Academic Appointments

Administrative Appointments

  • Director, Surveillance Research, Northern California Cancer Center (2000 - 2006)
  • Director, Greater Bay Area Cancer Registry, Cancer Prevention Institute of California (Northern California Cancer Center) (2005 - Present)
  • Interim Executive Director, Nothern California Cancer Center (2008 - 2009)
  • Chief Executive Officer, Cancer Prevention Institute of California (formerly Northern California Cancer Center) (2009 - 2013)

Professional Education

  • Ph.D., UC Berkeley, Epidemiology (1984)
  • M.S., UC Berkeley, Epidemiology (1978)
  • A.B., Harvard College, Social Relations (1972)

Research & Scholarship

Current Research and Scholarly Interests


Hodgkin lymphoma: Dr. Glaser has conducted numerous studies in the epidemiology of Hodgkin lymphoma, including descriptive analyses and population-based studies in women and to characterize the epidemiologic features of Epstein-Barr virus (EBV)-associated Hodgkin lymphoma. With colleagues Dr. Richard Ambinder and Dr. Margaret Gulley, Dr. Glaser evaluated the reliability of EBV detection assays, generating interpretation guidelines to minimize this variation. Dr. Glaser’s current research interests in Hodgkin lymphoma involve genetic determinants of risk and their interaction with environmental factors.

Breast cancer: Dr. Glaser has been involved in numerous studies of incidence and survival patterns of breast cancer. Her analytic studies have focused on immune function modulators.

Surveillance Research: Within the Greater Bay Area Cancer Registry, part of the NCI's SEER program, Dr. Glaser built a research program dedicated to the insightful use of population-based cancer registry data to inform understanding of site-specific cancer incidence and survival patterns in various population subgroups, particularly those defined by race/ethnicity and socioeconomic status. This program has had particular interest in breast, colon and prostate cancers, and in lymphomas, as well in examining racial/ethnic and birthplace disparities in cancer incidence and survival.


Registry leadership: Dr. Glaser has been the Director of the Greater Bay Area Cancer Registry since 2005. She and her registry team are committed to excellence in registry function and to preparing for changes facing cancer registration, including increasing electronic data transmission and expanding data content to include more information on biomarkers, comorbidities and intermediate endpoints such as recurrence.

Dr. Glaser served as the leader of the Cancer Prevention Institute of California from 2008 through 2013.


All Publications

  • Family history of cancer and risk of pediatric and adolescent Hodgkin lymphoma: A Children's Oncology Group study INTERNATIONAL JOURNAL OF CANCER Linabery, A. M., Erhardt, E. B., Richardson, M. R., Ambinder, R. F., Friedman, D. L., Glaser, S. L., Monnereau, A., Spector, L. G., Ross, J. A., Grufferman, S. 2015; 137 (9): 2163-2174


    Family history of lymphoid neoplasm (LN) is a strong and consistently observed Hodgkin lymphoma (HL) risk factor, although it has been only marginally examined in pediatric/adolescent patients. Here, healthy control children identified by random digit dialing were matched on sex, race/ethnicity and age to HL cases diagnosed at 0-14 years at Children's Oncology Group institutions in 1989-2003. Detailed histories were captured by structured telephone interviews with parents of 517 cases and 783 controls. Epstein-Barr virus (EBV) RNA detection was performed for 355 available case tumors. Two analytic strategies were applied to estimate associations between family cancer history and pediatric/adolescent HL. In a standard case-control approach, multivariate conditional logistic regression was used to calculate odds ratios and 95% confidence intervals (CIs). In a reconstructed cohort approach, each relative was included as a separate observation, and multivariate proportional hazards regression was used to produce hazard ratios (HRs) and 95% CIs. Using the latter, pediatric/adolescent HL was associated with a positive family history (HR = 1.20, 95% CI: 1.06-1.36), particularly early-onset cancers (HR = 1.30, 95% CI: 1.06-1.59) and those in the paternal lineage (HR = 1.38, 95% CI: 1.16-1.65), with a suggested association for LN in first-degree relatives (HR = 3.61, 95% CI: 0.87-15.01). There were no discernable patterns for EBV+ versus EBV- HL. The clustering of LN within pedigrees may signal shared genetic susceptibility or common environmental exposures. Heritable genetic risk variants have only recently begun to be discovered, however. These results are consistent with other studies and provide a compelling rationale for family-based studies to garner information about genetic susceptibility to HL.

    View details for DOI 10.1002/ijc.29589

    View details for Web of Science ID 000359782700015

    View details for PubMedID 25940226

  • Time Trends in Rates of Hodgkin Lymphoma Histologic Subtypes: True Incidence Changes or Evolving Diagnostic Practice? Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology Glaser, S. L., Clarke, C. A., Keegan, T. H., Chang, E. T., Weisenburger, D. D. 2015; 24 (10): 1474-1488


    Histologic subtypes of classical Hodgkin lymphoma [cHL; e.g., nodular sclerosis, mixed cellularity, not otherwise specified (NOS)] are epidemiologically and prognostically distinctive. Therefore, unexplained, ongoing incidence rate declines for mixed cellularity and increases for NOS require examination.We analyzed detailed histology-specific Hodgkin lymphoma incidence rates in 1992 through 2011 U.S. SEER data (n = 21,372) and reviewed a regional subset of 2007 through 2011 NOS pathology reports for insight into diagnostic practices.cHL rates were stable until 2007, then decreased for whites [annual percent change (APC) and 95% confidence interval (CI), -3.6% (-5.6% to -1.5%)]. Nodular sclerosis rates declined after 2007 by 5.9% annually, with variation by gender, age, and race/ethnicity. In 1992 through 2011, mixed cellularity rates declined [APC -4.0% (-4.7% to -3.3%)], whereas NOS rates rose [5.3% (4.5%-6.2%)] overall and in most patient groups. The 2007-2011 NOS age-specific rates were more similar to mixed cellularity rates for 1992-1996 than 2007-2011. Trends in combined rates were minimal, supporting increasing misclassification of mixed cellularity, lymphocyte depletion, and specific nodular sclerosis subtypes as NOS. Eighty-eight of 165 reviewed NOS pathology reports addressed classification choice. Twenty (12.1%) justified the classification, 21 (12.7%) described insufficient biopsy material, and coders missed specific subtype information for 27 (16.4%).Recent nodular sclerosis rate declines largely represent true incidence changes. Long-term rate decreases for mixed cellularity and other less common subtypes, and increases for NOS (comprising ∼30% of cHL cases in 2011), likely reflect changes in diagnostic and/or classification practice.Diminishing histologic subtyping undermines future surveillance and epidemiologic study of Hodgkin lymphoma. Guideline-based use of excisional biopsies and more coding quality control are warranted. Cancer Epidemiol Biomarkers Prev; 24(10); 1474-88. ©2015 AACR.

    View details for DOI 10.1158/1055-9965.EPI-15-0281

    View details for PubMedID 26215294

  • Racial/ethnic and socioeconomic disparities in survival among children with acute lymphoblastic leukemia in California, 1988-2011: A population-based observational study PEDIATRIC BLOOD & CANCER Abrahao, R., Lichtensztajn, D. Y., Ribeiro, R. C., Marina, N. M., Keogh, R. H., Marcos-Gragera, R., Glaser, S. L., Keegan, T. H. 2015; 62 (10): 1819-1825

    View details for DOI 10.1002/pbc.25544

    View details for Web of Science ID 000360228000021

  • Racial/ethnic and socioeconomic disparities in survival among children with acute lymphoblastic leukemia in California, 1988-2011: A population-based observational study. Pediatric blood & cancer Abrahão, R., Lichtensztajn, D. Y., Ribeiro, R. C., Marina, N. M., Keogh, R. H., Marcos-Gragera, R., Glaser, S. L., Keegan, T. H. 2015; 62 (10): 1819-1825


    Despite advances in treatment, survival from acute lymphoblastic leukemia (ALL) remains lower among non-White children than White children in the US. We investigated the association of race/ethnicity and socioeconomic status (SES) with survival.We analyzed 9,295 Californian children (3,251 Whites, 4,890 Hispanics, 796 Asians, and 358 Blacks) aged ≤19 years diagnosed with a first primary ALL during 1988-2011. We used the Kaplan-Meier method to estimate survival at 1, 5, and 10 years after diagnosis for three calendar periods. Hazard ratios of death for race/ethnicity, SES, and clinical factors were estimated by Cox regression models.Median follow-up time was 7.4 years (range 0-25 years). Over time, survival after ALL improved steadily, but inequalities persisted across races/ethnicities. Five-year survival (95% confidence interval) was 85.0% (83.6-86.2) for White, 81.4% (78.3-84.0) for Asian, 79.0% (77.8-80.2) for Hispanic, and 74.4% (69.4-78.8) for Black children. In multivariable-adjusted models, the hazard of death was increased by 57% among Black, 38% among Hispanic, and 33% among Asian children compared with White children. Patients residing in the lowest SES neighborhoods at diagnosis had a 39% increased risk of death relative to those living in higher SES neighborhoods.Despite significant improvements in survival, non-White children and children residing in low SES neighborhoods experienced worse survival even after adjusting for potential confounders. Our findings highlight the need to capture specific information on disease biology, treatment, and treatment adherence to better understand the predictors of lower survival in minority and low SES groups. Pediatr Blood Cancer © 2015 Wiley Periodicals, Inc.

    View details for DOI 10.1002/pbc.25544

    View details for PubMedID 25894846

  • The impact of neighborhood social and built environment factors across the cancer continuum: Current research, methodological considerations, and future directions CANCER Gomez, S. L., Shariff-Marco, S., DeRouen, M., Keegan, T. H., Yen, I. H., Mujahid, M., Satariano, W. A., Glaser, S. L. 2015; 121 (14): 2314-2330


    Neighborhood social and built environments have been recognized as important contexts in which health is shaped. The authors reviewed the extent to which these neighborhood factors have been addressed in population-level cancer research by scanning the literature for research focused on specific social and/or built environment characteristics and their association with outcomes across the cancer continuum, including incidence, diagnosis, treatment, survivorship, and survival. The commonalities and differences in methodologies across studies, the current challenges in research methodology, and future directions in this research also were addressed. The assessment of social and built environment factors in relation to cancer is a relatively new field, with 82% of the 34 reviewed articles published since 2010. Across the wide range of social and built environment exposures and cancer outcomes considered by the studies, numerous associations were reported. However, the directions and magnitudes of associations varied, in large part because of the variation in cancer sites and outcomes studied, but also likely because of differences in study populations, geographic regions, and, importantly, choice of neighborhood measures and geographic scales. The authors recommend that future studies consider the life-course implications of cancer incidence and survival, integrate secondary and self-report data, consider work neighborhood environments, and further develop analytical and statistical approaches appropriate to the geospatial and multilevel nature of the data. Incorporating social and built environment factors into research on cancer etiology and outcomes can provide insights into disease processes, identify vulnerable populations, and generate results with translational impact of relevance for interventionists and policy makers. Cancer 2015. © 2015 American Cancer Society.

    View details for DOI 10.1002/cncr.29345

    View details for Web of Science ID 000357340200008

  • Cancer Research in Asian American, Native Hawaiian, and Pacific Islander Populations: Accelerating Cancer Knowledge by Acknowledging and Leveraging Heterogeneity CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION Gomez, S. L., Glaser, S. L., Horn-Ross, P. L., Cheng, I., Quach, T., Clarke, C. A., Reynolds, P., Shariff-Marco, S., Yang, J., Lee, M. M., Satariano, W. A., Hsing, A. W. 2014; 23 (11): 2202-2205
  • Cancer research in Asian American, Native Hawaiian, and Pacific Islander populations: accelerating cancer knowledge by acknowledging and leveraging heterogeneity. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology Gomez, S. L., Glaser, S. L., Horn-Ross, P. L., Cheng, I., Quach, T., Clarke, C. A., Reynolds, P., Shariff-Marco, S., Yang, J., Lee, M. M., Satariano, W. A., Hsing, A. W. 2014; 23 (11): 2202-2205


    The Asian American, Native Hawaiian, and Pacific Islander population is large, growing, and extremely heterogeneous. Not only do they bear unique burdens of incidence and outcomes for certain cancer types, they exhibit substantial variability in cancer incidence and survival patterns across the ethnic groups. By acknowledging and leveraging this heterogeneity through investing in cancer research within these populations, we have a unique opportunity to accelerate the availability of useful and impactful cancer knowledge. See all the articles in this CEBP Focus section, "Cancer in Asian and Pacific Islander Populations." Cancer Epidemiol Biomarkers Prev; 23(11); 2202-5. ©2014 AACR.

    View details for DOI 10.1158/1055-9965.EPI-14-0624

    View details for PubMedID 25368394

  • Hodgkin lymphoma incidence in California Hispanics: Influence of nativity and tumor Epstein-Barr virus CANCER CAUSES & CONTROL Glaser, S. L., Clarke, C. A., Chang, E. T., Yang, J., Gomez, S. L., Keegan, T. H. 2014; 25 (6): 709-725


    For classical Hodgkin lymphoma (HL), migrant studies could elucidate contributions of environmental factors (including Epstein-Barr virus (EBV)) to the lower rates in non-whites. Given the well-described etiologic complexity of HL, this research requires a large, immigrant population, such as California Hispanics.With 1988-2004 California Cancer Registry data (2,595 Hispanic, 8,637 white HL cases) and tumor cell EBV status on a subset (218 Hispanics, 656 whites), we calculated ethnicity- and nativity-specific HL incidence rates simultaneously by age, sex, and histologic subtype, and tumor cell EBV prevalence.Compared with white rates, Hispanic HL rates were lower overall (70 %) and for nodular sclerosis HL, particularly among young adults (60-65 % for females). However, they were higher among children (200 %) and older adults, and for mixed cellularity HL. Compared with rates in foreign-born Hispanics, rates in US-born Hispanics were higher among young adults (>threefold in females), lower for children and adults over age 70, and consistently intermediate compared with rates in whites. EBV tumor prevalence was 67, 32, and 23 % among foreign-born Hispanics, US-born Hispanics, and whites, respectively, although with variation by age, sex, and histology.Findings strongly implicate environmental influences, such as nativity-related sociodemographic differences, on HL occurrence. In addition, lower young adult rates and higher EBV prevalence in US-born Hispanics than in whites raise questions about the duration/extent of environmental change for affecting HL rates and also point to ethnic differences in genetic susceptibility. Lesser variation in mixed cellularity HL rates and greater variation in rates for females across groups suggest less modifiable factors interacting with environmental influences.

    View details for DOI 10.1007/s10552-014-0374-6

    View details for Web of Science ID 000336023600007

    View details for PubMedID 24722952

  • A meta-analysis of Hodgkin lymphoma reveals 19p13.3 TCF3 as a novel susceptibility locus NATURE COMMUNICATIONS Cozen, W., Timofeeva, M. N., Li, D., Diepstra, A., Hazelett, D., Delahaye-Sourdeix, M., Edlund, C. K., Franke, L., Rostgaard, K., Van den Berg, D. J., Cortessis, V. K., Smedby, K. E., Glaser, S. L., Westra, H., Robison, L. L., Mack, T. M., Ghesquieres, H., HWANG, A. E., Nieters, A., De Sanjose, S., Lightfoot, T., Becker, N., Maynadie, M., Foretova, L., ROMAN, E., Benavente, Y., RAND, K. A., NATHWANI, B. N., Glimelius, B., Staines, A., Boffetta, P., Link, B. K., Kiemeney, L., Ansell, S. M., Bhatia, S., Strong, L. C., Galan, P., Vatten, L., Habermann, T. M., Duell, E. J., Lake, A., Veenstra, R. N., Visser, L., Liu, Y., Urayama, K. Y., Montgomery, D., Gaborieau, V., Weiss, L. M., Byrnes, G., Lathrop, M., Cocco, P., Best, T., Skol, A. D., Adami, H., Melbye, M., Cerhan, J. R., Gallagher, A., Taylor, G. M., Slager, S. L., Brennan, P., Coetzee, G. A., Conti, D. V., Onel, K., Jarrett, R. F., Hjalgrim, H., van den Berg, A., Mckay, J. D. 2014; 5


    Recent genome-wide association studies (GWAS) of Hodgkin lymphoma (HL) have identified associations with genetic variation at both HLA and non-HLA loci; however, much of heritable HL susceptibility remains unexplained. Here we perform a meta-analysis of three HL GWAS totaling 1,816 cases and 7,877 controls followed by replication in an independent set of 1,281 cases and 3,218 controls to find novel risk loci. We identify a novel variant at 19p13.3 associated with HL (rs1860661; odds ratio (OR)=0.81, 95% confidence interval (95% CI)=0.76-0.86, Pcombined=3.5 × 10(-10)), located in intron 2 of TCF3 (also known as E2A), a regulator of B- and T-cell lineage commitment known to be involved in HL pathogenesis. This meta-analysis also notes associations between previously published loci at 2p16, 5q31, 6p31, 8q24 and 10p14 and HL subtypes. We conclude that our data suggest a link between the 19p13.3 locus, including TCF3, and HL risk.

    View details for DOI 10.1038/ncomms4856

    View details for Web of Science ID 000338830700001

    View details for PubMedID 24920014

  • Response to Evens et al., Racial disparities in Hodgkin's lymphoma: a comprehensive population-based analysis, Annals of Oncology 23: 2128-2137, 2012. Annals of oncology Glaser, S. L., Clarke, C. A., Gomez, S. L. 2013; 24 (12): 3136-?

    View details for DOI 10.1093/annonc/mdt487

    View details for PubMedID 24281301

  • Exposure to UV radiation and risk of Hodgkin lymphoma: a pooled analysis BLOOD Monnereau, A., Glaser, S. L., Schupp, C. W., Smedby, K. E., de Sanjose, S., Kane, E., Melbye, M., Foretova, L., Maynadie, M., Staines, A., Becker, N., Nieters, A., Brennan, P., Boffetta, P., Cocco, P., Glimelius, I., Clavel, J., Hjalgrim, H., Chang, E. T. 2013; 122 (20): 3492-3499


    Ultraviolet radiation (UVR) exposure has been inversely associated with Hodgkin lymphoma (HL) risk, but only inconsistently, only in a few studies, and without attention to HL heterogeneity. We conducted a pooled analysis of HL risk focusing on type and timing of UVR exposure and on disease subtypes by age, histology, and tumor-cell Epstein-Barr virus (EBV) status. Four case-control studies contributed 1320 HL cases and 6381 controls. We estimated lifetime, adulthood, and childhood UVR exposure and history of sunburn and sunlamp use. We used 2-stage estimation with mixed-effects models and weighted pooled effect estimates by inverse marginal variances. We observed statistically significant inverse associations with HL risk for UVR exposures during childhood and adulthood, sunburn history, and sunlamp use, but we found no significant dose-response relationships. Risks were significant only for EBV-positive HL (pooled odds ratio, 0.56; 95% confidence interval, 0.35 to 0.91 for the highest overall UVR exposure category), with a significant linear trend for overall exposure (P = .03). Pooled relative risk estimates were not heterogeneous across studies. Increased UVR exposure may protect against HL, particularly EBV-positive HL. Plausible mechanisms involving UVR induction of regulatory T cells or the cellular DNA damage response suggest opportunities for new prevention targets.

