Susan Shaw Devesa, M.H.S., Ph.D. Chief of the Descriptive Studies Section Senior Investigator Location: Executive Plaza South, Room 8048 Phone: 301-496-8104 Fax: 301-402-0081 E-mail: devesas@mail.nih.gov Biography Research Selected Publications (citations) All Publications(texts and abstracts from our publications database) Collaborators

Biography

Dr. Devesa received a M.H.S. and Ph.D. in epidemiology from The Johns Hopkins School of Hygiene and Public Health. She joined the NCI in 1966, and was appointed chief of the Descriptive Studies Section in 1993. She is a Fellow of the American College of Epidemiology and has received the PHS Special Recognition Award for descriptive studies of the changing patterns of cancer in the United States, which have provided new clues to etiologic risk factors.

Research

We plan and conduct descriptive studies of cancer incidence and mortality in the United States and other countries, including analyses of trends in cancer rates and variations by age, sex, race and other demographic factors. Databases on deaths are used to produce maps of cancer mortality. The maps and associated descriptive and correlational studies are utilized by researchers at NCI and elsewhere to generate etiologic leads and test hypotheses through targeted studies into causes of cancer.

Geographic Variation in Cancer Rates

Evaluation of geographic variation in cancer rates may suggest clues to the roles of environmental or cultural influences as risk factors. Identification of regions at notably high or low risk may indicate areas where more intensive studies could be particularly fruitful. We published a new U.S. atlas of cancer mortality covering the years 1950 through 1994. The atlas is based on data files for cancer deaths of more than 9.5 million whites and 1.1 million blacks who died during the years 1970 to 1994, and for 4.8 million whites who died during the years 1950 to 1969. Corresponding estimates of person-years at risk were used to calculate observed and expected counts, age-adjusted rates, and confidence limits for more than 40 forms of cancer by race, sex, time period and geographic area. Using special graphics software designed for a personal computer running Microsoft Windows, more than 250 maps at the county or State Economic Area level were generated for the atlas, along with summary tables and figures. The maps show that the patterns previously observed for several cancers persist, such as the broad stretches of high rates for cancers of the breast, colon and rectum in the Northeast. Still, the regional variation has diminished somewhat as rates have risen in many areas of the South. For some tumors, the geographic clustering of areas with elevated rates has become more pronounced in the recent time period, as seen for cancers of the corpus uteri, prostate, bladder and biliary tract. For lung cancer, there have been remarkable changes in the geographic patterns, which correspond to regional/temporal variations in cigarette smoking by sex and race. These maps show the recent emergence of high mortality rates among white men across the South, among white women in the far western states, and among blacks in northern urban areas. The updated geographic maps of cancer mortality are helpful in formulating etiologic and other hypotheses, and in targeting high-risk populations for further epidemiologic research and cancer control efforts. The text, maps, rates, and the data used to generate the cancer mortality atlas are accessible on the internet at http://www.nci.nih.gov/atlasplus/. In addition, a component on the internet site allows the user to customize maps based on parameters selected from a menu.

We collaborated with investigators at the International Agency for Research on Cancer in assessing the international burden of and the time trends in cancer incidence and mortality. We estimated that worldwide, there would be over 10 million new cases, 6.2 million deaths, and 22.4 million persons living with cancer in the year 2000. Lung cancer is the main cancer in the world today, whether considered in terms of numbers of cases (1.2 million) or deaths (1.1 million), because of the high case fatality (ratio of mortality:incidence= 0.9). Breast cancer, although it is the second most common cancer overall (over one million new cases), ranks much less highly (5th) as a cause of death, because of the relatively favorable prognosis (ratio of mortality:incidence= 0.4). Colorectal cancer is third in importance in terms of number of cases (945,000 cases, 492,000 deaths), and stomach (876,000 cases, 647,000 deaths) fourth. We considered the eight most common cancers today (the above four, plus liver, prostate, cervix uteri, and esophagus) in terms of their overall frequency and geographical distribution, their recent trends in incidence and mortality, and the more important causes (risk factors) which explain these observations. A brief summary of the most promising strategy for prevention, in the current state of knowledge, was also included. Of particular note is the presentation of temporal trends in incidence and mortality in 14 areas of the world using comparable scaling not only within each figure but also across figures for all eight cancers, allowing comparison of the magnitude of the rates and trend slopes.

