females may broaden the evidence implicating tobacco smoke exposures in HL etiology.

    View details for Web of Science ID 000221360300006

    View details for PubMedID 15141139

  • Expert review of non-Hodgkin's lymphomas in a population-based cancer registry: Reliability of diagnosis and subtype classifications CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION Clarke, C. A., Glaser, S. L., Dorfman, R. F., Bracci, P. M., Eberle, E., Holly, E. A. 2004; 13 (1): 138-143

    Abstract

    Incidence rates of non-Hodgkin's lymphomas (NHLs) have nearly doubled in recent decades. Understanding the reasons behind these trends will require detailed surveillance and epidemiological study of NHL subtypes in large populations, using cancer registry or other multicenter data. However, little is known regarding the reliability of NHL diagnosis and subtype classification in such data, despite implications for the accuracy of incidence statistics and studies. Expert pathological re-review was completed for 1526 NHL patients who were reported to the Greater Bay Area Cancer Registry and who participated in a large population-based case-control study. Agreement of registry diagnosis with expert diagnosis and with International Classification of Diseases for Oncology-2 (Working Formulation) subtype classifications was measured with positive predictive values and kappa statistics. Agreement of registry and expert diagnoses was high (98%). Thirty patients were found on review not to have NHL; most of these had leukemia. For subtypes, agreement of registry and expert classification was more moderate (59%). Agreement varied substantially by subtype from 5% to 100% and was 77% for the most common subtype, diffuse large cell lymphoma. Seventy-seven percent of 128 registry-unclassified lymphomas were assigned a subtype on re-review. Our analyses suggest excellent diagnostic reliability but poorer subtype reliability of NHL in cancer registry data information that is critical to the interpretation of lymphoma time trends. Thus, overall NHL incidence and survival statistics from the early 1990s are probably accurate, but subtype-specific statistics could be substantially biased, especially because of high (15-20%) proportions of unclassified lymphomas.

    View details for Web of Science ID 000188438300023

    View details for PubMedID 14744745

  • Geographic excess of estrogen receptor-positive breast cancer CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION Benz, C. C., Clarke, C. A., Moore, D. H. 2003; 12 (12): 1523-1527

    Abstract

    Elevated and more rapidly increasing breast cancer incidence rates have been described for Marin County, California (CA), a homogeneous, high socioeconomic status population for which yearly surveillance is facilitated by its status as a county. The present study evaluates the histology and hormonal phenotype of the excess breast cancer cases occurring in white, non-Hispanic women living in Marin County between 1992 and 2000 and compares them with patterns occurring in the rest of the San Francisco Bay Area (SFBA) and other urban parts of CA. Incidence data for invasive breast cancer histological subtypes and estrogen receptor (ER) and progesterone receptor (PR) status were obtained from the 1992-2000 Surveillance, Epidemiology, and End Results program. Expected numbers for Marin County were computed based on age-specific rates for five other SFBA counties. Incidence rates were age-adjusted to the 2000 United States standard. Marin County breast cancer diagnoses during 1992-2000 compared with other SFBA and other urban CA Surveillance, Epidemiology, and End Results county rates for white, non-Hispanic women consisted of a disproportionate increase in ER+/PR+ tumors. The observed absolute excess (versus expected) numbers of Marin County ER+/PR+ lobular and nonlobular (predominantly ductal) cases were similar; however, the relative increase appeared greatest for lobular breast cancer. The progressive increase in breast cancer incidence rates observed in Marin County over the past decade is occurring in women with high prevalence of risk factors predisposing toward excess development of ER+/PR+ breast cancer.