    View details for DOI 10.1182/blood-2013-04-497586

    View details for Web of Science ID 000327666500019

    View details for PubMedID 24016459

  • Cigarette smoking and risk of Hodgkin lymphoma and its subtypes: a pooled analysis from the International Lymphoma Epidemiology Consortium (InterLymph) ANNALS OF ONCOLOGY Kamper-Jorgensen, M., Rostgaard, K., Glaser, S. L., ZAHM, S. H., Cozen, W., Smedby, K. E., Sanjose, S., Chang, E. T., Zheng, T., La Vecchia, C., Serraino, D., Monnereau, A., Kane, E. V., Miligi, L., Vineis, P., Spinelli, J. J., McLaughlin, J. R., Pahwa, P., Dosman, J. A., Vornanen, M., Foretova, L., Maynadie, M., Staines, A., Becker, N., Nieters, A., Brennan, P., Boffetta, P., Cocco, P., Hjalgrim, H. 2013; 24 (9): 2245-2255


    The etiology of Hodgkin lymphoma (HL) remains incompletely characterized. Studies of the association between smoking and HL have yielded ambiguous results, possibly due to differences between HL subtypes.Through the InterLymph Consortium, 12 case-control studies regarding cigarette smoking and HL were identified. Pooled analyses on the association between smoking and HL stratified by tumor histology and Epstein-Barr virus (EBV) status were conducted using random effects models adjusted for confounders. Analyses included 3335 HL cases and 14 278 controls.Overall, 54.5% of cases and 57.4% of controls were ever cigarette smokers. Compared with never smokers, ever smokers had an odds ratio (OR) of HL of 1.10 [95% confidence interval (CI) 1.01-1.21]. This increased risk reflected associations with mixed cellularity cHL (OR = 1.60, 95% CI 1.29-1.99) and EBV-positive cHL (OR = 1.81, 95% CI 1.27-2.56) among current smokers, whereas risk of nodular sclerosis (OR = 1.09, 95% CI 0.90-1.32) and EBV-negative HL (OR = 1.02, 95% CI 0.72-1.44) was not increased.These results support the notion of etiologic heterogeneity between HL subtypes, highlighting the need for HL stratification in future studies. Even if not relevant to all subtypes, our study emphasizes that cigarette smoking should be added to the few modifiable HL risk factors identified.

    View details for DOI 10.1093/annonc/mdt218

    View details for Web of Science ID 000323963100006

    View details for PubMedID 23788758

  • Rituximab use and survival after diffuse large B-cell or follicular lymphoma: a population-based study LEUKEMIA & LYMPHOMA Keegan, T. H., Moy, L. M., Foran, J. M., Alizadeh, A. A., Chang, E. T., Shema, S. J., Schupp, C. W., Clarke, C. A., Glaser, S. L. 2013; 54 (4): 743-751
  • Gastric Cancer Incidence among Hispanics in California: Patterns by Time, Nativity, and Neighborhood Characteristics CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION Chang, E. T., Gomez, S. L., Fish, K., Schupp, C. W., Parsonnet, J., DeRouen, M. C., Keegan, T. H., Clarke, C. A., Glaser, S. L. 2012; 21 (5): 709-719


    Better understanding about gastric cancer incidence patterns among Hispanics by birthplace, socioeconomic status (SES), and acculturation can improve preventive strategies and disease models.Incidence rates, rate ratios, and estimated annual percent change (EAPC) in rates of anatomic and histologic subtype-specific gastric cancer were calculated by age, sex, and nativity among Hispanics using California Cancer Registry data from 1988 through 2004. Incidence rates in 1998 to 2002 were compared by neighborhood SES and Hispanic enclave status according to 2000 US Census data.Incidence rates of diffuse gastric cancer increased from 1988 through 2004 among foreign-born Hispanic men (EAPC: 3.5%, 95% CI: 1.5%-5.5%) and U.S.-born Hispanic women (EAPC: 3.0%, 95% CI: 0.7%-5.3%). During the same time period, incidence rates of intestinal gastric cancer declined significantly and both cardia and noncardia gastric cancer were steady or declined among foreign-born and U.S.-born Hispanic men and women. Noncardia and both intestinal and diffuse gastric cancer were more common in foreign-born than U.S.-born Hispanic men and women, and in those from lower SES, higher enclave neighborhoods. By contrast, among younger and middle-aged Hispanic men, cardia tumors were more common in the U.S.-born than the foreign-born, and in higher SES, lower enclave neighborhoods.Varying gastric cancer risk factors among Hispanic subgroups and increasing rates of diffuse gastric cancer in foreign-born Hispanic men and U.S.-born Hispanic women merit further investigation to identify separate disease etiologies.Age, sex, birthplace, SES, and acculturation modify gastric cancer incidence in Hispanics and should be considered when examining disease risk and prevention.

    View details for DOI 10.1158/1055-9965.EPI-11-1208

    View details for Web of Science ID 000303908200004

    View details for PubMedID 22374991

  • A genome-wide meta-analysis of nodular sclerosing Hodgkin lymphoma identifies risk loci at 6p21.32 BLOOD Cozen, W., Li, D., Best, T., Van den Berg, D. J., Gourraud, P., Cortessis, V. K., Skol, A. D., Mack, T. M., Glaser, S. L., Weiss, L. M., Nathwani, B. N., Bhatia, S., Schumacher, F. R., Edlund, C. K., Hwang, A. E., Slager, S. L., Fredericksen, Z. S., Strong, L. C., Habermann, T. M., Link, B. K., Cerhan, J. R., Robison, L. L., Conti, D. V., Onel, K. 2012; 119 (2): 469-475


    Nodular sclerosing Hodgkin lymphoma (NSHL) is a distinct, highly heritable Hodgkin lymphoma subtype. We undertook a genome-wide meta-analysis of 393 European-origin adolescent/young adult NSHL patients and 3315 controls using the Illumina Human610-Quad Beadchip and Affymetrix Genome-Wide Human SNP Array 6.0. We identified 3 single nucleotide polymorphisms (SNPs) on chromosome 6p21.32 that were significantly associated with NSHL risk: rs9268542 (P = 5.35 × 10(-10)), rs204999 (P = 1.44 × 10(-9)), and rs2858870 (P = 1.69 × 10(-8)). We also confirmed a previously reported association in the same region, rs6903608 (P = 3.52 × 10(-10)). rs204999 and rs2858870 were weakly correlated (r(2) = 0.257), and the remaining pairs of SNPs were not correlated (r(2) < 0.1). In an independent set of 113 NSHL cases and 214 controls, 2 SNPs were significantly associated with NSHL and a third showed a comparable odds ratio (OR). These SNPs are found on 2 haplotypes associated with NSHL risk (rs204999-rs9268528-rs9268542-rs6903608-rs2858870; AGGCT, OR = 1.7, P = 1.71 × 10(-6); GAATC, OR = 0.4, P = 1.16 × 10(-4)). All individuals with the GAATC haplotype also carried the HLA class II DRB1*0701 allele. In a separate analysis, the DRB1*0701 allele was associated with a decreased risk of NSHL (OR = 0.5, 95% confidence interval = 0.4, 0.7). These data support the importance of the HLA class II region in NSHL etiology.

    View details for DOI 10.1182/blood-2011-03-343921

    View details for Web of Science ID 000299268900024

    View details for PubMedID 22086417

  • Risk factors by molecular subtypes of breast cancer across a population-based study of women 56 years or younger BREAST CANCER RESEARCH AND TREATMENT Gaudet, M. M., Press, M. F., Haile, R. W., Lynch, C. F., Glaser, S. L., Schildkraut, J., Gammon, M. D., Thompson, W. D., Bernstein, J. L. 2011; 130 (2): 587-597


    Differences in incidence, prognosis, and treatment response suggest gene expression patterns may discern breast cancer subtypes with unique risk factor profiles; however, previous results were based predominantly on older women. In this study, we examined similar relationships in women ? 56 years, classified by immunohistochemical staining for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor-2 for 890 breast cancer cases and 3,432 frequency-matched population-based controls. Odds ratios (OR) and 95% confidence intervals (CI) for tumor subtypes were calculated using multivariate polytomous regression models. A total of 455 (51.1%) tumors were considered luminal A, 72 (8.1%) luminal B, 117 (13.1%) non-luminal HER-2/neu+, and 246 (27.6%) triple negative. Triple negative tumors were associated with breast feeding duration (per 6 months: OR = 0.76, 95% CI 0.64-0.90). Among premenopausal women, increasing body size was more strongly associated with luminal B (OR = 1.73, 95% CI 1.07-2.77) and triple negative tumors (OR = 1.67, 95% CI 1.22-2.28). A history of benign breast disease was associated only with increased risk of luminal A tumors (OR = 1.89, 95% CI 1.43-2.50). A family history of breast cancer was a risk factor for luminal A tumors (OR = 1.93, 95% CI 1.38-2.70) regardless of age, and triple negative tumors with higher risks for women <45 (OR = 5.02, 95% CI 2.82-8.92; P for age interaction = 0.005). We found that little-to-no breastfeeding and high BMI were associated with increased risk of triple negative breast cancer. That some risk factors differ by molecular subtypes suggests etiologic heterogeneity in breast carcinogenesis among young women.

    View details for DOI 10.1007/s10549-011-1616-x

    View details for Web of Science ID 000295675700023

    View details for PubMedID 21667121

  • Lymphoid Malignancies in US Asians: Incidence Rate Differences by Birthplace and Acculturation CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION Clarke, C. A., Glaser, S. L., Gomez, S. L., Wang, S. S., Keegan, T. H., Yang, J., Chang, E. T. 2011; 20 (6): 1064-1077


    Malignancies of the lymphoid cells, including non-Hodgkin lymphomas (NHL), HL, and multiple myeloma, occur at much lower rates in Asians than other racial/ethnic groups in the United States. It remains unclear whether these deficits are explained by genetic or environmental factors. To better understand environmental contributions, we examined incidence patterns of lymphoid malignancies among populations characterized by ethnicity, birthplace, and residential neighborhood socioeconomic status (SES) and ethnic enclave status.We obtained data about all Asian patients diagnosed with lymphoid malignancies between 1988 and 2004 from the California Cancer Registry and neighborhood characteristics from U.S. Census data.Although incidence rates of most lymphoid malignancies were lower among Asian than white populations, only follicular lymphoma (FL), chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), and nodular sclerosis (NS) HL rates were statistically significantly lower among foreign-born than U.S.-born Asians with incidence rate ratios ranging from 0.34 to 0.87. Rates of CLL/SLL and NS HL were also lower among Asian women living in ethnic enclaves or lower SES neighborhoods than those living elsewhere.These observations support strong roles of environmental factors in the causation of FL, CLL/SLL, and NS HL.Studying specific lymphoid malignancies in U.S. Asians may provide valuable insight toward understanding their environmental causes.

    View details for DOI 10.1158/1055-9965.EPI-11-0038

    View details for Web of Science ID 000291308600003

    View details for PubMedID 21493873

  • The California Neighborhoods Data System: a new resource for examining the impact of neighborhood characteristics on cancer incidence and outcomes in populations CANCER CAUSES & CONTROL Gomez, S. L., Glaser, S. L., McClure, L. A., Shema, S. J., Kealey, M., Keegan, T. H., Satariano, W. A. 2011; 22 (4): 631-647


    Research on neighborhoods and health has been growing. However, studies have not investigated the association of specific neighborhood measures, including socioeconomic and built environments, with cancer incidence or outcomes. We developed the California Neighborhoods Data System (CNDS), an integrated system of small area-level measures of socioeconomic and built environments for California, which can be readily linked to individual-level geocoded records. The CNDS includes measures such as socioeconomic status, population density, racial residential segregation, ethnic enclaves, distance to hospitals, walkable destinations, and street connectivity. Linking the CNDS to geocoded cancer patient information from the California Cancer Registry, we demonstrate the variability of CNDS measures by neighborhood socioeconomic status and predominant race/ethnicity for the 7,049 California census tracts, as well as by patient race/ethnicity. The CNDS represents an efficient and cost-effective resource for cancer epidemiology and control. It expands our ability to understand the role of neighborhoods with regard to cancer incidence and outcomes. Used in conjunction with cancer registry data, these additional contextual measures enable the type of transdisciplinary, "cells-to-society" research that is now being recognized as necessary for addressing population disparities in cancer incidence and outcomes.

    View details for DOI 10.1007/s10552-011-9736-5

    View details for Web of Science ID 000288509100011

    View details for PubMedID 21318584

  • Disparities in Liver Cancer Incidence by Nativity, Acculturation, and Socioeconomic Status in California Hispanics and Asians CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION Chang, E. T., Yang, J., Alfaro-Velcamp, T., So, S. K., Glaser, S. L., Gomez, S. L. 2010; 19 (12): 3106-3118


    Asians and Hispanics have the highest incidence rates of liver cancer in the United States, but little is known about how incidence patterns in these largely immigrant populations vary by nativity, acculturation, and socioeconomic status (SES). Such variations can identify high-priority subgroups for prevention and monitoring.Incidence rates and rate ratios (IRR) by nativity among 5,400 Hispanics and 5,809 Asians diagnosed with liver cancer in 1988-2004 were calculated in the California Cancer Registry. Neighborhood ethnic enclave status and SES were classified using 2000 U.S. Census data for cases diagnosed in 1998-2002.Foreign-born Hispanic males had significantly lower liver cancer incidence rates than U.S.-born Hispanic males in 1988-2004 (e.g., IRR = 0.54, 95% confidence interval [CI] = 0.50-0.59 in 1997-2004), whereas foreign-born Hispanic females had significantly higher rates in 1988-1996 (IRR = 1.42, 95% CI = 1.18-1.71), but not 1997-2004. Foreign-born Asian males and females had up to 5-fold higher rates than the U.S.-born. Among Hispanic females, incidence rates were elevated by 21% in higher-enclave versus lower-enclave neighborhoods, and by 24% in lower- versus higher-SES neighborhoods. Among Asian males, incidence rates were elevated by 23% in higher-enclave neighborhoods and by 21% in lower-SES neighborhoods. In both racial/ethnic populations, males and females in higher-enclave, lower-SES neighborhoods had higher incidence rates.Nativity, residential enclave status, and neighborhood SES characterize Hispanics and Asians with significantly unequal incidence rates of liver cancer, implicating behavioral or environmental risk factors and revealing opportunities for prevention.Liver cancer control efforts should especially target foreign-born Asians, U.S.-born Hispanic men, and residents of lower-SES ethnic enclaves.

    View details for DOI 10.1158/1055-9965.EPI-10-0863

    View details for Web of Science ID 000285285900012

    View details for PubMedID 20940276

  • The influence of nativity and neighborhoods on breast cancer stage at diagnosis and survival among California Hispanic women BMC CANCER Keegan, T. H., Quach, T., Shema, S., Glaser, S. L., Gomez, S. L. 2010; 10


    In the US, foreign-born Hispanics tend to live in socioeconomic conditions typically associated with later stage of breast cancer diagnosis, yet they have lower breast cancer mortality rates than their US-born counterparts. We evaluated the impact of nativity (US- versus foreign-born), neighborhood socioeconomic status (SES) and Hispanic enclave (neighborhoods with high proportions of Hispanics or Hispanic immigrants) on breast cancer stage at diagnosis and survival among Hispanics.We studied 37,695 Hispanic women diagnosed from 1988 to 2005 with invasive breast cancer from the California Cancer Registry. Nativity was based on registry data or, if missing, imputed from case Social Security number. Neighborhood variables were developed from Census data. Stage at diagnosis was analyzed with logistic regression, and survival, based on vital status determined through 2007, was analyzed with Cox proportional hazards regression.Compared to US-born Hispanics, foreign-born Hispanics were more likely to be diagnosed at an advanced stage of breast cancer (adjusted odds ratio (OR) = 1.14, 95% confidence interval (CI): 1.09-1.20), but they had a somewhat lower risk of breast cancer specific death (adjusted hazard ratio (HR) = 0.94, 95% CI: 0.90-0.99). Living in low SES and high enclave neighborhoods was associated with advanced stage of diagnosis, while living in a lower SES neighborhood, but not Hispanic enclave, was associated with worse survival.Identifying the modifiable factors that facilitate this survival advantage in Hispanic immigrants could help to inform specific interventions to improve survival in this growing population.

    View details for DOI 10.1186/1471-2407-10-603

    View details for Web of Science ID 000284404300001

    View details for PubMedID 21050464

  • Availability and Accuracy of Medical Record Information on Language Usage of Cancer Patients from a Multi-Ethnic Population JOURNAL OF IMMIGRANT AND MINORITY HEALTH McClure, L. A., Glaser, S. L., Shema, S. J., Allen, L., Quesenberry, C., John, E. M., Gomez, S. L. 2010; 12 (4): 480-488


    Documentation of language usage in medical settings could be effective in identifying and addressing language barriers and would improve understanding of health disparities. This study evaluated the availability and accuracy of medical records information on language for 1,664 cancer patients likely to have poor English proficiency. Accuracy was assessed by comparison to language obtained from interview-based research studies. For patients diagnosed at facilities where information on language was not abstracted electronically, 81.6% had language information in their medical records, most often in admissions documents. For all 37 hospitals, agreement between medical records and interview language was 79.3% overall and was greater for those speaking English than another language. Language information is widely available in hospital medical records of cancer patients. However, for the data to be useful for research and reducing language barriers in medical care, the information must be collected in a consistent and accurate manner.

    View details for DOI 10.1007/s10903-009-9282-3

    View details for Web of Science ID 000281505900007

    View details for PubMedID 19685187

  • Disparities in Breast Cancer Survival Among Asian Women by Ethnicity and Immigrant Status: A Population-Based Study AMERICAN JOURNAL OF PUBLIC HEALTH Gomez, S. L., Clarke, C. A., Shema, S. J., Chang, E. T., Keegan, T. H., Glaser, S. L. 2010; 100 (5): 861-869


    We investigated heterogeneity in ethnic composition and immigrant status among US Asians as an explanation for disparities in breast cancer survival.We enhanced data from the California Cancer Registry and the Surveillance, Epidemiology, and End Results program through linkage and imputation to examine the effect of immigrant status, neighborhood socioeconomic status, and ethnic enclave on mortality among Chinese, Japanese, Filipino, Korean, South Asian, and Vietnamese women diagnosed with breast cancer from 1988 to 2005 and followed through 2007.US-born women had similar mortality rates in all Asian ethnic groups except the Vietnamese, who had lower mortality risk (hazard ratio [HR] = 0.3; 95% confidence interval [CI] = 0.1, 0.9). Except for Japanese women, all foreign-born women had higher mortality than did US-born Japanese, the reference group. HRs ranged from 1.4 (95% CI = 1.2, 1.7) among Koreans to 1.8 (95% CI = 1.5, 2.2) among South Asians and Vietnamese. Little of this variation was explained by differences in disease characteristics.Survival after breast cancer is poorer among foreign- than US-born Asians. Research on underlying factors is needed, along with increased awareness and targeted cancer control.

    View details for DOI 10.2105/AJPH.2009.176651

    View details for Web of Science ID 000276828800021

    View details for PubMedID 20299648

  • Are cancer registries unconstitutional? SOCIAL SCIENCE & MEDICINE McLaughlin, R. H., Clarke, C. A., Crawley, L. M., Glaser, S. L. 2010; 70 (9): 1295-1300


    Population-based cancer registration, mandated throughout the United States, is central to quantifying the breadth and impact of cancer. It facilitates research to learn what causes cancer to develop and, in many cases, lead to death. However, as concerns about privacy increase, cancer registration has come under question. Recently, its constitutionality was challenged on the basis of 1) the vagueness of statutory aims to pursue public health versus the individual privacy interests of cancer patients, and 2) the alleged indignity of one's individual medical information being transmitted to government authorities. Examining cancer registry statutes in states covered by the US National Cancer Institute's SEER Program and the US Centers for Disease Control and Prevention's National Program of Cancer Registries, we found that cancer registration laws do state specific public health benefits, and offer reasonable limits and safeguards on the government's possession of private medical information. Thus, we argue that cancer registration would survive constitutional review, is compatible with the civil liberties protected by privacy rights in the U.S., satisfies the conditions that justify public health expenditures, and serves human rights to enjoy the highest attainable standards of health, the advances of science, and the benefits of government efforts to prevent and control disease.

