Jill MacKinnon

University of Miami Miller School of Medicine, Miami, Florida, United States

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Publications (33)79.55 Total impact

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    ABSTRACT: Cancer registries link incidence data to state death certificates to update vital status and identify missing cases; they also link these data to the National Death Index (NDI) to update vital status among patients who leave the state after their diagnosis. This study explored the use of information from NDI linkages to identify potential duplicate cancer cases registered in both Florida and New York.
    Preventing chronic disease 09/2014; 11:E167. · 1.96 Impact Factor
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    ABSTRACT: Background - National survey data linked with state cancer registry data has the potential to create a valuable tool for cancer prevention and control research. A pilot project-developed in a collaboration of the Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS) and the Florida Cancer Data System (FCDS) at the University of Miami -links the records of the 1986-2009 National Health Interview Survey (NHIS) and the 1981-2010 FCDS. The project assesses the feasibility of performing a record linkage between NCHS survey data and a state-based cancer registry, as well as the value of the data produced. The linked NHIS-FCDS data allow researchers to follow NHIS survey participants longitudinally to examine factors associated with future cancer diagnosis, and to assess the characteristics and quality of life among cancer survivors. Methods - This report provides a preliminary evaluation of the linked national and state cancer data and examines both analytic issues and complications presented by the linkage. Conclusions - Residential mobility and the number of years of data linked in this project create some analytic challenges and limitations for the types of analyses that can be conducted. However, the linked data set offers the ability to conduct analyses not possible with either data set alone. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.
    Vital and health statistics. Series 2, Data evaluation and methods research 09/2014;
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    ABSTRACT: Background: To capture the complete first course of therapy and cancer incidence, given the shift in cancer care from the hospital to the private physician practice, central cancer registries (CCRs) in the United States are actively pursuing cancer reporting from ambulatory providers. The 837 medical health claim is a national standard which CCRs can use to capture and translate data into standardized cancer reporting for surveillance. Methods: The Florida Cancer Data System conducted a pilot project with a large medical oncology practice to transmit electronic claims from 2011 to 2013. Using the logic and platform developed under a previous National Cancer Institute (NCI) contract, claims were consolidated and translated into standardized cancer registry codes. Consolidated physician claims were compared against gold standard data from the practice electronic health record (EHR) and evaluated for enhancement to registry data. Results: A total of 623 patient tumor cases were collected from the practice EHR and matched to the physician claims data, and to the original cancer registry record. The claims captured 256 cases (41 percent) with chemotherapy, compared to 28 percent in the registry data set, and 45 percent in the gold standard EHR data set. Combining physician claims with registry data produced 280 cases (45 percent) with chemotherapy. The physician claims plus the registry cancer chemotherapy treatment data produced 92 percent agreement, 92 percent sensitivity, and 91 percent positive predictive value. Claims added 103 cases, or 16.5 percent, to the total chemotherapy received. Conclusions: Physician medical claims data capture chemotherapy information not otherwise reported by hospitals, and is a standardized and efficient mechanism for cancer reporting.
    Journal of registry management. 01/2014; 41(2):51-56.
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    ABSTRACT: The myelodysplastic syndromes (MDS) are often diagnosed in outpatient clinics and may be under-reported to state cancer registries, which predominantly rely on hospital records and laboratory reports. We used a new method of cancer case capture to determine the rate of missed cases and estimate a more accurate incidence of MDS. Using a unique keyword algorithm, we queried all electronic pathology (E-path) reports sent to the state of Florida cancer registry in 2006 to identify potential MDS cases. A stratified, random sample of E-path reports was then reviewed to confirm diagnosis and assign MDS subtype. Characteristics were compared between captured and uncaptured MDS cases. 7111 E-path reports with MDS keyword hits were identified, of which only 18% linked to a registered MDS case, 47% linked to a different cancer, and 34% did not link with any record. Case review of a stratified, random sampling of 285 individuals led to the discovery that uncaptured cases made up 37.7% of the total true MDS cases in 2006. It is estimated that the true incidence of MDS is 5.3 individuals out of 100,000, compared to previous reports of 3.3 out of 100,000. Uncaptured MDS cases were younger and more likely to have information in the pathology report facilitating MDS subtype assignment. Only two-thirds of true MDS cases are captured in Florida using current case-finding mechanisms. Application of a keyword search strategy to identify cases among E-path reports is a feasible technique to improve MDS case ascertainment.
