Cervical Adenocarcinoma and Squamous Cell CarcinomaIncidence Trends among Tunisian Women

Introduction: Uterine cervix cancer is an important public health problem in Tunisia. In this study, we reporttrends in the incidence of adenocarcinoma and squamous cell carcinoma of the cervix uteri in the central regionof Tunisia during 1993-2006. Design: Data were obtained from the Cancer Registry of the Center of Tunisiawhich registers invasive cancer cases by active methods. Five-year age-specific rates, crude incidence rates (CR),world age-standardized rates (ASR), percent change (PC) and annual percent change (APC) were calculatedusing annual population data. Results: Among all women cancers, cervix uteri cancer accounted for 5.9% andranked the fourth during the study period with an ASR of 6.9 per 100,000. The ASRs decreased notably with anAPC of -6.7% over the whole period. However, incidence rates of adenocarcinomas have increased during thelast years (APC: +14.4%). Conclusion: The introduction of cytological screening programs has led to a markeddecrease of the incidence rates of cervix uteri cancer among Tunisian women. The data underline the fact thatthe population-based cancer registry is an indispensable tool for providing data for planning and evaluation ofprograms for cancer control.     

Cancer of Corpus Uteri in Tunisia: Epidemiological and Clinicopathological Features

Introduction: The aim of this study was to survey for the first time the burden and characteristics of corpusuteri cancers in Central Tunisia. Design: Characteristics of all cancer cases diagnosed during a 15-year periodwere analyzed based on the data of the Cancer Registry of the Center of Tunisia. Five-year age-specific rates,crude incidence rates, world age-standardized rates (ASR), and annual percent change (APC) were calculatedusing annual data on population size and its estimated age structure. Results: A total of 218 new cases of corpusuteri cancer were recorded. The ASR was 3.1 per 100,000 with a significant increase over time (APC: +7.1%;95% CI: 3.1%, 11.1%). The median age at diagnosis was 60 years and only 20.6% of patients were less than50 years old. The tumor size was higher than 2 cm in 83.5% of cases. Stage I was the most frequent (59.9%)followed by advanced stages (23.2%). Endometrial adenocarcinoma was the most frequent histological type(62.8%) with grade II accounting for 48.5% of cases. Conclusion: Corpus uteri cancer is an important femalecancer with increasing trend over time. These findings justify the need to plan and develop effective programsaiming at the control of the spread of cancer in Tunisia.     

上海市区女性生殖系统恶性肿瘤发病趋势分析

目的对1972～1999年上海市区常见的女性生殖系统恶性肿瘤的发病率进行统计,分析其发病趋势及变化原因,为防治措施的制定提供依据.方法根据上海市肿瘤发病登记处收集的1972～1999年的上海市区卵巢癌、宫颈癌、宫体癌和不明部位子宫癌的病例资料和相应年份的人口资料,分别计算各年龄组的年龄别发病率.并采用直接法计算世界人口标化发病率,对数线性回归法计算标化率的年变化率(Annual percentage change,APC),并对病例数进行加权计算.结果1972～1999年上海市肿瘤登记处共登记卵巢癌6106例、宫颈癌8063例,宫体癌3 933例和不明部位子宫癌1 312例.28年来,宫体癌和卵巢癌的标化发病率呈上升趋势,分别从1972～1974年的2.49/10万和4.77/10万上升至1996～1999年的4.75/10万和6.88/10万,年增长率分别为3.0%和2.0%.同期宫颈癌的标化发病率从26.66/10万快速下降至2.18/10万,年下降率达10.5%.不明部位子宫癌的标化发病率亦呈下降趋势(P＜0.01).宫体癌以55～64和65～74岁组发病率上升最快,年增长率分别为2.5%和3.3%.卵巢癌各年龄组的发病率均有上升趋势,年变化率都在1.0%以上.宫颈癌发病率下降最快的年龄组是45～54和55～64岁组,25～34和35～44岁组的发病率在近几年有升高趋势.结论上述肿瘤的发病率及年龄别发病率的变化趋势提示,上海女性生活方式和环境因素的改变可能是导致这种变化的重要原因.     

