Adolescent and Young Adult Oncology Scientific Meeting 2013

Adolescent and Young Adult Oncology

Scientific Meeting 2013

Epidemiology Working Group

Members• Ann Geiger, NCI, Chair• Archie Bleyer, Oregon Health and Science University, Co-Chair• Ronald Barr, McMaster University• Lynne Harlan, NCI• Theresa Keegan, Cancer Prevention Institute of California• Denis Lewis, NCI• Brad Pollock, University of Texas Health Science Center at San

Antonio• Lynn Ries, NCI (sends her regrets)• Deborah Vollmer Dahlke, Texas A&M University Health Science

Center

Outline

• General Introduction & Breast: Ann

• Melanoma & colorectal: Theresa

• Leukemia & sarcoma: Denise

• Beyond SEER: Deborah

• Additional Observations & Summary: Archie

• Questions for Discussion: Last Slide

Methods

• AYA = 15 to 39 years old, inclusive

• 2000 to 2010 and subintervals

• SEER 18 (28% of US Population)– Limited publication of population-based, non-site

specific cancer epidemiology focused on AYA

Not Done

• Prevalence

• Stage at diagnosis for children, AYA, and older adults with the same cancers

• Only risk factor information is age, sex, and race/ethnicity

• Interpretation

Caution

• Incidence and mortality rates per 100,000– horizontal x axis shifts

• Trends

• Lots of information – copies of graphs available

Cancer <15 15-29 30-44 45-59 60-74 75+Thyroid carcinoma 4.2 4.0 6.2 6.7 7.3 6.0Renal carcinoma 8.2 5.3 2.6 2.6 2.2Colorectal carcinoma 2.8

* Testicular carcinoma 2.0Acute lymphoblastic leukemia

** Breast cancerHepatic carcinoma 5.3 3.6 2.7Medulloblastoma/PNETAstrocytoma***Ependymoma*** 2.7Acute myeloid leukemiaAcute monocytic leukemiaChronic myelogenous leukemiaHodgkin lymphomaNon-Hodgkin lymphomaOsteosarcomaChondrosarcoma -2.2Ewing tumorNon-RMS-KS^ soft-tissue sarcoma 2.3Nasopharyngeal carcinoma 11.0 -3.7Tongue & salivary carcinomaAdrenocortical carcinoma

** Ovarian carcinoma -2.0 -1.5** Cervix uteri cancer -3.1 -2.1 -2.4 -3.8

Melanoma 2.6 4.1Carcinoma of lung -4.9 -2.9 -2.3

<15 15-29 30-44 45-59 60-74 75+

AYA

Change in Incidence of Common Cancers in AYAs, 1992-2008, SEER131-2% >2%

Increase in IncidenceDecrease in Incidence

Age at Diagnosis (Years)

Cancer <15 15-29 30-44 45-59 60-74 75+

Acute lymphoblastic leukemiaThyroid carcinomaRenal carcinomaColorectal carcinomaCarcinoma of lung

* Testicular carcinomaMelanomaHepatic carcinomaEpendymomaTongue & salivary gland carcinomaAcute myeloid leukemiaAcute monocytic leukemiaHodgkin lymphomaOsteosarcomaChondrosarcomaEwing tumorNon-RMS-KS^ soft-tissue sarcomaNasopharyngeal carcinomaAdrenocortical carcinoma

** Breast CancerChronic myelogenous leukemiaMedulloblastoma/PNETAstrocytoma

** Ovarian carcinoma** Carcinoma of cervix and uterus

Non-Hodgkin lymphoma

<15 15-29 30-44 45-59 60-74 75+

*In males **In females



* In males ** in females *** excluding non-malignant ^ Kaposi sarcoma

Average Annual % Change (AAPC) in Incidence of

Cancers in AYAs by 15 -Year Age-at-Diagnosis

Intervals2000-2010

SEER18 (28% of U.S.)