    View details for Web of Science ID 000187575900021

    View details for PubMedID 14693747

  • Reproductive factors in Hodgkin's disease in women AMERICAN JOURNAL OF EPIDEMIOLOGY Glaser, S. L., Clarke, C. A., Nugent, R. A., Stearns, C. B., Dorfman, R. F. 2003; 158 (6): 553-563

    Abstract

    Reproductive factors have been suggested to have an impact on the development of Hodgkin's disease (HD) in women. In the San Francisco Bay Area, the authors conducted a population-based case-control study addressing the effects of reproductive experience and hormone use on HD risk. Cases were 370 women with HD diagnosed at ages 19-79 years between July 1988 and December 1994. Controls were 450 community women found through random digit dialing. Among the 312 cases and 325 controls interviewed, HD risk was related to parity versus nulliparity but only among never nursers (odds ratio (OR)=2.2, 95% confidence interval (CI): 1.0, 5.0). Risk was marginally related to having uterine fibroids (OR=0.6, 95% CI: 0.5, 1.0) and long-term versus short-term hormone use (OR=0.7, 95% CI: 0.4, 1.0) and was significantly related to recurrent miscarriage (OR=2.8, 95% CI: 1.1, 7.4). Among women aged 35-54 years, for whom the sex difference in incidence is largest, nursing decreased risk; among never nursers, a parity of 1 lowered risk and higher parity increased risk; long-term hormone use lowered risk; and recurrent miscarriage increased risk. Among women under age 35 years, endometriosis lowered HD risk; the lack of significant findings for most other variables may reflect selection bias in controls. Among older women, no significant associations were observed, although hormone use appeared to be protective. These data suggest that steroid hormones may affect HD development.

    View details for DOI 10.1093/aje/kwg198

    View details for Web of Science ID 000185310800008

    View details for PubMedID 12965881

  • Population-based patterns of human immunodeficiency virus-related Hodgkin lymphoma in the greater San Francisco Bay Area, 1988-1998 CANCER Glaser, S. L., Clarke, C. A., Gulley, M. L., Craig, F. E., DiGiuseppe, J. A., Dorfman, R. F., Mann, R. B., Ambinder, R. F. 2003; 98 (2): 300-309

    Abstract

    Epidemiologic characteristics of human immunodeficiency virus (HIV)-related Hodgkin lymphoma (HL) have not been examined in the Greater San Francisco Bay Area, a center of the HIV/acquired immunodeficiency syndrome (AIDS) epidemic, for a decade, despite changes in AIDS-associated diseases after the availability of highly active antiretroviral therapies (HAART).With population-based cancer registry data for 1988-1998, the authors examined risk factors, Epstein-Barr virus (EBV) association, incidence rates, and survival probabilities for 1752 patients with HL who were classified as HIV-positive or HIV-negative by a cancer registry-based method.One hundred twenty-eight patients with HL (7%) were classified with HIV/AIDS; 95% were male. Among males, multivariate analysis (n=514 patients) found that HIV-related HL was associated strongly at diagnosis with ages 30-49 years, San Francisco residence, late-stage disease, lymphocyte depletion and unspecified histologic subtypes, and tumor cell EBV but not with other clinical features or mixed cellularity histology. Survival among patients with HIV-related HL, although it was poor, did not differ by race/ethnicity but was worse for patients with the nonnodular sclerosis histologic subtypes. Patients who were HIV-positive with HAART era (1996-1998) diagnoses were slightly older, were less likely to live in San Francisco, and were much more likely to be Hispanic compared with HIV-positive patients who were diagnosed before the HAART era; they had somewhat less aggressive disease and better survival. Incidence rates were higher for patients with HL overall compared with patients who had HIV-unrelated HL by 11% for white patients, 22% for black patients, and by 14% for Hispanic patients; excesses were greater in young adults.Among males in the San Francisco Bay Area, HIV-related HL had distinctive demographic features, more aggressive clinical characteristics, stronger EBV association, and poorer survival and contributed to elevated regional HL incidence rates, particularly in young adults. Patients with HIV-related HL who were diagnosed after HAART was introduced appeared to have less aggressive disease and better survival.