Record linkage to correct under‐ascertainment of cancers in HIV cohorts: The Sinikithemba HIV clinic linkage project

The surveillance of HIV‐related cancers in South Africa is hampered by the lack of systematic collection of cancer diagnoses in HIV cohorts and the absence of HIV status in cancer registries. To improve cancer ascertainment and estimate cancer incidence, we linked records of adults (aged ≥ 16 years) on antiretroviral treatment (ART) enrolled at Sinikithemba HIV clinic, McCord Hospital in KwaZulu‐Natal (KZN) with the cancer records of public laboratories in KZN province using probabilistic record linkage (PRL) methods. We calculated incidence rates for all cancers, Kaposi sarcoma (KS), cervix, non‐Hodgkin's lymphoma and non‐AIDS defining cancers (NADCs) before and after inclusion of linkage‐identified cancers with 95% confidence intervals (CIs). A total of 8,721 records of HIV‐positive patients were linked with 35,536 cancer records. Between 2004 and 2010, we identified 448 cancers, 82% (n = 367) were recorded in the cancer registry only, 10% (n = 43) in the HIV cohort only and 8% (n = 38) both in the HIV cohort and the cancer registry. The overall cancer incidence rate in patients starting ART increased from 134 (95% CI 91–212) to 877 (95% CI 744–1,041) per 100,000 person‐years after inclusion of linkage‐identified cancers. Incidence rates were highest for KS (432, 95% CI 341–555), followed by cervix (259, 95% CI 179–390) and NADCs (294, 95% CI 223–395) per 100,000 person‐years. Ascertainment of cancer in HIV cohorts is incomplete, PRL is both feasible and essential for cancer ascertainment.     

Risk of Second Primary Female Genital Malignancies in Women with Breast Cancer: a SEER Analysis

Breast cancer survivors are at an increased risk of second primary cancers, and the risk factors for the latter may have clinical significance. The aims of our study were to evaluate the incidences and risk factors of second primary female genital cancers (corpus uteri, cervix uteri plus ovary) in a large cohort of breast cancer survivors. Using the Surveillance, Epidemiology, and End Results (SEER) database, we examined the standardized incidence ratio (SIR) and risk factors for second primary female genital cancers observed between 2000 and 2014. Breast cancer survivors had increased SIRs for second corpus uteri cancers and second ovarian cancers and a decreased SIR for second cervical cancers (SIR 1.17, 1.12, and 0.64, respectively). Risk factors of second corpus uteri cancers were the age at first cancer diagnosis, race (black vs. white, aHR?=?1.142 95% CI 1.005–1.298), and progesterone receptor (PR) status (PR+ vs. PR?, aHR?=?1.131 95% CI 1.004–1.273). In addition, the risk of second ovarian cancer was positively associated with age while inversely associated with race (black vs. white, aHR?=?0.691 95% CI 0.555–0.859) and estrogen receptor (ER) status (ER+ vs. ER?, aHR?=?0.655 95% CI 0.544–0.788). Age, race, and hormone receptor status are risk factors of developing second female genital cancers among breast cancer survivors. Older age, black race, and a PR+ status in survivors are associated with a higher risk of second corpus uteri cancers. Additionally, older age and an ER? status should increase vigilance for potential second ovarian cancers.     

Angiosarcoma after radiotherapy: a cohort study of 332,163 Finnish cancer patients

We evaluated the risk of angiosarcoma after radiotherapy among all patients with cancers of breast, cervix uteri, corpus uteri, lung, ovary, prostate, or rectum, and lymphoma diagnosed in Finland during 1953-2003, identified from the Finnish Cancer Registry. Only angiosarcomas of the trunk were considered, this being the target of radiotherapy for the first cancer. In the follow-up of 1.8 million person-years at risk, 19 angiosarcomas developed, all after breast and gynaecological cancer. Excess of angiosarcomas over national incidence rates were observed after radiotherapy without chemotherapy (standardised incidence ratio (SIR) 6.0, 95% confidence interval (CI) 2.7-11), after both radiotherapy and chemotherapy (SIR 100, 95% CI 12-360), and after other treatments (SIR 3.6, 95% CI 1.6-7.1). In the regression analysis however, the adjusted rate ratio for radiotherapy was 1.0 (95% CI 0.23-4.4). Although an increased risk of angiosarcoma among cancer patients is evident, especially with breast and gynaecological cancer, the excess does not appear to be strongly related to radiotherapy.     

