Reprint of: Cancer incidence and mortality patterns in South Eastern Europe in the last decade: Gaps persist compared with the rest of Europe

IntroductionCancer registration coverage and cancer control programmes in South Eastern (SE) Europe, embracing about six new EU member states, remain thin, despite a relatively high incidence and mortality burden from avoidable cancers, particularly in males. We assembled the most recent cancer registry data to estimate the burden of the 17 most common cancers in the region, from Slovenia to Cyprus and Malta.MethodsData were made available for analysis from Bulgaria, Croatia, Cyprus, Malta, Romania (Cluj County), Serbia, Slovenia and Turkey (Antalya and Izmir provinces). We analysed incidence and mortality of the 17 most common cancers (counts and age-standardised rates, for the most recent year available and for the period 1999–2008). We used Joinpoint regression to quantify recent trends.FindingsFor much of SE Europe, there were no marked declines in overall cancer mortality rates during 1999–2008. In men, lung cancer incidence and mortality rates were high compared to other European countries (age-standardised rates (ASRW) of incidence being 50–60/100,000 in most of the countries), and are still increasing in Bulgaria, Serbia and Turkey. Prostate cancer incidence rapidly increased throughout the region by 3–12% annually, largely without any clear declines in mortality. Colorectal cancer incidence increased throughout the region, as did mortality especially in Croatia, Serbia and Bulgaria (average annual percentage change (AAPC) 1.5–2%). In women, breast cancer mortality significantly declined in Slovenia, Croatia and Malta (AAPC −2%, −1% and −5%, respectively), but not elsewhere. Cervical cancer incidence rates remained very high in Romania, Serbia and Bulgaria (ASRW >20/100,000).InterpretationOur data confirmed the North West to South East Europe gradient of increasing incidence and mortality rates of tobacco-related cancers, as well as increasing mortality rates of screen-detectable cancers. Lack of decline in overall cancer mortality also indicates suboptimal levels of cancer control in the region.     

Disparities in melanoma incidence and mortality in South-Eastern Europe: Increasing incidence and divergent mortality patterns. Is progress around the corner?

IntroductionMost countries in South-Eastern Europe (SEE) have lower incidence, but higher mortality rates of malignant melanoma (MM) of the skin compared to North-Western Europe (NWE). We explored trends in MM incidence and mortality in SEE countries by sex and age and compared them with the trends in NWE.MethodsWe obtained data on incident cases and deaths from MM (ICD-10 code C43) from 11 population-based cancer registries in Bosnia and Herzegovina, Bulgaria, Croatia, Cyprus, Czech Republic, Malta, Romania, Serbia, Slovakia, Slovenia and Turkey. We calculated age-specific rates for 25–49 (‘young’), 50–69 (‘middle aged’) and 70+ years (‘older’) and estimated the average annual percent of change in incidence and mortality trends 2000–2010 according to age group and sex, using joinpoint regression analysis.FindingsThe incidence rates of MM across the region were uniformly increasing. Significant increases in mortality rates were observed in middle aged men in Serbia and Bulgaria, middle aged women in Slovenia, older men in the Czech Republic, Serbia and Turkey, and older women in Slovenia and Serbia.InterpretationWhile MM incidence rates were still increasing across SEE, mortality trends diverged and were less favourable than in NWE. Empowering cancer registration and improving the quality of incidence and mortality data will be essential for monitoring progress in MM control. In the context of prevention of melanoma, disparities in early detection appear to be widening the gap between SEE and NWE, while the provision of care to patients with advanced disease is likely to prove a challenge for regional healthcare budgets.     

