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      Incidence of Neuroendocrine Tumors in the United States from 2001-2015: A United States Cancer Statistics Analysis of 50 States

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      1 , , 2
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      Cureus
      Cureus
      gastroenterology, epidemiology, cancer, cancer epidemiology, neuroendocrine tumors, incidence

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          Abstract

          Introduction

          Neuroendocrine tumors (NETs), once considered a rare malignancy, has started to become a more common cancer within the United States (US). Given the limited data available on the incidence of NETs in the entire US population, our goal in this study was to investigate the incidence of NETs in at-risk populations in all 50 states.

          Methods

          The United States Cancer Statistics (USCS) was used to obtain data for NETs from 2001 to 2015. An incidence analysis was done for sex, race, stage, primary location within the gastrointestinal (GI) tract, and US regional location.

          Results

          The overall incidence of NETs from 2001 to 2015 was 2.89 per 100,000 people per year. The overall incidence rates were the greatest for each stratification of males, blacks, localized disease, primary location in the small intestine, and in the Northeast. The incidence in males between 2013 and 2015 increased with an annual percent change (APC) of 8.44. Between 2006 and 2015, the incidence in blacks increased with an APC of 1.89. Between 2013 and 2015, the incidence of localized disease and a primary location in the small intestine increased with an APC of 16.89 and 14.37, respectively. In the Northeast, between 2013 and 2015, the incidence increased with an APC of 11.09.

          Conclusion

          In this study, we investigated the incidence of NETs using data obtained from the USCS database, which covers all 50 states. We found that there is a rising incidence in most subpopulations possibly related to improved compliance with surveillance colonoscopies and improved endoscopic and radiographic techniques. Further studies are needed to ultimately determine the exact causes of our findings. However, our study will serve as an important first step to determine the exact etiology for the rising incidence of NETs in all 50 states.

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          Most cited references8

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          Carcinoid tumors of the gastrointestinal tract: trends in incidence in England since 1971.

          The epidemiology of gastrointestinal neuroendocrine tumors (GI-NETs) is poorly understood. Recent analyses have suggested changes in the incidence and distribution of such tumors, but have generally used data sets containing small patient numbers. We aimed to define trends in the epidemiology of GI-NETs in England over a 36-year period. We analyzed data from the national population-based cancer registry, which covers a population in excess of 50 million, over the period 1971-2006. In all, 10,324 cases of GI-NETs were identified. The overall incidence increased from 0.27 (per 100,000 per year) to 1.32 for men and from 0.35 to 1.33 for women. The anatomic distribution of tumors in the latest period analyzed was stomach 12%, small intestine 29%, appendix 38%, colon 13%, and rectum 8%. The largest absolute increase in incidence was seen in the appendix (from 0.03 to 0.41 in men; from 0.05 to 0.59 in women). The greatest relative increase was in gastric NETs, increasing 2,325% in men, and 4,746% in women. Overall, 48% of GI-NETs occurred in men. Sex-specific incidence rates for gastric, colonic, and rectal NETs are similar, whereas appendiceal lesions were more common in females, and small intestinal tumors in men. Large increases in the incidence of GI-NETs were observed, along with changes in anatomical distribution. Such changes may partly reflect changes in classification or improved detection through the increased use of endoscopy and imaging techniques. In view of the magnitude of these changes, particularly for gastric tumors, further studies to examine the underlying etiology of these changes are urgently indicated.
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            Disparities in colorectal cancer in African-Americans vs Whites: before and after diagnosis.

            There are differences between African-American and white patients with colorectal cancer, concerning their characteristics before and after diagnosis. Whites are more likely to adhere to screening guidelines. This is also the case among people with positive family history. Colorectal cancer is more frequent in Blacks. Studies have shown that that since 1985, colon cancer rates have dipped 20% to 25% for Whites, while rates have gone up for African-American men and stayed the same for African-American women. Overall, African-Americans are 38% to 43% more likely to die from colon cancer than are Whites. Furthermore, it seems that there is an African-American predominance in right-sited tumors. African Americans tend to be diagnosed at a later stage, to suffer from better differentiated tumors, and to have worse prognosis when compared with Whites. Moreover, less black patients receive adjuvant chemotherapy for resectable colorectal cancer or radiation therapy for rectal cancer. Caucasians seem to respond better to standard chemotherapy regimens than African-Americans. Concerning toxicity, it appears that patients of African-American descent are more likely to develop 5-FU toxicity than Whites, possibly because of their different dihydropyridine dehydrogenase status. Last but not least, screening surveillance seems to be higher among white than among black long-term colorectal cancer survivors. Socioeconomic and educational status account for most of these differences whereas little evidence exists for a genetic contribution in racial disparity. Understanding the nature of racial differences in colorectal cancer allows tailoring of screening and treatment interventions.
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              Incidence of Esophageal Cancer in the United States from 2001-2015: A United States Cancer Statistics Analysis of 50 States

              Introduction Esophageal cancer is one of the leading causes of death in males in the United States (US). Previous studies have analyzed incidence rates of esophageal cancer in the US using the data from the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) program. However, given its limited patient population, certain groups and regions in the US are underrepresented. Our study utilizes the United States Cancer Statistics (USCS) database, which combines the SEER database with the Centers for Disease Control and Prevention's (CDC) National Program of Cancer Registries (NPCR) to cover all 50 states to examine the incidence of esophageal cancer. Methods The USCS registry was used to obtain data for esophageal cancer from 2001 to 2015. Incidence analysis was stratified based on sex, race, stage, histology, and US regional location/histology. Results The overall incidence of esophageal cancer from 2001-2015 was 4.7 per 100,000 people per year. Overall incidence rates were greatest for each stratification in males, blacks, distant disease, adenocarcinoma, and those in the Midwest with adenocarcinoma. Blacks, compared to other races, had the greatest statistically significant decrease in incidence between 2001-2015 (annual percent change (APC) -4.55). The incidence rate is also increasing the most rapidly in those with adenocarcinoma in the Northeast from 2011 to 2015 (APC 2.16). Conclusion In our study, we were able to determine the incidence of esophageal cancer using data from all 50 states in the US. Our findings of decreasing incidence in blacks and increasing incidence of adenocarcinoma in the Midwest and Northeast help elucidate the at-risk populations. Moreover, our findings help bring to light risk factors that may be contributing to the development of esophageal cancer and how diagnosis and surveillance can be improved based on these risk factors.
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                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                26 March 2019
                March 2019
                : 11
                : 3
                : e4322
                Affiliations
                [1 ] Internal Medicine, New York University School of Medicine, New York, USA
                [2 ] Internal Medicine, Temple University, Philadelphia, USA
                Author notes
                Article
                10.7759/cureus.4322
                6538402
                31183301
                243717db-0ede-467e-ba9d-b91d6bcab7f6
                Copyright © 2019, Patel et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 5 March 2019
                : 25 March 2019
                Categories
                Internal Medicine
                Gastroenterology
                Epidemiology/Public Health

                gastroenterology,epidemiology,cancer,cancer epidemiology,neuroendocrine tumors,incidence

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