    View details for DOI 10.1016/j.socscimed.2010.01.032

    View details for Web of Science ID 000277500400006

    View details for PubMedID 20199835

  • Increasing Mastectomy Rates for Early-Stage Breast Cancer? Population-Based Trends From California JOURNAL OF CLINICAL ONCOLOGY Gomez, S. L., Lichtensztajn, D., Kurian, A. W., Telli, M. L., Chang, E. T., Keegan, T. H., Glaser, S. L., Clarke, C. A. 2010; 28 (10): E155-E157

    View details for DOI 10.1200/JCO.2009.26.1032

    View details for Web of Science ID 000276152200036

    View details for PubMedID 20159812

  • Hidden Breast Cancer Disparities in Asian Women: Disaggregating Incidence Rates by Ethnicity and Migrant Status AMERICAN JOURNAL OF PUBLIC HEALTH Gomez, S. L., Quach, T., Horn-Ross, P. L., Pham, J. T., Cockburn, M., Chang, E. T., Keegan, T. H., Glaser, S. L., Clarke, C. A. 2010; 100: S125-S131


    We estimated trends in breast cancer incidence rates for specific Asian populations in California to determine if disparities exist by immigrant status and age.To calculate rates by ethnicity and immigrant status, we obtained data for 1998 through 2004 cancer diagnoses from the California Cancer Registry and imputed immigrant status from Social Security Numbers for the 26% of cases with missing birthplace information. Population estimates were obtained from the 1990 and 2000 US Censuses.Breast cancer rates were higher among US- than among foreign-born Chinese (incidence rate ratio [IRR] = 1.84; 95% confidence interval [CI] = 1.72, 1.96) and Filipina women (IRR = 1.32; 95% CI = 1.20, 1.44), but similar between US- and foreign-born Japanese women. US-born Chinese and Filipina women who were younger than 55 years had higher rates than did White women of the same age. Rates increased over time in most groups, as high as 4% per year among foreign-born Korean and US-born Filipina women. From 2000-2004, the rate among US-born Filipina women exceeded that of White women.These findings challenge the notion that breast cancer rates are uniformly low across Asians and therefore suggest a need for increased awareness, targeted cancer control, and research to better understand underlying factors.

    View details for DOI 10.2105/AJPH.2009.163931

    View details for Web of Science ID 000275937600025

    View details for PubMedID 20147696

  • Disparities in survival after Hodgkin lymphoma: a population-based study CANCER CAUSES & CONTROL Keegan, T. H., Clarke, C. A., Chang, E. T., Shema, S. J., Glaser, S. L. 2009; 20 (10): 1881-1892


    Survival after Hodgkin lymphoma (HL) is generally favorable, but may vary by patient demographic characteristics. The authors examined HL survival according to race/ethnicity and neighborhood socioeconomic status (SES), determined from residential census-block group at diagnosis. For 12,492 classical HL patients ? 15 years diagnosed in California during 1988-2006 and followed through 2007, we determined risk of overall and HL-specific death using Cox proportional hazards regression; analyses were stratified by age and Ann Arbor stage. Irrespective of disease stage, patients with lower neighborhood SES had worse overall and HL-specific survival than patients with higher SES. Patients with the lowest quintile of neighborhood SES had a 64% (patients aged 15-44 years) and 36% (? 45 years) increased risk of HL-death compared to patients with the highest quintile of SES; SES results were similar for overall survival. Even after adjustment for neighborhood SES, blacks and Hispanics had increased risks of HL-death 74% and 43% (15-44 years) and 40% and 17% (? 45 years), respectively, higher than white patients. The racial/ethnic differences in survival were evident for all stages of disease. These data provide evidence for substantial, and probably remediable, racial/ethnic and neighborhood SES disparities in HL outcomes.

    View details for DOI 10.1007/s10552-009-9382-3

    View details for Web of Science ID 000271809000010

    View details for PubMedID 19557531

  • Recent trends in breast cancer incience in US white women by county-level urban/rural and poverty status BMC MEDICINE Hausauer, A. K., Keegan, T. H., Chang, E. T., Glaser, S. L., Howe, H., Clarke, C. A. 2009; 7


    Unprecedented declines in invasive breast cancer rates occurred in the United States between 2001 and 2004, particularly for estrogen receptor-positive tumors among non-Hispanic white women over 50 years. To understand the broader public health import of these reductions among previously unstudied populations, we utilized the largest available US cancer registry resource to describe age-adjusted invasive and in situ breast cancer incidence trends for non-Hispanic white women aged 50 to 74 years overall and by county-level rural/urban and poverty status.We obtained invasive and in situ breast cancer incidence data for the years 1997 to 2004 from 29 population-based cancer registries participating in the North American Association of Central Cancer Registries resource. Annual age-adjusted rates were examined overall and by rural/urban and poverty of patients' counties of residence at diagnosis. Joinpoint regression was used to assess trends by annual quarter of diagnosis.Between 2001 and 2004, overall invasive breast cancer incidence fell 13.2%, with greater reductions among women living in urban (-13.8%) versus rural (-7.5%) and low- (-13.0%) or middle- (-13.8%) versus high- (-9.6%) poverty counties. Most incidence rates peaked around 1999 then declined after second quarter 2002, although in rural counties, rates decreased monotonically after 1999. Similar but more attenuated patterns were seen for in situ cancers.Breast cancer rates fell more substantially in urban and low-poverty, affluent counties than in rural or high-poverty counties. These patterns likely reflect a major influence of reductions in hormone therapy use after July 2002 but cannot exclude possible effects due to screening patterns, particularly among rural populations where hormone therapy use was probably less prevalent.

    View details for DOI 10.1186/1741-7015-7-31

    View details for Web of Science ID 000268635200001

    View details for PubMedID 19558637

  • Incidence of lymphoid neoplasms by subtype among six Asian ethnic groups in the United States, 1996-2004 CANCER CAUSES & CONTROL Daniel Carreon, J., Morton, L. M., Devesa, S. S., Clarke, C. A., Gomez, S. L., Glaser, S. L., Sakoda, L. C., Linet, M. S., Wang, S. S. 2008; 19 (10): 1171-1181


    To establish baseline data for lymphoid neoplasm incidence by subtype for six Asian-American ethnic groups.Incident rates were estimated by age and sex for six Asian ethnic groups--Asian Indian/Pakistani, Chinese, Filipino, Japanese, Korean, Vietnamese--in five United States cancer registry areas during 1996-2004. For comparison, rates for non-Hispanic Whites were also estimated.During 1996-2004, Filipinos had the highest (24.0) and Koreans had the lowest incidence (12.7) of total lymphoid neoplasms. By subtype, Vietnamese and Filipinos had the highest incidence for diffuse large B-cell lymphoma (DLBCL) (8.0 and 7.2); Japanese had the highest incidence of follicular lymphoma (2.3). Although a general male predominance of lymphoid neoplasms was observed, this pattern varied by lymphoid neoplasm subtype. Whites generally had higher rates than all Asian ethnic groups for all lymphoid neoplasms and most lymphoma subtypes, although the magnitude of the difference varied by both ethnicity and lymphoma subtype.The observed variations in incidence patterns among Asian ethnic groups in the United States suggest that it may be fruitful to pursue studies that compare Asian populations for postulated environmental and genetic risk factors.

    View details for DOI 10.1007/s10552-008-9184-z

    View details for Web of Science ID 000260766300017

    View details for PubMedID 18543071

  • Racial/ethnic variation in EBV-positive classical Hodgkin lymphoma in California populations INTERNATIONAL JOURNAL OF CANCER Glaser, S. L., Gulley, M. L., Clarke, C. A., Keegan, T. H., Chang, E. T., Shema, S. J., Craig, F. E., DiGiuseppe, J. A., Dorfman, R. F., Mann, R. B., Anton-Culver, H., Ambinder, R. F. 2008; 123 (7): 1499-1507


    Epstein-Barr virus (EBV) is detected in the tumor cells of some but not all Hodgkin lymphoma (HL) patients, and evidence indicates that EBV-positive and -negative HL are distinct entities. Racial/ethnic variation in EBV-positive HL in international comparisons suggests etiologic roles for environmental and genetic factors, but these studies used clinical series and evaluated EBV presence by differing protocols. Therefore, we evaluated EBV presence in the tumors of a large (n = 1,032), racially and sociodemographically diverse series of California incident classical HL cases with uniform pathology re-review and EBV detection methods. Tumor EBV-positivity was associated with Hispanic and Asian/Pacific Islander (API) but not black race/ethnicity, irrespective of demographic and clinical factors. Complex race-specific associations were observed between EBV-positive HL and age, sex, histology, stage, neighborhood socioeconomic status (SES), and birth place. In Hispanics, EBV-positive HL was associated not only with young and older age, male sex, and mixed cellularity histology, but also with foreign birth and lower SES in females, suggesting immune function responses to correlates of early childhood experience and later environmental exposures, respectively, as well as of pregnancy. For APIs, a lack of association with birth place may reflect the higher SES of API than Hispanic immigrants. In blacks, EBV-positive HL was associated with later-stage disease, consistent with racial/ethnic variation in certain cytokine polymorphisms. The racial/ethnic variation in our findings suggests that EBV-positive HL results from an intricate interplay of early- and later-life environmental, hormonal, and genetic factors leading to depressed immune function and poorly controlled EBV infection.

    View details for DOI 10.1002/ijc.23741

    View details for Web of Science ID 000258892500003

    View details for PubMedID 18646185

  • Availability and utility of body mass index for population-based cancer surveillance CANCER CAUSES & CONTROL Keegan, T. H., Le, G. M., McClure, L. A., Glaser, S. L. 2008; 19 (1): 51-57


    To evaluate the availability of body height and weight data in the hospital medical record of cancer patients and discuss the utility of the findings to population-based cancer research and the surveillance of overweight and obesity in the United States.Medical records were reviewed for up to three measures of height and weight for a random sample of 1,739 patients diagnosed (2001-2003) with one of the 12 types of cancer and reported to the population-based Greater Bay Area Cancer Registry of Northern California.About 84% of cancer patients had at least one value of height, 91% had at least one value of weight, and 83% had both values recorded in the medical record such that body mass index (BMI) could be computed. About 60% of height and weight values were recorded within 2 months of cancer diagnosis, with most values (71%) recorded after cancer diagnosis. The availability of BMI varied somewhat by race/ethnicity, cancer site, initial treatment, and hospital characteristics.BMI may be sufficiently available to be included routinely in the population-based cancer registries, and, if so, would be useful for studies of cancer diagnoses and outcomes and permit nationwide surveillance of BMI in a large population-representative cohort of cancer patients.

    View details for DOI 10.1007/s10552-007-9069-6

    View details for Web of Science ID 000252386400006

    View details for PubMedID 17943455

  • Declines in breast cancer after the WHI: apparent impact of hormone therapy CANCER CAUSES & CONTROL Clarke, C. A., Glaser, S. L. 2007; 18 (8): 847-852


    Large numbers of US women stopped taking hormone therapies (HT), especially estrogen/progestin (EP) formulations, after the Women's Health Initiative trial detected elevated risks of breast cancer in EP users and was halted in July 2002. Recent reports have indicated substantial and significant declines in population-based breast cancer incidence, particularly hormone-sensitive forms, for 2003 and 2004. Are these events linked? This commentary considers the available evidence linking the mass cessation of HT in 2002 to the breast cancer incidence declines of 2003/2004 and quantifies the potential impact of the cessation on the overall burden of breast cancer in the US.

    View details for DOI 10.1007/s10552-007-9029-1

    View details for Web of Science ID 000248375100007

    View details for PubMedID 17619153

  • The burden of liver cancer in Asians and Pacific Islanders in the greater San Francisco Bay Area, 1990 through 2004 CANCER Chang, E. T., Keegan, T. H., Gomez, S. L., Le, G. M., Clarke, C. A., So, S. K., Glaser, S. L. 2007; 109 (10): 2100-2108


    To the authors' knowledge, no previous U.S. study has examined time trends in the incidence rate of liver cancer in the high-risk Asian/Pacific Islander population. In this study, liver cancer incidence trends were evaluated in Chinese, Filipino, Japanese, Korean, and Vietnamese men and women in the Greater San Francisco Bay Area of California between 1990 and 2004.Populations at risk were estimated by using the cohort-component demographic method. Annual percentage changes (APCs) in age-adjusted incidence rates of primary liver cancer among Asians/Pacific Islanders in the Greater Bay Area Cancer Registry were calculated by using joinpoint regression analysis.The incidence rate of liver cancer between 1990 and 2004 did not change significantly in Asian/Pacific Islander men or women overall. However, the incidence rate declined, although the decline was not statistically significant, among Chinese men (APC, -1.6%; 95% confidence interval [95% CI], -3.4-0.3%), Japanese men (APC, -4.9%; 95% CI, -10.7-1.2%), and Japanese women (APC, -3.6%; 95% CI, -8.9-2%). Incidence rates remained consistently high for Vietnamese, Korean, and Filipino men and women. Trends in the incidence rate of hepatocellular carcinoma were comparable to those for liver cancer. Although disparities in liver cancer incidence between Asians/Pacific Islanders and other racial/ethnic groups diminished between the period from 1990 through 1994 and the period from 2000 through 2004, the disparities among Asian subgroups increased.Liver cancer continues to affect Asian/Pacific Islander Americans disproportionately, with consistently high incidence rates in most subgroups. Culturally targeted prevention methods are needed to reduce the high rates of liver cancer in this growing population in the U.S.

    View details for DOI 10.1002/cncr.22642

    View details for Web of Science ID 000246252800024

    View details for PubMedID 17385214

  • Recent trends in breast cancer incidence among 6 Asian groups in the Greater Bay Area of Northern California INTERNATIONAL JOURNAL OF CANCER Keegan, T. H., Gomez, S. L., Clarke, C. A., Chan, J. K., Glaser, S. L. 2007; 120 (6): 1324-1329


    Asians and Pacific Islanders are typically aggregated in United States (US) cancer statistics even though the few studies that have considered subgroups separately have found marked differences in cancer incidence. The objective of this study was to evaluate trends in breast cancer incidence rates separately for US Chinese, Japanese, Filipino, Korean, South Asian and Vietnamese women overall and by age at diagnosis, histologic subtype and stage at diagnosis. Age-adjusted incidence rates and annual percent changes (APC) of new, primary breast cancer diagnosed in the Greater Bay Area Cancer Registry of Northern California (1990-2002) were calculated using SEER*Stat. In women under 50 years of age, annual incidence rates decreased for Japanese (APC = -4.1, p = 0.02) and Filipinas (APC = -1.9, p = 0.11), and increased or fluctuated in other subgroups over the study period. In women 50 years or older, rates of invasive breast cancer increased for most subgroups, except Filipinas (APC = -1.3, p = 0.32), and in Japanese until 1998-2000. Rates of breast cancer in situ increased in most subgroups from 1990 to 2002, as did rates of lobular breast cancer for Chinese (APC = +7.46, p < 0.01) women. In Japanese women, rates of lobular breast cancer were highest in 1995-1997 and decreased thereafter. Our data support the notion that the prevalence of established risk factors influence breast cancer incidence, as breast cancer rates increased for more recently immigrated groups and decreased among more established groups, and may suggest leads into other avenues of research, such as genetic differences, that may explain differences in incidence rates among Asian subgroups.

    View details for DOI 10.1002/ijc.22432

    View details for Web of Science ID 000244118600022

    View details for PubMedID 17163416

  • Making sense of seasonal fluctuations in lymphoma diagnosis LEUKEMIA & LYMPHOMA Chang, E. T., Clarke, C. A., Glaser, S. L. 2007; 48 (2): 223-224

    View details for DOI 10.1080/10428190601158662

    View details for Web of Science ID 000244528300005

    View details for PubMedID 17325879

  • Understanding the validity of self-reported positive family history of lymphoma in extended families to facilitate genetic epidemiology and clinical practice LEUKEMIA & LYMPHOMA Glaser, S. L., Chang, E. T., Horning, S. J., Clarke, C. A. 2007; 48 (6): 1110-1118


    The validity of self-reported information about familial Hodgkin lymphoma (HL), important for epidemiologic research and clinical practice, is undetermined. We attempted to validate 55 familial lymphomas previously reported by 48 subjects in a population-based case-control study of HL in women. Of 44 diagnoses (80%) reported by 40 (83%) recontacted subjects, we obtained medical documentation for 36 (82%). Twenty-nine (81%) were validated as lymphoma, with accuracy better for first-degree relatives and subjects with larger nuclear families and other family illness. Fourteen reports of familial HL were validated as lymphoma for 13 (93%) and as HL for nine (64%). Fifteen reports of familial NHL were validated as lymphoma for 10 (67%) and as NHL for 10 (67%). Thus, familial HL reported by HL patients and controls is highly likely to be lymphoma even in extended family members but less likely to be HL per se. Validity may vary with the subject's family size and medical history.

    View details for DOI 10.1080/10428190701302434

    View details for Web of Science ID 000247779100012

    View details for PubMedID 17577774

  • Recent changes in breast cancer incidence and risk factor prevalence in San Francisco Bay area and California women: 1988 to 2004 BREAST CANCER RESEARCH Keegan, T. H., Chang, E. T., John, E. M., Horn-Ross, P. L., Wrensch, M. R., Glaser, S. L., Clarke, C. A. 2007; 9 (5)


    Historically, the incidence rate of breast cancer among non-Hispanic white women living in the San Francisco Bay area (SFBA) of California has been among the highest in the world. Substantial declines in breast cancer incidence rates have been documented in the United States and elsewhere during recent years. In light of these reports, we examined recent changes in breast cancer incidence and risk factor prevalence among non-Hispanic white women in the SFBA and other regions of California.Annual age-adjusted breast cancer incidence and mortality rates (1988 to 2004) were obtained from the California Cancer Registry and analyzed using Joinpoint regression. Population-based risk factor prevalences were calculated using two data sources: control subjects from four case-control studies (1989 to 1999) and the 2001 and 2003 California Health Interview Surveys.In the SFBA, incidence rates of invasive breast cancer increased 1.3% per year (95% confidence interval [CI], 0.7% to 2.0%) in 1988-1999 and decreased 3.6% per year (95% CI, 1.6% to 5.6%) in 1999-2004. In other regions of California, incidence rates of invasive breast cancer increased 0.8% per year (95% CI, 0.4% to 1.1%) in 1988-2001 and decreased 4.4% per year (95% CI, 1.4% to 7.3%) in 2001-2004. In both regions, recent (2000-2001 to 2003-2004) decreases in invasive breast cancer occurred only in women 40 years old or older and in women with all histologic subtypes and tumor sizes, hormone receptor-defined types, and all stages except distant disease. Mortality rates declined 2.2% per year (95% CI, 1.8% to 2.6%) from 1988 to 2004 in the SFBA and the rest of California. Use of estrogen-progestin hormone therapy decreased significantly from 2001 to 2003 in both regions. In 2003-2004, invasive breast cancer incidence remained higher (4.2%) in the SFBA than in the rest of California, consistent with the higher distributions of many established risk factors, including advanced education, nulliparity, late age at first birth, and alcohol consumption.Ongoing surveillance of breast cancer occurrence patterns in this high-risk population informs breast cancer etiology through comparison of trends with lower-risk populations and by highlighting the importance of examining how broad migration patterns influence the geographic distribution of risk factors.