Childhood central nervous system tumours: Incidence and time trends in 13 Southern and Eastern European cancer registries

AimFollowing completion of the first 5-year nationwide childhood (0–14 years) registration in Greece, central nervous system (CNS) tumour incidence rates are compared with those of 12 registries operating in 10 Southern–Eastern European countries.MethodsAll CNS tumours, as defined by the International Classification of Childhood Cancer (ICCC-3) and registered in any period between 1983 and 2014 were collected from the collaborating cancer registries. Data were evaluated using standard International Agency for Research on Cancer (IARC) criteria. Crude and age-adjusted incidence rates (AIR) by age/gender/diagnostic subgroup were calculated, whereas time trends were assessed through Poisson and Joinpoint regression models.Results6062 CNS tumours were retrieved with non-malignant CNS tumours recorded in eight registries; therefore, the analyses were performed on 5191 malignant tumours. Proportion of death certificate only cases was low and morphologic verification overall high; yet five registries presented >10% unspecified neoplasms. The male/female ratio was 1.3 and incidence decreased gradually with age, apart from Turkey and Ukraine. Overall AIR for malignant tumours was 23/10⁶ children, with the highest rates noted in Croatia and Serbia. A statistically significant AIR increase was noted in Bulgaria, whereas significant decreases were noted in Belarus, Croatia, Cyprus and Serbia. Although astrocytomas were overall the most common subgroup (30%) followed by embryonal tumours (26%), the latter was the predominant subgroup in six registries.ConclusionChildhood cancer registration is expanding in Southern–Eastern Europe. The heterogeneity in registration practices and incidence patterns of CNS tumours necessitates further investigation aiming to provide clues in aetiology and direct investments into surveillance and early tumour detection.     

Incidence and mortality of second sarcomas – A population-based study

BackgroundStudies on second sarcoma in unselected populations of cancer survivors have not previously been published.MethodsSecond sarcoma was defined as a sarcoma following a previous invasive cancer. Patients with this malignancy were retrieved from the Cancer Registry in Norway for the period 1960–2007 among a total of 728 874 cancer patients including 11 612 with a sarcoma. Changes in incidence and average annual percent change (AAPC) were studied with join-point analyses. Overall and sarcoma-related mortalities were assessed using the Kaplan–Meier and competing risk methods, respectively.ResultsA total of 900 second sarcomas were identified comprising 7.5% of all sarcomas. The AAPC of second sarcoma incidence was 6.2 (95% CI = 5.7–6.7) as compared to 2.5 (95% CI = 2.1–2.8) for all sarcomas and 2.5 (95% CI = 2.4–2.6) for cancer in general. The annual incidence of second sarcomas doubled during the last decade of the study period. The distribution of histological subtypes was significantly different between second and sporadic sarcomas. The overall mortality was significantly higher and sarcoma-related mortality was significantly lower for patients with a second sarcoma compared to sporadic sarcoma.ConclusionsThere is an increasing incidence of second sarcomas among cancer survivors, and one may speculate a relation to the intensified use of cytotoxic treatment of the preceding malignancy. Sarcoma–related mortality after second sarcomas is significantly below that of sporadic sarcoma.     

Does solar exposure, as indicated by the non-melanoma skin cancers, protect from solid cancers: vitamin D as a possible explanation

BackgroundSkin cancers are known to be associated with sun exposure, whereas sunlight through the production of vitamin D may protect against some cancers. The aim of this study was to assess whether patients with skin cancer have an altered risk of developing other cancers.MethodsThe study cohort consisted of 416,134 cases of skin cancer and 3,776,501 cases of non-skin cancer as a first cancer extracted from 13 cancer registries. 10,886 melanoma and 35,620 non-melanoma skin cancer cases had second cancers. The observed numbers (O) of 46 types of second primary cancer after skin melanoma, basal cell carcinoma or non-basal cell carcinoma, and of skin cancers following non-skin cancers were compared to the expected numbers (E) derived from the age, sex and calendar period specific cancer incidence rates in each of the cancer registries (O/E = SIR, standardised incidence ratios). Rates from cancer registries classified to sunny countries (Australia, Singapore and Spain) and less sunny countries (Canada, Denmark, Finland, Iceland, Norway, Scotland, Slovenia and Sweden) were compared to each other.ResultsSIR of all second solid primary cancers (except skin and lip) after skin melanoma were significantly lower for the sunny countries (SIR(S) = 1.03; 95% CI 0.99–1.08) than in the less sunny countries (SIR(L) = 1.14; 95%CI 1.11–1.17). The difference was more obvious after non-melanoma skin cancers: after basal cell carcinoma SIR(S)/SIR(L) = 0.65 (95%CI = 0.58–0.72); after non-basal cell carcinoma SIR(S)/SIR(L) = 0.58 (95%CI = 0.50–0.67). In sunny countries, the risk of second primary cancer after non-melanoma skin cancers was lower for most of the cancers except for lip, mouth and non-Hodgkin lymphoma.ConclusionsVitamin D production in the skin seems to decrease the risk of several solid cancers (especially stomach, colorectal, liver and gallbladder, pancreas, lung, female breast, prostate, bladder and kidney cancers). The apparently protective effect of sun exposure against second primary cancer is more pronounced after non-melanoma skin cancers than melanoma, which is consistent with earlier reports that non-melanoma skin cancers reflect cumulative sun exposure, whereas melanoma is more related to sunburn.     

