Transcript Gestational age, weight gain and post

WHAT DOES THE DATA TELL US?
COLORECTAL CANCER IN NEVADA
Paulo S Pinheiro
University Nevada Las Vegas, Roseman SM 2016
Aims

To analyze Nevada Central Cancer Registry (NCCR) and
BRFSS data for prevalence of screening, 2014
Screening
 Incidence, Mortality
 Survival


TO Use SEER data to represent the US in the survival
analysis

To identify issues specific to Nevada, with an emphasis
on priorities for intervention
Nevada: How does Colorectal Cancer
affect the state?

Nevada: 2.9 million

Dynamic demographics


doubled its population in the
past 20 years

Highest proportion of
undocumented in the Nation
(8% of all population)

Diverse mix of people (raceethnicity, long-term residents,
recent arrivals)
difficult to characterize risk
patterns
Evidence-Based Action in Nevada





Nevada Central Cancer Registry
Incidence and survival indicators
General measures: all states
Evidence-based measures: Nevada-specific
How does Nevada differ from other
states?
Levels of Prevention
Legislation on
cancer
prevention
↓incidence
Access to
prevention
care
↓ incidence
Screening:
↓mortality
↓incidence
↑overall survival
Access to
quality
tertiary care –
↑survival,
↓mortality
SCREENING



Lowers incidence (risk)
Increases overall survival
Lowers mortality
Sigmoidoscopy/Colonoscopy in Nevada 2015
Demographic
Statewide
Geography
Race/Ethnicity
Education
Income
Grouping
Nevada
Clark County
Northwestern NV
Balance of State
White
N
1,688
501
906
281
1,375
Black
Other Race
52
117
Hispanic
Less than H.S.
109
141
H.S. or G.E.D.
Some Post H.S.
581
783
College Graduate
< 15,000
772
179
$15,000 to $24,999
$25,000 to $34,999
344
239
$35,000 to $49,999
$50,000 to $74,999
322
322
$75,000+
552
Weighted N
762,113
492,912
205,113
64,087
625,299
63,212
95,304
106,756
101,318
261,736
337,734
199,073
83,684
126,251
110,486
123,273
126,919
213,227
Yes
64.1 (60.2-68.1)
61.4 (55.6-67.1)
73.4 (69.6-77.2)
56.1 (48.8-63.3)
66.1 (62.8-69.4)
67.8 (53.4-82.1)
47.4 (32.3-62.6)
53.5 (41.3-65.7)
45.4 (32.8-58.1)
55.6 (49.4-61.9)
65.6 (60.6-70.6)
78.5 (73.7-83.3)
50.8 (37.7-63.9)
55.5 (47.3-63.8)
59.5 (48.1-71.0)
59.3 (50.2-68.3)
69.6 (61.7-77.6)
70.7 (64.5-76.9)
Source: Nevada State Health Division, B Towle
Aug 2016 BRFSS
Comparison:
High-Screening States vs Nevada
Connecticut
Utah
Nevada
76%
VERY HIGH
75%
VERY HIGH
64%
LOWER
I
26
26
21
II
26
24
25
III
25
28
31
IV
23
22
23
11.8
11.0
16.9
Combined
Screening
AJCC STAGE
DISTRIBUTION (%)
MORTALITY RATE
(per 100,000)
Source: Nevada Central Cancer Registry and
SEER
Nevada CRC Raw Numbers
New Cases

1140 per year
Deaths

482 per year
Source: CDC wonder
Colorectal Cancer
Incidence 2008-2010
Men 50.6 (US 50.3)
24
Women 36.3 (US 38.1)
40
51
33
51
36
49
49
Source: CDC wonder
Colorectal Cancer
Mortality 2011-2013
Men 19.9 (US 17.7)
10
Women 14.2 (US 12.4)
8
51
41
51
38
47
43
Source: CDC wonder
Incidence And Mortality Ranks For Nevada