    View details for DOI 10.1186/bcr1768

    View details for Web of Science ID 000253285800011

    View details for PubMedID 20210979

  • Recent declines in hormone therapy utilization and breast cancer incidence: clinical and population-based evidence. Journal of clinical oncology Clarke, C. A., Glaser, S. L., Uratsu, C. S., Selby, J. V., Kushi, L. H., Herrinton, L. J. 2006; 24 (33): e49-50

    View details for PubMedID 17114650

  • Misclassification of race/ethnicity in a population-based cancer registry (United States) CANCER CAUSES & CONTROL Gomez, S. L., Glaser, S. L. 2006; 17 (6): 771-781


    Cancer registry data on race/ethnicity are vital for understanding cancer patterns in population subgroups, as they inform public health policies for allocating resources and form the bases of etiologic hypotheses. However, accuracy of cancer registry data on race/ethnicity has not been systematically evaluated. By comparing race/ethnicity in the Greater Bay Area Cancer Registry to self-reported race/ethnicity for patients from 14 racial/ethnic groups, we determined the accuracy of this variable and the patient and hospital characteristics associated with disagreement. The extent of misclassification (measured by sensitivity and predictive value positive (PV+)) varied across racial/ethnic groups (total n=11,676). Sensitivities and PV+'s were high (exceeding 90%) for non-Hispanic Whites and Blacks, moderate for Hispanics and some Asian subgroups (70-90%), and very low for American Indians (<20%). Overall, registry and interview race/ethnicity disagreed for 11% of the sample. In a multivariate model, disagreement was associated with non-White race/ethnicity, younger age, being married, being foreign-born but preferring to speak English, and diagnosis in a large hospital. Improving data quality for race/ethnicity will be most effectively attempted at the reporting source. We advocate a concerted effort to systematize collection of these patient data across all facilities, which may be more feasible given electronic medical admissions forms.

    View details for DOI 10.1007/s10552-006-0013-y

    View details for Web of Science ID 000238340000003

    View details for PubMedID 16783605

  • Population attributable risk of breast cancer in white women associated with immediately modifiable risk factors BMC CANCER Clarke, C. A., Purdie, D. M., Glaser, S. L. 2006; 6


    Estrogen/progestin replacement therapy (EPRT), alcohol consumption, physical activity, and breast-feeding duration differ from other factors associated with breast cancer in being immediately modifiable by the individual, thereby representing attractive targets for future breast cancer prevention efforts. To justify such efforts, it is vital to quantify the potential population-level impacts on breast cancer considering population variations in behavior prevalence, risk estimate, and baseline incidence.For each of these four factors, we calculated population attributable risk percents (PARs) using population-based survey (2001) and cancer registry data (1998-2002) for 41 subpopulations of white, non-Hispanic California women aged 40-79 years, and ranges of relative risk (RR) estimates from the literature.Using a single RR estimate, subpopulation PARs ranged from 2.5% to 5.6% for hormone use, from 0.0% to 6.1% for recent consumption of > or = 2 alcoholic drinks daily, and 4.6% to 11.0% for physical inactivity. Using a range of RR estimates, PARs were 2-11% for EPRT use, 1-20% for alcohol consumption and 2-15% for physical inactivity. Subpopulation data were unavailable for breastfeeding, but PARs using published RR estimates ranged from 2% to 11% for lifetime breastfeeding > or = 31 months. Thus, of 13,019 breast cancers diagnosed annually in California, as many as 1,432 attributable to EPRT use, 2,604 attributable to alcohol consumption, 1,953 attributable to physical inactivity, and 1,432 attributable to never breastfeeding might be avoidable.The relatively feasible lifestyle changes of discontinuing EPRT use, reducing alcohol consumption, increasing physical activity, and lengthening breastfeeding duration could lower population breast cancer incidence substantially.

    View details for DOI 10.1186/1471-2407-6-170

    View details for Web of Science ID 000240419200001

    View details for PubMedID 16803628

  • Body size, physical activity, and risk of Hodgkin's lymphoma in women CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION Keegan, T. H., Glaser, S. L., Clarke, C. A., Dorfman, R. F., Mann, R. B., DiGiuseppe, J. A., Chang, E. T., Ambinder, R. F. 2006; 15 (6): 1095-1101


    Few studies have examined the associations of body size and physical activity with the development of Hodgkin's lymphoma (HL) in women. In data from a population-based case-control study in women ages 19 to 79 years, we assessed the relation of self-report height, weight, body mass index (BMI), and strenuous physical activity to HL risk in 312 cases with diagnostic re-review and 325 random-digit dialed controls using logistic regression. Analyses were stratified by age group and tumor cell presence of EBV. After adjustment for social class measures, taller childhood and adult height were associated with higher HL risk. In women ages 19 to 44 years, HL risk was elevated for higher, but healthy, BMI values, whereas in women ages 45 to 79 years, associations with BMI were inverse. The odds of developing HL were lower with participation (versus nonparticipation) in strenuous physical activity in the past year [odds ratio (OR), 0.58; 95% confidence interval (95% CI), 0.39-0.87 in women 19-44 years; OR, 0.45; 95% CI, 0.19-1.06 in women 45-79 years] and throughout adult life, and with sports team membership (versus nonmembership) in high school and/or at ages 18 to 22 years. Results were similar in cases (n = 269) with and without tumor-cell EBV compared with controls, although the inverse association with physical activity was somewhat stronger for women with EBV-positive disease. These findings show that in women, body size and strenuous physical activity, both modifiable characteristics, are associated with HL risk in adult life possibly through immunologic, infectious, or genetic mechanisms.

    View details for DOI 10.1158/1055-9965.EPI-06-0020

    View details for Web of Science ID 000238300100007

    View details for PubMedID 16775165

  • Changes in cancer registry coding for lymphoma subtypes: Reliability over time and relevance for surveillance and study CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION Clarke, C. A., Undurraga, D. M., Harasty, P. J., Glaser, S. L., Morton, L. M., Holly, E. A. 2006; 15 (4): 630-638


    Because lymphoma comprises numerous histologic subtypes, understanding the reasons for ongoing increases in its incidence requires surveillance and etiologic study of these subtypes. However, this research has been hindered by many coexisting classification schemes. The Revised European American classification of Lymphoid Neoplasms (REAL)/WHO system developed in 1994 and now used in clinical settings was not incorporated into the International Classification of Diseases-Oncology (ICD-O), used by cancer registries, until the release of the third edition (ICD-O-3) in 2001. Studies including patients diagnosed before 2001 may have codes from earlier ICD-O versions that must be converted to ICD-O-3 and have higher proportions of unclassified (e.g., lymphoma and not otherwise specified) cases. To better understand (a) the agreement of computer-converted ICD-O-3 codes to ICD-O-3 codes generated directly from diagnostic pathology reports and (b) the reproducibility of unclassified status, we reviewed a population-based series of diagnostic pathology reports for lymphoma patients diagnosed before (1988-1994; n = 1,493) and after (1998-2000; n = 1,527) the REAL/WHO scheme was introduced. Overall, computer- and coder-assigned ICD-O-3 codes agreed for 77% of patients in both groups and improved slightly (82%) when codes were grouped. The most common lymphoma subtypes, diffuse large B cell and follicular, had relatively good reliability (84-89%) throughout the study period. T-cell and natural killer cell lymphomas had worse agreement than B-cell lymphomas, even when grouped. Many (42-43%) lymphomas reported as unclassifiable could be assigned a subtype upon pathology report review. These findings suggest that the study of lymphoma subtypes could be improved by (a) use of more standardized terminology in pathology reports, (b) grouping individual ICD-O-3 codes to reduce misclassification bias, and (c) routine secondary editing of unclassified lymphomas by central cancer registries.

    View details for DOI 10.1158/1055-9965.EP1-05-0549

    View details for Web of Science ID 000237045100007

    View details for PubMedID 16614102

  • Cancer surveillance research: A vital subdiscipline of cancer epidemiology CANCER CAUSES & CONTROL Glaser, S. L., Clarke, C. A., Gomez, S. L., O'Malley, C. D., Purdie, D. M., West, D. W. 2005; 16 (9): 1009-1019


    Public health surveillance systems relevant to cancer, centered around population-based cancer registration, have produced extensive, high-quality data for evaluating the cancer burden. However, these resources are underutilized by the epidemiology community due, we postulate, to under-appreciation of their scope and of the methods and software for using them. To remedy these misperceptions, this paper defines cancer surveillance research, reviews selected prior contributions, describes current resources, and presents challenges to and recommendations for advancing the field. Cancer surveillance research, in which systematically collected patient and population data are analyzed to examine and test hypotheses about cancer predictors, incidence, and outcomes in geographically defined populations over time, has produced not only cancer statistics and etiologic hypotheses but also information for public health education and for cancer prevention and control. Data on cancer patients are now available for all US states and, within SEER, since 1973, and have been enhanced by linkage to other population-based resources. Appropriate statistical methods and sophisticated interactive analytic software are readily available. Yet, publication of papers, funding opportunities, and professional training for cancer surveillance research remain inadequate. Improvement is necessary in these realms to permit cancer surveillance research to realize its potential in resolving the growing cancer burden.

    View details for DOI 10.1007/s10552-005-4501-2

    View details for Web of Science ID 000232139900002

    View details for PubMedID 16184466

  • Epstein-Barr virus as a marker of survival after Hodgkin's lymphoma: A population-based study JOURNAL OF CLINICAL ONCOLOGY Keegan, T. H., Glaser, S. L., Clarke, C. A., Gulley, M. L., Craig, F. E., DiGiuseppe, J. A., Dorfman, R. F., Mann, R. B., Ambinder, R. F. 2005; 23 (30): 7604-7613


    Epstein-Barr virus (EBV) in Hodgkin's lymphoma (HL) cells has been considered as a prognostic marker for this heterogeneous disease, but studies have yielded mixed findings, likely because of selected patient series and failure to acknowledge an effect of age on outcome. This study assessed survival after HL in a population-based cohort large enough to examine the joint effects of EBV with other factors including age, sex, and histologic subtype.Included were 922 patients with classical HL diagnosed between mid-1988 and 1997 in the Greater San Francisco Bay Area, with archived biopsy specimens assayed for EBV with immunohistochemistry and in situ hybridization. Vital status was followed through December 30, 2003 (median follow-up time, 97 months). Overall and disease-specific survival were analyzed with the Kaplan-Meier method and Cox proportional hazards regression models.In children less than 15 years old, EBV presence was suggestively associated (P = .07) with favorable survival. In adults aged 15 to 44 years, EBV did not affect HL outcome, although a protective effect was suggested. In older adults (45 to 96 years), EBV presence nearly doubled the risk of overall and HL-specific mortality but only for patients with nodular sclerosis (NS) histologic subtype (hazard ratio for death = 2.5; 95% CI, 1.5 to 4.3).In HL, EBV tumor cell presence is associated with better survival in young patients and poorer survival in older patients with NS, independent of other factors. Variation in outcome by age and histology could indicate biologically distinct disease entities. Evidence that EBV is a meaningful prognostic marker may have therapeutic relevance.

    View details for DOI 10.1200/JCO.2005.02.6310

    View details for Web of Science ID 000232935300034

    View details for PubMedID 16186595

  • Incidence of male breast cancer in California, 1988-2000: racial/ethnic variation in 1759 men BREAST CANCER RESEARCH AND TREATMENT O'Malley, C., Shema, S., White, E., Glaser, S. 2005; 93 (2): 145-150


    Breast cancer among males is rare, accounting for less than 1% of all breast cancers in the United States. Although it is rare, it can cause significant morbidity and mortality. We analyzed data from 1759 California males whose diagnosis of breast cancer was made between 1988 and 2000 and reported to the population-based California Cancer Registry. Cases were primary, microscopically confirmed in situ and invasive breast cancer. Age-adjusted incidence rates per 100,000 men were highest in Blacks (1.65), intermediate in whites (1.31) and lowest in Hispanics and Asian/Pacific Islanders (0.68, 0.66, respectively). Age at diagnosis differed by race (p = 0.001) with blacks diagnosed at an earlier age than whites or Asians/Pacific Islanders. Stage at diagnosis also differed by race (p = 0.001) with blacks more likely to be diagnosed at distant stage. Further investigation showed that blacks and Hispanics were more likely to be diagnosed with tumors 5 cm in diameter or greater. The proportion of men having surgery following a diagnosis of breast cancer also varied by race/ethnicity (p = 0.001) with blacks least likely to have surgery following diagnosis. Understanding racial/ethnic variation in male breast cancer may provide clinical and etiologic implications for breast cancer in different populations.

    View details for DOI 10.1007/s10549-005-4517-z

    View details for Web of Science ID 000232161300007

    View details for PubMedID 16187234

  • Quality of cancer registry birthplace data for Hispanics living in the United States CANCER CAUSES & CONTROL Gomez, S. L., Glaser, S. L. 2005; 16 (6): 713-723


    Patient birthplace from the SEER population-based cancer registries is potentially useful for identifying disparities in cancer occurrence and for studying cancer etiology. However, for Hispanics, completeness and accuracy of registry birthplace is unknown. By comparing registry birthplace to self-reported birthplace from 13 interview studies, we determined the completeness and accuracy of this variable and the associations of these measures with patient and hospital characteristics in the Greater Bay Area. Registry birthplace was unrecorded for 46% of 1277 Hispanic cancer cases, and unrecorded birthplace (i.e., incompleteness) was associated with younger age, higher education, English language preference, US birthplace, and admission at certain hospitals. For 691 Hispanics with available registry birthplace, sensitivity and positive predictive value compared to self-report (i.e., accuracy) were 96.3 and 97.3 among foreign-born, and 96.8 and 95.6 among US-born. US-born Hispanics misclassified in the registry as foreign-born were more likely to have unavailable education information, be deceased, prefer a language besides English, and be diagnosed at a smaller hospital or before 1996. Among self-reported foreign-born Hispanics, those misclassified as US-born were less likely to have been diagnosed at an HMO. Although the completeness and accuracy of birthplace information may vary across registries, this variable appears to be limited for analyses involving Hispanics.

    View details for DOI 10.1007/s10552-005-0694-7

    View details for Web of Science ID 000230844600011

    View details for PubMedID 16049810

  • Exposure to childhood infections and risk of Epstein-Barr virus-defined Hodgkin's lymphoma in women INTERNATIONAL JOURNAL OF CANCER Glaser, S. L., Keegan, T. H., Clarke, C. A., Trinh, M., Dorfman, R. F., Mann, R. B., DiGiuseppe, J. A., Ambinder, R. F. 2005; 115 (4): 599-605


    The role of Epstein-Barr virus (EBV) in Hodgkin's lymphoma (HL) etiology remains unresolved as EBV is detected in only some HL tumors and few studies have tried to reconcile its presence with factors suggesting viral etiology (e.g., childhood social class, infection history). In a population-based case-control study of San Francisco Bay area women, we analyzed interview data by tumor EBV status. Among 211 young adult cases, EBV-positive HL (11%) was associated with a single vs. shared bedroom at age 11 (OR = 4.0, 95% CI 1.1-14.4); risk was decreased for common childhood infections (OR = 0.3, 95% CI 0.1-1.0), including measles before age 10, but not with prior infectious mononucleosis (IM), which is delayed EBV infection. No study factors affected risk of young adult EBV-negative HL. Among 57 older adult cases, EBV-positive HL (23%) was unrelated to study factors; EBV-negative HL was associated with a single bedroom at age 11 (OR = 3.6, 95% CI 1.5-9.1) and IM in family members (OR = 3.1, 95% CI 1.1-9.0). Thus, delayed exposure to infection may increase risk of EBV-positive HL in young adults, but risk patterns differ in younger and older women for both EBV-positive and -negative HL. Late EBV infection does not appear relevant to risk, suggesting that other pathogens impact HL etiology in affluent female populations. Inconsistency of findings with prior studies may reflect failure of study risk factors to proxy meaningful exposures, risk differences by gender, or selection or misclassification bias. Null findings for EBV-negative HL indicate that etiologic models should be reconsidered for this common form.

    View details for DOI 10.1002/ijc.20787

    View details for Web of Science ID 000229082800013

    View details for PubMedID 15700307

  • Neighborhood socioeconomic status and Hodgkin's lymphoma incidence in California CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION Clarke, C. A., Glaser, S. L., Keegan, T. H., Stroup, A. 2005; 14 (6): 1441-1447


    Hodgkin's lymphoma occurrence has long been noted to associate with higher socioeconomic status (SES). However, the Hodgkin's lymphoma-SES association has not been examined recently or across important, possibly etiologically distinct, patient subgroups. In approximately 150 million person-years of observation in the multiethnic population of California, we examined the association of Hodgkin's lymphoma incidence with a composite measure of neighborhood-level SES in patient subgroups defined by age, sex, race/ethnicity, and Hodgkin's lymphoma histologic subtype. Using population-based cancer registry data on 3,794 Hodgkin's lymphoma patients diagnosed 1988 to 1992 and 1990 census data, we assigned a previously validated, multidimensional SES index to census block groups of patient residence. We then calculated neighborhood SES-specific incidence rates and estimated rate ratios using Poisson regression. Positive neighborhood SES gradients in Hodgkin's lymphoma incidence were observed only in young adults (ages 15-44 years at diagnosis) with nodular sclerosis Hodgkin's lymphoma and older adult (ages > or =45 years) White and Hispanic males with mixed cellularity Hodgkin's lymphoma. For young adults, associations were marked in Hispanic and Asian women, weaker in Hispanic and White men and White women, and subtle to nonexistent in Blacks and Asian men. Neighborhood SES gradients in Hodgkin's lymphoma incidence varied by age, sex, race/ethnicity, and histologic subtype, underscoring etiologic complexity in Hodgkin's lymphoma. Racial/ethnic gradients were not entirely explained by neighborhood SES. In California, etiologically relevant exposures for young adult Hodgkin's lymphoma, the most common form, could associate more with race/ethnicity or foreign birthplace than neighborhood SES and may be modified by reproductive or other sex-specific factors.

    View details for Web of Science ID 000229766600019

    View details for PubMedID 15941953

  • Real-time PCR measures Epstein-Barr virus DNA in archival breast adenocarcinomas DIAGNOSTIC MOLECULAR PATHOLOGY Thorne, L. B., RYAN, J. L., Elmore, S. H., Glaser, S. L., Gulley, M. L. 2005; 14 (1): 29-33


    The role of Epstein-Barr Virus (EBV) in breast cancer pathogenesis remains controversial. Fifty-five cases of paraffin-embedded, formalin-fixed invasive breast cancer were screened for the presence of EBV using quantitative polymerase chain reaction (PCR) directed at five different targets within the EBV genome (BamH1W, LMP1, EBNA1, LMP2, and BZLF1 regions). In four tumors (7%), low level EBV DNA was detected by at least one of the assays, with levels of up to 11 copies of EBV DNA per 100,000 cells. Immunohistochemisty for viral BMRF1 and BZLF1 and in situ hybridization for lytic gene transcripts showed no evidence of replicative EBV gene expression. Lymphocytes and malignant cells were also negative for latent infection by EBER in situ hybridization. Laser capture microdissection followed by quantitative real-time PCR was not useful in localizing EBV DNA to malignant cells or bystander lymphocytes. In conclusion, EBV DNA is detectable in a fraction of breast cancer specimens using real-time PCR as a screening tool, albeit at quite low levels, which suggests that only rare cells are infected. The low levels probably confounded our ability to localize the virus to particular cell types or to characterize viral gene expression.