    View details for DOI 10.1002/cncr.11459

    View details for Web of Science ID 000183944300013

    View details for PubMedID 12872349

  • Hodgkin's disease etiology and novel viruses: Clues from groups exposed to blood products INTERNATIONAL JOURNAL OF CANCER Glaser, S. L., Clarke, C. A., Darrow, L. A. 2003; 104 (6): 796-797

    View details for DOI 10.1002/ijc.11005

    View details for Web of Science ID 000182214900020

    View details for PubMedID 12640690

  • Cancer survival in US racial/ethnic groups: Heterogeneity among Asian ethnic subgroups ARCHIVES OF INTERNAL MEDICINE Gomez, S. L., Clarke, C. A., Glaser, S. L. 2003; 163 (5): 631-632

    View details for Web of Science ID 000181561000018

    View details for PubMedID 12622614

  • Cancer incidence patterns in Koreans in the US and in Kangwha, South Korea CANCER CAUSES & CONTROL Gomez, S. L., Le, G. M., Clarke, C. A., Glaser, S. L., France, A. M., West, D. W. 2003; 14 (2): 167-174

    Abstract

    In the US, Koreans are a rapidly growing group and comprised 10.5% of the total Asian population as of 2000. However, little has been published regarding cancer patterns in this subpopulation.Using data from the Surveillance, Epidemiology, and End Results program, the California Cancer Registry, and the International Association for Research on Cancer, we compared age-adjusted and age-specific incidence rates for cancers of the prostate, breast, cervix, lung, colon, rectum, stomach, liver, and esophagus in US Koreans with rates of these cancers in residents of Kangwha, South Korea, and in US whites as a reference.While the most frequently diagnosed cancer was lung among US Korean males and breast among US Korean females, it was stomach cancer for both sexes in Kangwha. Rates of prostate, breast, and colon cancer were considerably higher for Koreans in the US than in Kangwha, but were not as high as in whites. Cervical and stomach cancers showed the opposite racial/ethnic pattern, with rates highest in Kangwha, intermediate among US Koreans, and lowest among whites. Rates of rectal cancer in females and esophageal cancer in males were two-times higher in Kangwha than in US Koreans but esophageal cancer rates were similar between US Koreans and whites. Liver cancer rates were similar between Kangwha residents and US Koreans, but nearly 10-times lower among whites.Although these comparisons may have methodologic limitations, including data quality and racial/ethnic misclassification, the differences seen in migrant and native Koreans for some cancers warrant further investigation in this growing subpopulation.

    View details for Web of Science ID 000182447400008

    View details for PubMedID 12749722

  • Existing data on breast cancer in African-American women: what we know and what we need to know. Cancer Clarke, C. A., West, D. W., Edwards, B. K., Figgs, L. W., Kerner, J., Schwartz, A. G. 2003; 97 (1): 211-221

    Abstract

    Much of what is known about breast cancer in African-American (AA) women is based on existing cancer surveillance data. Thus, it is important to consider the accuracy of these resources in describing the impact of breast cancer in AA populations.National cancer surveillance data bases are described, their most recent findings are presented, their limitations are outlined, and recommendations are made for improving their utility.Breast cancer characteristics have been studied well in urban (but not in rural) and Southern AA populations. The recent Surveillance, Epidemiology, and End Results (SEER) Program expansion and the continued improvement of state cancer registry operations will provide opportunities to study larger and more diverse AA subpopulations. Recommendations for improving the utility of surveillance data bases include adding new items to better describe correlates of advanced stage at diagnosis and reduced survival of AA women with breast cancer by linking surveillance data bases with other large data bases to provide area-level socioeconomic status, health insurance status, and retrieving new information about patient comorbidities and biomarkers from medical records; improving the completeness and accuracy of treatment and survival information already collected for all patients; working to improve the dissemination of appropriate cancer data to nonresearch consumer communities, including clinicians, patients, advocates, politicians, and health officials; and the development of new training programs for cancer registrars and researchers.The continued improvement of cancer surveillance systems should be considered important activities in this research agenda, because these data will play a far-reaching role in the prevention and control of breast cancer in AA women.