Incidence Trend for Non-Hodgkin Lymphoma in the North Tunisian Population, 1998-2009

Background: In 2008, non-Hodgkin lymphoma ranked tenth among other malignancies worldwide with an incidence of around 5 cases per 100,000 in both genders. The latest available rates in Tunisia are from 2006. Materials and Methods: This study aimed to provide an update about NHL incidence for 2009 and its trend between 1998 and 2009 as well as a projection until 2024, using data from the Salah Azaiz Institute hospital registry and the Noth Tunisia cancer registry. Results: In 2009, the NHL incidence in the north of Tunisia was 4.03 cases per 100,000, 4.97 for men and 3.10 for women. Diffuse large B-cell lymphoma (DLBCL) accounted for 63.2% of all NHL subtypes. Between 1998 and 2009, the overall trend showed no significant change. When we compared the trend between two periods (1998-2005 and 2005-2009), joinpoint regression showed a significant decrease of NHL incidence in the first period with an annual percentage change (APC) of -6.7% (95% CI:[-11.2%;-2%]), then the incidence significantly increased from 2005 to 2009 with an APC of 30.5% (95% CI: [16.1%; 46.6%]. The analyses of the different subtype trends showed a significant decrease in DLBCL incidence between 1998 and 2000 (APC:-21.5; 95% CI: [-31.4%;-10.2%]) then the incidence significantly increased between 2004 and 2007 (APC: 18.5; 95% CI: [3,6%;35.5%]). Joint point analysis of the age-period-cohort model projection showed a significant increase between 2002 and 2024 with an APC of 4.5% (%95 CI: [1.5%; 7.5%]). The estimated ASR for 2024 was 4.55/100 000 (95% CI: [3.37; 6.15]). Conclusions: This study revealed an overall steady trend in the incidence of NHL in northern Tunisia between 1998 and 2009. Projection showed an increase in the incidence in NHL in both genders which draw the attention to the national and worldwide burden of this malignancy.     

Population‐based breast (female) and cervix cancer rates in the Gambia: Evidence of ethnicity‐related variations

Since 1987, the Gambia National Cancer Registry has provided nationwide cancer registration for the Gambia. We used data from 1998 to 2006 to assess age‐standardized incidence rates (ASRs) of 2 common cancers in women, breast and cervix. With an ASR of 15.42 (95% CI [14.18–16.66]) for cervix and 5.86 (95% CI [5.12–6.59]) for breast per 10⁵ person‐years, these cancers ranked first and third, respectively, among Gambian women (the second most common being liver, ASR 14.90). Incidence of both cancers, breast and cervix, increased rapidly at young ages to reach a peak at ages 40–44 years. Significant differences were observed in relation to ethnicity. Using the Mandinka (42% of the population) as a reference, breast cancer incidence rates were 2.16‐fold higher (95% CI [1.33–3.52]) in Jola (10% of the population), specially at early‐onset ages (before 40 years). For cervix cancer, highest rates were observed in Fula (18% of the population; risk ratio (RR): 1.84 (95% CI [1.44–2.36])). In contrast, a significantly lower risk was observed in the Serrahuleh (9% of the population; RR: 0.54 (95% CI [0.31–0.96]). This study revealed a preponderance of early‐onset breast cancer among Gambian women similar to that seen in African women in more developed countries but also demonstrates large ethnic variations. It points to the need for further studies on cancer determinants to improve prevention, early detection and therapeutic management of these diseases in a low‐resource setting in West Africa.     

