The changing pattern of kidney cancer incidence and mortality in Europe

OBJECTIVE

To update trends in kidney cancer mortality in 32 European countries and the European Union (EU) as a whole, as mortality from kidney cancer has increased throughout Europe until the late 1980s or early 1990s, and has tended to stabilise or decline thereafter.

METHODS

Data from the World Health Organization mortality database over the period 1980–2004 were used to compute age‐specific and age‐standardized (world standard) rates per 100 000 persons at all ages, and truncated to 35–64 years.

RESULTS

In men in the EU, mortality rates from kidney cancer peaked at 4.8 per 100 000 in 1990–1994, and declined to 4.1 (?13%) in 2000–2004. In women in the EU, the corresponding values were 2.1 in 1990–1994 and 1.8 (?17%) in 2000–2004. The main decreases were in Scandinavian countries, and other western European countries. In most eastern European countries kidney mortality rates tended to stabilise, even if values remained high, especially in the Czech Republic and Baltic countries. For kidney cancer incidence, there were decreases in rates for both sexes in Sweden throughout the 25‐year calendar period considered. In the last 10 years considered, incidence rates decreased or tended to stabilise also in other northern European countries in both sexes, except in the UK.

CONCLUSION

The present work confirms and further quantifies the recent favourable trends in kidney cancer mortality and (to a lesser degree) in incidence across most European countries. Thus, improvements in diagnosis and treatments cannot largely explain the declines in mortality. Apart from a favourable role of reduced tobacco smoking in men, the interpretation of these trends remains undefined.     

Declining mortality from bladder cancer in Europe

OBJECTIVE

To update trends in bladder cancer mortality in 32 European countries and the European Union (EU) as a whole, as mortality from bladder cancer has been declining in most of Western Europe since the early 1990s, but it has still been increasing in several central and eastern European countries up to the mid 1990s.

METHODS

We used data from the World Health Organization (WHO) database over the period 1970–2004. Significant changes in mortality rates were identified using join‐point regression analysis.

RESULTS

In the EU overall (27 countries), bladder cancer mortality rates (age‐standardized, world standard population) were stable up to the early 1990s at ≈ 7/100 000 men and 1.5/100 000 women, and declined thereafter by ≈ 16% in men and 12% in women, to reach values of 6 and 1.3/100,000, respectively, in the early years of the present decade. Over recent years, most countries showed decreasing trends, except Croatia and Poland in both sexes, Romania in men and Denmark in women. Truncated rates at age 35–64 years were lower in both sexes and trends for men were more favourable, with an overall decrease by >21% during the last decade. Join point regression analysis indicates that, for most countries, the trends were more favourable over recent calendar periods.

CONCLUSION

The favourable trends in men are partly or largely due to the recent declines in the prevalence of smoking in European men, together with reduced occupational exposure to occupational carcinogens. The decreases in women are more difficult to explain. Better control of urinary tract infections has probably played a role, while the role of diet and other potential urinary tract carcinogens remains undefined.     

Testicular cancer variations in time and space in Europe

OBJECTIVES: Testicular cancer (TC) is the most common malignancy in young men. A review of all published articles on TC incidence revealed an increased incidence in Northern and Central Europe. We extended the analysis to the whole of Europe by using all data available, notably from registries. METHODS: We performed a PubMed search and selected articles dealing with TC incidence. We obtained additional information from data of European registries through the eight volumes of the Cancer Incidence in Five Continents, IARC Scientific Publications. RESULTS: Since the Second World War, TC incidence has been increasing in nearly all European countries. It has doubled in several countries, including France, since 1970. We observed that the increase followed a gradient: the highest rate is centred in Denmark and Germany, and decreases progressively in a centrifugal manner. CONCLUSIONS: TC incidence is increasing throughout Europe, but wide discrepancies exist between the different countries. The reasons for such a phenomenon are still unclear although environmental factors are strongly suspected, which could have an impact on male fertility. From a public health perspective, further research using cases collected through national and regional population-based registers and case-control studies must be strongly encouraged.     