    View details for PubMedID 12491484

  • Cancer incidence patterns among Vietnamese in the United States and Ha Noi, Vietnam INTERNATIONAL JOURNAL OF CANCER Le, G. M., Gomez, S. L., Clarke, C. A., Glaser, S. L., West, D. W. 2002; 102 (4): 412-417

    Abstract

    Nearly 600,000 persons have immigrated to the United States from Vietnam since the end of the Vietnam War. Despite the rapid growth of the U.S. Vietnamese population, little is known about cancer incidence in this migrant group. Using population-based data from the Surveillance, Epidemiology and End Results program, California Cancer Registry and International Agency for Research on Cancer, we compared cancer incidence rates for Vietnamese in the United States (1988-1992) to rates for residents of Ha Noi, Vietnam (1991-1993); non-Hispanic whites were included to serve as the U.S. reference rates. Lung and breast cancers were the most common among Vietnamese males and females, respectively, regardless of geographic region. Rates of cancers more common to U.S. whites, such as breast, prostate and colon cancers, were elevated for U.S. Vietnamese compared to residents in Ha Noi but still lower than rates for U.S. whites. Rates of cancers more common to Asian countries, such as stomach, liver, lung and cervical cancers, were likewise elevated for U.S. Vietnamese compared to residents of Ha Noi and exceeded corresponding rates for whites. Incidence patterns for stomach, liver, lung and cervical cancers may reflect increased risk of exposures in this migrant population and should be further explored to uncover the relative contributions of environmental and genetic factors to cancer etiology.

    View details for DOI 10.1002/ijc.10725

    View details for Web of Science ID 000179013100015

    View details for PubMedID 12402312

  • Studying cancer incidence and outcomes in immigrants: Methodological concerns AMERICAN JOURNAL OF PUBLIC HEALTH Lin, S. S., Clarke, C. A., O'Malley, C. D., Le, G. M. 2002; 92 (11): 1757-1759

    View details for Web of Science ID 000178868600022

    View details for PubMedID 12406802

  • Increase in breast cancer incidence in middle-aged women during the 1990s ANNALS OF EPIDEMIOLOGY Prehn, A. W., Clarke, C., Topol, B., Glaser, S., West, D. 2002; 12 (7): 476-481

    Abstract

    The San Francisco Bay Area has a history of high breast cancer incidence rates relative to the rest of the United States. For Marin County, where Bay Area rates are highest and, moreover, have continued to increase over time, age- and tumor-specific incidence trends were compared with the rest of the region.The study included all white women diagnosed with invasive breast cancer in 1988 to 1997 in the five-county Bay Area (N = 19807). Annual age-specific incidence rates and estimated annual percent changes (EAPCs) were calculated for women ages less than 45, 45 to 64, and greater than or equal to age 65.Women aged 45 to 64 from Marin County experienced a marked increase in breast cancer rates between 1991 and 1997 (EAPC = 8%, p = 0.02), regardless of disease stage or tumor histology. For the youngest and oldest women, no rate differences were observed by region or over time.This regional difference in trend by age did not appear to be due to screening mammography or environmental exposures. Cohort exposures to breast cancer risk factors, such as oral contraceptive and/or hormone replacement therapy use, may have contributed to these rate increases. Although the reasons remain unclear, the finding may signal a rising risk of breast cancer in this demographic group.

    View details for Web of Science ID 000178041400006

    View details for PubMedID 12377425

  • Birthplace and survival among Asian women diagnosed with breast cancer in cancer registry data: the impact of selection bias INTERNATIONAL JOURNAL OF EPIDEMIOLOGY Lin, S. S., O'Malley, C. D., Clarke, C. A., Le, G. M. 2002; 31 (2): 511-513

    View details for Web of Science ID 000175882500049

    View details for PubMedID 11980831

  • Changing incidence of non-Hodgkin lymphomas in the United States CANCER Clarke, C. A., Glaser, S. L. 2002; 94 (7): 2015-2023