    Leukemia research 11/2013; · 2.36 Impact Factor
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    ABSTRACT: Background: The Florida Department of Health (FL DOH) and Florida Cancer Data System (FCDS) linked cancer registry data with breast cancer patients' hospital electronic medical records (EMRs). Linking EMRs to cancer registry data enable patient-centered outcomes research. However, technical barriers must be resolved to perform linkages. Methods: The FL DOH partnered with a Florida hospital to link their EMRs for patients diagnosed with and/or treated for breast cancer between 2007 and 2011. Medical ICD-9-CM codes were used to identify patients from EMR data. Hospital staff identified patient treatment profiles, medication orders, discharge reports, and clinicians' notes. EMR data were transmitted through FCDS' Secure File Transfer Protocol and matched with registry data. Pathology and treatment data were processed to remove sensitive elements. Results: Hospital staff identified EMRs from within its network of providers, inpatient and outpatient care units, billing departments, and external pharmacies. These data were processed in a flat file format that the registry could receive and interpret. Data for 11,506 breast cancer patients were matched. Discussion: Incorporating cancer data from EMRs into statewide disease registries is feasible and may be ongoing if hospital leadership makes then a priority and dedicates staff with data linkage expertise. Data linkage policies and procedures are needed to ensure patient confidentiality. Such policies and procedures should: (1) address how patient confidentiality is protected; (2) define the legal obligation for reporting data; (3) define data ownership issues; (4) establish compatibility of data systems within hospital networks and state registries; and (5) ensure secure means of transmission through data sharing agreements.
    141st APHA Annual Meeting and Exposition 2013; 11/2013
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    ABSTRACT: To evaluate, in the setting of breast cancer, the accuracy of registry radiation therapy (RT) coding compared with the gold standard of Medicare claims. Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data, we identified 73,077 patients aged ≥66 years diagnosed with breast cancer in the period 2001-2007. Underascertainment (1 - sensitivity), sensitivity, specificity, κ, and χ(2) were calculated for RT receipt determined by registry data versus claims. Multivariate logistic regression characterized patient, treatment, and geographic factors associated with underascertainment of RT. Findings in the SEER-Medicare registries were compared with three non-SEER registries (Florida, New York, and Texas). In the SEER-Medicare registries, 41.6% (n=30,386) of patients received RT according to registry coding, versus 49.3% (n=36,047) according to Medicare claims (P<.001). Underascertainment of RT was more likely if patients resided in a newer SEER registry (odds ratio [OR] 1.70, 95% confidence interval [CI] 1.60-1.80; P<.001), rural county (OR 1.34, 95% CI 1.21-1.48; P<.001), or if RT was delayed (OR 1.006/day, 95% CI 1.006-1.007; P<.001). Underascertainment of RT receipt in SEER registries was 18.7% (95% CI 18.6-18.8%), compared with 44.3% (95% CI 44.0-44.5%) in non-SEER registries. Population-based tumor registries are highly variable in ascertainment of RT receipt and should be augmented with other data sources when evaluating quality of breast cancer care. Future work should identify opportunities for the radiation oncology community to partner with registries to improve accuracy of treatment data.