Annual cancer incidence rates for Hispanics in the United States: surveillance, epidemiology, and end results, 1992-1996

BACKGROUND: The expansion of the Surveillance, Epidemiology, and End Results (SEER) program and the determination of annual population estimates by county level for different racial/ethnic groups since 1990 allow the calculation of annual cancer incidence rates for Hispanics. METHODS: Incidence rates were calculated for 11 SEER areas representing 25% of the Hispanic population. Standard regression analyses of log-transformed rates were used to determine the trends of the rates. RESULTS: An important measure of the cancer burden among Hispanics is the rank order of their cancers. For Hispanic males, the five major cancers (in declining order) are prostate, lung and bronchus, colon/rectum, non-Hodgkin lymphoma, and stomach cancers. For Hispanic females, the top five cancers are breast, colon/rectum, lung and bronchus, cervix, and endometrial cancers. Another measure of cancer burden is their rates relative to white non-Hispanics. Hispanic males have rates greater than white non-Hispanic males for stomach (1.6 times greater) and liver and IBD cancers (2.2), whereas Hispanic females have greater rates for cervix (2.2 times greater), liver and IBD (2.0), stomach (2.1), and gallbladder cancers (3.3). Other measures of cancer burden include the trends in Hispanic rates. Hispanic males have significant declining trends for all sites, prostate cancer, and urinary bladder cancer, and an increasing trend for liver and IBD cancers. Hispanic females have significant declining trends for cervix and urinary bladder cancers. CONCLUSIONS: The SEER cancer incidence rates and trends provide a general overview of the cancer burden among Hispanics residing in the SEER sites. This type of information is critical for determining interventions to reduce the cancer burden among Hispanics in the United States.     

Salted Meat Consumption and the Risk of Cancer: a Multisite Case-Control Study in Uruguay

Background: Previous studies have suggested that a high intake of salted meat may increase the risk ofesophageal and stomach cancers, but the results are not conclusive. Methods: We used polytomous logisticregression to estimate odds ratios (ORs) and 95 % confidence intervals (CIs) for the association between saltedmeat intake and the risk of several cancers in a case-control study from Uruguay that was conducted between1988 and 2005. The study included 13,050 participants (9,252 cases and 3,798 controls) which were drawn fromthe four major public health hospitals in Montevideo, Uruguay. Results: Salted meat intake was significantlyassociated with increased odds of cancers of the oesophagus (OR=2.28, 95% CI: 1.75-2.97), colon and rectum(OR=1.53, 95% CI: 1.16-2.03), lung (OR=1.57, 95% CI: 1.26-1.97), cervix uteri (OR=1.76, 95% CI: 1.05-2.25),prostate (OR=1.60, 95% CI: 1.18-2.17), urinary bladder (OR=2.23, 95% CI: 1.63-3.04), kidney (OR=1.62, 95%CI: 1.03-2.54) and non-Hodgkin’s lymphoma (OR=1.81, 95% CI: 1.12-2.95). Conclusion: Our results confirmprevious reports of an elevated risk of oesophageal cancer with higher intake of salted meat, but also suggestthat salted meat intake may increase the risk of several other cancers.     

Incidence of bone and soft tissue sarcoma after radiotherapy: a cohort study of 295,712 Finnish cancer patients