Males:
 #24

for Incidence but #10 for Mortality
Females:
 #40
for Incidence but #8 for Mortality
Anything strange with this?
Deaths Per Year in Nevada, 2013
Leading Cancers
Men and Women
Men
Women
All Cancers
4,817
2,609
2,208
LUNG
1,335
719
616
COLORECTAL
482
264
218
BREAST
352
-
352
PANCREAS
325
167
158
PROSTATE
278
278
-
LEUKEMIA
196
132
64
LIVER
182
131
51
BLADDER
139
107
32
MELANOMA
68
49
19
Source: CDC
CRC – If Nevada was just average
Of the 482 annual deaths in the state,
we could save
57 every year
NV MORTALITY RANK: Colorectal CANCER 2011-2013
(out of 51)
15
Men
Women
ALL RACES
10
8
Whites
4*
1*
Blacks
42
40
Hispanics
32
29
Asians
19
17
*Significantly
higher than US average p<0.05
Source: CDC Wonder

SURVIVAL
Data from SEER and NCCR








Diagnoses: 2003-2013
Age-adjustment by ICCC standards
Follow-up until Dec 31, 2013
Presumed-Alive assumption
N=10,076 first primaries of CRC in
Nevada
Cause-specific survival
Nevada data: no National Linkage
Life Tables Method and Cox Regression
SURVIVAL BY AJCC STAGE AT DIAGNOSIS
MEN
WOMEN
95
95
90.7
90
89.8
85
92.1 92.1
90
85
81.5
80
83
80.4
80
77.3
75
75
70
70
67.5
65.8
65.4
63.6
65
65
60
60
55
55
Stage I
Stage II
US
Stage III
NV
Stage I
Stage II
US
Stage III
NV
SURVIVAL BY REGION
71
69.3
69
66.6
67
66.5
65.8
65.2
65.1
65.6
65
63.4
62.7
63
61.9
61
59
57
55
Males
SEER
NEVADA
Females
Northwest (Washoe, CC)
South (Clark)
Rural
Risk of Death Colorectal Cancer Nevada 2003-2013
Cox Proportional Hazards Model
N =10,076
HR*
(95% CI)
AJCC Stage I
1,711
1
II
2,047
2.2
1.8-2.7
III
2,407
4.0
3.3-4.8
IV
1,766
14.5
12.1-17.5
Race/Ethnicity: NH-White
7,495
1
NH-Black
737
0.88
0.76-1.01
Hispanic
928
0.83
0.73-0.95
Asian Pacific Islander
618
0.77
0.62-0.95
66
0.92
0.54-1.56
American Indian
Region: North – Reno
2,304
1
South – Las Vegas
7,038
1.12
1.02-1.22
734
0.98
0.84-1.15
Rural
*Adjusted for age, gender, year of diagnosis, sublocation (right colon, sigmoid, rectum, NOS) , grade of tumor, insurance
type, SES
Reasons for North-South Gap?

Lower screening in South


Low Number of general & family practice
physicians




22 vs 31 (US) per 100,000
Low Number of Medical Doctors


2015, 61% VS 73%
216 vs 327 (US) per 100,000
Washoe at 336 per 100,000
Clark County: only 65% of the US average
number of physical specialists
Lack of a LV-based MD School of Medicine:

research activity, teaching status, clinical trials,
etc.
Treatment for Colorectal Cancer
Stage
Treatment
0
POLIPECTOMY (during colonoscopy)
I
SURGERY
II
SURGERY with/without ADJUVANT CHEMOTHERAPY,
RADIOTHERAPY (for rectal cancer)
III
SURGERY with ADJUVANT CHEMOTHERAPY, and
RADIOTHERAPY (for rectal cancer)
IV
COMBINATIONS (SURGERY, CHEMO, RADIO)
Source: cancer.net ASCO
Conclusions

1-Incidence in NV (risk) is average

2-Mortality in NV is high

3-Unfavorable stage distribution, lower rates
of screening, low survival by stage in Clark
County drive the state’s numbers

FOCUS:
 i)-Increase Screening (will affect stage
distribution)
 ii)-Improve Quality of Care (will improve
survival)

[email protected]

702-895-5717

THANK YOU