10537 Background: In the United States, Asian women have traditionally been considered at low risk for breast cancer; yet it is unknown how distant stage disease has trended by geographic, demographic, and modifiable risk factors since 2001. Methods: Data were obtained from the United States Cancer Statistics (USCS) program from 2001-2018, the Behavioral Risk Factor Surveillance System (BRFSS) from 2000-2018. SEER*Stat 8.3.9.2 and the Joinpoint regression program 4.9.0.0 were used to calculate the incidences and trends of distant stage breast cancer per 100,000 women. The trend was presented as average annual or biennial percent change (AAPC or ABPC). Results: Using the USCS program, the overall incidence of postmenopausal breast cancer decreased from 367.90 to 345.07 (per 100,000); however, the incidence of distant stage cancer increased from 16.75 to 19.77 (per 100,000) over 18 years. The incidence is the highest for Black, followed by White, Hispanic, and Asian women at 27.14, 19.86, 14.15, and 11.98 (per 100,000) in 2018, respectively. The annual increase is highest in Asian, followed by Black, White, and Hispanic women at 2.28%, 1.44%, 1.17%, and 0.87% (P < 0.001), respectively. On intersection analysis, postmenopausal Asian women living in the Northeast have the highest annual rise at 2.54% (P = 0.004). BRFSS data revealed that the proportion of women non-compliant with screening mammograms decreased from 36.03% in 2000 to 20.93% in 2018. In 2018, Asian women were the most non-compliant followed by Hispanic, Black, and White women at 40.99%, 40.06%, 21.67%, and 18.17%, respectively. Over time, White, Black, and Hispanic women improved on compliance by 3.43%, 3.32%, and 1.24% (p < 0.05) on screening rates biennially; however, Asian women have not made any improvement (ABPC 0.80%, p = 0.410). On intersectional analysis, the most non-compliant group in 2018 were Asian women in the Midwest at 54.48%. We then evaluated upstream social determinants of breast cancer, such as obesity. While the baseline incidence of obesity in Asian Americans is low compared to other racial groups, it has increased from 9.22 in 2001 to 13.67 (per 100,000) in 2016. Specifically, the incidence of obesity increased the most in postmenopausal Asian 65 to 74-year-olds at 3% compared to White, Hispanic, and Black Americans of the same age group at 2.5%, 2.2%, and 1.1% (p < 0.05), respectively. Conclusions: Although the incidence of breast cancer has decreased in the United States since 2001, the rate of distant stage breast cancer continues to rise. Postmenopausal Asian women with distant stage breast cancer are increasing at the highest rate compared to other racial groups. Further, Asian women are more non-compliant with screening mammograms and have an increased rate of obesity. Tailored interventions are warranted to enhance primary and secondary prevention and decrease distant stage cancer in this high-risk group.
10574 Background: Human papillomavirus (HPV) is a causative agent of many human cancers. This study aims to determine the incidences and trends of HPV-associated cancers in the Republic of China. Methods: HPV-associated cancers included: cervical carcinoma, oropharyngeal squamous cell carcinoma (SCC), anal/rectal, vulvo-vaginal, and penile SCC. Deidentified data were obtained from Taiwan’s National Health Insurance Research Database from 2001 to 2018. SEER*Prep 2.6.0, SEER*Stat 8.3.9.2, and Joinpoint regression program 4.9.0.0 were used to calculate incidences and trends of HPV-associated cancers per 100,000. The age-adjusted incidence was adjusted by the WHO 2000 standard population. Results: A total of 55,248 HPV-associated cancers were identified. Of these, 34,730 (62.9%) were identified in women and 20,518 (37.1%) in men. The majority (60.0%) were cervical followed by oropharyngeal at 37.6%, and other HPV-associated cancers comprised 2.4%. Over the 18-year study, the overall age-adjusted incidence of HPV-associated cancers decreased from 13.41 to 8.92 (per/100,000) with an annual decrease of 2.02% ( P< 0.001). More specifically, cervical cancer incidence decreased from 20.42 to 7.70 per 100,000 with an annual decrease of 5.6% ( P< 0.001). Other cancers, such as vaginal and vulvar, decreased 2.34% ( P< 0.001) and 1.82% ( P< 0.001), respectively. With respect to oropharyngeal SCC, the incidence was over 12-fold higher in men compared to women (8.37 vs. 0.67/100,000) with both sexes increasing at 3.61% ( P< 0.001) and 3.59% ( P< 0.001) annually. Anal/rectal SCC increased at 3.55% ( P< 0.001) whereas penile cancer decreased at 2.52% ( P< 0.001). Of note, all HPV-associated cancers among non-smokers decreased 2.02% ( P< 0.001) annually, whereas they increased in smokers at 1.00% ( P> 0.05) per year. This increase in incidence was particularly evident in oropharyngeal SCC and cervical carcinomas. Conclusions: Women comprised over 60% of HPV related cancers, with cervical cancer being most common followed by oropharyngeal cancer. Over the last 18 years, cervical and vulvovaginal cancers decreased, but the rates of oropharyngeal cancers in men was 12-fold higher than women and continues to increase. Public awareness and education of these trends are needed toward prevention and screening.