Generating New Hypotheses Based on Cancer Trends and Demographic Factors
We conduct a variety of descriptive epidemiologic studies to quantify the incidence of and mortality from cancer, investigate variations in cancer rates by demographic factors, examine temporal trends and geographic patterns, and identify leads for further analytic research. Using national and international incidence and mortality data, we analyzed the descriptive epidemiology for cancers of the esophagus, stomach, liver, lung, breast, cervix, prostate, bladder and kidney, multiple myeloma, the leukemias, and cancers among children, the elderly, and women.

In contrast to mortality data, which are limited to specifying the form of cancer, records on incidence data include information on histologic type and often the subsite of origin. We used incidence data from the NCI Surveillance, Epidemiology, and End Results (SEER) program to investigate further the demographic patterns of tumor subgroups that may be of etiologic significance. Since clinical investigations have shown prognostic heterogeneity among non-Hodgkin's lymphoma (NHL), we assessed demographic patterns and trends in population-based rates of different histologic subgroups of NHL. Overall, the broad categories of small lymphocytic, follicular, diffuse, high-grade and peripheral T-cell NHL emerged as distinct entities with specific age, sex, racial, temporal and geographic variations in rates.

Using population-based data from the Shanghai Cancer Registry, we updated incidence trends for the years 1972 through 1994. Over the 23-year period, the rate for all cancers combined, excluding non-melanoma skin cancer, decreased from 248 to 215 per 100,000 person-years among men and from 174 to 154 per 100,000 person-years among women. However, trends for individual forms of cancer varied considerably. Rates doubled for cancers of the colon and biliary tract in both sexes, and increased substantially for cancers of the brain and nervous system, kidney, pancreas, prostate, corpus uteri, female breast and ovary, and for NHL. There was little change in rates for cancers of the lung and rectum. Incidence rates declined by at least one-half for cancers of the esophagus and cervix, with notable decreases also for cancers of the stomach and liver. Although some of these trends may reflect variations in diagnostic or screening practices, changes in lifestyle and other environmental exposures are likely to play important roles.

Using Descriptive Data to Assess Consistency with Hypotheses
Cancer incidence and mortality rates may be used to assess consistency with etiologic hypotheses suggested by other studies. Ovarian cancer incidence and mortality rates have declined among U.S. women age 35 to 59 years during the period 1970 through 1995. Epidemiologic studies have shown that ovarian cancer risk decreases with increasing parity and increasing duration of oral contraceptive use. During this time period, parity declined while oral contraceptive use increased. We compared temporal trends in observed ovarian cancer incidence rates with rates predicted by changes in parity and duration of oral contraceptive use. Predicted rates agreed well with observed rates in young women (age 30 to 49), but were substantially lower than observed rates in older women (age 50 to 64). In another analysis, we studied the relation between retinoblastoma incidence and ultraviolet (UV-B) radiation levels in the U.S. using weighted regression, as well as in international data after adjusting for race, economic development, and climate. Our findings suggest that environmental factors other than UV-B may be responsible for the geographic patterns of retinoblastoma.

Keywords
cancer incidence, cancer mortality, cancer mortality atlas, cancer trends, descriptive studies, geographical variation, hypothesis testing

