Degree Name

DrPH (Doctor of Public Health)


Public Health

Date of Award


Committee Chair or Co-Chairs

James L. Anderson

Committee Members

Martin Whiteside, Joel J. Hillhouse, Shimin Zheng


Adolescents and Young Adults (AYAs) ages 15-39 years with cancer have received little attention in the medical and health fields, resulting in a lack of progress for this age group. Little is known about the unique biologic, epidemiologic, and psychosocial issues that play an integral role in the AYA cancer journey. The purposes of this study were to use the Tennessee Cancer Registry for all new cancer cases from 2004-2008 to determine 1) the main types of cancer that affect AYAs in TN, 2) the predictors of late-stage diagnosis of melanoma, and 3) the factors that predict a total thyroidectomy for cancer treatment. A total of 8,097 cancer cases were diagnosed in AYAs in Tennessee from 2004-2008. The five main cancer types were breast cancers, melanomas, thyroid cancers, lymphomas, and testicular cancers and accounted for over 50% (N=4,269) of cancers in AYAs in Tennessee during the study period. Females were significantly more likely to be diagnosed with melanomas (age adjusted incidence rate (AIR) 14.01, 95% CI 12.96-15.06) and thyroid cancers (AIR 13.39, CI 12.37-14.42) compared to males (AIR 8.08, CI 7.28-8.88 and AIR 3.50, CI 2.98-4.03, respectively). All cancer types increased with age. Individuals with government insurance (OR 8.41, CI 3.04-23.27) and those 15-19 years of age (OR 6.30, CI 1.74-22.86) had the highest risk of late-stage melanoma. Significant predictors of a using total thyroidectomy for thyroid cancer treatment included regional/distant stage cancer at diagnosis (OR 2.80, CI 1.34-5.85) compared to localized stage, papillary carcinoma (OR 2.64, CI 1.02-6.83) and papillary adenocarcinoma (OR 3.56, CI1.37-9.19) histology types compared to follicular adenocarcinoma, and residence in non-Appalachian Tennessee (OR 2.07, CI 1.26-3.42) compared to Appalachian TN. An increased awareness of cancer types that affect AYAs in Tennessee will provide a basis for developing public health campaigns for cancer prevention and control in this population. This research serves as a first step in using state-based cancer registries to identify the unique characteristics of cancer in AYAs and will set the stage for future state-based research in this underserved population.

Document Type

Dissertation - unrestricted


Copyright by the authors.