Cancer trends among the extreme elderly in the era of cancer screening

BackgroundThe extreme elderly (EE; > 84 years) are among the fastest growing segments of the population and bear a substantial cancer burden. We examined cancer incidence and cancer specific mortality changes among the EE during the implementation of cancer screening from the 1980s to 2000s.MethodsWe examined incidence and mortality rates for breast, colon, prostate, and lung cancer by age group between 1973 and 2009 in the SEER database. We compared incidence/mortality between EE and middle aged (MA; age 50–69) patients.ResultsProstate cancer incidence and mortality rose and then, in the early 1990s, declined (− 3.61%/year and − 2.91%/year, respectively) among EE. Prostate cancer incidence rose steadily throughout the study period for MA. Breast cancer incidence rose and then declined for both MA and EE, with the decline starting in 1990 for EE (− 1.34%/year), and 1998 for MA (− 1.24%/year). Both age groups experienced an increase and then decrease in colon cancer incidence. The decrease in colon cancer mortality over the last decade was profound for all patients (− 2.88%/year MA, and − 3.29%/year EE). Lung cancer incidence (+ 2.35%/year to 2005) and mortality (+ 1.25%/year from 1995) increased for EE. Lung cancer incidence and mortality increased and then decreased (− 2.54%/year for mortality from 1990) for MA.ConclusionRecent trends in incidence and mortality for screened cancers (breast, colon, prostate) show substantial gains for the extreme elderly, likely due in part to the effect of screening. Incidence and mortality from lung cancer, with no recommended screening during the study period, have continued to worsen for the extreme elderly, despite improvements in younger patient populations.     

Trends of cutaneous squamous cell carcinoma in the Netherlands: increased incidence rates, but stable relative survival and mortality 1989-2008

BackgroundIncidence rates of cutaneous squamous cell carcinoma (SCC) are increasing in many countries, though detailed information is scarce.ObjectivesTo describe detailed trends in incidence rates, relative survival and estimate mortality rates of SCC in the Netherlands.MethodsInformation on newly diagnosed SCC patients between 1989 and 2008 was obtained from the Netherlands Cancer Registry (NCR). Information of non-melanoma skin cancer (NMSC) mortality was obtained from Statistics Netherlands. European Standardised Rates (ESR) and Estimated Annual Percentage Change (EAPC) were calculated. Incidence rates were fitted to two different models and predicted by the best fitted model. Cohort-based and multivariate survival analyses were performed to assess changes over time.ResultsThe ESR increased from 22.2 to 35.4 per 100,000 inhabitants for males and from 7.8 to 20.5 for females. The EAPC was 6.9% (95% confidence interval: 5.8–8.7) for males and 9.2% (95% CI: 7.5–11.0) for females. Incidence rates increased for all body sites, except for the lips, where a decreasing trend for males was observed. The predicted ESR in 2020 is 46.9 per 100,000 inhabitants for males and 28.7 for females. The 5-year relative survival rate was 92.0% (95% CI: 91.3–92.8) for males and 94.9% (95% CI: 94.0–95.7) for females and remained stable over time. Overall relative survival was better for females, but females with advanced disease had a 30.4 relative excess risk of dying compared to those in stage I. This difference was 9.9 for men. The estimated mortality rate decreased with –1.9% (95% CI: –3.1% to –0.7%) annually.ConclusionsIncidence rates of SCC increased rapidly. Relative survival was high, as most SCCs were diagnosed in stage I. Nevertheless, the number of newly diagnosed patients may exceed 11,000 by 2020, emphasising the need to improve methods to prevent skin cancer.     