Patterns and trends in prostate cancer incidence,survival, prevalence and mortality. Part I: international comparisons

The international patterns and trends in prostate cancer incidence, survival, prevalence and mortality were examined. Age-standardized incidence and death rates among men in a variety of countries worldwide were obtained from various sources, survival rates from European sources and elsewhere, and prevalence estimates from the EUROPREVAL study. Results from many published studies were summarized. The incidence of prostate cancer varies widely around the world, with by far the highest rates in the USA and Canada. There has been a gradual increase in the incidence of prostate cancer since the 1960s in many countries and in most continents; there were large increases in the late 1980s and early 1990s in the USA, but increases have also occurred in countries with comparatively low incidence, e.g. India. Survival from prostate cancer improved during the 1970s and 1980s; further increases in the 1990s may be largely a result of earlier diagnosis. There were wide differences in survival across Europe, with rates in the UK well below the average, but all European rates were far below those in the USA. There was wide variation in the prevalence of prostate cancer in Europe; in some countries with high incidence and high life-expectancy, prostate cancers formed approximately 15% of all prevalent cancers in men. Mortality from prostate cancer has also increased in many countries, but to a lesser extent than incidence; this is consistent with the observed trends in survival. Mortality decreased slightly in the mid to late 1990s in several countries, including the USA, Canada, England, France and Austria. Part of the apparent increases in the incidence of prostate cancer has been associated with diagnostic artefacts (particularly detecting preclinical tumours through the increased use of transurethral resection) which may also have had an effect on death certification through the incorrect attribution of prostate cancer as the underlying cause of death. However, the greatest effect on the registration of new cases of prostate cancer has been the increased availability of prostate specific antigen testing during the early- to mid-1990s. Possibly, in addition to the effect of attribution bias, the earlier diagnosis of prostate cancers has contributed to the recent slight decreases in mortality. However, this is unlikely to account for much of the reduction, given the slow development of the disease from onset to death. Changes in disease management are probably more important. There are many strong arguments against introducing population-based screening for prostate cancer.     

Acute Care Surgery: The European Model

BACKGROUND: This study was designed to determine whether there is in fact a European model of acute care surgery and to describe the different care systems in the individual European countries. METHODS: Questionnaires were sent to experts on emergency surgery in 27 European countries. The assessment of attitudes toward the emerging discipline of acute care surgery was the main outcome measure. RESULTS: Replies were received from at least one respondent from each of 18 countries. They indicated a high awareness of the new field of acute care surgery, although this has not yet become a recognized (sub-)specialty in any of the countries polled. In addition, several interesting new trends were identified: for example, different approaches depending on individual political influences. CONCLUSIONS: There is no European consensus on acute care surgery. In some central European countries, specialists qualify in general and orthopedic trauma surgery; these all rounders also perform life-saving thoracic and neurosurgical procedures, such as emergency thoracotomies and craniotomies. The European model is not a uniform system for acute surgical care.     

Trends and predictions to 2020 in breast cancer mortality in Europe

ObjectivesWe analyzed trends in mortality from breast cancer in women in 36 European countries and the European Union (EU) over the period 1970–2014, and predicted numbers of deaths and rates to 2020.Materials and methodsWe derived breast cancer death certification data and population figures from the World Health Organization and Eurostat databases. We obtained 2020 estimates using a joinpoint regression model.ResultsOverall, EU breast cancer mortality rates (world standard) declined from 17.9/100,000 in 2002 to 15.2 in 2012. The predicted 2020 rate is 13.4/100,000. The falls were largest in young women (20–49 years, −22% between 2002 and 2012). Within the EU, declines were larger in the United Kingdom (UK) and other northern and western European countries than in most central and eastern Europe. The UK has the second lowest predicted breast cancer mortality rate in 2020 (after Spain), starting from the highest one in 1970. Breast cancer mortality is predicted to rise in Poland, where the predicted 2020 rate is 15.3/100,000. We estimated that about 32,500 breast cancer deaths will be avoided in 2020 in the EU as compared to the peak rate of 1989, and a total of 475,000 breast cancer deaths over the period 1990–2020.ConclusionThe overall favourable breast cancer mortality trends are mainly due to a succession of improvements in the management and treatment of breast cancer, though early diagnosis and screening played a role, too. Improving breast cancer management in central and eastern Europe is a priority.     