    Abstract

    The incidence of non-Hodgkin lymphoma (NHL) has been rising in many regions and populations during the last few decades. Data from the Surveillance, Epidemiology, and End Results (SEER) Program show that age-adjusted rates of NHL increased through the 1980s but leveled off in the 1990s.To determine whether the incidence of NHL stabilized in all population subgroups, particularly in age-defined groups with distinctive risks of NHL, the authors investigated trends in NHL incidence among persons aged 0-14 years, 15-24 years, 25-34 years, 35-44 years, 45-54 years, 55-64 years, 65-74 years, and > 75 years by gender and race using 1973-1998 data from the SEER Program, which covered approximately 10% of the U.S. population. Joinpoint regression was used to assess changes in trends across the period.NHL incidence trends changed significantly among males aged 25-54 years, in whom rates began to decrease (6-16% per year) in the middle to late 1990s, as well as among most whites aged > or = 55 years, in whom rate increases slowed from 3-4% to 1-2% per year in the late 1980s. Incidence trends were steady in other groups, with uniform increases among whites aged 15-24 years (2-3% per year), women aged 25-54 years (1-6% per year), and blacks aged > or = 55 years (2-4% per year). Although recent age specific incidence rates were generally higher in males compared with females and in whites compared with blacks, among males aged 25-54 years, rates were significantly higher in black males compared with white males.There have been changes in the demographic groups impacted by NHL. The trends for human immunodeficiency virus probably are related to recent decreases in NHL incidence among males aged 25-54 years. The rate change in the older white population is unexplained but represents both an alleviation of the burden of NHL in this population and a potential opportunity to generate hypotheses regarding risk factors for the development of NHL.

    View details for DOI 10.1002/cncr.10403

    View details for Web of Science ID 000174717700015

    View details for PubMedID 11932904

  • Social class and risk of Hodgkin's disease in young-adult women in 1988-94 INTERNATIONAL JOURNAL OF CANCER Glaser, S. L., Clarke, C. A., Nugent, R. A., Stearns, C. B., Dorfman, R. F. 2002; 98 (1): 110-117

    Abstract

    Hodgkin's disease (HD) risk in young adults has been associated with higher childhood social class. Although recent decades have witnessed increases in both young-adult HD incidence rates and the socioeconomic affluence reported to influence risk, social class risk factors have not been reexamined. For 204 cases and 254 controls aged 19-44 years from a population-based case-control study of HD diagnosed in 1988-94 in San Francisco area females, we evaluated social class predictors of HD overall and for subgroups defined by age and by ethnicity. HD was associated weakly with a few childhood social class markers but more strongly with combinations of these variables. Risk was higher for women with family-owned than rented childhood homes; for US-born women with single vs. shared bedrooms at age 11; and for women with 2+ births who were from smaller than larger childhood households. These patterns differed by age, with risk appearing to increase over the young-adult years for some factors and to decrease for others. In whites, risk was additionally associated with having a single childhood bedroom in larger households, and with tall adult height in women from smaller childhood households. In nonwhites, risk was higher for single bedrooms at age 11 in smaller childhood households, taller height and higher maternal education. Most study findings support the hypothesis that HD development in young adults follows protection from early exposure to other children. Variation in risk by age suggests differing etiologies across young adulthood, or the importance of birth cohort-appropriate social-class measures. Negative findings for previously reported risk factors may reflect their insufficient heterogeneity of exposure or their failure to measure cohort-relevant exposures in this population.