Trends in corpus uteri cancer mortality in member states of the European Union

ObjectivesThe burden of corpus uteri cancer varies in the European Union (EU). We analysed trends in corpus uteri cancer mortality in 26 EU member states from 1970 onward.MethodsPopulation numbers and number of uterine cancer deaths were extracted from the World Health Organisation mortality database. Corpus uteri cancer mortality rates were corrected for certification problems using different reallocation rules for deaths registered as uterine cancer not otherwise specified, or using mixed disease codes. Join point regression was used to study the annual percentage change of age-standardised corpus uteri cancer mortality rates. Changes in corpus uteri cancer mortality rates by calendar period and standardised cohort mortality ratios were also estimated.ResultsIn 2008, 12,903 women died from corpus uteri cancer in the EU. Corrected age-standardised corpus uteri cancer mortality rates have decreased significantly over the past decades in most member states, with exception of Malta and Bulgaria, where rates increased; Greece, where rates remained low but stable; and Sweden, where rates have been stable since 1970. Original member states showed a steeper decrease than newer member states. The standardised cohort mortality ratios indicated that corpus uteri cancer mortality does not decrease further, nor does it increase, among women born after 1940, although these birth cohorts may still be too young for corpus uteri cancer incidence to be fully evaluated.ConclusionOur corrected corpus uteri cancer mortality rates showed a decrease in most EU member states among women born before 1940.     

Trends in cancer mortality in the elderly in Japan, 1970–2007

ObjectiveThe primary objective of this study is to describe cancer mortality rates and trends among Japanese elderly aged 65–84 years for the period 1970–2007.Materials and methodsAge-standardized mortality rates were calculated by the direct method using age-specific mortality rates at 5-year age intervals and weights based on the age distribution of the standard world population. The joinpoint regression model was used to describe changes in trends.ResultsFor all cancers combined, the mortality rate at age 65–84 years during 2000–2007 was 1145.13 (per 100 000 population) for men and 461.93 (per 100 000) for women. Mortality rates have declined in the past 10 years in both sexes. These favorable trends were driven largely by decreases in mortality for three leading cancers in the elderly men [lung, stomach and colorectal cancer (CRC)] and for two of the three most common cancers in the elderly women (stomach and CRC), combined with a leveling off of death rate from lung cancer in women.ConclusionThe population-based data in the current study underscore the importance of cancer research and prevention for the older segment in Japan to reduce the additional cancer burden among the growing number of elderly persons.     

Morbidity and mortality in relation to smoking among women and men of Chinese ethnicity: the Singapore Chinese Health Study

ObjectivesWe examined the association among cigarette smoking, smoking cessation and a broad range of cancer incidence and all cause and cause-specific mortality in a population-based cohort of adults of Chinese ethnicity in Singapore.MethodsSubjects were 61,320 participants of the Singapore Chinese Health Study (44.5% men, aged 45–74 years, recruitment from 1993–1998) who were free of cancer at the baseline examination. Main outcomes-of-interest included cancer incidence, all cause and cause-specific mortality as of December 31, 2005.ResultsCigarette smoking was positively associated with overall cancer incidence, including cancers at the following specific sites: head and neck region, upper gastrointestinal tract, hepatobiliary and pancreas cancer, lung, and bladder/renal pelvis cancer. Compared to never smokers, the relative risk (RR) (95% confidence interval [CI]) of cancer incidence (all cancer sites) among current smokers smoking >22 cigarettes/day was 1.9 (1.7–2.1), p-trend < 0.0001. Similarly, cigarette smoking was associated with all cause and cause-specific mortality, including deaths due to cancer, ischemic heart disease, other heart diseases, and chronic obstructive pulmonary disease. Compared to never smokers, RR (95%CI) of all cause mortality among current smokers smoking >22 cigarettes/day was 1.8 (1.6–2.0), p-trend < 0.0001. Also, relative to current smokers, ex-smokers experienced reduced cancer incidence and total mortality. The population attributable risk of smoking in men for cancer incidence as well as all-cause mortality was 23%, whereas in women it ranged from 4–5%.ConclusionsCigarette smoking is an important risk factor for cancer incidence and major causes of mortality in Chinese men and women of Singapore.     