    View details for Web of Science ID 000227231100005

    View details for PubMedID 15714061

  • Inconsistencies between self-reported ethnicity and ethnicity recorded in a health maintenance organization ANNALS OF EPIDEMIOLOGY Gomez, S. L., Kelsey, J. L., Glaser, S. L., Lee, M. M., Sidney, S. 2005; 15 (1): 71-79


    Information on patient ethnicity in hospital admissions databases is often used in epidemiologic and health services research. However, the extent of consistency of these data with self-reported ethnicity is not well studied, particularly for specific Asian subgroups. We examined agreement between ethnicity in records of a sample of members of five Northern California Kaiser Permanente medical centers with self-reported ethnicity.Subjects were 3168 cases and 2413 controls aged 45 years and older from a study of fractures. Ethnicity recorded in the Kaiser admissions database (primarily inpatient) was compared with self-reported ethnicity from the study interviews.Among study subjects with available Kaiser ethnicity, sensitivities and positive predictive values of the Kaiser classification were high among blacks (0.95 for both measures) and whites (0.98 and 0.94, respectively), slightly lower among Asians (0.88 and 0.95, respectively), and considerably lower among Hispanics (0.55 and 0.81, respectively) and American Indians (0.47 and 0.50, respectively). Among Asian subgroups, the proportion classified as Asian was high among Chinese (0.94) and Japanese (0.99) but lower among Filipinos (0.79) and other Asians (0.74). Among the 228 (4%) subjects who self-identified with multiple ethnicities, 13 of 18 white + Hispanic subjects were classified as being white, and of the 77 subjects identifying as part American Indian, only one was classified as being American Indian in the Kaiser database.Given the importance of ethnicity information, medical facilities should be encouraged to adopt policies toward collecting high quality data.

    View details for DOI 10.1016/j.annepidem.2004.03.002

    View details for Web of Science ID 000225798100010

    View details for PubMedID 15571996

  • Breast implants following mastectomy in women with early-stage breast cancer: prevalence and impact on survival BREAST CANCER RESEARCH Le, G. M., O'Malley, C. D., Glaser, S. L., Lynch, C. F., Stanford, J. L., Keegan, T. H., West, D. W. 2005; 7 (2): R184-R193


    Few studies have examined the effect of breast implants after mastectomy on long-term survival in breast cancer patients, despite growing public health concern over potential long-term adverse health effects.We analyzed data from the Surveillance, Epidemiology and End Results Breast Implant Surveillance Study conducted in San Francisco-Oakland, in Seattle-Puget Sound, and in Iowa. This population-based, retrospective cohort included women younger than 65 years when diagnosed with early or unstaged first primary breast cancer between 1983 and 1989, treated with mastectomy. The women were followed for a median of 12.4 years (n = 4968). Breast implant usage was validated by medical record review. Cox proportional hazards models were used to estimate hazard rate ratios for survival time until death due to breast cancer or other causes for women with and without breast implants, adjusted for relevant patient and tumor characteristics.Twenty percent of cases received postmastectomy breast implants, with silicone gel-filled implants comprising the most common type. Patients with implants were younger and more likely to have in situ disease than patients not receiving implants. Risks of breast cancer mortality (hazard ratio, 0.54; 95% confidence interval, 0.43-0.67) and nonbreast cancer mortality (hazard ratio, 0.59; 95% confidence interval, 0.41-0.85) were lower in patients with implants than in those patients without implants, following adjustment for age and year of diagnosis, race/ethnicity, stage, tumor grade, histology, and radiation therapy. Implant type did not appear to influence long-term survival.In a large, population-representative sample, breast implants following mastectomy do not appear to confer any survival disadvantage following early-stage breast cancer in women younger than 65 years old.

    View details for DOI 10.1186/bcr974

    View details for Web of Science ID 000227583300010

    View details for PubMedID 15743498

  • Immigration and acculturation in relation to health and health-related risk factors among specific Asian subgroups in a health maintenance organization AMERICAN JOURNAL OF PUBLIC HEALTH Gomez, S. L., Kelsey, J. L., Glaser, S. L., Lee, M. M., Sidney, S. 2004; 94 (11): 1977-1984


    We sought to determine how risk factors for disease vary among Asian subgroups.Using data from a case-control study conducted at Northern California Kaiser Medical Centers (from 1996 to 2001), we compared prevalence of selected risk factors among Asian subgroups and evaluated the associations of these risk factors with sociodemographic factors.Chinese and Japanese patients had a lower body mass index (kg/m(2)) than did other Asians. In all subgroups, being born in the United States was associated with having a body mass index greater than 25 kg/m(2). Compared with other Asians, more Japanese and multiple-race Asians smoked, and more Filipino and multiple-race Asian smokers started smoking at 18 years or younger. Filipinos and multiple-race Asians also were more likely to report diabetes.These data support the importance of efforts to distinguish among Asian subgroups in public health practice and research.

    View details for Web of Science ID 000224780800033

    View details for PubMedID 15514240

  • Epstein-Barr virus quantitation by real-time PCR targeting multiple gene segments - A novel approach to screen for the virus in paraffin-embedded tissue and plasma JOURNAL OF MOLECULAR DIAGNOSTICS RYAN, J. L., Fan, H. X., Glaser, S. L., Schichman, S. A., Raab-Traub, N., Gulley, M. L. 2004; 6 (4): 378-385


    Epstein-Barr Virus (EBV) infects nearly all humans and then persists for the life of the host. In some people who later develop cancer, EBV DNA is present within malignant cells and circulates at elevated levels in the plasma. In the current study, we validated five novel quantitative polymerase chain reaction (Q-PCR) assays targeting disparate but highly conserved segments of the EBV genome (BamH1W, EBNA1, LMP1, LMP2, and BZLF1). Each assay was sensitive to as few as 50 copies of EBV DNA per reaction and was linear across at least four orders of magnitude. When applied to paraffin-embedded tissues in concert with EBV-encoded RNA (EBER) in situ hybridization, the BamH1W and EBNA1 assays were the most informative, while use of the entire battery of EBV PCR assays may help identify genomic polymorphisms or deletions. Higher viral loads were found in the 17 EBER-positive compared with the 13 EBER-negative tumors (means 84,978 versus 22 copies of EBV per 100,000 cells, respectively). The five Q-PCR assays were also informative in plasma samples where EBV was measurable in all nine patients with lymphoma or infectious mononucleosis, whereas EBV was undetectable in all nine healthy controls. The findings suggest that Q-PCR is an effective method of distinguishing disease-associated virus from incidental virus in paraffin-embedded tissue and in plasma samples.

    View details for Web of Science ID 000226190000014

    View details for PubMedID 15507678

  • Attenuation of social class and reproductive risk factor associations for Hodgkin lymphoma due to selection bias in controls CANCER CAUSES & CONTROL Glaser, S. L., Clarke, C. A., Keegan, T. H., Gomez, S. L., Nugent, R. A., Topol, B., Stearns, C. B., Stewart, S. L. 2004; 15 (7): 731-739


    Hodgkin lymphoma (HL) risk has been linked with higher social class and lower parity, but our prior population-based case-control study in adult women had unexpected null findings for these variables. Because subject participation was 87% for cases but 65% for random digit-dialing (RDD) controls, we examined representativeness of our controls and the impact of detected bias on prior results.Using data from RDD enumeration, abbreviated interviews with nonparticipating controls, and the US census, we compared participating and nonparticipating RDD controls across several age groups and then recomputed odds ratios for risk factor associations adjusted for bias.The 325 RDD control participants were younger, more likely to be white, better educated, and of lower birth order and lower parity than the nonparticipants. Adjustment of odds ratios for bias strengthened previously null findings for education and for parity, breast-feeding and miscarriages in young adult women; these latter changes eliminated previously apparent age modification of risks.Selection bias in female RDD controls resulted from differential participation by socioeconomic factors, varied with age, and produced underestimations of several associations in young women, including reproductive factors. Thus, our prior conclusions of etiologic irrelevance for some study variables may have been inaccurate.

    View details for Web of Science ID 000223620900011

    View details for PubMedID 15280631

  • Population-based surveillance of HIV-associated cancers: utility of cancer registry data JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES Clarke, C. A., Glaser, S. L. 2004; 36 (5): 1083-1091


    Long-term cancer risks are uncertain in HIV-infected persons, particularly those using highly active antiretroviral therapy (HAART). Timely, population-based surveillance of HIV-associated malignancies in the United States has been challenging because of various data inadequacies. Cancer registries represent a resource for this surveillance, if uncertainties around accurate differentiation of HIV-associated and unassociated cancers can be resolved. To inform the utility of cancer registry data for classifying and monitoring HIV-associated cancers, the completeness and quality of cancer registry-available information about patient HIV status was assessed. For all 10,126 non-Hodgkin lymphomas (NHLs), 1497 Hodgkin lymphomas (HLs), and 895 anal cancers reported to the Greater San Francisco Bay Area registry during 1990-1998, 6 indicators of patient HIV status were retrieved from 2 cancer registry-available sources (cancer registry records, death records) and from linkage with the California AIDS registry. Cross-tabulations were used to examine the distributions of patients with evidence of positive HIV status by indicator and source. Together, 5 cancer registry-available HIV indicators identified 25% more presumed HIV-positive NHL patients and nearly 50% more HL and anal cancer patients than were detected by AIDS registry linkage. Eighty-three percent of NHL patients and at least half of HL and anal cancer patients were identified by multiple sources of HIV indicators, and most individual indicators agreed acceptably with others. However, optimal strategies for classifying HIV-associated patients differed by cancer site. At least in this region, cancer registry data represent a useful resource for monitoring HIV-associated lymphomas and anal cancer and may offer benefits over linkage-based means in the age of HAART.

    View details for Web of Science ID 000222974300012

    View details for PubMedID 15247562

  • Smoking and Hodgkin lymphoma risk in women United States CANCER CAUSES & CONTROL Glaser, S. L., Keegan, T. H., Clarke, C. A., Darrow, L. A., Gomez, S. L., Dorfman, R. F., Mann, R. B., DiGiuseppe, J. A., Ambinder, R. F. 2004; 15 (4): 387-397


    Smoking has received little consideration as a risk factor for Hodgkin lymphoma (HL) in women, despite recent significant findings in men and gender differences in HL incidence. We investigated the association of HL with lifetime cigarette smoking and household environmental tobacco smoke (ETS) exposure in women.In data from a population-based case-control study in women ages 19-79, we analyzed HL risk associated with self-reported smoking and household ETS exposure in 312 diagnostically re-reviewed cases and 325 random-digit dialing controls using logistic regression. Epstein-Barr virus (EBV) presence was determined in tumors of 269 cases.In 253 cases compared to 254 controls ages 19-44, risks of HL overall, and of nodular sclerosis and EBV-negative HL, were increased 50% with ETS exposure in childhood; for 11 cases of mixed cellularity (MC) HL, current smoking and adult ETS exposure also increased risk; for 24 cases of EBV-positive HL, risk was elevated for current smoking, greater smoking intensity and duration, and ETS exposure. In 59 cases and 71 controls ages 45-79, most smoking characteristics did not appear to affect risk.Apparent effects of current smoking on risks of MC HL and EBV-positive HL and of household ETS on risk of all HL in young adult females may broaden the evidence implicating tobacco smoke exposures in HL etiology.

    View details for Web of Science ID 000221360300006

    View details for PubMedID 15141139

  • Epstein-Barr virus and breast cancer: State of the evidence for viral carcinogenesis CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION Glaser, S. L., Hsu, J. L., Gulley, M. L. 2004; 13 (5): 688-697


    As the etiology and progression of breast cancer remain incompletely understood, novel routes of disease pathogenesis are important to consider. Viral pathogens have not been much explored, but recent interest has focused on Epstein-Barr virus (EBV). Studies of an association of this ubiquitous herpesvirus with breast cancer have had notably inconsistent results, marked by varying EBV presence (from 0% to 50% of tumors) and the absence of certain viral characteristics found in other EBV-related malignancies. The research has been plagued by the technical challenges of localizing EBV to tumor cells and by a tendency to overlook epidemiological cofactors, shown in all other EBV-related cancers to impact the EBV association. Breast cancer studies to date have used several viral detection methods of varying or uncertain sensitivity and specificity; most have involved small and/or poorly characterized case series and paid insufficient attention to epidemiological cofactors relevant to breast cancer and to EBV-related malignancies. Given these limitations and the established complexity of the connection of EBV with other cancers, a definitive judgment regarding the presence of this virus in breast cancer cannot yet be rendered. Recent advances in laboratory methodologies should help overcome the challenges of EBV detection in breast cancers. Further research is warranted, given the potential for an EBV association to inform not only breast cancer etiology but also early detection, treatment, and prevention.

    View details for Web of Science ID 000221573300001

    View details for PubMedID 15159298

  • Bias in completeness of birthplace data for Asian groups in a population-based cancer registry (United States) CANCER CAUSES & CONTROL Gomez, S. L., Glaser, S. L., Kelsey, J. L., Lee, M. M. 2004; 15 (3): 243-253


    Data on place of birth are routinely collected by population-based cancer registries in the United States and are used to study effects of immigration on cancer patterns in Asian migrants, who comprise about a quarter of the US immigrant population. However, the quality of this research, which has the potential for informing cancer etiology and control, is unclear because registry birthplace information is incomplete, and its accuracy has not been examined. We quantified misclassification of birthplace data for Asian cancer patients in the Greater Bay Area Cancer Registry in northern California by comparing registry birthplace information with self-reported birthplace from interview, and then identified sociodemographic and hospital characteristics associated with birthplace completeness and misclassification. Of the 1836 eligible Asian patients, 649 (35%) had unrecorded registry birthplace. For all except Vietnamese, these persons were less likely than those with recorded birthplace to be foreign-born (OR = 0.5, 95% CI = 0.4-0.7), to be diagnosed in public than private hospitals (OR = 0.7, 95% CI = 0.5-0.8) and in teaching than non-teaching hospitals (OR = 0.8, 95% CI = 0.6-1.1), and were more likely to have been diagnosed at a large regional health maintenance organization (OR = 1.7, 95% CI = 1.3-2.2) and after 1995 (OR = 1.6, 95% CI = 1.1-2.1). Among Asians with registry birthplace information (n = 1187), sensitivity and predictive value positive for birthplace exceeded 90% for both US- and foreign-born, except for Japanese (predictive value positive = 85.7%). Among US-born Asians, those misclassified as foreign-born were more likely than those correctly classified to prefer a non-English primary language (OR = 29.4, 95% CI = 1.9-459.9). These results suggest that cancer registry birthplace data for Asians should not be used if they continue to be differentially incomplete for a large proportion of the subjects.

    View details for Web of Science ID 000220868600003

    View details for PubMedID 15090719

  • Quality of birthplace information obtained from death certificates for Hispanics, Asians, and Pacific Islanders ETHNICITY & DISEASE Gomez, S. L., Glaser, S. L. 2004; 14 (2): 292-?

    View details for Web of Science ID 000221035900016

    View details for PubMedID 15132217

  • Inter- and intra-observer reliability of Epstein-Barr virus detection in Hodgkin lymphoma using histochemical procedures LEUKEMIA & LYMPHOMA Glaser, S. L., Gulley, M. L., Borowitz, M. J., Craig, F. E., Mann, R. B., Stewart, S. L., Shema, S. J., Ambinder, R. F. 2004; 45 (3): 489-497


    EBER in situ hybridization (EBER) and LMP-1 immunohistochemistry (LMP-1) are widely used for identifying Epstein-Barr virus (EBV) within tumor cells of Hodgkin lymphoma (HL), but measurement error has never been formally evaluated. To determine assay reliability, 40 HL tumors with known EBV status were stained for both EBER and LMP-1 by two laboratories and reviewed twice by four hematopathologists. Inter- and intra-observer agreement were good to excellent, with kappas above 0.78 overall and above 0.60 for most subgroup analyses. However, reliability varied by histologic subtype, preparing laboratory, reviewer and EBV status determined on consensus review. For EBER, inter-observer agreement was high for nodular sclerosis HL but somewhat lower for EBV-negative mixed cellularity HL. For LMP-1, agreement was excellent for mixed cellularity HL but somewhat less reliable for EBV-positive nodular sclerosis HL. Agreement was good for EBER and LMP-1 applied to the same specimens but differed by consensus EBV status. The variability in assay interpretation justifies caution in comparing EBV association results across HL studies and underscores the need for interpretation guidelines.

    View details for DOI 10.1080/1042819032000141310

    View details for Web of Science ID 000187022400009

    View details for PubMedID 15160910

  • Expert review of non-Hodgkin's lymphomas in a population-based cancer registry: Reliability of diagnosis and subtype classifications CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION Clarke, C. A., Glaser, S. L., Dorfman, R. F., Bracci, P. M., Eberle, E., Holly, E. A. 2004; 13 (1): 138-143


    Incidence rates of non-Hodgkin's lymphomas (NHLs) have nearly doubled in recent decades. Understanding the reasons behind these trends will require detailed surveillance and epidemiological study of NHL subtypes in large populations, using cancer registry or other multicenter data. However, little is known regarding the reliability of NHL diagnosis and subtype classification in such data, despite implications for the accuracy of incidence statistics and studies. Expert pathological re-review was completed for 1526 NHL patients who were reported to the Greater Bay Area Cancer Registry and who participated in a large population-based case-control study. Agreement of registry diagnosis with expert diagnosis and with International Classification of Diseases for Oncology-2 (Working Formulation) subtype classifications was measured with positive predictive values and kappa statistics. Agreement of registry and expert diagnoses was high (98%). Thirty patients were found on review not to have NHL; most of these had leukemia. For subtypes, agreement of registry and expert classification was more moderate (59%). Agreement varied substantially by subtype from 5% to 100% and was 77% for the most common subtype, diffuse large cell lymphoma. Seventy-seven percent of 128 registry-unclassified lymphomas were assigned a subtype on re-review. Our analyses suggest excellent diagnostic reliability but poorer subtype reliability of NHL in cancer registry data information that is critical to the interpretation of lymphoma time trends. Thus, overall NHL incidence and survival statistics from the early 1990s are probably accurate, but subtype-specific statistics could be substantially biased, especially because of high (15-20%) proportions of unclassified lymphomas.

    View details for Web of Science ID 000188438300023

    View details for PubMedID 14744745

  • Reproductive factors in Hodgkin's disease in women AMERICAN JOURNAL OF EPIDEMIOLOGY Glaser, S. L., Clarke, C. A., Nugent, R. A., Stearns, C. B., Dorfman, R. F. 2003; 158 (6): 553-563


    Reproductive factors have been suggested to have an impact on the development of Hodgkin's disease (HD) in women. In the San Francisco Bay Area, the authors conducted a population-based case-control study addressing the effects of reproductive experience and hormone use on HD risk. Cases were 370 women with HD diagnosed at ages 19-79 years between July 1988 and December 1994. Controls were 450 community women found through random digit dialing. Among the 312 cases and 325 controls interviewed, HD risk was related to parity versus nulliparity but only among never nursers (odds ratio (OR)=2.2, 95% confidence interval (CI): 1.0, 5.0). Risk was marginally related to having uterine fibroids (OR=0.6, 95% CI: 0.5, 1.0) and long-term versus short-term hormone use (OR=0.7, 95% CI: 0.4, 1.0) and was significantly related to recurrent miscarriage (OR=2.8, 95% CI: 1.1, 7.4). Among women aged 35-54 years, for whom the sex difference in incidence is largest, nursing decreased risk; among never nursers, a parity of 1 lowered risk and higher parity increased risk; long-term hormone use lowered risk; and recurrent miscarriage increased risk. Among women under age 35 years, endometriosis lowered HD risk; the lack of significant findings for most other variables may reflect selection bias in controls. Among older women, no significant associations were observed, although hormone use appeared to be protective. These data suggest that steroid hormones may affect HD development.

