Standardized mortality ratios (SMRs) and absolute risk of all-cause mortality among children and adolescents diagnosed with Hodgkin lymphoma, non-Hodgkin lymphoma, and central nervous system tumors, SEER 8, 1975-2021.

Abstract Background: Childhood and adolescent cancer survivors represent a growing population whose outcomes reflect both advances in therapy and late effects of treatment. We quantified trends in long-term excess mortality risk and survival using standardized mortality ratios (SMR) and relative survival, respectively. Methods: Using the Surveillance, Epidemiology, and End Results data, we assessed 5-year relative survival and 5-year relative survival, conditional on surviving 5 years, by period of diagnosis (1975–1979 vs. 2016–2020, and 1975–1979 vs. 2011–2015, respectively). Trends were quantified by year at diagnosis using the joinpoint survival model. SMRs were estimated by 5-year time-since-diagnosis intervals and calendar-year diagnosis periods. Results: Between 1975 and 2020, there were improvements in 5-year relative survival, with acute myeloid leukemia (AML) and non–Hodgkin lymphoma (NHL) having the greatest survival gains. For osteosarcoma, central nervous system tumors, and Wilms tumor, 5-year relative survival plateaued in recent decades. Five-year relative survival, conditional on surviving 5 years, was >90% for survivors diagnosed between 2011 and 2015 for all cancer sites analyzed. Overall, SMRs declined with increasing time since diagnosis. Excess mortality risk also decreased over calendar-year diagnosis periods, particularly during the first 5 years since diagnosis, for cancers such as lymphoid leukemia, AML, Hodgkin lymphoma, and NHL. Conclusions: Overall, we observed considerable improvements in 5-year relative survival and declines in excess mortality risk over time. Impact: These findings reflect advances in treatment and survivorship care. Long-term follow-up and continued research efforts are needed to understand long-term mortality risks within an evolving treatment landscape and to achieve further progress. See related In the Spotlight, p. 791

The increasing incidence of early-onset cancers is a growing concern. Using newly released Surveillance Epidemiology and End Results (SEER) data incorporating 2023 incidence rates, we evaluated emerging trends by comparing 5-year average annual percent changes (AAPC) in incidence rates for 2018-2022 and 2019-2023 across the 22 most common cancer types in individuals under 50 years of age. The AAPC changed significantly for liver and intrahepatic bile duct cancer from 2.6% (non-significant) in 2018-2022 to 3.7% (increasing) in 2019-2023. For non-Hodgkin lymphoma and lung and bronchus cancer, AAPCs changed from -0.5% to 1.1% and from -2.0% to 0.3%, respectively (decreasing to non-significant). A continuous increase in incidence rates was observed for cancers including but not limited to colorectal cancer (excluding appendix) and ovarian cancer. These findings underscore the need for robust cancer registry data to support surveillance research and inform prevention and control efforts in younger populations.

Standardized mortality ratios (SMRs) by intervals of years since diagnosis (10+ years) and diagnosis period for children and adolescents diagnosed with osteosarcoma, Ewing’s sarcoma, rhabdomyosarcoma, neuroblastoma, and Wilms tumor. Note: Not all individuals diagnosed during a specified diagnosis period had the minimum length of follow-up for a particular interval and were thus excluded from the calculation for that time-since-diagnosis interval. For example, for the 2005-2016 diagnosis period, individuals diagnosed after 2011 were excluded from the calculation for the 10 to <15 years-since-diagnosis interval.

Standardized mortality ratios (SMRs) and absolute risk of all-cause mortality among children and adolescents diagnosed with neuroblastoma and Wilms tumor, SEER 8, 1975-2021.