    International journal of radiation oncology, biology, physics 07/2013; 86(4):686-93. · 4.59 Impact Factor
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    ABSTRACT: BACKGROUND: Cancer registries collect cancer reports through manual reviewing and abstracting medical records. Many hospitals have implemented electronic medical record (EMR) in Florida. Collecting information on cancer diagnosis and treatment through linking hospital EMR may improve timeliness, completeness and quality of cancer registry data. The purpose of this study is to access feasibility and value of collecting cancer patient data through linking state cancer registry with hospital EMR system. METHODS: The Florida Department of Health and the Florida Cancer Data System (FCDS) established a partnership with a Florida hospital system to develop methods for hospital EMR extraction and transmission. Patients were identifies based on ICD-9-CM cancer diagnosis codes. The patient EMR submitted to FCDS data consist of detailed treatment, medication, and discharge reports. Once transmitted to FCDS, EMR were matched with registry data. Hospital pathology data were processed to identify records relevant to cancer. The study was funded by Agency for Healthcare Research and Quality (AHRQ), grant # R24 H2019658-01. RESULTS: 11,506 patients diagnosed with or treated for breast cancer between 2007 and 2010 at a Florida hospital network comprised of 9 facilities whose EMR were submitted to FCDS and linked with cancer registry data. Patient demographics, socio-economic status, and co-morbidities were investigated in relationship to completion of treatment. Records represented patient data for each episode of care, including detailed treatment information for chemotherapy and radiation dosage, surgery, and pathology test results. EMR provided additional information to the cancer registry data: 5% of registry surgery information, 1% of radiation records, and 7% of chemotherapy records were updated using EMR data. EMR provided unique detail information on cancer treatments that cancer registry does not routinely collect. CONCLUSIONS: Collecting cancer data through linking hospital EMR data is feasible when technical expertise is invested. Hospital EMR includes a range of important data elements not included in routine cancer reporting which are useful for analyzing treatment effectiveness. Data processing methodologies are limited to the capabilities of a given hospital EMR system due to lack of data collection and coding standards.
    2013 Council of State and Territorial Epidemiologists Annual Conference; 06/2013
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    ABSTRACT: BACKGROUND: Various attempts have been made to understand how patient choice determines utilization patterns for clinical care and service delivery. In 2010 the Florida Cancer Data System (FCDS) received funding from NPCR/CDC to become an Enhanced Registry for Comparative Effectiveness Research. FCDS staff collection detailed first course of treatment for cancers of the breast, colon, rectum, and chronic myeloid leukemia diagnosed in 2011 and patient data across Florida’s five most populous counties. Both the planned and received treatments were recorded by agent NSC number, dosages, dates received, and reasons for discontinued treatment, as well as biomarker status. METHODS: The data capture process consisted of FCDS field staff conducting on-site case collection and follow-back to hospital facilities. Throughout data collection the FCDS recorded text documentation that supported the coded values for patient treatment data. Particular documentation also was made for cases where codified treatment values were not complete in detailing treatment decisions. FCDS conducted a qualitative analysis of these cases to identify contextual factors behind treatment decisions that were not captured through selection of codified values. Additionally, a qualitative assessment of the abstractors’ experience during data collection provided insight into the pattern of information available on patient medical charts, as well as the trend in types of biomarkers ordered, and the difference between hospital-based and physician-based treatment decisions. RESULTS: In many circumstances reasons that guide treatment decisions were not captured by available codes. Reason for refusing treatment, for example, was often due to lack of financial resources and insurance, as indicated in the original patient medical chart. There were no codes in the CER record applicable for these circumstances. Other patterns observed relate to the type of biomarkers ordered in the physician office compared to treating hospitals. Oncotyping was a common test ordered among private oncology practices that drove breast cancer treatment decisions despite presence of nodes positive in patients. Due to low recurrence scores among these cases, many patients opted to forgo chemotherapy. CONCLUSIONS: Qualitative review of text data provides important contextual information by capturing a more comprehensive profile of treatments planned and eventually received, reasons for refusing treatment, and utilization of specific prognostic biomarkers for treatment decisions. While evaluation of experience-based knowledge of registrars after data collection may not be feasible on a larger scale, for the purposes of this project in Florida, it added much value to the coded dataset and highlighted emerging patterns that can now be targeted in broader analyses.