Selected Publications

• Hsing A, Devesa SS, Jin F, Fraumeni JF Jr, Gao Y-T. Rising incidence of biliary tract cancers in Shanghai. Int J Cancer 1998;75:368-70.
• Hsing A, Devesa SS, Fan J, Gao Y-T. Rising incidence of prostate cancer in Shanghai, China. Cancer Epidemiol Biomarkers Prev 1998;7:83-84.
• Strickler HD, Rosenberg PS, Devesa SS, Hertel J, Fraumeni JF Jr, Geodert JJ. The contamination of poliovirus vaccines with simian virus 40 (1955-1963) and subsequent cancer rates in the United States. JAMA 1998;279:292-95.
• Groves FD, Travis LB, Devesa SS, Ries LAG, Fraumeni JF Jr. Waldenstroms's macroglobulinemia: incidence patterns in the United States, 1988-1994. Cancer 1998;82:1078-81.
• Strickler HD, Rosenberg PS, Devesa SS, Fraumeni JF Jr, and Goedert JJ. SV40-contaminated poliovirus vaccine and childhood cancer risk [letter; comment]. J Am Med Assoc 1998;279:1527-1528.
• Strickler HD, Rosenberg PS, Devesa SS, Fraumeni JF Jr, and Goedert JJ. Simian virus 40-contaminated polio vaccine and cancer rates [letter; comment]. J Am Med Assoc 1998;280:1481-1482.
• Devesa SS, Blot WJ, Fraumeni JF Jr. Changing patterns in the incidence of esophageal and gastric cancer in the United States. Cancer 1998;83:2049-53.
• Ji BT, Devesa SS, Chow WH, Jin F, Gao YT. Colorectal cancer incidence trends by subsite in urban Shanghai, 1972-1994. Cancer Epidemiol Biomarkers Prev 1998;7:661-6.
• Strickler HD, Rosenberg PS, Devesa SS, Fraumeni JF Jr, Goedert JJ. Contamination of poliovirus vaccine with SV40 and the incidence of medulloblastoma. Med Pediatr Oncol 1999;32:77-8.
• Troisi R, Freedman A, Devesa S. Incidence of colorectal carcinoma in the United States: an update of trends by gender, race, age, subsite, and stage, 1975-1994. Cancer 1999;85:1670-6.
• Chow WH, Devesa SS, Warren JL, Fraumeni JF Jr. Rising incidence of renal cell cancer in the United States. JAMA 1999;281:1628-31.
• Devesa SS, Fraumeni JF Jr. The rising incidence of gastric cardia cancer. J Natl Cancer Inst 1999;91:747-9.
• Devesa SS, Grauman DJ, Blot WJ, Fraumeni JF Jr. Cancer Surveillance Series: Changing geographic patterns of lung cancer mortality in the United States, 1950 through 1994. J Natl Cancer Inst 1999;91:1040-50.
• Linet MS, Ries LAG, Smith MA, Tarone RE, Devesa SS. Cancer Surveillance Series: Recent trends in childhood cancer incidence and mortality in the United States. J Natl Cancer Inst 1999;91:1051-8.
• Silverman DT, Rothman N, Devesa SS. Epidemiology of bladder cancer. In: Syrigos KN, ed. Bladder Cancer. Oxford: Oxford University Press, 1999, pp. 11-55.
• Hewitt M, Breen N, Devesa S. Cancer prevalence and survivorship issues: analyses of the 1992 National Health Interview Survey. J Natl Cancer Inst 1999;91:1480-6.
• Pennello GA, Devesa SS, Gail MH. Using a mixed effects model to estimate geographic variation in cancer rates. Biometrics 1999;55:774-81.
• Jin F, Devesa SS, Chow WH, Zheng W, Ji BT, Fraumeni JF Jr. Cancer incidence trends in urban Shanghai, 1972-1994: an update. Int J Cancer 1999;83:435-40.
• Devesa SS, Grauman DG, Blot WJ, Pennello G, Hoover RN, Fraumeni JF Jr. Atlas of cancer mortality in the United States, 1950-94. Washington, DC: US Govt Print Off; 1999 [NIH Publ No. (NIH) 99-4564].
• Chow WH, Devesa SS, Fraumeni JF Jr. Increasing incidence of renal cell cancer. JAMA 1999;282:2121.
• Jin F, Devesa SS, Xiang YB, Gao YT. Temporal patterns in cervical cancer incidence and survival in urban Shanghai. Cancer Strategy 1999;1:210-2.
• Devesa SS. Cancer in women. In: Goldman MB, Hatch MC, eds. Women and Health. San Diego: Academic Press, 2000, pp. 863-70.
• Hsing AW, Tsao L, Devesa SS. International trends and patterns of prostate cancer incidence and mortality. Int J Cancer 2000;85:60-7.
• Chow WH, Devesa SS, Fraumeni JF Jr. Epidemiology of renal carcinoma. In: Vogelzang NJ, Scardino PT, Shipley WU, Coffey DS, eds. Comprehensive textbook of genitourinary oncology, 2nd ed. Baltimore: Lippincott Williams and Wilkins, 2000, pp. 101-10.
• Devesa SS, Hunter C. The cancer burden among the elderly. In: Hunter CP, Johnson KA, Muss HB, eds. Cancer in the elderly. New York: Marcel Dekker, 2000, pp. 1-24.
• Gnagy S, Ming EE, Devesa SS, Hartge P, Whittemore AS. Declining ovarian cancer rates in U.S. women: relation to parity and oral contraceptive use. Epidemiology 2000;11:102-5.
• Pennello G, Devesa S, Gail M.. Association of surface ultraviolet B radiation levels with melanoma and nonmelanoma skin cancer in United States blacks. Cancer Epidemiol Biomarkers Prev 2000;9:291-7.
• Grauman DJ, Tarone RE, Devesa SS, Fraumeni JR Jr. Alternate ranging methods for cancer maps. J Natl Cancer Inst 2000;92:534-43.
• Jemal A, Grauman D, Devesa SS. Recent geographic patterns of lung cancer and mesothelioma mortality rates in 49 shipyard counties in the United States, 1970-94. Am J Ind Med 2000;37:512-21.