    View details for DOI 10.1093/aje/kwg198

    View details for Web of Science ID 000185310800008

    View details for PubMedID 12965881

  • Population-based patterns of human immunodeficiency virus-related Hodgkin lymphoma in the greater San Francisco Bay Area, 1988-1998 CANCER Glaser, S. L., Clarke, C. A., Gulley, M. L., Craig, F. E., DiGiuseppe, J. A., Dorfman, R. F., Mann, R. B., Ambinder, R. F. 2003; 98 (2): 300-309


    Epidemiologic characteristics of human immunodeficiency virus (HIV)-related Hodgkin lymphoma (HL) have not been examined in the Greater San Francisco Bay Area, a center of the HIV/acquired immunodeficiency syndrome (AIDS) epidemic, for a decade, despite changes in AIDS-associated diseases after the availability of highly active antiretroviral therapies (HAART).With population-based cancer registry data for 1988-1998, the authors examined risk factors, Epstein-Barr virus (EBV) association, incidence rates, and survival probabilities for 1752 patients with HL who were classified as HIV-positive or HIV-negative by a cancer registry-based method.One hundred twenty-eight patients with HL (7%) were classified with HIV/AIDS; 95% were male. Among males, multivariate analysis (n=514 patients) found that HIV-related HL was associated strongly at diagnosis with ages 30-49 years, San Francisco residence, late-stage disease, lymphocyte depletion and unspecified histologic subtypes, and tumor cell EBV but not with other clinical features or mixed cellularity histology. Survival among patients with HIV-related HL, although it was poor, did not differ by race/ethnicity but was worse for patients with the nonnodular sclerosis histologic subtypes. Patients who were HIV-positive with HAART era (1996-1998) diagnoses were slightly older, were less likely to live in San Francisco, and were much more likely to be Hispanic compared with HIV-positive patients who were diagnosed before the HAART era; they had somewhat less aggressive disease and better survival. Incidence rates were higher for patients with HL overall compared with patients who had HIV-unrelated HL by 11% for white patients, 22% for black patients, and by 14% for Hispanic patients; excesses were greater in young adults.Among males in the San Francisco Bay Area, HIV-related HL had distinctive demographic features, more aggressive clinical characteristics, stronger EBV association, and poorer survival and contributed to elevated regional HL incidence rates, particularly in young adults. Patients with HIV-related HL who were diagnosed after HAART was introduced appeared to have less aggressive disease and better survival.

    View details for DOI 10.1002/cncr.11459

    View details for Web of Science ID 000183944300013

    View details for PubMedID 12872349

  • Hodgkin's disease etiology and novel viruses: Clues from groups exposed to blood products INTERNATIONAL JOURNAL OF CANCER Glaser, S. L., Clarke, C. A., Darrow, L. A. 2003; 104 (6): 796-797

    View details for DOI 10.1002/ijc.11005

    View details for Web of Science ID 000182214900020

    View details for PubMedID 12640690

  • Cancer survival in US racial/ethnic groups: Heterogeneity among Asian ethnic subgroups ARCHIVES OF INTERNAL MEDICINE Gomez, S. L., Clarke, C. A., Glaser, S. L. 2003; 163 (5): 631-632

    View details for Web of Science ID 000181561000018

    View details for PubMedID 12622614

  • Cancer incidence patterns in Koreans in the US and in Kangwha, South Korea CANCER CAUSES & CONTROL Gomez, S. L., Le, G. M., Clarke, C. A., Glaser, S. L., France, A. M., West, D. W. 2003; 14 (2): 167-174


    In the US, Koreans are a rapidly growing group and comprised 10.5% of the total Asian population as of 2000. However, little has been published regarding cancer patterns in this subpopulation.Using data from the Surveillance, Epidemiology, and End Results program, the California Cancer Registry, and the International Association for Research on Cancer, we compared age-adjusted and age-specific incidence rates for cancers of the prostate, breast, cervix, lung, colon, rectum, stomach, liver, and esophagus in US Koreans with rates of these cancers in residents of Kangwha, South Korea, and in US whites as a reference.While the most frequently diagnosed cancer was lung among US Korean males and breast among US Korean females, it was stomach cancer for both sexes in Kangwha. Rates of prostate, breast, and colon cancer were considerably higher for Koreans in the US than in Kangwha, but were not as high as in whites. Cervical and stomach cancers showed the opposite racial/ethnic pattern, with rates highest in Kangwha, intermediate among US Koreans, and lowest among whites. Rates of rectal cancer in females and esophageal cancer in males were two-times higher in Kangwha than in US Koreans but esophageal cancer rates were similar between US Koreans and whites. Liver cancer rates were similar between Kangwha residents and US Koreans, but nearly 10-times lower among whites.Although these comparisons may have methodologic limitations, including data quality and racial/ethnic misclassification, the differences seen in migrant and native Koreans for some cancers warrant further investigation in this growing subpopulation.

    View details for Web of Science ID 000182447400008

    View details for PubMedID 12749722

  • Socioeconomic status and breast carcinoma survival in four racial/ethnic groups - A population-based study CANCER O'Malley, C. D., Le, G. M., Glaser, S. L., Shema, S. J., West, D. W. 2003; 97 (5): 1303-1311


    Although overall survival for invasive breast carcinoma remains high, black women experience poorer survival than whites. Less is known about the survival of Hispanics and Asians, who may share clinical and socioeconomic risk factors similar to blacks. To better understand racial/ethnic survival patterns, we investigated the effect of socioeconomic status (SES) and disease stage on racial/ethnic differences in breast carcinoma survival in a large population-based cohort.Using data from the Surveillance, Epidemiology, and End Results program (SEER), we identified 10,414 white, 940 black, 1100 Hispanic, and 1180 Asian females diagnosed with breast carcinoma in the Greater San Francisco Bay Area between 1988 and 1992. We used the Kaplan-Meier method to generate survival rates and Cox proportional hazards regression to estimate the risk of death by race/ethnicity, after adjustment for clinical, demographic, and census-derived SES variables.The 10-year unadjusted survival rates were 81% for whites, 69% for blacks, 75% for Hispanics, and 79% for Asians. Adjusting for stage decreased the relative risk of mortality for blacks from 1.81 to 1.29; the stage-adjusted relative risk for Hispanics (1.11) and Asians (1.02) did not differ significantly from whites. Additional adjustment for age, tumor characteristics, and treatment factors did little to alter the relative risk in blacks; adding blue-collar status to the model further decreased the relative risks for blacks to 1.22. Residing in a blue-collar neighborhood was independently associated with a 1.16 increase in risk of death.After adjustment for multiple factors, blacks continue to have slight but significantly poorer survival after breast carcinoma compared with whites, whereas the survival of Hispanics and Asians did not differ from whites.

    View details for Web of Science ID 000181190000022

    View details for PubMedID 12599239

  • Correspondence re: Yasui et al, Breast cancer risk and "delayed" primary Epstein-Barr virus infection. 10: 9-16, 2001. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology Glaser, S. L. 2003; 12 (1): 73-?

    View details for PubMedID 12540510

  • Cancer incidence patterns among Vietnamese in the United States and Ha Noi, Vietnam INTERNATIONAL JOURNAL OF CANCER Le, G. M., Gomez, S. L., Clarke, C. A., Glaser, S. L., West, D. W. 2002; 102 (4): 412-417


    Nearly 600,000 persons have immigrated to the United States from Vietnam since the end of the Vietnam War. Despite the rapid growth of the U.S. Vietnamese population, little is known about cancer incidence in this migrant group. Using population-based data from the Surveillance, Epidemiology and End Results program, California Cancer Registry and International Agency for Research on Cancer, we compared cancer incidence rates for Vietnamese in the United States (1988-1992) to rates for residents of Ha Noi, Vietnam (1991-1993); non-Hispanic whites were included to serve as the U.S. reference rates. Lung and breast cancers were the most common among Vietnamese males and females, respectively, regardless of geographic region. Rates of cancers more common to U.S. whites, such as breast, prostate and colon cancers, were elevated for U.S. Vietnamese compared to residents in Ha Noi but still lower than rates for U.S. whites. Rates of cancers more common to Asian countries, such as stomach, liver, lung and cervical cancers, were likewise elevated for U.S. Vietnamese compared to residents of Ha Noi and exceeded corresponding rates for whites. Incidence patterns for stomach, liver, lung and cervical cancers may reflect increased risk of exposures in this migrant population and should be further explored to uncover the relative contributions of environmental and genetic factors to cancer etiology.

    View details for DOI 10.1002/ijc.10725

    View details for Web of Science ID 000179013100015

    View details for PubMedID 12402312

  • Differences in treatment patterns for localized breast carcinoma among Asian/Pacific islander women CANCER Prehn, A. W., Topol, B., Stewart, S., Glaser, S. L., O'Connor, L., West, D. W. 2002; 95 (11): 2268-2275


    Many studies have examined racial/ethnic differences in treatment for localized breast carcinoma, but to the authors' knowledge few have included Asian/Pacific Islander (API) women.The population-based study included API and non-Hispanic white women diagnosed with localized invasive breast carcinoma in the Greater San Francisco Bay Area during 1994 (n = 1772). Multiple logistic regression was used to assess the association between race/ethnicity and type of surgery, radiation therapy following breast-conserving surgery (BCS), and hormone therapy for estrogen receptor-positive tumors while adjusting for demographic, medical, and census block-group socioeconomic characteristics.API women were significantly more likely to undergo mastectomies than white women (58% vs. 42%). This difference remained for Chinese and Filipino women after multivariate adjustment (odds ratio vs. whites [OR] = 2.4, 95% confidence interval [95% CI] = 1.4-4.2; OR [95%CI] = 1.8[1.0-3.1], respectively). Chinese women were also more likely than white women to not receive adjuvant therapy, be it radiation after BCS or hormone therapy for estrogen receptor-positive disease. Other API women did not differ from white women in adjuvant therapy use.This population-based study identified differences in treatment for localized breast carcinoma by race/ethnicity that were not explained by differences in demographic, medical, or socioeconomic characteristics. These results underscore the importance of looking at treatment patterns separately for API subgroups and support the need for research into cultural differences that may influence breast carcinoma treatment choices.

    View details for DOI 10.1002/cncr.10965

    View details for Web of Science ID 000179371400003

    View details for PubMedID 12436431

  • Increase in breast cancer incidence in middle-aged women during the 1990s ANNALS OF EPIDEMIOLOGY Prehn, A. W., Clarke, C., Topol, B., Glaser, S., West, D. 2002; 12 (7): 476-481


    The San Francisco Bay Area has a history of high breast cancer incidence rates relative to the rest of the United States. For Marin County, where Bay Area rates are highest and, moreover, have continued to increase over time, age- and tumor-specific incidence trends were compared with the rest of the region.The study included all white women diagnosed with invasive breast cancer in 1988 to 1997 in the five-county Bay Area (N = 19807). Annual age-specific incidence rates and estimated annual percent changes (EAPCs) were calculated for women ages less than 45, 45 to 64, and greater than or equal to age 65.Women aged 45 to 64 from Marin County experienced a marked increase in breast cancer rates between 1991 and 1997 (EAPC = 8%, p = 0.02), regardless of disease stage or tumor histology. For the youngest and oldest women, no rate differences were observed by region or over time.This regional difference in trend by age did not appear to be due to screening mammography or environmental exposures. Cohort exposures to breast cancer risk factors, such as oral contraceptive and/or hormone replacement therapy use, may have contributed to these rate increases. Although the reasons remain unclear, the finding may signal a rising risk of breast cancer in this demographic group.

    View details for Web of Science ID 000178041400006

    View details for PubMedID 12377425

  • Racial/ethnic differences in survival rates in a population-based series of men with breast carcinoma CANCER O'Malley, C. D., Prehn, A. W., Shema, S. J., Glaser, S. L. 2002; 94 (11): 2836-2843


    A rare occurrence, about 1500 men in the United States develop breast carcinoma each year. Little is known about survival patterns at the population level, particularly about racial/ethnic variation.Using data from the Surveillance, Epidemiology, and End Results Program, we examined survival rates in 1979 men diagnosed with primary invasive breast carcinoma between 1973 and 1997. Race was defined as non-Hispanic white, non-Hispanic black, and other race/ethnicity (predominantly Asian/Pacific Islander and Hispanic). The two outcomes were all-cause and breast carcinoma- specific mortality. Survival curves were drawn using Kaplan-Meier estimates and Cox regression was used to estimate the risk of death with hazard ratios and 95% confidence intervals. For both outcomes, the racial/ethnic survival curves differed significantly when the log rank test was used. Therefore, separate models were run for each racial/ethnic group. Covariates included age, stage, histology, surgery, radiation therapy, and year of diagnosis. Estrogen and progesterone receptor status were available for 616 men.Survival rates differed significantly by race/ethnicity. Overall, 5-year survival rates were 66% for whites, 57% for blacks, and 75% for men of other race/ethnicity. Blacks presented with more advanced disease. By stage, whites and blacks had worse survival rates compared with men of other race/ethnicity. The effects of prognostic factors such as age, surgery type, and radiation were similar, but not always significant, for all groups. Diagnosis year and estrogen receptor status did not affect survival.Survival following male breast carcinoma differed by race/ethnicity, whereas the prognostic factors associated with survival were similar.

    View details for DOI 10.1002/cncr.10521

    View details for Web of Science ID 000175789900005

    View details for PubMedID 12115370

  • Reliability of random digit dialing calls to enumerate an adult female population AMERICAN JOURNAL OF EPIDEMIOLOGY Glaser, S. L., Stearns, C. B. 2002; 155 (10): 972-975


    Challenges to random digit dialing have been documented, but the reliability of random digit dialing outcomes from telephone number calling, household identification, and enumeration has never been addressed, despite its potential to bias population representativeness by affecting completeness of coverage. The authors explored interobserver reliability of calls to numbers generated by random digit dialing for a 1990-1996 population-based case-control study in San Francisco, California, area women, using data from a quality control effort in which 122 of 4,890 random digit dialing numbers were assigned to a second interviewer for recontacting within 4 months. The 34 numbers discrepant between the first and second calls did not differ from the 88 unchanged outcomes, and reliability was good (kappa = 0.65, 95% confidence interval: 0.55, 0.75). Eligibility (an adult woman in the household) was confirmed for nine of 11 eligible households. However, six of 29 households originally ineligible because of gender were eligible on recontact, and eligible residences rose from 24% to 39% between the two calls, although the two groups of eligible women did not differ in age or race. This underenumeration of women by random digit dialing confirms prior observations, although interviewer differences or changes in respondents or household composition between the first and second calls may have contributed. Recontact of gender-ineligible households may improve completeness of random digit dialing coverage for female populations.

    View details for Web of Science ID 000175628800013

    View details for PubMedID 11994238

  • Reliability of self-reported reproductive factors and childhood social class indicators in a case-control study in women ANNALS OF EPIDEMIOLOGY Lin, S. S., Glaser, S. L., Stewart, S. L. 2002; 12 (4): 242-247


    Reproductive factors are often evaluated in epidemiologic interview studies as risk factors for diseases in women. Similarly, childhood social class has been implicated in the etiology of several diseases. Nevertheless, questions related to these factors have not been thoroughly evaluated for test-retest reliability. This research measured the test-retest reliability of reproductive and childhood social class variables, and determined whether reliability differed by case-control status, age, educational level, time between interviews, and interviewer-rated quality of the interview.Subjects were participants in a population-based case-control in-person interview study of Hodgkin's disease in northern California women. Twenty-four cases and 22 controls were reinterviewed by telephone between 1992 and 1995, with an average interval of 8 months between interviews. Reliability was assessed using kappa or intraclass correlation coefficients; mean reliability coefficients and 95% confidence intervals (CIs) were estimated using the bootstrap method.Reliability was excellent for all variables (reliability coefficients between 0.76 and 0.96) and did not differ by case-control status (mean reliability = 0.82 for cases and 0.84 for controls), age (mean reliability = 0.85 for age < 40 and 0.82 for age > or = 40), time between interviews (mean reliability = 0.75 for 0-5 months, 0.88 for 6-11 months, and 0.87 for 1 year or more), or interviewer-rated quality of the validity of the original responses (mean reliability = 0.93 for "not too confident" and 0.83 for "confident"). However, reliability was consistently lower among less educated women (mean reliability = 0.56 for high school or less and 0.88 for more than high school), a finding consistent with results of prior studies.These results indicate that questions about reproductive experience and childhood social class posed in in-person interviews can be answered reliably. However, inclusion of subjects at lower socioeconomic status may result in lower reliability for some interview responses.

    View details for Web of Science ID 000175129300005

    View details for PubMedID 11988412

  • Changing incidence of non-Hodgkin lymphomas in the United States CANCER Clarke, C. A., Glaser, S. L. 2002; 94 (7): 2015-2023


    The incidence of non-Hodgkin lymphoma (NHL) has been rising in many regions and populations during the last few decades. Data from the Surveillance, Epidemiology, and End Results (SEER) Program show that age-adjusted rates of NHL increased through the 1980s but leveled off in the 1990s.To determine whether the incidence of NHL stabilized in all population subgroups, particularly in age-defined groups with distinctive risks of NHL, the authors investigated trends in NHL incidence among persons aged 0-14 years, 15-24 years, 25-34 years, 35-44 years, 45-54 years, 55-64 years, 65-74 years, and > 75 years by gender and race using 1973-1998 data from the SEER Program, which covered approximately 10% of the U.S. population. Joinpoint regression was used to assess changes in trends across the period.NHL incidence trends changed significantly among males aged 25-54 years, in whom rates began to decrease (6-16% per year) in the middle to late 1990s, as well as among most whites aged > or = 55 years, in whom rate increases slowed from 3-4% to 1-2% per year in the late 1980s. Incidence trends were steady in other groups, with uniform increases among whites aged 15-24 years (2-3% per year), women aged 25-54 years (1-6% per year), and blacks aged > or = 55 years (2-4% per year). Although recent age specific incidence rates were generally higher in males compared with females and in whites compared with blacks, among males aged 25-54 years, rates were significantly higher in black males compared with white males.There have been changes in the demographic groups impacted by NHL. The trends for human immunodeficiency virus probably are related to recent decreases in NHL incidence among males aged 25-54 years. The rate change in the older white population is unexplained but represents both an alleviation of the burden of NHL in this population and a potential opportunity to generate hypotheses regarding risk factors for the development of NHL.

    View details for DOI 10.1002/cncr.10403

    View details for Web of Science ID 000174717700015

    View details for PubMedID 11932904

  • Social class and risk of Hodgkin's disease in young-adult women in 1988-94 INTERNATIONAL JOURNAL OF CANCER Glaser, S. L., Clarke, C. A., Nugent, R. A., Stearns, C. B., Dorfman, R. F. 2002; 98 (1): 110-117


    Hodgkin's disease (HD) risk in young adults has been associated with higher childhood social class. Although recent decades have witnessed increases in both young-adult HD incidence rates and the socioeconomic affluence reported to influence risk, social class risk factors have not been reexamined. For 204 cases and 254 controls aged 19-44 years from a population-based case-control study of HD diagnosed in 1988-94 in San Francisco area females, we evaluated social class predictors of HD overall and for subgroups defined by age and by ethnicity. HD was associated weakly with a few childhood social class markers but more strongly with combinations of these variables. Risk was higher for women with family-owned than rented childhood homes; for US-born women with single vs. shared bedrooms at age 11; and for women with 2+ births who were from smaller than larger childhood households. These patterns differed by age, with risk appearing to increase over the young-adult years for some factors and to decrease for others. In whites, risk was additionally associated with having a single childhood bedroom in larger households, and with tall adult height in women from smaller childhood households. In nonwhites, risk was higher for single bedrooms at age 11 in smaller childhood households, taller height and higher maternal education. Most study findings support the hypothesis that HD development in young adults follows protection from early exposure to other children. Variation in risk by age suggests differing etiologies across young adulthood, or the importance of birth cohort-appropriate social-class measures. Negative findings for previously reported risk factors may reflect their insufficient heterogeneity of exposure or their failure to measure cohort-relevant exposures in this population.