Leveling of prostate cancer mortality in Western Europe

BACKGROUND: Mortality from prostate cancer (CaP) has increased throughout Europe until the early 1990s. Trends in 24 European countries, the European Union (EU), six selected Central and Eastern European countries, and the Russian Federation have been updated to 1999. METHODS: Cancer death certification data for CaP were abstracted from the World Health Organization database. RESULTS: In the EU, the peak rate (15.7/100,000) was reached in 1993, followed by a leveling off and a decline to 14.1/100,000 in 1999. Age-standardized analysis for each subsequent age group of men aged 50 or over showed larger absolute falls in the elderly. CaP rates were lower in Central and Eastern European countries providing data, but showed a rise from 9.7/100,000 in 1980 to 11.3 in 1996, and leveled off thereafter. Rates were originally lower, but the rises larger in the Russian Federation (from 5.1/100,000 in 1980 to 8.1/100,000 in 1999). In the late 1990s, there was a threefold difference between the highest rates of 22/100,000 in Norway and those of 7.7 in Russia or 7.3 in Ukraine. Such a difference was, however, restricted to the elderly, since at age 35-64 the Russian rate (6.7/100,000) was the same as that of Norway, and only Greece and Italy had appreciably lower rates. CONCLUSION: The pattern of trends in CaP rates observed across Europe is consistent with a favorable role of improved diagnosis, but mainly of advancements of therapy (including more widespread adoption of radical prostatectomy and androgen blockage) on CaP mortality in Western Europe.     

Recent trends in mortality from benign prostatic hyperplasia

BACKGROUND: We have considered trends in mortality from benign prostatic hyperplasia (BPH) over the last decades in Europe and, for comparative purposes, the USA and Japan. METHODS: Cancer death certification data for benign prostatic hyperplasia were derived from the World Health Organisation database. RESULTS: Between the early 1950s and the late 1990s, overall mortality from BPH in the European Union (EU) fell from 5.9 to 3.5 per million, and the decline since the late 1950s was over 96%. Comparable falls were observed in the USA and Japan, and BPH mortality rates in the late 1990s were lower than in the EU (1.8/10(6) in the USA, 1.4 in Japan). BPH mortality trends were downwards also in the Eastern Europe, although rates in the late 1990s were about fourfold higher than in the EU. CONCLUSION: BPH rates have been steadily declining in developed countries. The excess BPH mortality in Eastern Europe indicates the scope for further reduction too.     

International Variations and Trends in Testicular Cancer Incidence and Mortality

Context

Testicular cancer (TC) is the most common cancer in men aged 15–44 yr in many countries that score high or very high on the Human Development Index (HDI). Despite the very good prognosis for TC, wide variations in mortality rates have been reported internationally.

Objective

To describe and contrast global variations and recent trends in TC incidence and mortality rates.

Evidence acquisition

To compare TC incidence and mortality rates, we used GLOBOCAN 2008 estimates. We used the Cancer Incidence in Five Continents series to analyse recent trends in TC incidence in 41 countries by way of joinpoint analysis. To examine recent trends in mortality, we used the World Health Organisation mortality database.

Evidence synthesis

Northern Europe remains the highest TC incidence area, with the highest rates observed in Norway and Denmark. Incidence rates continue to increase in most countries worldwide, more markedly in Southern Europe and Latin America, while attenuating in Northern Europe, the United States, and Australia. Mortality from TC shows a different pattern, with higher rates in some countries of medium to high HDI. The highest mortality rates were seen in Chile and Latvia, as well as in selected Central European and Eastern European countries. In high-income countries, TC mortality rates are declining or stable at very low levels of magnitude, while no significant decreases were observed in middle-income regions in Latin America and Asia.

Conclusions

The rises in TC incidence appear to be recently attenuating in countries with the highest HDIs, with corresponding mortality rates either continuing to decline or stabilising at very low levels. In a number of countries transiting towards higher levels of development, the TC incidence is increasing while mortality rates are stable or increasing.

Patient summary

In this study we looked at international testicular cancer trends. We found that testicular cancer is becoming more common in low- and middle-income countries, where the optimal treatment might not yet be available.     

Renal Replacement Therapy in Patients with Diabetic Nephropathy, 1980-1985: Report from the European Dialysis and Transplant Association Registry