Radiotherapy is commonly used for treatment of malignant disease. As a consequence of radiotherapy, an increased risk of developing a second malignant neoplasm has been shown. However, little is known about the effects of radiation on developing sarcoma. The aim of this study was to examine the risk of developing a bone or soft tissue sarcoma after radiotherapy for a first primary cancer. The study population included all the patients with primary cancers of breast, cervix uteri, corpus uteri, lung, ovary, prostate, rectum and lymphoma diagnosed during 1953-2000 and identified from the Finnish Cancer Registry. Patients were followed up for subsequent sarcomas. The follow-up yielded 1.5 million person-years at risk and 147 sarcomas. Compared to the national incidence rates, after 10 years of follow-up sarcoma risk was increased among patients who had received neither radiotherapy nor chemotherapy (standardised incidence ratio (SIR) 2.0, 95% CI 1.3-3.0), radiotherapy without chemotherapy (SIR 3.2, 95% CI 2.3-4.3), chemotherapy without radiotherapy (SIR 4.9, 95% CI 1.0-14.4), as well as combined radiotherapy and chemotherapy (SIR 3.4, 95% CI 0.4-12.5). For radiotherapy in ages below 55 the SIR was 4.2 (95% CI 2.9-5.8). In the adjusted regression analysis the rate ratio was 1.5 (95% CI 0.9-2.6) for the radiotherapy group. In conclusion, radiotherapy appears to be associated with an increased risk of developing sarcoma especially among younger patients. Further investigation is needed to clarify the dose-response of the preceding ionizing radiation.     

Incidence and Epidemiological Features of Cancers of the Genitourinary Tract in Izmir between 1993-2002

Background: There is a relative lack of epidemiological data on cancer in Turkey, which is a large countrywith a population of 71 million. The first population-based registry in the country is Izmir Cancer Registry(ICR) which was not established until 1992. The present study, aiming to address the gap in this kind ofepidemiological data for this part of the world, reports the incidence of cancers of the genitourinary tract inIzmir province over a ten year period. Methods: Cancer incidence data for 1993-2002 was obtained from theICR database, which employs a population based registry system, and actively collects data by followinginternational registration rules. Annual crude and age standardized incidence rates were calculated for thewhole period and also for ear lier and later periods. Results: The age-standardized incidence rate (worldpopulation) for all sites was 198.3 per 100,000 for males and 116.4 per 100,000 for females. The most commonprimary sites for men were lung (35.6%), bladder (7.8%), colon and rectum (6.1%), larynx (5.7%) and prostate(5.4%). For women, the principal cancers were breast (28.7%), colon and rectum (7.2%), corpus uteri (5.3%),cervix uteri (4.8%) and lung (4.7%). Urogenital cancers accounted for 11.2% of all new cancer cases for the1993-2002 period in Izmir. Of the total, 89.6% were observed in males and 10.4% were diagnosed in females.Carcinoma of the bladder was the most common among the urogenital cancers in Izmir province (Agestandardized incidence rate, world standard population17.1 per 100 000). Conclusions: Bladder cancer incidenceswere quite high, especially for men, and appear to be increasing. Prostate cancer has lower incidence rates ascompared to western countries, but the trend is for rise. Although there might be an underestimate of incidences,owing to an inability to use data from death certificates, the overall profile is an accurate reflection of incidencein this region of Turkey and provides adequate information for planning strategies for cancer control.     

Cancer incidence trends in Urban Shanghai, 1972-1989

Incidence data pertaining to more than 250,000 cancer cases diagnosed during the years 1972-1989 among residents of urban Shanghai, China, were analyzed to determine the relative importance of the various malignancies and to discover changes over time. In the most recent 3-year period, lung cancer was the most frequent cancer among men (57.0 per 100,000 person-years, age-adjusted world standard), followed by cancers of the stomach (50. 1), liver (29.6), esophagus (13.3), colon (11.2) and rectum (9.4). Among women, breast cancer leads (25.1), followed by cancers of the stomach (23.2), lung (18.8), liver (10.9), colon (10.2) and rectum (7.3). The most impressive increases in incidence rates from 1972-74 to 1987-89 were observed for cancers of the gallbladder (119% and 101% among men and women, respectively), colon (85% and 78%), and brain and other nervous system (71% and 60%). In addition, increases of 20-50% occurred for cancers of the pancreas, male lung, female breast, corpus uteri, kidney, and for non-Hodgkin's lymphoma. Rates declined notably for cancers of the esophagus (-54% and -53%), cervix uteri (-86%), and to a lesser extent (10-20%) cancers of the male stomach and liver. These observed trends can be explained only partly by improvements in cancer diagnosis and completeness of the cancer registry, and most likely reflect changes in the prevalence of risk factors in this population.     

