mutations and tumor location have been associated with response to targeted therapy among patients with stage IV colorectal cancer (CRC) in various trials. This study performed the first population-based examination of associations between mutations, tumor location, and survival, and assessed factors associated with documented testing. Patients with stage IV adenocarcinoma of the colon/rectum diagnosed from 2010 to 2013 were extracted from SEER data. Analyses of patient characteristics, testing, and tumor location were conducted using logistic regression. Cox proportional hazards models assessed relationships between mutations, tumor location, and risk of all-cause death. Of 22,542 patients, 30% received testing, and 44% of these had mutations. Those tested tended to be younger, married, and metropolitan area residents, and have private insurance or Medicare. Rates of testing also varied by registry (range, 20%-46%). Patients with right-sided colon cancer (vs left-sided) tended to be older, female, and black; have mucinous, -mutant tumors; and have a greater risk of death (hazard ratio [HR], 1.27; 95% CI, 1.22-1.32). mutations were not associated with greater risk of death in the overall population; however, they were associated with greater risk of death among patients with left-sided colon cancer (HR, 1.19; 95% CI, 1.05-1.33). This large population-based study showed that among patients initially diagnosed with stage IV CRC, right-sided colon cancer was associated with greater risk of death compared with left-sided cancer, and mutations were only associated with risk of death in left-sided colon cancer. An unexpected finding was that among patients with stage IV disease, right-sided cancer was more commonly seen in black patients versus whites. Future studies should further explore these associations and determine the role of biology versus treatment differences. In addition, use of testing is increasing, but there is wide geographic variation wherein disparities related to insurance coverage and rurality may warrant further study.

The diagnosis of small tumors is occurring at greater rates in whites (vs non-whites) and insured (vs Medicaid and uninsured) patients; consequently, these groups may be vulnerable to unnecessary tests and treatments or potentially aided by early detection. Guidelines that define postdetection interventions may be needed to limit the overtreatment of indolent and small papillary carcinomas. Cancer 2018;124:1483-91. © 2018 American Cancer Society.

Background Recent declines in cancer incidence and mortality have not been distributed equally across the United States. Factors such as tobacco cessation and human papillomavirus presence might differentially affect urban and rural portions of the country. Methods We used the Surveillance, Epidemiology, and End Results database to assess cancer incidence rates and trends from 1973 to 2015. We compared incidence rates for oral cavity, oropharynx, and larynx cancer in urban and rural counties and identified trends using Joinpoint software. Results Incidence of larynx and oral cavity cancer are decreasing faster in urban areas than in rural areas, while incidence of oropharynx cancer is increasing faster in rural areas than urban areas. Conclusions Relative trends in incidence of larynx, oral cavity, and oropharynx cancer over the past 40 years are unfavorable for rural United States counties compared with urban areas. Cancer control programs should take this into account.

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Background: Many rectal cancer patients are treated at small, low-volume hospitals despite evidence that better outcomes are associated with larger, high-volume hospitals.Objectives: Examine trends of rectal cancer patients receiving care at large hospitals, determine patient characteristics associated with treatment at large hospitals, and assess relationships between treatment at large hospitals and guideline-recommended therapy.Design: This study was a retrospective cohort analysis to assess trends in rectal cancer treatment.