Diabetic nephropathy, a rarely listed cause of end-stage renalfailure (ESRF) among patients starting renal replacement therapy(RRT) in the early seventies, has progressively gained in importanceand become one of the major reasons for the continuous growthof the patient population on RRT in most European countries.Amongst new patients commencing RRT in 1985, the acceptancerate varied between 3 and 12 per million population for typeI diabetes mellitus and between one and four per million populationfor type II diabetes mellitus. Nordic countries, particularlySweden and Finland, had the highest acceptance rate of youngpatients with type I diabetes mellitus whose median ages were38–42 years. In most central and southern European countriesthe median age of patients with type I diabetes mellitus variedbetween 50 and 58 years. The high number of young patients withtype I diabetes mellitus and ESRF in Nordic countries pointto a different natural history of this disease. It cannot beexcluded, however, that the higher median age in other countriesmight result from doctors mistakenly diagnosing type I diseasein patients with type II disease who need insulin treatment.Patients with type II diabetes mellitus had a similar age distributionat start of RRT throughout Europe and their median ages clusteredaround 60 years in most countries. The contribution of haemodialysis, peritoneal dialysis and renaltransplantation was analysed for diabetic compared to non-diabeticESRF. Despite large geographical differences in the proportionaluse of methods of treatment, a general trend to apply CAPD morefrequently in diabetic as compared to non-diabetic patientswas observed, and this was true for countries with both predominanthaemodialysis and predominant transplant programmes. Transplantationwithout prior dialysis was performed in 17% of Swedish and 30%of Norwegian patients with type I diabetes mellitus. In order to better explain the high mortality of patients withdiabetic ESRF, the proportional distribution of causes of deathwas analysed. Myocardial ischaemia and infarction was confirmedto be the leading cause of death in patients with diabetes mellituson RRT. The coronary death rate was estimated to be 10 timesgreater in young patients with type I diabetes mellitus as comparedto their non-diabetic counterparts. Other cardiovascular aswell as infectious causes were recorded in a similar proportionof deaths in diabetics as in non-diabetics. Cancer deaths, however,appeared to be definitely less frequent in patients on RRT dueto diabetic nephropathy.     

Trends in mortality from urologic cancers in Europe, 1970-2008

Background

In recent decades, there have been substantial changes in mortality from urologic cancers in Europe.

Objective

To provide updated information, we analyzed trends in mortality from cancer of the prostate, testis, bladder, and kidney in Europe from 1970 to 2008.

Design, setting, and participants

We derived data for 33 European countries from the World Health Organization database.

Measurements

We computed world-standardized mortality rates and used joinpoint regression to identify significant changes in trends.

Results and limitations

Mortality from prostate cancer has leveled off since the 1990 s in countries of western and northern Europe, particularly over the last few years while it was still rising in Bulgaria, Romania, and Russia. In the European Union (EU), it reached a peak in 1995 at 15.0 per 100 000 men and declined to 12.5 per 100 000 in 2006. Mortality from testicular cancer has steadily declined in most countries in western and northern Europe since the 1970 s. The declines were later and appreciably lower in central/eastern Europe. In EU, rates declined from 0.75 in 1980 to 0.32 per 100 000 men in 2006, with stronger declines up to the late 1990 s and an apparent leveling off in rates thereafter. Over the last 15 years, mortality from bladder cancer has declined in most European countries in both sexes. The major exceptions were Bulgaria, Poland, and Romania. In the EU, bladder cancer mortality was stable until 1992 and declined thereafter from 7.3 to 5.5 per 100 000 men and from 1.5 to 1.2 per 100 000 women in 2006. Mortality from kidney cancer increased throughout Europe until the early 1990 s and leveled off thereafter in many countries, except in a few central and eastern ones. Between 1994 and 2006, rates declined from 4.9 to 4.3 per 100 000 in EU men and from 2.1 to 1.8 per 100 000 in EU women.

Conclusions

Over the last two decades, trends in urologic cancer mortality were favorable in Europe, with the exception of a few central and eastern countries.     

The state of men’s health in Western Europe

Background: A European-wide study of men’s health was carried out to determine the health needs of men.Methods: Mortality and morbidity statistics from the World Health Organisation Statistical Information Service (WHOSIS), the European Union (Eurostat), the Organisation for Economic Co-operation and Development (OECD), Globocan and other important European sources were used.Results: Differences were found between the health of men and women across all age groups. Wide country-to-country variations in the influence of the different health issues were evident, with clear geographical differences for some disease states. Men had a higher rate of death than women for a wide range of risks such as ischaemic heart disease, cancer of the colon, accidents and deaths due to external causes.Conclusions: There is a need to create greater equity in health status between countries and between the sexes.     

International Variations in Bladder Cancer Incidence and Mortality

Context

Previous studies have reported substantial worldwide regional variations in bladder cancer (BCa) incidence and mortality.

Objective

To describe contemporary international variations in BCa incidence and mortality rates and trends using the most recent data from the International Agency for Research on Cancer (IARC).