Trends in the incidence of cancer in Qidong, China, 1978-2002

A population-based cancer registry was established in Qidong, Jiangsu Province, China, in 1972, and the trends in incidence rates of the major cancer sites have been analyzed for a 25-year period, 1978-2002. Five-year age-specific rates, crude incidence rates, world age-standardized rates (ASR), percent change (PC) and annual percent change (APC) were calculated using annual data on population size, and estimates of its age structure. The indices of histological verification of diagnosis, death certificate only and proportion of mortality to incidence were employed for assessing the registration quality. A total of 51,933 incident cases of cancer were registered in Qidong from years 1978 to 2002, with a male-to-female sex ratio of 1.9:1. Crude incidence increased markedly over the 25-year period (PC and APC of +55.6% and +2.1%, respectively), but ASR showed a slight decrease (-0.4% in males, and -0.3% in females), indicating that the major part of this is due to population ageing. The leading cancer sites in rank were liver (average ASR = 50.8 per 100,000), stomach (26.7), lung (22.7), colon-rectum (8.9), oesophagus (7.4) and breast (5.4). Cancers of liver, lung, colon-rectum and female breast all showed increases in incidence during the study period, with APCs (ASR) of +0.1%, +1.7% and +1.4% for males, and +0.2%, +0.9%, +1.9% and +1.1% for females, while the cancers of stomach (APC: -3.2% in male, and --2.4% in female) and cervix (APC: -4.7%) showed notable declines. Examination of age-specific rates showed declining trends in the younger generations for liver cancer, but increases for cervix cancer. The results underline the increasing importance of cancer as a cause of mortality and morbidity in a population that is ageing and undergoing profound changes in socioeconomic development and lifestyle. The cancers of high lethality that have been common in the Chinese population (liver, stomach, oesophagus) are showing some evidence of decline, at least in younger generations, but they remain major problems. At the same time, the cancers associated with economically "developed" societies -- lung, colon-rectum and female breast -- are showing increases. The population-based cancer registry is an indispensable tool for providing data for planning and evaluation of programmes for cancer control in all societies.     

Cancer survival in Seoul, Republic of Korea, 1993-1997

The Seoul cancer registry was established in 1991. Cancer is a notifiable disease, and registration of cases is done by passive and active methods. The registry contributed survival data for 56 cancer sites or types registered during 1993-1997. Follow-up information has been gleaned predominantly by passive methods with median follow-up ranging between 5-82 months for various cancers. The proportion with histologically verified diagnosis for different cancers ranged between 23-99%; death certificates only (DCOs) comprised 0-67%; 33-100% of total registered cases were included for survival analysis. The top-ranking cancers on 5-year age-standardized relative survival rates were testis and placenta (95%), thyroid (93%), non-melanoma skin (93%), corpus uteri (79%), renal pelvis (77%), cervix (76%), Hodgkin lymphoma (75%), breast (74%) and prostate (74%). Five-year relative survival by age group showed a decreasing trend with increasing age groups for cancers of the small intestine, colon, gall bladder, cervix, corpus uteri, ovary, kidney, urinary bladder and thyroid, or was fluctuating for other cancers.     

Digoxin use and the risk of cancers of the corpus uteri, ovary and cervix

Digoxin is a phyto-estrogen capable of inducing hormonal effects. Use has been associated with increased risk of breast cancer, an estrogen-sensitive malignancy. The incidence of corpus uteri (uterus) cancer is also strongly increased with exposure to estrogens. Therefore, we evaluated whether digoxin use might also increase its incidence. In all women in Denmark, we identified digoxin users from 1995 through 2008 using a nationwide pharmacy registry system. Cancer occurrence was obtained from Danish Cancer Registry. Relative risk was determined using incidence risk ratios (RR) and 95% confidence intervals (CIs) relative to non-users after adjustment for age- and calendar-time. For ovarian and cervical cancers, RRs in users and non-users were similarly evaluated, these cancers representing gynecological cancers with weak or no associations to estrogen exposure. Of 2.1 million women, 104,648 (4.9%) had digoxin exposure and 137,493 6.5% had exposure to angina drugs but not digoxin during the study period. For uterus cancer, the RR was increased in current digoxin users (1.48, 95% CI: 1.32-1.65; N = 350). Incidence was marginally increased in former users. For ovary and cervix cancers, RRs in current digoxin users were 1.06 (95% CI: 0.92-1.22; N = 207) and 1.00 (95% CI: 0.79-1.25; N = 81), respectively. We examined risks in women using angina drugs but not digoxin to determine whether being under cardiac care affected risk. Among women using angina drugs only, RRs for uterus, ovary or cervix cancers were not statistically significant. We conclude that women currently using digoxin, a phyto-estrogen, have an increased risk of developing uterus cancers.     

