Surveillance for Health Behaviors of American Indians and Alaska Natives—Findings From the Behavioral Risk Factor Surveillance System, 2000–2006

BACKGROUND. The authors compared estimates for cancer risk factors, use of cancer screening tests, health status indicators, and access to care for American Indians and Alaska Natives (AI/ANs) and non-Hispanic whites (NHWs) in the US and for AI/ANs in 6 Indian Health Service regions. METHODS. Behavioral Risk Factor Surveillance System data were aggregated from the years 2000 through 2006 and were used to calculate weighted prevalence estimates by gender for key variables except demographic variables. RESULTS. Compared with NHWs, AI/ANs had lower prevalence estimates for income, educational attainment, insurance coverage, and access to personal healthcare providers. AI/ANs in Alaska and NHWs had similar estimates for diabetes (approximately 6%); however, the prevalence was nearly twice as high among AI/ANs in the other regions. The prevalence of obesity was higher for AI/ ANs (29.6%) than for NHWs (20.9%). The prevalence of binge drinking was higher among AI/AN males (24.9%) than among AI/AN females (8.5%). Heavy drinking was more prevalent among NHW females (5.3%) than among AI/AN females (3.5%). AI/ANs were more likely to be current smokers (31.1%) than NHWs (22.8%). The prevalence of AI/ANs who never smoked ranged from 31.5% in Alaska to 56.9% in the Southwest. In 5 of the 6 regions, AI/AN females had lower prevalence estimates of both Papanicolaou and mammography testing than NHW females. The use of colorectal cancer screening tests was more common among NHWs (53.8%) than among AI/ANs (44%). CONCLUSIONS. Although cancer health disparities persist among AI/ANs, the current analysis indicated that variation in the prevalence of their chronic disease risk factors may be obscured when national data are not examined by smaller geographic areas such as regions

Colorectal Cancer in U.S. Adults Younger than 50 Years of Age, 1998--2001

BACKGROUND. Colorectal cancer (CRC) incidence rates are increasing among persons younger than 50 years of age, a population routinely not screened unless an individual has a high risk of CRC. This population-based study focuses primarily on describing the CRC burden for persons in this age group. METHODS. The data used for this study were derived from the National Program of Cancer Registries (NPCR) and Surveillance, Epidemiology, and End Results (SEER) surveillance systems. Age-adjusted incidence rates, rate ratios, and their corresponding 95% confidence intervals were calculated. RESULTS. CRC is ranked among the top 10 cancers occurring in males and females aged 20–49 years regardless of race. Persons younger than 50 years were more likely to present with less localized and more distant disease than do older adults. Among younger adults, age-adjusted incidence rates for poorly differentiated cancers were twice as high as rates for well-differentiated cancers. Incidence rates for poorly differentiated cancers were 60% higher than that for welldifferentiated cancers diagnosed in older adults. Rates were significantly higher for blacks and significantly lower for Asians/Pacific Islanders when compared with that for whites for the most demographic and tumor characteristics examined. CONCLUSIONS. This study confirms the findings of previous population-based studies suggesting that younger patients present with more advanced disease than do older patients. This study also identifies racial and ethnic disparities in CRC incidence in this population. These findings suggest the need for additional studies to understand the behavior and etiology of CRC in blacks

Using Population-based Cancer Registry Data to Assess the Burden of Human Papillomavirus-associated Cancers in the United States: Overview of Methods

Increased attention to human papillomavirus (HPV)-associated cancers in light of the recent release of an HPV vaccine, as well as increased availability of cancer registry data that now include reporting from a large proportion of the US population, prompted the current assessment of HPV-associated cancers. This article describes methods used to assess the burden of HPV-associated cervical, vulvar, vaginal, penile, anal, and oral cavity/oropharyngeal cancers in the United States during 1998 through 2003 using cancer registry data, and it provides a brief overview of the epidemiology of these cancers. Persistent infection with the human papillomavirus (HPV) is considered to be a cause of nearly all cervical cancer.1 It is believed that HPV also is associated with approximately 90% of anal cancers; 40% of penile, vaginal, and vulvar cancers; 25% of oral cavity cancers; and 35% of oropharyngeal cancers.2,3 A quadrivalent HPV vaccine that protects against HPV type 6 (HPV-6), HPV-11, HPV-16, and HPV-18 has been approved for use in the United States for females ages 9 years to 26 years, and a bivalent vaccine that protects against HPV-16 and HPV-18 currently is under review by the US Food and Drug Administration. It has been demonstrated that the HPV vaccine reduces the incidence of cervical, vaginal, and vulvar precancers, offering hope for the reduction in incidence of these diseases and the corresponding invasive cancers among women.4,5 Current studies are assessing the efficacy of the vaccine on HPV-associated disease in men.6 Close surveillance of these cancers will be necessary to ensure that high-risk populations are being reached by vaccination programs. Increased attention to HPV-associated cancers in light of the recent release of the vaccine, as well as increased availability of cancer registry data, prompted the current Supplement of Cancer titled ‘‘Assessing the Burden of HPV-Associated Cancers in the United States’’ (ABHACUS). The major purposes of this Supplement are to assess the current burden of anogenital and oropharyngeal cancers associated with HPV within the United States and to provide a baseline for monitoring future trends in HPV-associated cancers. This article describes methods used to assess the burden of HPV-associated cancers in the United States—methods that are common to several articles in the Supplement. This article describes the data sources, case definitions, variables, and analytic methods of descriptive epidemiologic articles that are included in this Supplement, and it provides an overall picture of the burden of HPV-associated cancers