    2013 Council of State and Territorial Epidemiologists Annual Conference; 06/2013
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    ABSTRACT: We sought to identify high-risk areas of pancreatic cancer incidence, and determine if clusters of persons diagnosed with pancreatic cancer were more likely to be located near arsenic-contaminated drinking water wells. A total of 5,707 arsenic samples were collected from December 2000 to May 2008 by the Florida Department of Health, representing more than 5,000 individual privately owned wells. During that period, 0.010 ppm (10 ppb) or greater arsenic levels in private well water were considered as the threshold based on standard of United States Environmental Protection Agency (EPA). Spatial modeling was applied to pancreatic cancer cases diagnosed between 1998-2002 in Florida (n = 11,405). Multivariable logistic regression was used to determine if sociodemographic indicators, smoking history, and proximity to arsenic-contaminated well sites were associated with residence at the time of pancreatic cancer diagnosis occurring within versus outside a cluster. Spatial modeling identified 16 clusters in which 22.6% of all pancreatic cancer cases were located. Cases living within 1 mile of known arsenic-contaminated wells were significantly more likely to be diagnosed within a cluster of pancreatic cancers relative to cases living more than 3 miles from known sites (odds ratio = 2.1 [95% CI = 1.9, 2.4]). Exposure to arsenic-contaminated drinking water wells may be associated with an increased risk of pancreatic cancer. However, case-control studies are needed in order to confirm the findings of this ecological analysis. These cluster areas may be appropriate to evaluate pancreatic cancer risk factors, and to perform targeted screening and prevention studies.
    BMC Cancer 01/2013; 13:111. · 3.32 Impact Factor
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    ABSTRACT: Background: Hospital electronic medical record (EMR) systems are becoming increasingly integrated for management of patient data, especially given recent policy changes issued by the Centers for Medicaid and Medicare Services. In addition to data management, these data provide evidence for patient-centered outcomes research for a range of diseases, including cancer. Integrating EMR patient data with existing disease registries strengthens all essential components for assuring optimal health outcomes. Objectives: To identify the mechanisms for extracting, linking, and processing hospital EMR data with the Florida Cancer Data System (FCDS); and to assess the completeness of existing registry treatment data as well as the potential for data enhancement. Methods: A partnership among the Florida Department of Health, FCDS, and a large Florida hospital system was established to develop methods for hospital EMR extraction and transmission. Records for admission years between 2007 and 2010 were extracted using ICD-9-CM codes as the trigger and were linked with the cancer registry for patients with invasive cancers of the breast. Results: A total of 11,506 unique patients were linked with a total of 12,804 unique breast tumors. Evaluation of existing registry treatment data against the hospital EMR produced a total of 5 percent of registry records with updated surgery information, 1 percent of records with updated radiation information, and 7 percent of records updated with chemotherapy information. Enhancement of registry treatment information was particularly affected by the availability of chemotherapy medications data. Conclusion: Hospital EMR linkages to cancer disease registries is feasible but challenged by lack of standards for data collection, coding and transmission, comprehensive description of available data, and the exclusion of certain hospital datasets. The FCDS standard treatment data variables are highly robust and complete but can be enhanced by the addition of detailed chemotherapy regimens that are commonly used in patient centered outcomes research.
    J Registry Manag 01/2013; 40(1):40-7.
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    ABSTRACT: Hispanic colorectal cancer (CRC) rates historically have been lower than for non-Hispanic Whites in the United States and in Florida. The aim of this study is to understand CRC trends in Florida Hispanics and non-Hispanic Whites. Using a cross-sectional study design, all invasive CRCs diagnosed among Florida residents between 1989 and 2006 were accessed from the Florida Cancer Data System (FCDS). These cases were analyzed by Hispanic and non-Hispanic White ethnic identification. The Hispanic Origin Identification Algorithm was applied to the FCDS data to identify Hispanic subjects. Primary cancer site and histology data were organized according to SEER (Surveillance Epidemiology and End Results) categories. Joinpoint regression was used to generate incidence trends by stage and subsite location. Rates of CRC incidence were higher for Florida Hispanics compared with non-Hispanic Whites since the mid 1990s. There was a consistent significant increase in the incidence of distant stage CRC in Hispanics (annual percent change (APC) of 1.26 and 0.90 in males and females), whereas rates in non-Hispanics decreased significantly during the same time period (APC -1.36 and -1.28, respectively). Similar trends were found in distant-stage right-sided CRC. Among right-sided CRCs, local stage incidence rate increased for both non-Hispanic Whites and Hispanics, whereas the incidence rate for regional stage decreased for both racial/ethnic groups. Trends for distant-stage CRC are increasing among Florida Hispanics. This is a particular public health concern given that CRC is a cancer for which screening modalities exist and could imply a concomitant increase in CRC-related mortality among Florida Hispanics. Lower rates of CRC screening in Hispanics are documented at the state level, relative to non-Hispanic Whites. Screening programs targeting the Florida Hispanic population are warranted.