Trends in childhood cancer incidence in the U.S. (1992-2004)

BACKGROUND: The etiology of most pediatric neoplasms remains elusive. Examination of population-based incidence data provides insight regarding etiology among various demographic groups and may result in new hypotheses. The objective of the current study was to present updated information regarding childhood cancer incidence and trends in the U.S. overall and among demographic subgroups, including Asian/Pacific Islanders and Hispanics, for whom to the authors' knowledge trends have not been previously examined. METHODS: Data obtained by 13 registries of the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program were evaluated to assess incidence and trends of common primary cancers diagnosed between 1992 and 2004 among children aged birth to 19 years. Frequencies, age-adjusted incidence rates, and joinpoint regression results, including annual percent change (APC) in incidence rates (and 95% confidence intervals [95% CI]), were calculated. RESULTS: Between 1992 and 2004, a modest, nonsignificant increase in the average annual incidence rate (APC, 0.4%; 95% CI, -0.1%-0.8%) was observed for all pediatric cancer diagnoses combined. There was a suggestion of an increase in leukemia (APC, 0.7%; 95% CI, -0.1%-1.5%), and acute lymphoblastic leukemia in particular (APC, 0.8%; 95% CI, -0.4%-1.9%), whereas rates for central nervous system tumors overall were stable (APC, -0.1%; 95% CI, -1.1%-1.0%); 2 joinpoints were observed for astrocytoma. Rate increases were noted for hepatoblastoma (APC, 4.3%; 95% CI, 0.2%-8.7%) and melanoma (APC, 2.8%; 95% CI, 0.5%-5.1%). Differences by demographic group (sex, age, and race/ethnicity) are also described. CONCLUSIONS: The observed trends reinforce an ongoing need for population-based surveillance and further etiologic studies.     

Second primary cancer after treatment for cervical cancer. Late effects after radiotherapy

Using data from the population-based Danish Cancer Registry, the relative risk (RR) of second primary cancer was assessed among 24,970 women with invasive cervical cancer (1943-1982) and 19,470 women with carcinoma in situ of the cervix. The analysis was stratified according to treatment with (+) and without (-) radiation. For all second primaries combined, a RR+ = 1.1 (95% confidence interval (CI) = 1.06-1.18) and a RR- = 1.3 (95% CI = 1.13-1.40) was observed after invasive cervical cancers and a RR+ = 3.5 (95% CI = 1.4-7.2) and RR- = 1.1 (95% CI = 0.7-1.6) following in situ cancer. The small overall excess of second primary cancer is accounted for by an increase of some cancers such as lung, bladder, and a concurrent decrease in others such as breast. Although not statistically different from nonirradiated, the RR increased with time since treatment among irradiated invasive cervical cancer patients in organs close to and at intermediate distance from the cervix, reaching a maximum after 30 or more years of follow-up (RR = 1.9; 95% CI = 1.4-2.5). Altogether, for these sites an excess of 64 cases per 10,000 women per year were attributable to radiation among survivors of 30+ years. The highest risks among long-term survivors were observed for the following: other genital organs (RR = 5.8; 95% CI = 1.8-13.0) bladder (RR = 5.5; 95% CI = 2.8-9.5), connective tissue (RR = 3.3; 95% CI = 0.4-12.0), stomach (RR = 2.5; 95% CI = 1.1-4.7) and rectum (RR = 2.4; 95% CI = 1.1-4.6). A significant deficit of risk for breast cancer (RR = 0.7, 95% CI = 0.6-0.8) was observed for 10+ years, may be attributable to the effect of ovarian ablation by radiotherapy. It is speculated that the same effect also may explain the observed deficits of brain tumors (RR = 0.6; 95% CI = 0.4-1.0) and skin melanomas (RR = 0.6; 95% CI = 0.3-1.0). It is concluded that cancers attributable to radiation, apart from acute nonlymphocytic leukemias, tend to appear late (10 or more years after radiotherapy), and that the risk remains elevated for more than 30 years.     