Incidence of human papillomavirus positive tonsillar and base of tongue carcinoma: A stabilisation of an epidemic of viral induced carcinoma?

AimTo investigate whether the rise during the past decades in the incidence of tonsillar and base of tongue squamous cell carcinoma (TSCC and BOTSCC) and the proportion of human papillomavirus (HPV) positive cancer has continued in Stockholm.Patients and methodsPre-treatment biopsies (n = 252) available from 280 patients diagnosed with TSCC and BOTSCC during 2008–2012 in the County of Stockholm were tested for HPV DNA by a multiplex bead-based assay. Incidence records were acquired from the Swedish Cancer Registry. The data obtained were evaluated together with previous figures from 1970 to 2007.ResultsHPV DNA was present in 186/252 (74%) of TSCC and BOTSCC biopsies obtained during 2008–2012 in Stockholm. In this region the age-standardised incidence, including the prevalence of HPV-positive and HPV-negative TSCC stabilised 2007–2012 compared to 2000–2006, while for BOTSCC throughout 1998–2012 the same parameters increased moderately (p < 0.05, for all). In parallel, from 2000 to 2006 through 2007–2012 in Sweden, the age-standardised incidence of both TSCC and BOTSCC continued to rise (p = 0.012 and p = 0.001 respectively).ConclusionDuring 2000–2012 the age-standardised incidence and the proportion of HPV-positive TSCC have stabilised at a high level, while the proportion of HPV-negative cancer has remained at a low level in Stockholm, whereas for BOTSCC all parameters are increasing moderately. In contrast, in Sweden the incidence of both TSCC and BOTSCC is still increasing. We hypothesise that the HPV epidemic could be stabilising, first for TSCC, but so far not for BOTSCC, in e.g. some urban areas, while previous trends for both tumours persist at other geographic locations.     

Ageing and other factors behind recent cancer incidence and mortality trends in Italy

ObjectiveThe aim of this paper is to outline the age effect on cancer trends observed in Italy between 1998 and 2005.MethodsWe analysed crude and age-adjusted cancer incidence and mortality trends for 36 sites and both sexes using data from 22 population-based registries of the Italian Network of Cancer Registries (AIRTUM). Some 818,017 incident cancers and 342,444 cancer deaths were analysed.ResultsThe population aged 65 years and older increased from 19.0% to 20.6% between 1998 and 2005 with a significant effect on the cancer burden. The all-cancer, age-adjusted incidence rate was quite stable over the period (all sites excluding non-melanoma skin cancers: annual percent change (APC) men + 0.3 CI + 0.1/+0.5, women + 0.2 CI ? 0.1/+0.4), but population ageing resulted in a growing number of new cases (crude rates: APC men + 1.3 CI + 1.0/+1.7, women + 0.9 CI + 0.6/+1.2). This effect was not evident for those cancer sites with high incidence rates among young subjects. The all-cancer, age-adjusted mortality rate decreased in both sexes but the crude rate changed in women only. Mortality increased for lung cancer among women (APC + 1.5; CI + 0.5/+2.5) and for melanoma among men (APC + 2.7; CI + 0.5/+4.8).ConclusionsRecent cancer trends in Italy are quite favourable, showing decreasing mortality rates for most sites (except for lung cancer among women and melanoma among men) and showing overall stable incidence. However, it follows that population ageing will have increased the cancer diagnostic and therapeutic needs and costs.     