    View details for DOI 10.1002/ijc.10164

    View details for Web of Science ID 000173616200019

    View details for PubMedID 11857394

  • Hodgkin's disease in Asians: incidence patterns and risk factors in population-based data LEUKEMIA RESEARCH Glaser, S. L., Hsu, J. L. 2002; 26 (3): 261-269


    Hodgkin's disease (HD) has been reported to be rare in Asians. Data sparseness has hindered studies exploring the relative contributions of environment and heredity to HD etiology, and individual risk factors have never been studied in an Asian population. With the most recent, uniformly collected population-based data from the US and Asia, we compared HD incidence rates in Chinese, Japanese, Filipinos, and Asian Indians in the US and in Asia. HD incidence rates were quite low in all Asian subgroups, but approximately double in US Asians as in native Asians. In both, rates were lower for Japanese and Chinese than for Filipinos and Asian Indians. A modest young-adult rate peak occurred for most US Asian groups, but not for any population in Asia. In data from a population-based case-control study of HD in San Francisco area women, young-adult Asian cases, like young-adult cases of other racial/ethnic groups, had childhood social environments indicative of less early contact with children. Given environmental and lifestyle differences between the US and Asia, the consistently low rates of HD in Asians suggest genetic resistance to disease development, possibly associated with HLA type. International and inter-ethnic differences, and risk factor patterns in case-control data, implicate environmental influences in the etiology of HD.

    View details for Web of Science ID 000174697000007

    View details for PubMedID 11792415

  • Survival differences among Asian subpopulations in the United States after prostate, colorectal, breast, and cervical carcinomas Lin, S. S., Clarke, C. A., Prehn, A. W., Glaser, S. L., West, D. W., O'Malley, C. D. JOHN WILEY & SONS INC. 2002: 1175-1182


    Information is limited for Asian subgroups regarding survival after diagnosis of the common cancers amenable to routine screening. The authors examined survival after carcinomas of the prostate, colon/rectum, breast, and cervix separately for Chinese, Japanese, Filipinos, and non-Hispanic whites in the United States.Using data from the Surveillance, Epidemiology, and End Results program, the authors compared the distributions of stage at diagnosis and computed 5-year cause specific survival probabilities, overall and by stage of disease, for cancer patients whose diagnosis was in 1988-1994 and who were observed through 1997.Among males, Filipinos were more likely to be diagnosed with advanced stage colorectal and prostate carcinomas than other Asians and non-Hispanic whites; they also experienced worse survival after these cancers. This survival deficit occurred across all stages of colorectal carcinoma and remained apparent within distant stage prostate carcinoma. Among females, Chinese were less likely to receive diagnoses of early stage colorectal carcinoma than Japanese and Filipinas. In addition, their survival was consistently lower across more advanced stages of disease. Chinese also experienced somewhat worse survival after diagnosis of early stage cervical carcinoma. Japanese were more likely to be diagnosed with early stage carcinomas but also tended to experience better survival after prostate, colorectal, and breast carcinomas regardless of stage.Chinese, Japanese, and Filipinos experienced unequal survival after these screenable carcinomas, indicating that certain groups may benefit from more aggressive screening efforts. The heterogeneity of cancer outcomes observed within the community classified as Asian reinforces the need for cancer statistics to be reported for disaggregated subgroups.

    View details for DOI 10.1002/cncr.10319

    View details for Web of Science ID 000173907600037

    View details for PubMedID 11920489

  • Guidelines for interpreting EBER in situ hybridization and LMP1 immunohistochemical tests for detecting Epstein-Barr virus in Hodgkin lymphoma AMERICAN JOURNAL OF CLINICAL PATHOLOGY Gulley, M. L., Glaser, S. L., Craig, F. E., Borowitz, M., Mann, R. B., Shema, S. J., Ambinder, R. F. 2002; 117 (2): 259-267


    Histochemical stains demonstrate Epstein-Barr virus (EBV) in approximately 40% of all Hodgkin hymphomas, suggesting a role in tumorigenesis and the potentialfor EBV-targeted therapy. As research progresses, it is important to define criteria for interpreting histochemical stains. Four hematopathologists independently interpreted EBV-encoded RNA (EBER) and latent membrane protein 1 (LMP1) histochemical stains from 40 cases of Hodgkin lymphoma and then reviewed the stains as a group to resolve discrepancies and to develop interpretation guidelines. To call a Hodgkin case EBV-related, the EBER and/or LMP1 signal must be unequivocally present in Reed-Sternberg/Hodgkin (RS/H) cells. The cytologic features and distribution of stained cells should be matched with those on the corresponding H&E-stained slide to help interpret whether the EBER or LMP1 signal is in malignant or reactive cells. The EBER signal is localized to the nucleus, whereas LMP1 is in the cytoplasm and surface membrane. In some cases, only a fraction of RS/H cells express these factors for technical or biologic reasons. Before calling a case EBER-negative, it is essential to show that tumor cell RNA is preserved and available for hybridization. LMP1 staining, although usually strong among all tumor cells in a given case, may alternatively be focal and weak, contributing to false-negative interpretation. EBER and LMP1 assays in combination are more effective than either assay alone for identifying EBV-related Hodgkin lymphoma.

    View details for Web of Science ID 000173661600012

    View details for PubMedID 11863222

  • Breast cancer incidence and mortality trends in an affluent population: Marin County, California, USA, 1990-1999 BREAST CANCER RESEARCH Clarke, C. A., Glaser, S. L., West, D. W., Ereman, R. R., Erdmann, C. A., Barlow, J. M., Wrensch, M. R. 2002; 4 (6)


    Elevated rates of breast cancer in affluent Marin County, California, were first reported in the early 1990s. These rates have since been related to higher regional prevalence of known breast cancer risk factors, including low parity, education, and income. Close surveillance of Marin County breast cancer trends has nevertheless continued, in part because distinctive breast cancer patterns in well-defined populations may inform understanding of breast cancer etiology.Using the most recent incidence and mortality data available from the California Cancer Registry, we examined rates and trends for 1990-1999 for invasive breast cancer among non-Hispanic, white women in Marin County, in other San Francisco Bay Area counties, and in other urban California counties. Rates were age adjusted to the 2000 US standard, and temporal changes were evaluated with weighted linear regression.Marin County breast cancer incidence rates between 1990 and 1999 increased 3.6% per year (95% confidence interval, 1.8-5.5), six times more rapidly than in comparison areas. The increase was limited to women aged 45-64 years, in whom rates increased at 6.7% per year (95% confidence interval, 3.8-9.6). Mortality rates did not change significantly in Marin County despite 3-5% yearly declines elsewhere.Patterns of breast cancer incidence and mortality in Marin County are unlike those in other California counties, and they are probably explained by Marin County's unique sociodemographic characteristics. Similar trends may have occurred in other affluent populations for which available data do not permit annual monitoring of cancer occurrence.

    View details for Web of Science ID 000178822900002

    View details for PubMedID 12473174

  • Age-specific survival after Hodgkin's disease in a population-based cohort (United States) CANCER CAUSES & CONTROL Clarke, C. A., Glaser, S. L., Prehn, A. W. 2001; 12 (9): 803-812


    To examine risk factors for disease-specific survival in young and older adults diagnosed with Hodgkin's disease (HD) in a representative case series of adequate size for detecting effect modification by age group.For 5630 young adults (ages 15-44) and 2424 older adults (ages 45 and older) diagnosed with HD and reported to the population-based Surveillance, Epidemiology, and End Results program of the National Cancer Institute between 1983 and 1995, Kaplan-Meier survival curves were constructed and Cox proportional hazards regression used to evaluate the influences of age, sex, race/ethnicity, histologic subtype, Ann Arbor stage at diagnosis, and calendar year on hazard of disease-specific death.The effects of most previously studied risk factors for HD death were different for young and older adults. Age was not associated with disease-specific survival in young adults, but in older adults, 1-year increases in age elevated the relative hazard of HD death by 4 6%. Male sex was related to outcome in young but not older adults, and Ann Arbor stage and B-symptom status exhibited markedly different relationships to survival by age. Older adult patients with and without B-symptoms had different hazards of mortality and had to be assessed separately.Factors associated with disease-specific survival were different for young and older adults with HD. These findings provide further support for two etiologically and clinically distinct disease entities.

    View details for Web of Science ID 000171398000005

    View details for PubMedID 11714108

  • Age variation in Hodgkin's disease risk factors in older women: Evidence from a population-based case-control study LEUKEMIA & LYMPHOMA Glaser, S. L., Clarke, C. A., Stearns, C. B., Dorfman, R. F. 2001; 42 (5): 997-1004


    Hodgkin's disease (HD), which affects all age groups, has been associated with childhood social class, particularly among adults under age 40. Little is known about social class risk factors in older adults, and the few existing studies have conflicting findings. As part of a population-based case-control study of HD in women, we examined social class risk factors by diagnostic age groups (45-54 years and 55-79 years) corresponding to incidence patterns and by histologic subtypes based on a uniform pathologic review. Among women ages 45-54, cases were more likely to be Catholic, to have lower income and to be taller than controls. Among women ages 55-79, cases tended to have come from small or large childhood households, lived in single-family childhood housing, and had a single rather than shared bedroom at age 11. For the nodular sclerosis (NS) histologic subtype, similar age differences in risk factors were apparent. Comparisons between the NS and non-NS subtypes in women ages 55-79 identified some common risk factors (single-family childhood home, single bedroom at age 11) but others specific to one subtype (childhood household size, adult height for NS; lower maternal education for non-NS). Thus, some social class associations with HD differed between middle-aged and older women, as well as between these groups and younger adults, while others were shared across age groups. Risk also was associated with both higher and lower childhood social class in middle-aged and older women, in contrast with previous findings. None of these patterns was explained entirely by histologic subtype but may reflect age and histology subtype variation in the HD-EBV association.

    View details for Web of Science ID 000170723700018

    View details for PubMedID 11697655

  • Epidemiologic trends in HIV-associated lymphomas CURRENT OPINION IN ONCOLOGY Clarke, C. A., Glaser, S. L. 2001; 13 (5): 354-359


    Infection with HIV increases the risk of developing non-Hodgkin lymphoma and, to a lesser extent, Hodgkin disease. The introduction of highly active antiretroviral therapy (HAART) in 1996 changed the natural history of HIV disease, but the HIV-infected population also has changed in composition. Accordingly, the epidemiology of HIV-associated lymphomas now differs from that observed in the first 15 years of the HIV epidemic. In populations with access to HAART, reductions in lymphoma risk have been reported for NHL and suggested for Hodgkin disease, but long-term risks are as yet unknown. Lymphomas are increasingly common cancers in persons with HIV and are fatal in most patients, warranting continued attention to their incidence and etiology.

    View details for Web of Science ID 000170664400007

    View details for PubMedID 11555712

  • Expert review of the diagnosis and histologic classification of Hodgkin disease in a population-based cancer registry - Interobserver reliability and impact on incidence and survival rates CANCER Glaser, S. L., Dorfman, R. F., Clarke, C. A. 2001; 92 (2): 218-224


    The reliability of Hodgkin disease (HD) diagnosis and histologic classification is an ongoing concern but has not been evaluated in a population-based case series in 20 years. Yet, diagnostic error in cancer registry data used in surveying HD occurrence may produce statistics that misrepresent incidence, mortality, or survival.Uniform pathology review was attempted for all 395 women ages 19--79 years with incident HD reported to a population-based cancer registry in 1988--94. Agreement between original registry and review diagnoses was measured with positive predictive values and kappa statistics. Incidence rates and survival probabilities were computed based on registry and review diagnoses.Registry and review diagnosis agreed for 245 of the 362 reviewed cases. Positive predictive values varied by histologic subtype (nodular sclerosis, 95%; lymphocyte predominance, 69%; mixed cellularity, 58%; lymphocyte depletion, 0%; not otherwise specified, 40%), but agreement was good overall (kappa, 0.66, 95% confidence interval, 0.56--0.76). Eleven patients were determined not to have HD; all were older than age 44 years. Hodgkin disease incidence rates differed for original and review diagnoses only in older women, for whom registry rates slightly overestimated incidence. Five-year survival rates did not differ for registry and review data overall or by age group.For most adult women patients, the diagnosis of HD was confirmed on review, reflecting the very good agreement between registry and review diagnoses for nodular sclerosis, the most common subtype. Thus, cancer registry statistics for this time period can provide accurate estimates of disease patterns for HD overall and for the nodular sclerosis variant. For other histologic subtypes, rates may be unreliable, and HD occurrence overall may be less dependable in populations with larger proportions of these subtypes.

    View details for Web of Science ID 000169943900002

    View details for PubMedID 11466672

  • Epstein-Barr virus and survival after Hodgkin disease in a population-based series of women Clarke, C. A., Glaser, S. L., Dorfman, R. F., Mann, R., DiGiuseppe, J. A., Prehn, A. W., Ambinder, R. F. JOHN WILEY & SONS INC. 2001: 1579-1587


    Epstein-Barr virus (EBV) positive Hodgkin disease (HD), as defined by the presence of EBV genes or gene products in the malignant cells, differs epidemiologically from EBV negative HD. However, survival patterns for EBV-defined HD have not been well studied. To determine if EBV status influenced survival time after HD, the authors investigated a large, population-based series of female patients.For 311 female patients living in the Greater San Francisco Bay Area who were aged 19-79 years with HD diagnosed between mid-1988 and 1994, histopathologically rereviewed archived biopsy specimens were assayed for EBV with immunohistochemistry and in situ hybridization. The 53 subjects with EBV positive and the 258 with EBV negative HD were observed for vital status through 1998; overall survival was analyzed with Kaplan-Meier and Cox proportional hazards regression methods.Epstein-Barr virus positive HD patients were older, received diagnosis at a later stage, and were less likely to have nodular sclerosis histology than EBV negative patients. Deaths were reported for 21 (40%) EBV positive and 37 (14%) EBV negative patients. No survival differences were observed between EBV positive and negative women aged 19-44 years, but survival was significantly poorer in women aged 45-79 years with EBV positive HD. Regression analysis confirmed this strong negative effect of EBV positive status on survival (hazard ratio for death, 3.0; 95% confidence interval, 1.5-6.2) as unrelated to age, stage at diagnosis, or tumor histology.This study found a marked survival disadvantage for EBV positive HD in older but not young adult women. These findings suggest influences of both EBV status and age on HD survival, as well as pathogenesis.

    View details for Web of Science ID 000168081200024

    View details for PubMedID 11301409

  • Epstein-Barr virus-associated malignancies: epidemiologic patterns and etiologic implications CRITICAL REVIEWS IN ONCOLOGY HEMATOLOGY Hsu, J. L., Glaser, S. L. 2000; 34 (1): 27-53


    Epstein-Barr virus (EBV), a ubiquitous B-lymphotrophic herpesvirus, has been found in the tumor cells of a heterogeneous group of malignancies (Burkitt's lymphoma, lymphomas associated with immunosuppression, other non-Hodgkin's lymphomas, Hodgkin's disease, nasopharyngeal carcinoma, gastric adenocarcinoma, lymphoepithelioma-like carcinomas, and immunodeficiency-related leiomyosarcoma). As the epidemiologic characteristics of these cancers have not been considered together, this review seeks to relate their incidence patterns and risk factors to EBV biology and virus-host interaction in an attempt to help elucidate factors involved in EBV-related carcinogenesis. We include a brief review of EBV virology and primary infection to provide a biologic context for considering the epidemiology, summarize the most salient epidemiologic features of each malignancy, synthesize epidemiologic data by risk factor to uncover commonalities and informative contrasts across the diseases, and propose hypotheses regarding etiologic mechanisms, based on the possible effect of the risk factors at various stages in the viral life cycle.

    View details for Web of Science ID 000087010800002

    View details for PubMedID 10781747

  • Acute myeloid leukemia. NEW ENGLAND JOURNAL OF MEDICINE Clarke, C. A., Glaser, S. L. 2000; 342 (5): 358-358

    View details for Web of Science ID 000085070300023

    View details for PubMedID 10660402

  • Comparison of methods for classifying Hispanic ethnicity in a population-based cancer registry AMERICAN JOURNAL OF EPIDEMIOLOGY Stewart, S. L., Swallen, K. C., Glaser, S. L., Horn-Ross, P. L., West, D. W. 1999; 149 (11): 1063-1071


    The accuracy of ethnic classification can substantially affect ethnic-specific cancer statistics. In the Greater Bay Area Cancer Registry, which is part of the Surveillance, Epidemiology, and End Results (SEER) Program and of the statewide California Cancer Registry, Hispanic ethnicity is determined by medical record review and by matching to surname lists. This study compared these classification methods with self-report. Ethnic self-identification was obtained by surveying 1,154 area residents aged 20-89 years who were diagnosed with cancer in 1990 and were reported to the registry as being Hispanic or White non-Hispanic. Predictive value positive, sensitivity, and relative bias were used to assess the accuracy of Hispanic classification by medical record and surname. Among those persons classified as Hispanic by either or both of these sources, only two-thirds agreed (predictive value positive = 66%), and many self-identified Hispanics were classified incorrectly (sensitivity = 68%). Classification based on either medical record or surname alone had a lower sensitivity (59% and 61%, respectively) but a higher predictive value positive (77% and 70%, respectively). Ethnic classification by medical record alone resulted in an underestimate of Hispanic cancer cases and incidence rates. Bias was reduced when medical records and surnames were used together to classify cancer cases as Hispanic.

    View details for Web of Science ID 000080524100012

    View details for PubMedID 10355383

  • Adjustment of cancer incidence rates for ethnic misclassification BIOMETRICS Stewart, S. L., Swallen, K. C., Glaser, S. L., Horn-Ross, P. L., West, D. W. 1998; 54 (2): 774-781


    Although ethnic population counts measured by the United States Census are based on self-identification, the same is not necessarily true of cases reported to cancer registries. The use of different ethnic classification methods for numerators and denominators may therefore lead to biased estimates of cancer incidence rates. The extent of such misclassification may be assessed by conducting an ethnicity survey of cancer patients and estimating the proportion misclassified using double sampling models that account for sample stratification. For two ethnic categories, logistic regression may be used to model self-identified ethnicity as a function of demographic variables and the fallible classification method. Incidence rates then may be adjusted for misclassification using regression results to estimate the number of cancer cases of a given age, sex, and site in each self-identified ethnic group. An example is given using this method to estimate ethnic misclassification of San Francisco Bay area Hispanic cancer patients diagnosed in 1990. Results suggest that the number of cancer cases reported as Hispanic is an underestimate of the number of cases self-identified as Hispanic, resulting in an underestimate of Hispanic cancer rates.