Uroepithelial and kidney carcinoma in Lynch syndrome

Increased risk for urological tumors has been observed in mutation carriers with Lynch syndrome (LS). In this study, we evaluated the clinical features of uroepithelial (bladder and ureter) and kidney cancers in 974 Finnish mutation carriers. Altogether 30 patients had a total of 34 urological tumors: 12 ureter, 12 bladder, and 10 kidney cancers. Urological tumor was the only tumor in 9 (30?%) patients, and metachronous other tumor occurred in 21 (70?%). The occurrence of uroepithelial cancers was significantly higher in MSH2 mutation carriers (6?%; 95?% CI, 2.7–11.0) than in MLH1 carriers (2?%; 95?% CI, 1.1–3.2) and MSH6 mutation carriers (0?%) (p?=?0.014). The mean ages of patients at the time of diagnosis were: bladder cancer, 57?years; ureter cancer, 58?years; and kidney cancer, 64?years. Overall 5-year survival rates were 70?% (95?% CI, 0.32–0.89) in bladder cancer, 81?% (95?% CI, 0.45–0.95) in ureter cancer, and 75?% (95?% CI, 0.31–0.93) in kidney cancer. Cancer-specific 5-year survival rates were 70?% (95?% CI, 0.32–0.89) in bladder cancer, 91?% (95?% CI, 0.51–0.98) in ureter cancer, and 100?% in kidney cancer. In conclusion, early age of onset was observed in patients with uroepithelial tumors, but not in patients with kidney cancer. The frequency of uroepithelial tumors was significantly higher in MSH2 mutation carriers than in MLH1 carriers. Further studies with larger numbers of patients, however, are needed to evaluate the potential benefit of surveillance of urological tumors in LS.     

Trends in Distant-Stage Breast, Colorectal, and Prostate Cancer Incidence Rates from 1992 to 2004: Potential Influences of Screening and Hormonal Factors

Differential utilization of cancer screening between populations could lead to changes in cancer disparities. Evaluating incidence rates trends is one means of monitoring these disparities. Using Surveillance, Epidemiology, and End Results data, we compared annual percent changes (APC) in age-adjusted incidence rates of distant-stage breast, colorectal, and prostate cancer between non-Hispanic whites (NHW) and African Americans (AA). From 1992 to 2004, distant-stage breast cancer incidence rates remained essentially constant among both AA and NHW women, though rates were 30–90% higher among AA women throughout. NHW men and women experienced declines in distant-stage colorectal cancer incidence rates [APC?=??1.6, 95% confidence interval (CI) ?2.3, ?0.9], but AA men and women did not. Distant-stage prostate cancer incidence rates declined for both AA (APC?=??5.8, 95% CI ?7.9, ?3.8) and NHW (APC?=??5.1, 95% CI ?6.7, -3.4). Despite now having nearly equal mammography screening rates, the persistent breast cancer disparity observed among AAs compared to NHWs may be due to the greater susceptibility of AAs to more aggressive tumors, particularly hormone-receptor-negative disease, which is more difficult to detect by mammography. For colorectal cancer, greater utilization of screening tests among NHWs vs. AAs is likely a primary contributor to the observed widening disparity. Wider recognition of AA race as a prostate cancer risk factor may contribute to the narrowing disparity in the incidence of disease.