APC: 1-2% 2-3% >3%Increase in Incidence

Decrease in Incidence

p < .05AAPC:

Ages 15-19All Races

White Non-HispanicWhite Hispanic

BlackAsian/Pacific Islander

Ages 20-24All Races



Ages 25-29All Races



Ages 30-34All Races



Ages 35-39All Races



BREAST CANCERINCIDENCEper 100,000

2001-2010

BREAST CANCERMORTALITYper 100,000

2001-2010

Ages 15-19All Races



Ages 20-24All Races



Ages 25-29All Races



Ages 30-34All Races



Ages 35-39All Races



BREAST CANCERTRENDS

Overall

Incidence NS

Mortality -3.3

BREAST: Summary

• Incidence rates– Increase with age– Similar blacks and whites– No trend

• Mortality rates– Increase with age– Higher in blacks– Decreasing

Ages 15-19All Races



Ages 20-24All Races



Ages 25-29All Races



Ages 30-34All Races



Ages 35-39All Races



MELANOMAINCIDENCEper 100,000

2001-2010

Ages 15-19All Races



Ages 20-24All Races



Ages 25-29All Races



Ages 30-34All Races



Ages 35-39All Races



MELANOMAMORTALITYper 100,000

2001-2010

MELANOMATRENDS

Overall

Incidence

Males -1.5

Females NS

Mortality too low to assess

Melanoma: Summary

• Incidence rates– Increase with age– Higher in women and in whites– Declining

• Mortality rates– Increase with age– Higher in whites– No trend assessment

Ages 15-19All Races



Ages 20-24All Races



Ages 25-29All Races



Ages 30-34All Races



Ages 35-39All Races



COLORECTALCANCER

INCIDENCEper 100,000

2001-2010

Ages 15-19All Races



Ages 20-24All Races



Ages 25-29All Races



Ages 30-34All Races



Ages 35-39All Races



COLORECTALCANCERMORTALTYper 100,000

2001-2010

COLORECTALCANCERTRENDS

Overall

Incidence

Males +1.2

Females +2.3

Mortality NS

Colorectal: Summary

• Incidence rates– Increase with age– Modestly higher in males– Increasing

• Mortality rates– Increase with age– Much higher in blacks– Trend?

0123456

3.73.4

5.62.2

2.7

3.02.6

4.42.32.3

3.02.8

3.62.6

2.3

3.53.5

3.93.2

2.8

4.44.44.34.2

4.3

Male

Series1

0 1 2 3 4 5 6

2.42.2

3.41.81.9

2.12.0

2.81.9

1.6

2.12.1

2.41.71.8

2.82.7

3.42.5

2.7

3.33.4

3.72.5

2.9

FemaleAges 15-19

All RacesWhite Non-Hispanic

White HispanicBlack

Asian/Pacific Islander

Ages 20-24All Races



Ages 25-29All Races



Ages 30-34All Races



Ages 35-39All Races



LEUKEMIAINCIDENCEper 100,000

2001-2010

0.00.20.40.60.81.01.21.41.61.82.0

1.11.0

1.80.9

0.7

1.41.3

1.91.2

0.9

1.31.2

1.61.3

0.9

1.41.4

1.81.6

1.0

1.61.5

1.81.9

1.4

Male

Series1

0.0 0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0

0.80.7

1.10.70.7

0.80.8

1.20.8

0.5

0.90.8

1.10.9

0.8

1.01.0

1.21.1

0.9

1.31.3

1.51.2

1.0

FemaleAges 15-19

All Races

White Non-Hispanic

White Hispanic

Black


Ages 20-24

All Races

White Non-Hispanic

White Hispanic

Black


Ages 25-29

All Races

White Non-Hispanic

White Hispanic

Black


Ages 30-34

All Races

White Non-Hispanic

White Hispanic

Black


Ages 35-39

All Races

White Non-Hispanic

White Hispanic

Black


Ages 15-19All Races



Ages 20-24All Races



Ages 25-29All Races



Ages 30-34All Races



Ages 35-39All Races



LEUKEMIAMORTALITYper 100,000

2001-2010

LEUKEMIATRENDS

Overall

Incidence

Males NS

Females +2.2

Mortality

Males -1.4

Females -2.1

LEUKEMIA: Summary

• Incidence rates– Modest increase with age– Female less than male– Possible increase in females, particularly older

• Mortality rates– Modest increase with age– Female less than male– Decreasing, particularly younger females

Ages 15-19All Races



Ages 20-24All Races



Ages 25-29All Races



Ages 30-34All Races



Ages 35-39All Races



SARCOMAINCIDENCEper 100,000

2001-2010

SARCOMA

TRENDS

Incidence NS

SARCOMA

• Incidence– Occurs across age groups, although still increases

with age– More common in black males (& females)– No trend

OVERALL INCIDENCE: SUMMARY• Thyroid and kidney carcinoma are dramatically

increasing in AYAs and older adults (and for thyroid cancer, also in children).

• Colorectal and testis carcinoma is increasing in young AYAs but not as rapidly as thyroid and kidney cancer.