• Jemal A, Devesa SS, Fears TR, Hartge P. Cancer Surveillance Series: Changing patterns of cutaneous malignant melanoma mortality rates among whites in the United States. J Natl Cancer Inst 2000;92:811-8.
• Jemal A, Fears TR, Devesa SS, Fraumeni JF Jr. Retinoblastoma incidence and sunlight exposure. Brit J Cancer 2000;82:1875-8.
• Groves FD, Linet MS, Travis LB, Devesa SS. Cancer Surveillance Series: Non-Hodgkin's lymphoma incidence by histologic subtype in the United States, 1978-1995. J Natl Cancer Inst 2000;92:1240-51.
• Jemal A, Devesa SS, Hartge P, Tucker MA. Cancer Surveillance Series: Recent trends in cutaneous melanoma incidence among whites in the United States. J Natl Cancer Inst 2001;93:678-83.
• Sgambati M, Devesa SS, Linet MS. Chronic lymphocytic leukemia: epidemiologic, familial and genetic aspects. In: Cheson B, ed. Chronic lymphoid leukemia. New York: Marcel Dekker, 2001, pp. 33-62.
• McGlynn KA, Tsao L, Hsing AW, Devesa SS, Fraumeni JF Jr. International trends and patterns of primary liver cancer. Int J Cancer 2001;94:290-6.
• Hsing A, Devesa SS. Trends and patterns of prostate cancer: what do they suggest? Epidemiol Rev 2001;23:3-13.
• Parkin DM, Bray FI, Devesa SS. Cancer burden in the year 2000: the global picture. Eur J Cancer 2001;37 Suppl 8:4-66.
• Brown LM, Devesa SS, Fraumeni JF Jr. Epidemiology of esophageal cancer. In: Posner MC, Vokes EE, Weichselbaum RR, eds. Cancer of the Upper Gastrointestinal Tract. Hamilton, Ontario: BC Decker- American Cancer Society, 2002, pp. 1-22.
• Hewitt M, Devesa S, Breen N. Pap test use among reproductive-age women at high risk for cervical cancer: analyses of the 1995 National Survey of Family Growth. Am J Public Health 2002;92:666-9.
• Jemal A, Graubard BI, Devesa SS, Flegal KM. The association of blood lead level and cancer mortality among whites in the United States. Environ Health Persp 2002;110:325-9.
• Mathew A, Devesa SS, Fraumeni JF Jr, Chow WH. Global increases in kidney cancer incidence, 1973-1992. Eur J Cancer Prev 2002;11:171-8.
• Lacey JV, Devesa SS, Brinton LA. Recent trends in breast cancer incidence and mortality. Environ Molecular Mutagenesis 2002;39:82-8.
• Canto MT, Devesa SS. Oral cavity and pharynx cancer incidence rates in the United States, 1975-1998. Oral Oncology 2002;38:610-7.
• Eltom MA, Jemal A, Mbulaiteye SM, Devesa SS, Biggar RJ. Cancer Surveillance Series: Trends in Kaposi's sarcoma and non-Hodgkin's lymphoma incidence in the United States from 1973 through 1998. J Natl Cancer Inst 2002;94:1204-10.
• Jemal A, Kulldorff M, Devesa SS, Hayes RB, Fraumeni JF Jr. A geographic analysis of prostate cancer mortality in the United States, 1970-89. Int J Cancer 2002;101:168-74.
• Brown LM, Devesa SS. Epidemiologic trends in esophageal and gastric cancer in the United States. Surg Oncol Clin N Am 2002;11:235-56.
• Brinton LA, Lacey J, Devesa SS. Epidemiology of breast cancer. In: Donegan WL, Spratt JS, eds. Cancer of the breast, 5th ed. Orlando, FL: WB Saunders, 2002, pp. 111-132.
• Mink PJ, Sherman ME, Devesa SS. Incidence patterns of invasive and borderline ovarian tumors among white and black women in the United States: results from the SEER program, 1978-1998. Cancer 2002;95:2380-9.
• Linet MS, Devesa SS. Epidemiology of leukemia: overview and patterns of occurrence. In: Leukemia. Henderson E, Lister TA, Greaves MF, eds. Leukemia. 7th ed. Philadelphia: WB Saunders, 2002, pp. 131-51.
• Strickler HD, Goedert JJ, Devesa SS, Lahey J, Fraumeni JF Jr, Rosenberg PS. Trends in U.S. pleural mesothelioma incidence rates following Simian Virus 40 contamination of early poliovirus vaccines. J Natl Cancer Inst 2003;95:38-45.
• McGlynn KA, Devesa SS, Sigurdson AJ, Brown LM, Tsao L, Tarone RE. Trends in the incidence of testicular germ cell tumors in the United States. Cancer 2003;97:63-70.
• Brown LM, Baris D, Devesa SS. Epidemiology of multiple myeloma. In: Wiernik PH, et al. (eds). Neoplastic Diseases of the Blood. Cambridge University Press, 4th edition. (In Press).
• You WC, Jin F, Gridley G, Schatzkin A, Yang G, Rosenberg P, Xiang YB, Hu YR, Li Q, Devesa SS. Rapid increase in colorectal cancer rates in urban Shanghai, 1972-1998, in relation to dietary changes. J Epidemiol Biostat (In Press).
• Brinton LA, Lacey JV, Sherman ME, Devesa SS. Epidemiology of corpus uteri cancer. In: Gershenson DM, Gore M, McGuire WP, Quinn M, Thomas G (eds). Gynecologic Cancer: Controversies in Management. Elsevier Science (In Press).
• Inskip P, Devesa SS, Fraumeni JF Jr. Recent trends in the incidence of ocular melanoma in the United States. Cancer Causes and Control (In Press).
• Jemal A, Travis WD, Tarone RE, Travis L, Devesa SS. Lung cancer rates convergence in young men and women in the U.S.: an analysis by birth cohort and histologic type. Int J Cancer (In Press).