    View details for Web of Science ID 000074161600033

    View details for PubMedID 9629656

  • Absence of Epstein-Barr virus EBER-1 transcripts in an epidemiologically diverse group of breast cancers INTERNATIONAL JOURNAL OF CANCER Glaser, S. L., Ambinder, R. F., DiGiuseppe, J. A., Horn-Ross, P. L., Hsu, J. L. 1998; 75 (4): 555-558


    Epstein-Barr virus (EBV), a ubiquitous herpesvirus associated with certain lymphomas and carcinomas, has been identified within the malignant cells of a small proportion of breast tumors. As breast cancer is a very common malignancy in women, a pathogenetic role of EBV for even a subgroup of patients could have important implications for etiology and prevention. Therefore, we attempted to confirm the EBV-breast cancer association by exploring it in a representative case series stratified by characteristics that modify breast cancer risk. We studied a sample of 97 female and 28 male patients identified from a US population-based cancer registry. Patients were selected randomly within age, sex, ethnicity and tumor estrogen-receptor status groups. With their archived tumor tissues, we examined EBV presence using in situ hybridization for the EBER-1 transcript. In the 107 technically adequate specimens, we did not detect this viral transcript in any tumors, including one from a woman who also had an EBER-positive nasopharyngeal carcinoma. Our uniformly negative findings are extremely unlikely to have occurred by chance and cannot be attributed to selective sampling, as our study group included persons at diverse risk for breast cancer. We conclude that the EBV EBER-1 transcript is not commonly expressed in breast cancer, based on a broadly representative case series, though we cannot exclude an association of EBV within a particular population subgroup.

    View details for Web of Science ID 000071797400010

    View details for PubMedID 9466655

  • Accuracy of racial classification of Vietnamese patients in a population-based cancer registry. Ethnicity & disease Swallen, K. C., Glaser, S. L., Stewart, S. L., West, D. W., Jenkins, C. N., McPhee, S. J. 1998; 8 (2): 218-227


    Racial classification of Asian subgroups is increasingly important for health statistics, given the growing Asian-American populations. This study reports the reliability of racial classification of Vietnamese in population-based cancer registry data from northern California. From the Greater Bay Area Cancer Registry, we selected 2240 persons diagnosed with cancer in 1989-1992 and whom the registry considered Vietnamese by birthplace and/or registry race and/or surname, or who were Southeast Asian or Chinese by race. One thousand ninety persons (49%) were interviewed. Sensitivity and predictive value positive, and cancer incidence rates, were calculated using different combinations of the classification factors (birthplace, registry race, and name). By registry-reported race alone, 74% of those the registry classified as Vietnamese agreed with this classification on interview, while 90% of those identifying themselves as Vietnamese were so classified. With classification based on 2 of 3 factors, 78% of those classified as Vietnamese agreed, and 91% of self-reported Vietnamese were correctly classified. Misclassification was associated with age, sex, year of immigration, education, and language use. Registry-based annual age-adjusted all-site cancer incidence rates per 100,000 for Vietnamese were 287.7 for males and 221.3 for females. Rates adjusted for self-reported ethnicity were 242.8 (male) and 213.7 (female). Registry classification of Vietnamese is currently problematic. Approximately 20% of cancer cases classified as Vietnamese are probably not Vietnamese. The higher incidence rates for Vietnamese in the United States than in Vietnam partly may reflect such classification error.

    View details for PubMedID 9681287

  • Racial/ethnic differences in breast cancer survival among San Francisco Bay Area women JOURNAL OF THE NATIONAL CANCER INSTITUTE Hsu, J. L., Glaser, S. L., West, D. W. 1997; 89 (17): 1311-1312

    View details for Web of Science ID A1997XU08000014

    View details for PubMedID 9293922

  • Predictors of misclassification of Hispanic ethnicity in a population-based cancer registry Swallen, K. C., West, D. W., Stewart, S. L., Glaser, S. L., HORNROSS, P. L. ELSEVIER SCIENCE INC. 1997: 200-206


    Hispanic ethnicity is often used as a category for calculating population-based rates or assessing risk of epidemiologic studies. However, ethnic misclassification can lead to false conclusions unless the extent of misclassification and the characteristics of those misclassified are understood.This study explored determinants of ethnic misclassification in a sample of 1154 cancer cases in the San Francisco-Oakland cancer registry, where ethnic classification is based on surname or medical record report. We compared the following: correctly classified Hispanics, persons classified as Hispanic who self-identified as non-Hispanic, and persons classified as non-Hispanic who self-identified as Hispanic.Among men classified as Hispanic, those most likely to self-identify as non-Hispanic did not speak Spanish, had non-Spanish surnames, and were recent immigrants. Women misclassified as Hispanic did not speak Spanish or have Spanish maiden names, nor did they have mothers with Spanish maiden names. Persons who called themselves Hispanic, but were misclassified by the registry, were likely to be non-Spanish speaking college-education males.Researchers using ethnicity should be aware of how ethnicity was determined and how this classification may bias or confound their results.

    View details for Web of Science ID A1997WX57800007

    View details for PubMedID 9141643

  • Epstein-Barr virus-associated Hodgkin's disease: Epidemiologic characteristics in international data INTERNATIONAL JOURNAL OF CANCER Glaser, S. L., Lin, R. J., Stewart, S. L., Ambinder, R. F., Jarrett, R. F., Brousset, P., PALLESEN, G., Gulley, M. L., Khan, G., OGrady, J., Hummel, M., Preciado, M. V., Knecht, H., Chan, J. K., Claviez, A. 1997; 70 (4): 375-382


    Hodgkin's disease (HD) has long been suspected to have an infectious precursor, and indirect evidence has implicated Epstein-Barr virus (EBV), a ubiquitous herpesvirus, as a causal agent. Recent molecular studies using EBER in situ hybridization or latency membrane protein-I (LMP-I) immunohistochemistry have identified EBV latent infection in up to 50% of HD tumors. However, the epidemiologic features of these cases have not been examined in detail. To explore the epidemiology of EBV-positive HD so as to understand the role of EBV in HD etiology more clearly, this project accumulated patient data from 14 studies that had applied these EBV assays to HD tumors. With information on age at diagnosis, sex, ethnicity, histologic subtype, country of residence, clinical stage and EBV tumor status from 1,546 HD patients, we examined risk for EBV-positive disease using logistic regression. Forty percent of subjects had EBV-positive tumors, and EBV prevalence varied significantly across groups defined by the study variables. Odds ratios (OR) for EBV-associated HD were significantly elevated for Hispanics vs. whites (OR = 4.1), mixed cellularity vs. nodular sclerosis histologic subtypes (OR = 7.3, 13.4, 4.9 for ages 0-14, 15-49, 50+ years), children from economically less-developed vs. more-developed regions and young adult males vs. females (OR = 2.5). These findings suggest that age, sex, ethnicity and the physiologic effects of poverty may represent biologic modifiers of the EBV association and confirm that this association is strongly but variably linked to histologic subtype. The data augment biologic evidence that EBV is actively involved in HD pathogenesis in some cases but describe epidemiologic complexity in this process.

    View details for Web of Science ID A1997WF99000001

    View details for PubMedID 9033642

  • The epidemiology of Hodgkin's disease BAILLIERES CLINICAL HAEMATOLOGY Glaser, S. L., Jarrett, R. F. 1996; 9 (3): 401-416


    Much of the epidemiological heterogeneity of HD incidence reflects the behaviour of the NS subtype, at least in the USA. Incidence variation across races (except Asians) and time periods is most marked in this subtype. In young adults with HD, there is compelling evidence for social class modification of risk consistent with an infectious aetiology; limited data suggest that this effect occurs within the NS subtype, but considerable evidence indicates that it does not primarily involve EBV infection. Findings from familial aggregation studies and HLA associations point to inherited susceptibility to this subtype. Despite little sex difference for NS in young adulthood in the latest incidence data, parity nevertheless appears to be protective against this subtype for women. Therefore, the greater increase for females than males in the incidence of young-adult NS in recent years may reflect the impact of population trends towards later childbearing and lower parity. This change, as well as the concomitant smaller family sizes and growing affluence, could explain part of the burgeoning incidence of NS in young adults in the USA. These observations suggest that NS in young adults constitutes a separate disease, probably of infectious origin. The incongruous occurrence of this subtype in older adults, and the presence of EBV in some NS cases, could reflect heterogeneity within NS, for example, representing features of the cellular phase of NS (Cozen et al, 1992; Medeiros and Greiner, 1995). For the non-NS subtypes, many of the factors that predict risk of NS may also be relevant. Patterns of social class determinants in children and older adults, the age groups at risk for MC, support involvement of an infectious precursor given intense exposure, and EBV is a likely candidate, based on its high prevalence in these groups. However, little aetiological research has been directed explicitly at the non-NS subtypes. Considerable effort has gone into exploring an infectious aetiology of HD. Recently, this line of investigation has moved beyond social class determinants to molecular epidemiological studies of EBV and, to a lesser degree, other potentially involved viruses. The roles of genetic susceptibility and sex hormones also represent promising areas for exploration, particularly in their possible interaction with infectious agents and other environmental factors. Ultimately, clearer epidemiological understanding of HD will be aided by more precise classification of this disease at the molecular level.

    View details for Web of Science ID A1996VP45600001

    View details for PubMedID 8922237



    Diseases associated with Helicobacter pylori infection, such as peptic ulcer disease and gastric cancer, afflict men more frequently than women. No study, however, has demonstrated any difference in sex-specific rates of H. pylori infection. In a healthy population undergoing multiphasic health evaluations in 1992-1993 as members of the Kaiser Permanente Medical Care Program of Northern California, adults aged 20-39 years were screened for antibodies to H. pylori infection using a serum enzyme-linked immunosorbent assay and were surveyed with regard to their demographic characteristics and health practices. Among 556 African-American, Hispanic, and white men and women, male sex was a significant risk factor for infection. Other risk factors included African-American race and Hispanic ethnicity, increasing age, living with children, birth in a developing country, and lower levels of income and education. Men consistently had a higher prevalence of antibodies across all strata of race/ethnicity, age, education, and income, and in multivariate analysis male sex remained significantly associated with infection (odds ratio = 2.0, 95% confidence interval 1.2-3.1). African-American race, Hispanic ethnicity, increasing age, lower levels of education, and birth in a developing country were also associated with infection in multivariate analysis. Data from previously reported seroprevalence studies support a tendency for men to have a higher risk of infection. The higher prevalence of infection among young males as observed in Northern California may account in part for the increased incidence of H. pylori-related diseases among men in later decades of life.

    View details for Web of Science ID A1995TA75600010

    View details for PubMedID 7572962



    Understanding of Hodgkin's disease causes continues to be elusive. The prime etiologic candidate, Epstein-Barr virus, has been detected in only a proportion of cases, and there are few other active leads. Epidemiologic data reviewed here describe sex differences in Hodgkin's disease consistent with an involvement of reproductive and thus hormonal factors in its pathogenesis in women. This hypothesis has received very little research attention. Yet, the male predominance in incidence shows variation with age, particularly around the childbearing years, that is unusual for a malignancy. Indirect evidence relating Hodgkin's disease incidence to marital status, religion, and population parity trends demonstrates lower rates in women of presumed higher parity. Two studies that examined parity found strong but opposing associations with risk of Hodgkin's disease. The role of parity is difficult to interpret because of study design differences and the likelihood of confounding by social class. However, the incidence, clinical, and experimental findings, which should not be due to social class differences between men and women, are also compatible with a protective influence of reproductive experience in Hodgkin's disease in women. Prior infection with any ubiquitous virus seems unlikely to explain the sex differences in descriptive statistics. On the whole, the evidence suggests a role of hormonal factors in the pathogenesis of Hodgkin's disease, possibly operating through an effect on the immune system, and this hypothesis may prove fruitful to explore.

    View details for Web of Science ID A1994MX21800001

    View details for PubMedID 8116598



    Black-white differences in Hodgkin's disease (HD) occurrence have been reported in older US mortality statistics and in limited international data, suggesting either genetic or socioeconomic determinants of susceptibility. However, there has been no evaluation with reliable data of the interracial incidence patterns by age, sex, and histologic subtype, that are prerequisite to understanding the causes of such variation. This project utilized 15 years of recent, high quality, incidence data from well-defined black and white US populations to calculate age-, sex-, and histology-specific rates of HD by race over time. Rates were somewhat lower for blacks (N = 593) than whites (N = 8,541) of both sexes, except among young boys. For blacks, age-specific incidence curves were slightly bimodal, although less than for whites; the male excess of HD was larger; and rates among women were low at all ages. For each histology subtype, blacks had lower incidence than whites; however, for the first time, nodular sclerosis was found to be the most common variant for both races. Between 1969-74 and 1980-84, HD rates declined in whites over age 55 but increased in white young adult women; among blacks, rates decreased slightly for boys and young adult men, the latter likely due to improving population enumeration. These findings confirm some interracial differences noted previously in HD. For blacks, they also reveal an incipiently bimodal age incidence and more prominent nodular sclerosis subtype occurrence that support a strong role for environmental factors in racial variation of this lymphoma.

    View details for Web of Science ID A1991FK35400011

    View details for PubMedID 2066245


    View details for Web of Science ID A1990EM75000002

    View details for PubMedID 2251512



    A prior study of Hodgkin's disease (HD) incidence using national cancer survey data (1969-1980) identified unprecedented rate declines among white persons older than 40 years, and rate increases among young adults aged 15 through 39. These trends could be due to improved diagnostic accuracy. To investigate this hypothesis, the authors updated incidence rates in whites by age, sex, and histologic subtype through 1984; quantified diagnostic accuracy in corresponding detail using Repository Center for Lymphoma Clinical Studies data, which include original and expert review diagnoses on lymphoma patients; and recalculated HD incidence rates (1969-1984) corrected for diagnostic error. Updated HD incidence rates through 1984 continued to decline in older adults and showed persistent increases for young adults with the nodular sclerosis (NS) histologic subtype. The percentage of original HD diagnoses confirmed on review (confirmation rate) decreased with age and increased over time; in older adults, these patterns opposed observed incidence trends. However, for young adults, confirmation rates of NS, the most common subtype at these ages, were high and changed little over time. After adjustment for diagnostic error, incidence rates for older adults were lower than previously observed and showed no secular changes. However, young adults with NS had slightly larger rate increases than in uncorrected data. Thus, contemporary changes in HD incidence for whites primarily involve growing risk to persons at the start of adult life. These patterns are compatible with trends in suspected sociodemographic risk factors that suggest an infectious etiology for HD.

    View details for Web of Science ID A1990EH74500025

    View details for PubMedID 2224775



    Numerous investigations of time-space clustering in Hodgkin's disease, designed to investigate its communicability, have produced equivocal results. Few studies have considered the spatial clustering reflecting a broader range of exposures despite sporadic evidence of such groupings of Hodgkin's disease cases. This project examined spatial (residential) patterns among 741 white Hodgkin's disease cases from the San Francisco-Oakland, California, area using 1969-1977 cancer registry incidence data and 1970 population counts. Two types of distances between cases were evaluated using new statistical methods that adjust for population density. Hodgkin's disease cases lived closer to their nearest case neighbors than expected in four of five study counties. Significant clustering of this type occurred among case subgroups defined by sex, age, and social class. There was little evidence of larger-scale clustering around a single point-source exposure. The small, widely dispersed clusters detected here suggest late exposure to a ubiquitous environmental agent involved in Hodgkin's disease etiology. These case aggregations are consistent both with prior reports of spatial clustering in this lymphoma and with evidence implicating viral or other factors in its pathogenesis.

    View details for Web of Science ID A1990DM37500022

    View details for PubMedID 2356828



    Geographic distribution in Hodgkin's disease (HD) incidence was examined for whites by age, sex and Rye histologic subtype in several regions of the US for 1969 to 1971 and 1973 to 1980, using data from national cancer surveys. Average annual age-adjusted rates (1973-1980) ranged between 2.0 and 3.6 per 100,000 persons. Significant regional variation in HD was confined to elevated rates in Connecticut and San Francisco-Oakland, and low rates in Hawaii, Atlanta, and New Orleans. In young adults (ages 20-34 years) HD was positively associated across regions with rates for children (ages 5-14 years), and with community-wide socioeconomic status (SES), but did not vary with older adult rates. Patterns of geographic variation differed among the histologic subtypes, with no significant variation for the lymphocyte predominance form. Incidence of nodular sclerosis increased with regional SES, and was inversely correlated with rates of lymphocyte predominance. Among women, HD incidence became less heterogeneous across regions with time.

    View details for Web of Science ID A1987K861900039

    View details for PubMedID 3677017



    Incidence data from national cancer surveys (1947, 1969-71, 1973-80) in selected regions of the United States were used to describe the epidemiology of Hodgkin's disease (HD) in whites over all regions by age, sex and Rye histologic subtype in the 1970s, and time trends for HD overall. Before 1971, rates increased in young adults, notably men, and in older persons. During the 1970s, rates in children were stable, but young adult rates were high and rose slightly, particularly among women; both trends reflected elevated incidence of Nodular Sclerosis, the only subtype with increasing rates. For adults over 40, rates of all subtypes declined after 1969-71. Thus HD incidence in this country is not static, even over the last decade. Rate stability in younger children may indicate disappearance of environmentally caused HD. Incidence declines for older persons suggest a cohort effect, depletion of young adult susceptibles, or improvements in diagnostic accuracy.

    View details for Web of Science ID A1986E473400004

    View details for PubMedID 3760107



    An ecologic study design was used to investigate the relationship between exposure to air emissions produced by the petroleum and chemical industries, and average annual cancer incidence and major cause mortality rates among whites in Contra Costa County, California. Estimates for the exposure to major industrial sources of sulfur dioxide, hydrocarbons and oxides of nitrogen were used to subdivide the county by level of exposure to petroleum refinery and chemical plant emissions. Cancer incidence and major cause mortality rates were then calculated for whites in each of the exposure areas. In both males and females, residential exposure to petroleum and chemical air emissions was associated with an increased incidence of cancer of the buccal cavity and pharynx. In males, age-adjusted incidence rates for cancers of the stomach, lung, prostate and kidney and urinary organs were also associated with petroleum and chemical plant air emission exposures. In both sexes, we found a strong positive association between degree of residential exposure and death rates from cardiovascular disease and cancer, and a less strong positive association between exposure and death rates from cerebrovascular disease. There was also a positive association in men for deaths from cirrhosis of the liver. Although these observed associations occurred across areas of similar socioeconomic and broad occupational class, confounding variables and the "ecologic fallacy" must be considered as possible explanations. In particular, the stronger findings in men suggest an occupational explanation of the cancer incidence trends, and the effect observed in cirrhosis mortality suggests that lifestyle variables such as alcohol consumption were not adequately controlled for. While the public health implications of our findings remain unclear, the evidence presented is sufficient to warrant follow-up studies based on individual data in which possible biases can be more readily controlled.

    View details for Web of Science ID A1984ST28400055

    View details for PubMedID 6734567

  • Ozone toxicity symptoms among flight attendants. American journal of industrial medicine Reed, D., Glaser, S., KALDOR, J. 1980; 1 (1): 43-54


    Because of persistent complaints of ozone-toxicity type symptoms among crew members of commercial airlines, we undertook a survey to determine the extent of the problem and the associated flight factors. Self-reported questionnaires and flight diaries were completed by 1,330 flight attendants, (FAs) working for three different airlines. Ozone-toxicity type symptoms were reported three or four times more frequently by FAs with airlines flying at high altitudes than by those with low-flying airlines. When examined by characteristics of flights, the ozone-toxicity type symptoms were significantly associated with flight altitude, duration and type of aircraft, but not with years worked, sex, medical history, or home residence. Other symptoms indicative of fatigue or stress were mainly associated with flight duration. While these indirect data cannot implicate ozone specifically, they offer evidence that ozone-related health problems do exist among a large proportion of FAs.

    View details for PubMedID 7342754

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