    View details for DOI 10.1002/ijc.10164

    View details for Web of Science ID 000173616200019

    View details for PubMedID 11857394

  • Breast cancer incidence and mortality trends in an affluent population: Marin County, California, USA, 1990-1999 BREAST CANCER RESEARCH Clarke, C. A., Glaser, S. L., West, D. W., Ereman, R. R., Erdmann, C. A., Barlow, J. M., Wrensch, M. R. 2002; 4 (6)

    Abstract

    Elevated rates of breast cancer in affluent Marin County, California, were first reported in the early 1990s. These rates have since been related to higher regional prevalence of known breast cancer risk factors, including low parity, education, and income. Close surveillance of Marin County breast cancer trends has nevertheless continued, in part because distinctive breast cancer patterns in well-defined populations may inform understanding of breast cancer etiology.Using the most recent incidence and mortality data available from the California Cancer Registry, we examined rates and trends for 1990-1999 for invasive breast cancer among non-Hispanic, white women in Marin County, in other San Francisco Bay Area counties, and in other urban California counties. Rates were age adjusted to the 2000 US standard, and temporal changes were evaluated with weighted linear regression.Marin County breast cancer incidence rates between 1990 and 1999 increased 3.6% per year (95% confidence interval, 1.8-5.5), six times more rapidly than in comparison areas. The increase was limited to women aged 45-64 years, in whom rates increased at 6.7% per year (95% confidence interval, 3.8-9.6). Mortality rates did not change significantly in Marin County despite 3-5% yearly declines elsewhere.Patterns of breast cancer incidence and mortality in Marin County are unlike those in other California counties, and they are probably explained by Marin County's unique sociodemographic characteristics. Similar trends may have occurred in other affluent populations for which available data do not permit annual monitoring of cancer occurrence.

    View details for Web of Science ID 000178822900002

    View details for PubMedID 12473174

  • Age-specific survival after Hodgkin's disease in a population-based cohort (United States) CANCER CAUSES & CONTROL Clarke, C. A., Glaser, S. L., Prehn, A. W. 2001; 12 (9): 803-812

    Abstract

    To examine risk factors for disease-specific survival in young and older adults diagnosed with Hodgkin's disease (HD) in a representative case series of adequate size for detecting effect modification by age group.For 5630 young adults (ages 15-44) and 2424 older adults (ages 45 and older) diagnosed with HD and reported to the population-based Surveillance, Epidemiology, and End Results program of the National Cancer Institute between 1983 and 1995, Kaplan-Meier survival curves were constructed and Cox proportional hazards regression used to evaluate the influences of age, sex, race/ethnicity, histologic subtype, Ann Arbor stage at diagnosis, and calendar year on hazard of disease-specific death.The effects of most previously studied risk factors for HD death were different for young and older adults. Age was not associated with disease-specific survival in young adults, but in older adults, 1-year increases in age elevated the relative hazard of HD death by 4 6%. Male sex was related to outcome in young but not older adults, and Ann Arbor stage and B-symptom status exhibited markedly different relationships to survival by age. Older adult patients with and without B-symptoms had different hazards of mortality and had to be assessed separately.Factors associated with disease-specific survival were different for young and older adults with HD. These findings provide further support for two etiologically and clinically distinct disease entities.

    View details for Web of Science ID 000171398000005

    View details for PubMedID 11714108

  • Changing incidence of Kaposi's sarcoma and non-Hodgkin's lymphoma among young men in San Francisco AIDS Clarke, C. A. 2001; 15 (14): 1913-1915

    View details for Web of Science ID 000171375100035

    View details for PubMedID 11579268

  • Epidemiologic trends in HIV-associated lymphomas CURRENT OPINION IN ONCOLOGY Clarke, C. A., Glaser, S. L. 2001; 13 (5): 354-359

    Abstract

    Infection with HIV increases the risk of developing non-Hodgkin lymphoma and, to a lesser extent, Hodgkin disease. The introduction of highly active antiretroviral therapy (HAART) in 1996 changed the natural history of HIV disease, but the HIV-infected population also has changed in composition. Accordingly, the epidemiology of HIV-associated lymphomas now differs from that observed in the first 15 years of the HIV epidemic. In populations with access to HAART, reductions in lymphoma risk have been reported for NHL and suggested for Hodgkin disease, but long-term risks are as yet unknown. Lymphomas are increasingly common cancers in persons with HIV and are fatal in most patients, warranting continued attention to their incidence and etiology.