• ALL was increasing in and only in AYAs, but the trend slowed in 2008 (data not shown).

• Breast cancer may be increasing in young AYAs during the past decade.

• Melanoma declined in older AYAs as did lung cancer and carcinoma of the cervix in young AYAs.

28Bleyer

1 in 59*including “non-invasive”, “benign”, “borderline”

1 in 56

2000-2002 2008-2010

Risk of cancer* from age 15 to 39 SEER18

29Bleyer

1 in 48

2000-2002 2008-2010


Females

1 in 44*including “non-invasive”, “benign”, “borderline”

30Bleyer

1 in 41

Non-Hispanic White Females

1 in 38 *including “non-invasive”, “benign”, “borderline”


2000-2002 2008-2010

31Bleyer

Death Rates

32Bleyer

One of 10 deaths in 15-39 year-olds is due to cancer (neoplasms)

2010

1 in 10Same rate since 1988

33Bleyer

One of 14 deaths in 15-39 year-old males is due to cancer (neoplasms)

2010


34Bleyer

One of 6 deaths in 15-39 year-old females is due to cancer (neoplasms)

2010


35Bleyer

One of 4 deaths due to disease in 15-39 year-olds is from a neoplasm

2010


36Bleyer

1 in 5

One of 5 deaths due to disease in 15-39 year-old males is from a neoplasm

2010

37Bleyer

1 in 4

One of 4 deaths due to disease in15-39 year-old females is from a neoplasm

2010

Incidence including Cancers with “Non-Malignant” Behavior

0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85Age at Diagnosis (Years)

Proportion of All Cancer that is not Reported as Malignant,

by Individual Year at Diagnosis, SEER18, 2000-2009

AYA

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

AYAs: 12%-16%

“Non-Malignant”

“Non

-Mal

igna

nt”

Females

Males

0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85Age at Diagnosis (Years)

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

22%

Proportion of All Cancer that is not Reported as Malignant,

by Individual Year at Diagnosis and Sex, SEER18, 2000-2009AYA Females: 14%-22%“Non- Malignant”

AYA Males: 8%-12%“Non- Malignant”

AYA

0 1 2 3 4 5 6 7 8 9 10Years after Diagnosis

Non-Malignant Behavior (N=21,566)

All Cancer (N=221,793)Malignant Behavior (N=200,227)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Comparison of Survival of All Cancer and of Malignant Cancer, 2000-2010, SEER18

95% C.I.

The 95% confidence interval at 10-years for all cancer is 77.7%-78.2%.

95% C.I.

AYA Cancer Survival Trends

AAPC

All Other CancerBest Prognosis

Annual Average % Change (AAPC) in 5-Year Relative Survival by Age1990-2004


010 15 20 25 30 35 40 45 50 55 60 65 70

Hodgkin LymphomaMelanomaThyroid CancerTesticular Carcinoma

Except Kaposi Sarcoma and Non-Hodgkin Lymphoma

0.630.55

0.21

0.680.64 0.63

0.81

1.45

1.69

1.29

0.85

0.19

0.08 0.11 0.140.22

0.270.20

0.30 0.32

0.46

0.07

0.44

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

1.8

-0.1

Beyond Seer: Leveraging and Expanding AYA Data Resources

• Improving data collection: defining key relevant variables and standardizing collection

• Data harmonization/pooling in current and future studies

• Expand capture of population-based AYA cancer epidemiology beyond SEER.

• Access data captured by Electronic Health Records, Health Information Exchanges , Accountable Care Organizations and Health Insurance Firms.

Beyond Seer: Leveraging and Expanding AYA Data Resources

• Pursue linkage of data from SEER with Medicaid, state cancer registry data and large insurers

• Leverage existing and future studies involving AYA that are not cancer focused

• Conduct an AYA-Focused NCI Patterns of Care Study

Questions for Discussion

• Can the work of other groups provide a context in which to understand these data?

• What do these data suggest about future prevention, clinical, and research priorities?

• What are the next steps in terms of data to address future priorities?

Overall Summary

• Incidence and mortality rates increase with age– Complex patterns by sex and race/ethnicity

• Rate trends– Decreasing: breast cancer mortality, melanoma incidence,

& leukemia mortality– Increasing: colorectal incidence & leukemia incidence

• Need additional data sources– Leverage existing study and health plan data– Repeat POC study

Documents

Adolescent and Young Adult Oncology Scientific Meeting 2013