    Clinical and translational gastroenterology. 09/2012; 3:e21.
  • 2012 Centers for Disease Control National Cancer Conference, Washington, DC; 08/2012
  • 2012 North American Association of Central Cancer Registries, Portland, OR; 06/2012
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    ABSTRACT: Smoking-attributable risks for lung, esophageal, and head and neck (H/N) cancers range from 54% to 90%. Identifying areas with higher than average cancer risk and smoking rates, then targeting those areas for intervention, is one approach to more rapidly lower the overall tobacco disease burden in a given state. Our research team used spatial modeling techniques to identify areas in Florida with higher than expected tobacco-associated cancer incidence clusters. Geocoded tobacco-associated incident cancer data from 1998 to 2002 from the Florida Cancer Data System were used. Tobacco-associated cancers included lung, esophageal, and H/N cancers. SaTScan was used to identify geographic areas that had statistically significant (P<0.10) excess age-adjusted rates of tobacco-associated cancers. The Poisson-based spatial scan statistic was used. Phi correlation coefficients were computed to examine associations among block groups with/without overlapping cancer clusters. The logistic regression was used to assess associations between county-level smoking prevalence rates and being diagnosed within versus outside a cancer cluster. Community-level smoking rates were obtained from the 2002 Florida Behavioral Risk Factor Surveillance System (BRFSS). Analyses were repeated using 2007 BRFSS to examine the consistency of associations. Lung cancer clusters were geographically larger for both squamous cell and adenocarcinoma cases in Florida from 1998 to 2002, than esophageal or H/N clusters. There were very few squamous cell and adenocarcinoma esophageal cancer clusters. H/N cancer mapping showed some squamous cell and a very small amount of adenocarcinoma cancer clusters. Phi correlations were generally weak to moderate in strength. The odds of having an invasive lung cancer cluster increased by 12% per increase in the county-level smoking rate. Results were inconsistent for esophageal and H/N cancers, with some inverse associations. 2007 BRFSS data also showed a similar results pattern. Spatial analysis identified many nonoverlapping areas of high risk across both cancer and histological subtypes. Attempts to correlate county-level smoking rates with cancer cluster membership yielded consistent results only for lung cancer. However, spatial analyses may be most useful when examining incident clusters where several tobacco-associated cancer clusters overlap. Focusing on overlapping cancer clusters may help investigators identify priority areas for further screening, detailed assessments of tobacco use, and/or prevention and cessation interventions to decrease risk.
    Journal of Carcinogenesis 01/2011; 10:22.
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    ABSTRACT: To compare melanoma trends within Florida with national melanoma trends from 1992 through 2004. An analysis of state and national melanoma trends is critical for the identification of high-risk regions of the country. Data from the Florida Cancer Data System (FCDS) and Surveillance, Epidemiology, and End Results (SEER) were evaluated to determine age-adjusted and race/ethnicity- and sex-specific invasive cutaneous melanoma incidence trends for 1992 through 2004 using joinpoint regression analysis. Standardized incidence rate ratios (SIRRs) were computed to compare Florida with the United States. A population of 109 633 patients with invasive melanoma was evaluated: 73 206 (66.8%) from SEER and 36 427 (33.2%) from FCDS. Melanoma incidence and change in melanoma rates over time. The incidence of melanoma among male Hispanic patients residing in Florida was 20% higher than that of their male counterparts in the SEER catchment areas (SIRR, 1.2; 95% confidence interval [CI], 1.1-1.4). Conversely, the incidence of melanoma among female Hispanic patients residing in Florida was significantly lower than that in SEER (SIRR, 0.7; 95% CI, 0.7-0.8). Differences in melanoma incidence were identified in female non-Hispanic black (NHB) patients in Florida who had a 60% significantly higher incidence of melanoma compared with female NHB patients in SEER (SIRR, 1.6; 95% CI, 1.3-2.0). These findings suggest an emerging public health concern in race/ethnic subgroups that were previously understudied.