    View details for Web of Science ID 000170664400007

    View details for PubMedID 11555712

  • Age variation in Hodgkin's disease risk factors in older women: Evidence from a population-based case-control study LEUKEMIA & LYMPHOMA Glaser, S. L., Clarke, C. A., Stearns, C. B., Dorfman, R. F. 2001; 42 (5): 997-1004

    Abstract

    Hodgkin's disease (HD), which affects all age groups, has been associated with childhood social class, particularly among adults under age 40. Little is known about social class risk factors in older adults, and the few existing studies have conflicting findings. As part of a population-based case-control study of HD in women, we examined social class risk factors by diagnostic age groups (45-54 years and 55-79 years) corresponding to incidence patterns and by histologic subtypes based on a uniform pathologic review. Among women ages 45-54, cases were more likely to be Catholic, to have lower income and to be taller than controls. Among women ages 55-79, cases tended to have come from small or large childhood households, lived in single-family childhood housing, and had a single rather than shared bedroom at age 11. For the nodular sclerosis (NS) histologic subtype, similar age differences in risk factors were apparent. Comparisons between the NS and non-NS subtypes in women ages 55-79 identified some common risk factors (single-family childhood home, single bedroom at age 11) but others specific to one subtype (childhood household size, adult height for NS; lower maternal education for non-NS). Thus, some social class associations with HD differed between middle-aged and older women, as well as between these groups and younger adults, while others were shared across age groups. Risk also was associated with both higher and lower childhood social class in middle-aged and older women, in contrast with previous findings. None of these patterns was explained entirely by histologic subtype but may reflect age and histology subtype variation in the HD-EBV association.

    View details for Web of Science ID 000170723700018

    View details for PubMedID 11697655

  • Expert review of the diagnosis and histologic classification of Hodgkin disease in a population-based cancer registry - Interobserver reliability and impact on incidence and survival rates CANCER Glaser, S. L., Dorfman, R. F., Clarke, C. A. 2001; 92 (2): 218-224

    Abstract

    The reliability of Hodgkin disease (HD) diagnosis and histologic classification is an ongoing concern but has not been evaluated in a population-based case series in 20 years. Yet, diagnostic error in cancer registry data used in surveying HD occurrence may produce statistics that misrepresent incidence, mortality, or survival.Uniform pathology review was attempted for all 395 women ages 19--79 years with incident HD reported to a population-based cancer registry in 1988--94. Agreement between original registry and review diagnoses was measured with positive predictive values and kappa statistics. Incidence rates and survival probabilities were computed based on registry and review diagnoses.Registry and review diagnosis agreed for 245 of the 362 reviewed cases. Positive predictive values varied by histologic subtype (nodular sclerosis, 95%; lymphocyte predominance, 69%; mixed cellularity, 58%; lymphocyte depletion, 0%; not otherwise specified, 40%), but agreement was good overall (kappa, 0.66, 95% confidence interval, 0.56--0.76). Eleven patients were determined not to have HD; all were older than age 44 years. Hodgkin disease incidence rates differed for original and review diagnoses only in older women, for whom registry rates slightly overestimated incidence. Five-year survival rates did not differ for registry and review data overall or by age group.For most adult women patients, the diagnosis of HD was confirmed on review, reflecting the very good agreement between registry and review diagnoses for nodular sclerosis, the most common subtype. Thus, cancer registry statistics for this time period can provide accurate estimates of disease patterns for HD overall and for the nodular sclerosis variant. For other histologic subtypes, rates may be unreliable, and HD occurrence overall may be less dependable in populations with larger proportions of these subtypes.