10534 Background: To evaluate trends of HPV-associated oropharyngeal cancers and HPV infections in the United States. Methods: Data was extracted from the United States Cancer Statistics Public Use Database (USCS) between 2001 and 2017 and the National Health and Nutrition Examination Survey (NHANES) between 2011 to 2016. Data on oropharyngeal squamous cell carcinoma (OSCC) was obtained from the USCS database. HPV vaccination and screening (oral washings) data were obtained from NHANES. Based on CDC guidelines, HPV strains were further subdivided into high-risk strains (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68). Results: Based on USCS, oropharyngeal cancer incidence rates have increased in males by 1.64% every year (p < 0.001) while remaining stable in females over the last 17 years. Oropharyngeal cancers have increased for all age groups over the age of 55, with the largest increase seen in those between the ages of 65-69 years old (p < 0.001). However, individuals between the ages of 30-34 had the largest decrease in oropharyngeal cancers over the same time period (p = 0.016). Based on race, Whites had the highest incidence rates at 5.12/100,000 followed by 2.99 in Blacks, 2.32 in Hispanics, and 1.11 in Asians. By geographical region, the incidence was found to be the highest in the Midwest with 4.68/100,000 and the lowest in the West at 3.78. Our intersectional analysis showed that White males in the South aged 65-69 had the highest incidence of oropharyngeal cancers at 40.57/100,000 and this same group aged 60-64 had the highest annual increase at 4.65% (p < 0.001). Using the NHANES database, we showed that those with greater than 4 lifetime sexual partners have a 3-fold higher risk of high risk HPV infection compared to those with 4 or under (7.1% vs 1.9%, p < 0.0001). 8.8% of current smokers are infected with high risk oral HPV compared to only 3.9% of non smokers (p < 0.001). The incidence of any HPV infection for those <39 years old was 5.9% in 2011 and 4.7% in 2016 (p = 0.4723). In contrast, the incidence in those > 39 years old was 6.6% in 2011 and 6.4% in 2016 (p = 0.99). On multivariate analysis, males have a 4-fold higher risk of high risk HPV infections compared to females (4.45, 95% CI: 2.94 - 6.74, p < 0.0001). Those with five or more sexual partners have 7-fold higher rate of high risk oral HPV infections compared to those without any sexual partners (7.15, 95% CI: 1.94 - 26.3, p = 0.0039). Furthermore, current smokers (1.81, 95% CI: 1.17 - 2.77, p = 0.0081) and three to four drinks per day (1.63, 95% CI: 1.05 - 2.55, p = 0.0312) have an increased risk of high risk oral HPV infections. Conclusions: Over the last 18 years, oropharyngeal cancers are increasing in individuals over the age of 55, particularly White males residing in the South. Individuals with greater than 4 lifetime sexual partners, current smokers, and those who consume three to four drinks per day have increased HPV infectivity rates.