    Archives of dermatology 07/2010; 146(7):741-6. · 4.76 Impact Factor
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    ABSTRACT: We sought to determine whether patients with esophageal carcinoma benefit from regionalization of care. The Florida Cancer Data System (FCDS) and the Agency for Health Care Administration data sets (1998-2002) were merged and queried. A total of 5,041 patients (87.6% Caucasian vs. 11.1% African American (AA)) demonstrated a median survival time of 9.8 months overall and 23.4 months following surgical resection (P < 0.001). Adenocarcinoma arose predominantly in Caucasian patients (98.1%). Patients with adenocarcinoma (n = 2,248) derived a treatment benefit at a TF (HR = 1.35, P = 0.003), including an improved 90-day mortality following surgery (2.1% vs. 4.0%, P < 0.001). Squamous cell carcinoma (SCC) arose predominantly in AA patients (91.6%). No overall survival benefit at TF was observed (HR = 1.01, P = 0.915), however a trend for reduced 90-day surgical mortality was observed at TF (1.9% vs. 5.2%, P = 0.062). Multivariate analysis for adenocarcinoma demonstrates that poverty, lack of chemotherapy or surgery, and failure to provide treatment at a TF are independent predictors of worse survival. For SCC patients, AA race was a significant predictor of poorer survival while TF and poverty level were not. These data suggest no benefit from potential regionalized care for patients with squamous histology, which disproportionately affects AA.
    Journal of Surgical Oncology 03/2010; 102(1):18-26. · 2.84 Impact Factor
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    ABSTRACT: Introduction: We sought to identify high-risk areas of pancreatic cancer incidence and determine if PC clusters were more likely to be located near arsenic-contaminated drinking water wells. Methods: Spatial modeling was applied to pancreatic cancer cases diagnosed between 1998-2002 in Florida (n=11,405). Multivariable regression was used to determine if sociodemographic indicators, smoking history, and proximity to arsenic-contaminated well sites were associated with residence at the time of pancreatic cancer diagnosis within versus outside a cluster. Results: Spatial modeling identified 2581 clusters in which 24.8% of all pancreatic cancer cases were located. Cases living within 4 miles and 1 mile of known arsenic-contaminated wells were significantly more likely to be diagnosed within a cluster of pancreatic cancers relative to cases living more than 4 miles from known sites (Odds Ratio= 1.58 [95% confidence interval=1.38-1.81] and 2.0 [1.59-2.52], respectively). Conclusions: Exposure to arsenic-contaminated wells may be associated with an increased risk of pancreatic cancer. Case-control studies are needed in order to confirm the findings of this ecological analysis.
    137st APHA Annual Meeting and Exposition 2009; 11/2009
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    ABSTRACT: Although cervical cancer incidence has declined in the past decade, considerable racial and ethnic differences remain. The objective of this study was to examine differences in incidence by histology and cancer stage in Florida stratified further by race, ethnicity, and 5-year time intervals. Women who were diagnosed with invasive cervical cancer in Florida between January 1985 and December 2004 were included in the analysis. Age-adjusted incidence rates by race and ethnicity were estimated for different histologic types and stages of cancer. The annual percentage of change in incidence also was calculated for each histologic type. Rate ratios were estimated by race and ethnicity using whites and non-Hispanics as the reference group. Overall, the incidence in Florida of cervical squamous cell carcinoma and transitional cell carcinoma declined significantly from 9.1 per 100,000 women in 1985 to 5.6 per 100,000 women in 2004 (P < .05), whereas the incidence of cervical adenocarcinoma remained stable (P > .05). The incidence of invasive cervical cancer was 9.6 per 100,000 women among whites and 13.13 per 100,000 women among African Americans from 2000 to 2004. African-American women were nearly 2 times more likely to be diagnosed at regional and distant cancer stages than white women for all periods examined. Furthermore, among African-American women aged >40 years, the age-specific incidence of invasive cervical cancer increased considerably, whereas the rates among other racial groups decreased. The increasing rate of invasive cervical cancer among African-American women aged >40 years in Florida, coupled with their diagnosis at a later stage of cancer, is of great concern. Most screening organizations recommend stopping screening at age 65 years. The observations from these analyses highlighted the need to focus prevention and screening efforts on African-American women living in Florida, and particularly on women of postreproductive age.