    View details for Web of Science ID 000169943900002

    View details for PubMedID 11466672

  • Acute myeloid leukemia. NEW ENGLAND JOURNAL OF MEDICINE Clarke, C. A., Glaser, S. L. 2000; 342 (5): 358-358

    View details for Web of Science ID 000085070300023

    View details for PubMedID 10660402

Conference Proceedings


  • Survival differences among Asian subpopulations in the United States after prostate, colorectal, breast, and cervical carcinomas Lin, S. S., Clarke, C. A., Prehn, A. W., Glaser, S. L., West, D. W., O'Malley, C. D. JOHN WILEY & SONS INC. 2002: 1175-1182

    Abstract

    Information is limited for Asian subgroups regarding survival after diagnosis of the common cancers amenable to routine screening. The authors examined survival after carcinomas of the prostate, colon/rectum, breast, and cervix separately for Chinese, Japanese, Filipinos, and non-Hispanic whites in the United States.Using data from the Surveillance, Epidemiology, and End Results program, the authors compared the distributions of stage at diagnosis and computed 5-year cause specific survival probabilities, overall and by stage of disease, for cancer patients whose diagnosis was in 1988-1994 and who were observed through 1997.Among males, Filipinos were more likely to be diagnosed with advanced stage colorectal and prostate carcinomas than other Asians and non-Hispanic whites; they also experienced worse survival after these cancers. This survival deficit occurred across all stages of colorectal carcinoma and remained apparent within distant stage prostate carcinoma. Among females, Chinese were less likely to receive diagnoses of early stage colorectal carcinoma than Japanese and Filipinas. In addition, their survival was consistently lower across more advanced stages of disease. Chinese also experienced somewhat worse survival after diagnosis of early stage cervical carcinoma. Japanese were more likely to be diagnosed with early stage carcinomas but also tended to experience better survival after prostate, colorectal, and breast carcinomas regardless of stage.Chinese, Japanese, and Filipinos experienced unequal survival after these screenable carcinomas, indicating that certain groups may benefit from more aggressive screening efforts. The heterogeneity of cancer outcomes observed within the community classified as Asian reinforces the need for cancer statistics to be reported for disaggregated subgroups.

    View details for DOI 10.1002/cncr.10319

    View details for Web of Science ID 000173907600037

    View details for PubMedID 11920489

  • Epstein-Barr virus and survival after Hodgkin disease in a population-based series of women Clarke, C. A., Glaser, S. L., Dorfman, R. F., Mann, R., DiGiuseppe, J. A., Prehn, A. W., Ambinder, R. F. JOHN WILEY & SONS INC. 2001: 1579-1587

    Abstract

    Epstein-Barr virus (EBV) positive Hodgkin disease (HD), as defined by the presence of EBV genes or gene products in the malignant cells, differs epidemiologically from EBV negative HD. However, survival patterns for EBV-defined HD have not been well studied. To determine if EBV status influenced survival time after HD, the authors investigated a large, population-based series of female patients.For 311 female patients living in the Greater San Francisco Bay Area who were aged 19-79 years with HD diagnosed between mid-1988 and 1994, histopathologically rereviewed archived biopsy specimens were assayed for EBV with immunohistochemistry and in situ hybridization. The 53 subjects with EBV positive and the 258 with EBV negative HD were observed for vital status through 1998; overall survival was analyzed with Kaplan-Meier and Cox proportional hazards regression methods.Epstein-Barr virus positive HD patients were older, received diagnosis at a later stage, and were less likely to have nodular sclerosis histology than EBV negative patients. Deaths were reported for 21 (40%) EBV positive and 37 (14%) EBV negative patients. No survival differences were observed between EBV positive and negative women aged 19-44 years, but survival was significantly poorer in women aged 45-79 years with EBV positive HD. Regression analysis confirmed this strong negative effect of EBV positive status on survival (hazard ratio for death, 3.0; 95% confidence interval, 1.5-6.2) as unrelated to age, stage at diagnosis, or tumor histology.This study found a marked survival disadvantage for EBV positive HD in older but not young adult women. These findings suggest influences of both EBV status and age on HD survival, as well as pathogenesis.

    View details for Web of Science ID 000168081200024

    View details for PubMedID 11301409

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