Background: There is substantial variability in the use of contralateral prophylactic mastectomy (CPM) in women with unilateral breast cancer across the United States. Iowa is one of several rural Midwestern states found to have the highest proportions of CPM nationally in women <45 years of age. We evaluated the role of rurality and travel distance as factors related to these surgical patterns. Methods: Women with unilateral breast cancer (2007-2017) were identi ed using Iowa Cancer Registry records. Patients and treating hospitals were classi ed as metro, nonmetro and rural based on Rural-Urban Continuum Codes. Differences in patient, tumor, and treatment characteristics and median travel distances (MTD) were compared. Characteristics associated with CPM were evaluated with multivariate logistic regression. Results: 22,158 women were identi ed: 57% metro, 26% nonmetro and 18% rural. The overall proportion of CPM in Iowa was consistently higher than in the national Surveillance, Epidemiology, and End Results (SEER18) throughout the interval from 2007-2015. Young rural women had the highest proportion of CPM (<40 years: 52%, 39% and 40% for rural, metro, nonmetro, respectively). Half of all rural women had surgery at metro hospitals; these women had the longest MTD (56 miles). Of all women treated at metro hospitals, rural women had the highest proportion with CPM (17% rural; vs 14% metro/nonmetro, p=0.007). On multivariate analysis, traveling ≥50 miles (ORs 1.48-2.34) or being rural regardless of travel distance was predictive of CPM (OR = 1.36). Other risk factors were young age (<40 years: OR=7.18, 95% CI: 5.89-8.76) and surgery at a metro hospital that offers reconstruction (OR=2.3, 95% CI: 1.70-3.21) and is not NCIdesignated (OR=2.19, 95% CI: 1.78-2.69). Conclusion: There is an unexpectedly high proportion of CPM use in young rural women in Iowa. Travel ≥50 miles and rural residence are independently associated with likelihood of CPM. Disparities in access to specialty care may underlie the desire for surgery that is perceived to minimize follow-up visits. Methods: Women with unilateral breast cancer (2007-2017) were identi ed using Iowa Cancer Registry records. Patients and treating hospitals were classi ed as metro, nonmetro and rural based on Rural-Urban Continuum Codes. Differences in patient, tumor, and treatment characteristics and median travel distances (MTD) were compared. Characteristics associated with CPM were evaluated with multivariate logistic regression. Results: 22,158 women were identi ed: 57% metro, 26% nonmetro and 18% rural. The overall proportion of CPM in Iowa was consistently higher than in the national Surveillance, Epidemiology, and End Results (SEER18) throughout the interval from 2007-2015. Young rural women had the highest proportion of CPM (< 40 years: 52%, 39% and 40% for rural, metro, nonmetro, respectively). Half of all rural women had surgery at metro hospitals; these women had the longest MTD (56 miles). Of all women treated at metro hospitals, rural women had the highest p...

BACKGROUND: Despite evidence of superior outcomes for rectal cancer at high-volume, multidisciplinary cancer centers, many patients undergo surgery in low-volume hospitals.OBJECTIVE: This study aimed to examine considerations of former patients with rectal cancer when selecting their surgeon and to evaluate which considerations were associated with surgery at high-volume hospitals. DESIGN: In this retrospective cohort study, patients were surveyed about what they considered when selecting a cancer surgeon. SETTINGS: Study data were obtained via survey and the statewide Iowa Cancer Registry. PATIENTS: All eligible individuals diagnosed with invasive stages II/III rectal cancer from 2013 to 2017 identified through the registry were invited to participate. MAIN OUTCOME MEASURES:The primary outcomes were the characteristics of the hospital where they received surgery (ie, National Cancer Institute designation, Commission on Cancer accreditation, and rectal cancer surgery volume).RESULTS: Among respondents, 318 of 417 (76%) completed surveys. Sixty-nine percent of patients selected their surgeon based on their physician's referral/ recommendation, 20% based on surgeon/hospital reputation, and 11% based on personal connections to the surgeon. Participants who chose their surgeon based on reputation had significantly higher odds of surgery at National Cancer Institute-designated (OR 7.5; 95% CI, 3.8-15.0) or high-volume (OR 2.6; 95% CI, 1.2-5.7) hospitals than those who relied on referral.LIMITATIONS: This study took place in a Midwestern state with a predominantly white population, which limited our ability to evaluate racial/ethnic associations.CONCLUSION: Most patients with rectal cancer relied on referrals in selecting their surgeon, and those who did were less likely to receive surgery at a National Cancer Institute-designated or high-volume hospitals compared to those who considered reputation. Future research is needed to determine the impact of these decision factors on clinical outcomes, patient satisfaction, and quality of life. In addition, patients should be aware that relying on physician referral may not result in treatment from the most experienced or comprehensive care setting in their area. See

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