    Cancer 06/2009; 115(17):3991-4000. · 4.90 Impact Factor
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    ABSTRACT: Modifiable risk factors for bladder cancer have been identified, ie tobacco and chemical exposure. We identified high risk bladder cancer areas and risk factors associated with bladder cancer clusters in Florida using individual and area based data. Spatial modeling was applied to 23,266 early and advanced bladder cancer cases diagnosed between 1998 and 2002 in Florida to identify areas of excess bladder cancer risk. Multivariable regression was used to determine whether sociodemographic indicators, smoking history and proximity to known arsenic contaminated drinking water well sites were associated with bladder cancer diagnosis in a specific area (cluster). A total of 25 clusters were found to have a higher than expected bladder cancer rate, including 13 and 12 of early and late stage disease, respectively. Urban white patients were more likely to live in an advanced bladder cancer cluster. Advanced bladder cancer cluster membership was associated with living in close proximity to known arsenic contaminated drinking water wells. There are multiple areas of early and late stage bladder cancer clusters in Florida. Individuals in an advanced bladder cancer cluster tended to live close to arsenic contaminated wells. Increased evaluation of potentially contaminated well water is warranted in these high risk areas. Targeted bladder cancer public awareness campaigns, smoking cessation support and potentially targeted screening should also be considered in communities at increased risk for bladder cancer. Our analytical approach can also be used by others to systematically identify communities at high risk for bladder and other cancers.
    The Journal of urology 06/2009; 182(1):46-50; discussion 51. · 3.75 Impact Factor
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    ABSTRACT: To better understand national patterns of invasive cervical cancer (ICC) incidence by race and ethnicity in order to develop appropriate ICC prevention policies. Age-adjusted and age-specific ICC incidence rates were calculated by combined race/ethnicity, making distinct the Hispanic/all races category from three other Non-Hispanic (White, Black and other) racial categories. There was a significant downward trend in ICC incidence during both time periods for every combination of race/ethnicity (p-value <0.05) except Hispanic/all races during 1995-1999. Non-Hispanic/Black and Hispanic/all races women had significantly higher incidence rates of ICC compared to Non-Hispanic/White women. ICC incidence peaked much earlier for Non-Hispanic/White women (35-44 years of age) compared to any other racial/ethnic group. Non-Hispanic (White, Black and other) women had lower rates of adenocarcinoma and squamous cell carcinoma compared to Hispanic/all races women. Non-Hispanic/Black and Hispanic/all races women were more likely to be diagnosed at late stage or unstaged at diagnosis than Non-Hispanic/White women. Although ICC incidence decreased significantly over the last 10 years, Black or Hispanic US populations continue to have the highest ICC incidence compared to Non-Hispanic/Whites, highlighting the need for improved health literacy and social support to ensure their equal access to ICC screening and HPV prevention including HPV vaccination.
    Cancer Causes and Control 03/2009; 20(7):1129-38. · 3.20 Impact Factor

Publication Stats

297 Citations
79.55 Total Impact Points


  • 2002–2013
    • University of Miami Miller School of Medicine
      • • Department of Epidemiology and Public Health
      • • Sylvester Comprehensive Cancer Center
      Miami, Florida, United States
  • 2009
    • Columbia University
      • Department of Urology
      New York, New York, United States
  • 2006
    • University of Miami
      • Sylvester Comprehensive Cancer Center
      Coral Gables, FL, United States
    • University of Florida
      • Department of Medicine
      Gainesville, FL, United States