Importance:Breast cancer incidence among Asian American, Native Hawaiian, and Pacific Islander females as an aggregated group have been increasing rapidly. The extent to which these trends apply across Asian American, Native Hawaiian, and Pacific Islander ethnic groups is unclear. Objective:To examine incidence trends of invasive breast cancer in 7 Asian American (Asian Indian or Pakistani, Chinese, Filipino, Japanese, Korean, Laotian or Kampuchean, and Vietnamese) and 2 Native Hawaiian or Pacific Islander (Guamanian, Chamorro, and Samoan and Native Hawaiian) ethnic groups overall and by age, stage, and subtype. Design, Setting, and Participants:This population-based, descriptive, cross-sectional study used National Cancer Institute Surveillance, Epidemiology, and End Results Program data contributed by 14 US states (3 in the Northeast, 2 in the Midwest, 4 in the South, and 5 in the West). Asian American, Native Hawaiian, and Pacific Islander females of any age diagnosed with invasive breast cancer between January 1, 2000, and December 31, 2022, were included. Data were analyzed between September 2025 and March 2026. Main Outcomes and Measures:Annual (or triannual) percentage change (APC) and 95% CIs of incidence rates were estimated using joinpoint regression, by age (<50 years, ≥50 years), stage (localized, regional, distant), and subtype (hormone receptor [HR] and ERBB2 [formerly HER2/neu] negativity and positivity). Results:A total of 148 608 Asian American, Native Hawaiian, and Pacific Islander females with breast cancer (44 234 aged <50 years [29.8%] and 104 374 aged ≥50 years [70.2%] at diagnosis; 138 808 of Asian American [93.4%] and 9800 of Native Hawaiian or Pacific Islander [6.6%] race and ethnicity) were included, among whom 63.9% were diagnosed at a localized stage and 66.6% with the HR-positive and ERBB2-negative subtype. Increased incidence rates of invasive breast cancer were observed among Asian American females (APC, 2.34%; 95% CI, 1.83%-3.68%) from 2012 to 2022, surpassing the trend in other racial and ethnic groups. A smaller steady increase was observed among Native Hawaiian or Pacific Islander females (APC, 0.84%; 95% CI, 0.48%-1.29%) from 2000 to 2022. Significant increases in overall and early-onset (ie, age <50 years) breast cancer were evident in all Asian American, Native Hawaiian, and Pacific Islander ethnic groups, with Chinese and Vietnamese females experiencing increased APCs of 4.57% (95% CI, 2.03%-8.36%) and 4.30% (95% CI, 1.98%-8.93%) since 2015 and 2016, respectively. Incidence increases were most pronounced for distant stage disease, with APCs of 4.02% (95% CI, 2.74%-5.72%) for Asian Indian and Pakistani females and 4.52% (95% CI, 2.55%-7.09%) for Chinese females. All Asian American groups, except Laotian and Kampuchean females, experienced increasing trends of HR-positive and ERBB2-negative cancer, with APCs ranging from 2.10% (95% CI, 0.74%-3.45%) for Japanese females to 6.00% (95% CI, 3.62%-8.78%) for Korean females since 2010, whereas Native Hawaiian and Pacific Islander groups saw stable trends. Nearly all Asian American groups experienced increases in triple-negative breast cancer, with an APC as high as 6.17% (95% CI, 3.30%-11.73%) among Chinese females for 2017 to 2022. Conclusions and Relevance:This cross-sectional study found that breast cancer incidence rates increased rapidly across Asian American, Native Hawaiian, and Pacific Islander ethnic groups over a 20-year period. Research tailored to these distinct ethnic groups is needed to discern potentially novel risk factors for breast cancer. Culturally sensitive efforts are needed to promote awareness and increase breast cancer screening in distinct ethnic groups. The rapid recent increases in breast cancer incidence in Asian American, Native Hawaiian, and Pacific Islander women, especially early-onset disease, warrant urgent attention.

Standardized mortality ratios (SMRs) and absolute risk of all-cause mortality among children and adolescents diagnosed with cancer (all cancer sites combined), lymphoid leukemia, and acute myeloid leukemia, SEER 8, 1975-2021.