Convergence of decreasing male and increasing female incidence rates in major tobacco-related cancers in Europe in 1988–2010

IntroductionSmoking prevalence has been declining in men all over Europe, while the trend varies in European regions among women. To study the impact of past smoking prevalence, we present a comprehensive overview of the most recent trends in incidence, during 1988–2010, in 26 countries, of four of the major cancers in the respiratory and upper gastro-intestinal tract associated with tobacco smoking.MethodsData from 47 population-based cancer registries for lung, laryngeal, oral cavity and pharyngeal, and oesophageal cancer cases were obtained from the newly developed data repository within the European Cancer Observatory (http://eco.iarc.fr/). Truncated age-standardised incidence rates (35–74 years) by calendar year, average annual percentage change in incidence over 1998–2007 were calculated. Smoking prevalence in selected countries was extracted from the Organisation for Economic Co-operation and Development and the World Health Organization databases.ResultsThere remained great but changing variation in the incidence rates of tobacco-related cancers by European region. Generally, the high rates among men have been declining, while the lower rates among women are increasing, resulting in convergence of the rates. Female lung cancer rates were above male rates in Denmark, Iceland and Sweden (35–64 years). In lung and laryngeal cancers, where smoking is the main risk factor, rates were highest in central and eastern Europe, southern Europe and the Baltic countries. Despite a lowering of female smoking prevalence, female incidence rates of lung, laryngeal and oral cavity cancers increased in most parts of Europe, but were stable in the Baltic countries. Mixed trends emerged in oesophageal cancer, probably explained by differing risk factors for the two main histological subtypes.ConclusionsThis data repository offers the opportunity to show the variety of incidence trends by sex among European countries. The diverse patterns of trends reflect varied exposure to risk factors. Given the heavy cancer burden attributed to tobacco and the fact that tobacco use is entirely preventable, tobacco control remains a top priority in Europe. Prevention efforts should be intensified in central and eastern Europe, southern Europe and the Baltic countries.     

Interval cancers in the Antwerp European randomised study of screening for prostate cancer study, using a 6 year screening interval

BackgroundThe European randomised study of screening for prostate cancer (ERSPC) was initiated to evaluate the effect of Prostate Specific Antigen (PSA) screening on prostate cancer mortality. Variations in screening modalities between participating centres, such as the interval between screening rounds are likely to affect the outcome of screening.MethodsThe study describes the number and characteristics of interval cancers in men in the screening arm of the Antwerp ERSPC aged 55–65 years at the time of randomisation and participating in the screening rounds they were invited for. The interval between the first screening rounds was 6 years on average. Interval cancers were defined as cancers diagnosed during the screening interval but not detected by screening. Cases with a positive screening test were considered as interval cancers if diagnosis through biopsy occurred more than 1 year after screening. Interval cancer cases were identified through linkage with cancer registries. Aggressive interval cancer was defined as cancer with at least one of the following characteristics: stage M1 or N1, Gleason score higher than 7 or World Health Organisation (WHO) score of 3.ResultsThe 10 year cumulative incidence of interval cancers was 3.0% (n = 50) and the cumulative incidence of aggressive interval cancers was 0.5% (n = 8). During the first screening interval 36 interval cancers were detected. Of these 20 (55.6%) were detected more than 4 years after the initial screening and 5 (13.9%) were considered aggressive. All aggressive interval cancers emerged more than 4 years after initial screening.ConclusionThe occurrence of interval cancers in this study was higher than in the ERSPC centres that used a shorter screening interval. Aggressive interval cancers only started to emerge 4 years after initial screening.     

The recent decline in mortality from Hodgkin lymphomas in central and eastern Europe

BackgroundHodgkin lymphoma (HL) is a largely curable disease and its mortality had steadily declined in western Europe since the late 1960s. Only modest declines were, however, observed in central/eastern Europe.Materials and methodsWe updated trends in mortality from HL in various European areas up to 2004 and analyzed patterns in incidence for selected European countries providing national data.ResultsIn most western European countries, HL mortality continued to steadily decline up to the mid 2000s. More recent reductions were also observed in eastern European countries. Overall, mortality from HL declined from 1.17/100 000 (age-standardized, world population) in 1980–1989 to 1.42/100 000 in 2000–2004 in men from the 15 member states of the European Union (EU) from western and northern Europe. In the EU 10 accession countries of central and eastern Europe, male mortality from HL was 1.42/100 000 in 1980–1984, 1.32 in 1990–1994, and declined to 0.76 in 2000–2004. Similar trends were observed in women. No consistent patterns were found for HL incidence.ConclusionsThe present work confirms the persistent declines in HL mortality in western European countries, and shows favorable patterns over more recent calendar years in central/eastern ones, where rates, however, are still at levels observed in western Europe in the early 1990s.     