Evidence acquisition

Estimated 2008 BCa incidence and mortality rates for each country by sex were obtained from GLOBOCAN. Recent trends in incidence for 43 countries and in mortality for 64 countries were assessed by join-point model using data from the IARC's Cancer Incidence in Five Continents and from the World Health Organisation's mortality database, respectively.

Evidence synthesis

The highest incidence rates for both men and women are found in Europe, the United States, and Egypt, and the lowest rates are found in sub-Saharan Africa, Asia, and South America. Mortality rates are highest in parts of Europe and northern Africa and lowest in Asia, Central America, and middle Africa. Incidence rates among men decreased in 11 of 43 countries (46 registries) (North America, western and northern Europe), remained stable in 20, and increased in 12 countries (southern, central, and eastern Europe). Among women, incidence rates decreased in 10 countries, stabilised in 22 countries, and increased in 12 countries. Mortality rates among men decreased in 32 of 65 countries (throughout all world regions except Central and South America), stabilised in 30 countries, and increased in 3 (Romania, Slovenia, and Cuba). Among women, mortality rates decreased in 24 countries, remained stable in 36 countries, and increased in 5 countries (central and eastern Europe).

Conclusions

Incidence and mortality rates in general decreased in most Western countries but increased in some eastern European and developing countries. These patterns in part may reflect differences in the stage and extent of the tobacco epidemic, changes in coding practices, prevalence of schistosomiasis (Africa), and occupational exposure.     

The European experience with vascular injuries

The rich and diverse heritage of the management of vascular injuries in the 45 independent European countries prevents the authors from revealing a uniform picture of the European experience, but some trends are clearly emerging. In countries with a low incidence of penetrating trauma and increasing use of interventional vascular procedures, the proportion of iatrogenic vascular trauma exceeds 40% of all vascular injuries, whereas on other parts of the continent, armed conflicts are still a major cause of vascular trauma. National vascular registries, mostly in the Scandinavian countries, produce useful, nationwide data about vascular trauma and its management but suffer still from inadequate data collection. Despite a relatively low incidence of vascular trauma in most European countries, the results are satisfactory, probably in most cases because of active and early management by surgeons on call, whether with vascular training or not, treating all kinds of vascular surgical emergencies. In some countries, attempts at developing a trauma and emergency surgical specialty, including expertise in the management of vascular injuries, are on their way.     

Epidemiological trends in stage IV colorectal cancer

Epidemiological trends in stage IV colorectal cancer are concerning. As older adults in highly developed countries enjoy decreasing colorectal cancer incidence and mortality, younger patients are developing metastatic disease with increasing frequency, and profound systemic disparities persist in screening, treatment, and survival. Globally, the young populations of low- and middle-income countries are exposed to ever higher levels of colorectal cancer risk factors without colorectal cancer screening systems in place or ability to provide care, leading to an impending crisis. Scientific discoveries reveal the complex interplay between inherent, tumor-specific, and environmental risks, but the most profound factor underlying the epidemiology of metastatic colorectal cancer is inequality, globally and within the United States.     

Demography of paediatric renal care in Europe: organization and delivery.

BACKGROUND: Members of the European Society of Paediatric Nephrology (ESPN) initiated a study of the demography and policy of paediatric renal care among European countries at the end of the 20th century. METHODS: A questionnaire was mailed to the presidents of each of 43 national renal paediatric societies or working groups in Europe. Data on each country's population, income as reflected by its gross national product and infant mortality rate, were obtained from the United Nations. The paediatric health care systems were previously divided into three types: general practitioner care system, paediatric care system and combined care system (CCS). RESULTS: In 1998, 842 specialized paediatric nephrologists worked in hospitals in 42 European countries. The median number of paediatric nephrologists per million child population (pmcp) was 4.9 (range 0-15). The median number of children served per paediatric nephrologist was significantly higher in countries with the general practitioner care system than in those with the paediatric or combined care system (CCS), namely 370 747 vs 169 456 and 191 788, respectively. In addition to specially trained paediatric nephrologists, there were 1087 paediatricians with a part-time interest/activity in paediatric nephrology in hospitals in 34 European countries. Eastern European countries had significantly more general paediatricians with part-time nephrological activities than countries belonging to the European Union (EU), 16.7 vs 6.6 pmcp. In 1998, 92% of 42 European countries offered paediatric dialysis facilities for acute renal failure and 90% for chronic renal failure and 55% offered paediatric renal transplantation (RTx). Only 30% of Eastern European countries (central omitted) offered paediatric RTx vs 87% of EU countries. The availability of paediatric RTx was associated significantly with the countries' gross national product (r = 0.53, P<0.001). The median number of paediatric hospitals offering dialysis for childhood chronic renal failure was 1.5 pmcp (range 0-5.0) and the median number of paediatric hospitals offering paediatric RTx was 0.4 pmcp (range 0-3.5). Fewer children were on dialysis or were transplanted in Eastern European countries than in the EU. CONCLUSIONS: At the end of the 20th century, there was a marked variation in delivery of paediatric renal care within Europe. This was related to factors such as size of the population, geographical and political situation, the type of primary paediatric care system and economic situation. European countries were far from equal with regard to access of renal replacement therapy for children. Improvement of the economic situation is beyond the capabilities of paediatric nephrologists. However, in these days of world-wide globalization paediatricians in greater Europe should be able to achieve better cooperation and exchange of ideas and information which would be the first step towards equality of renal care for children.     