Standardized mortality ratios (SMRs) by intervals of years since diagnosis (10+ years) and diagnosis period for children and adolescents diagnosed with cancer (all cancer sites combined), lymphoid leukemia, acute myeloid leukemia, Hodgkin lymphoma, non-Hodgkin lymphoma, and central nervous system tumors. Note: Not all individuals diagnosed during a specified diagnosis period had the minimum length of follow-up for a particular interval and were thus excluded from the calculation for that time-since-diagnosis interval. For example, for the 2005-2016 diagnosis period, individuals diagnosed after 2011 were excluded from the calculation for the 10 to <15 years-since-diagnosis interval.

Standardized mortality ratios (SMRs) and absolute risk of all-cause mortality among children and adolescents diagnosed with osteosarcoma, Ewing’s sarcoma, and rhabdomyosarcoma, SEER 8, 1975-2021.

BACKGROUND:Asian Americans (AA), Native Hawaiians, and Pacific Islanders (NHPI), collectively referred to as AANHPI, are heterogeneous populations with varying cancer risks across ethnic groups. Incidence rates and trends are examined for eight AA groups (Asian Indian/Pakistani, Chinese (including Taiwanese), Filipino, Japanese, Kampuchean, Korean, Laotian, and Vietnamese) and three NHPI groups (Native Hawaiian, Guamanian/Chamorro, and Samoan). METHODS:Annual cancer incidence from 21 Surveillance, Epidemiology, End Results (SEER) registries and population denominators from 2000-2022 were used to calculate incidence rates and average annual percentage change (AAPC). RESULTS:Among females, top five cancers included breast, lung, colon and rectum (CRC), uterus, and thyroid. Cancer incidence trends for breast and uterus were stable or increasing in most groups (AAPC: 0.68% to 5.29% for breast across ethnic groups; 2.13% to 3.65% for uterus). CRC trends were stable or decreasing (-4.01% to-1.06%), except among Asian Indians/Pakistanis (AAPC: 0.79%). Lung cancer increased among Asian Indians/Pakistanis (2.30%) but decreased among Chinese (-1.96%). Thyroid trends increased among Japanese (1.92%) and Vietnamese (1.35%).Among males, top five cancers included prostate, lung, CRC, liver, and non-Hodgkin lymphoma (NHL). Lung, CRC, and liver trends were stable or decreasing in most groups. Prostate trends increased in most groups (2.12% to 5.03%) but decreased among Laotians (-11.79%), Guamanians/Chamorros (-4.67%) and Samoans (-6.89%). NHL trends increased among Asian Indians/Pakistanis (0.98%) and Chinese (1.12%). CONCLUSIONS:A nationwide SEER database for evaluating cancer incidence trends through 2022 in disaggregated AANHPI groups is now available from SEER. It highlights ethnically distinct contemporary patterns relevant to research and cancer control initiatives.

BACKGROUND:Alcohol consumption is a risk factor for certain cancers and is increasing in the United States. We estimated the impact of alcohol consumption on cancer incidence trends in the United States from 2008 to 2019 across six alcohol-related cancers among men and women. METHODS:Average daily alcohol consumption (ADC) was calculated from the National Health Interview Survey (1998-2009) and adjusted to per capita sales data to account for underreporting alcohol use. Population-attributable fractions (PAF) were calculated combining RRs from large meta-analyses and annual ADC estimates for six cancers: female breast cancer, colorectal cancer, esophageal squamous cell carcinoma, laryngeal cancer, liver cancer, and oral and pharyngeal cancer assuming a 10-year latency period. PAF estimates were combined with cancer registry data to calculate incidence rates attributable (and unattributable) to ADCs. RESULTS:The highest PAFs were observed for esophageal squamous cell carcinoma, ranging from 13.9% to 16.7% in women and 26.6% to 28.7% in men. The largest increase in overall alcohol-attributable cancer rates was for breast cancer among women, increasing from 6.6 to 8.1 cases per 100,000. High ADC contributed to the most cancer cases; however, even low ADC levels translated to increased cancer risk. An estimated 18,463 of 297,790 new US breast cancer cases will be attributable to alcohol, with 4,958 due to low consumption. CONCLUSIONS:The PAFs for alcohol-related cancers have increased among women and men. IMPACT:Alcohol consumption is an important contributor to cancer incidence, and troublingly its impact has increased over time. Implementing strategies to reduce alcohol use at the population level could help lower the incidence of alcohol-associated cancers.