e18765 Background: An estimated 94,000 women have newly diagnosed gynecologic cancer (ovarian, uterine, cervical, and vulvovaginal) annually–with rates increasing over the last 20 years. Surgical site infections (SSIs) complicate up to 4% of all hysterectomies in the United States. Other surgical sequelae, such as operative length, estimated blood loss, wound dehiscence, and 30-day readmission, further complicate the post-surgical course of this vulnerable population. Methods: A quality improvement initiative was conducted in a large academic health system between January to June 2022 to investigate whether implementing an SSI bundle, defined as a set of 11 evidence-based practices performed collaboratively, can reduce intraoperative and postoperative complications. The study population included women who received gynecologic oncologic surgery. To evaluate trends following the implementation of an SSI prevention bundle, we studied two time periods: 1/1/22-3/31/22 and 4/1/22-6/30/22. Trends were analyzed using chi-squared and a two-sample t-test. Results: Over our six-month study period, 233 patients underwent primary gynecologic oncologic surgery. Robotic-assisted hysterectomies were the most common (27.89%, n = 65), followed by total abdominal hysterectomies (21%, n = 49), laparoscopic hysterectomies (7.72%, n = 18), and supracervical hysterectomies (3%, n = 7). An invasive, abdominal approach was needed for less than half of the surgeries for whom intraoperative and postoperative outcomes were measured (46.35%, n = 108). Following the implementation of our SSI bundle, there was a rise in estimated blood loss (134.49 to 252.67 mL), operative length (199.24 to 227.23 min), and length of stay (1.58 to 2.20 days). Yet, there was a decline in the SSI rate from 4.62% to 3.7% (p = 0.97) and 30-day all-cause readmission from 12.96% to 7.4% (p < 0.05). The overall incidence of 30-day wound dehiscence also declined over six months from 3.7% to 1.85% (p = 0.74). Upon intersectional analysis, patients with SSI were older (55.93 vs. 62, p = 0.39) and were more likely to be obese (BMI 27.04 vs. 31.06, p < 0.05). Individuals with functional status limitations, ECOG score > 2, had longer lengths of stays (4.7 vs. 1.76 days, p < 0.05), estimated blood loss (230 vs. 185.9 mL, p = 0.12), and operative length (374 vs. 205.2 min, p < 0.001). Those with a supracervical hysterectomy also had a longer length of stays (4 days, p < 0.05), blood loss (921.43 mL, p < 0.001), and operative lengths (315.14 min, p < 0.001). Conclusions: Following the implementation of an evidence-based SSI quality improvement project, cancer patients had fewer SSI, hospital readmissions, and wound dehiscence. High ECOG scores, supracervical hysterectomies, and obesity were all associated with worse postoperative outcomes. Prospective studies on postoperative surgical quality are needed to improve care for our most vulnerable patients.
Background The incidence of metastatic breast cancer is rising, but few studies have analyzed Asian American women with a focus on screening and obesity rates.Methods Data from the U.S. Cancer Statistics were examined for trends and incidence rates of breast cancer. Using the Center for Disease Control data mammogram compliance and obesity rates in Asian women were analyzed.Results Over our 18-year study period, the incidence of postmenopausal metastatic breast cancer increased by 2.19% annually in Asian women compared to only 1.03% in White women. Asians also had higher rates of mammogram non-compliance compared to other racial groups. Of Asians, the rates of obesity in postmenopausal women were highest in those aged 65–74 years.Conclusions Compared to other races, Asians have the highest increase in the incidence of metastatic breast cancer with lower rates of screening mammograms. Further research is needed to better understand these disparities.
Chinese were defined as individuals from Taiwan. SEER*Stat and Joinpoint regression programs were used for analyses.
Objectives One of the major changes in the revised 2018 FIGO-staging system is the addition of stage IIIC, which includes patients with pelvic and/or para-aortic lymph node metastases. Therefore, we evaluated the prognostic value of positive pelvic and/or para-aortic lymph nodes in patients with cervical cancer. Methods A nationwide retrospective cohort study was performed by identifying all patients diagnosed with stage IB-IVA between 2005-2018 from the Netherlands Cancer Registry. Data was converted to the FIGO 2018 stage based on the TNM-classification. 5-year and overall survival rates (OS) were estimated with the Kaplan-Meier method. Results Of the included 6,082 patients, 1,740 patients, had pelvic and/or para-aortic lymph node metastases. For patients with FIGO 2009 stage IB-IB1-IIA-IIA1 with pelvic and/or para-aortic lymph node metastases 5-year survival is 77% and OS is 70%, without lymph node metastases survival rates are 92% and 87% (p<0.001). For FIGO 2009 stage IB2-IIA2-IIB, with pelvic and/or para-aortic lymph node metastases 5-year survival is 67% and OS is 62%, without lymph node metastases survival rates are 74% and 65% (p=0.009). FIGO 2009 stage IIIA-IIIB and IVA survival rates are not significantly influenced by pelvic and/or para-aortic lymph node metastases (p=0.640, p=0.939). Patients with FIGO 2018 stage IIIC have a 5-year survival of 65% and OS of 59%. Conclusions Patients with FIGO 2009 stage IB-IB1-IIA-IIA1-IB2-IIA2-IIB cervical cancer with positive pelvic and/or paraaortic lymph node metastases have a significant impaired survival compared to patients without metastases. Survival rates of patients with FIGO 2009 stage IIIA-IIIB-IVA are not significant affected by lymph node metastases.
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