Collaborators

Other NCI Collaborators
Nancy Breen, Ph.D.; Dan Grauman, M.A.; Lynn Ries, M.S.; Malcolm Smith, M.D.; Maria Sgambati, M.D.; Joan Warren, Ph.D.

Other NIH Collaborators
Carrie P. Hunter, M.D., M.P.H., Office for Research on Women's Health
Maria Cantos, D.D.S., National Institute of Dental and Craniofacial Research

Other Scientific Collaborators
William Blot, Ph.D., International Epidemiology Institute, Rockville, MD
Yu-Tang Gao, M.D.; Robert Tarone, Ph.D.; Fan Jin, M.D., Shanghai Cancer Institute, Shanghai, China
Susanne Gnagy, Ph.D.; Eileen Ming, Ph.D.; Alice Whittemore, Ph.D., Stanford University School of Medicine, Stanford, CA
Frank Groves, M.D., Medical University of South Carolina, Charleston, SC
Maria Hewitt, Ph.D., National Academy of Sciences, Washington, D.C.
Ahmedin Jemal, D.V.M., Ph.D., American Cancer Society, Atlanta, GA
Martin Kulldorf, Ph.D., University of Connecticut Health Center, Farmington, CT
Lian-Di Li, M.D.; You-Lin Qiao, M.D., Cancer Institute, Chinese Academy of Medical Sciences, Beijing, China
Howard Strickler, M.D., Albert Einstein College of Medicine, Bronx, NY
Max Parkin, M.D., International Agency for Research on Cancer, Lyon, France
Gene Pennello, Ph.D., Food and Drug Administration, Rockville, MD
Pamela J. Mink, Ph.D., Exponent Health Group, Washington, DC
Susan Sturgeon, Ph.D., University of Massachusetts, Amherst, MA
William Travis, M.D., Armed Forces Institute of Pathology, Washington, D.C.
Wei-Cheng You, M.D., Beijing Institute for Cancer Research, Beijing, China
Wei Zheng, M.D., Vanderbilt University, Nashville, TN