Supplemental Table 3 shows estimated cancer cases due to alcohol consumption in 2023.

Supplementary Table 1 shows codes used to classify surgery types by cancer

Patients with cancer diagnosed early in the COVID-19 pandemic may have been particularly vulnerable due to immunosuppression caused by their cancer. The objective was to assess cause of death due to COVID-19, cancer, and other causes among patients with cancer during the pandemic. We thus examined causes of death (cancer, COVID-19, other causes) among patients with cancer diagnosed in 2020 (N = 503,128) compared with 2018 (N = 537,006) in the Surveillance, Epidemiology, and End Results-22. We focused on 1-year cause-specific mortality by cancer type, stage, and age at diagnosis. In a counterfactual analysis, we estimated the number and proportions of patients with cancer dying of cancer or other competing causes if COVID-19 were eliminated as a possible cause of death. Among 2020 patients with cancer, 15.8% died of cancer, 3.3% from other causes, and 0.7% from COVID-19. Among those who died, COVID-19 mortality was 9%, 7.6%, 2.8%, 2.8%, and 1.2% of all deaths for prostate, breast, colorectal, lung, and pancreatic cancers, respectively. In a counterfactual analysis assuming that COVID-19 had not occurred, similar percentages would have died of cancer or other causes, except for lung and pancreatic cancers. In summary, cancer was the leading cause of death in 2020, but COVID-19 did not have a large influence on competing-cause mortality. These findings inform healthcare strategies to mitigate excess mortality among patients with cancer during future healthcare disruptions.Significance: These findings show that, among patients with cancer, cancer remains a leading cause of death during the COVID-19 pandemic. These results underscore the importance of cancer care even amid other public health emergencies.

INTRODUCTION:The Surveillance, Epidemiology, and End Results (SEER) Program collects data on the first course of cancer treatment, but no and unknown receipt of treatment cannot be distinguished for radiation therapy (RT) and chemotherapy. As part of the Data Use Agreement (DUA), users must acknowledge that they understand the data limitations and agree to include a description of the limitations in any analyses published using the data. The objective of this review was to evaluate users' compliance with the recommendations of the DUA. METHODS:Publications from a PubMed search were matched with the names of SEER treatment data users, and keywords were applied to identify relevant studies. Five reviewers (with 2 per publication) independently assessed if the authors (a) conducted analyses supported by these data, (b) correctly labelled no/unknown treatment as "no/unknown", and (c) described the limitations of their use. Publications were classified as "followed recommendations", "partially followed recommendations", or "did not follow recommendations" of the DUA. RESULTS:Among a total of 120 studies included in the review, 106 (88.3%) studies did not follow recommendations, 11 (9.2%) partially followed recommendations, and 3 studies (2.5%) followed recommendations. Only 11.7% of publications correctly labelled the "no/unknown" category as "no/unknown", and described the limitations associated with the no/unknown issue. CONCLUSIONS:In this review, we found substantial misuse of the SEER treatment data and limited acknowledgement of the limitations of the SEER treatment data in publications. Such findings highlight the need to think of effective ways of encouraging appropriate use of the treatment data.

Supplemental Tables 1 shows the RR estimates from the Bagnardi et al. paper used in the PAF calculations separately for men and women.

