Introduction: Spatial, temporal and racial patterns of cancer remain largely unexplained in the United States. Time trends of cancer incidence and mortality can be used to estimate the current cancer burden, anticipate clinical care needs, and suggest hypotheses regarding possible etiologic explanations for underlying trends. Methods: Using U.S. 1979-2003 cancer incidence and 1969-2003 cancer mortality data, age-period-cohort and Joinpoint regression models were fit to summarize gender- and race-specific temporal trends for three broad cancer categories that include tobacco-related cancer, screen-detectable cancer, and cancer unrelated to tobacco and screening. Demographic patterns and time trends of non-Hodgkins lymphoma (NHL) incidence between Pennsylvania and the U.S. from 1985 to 2004 were compared. Using Idaho cancer incidence, 1990-2005, and arsenic levels in ground water, 1990-2005, spatial analysis was conducted to identify geographic patterns of cancer incidence and to evaluate the relationship between arsenic exposure in ground water and cancer incidence in Idaho. Results: Over the last three decades, tobacco-related cancer incidence declined among men and increased among women. Screen-detectable cancer incidence increased, more rapidly among men than women. For cancer unrelated to tobacco and screening, incidence increased in every gender-and-race group. Though not identical, NHL incidence patterns, with substantial increases, were similar in the U.S. and Pennsylvania. NHL incidence was higher in Pennsylvania counties with a greater percentage of urban residents. Although spatial clustering was demonstrated in Idaho cancer incidence, no relationship was found between arsenic exposure in ground water and Idaho cancer incidence. Conclusion: NHL and other cancers unrelated to smoking or screening have increased in the U.S. in the past two decades in white and black men and women. Etiologic research should attempt to identify modifiable risk factors, including environmental exposures, responsible for the increasing incidence of NHL and cancer unrelated to tobacco and screening. The ecologic association observed in Pennsylvania between NHL incidence and urban residence may be relevant to NHL risk in the entire United States. Additional environmental and demographic information should be evaluated in order to clarify the arsenic-related cancer risk in Idaho counties where ground water has been found to contain higher levels of arsenic. Public Health Significance: Age, period and cohort modeling of cancer incidence and mortality provides important indications of current and future health care needs and also suggests hypotheses for future research. The results of this analysis provide health professionals, researchers, and policy-makers with detailed information and an understandable overview of cancer patterns in the United States. Hypotheses should be generated about these unexplained patterns of cancer so that avoidable cancer risks can be identified that will decrease the cancer burden and associated requirements for health care.
| Identifer | oai:union.ndltd.org:PITT/oai:PITTETD:etd-08012007-161547 |
| Date | 28 September 2007 |
| Creators | Han, Yueh-Ying |
| Contributors | Bernard D. Goldstein, Gregg E. Dinse, Evelyn O.Talbott, Devra L. Davis, Joel L. Weissfeld |
| Publisher | University of Pittsburgh |
| Source Sets | University of Pittsburgh |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.library.pitt.edu/ETD/available/etd-08012007-161547/ |
| Rights | restricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to University of Pittsburgh or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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