Christine F Brainson1, Bin Huang2, Quan Chen3, Laurie E McLouth4, Chunyan He5, Zhonglin Hao5, Susanne M Arnold5, Ralph G Zinner5, Timothy W Mullett6, Therese J Bocklage7, David K Orren8, John L Villano5, Eric B Durbin9. 1. Department of Toxicology and Cancer Biology, College of Medicine, University of Kentucky, Lexington, KY; Markey Cancer Center, University of Kentucky, Lexington, KY. Electronic address: cfbrainson@uky.edu. 2. Markey Cancer Center, University of Kentucky, Lexington, KY; Division of Cancer Biostatistics, College of Medicine, University of Kentucky, Lexington, KY; Kentucky Cancer Registry, Markey Cancer Center, University of Kentucky, Lexington, KY. 3. Markey Cancer Center, University of Kentucky, Lexington, KY; Kentucky Cancer Registry, Markey Cancer Center, University of Kentucky, Lexington, KY. 4. Markey Cancer Center, University of Kentucky, Lexington, KY; Department of Behavioral Science, Center for Health Equity Transformation, College of Medicine, University of Kentucky, Lexington, KY. 5. Markey Cancer Center, University of Kentucky, Lexington, KY; Department of Medicine, Division of Medical Oncology, College of Medicine, University of Kentucky, Lexington, KY. 6. Department of Surgery, Division of Cardiothoracic Surgery, College of Medicine, University of Kentucky, Lexington, KY. 7. Department of Pathology and Laboratory Medicine, College of Medicine, University of Kentucky, Lexington, KY. 8. Department of Toxicology and Cancer Biology, College of Medicine, University of Kentucky, Lexington, KY; Markey Cancer Center, University of Kentucky, Lexington, KY. 9. Markey Cancer Center, University of Kentucky, Lexington, KY; Kentucky Cancer Registry, Markey Cancer Center, University of Kentucky, Lexington, KY; Division of Biomedical Informatics, Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY.
Abstract
INTRODUCTION: Kentucky is recognized as the state with the highest lung cancer burden for more than 2 decades, but how lung cancer differs in Kentucky relative to other US populations is not fully understood. PATIENTS AND METHODS: We examined lung cancer reported to the Surveillance, Epidemiology, and End Results (SEER) Program by Kentucky and the other SEER regions for patients diagnosed between 2012 and 2016. Our analyses included histologic types, incidence rates, stage at diagnosis, and survival in Kentucky and Appalachian Kentucky relative to other SEER regions. RESULTS: We found that both squamous cell carcinomas and small-cell lung cancers represent larger proportions of lung cancer diagnoses in Kentucky and Appalachian Kentucky than they do in the SEER registries. Furthermore, age-adjusted cancer incidence rates were higher in Kentucky for every subtype of lung cancer examined. Most notably, for Appalachian women the rate of small-cell carcinomas was 3.5-fold higher, and for Appalachian men the rate of squamous cell carcinoma was 3.1-fold higher, than the SEER rates. In Kentucky, lung cancers were diagnosed at later stages and lung cancer survival was lower for adenocarcinoma and neuroendocrine carcinomas than in SEER registries. Squamous cell carcinomas and small-cell carcinomas were most lethal in Appalachian Kentucky. CONCLUSION: Together, these data highlight the considerable disparities among lung cancer cases in the United States and demonstrate the continuing high burden and poor survival of lung cancer in Kentucky and Appalachian Kentucky. Strategies to identify and rectify causes of these disparities are discussed.
INTRODUCTION: Kentucky is recognized as the state with the highest lung cancer burden for more than 2 decades, but how lung cancer differs in Kentucky relative to other US populations is not fully understood. PATIENTS AND METHODS: We examined lung cancer reported to the Surveillance, Epidemiology, and End Results (SEER) Program by Kentucky and the other SEER regions for patients diagnosed between 2012 and 2016. Our analyses included histologic types, incidence rates, stage at diagnosis, and survival in Kentucky and Appalachian Kentucky relative to other SEER regions. RESULTS: We found that both squamous cell carcinomas and small-cell lung cancers represent larger proportions of lung cancer diagnoses in Kentucky and Appalachian Kentucky than they do in the SEER registries. Furthermore, age-adjusted cancer incidence rates were higher in Kentucky for every subtype of lung cancer examined. Most notably, for Appalachian women the rate of small-cell carcinomas was 3.5-fold higher, and for Appalachian men the rate of squamous cell carcinoma was 3.1-fold higher, than the SEER rates. In Kentucky, lung cancers were diagnosed at later stages and lung cancer survival was lower for adenocarcinoma and neuroendocrine carcinomas than in SEER registries. Squamous cell carcinomas and small-cell carcinomas were most lethal in Appalachian Kentucky. CONCLUSION: Together, these data highlight the considerable disparities among lung cancer cases in the United States and demonstrate the continuing high burden and poor survival of lung cancer in Kentucky and Appalachian Kentucky. Strategies to identify and rectify causes of these disparities are discussed.
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