Sex difference in the incidence of nasopharyngeal carcinoma in Hong Kong 1983–2008: Suggestion of a potential protective role of oestrogen

BackgroundNasopharyngeal carcinoma (NPC) shows a male predominance in incidence while the underlying reasons have rarely been explored.MethodsWe analysed incident cases of NPC recorded in Hong Kong Cancer Registry during the period 1983–2008. All cases were divided into 5-year age groups. Age group specific incidence rates of NPC by sex and male to female ratios in incidence rate by age group were calculated. A curve fitting approach was taken to quantitatively describe the age-specific incidence rates of NPC using non-linear regressions.ResultsDuring the period 1983–2008, a total of 27,579 new cases of NPC were identified (20,060 males and 7519 females) in Hong Kong. The overall male to female ratio of the annual age-standardised incidence rates of NPC ranged 2.2–3.1. The male to female ratio of NPC incidence increased with age until peaking at ages 55–59 years and showed a decline thereafter. An additional minor increase at ages 15–19 years was also observed. Modelling of the age-specific incidence curves suggested divergent slopes for men and women and a delay in increasing incidence with age among females, by around 5–10 years before menopause ages.ConclusionThe age-dependent pattern of the sex difference in the incidence of NPC could not be completely explained by known risk factors for NPC. The contributions of intrinsic exposures, such as sex hormones, merit consideration and further investigations.     

Cancer in the oldest old in the United States: Current statistics and projections

ObjectivesThe oldest old population in the US, defined as aged ≥ 85 years, is projected to double from 4.3 million in 2000 to 9.6 million in 2030. The purpose of this study was to assess the current and projected cancer burden in the oldest old.Materials and MethodsThis was a retrospective cohort study using the national Surveillance, Epidemiology, and End Results (SEER) tumor registry. Historical trends were assessed and projections were created for the top 10 cancers by incidence, and also by proportion of cancer deaths for those aged ≥ 85 years.ResultsCurrently, the oldest old experiences about 7% of annual new cancer cases and 14% of cancer deaths. The most common cancers by incidence per 100,000 people are colorectal (336), lung (297), breast (254), and prostate (165), while the leading causes of cancer deaths are lung (19%), colorectal (13%), prostate (9%), and breast (7%). The incidences of non-Hodgkin lymphoma, melanoma, bladder, lung, and pancreatic cancers have been increasing, while those of other cancers are stable or decreasing. A substantial proportion of the oldest old (24%) had prior primary cancers. If historical trends continue to 2030, we project that 9% of newly diagnosed cancer cases and 23% of cancer deaths annually will occur in the oldest old.ConclusionThe oldest old may have unique cancer incidence and mortality. To manage a projected major increase in the burden of cancer care, substantial investments in geriatric oncology research, education, and practice are needed.     

Reduced risk of oestrogen receptor positive breast cancer among peri- and post-menopausal women in Scotland following a striking decrease in use of hormone replacement therapy

Many countries report a decline in breast cancer incidence among peri- and post-menopausal women following a decline in HRT prescribing. To investigate recent Scottish incidence trends, European age-standardised incidence rates from 1997 to 2005 were stratified by method of first detection, ER status and age group. We developed change point models of the annual age-specific cases for the peri- and post-menopausal age groups and ER status using Poisson regression.In Scotland all HRT categories together show a 32.4% increase in the number of items dispensed in 1993–2000 followed by a striking 61.8% decline by 2007.The incidence rates of screen-detected tumours increased gradually in the 50–64 and 65–74 age groups. For the older age group this increase accelerated after 2003 corresponding to an extension of the age range of screening.For ER positive tumours in the 50–64 age group, age-standardised rates increased 31.5% from 1997 to 2000, followed by a statistically significant decrease of 11.2% by 2005 (change in slope = ?0.0943, P < 0.0001). We conclude that an overall incidence in the 50–64 age group declined since 2000 reflecting the sudden fall in HRT dispensed items and is largely accounted for by the decrease in ER positive tumour incidence. A longer term decline in ER negative tumours for this age group was pre-existing and is unaffected by the collapse in HRT prescribing.