BACKGROUND:Almost half of Medicare beneficiaries diagnosed with cancer from 1992 to 2005 had at least one comorbid condition. Conditions affect a range of domains from clinical decision-making to quality of life, which are important to consider when conducting cancer research. We introduce a new Surveillance, Epidemiology, and End Results (SEER)-Medicare resource to facilitate using claims data for patients with cancer. METHODS:We use the SEER-Medicare resource to estimate prevalence of comorbidities, 5-year survival rate by cancer site, stage, age and comorbidity severity, and prevalence of surgery by comorbidity for breast, prostate, colorectal and lung cancers. RESULTS:Overall, the most prevalent comorbidities in the year prior to cancer diagnosis were diabetes (27%), chronic obstructive pulmonary disease (22%), peripheral vascular disease (14%), and congestive heart failure (12%). Comorbidity severity had a greater impact on the probability of dying from noncancer causes than dying from cancer. Severity of comorbidity and age consistently increased the probability of noncancer death. The percentage of persons receiving surgery tended to be lower among those with severe comorbidity. CONCLUSIONS:This study demonstrates the utility of new SEER*Stat databases that contain Medicare beneficiaries and claims-based measures of comorbidity. Our results demonstrate that comorbidity is common among older persons diagnosed with cancer and the impact of comorbidity on the probability of dying from cancer varies by cancer site, stage at diagnosis, and age. IMPACT:Comorbidity is common among persons with cancer and affects survival. Future research on the impact of comorbidity among cancer survivors is facilitated by new databases.

1519 Background: Cancer diagnosis is associated with increased risk of financial hardship in the US. This study examined the associations of court-documented major adverse financial events (AFEs) of bankruptcies, liens, and evictions prior to cancer diagnosis and risks of all-cause and cancer-specific mortality. Methods: Individuals aged 21 to 69 years diagnosed with common cancer types, including bladder, female breast, colorectal, kidney, lung and bronchus, oral cavity/pharynx, or prostate cancers or melanoma during 2014-2015 were identified from the SEER population-based registries for Seattle, Louisiana, and Georgia. Registry data were linked with LexisNexis consumer data to identify history of court-documented AFEs of bankruptcies, liens, and evictions. Vital status and cause of death were examined through December 31, 2021. The association of pre-diagnosis AFEs and risk all-cause and cancer-specific mortality was assessed with separate multivariable Cox proportional hazards models for each survival outcome, stratified by cancer site. Models were adjusted for stage, age, race and ethnicity, marital status, registry, registry-specific income categories, and the interaction between income and registry. Results: Of 58,796 individuals diagnosed with one of the 8 selected cancers, 21,694 (36.9%) had a pre-diagnosis AFE and there were 16,714 deaths (28.4%) during the study period between 2014 and 2021. Pre-diagnosis AFEs were associated with higher risk of all-cause mortality for individuals diagnosed with female breast (hazard ratio (HR): 1.18; 95% confidence interval (CI): 1.09-1.28), colorectal (HR: 1.14; 95% CI: 1.06-1.23), oral cavity/pharynx (HR: 1.14; 95% CI: 1.06-1.23 ) and prostate (HR: 1.33; 95%CI: 1.20-1.47) cancer and early- and late-stage melanoma (HR: 2.23; 95% CI: 1.89-2.99 and HR:1.34; 95% CI:1.01-1.80, respectively), in adjusted models. Pre-diagnosis AFEs were also associated with significantly higher risk of cancer-specific mortality for these five cancers. Conclusions: Court-documented AFEs of pre-diagnosis bankruptcy, lien, or eviction was associated with increased risk of all-cause and cancer-specific mortality for multiple cancer types in this study using a novel SEER cancer registry-LexisNexis consumer data linkage. The association of pre-diagnosis AFEs and mortality risk underscores lasting adverse consequences of patient financial vulnerability prior to incurring high out-of-pocket costs of cancer treatment. Our findings are especially timely, with growing efforts by health care providers to screen and address patient health-related social needs as part of comprehensive oncology care.