已行和未行包皮环切术的青年男性对包皮及包皮环切术认识和态度的比较研究

目的:探讨青年男性对包皮及包皮环切术知识的掌握程度以及他们是否接受包皮环切术的影响因素。方法:采用自行设计的问卷对泌尿外科门诊已行和未行包皮环切术的青年男性各100名进行调查研究。统计学方法采用SPSS 11.0软件包中χ2检验。结果:已行包皮环切术的青年男性接受该手术的原因依次为:使阴茎更卫生、为预防阴茎癌和期望提高性功能,分别占63%、27%和26%;青年男性未行包皮环切术的主要原因是不清楚包皮环切术的益处和担心术后并发症,分别占47%和24%。同时,周围同龄人的影响也是决定是否接受包皮环切术的重要因素。已行包皮环切术的青年男性对何时进行该手术并不十分清楚。结论:青年男性接受包皮环切术的主要因素是认为术后可改善阴茎局部卫生和期待提高性功能;而拒绝该手术者则不清楚包皮环切术的益处和担心术后并发症。故应加强对包皮和包皮环切术相关知识的宣教工作。     

Dupuytren's disease: relation to work and injury

The present status of adjudication for workers claiming compensation for Dupuytren's disease is inconsistent and, therefore, unfair to both workers and employers. In some Eastern European countries Dupuytren's disease is classified as an industrial disease, whereas in other countries it is considered to have no relation to manual work or hand injury. In jurisdictions that sometimes award compensation, the reasons for acceptance or rejection of a claim vary from case to case and are not necessarily based on our present knowledge of the disease. The purpose of this communication is to highlight the features of Dupuytren's disease that are pertinent to manual work and hand injury and to suggest guidelines that would provide some consistency in the adjudication process. It is hoped that these guidelines would be valuable to the individual surgeon, insurance agencies, and compensation boards.     

Mechanisms of disease: The epidemiology of bladder cancer

Mortality from bladder cancer has shown downward trends over the last 2 decades in several western European countries (albeit 10-15 years later than similar trends in the US), but is still increasing in some eastern European countries. Tobacco smoking and occupational exposure to aromatic amines are the two major established environmental risk factors for bladder cancer. Controlling exposure to these factors has been an important contributor to the reduction in bladder cancer mortality, particularly among men. Diet could influence bladder carcinogenesis, as many compounds contained in foods--and their metabolites--are excreted through the urinary tract. Fruit and vegetable consumption was inversely related with bladder cancer in many studies, but no consistent association has emerged between intake of related micronutrients and reduced risk of bladder cancer. Other widely investigated lifestyle habits are probably not associated with risk of developing bladder cancer (e.g. coffee consumption, artificial sweetener use, hair dyes) or are difficult to assess (e.g. fluid intake). Infections and stones in the urinary tract might cause chronic irritation of the bladder epithelium, and thus increase bladder cancer risk. First-degree relatives of bladder cancer patients have a 50-100% increased relative risk of developing the disease, a risk that could be even higher when the proband is diagnosed at an early age.     

Mortality from burns in developing countries

The present article provides a review of mortality from burns in some of the developing countries for which national data are available for the period 1967-77. The trends in mortality and age and sex differentials have been obtained to evaluate the overall situation and to find out the sociodemographic correlates of mortality due to burns. The presentation is restricted to statistical facts only and no attempt has been made to find out the reasons for the variations obtained in the analysis.