Cancer prevalence in European registry areas.

BACKGROUND: Information on cancer prevalence is of major importance for health planning and resource allocation. However, systematic information on cancer prevalence is largely unavailable. MATERIALS AND METHODS: Thirty-eight population-based cancer registries from 17 European countries, participating in EUROPREVAL, provided data on almost 3 million cancer patients diagnosed from 1970 to 1992. Standardised data collection and validation procedures were used and the whole data set was analysed using proven methodology. The prevalence of stomach, colon, rectum, lung, breast, cervix uteri, corpus uteri and prostate cancer, as well as of melanoma of skin, Hodgkin's disease, leukaemia and all malignant neoplasms combined, were estimated for the end of 1992. RESULTS: There were large differences between countries in the prevalence of all cancers combined; estimates ranged from 1170 per 100000 in the Polish cancer registration areas to 3050 per 100000 in southern Sweden. For most cancers, the Swedish, Swiss, German and Italian areas had high prevalence, and the Polish, Estonian, Slovakian and Slovenian areas had low prevalence. Of the total prevalent cases, 61% were women and 57% were 65 years of age or older. Cases diagnosed within 2 years of the reference date formed 22% of all prevalent cases. Breast cancer accounted for 34% of all prevalent cancers in females and colorectal cancer for 15% in males. Prevalence tended to be high where cancer incidence was high, but the prevalence was highest in countries where survival was also high. Prevalence was low where general mortality was high (correlation between general mortality and the prevalence of all cancers = -0.64) and high where gross domestic product was high (correlation = +0.79). Thus, the richer areas of Europe had higher prevalence, suggesting that prevalence will increase with economic development. CONCLUSIONS: EUROPREVAL is the largest project on prevalence conducted to date. It has provided complete and accurate estimates of cancer prevalence in Europe, constituting essential information for cancer management. The expected increases in prevalence with economic development will require more resources; allocation to primary prevention should therefore be prioritised.     

Cancer prevalence in Central Europe: the EUROPREVAL Study.

BACKGROUND: Information on cancer prevalence is either absent or largely unavailable for central European countries. MATERIALS AND METHODS: Austria, Germany, The Netherlands, Poland, Slovakia, Slovenia and Switzerland cover a population of 13 million inhabitants. Cancer registries in these countries supplied incidence and survival data for 465 000 cases of cancer. The prevalence of stomach, colon, rectum, lung, breast, cervix uteri, corpus uteri and prostate cancer, as well as skin melanoma, Hodgkin's disease, leukaemia and all malignant neoplasms combined was estimated for the end of 1992. RESULTS: A large heterogeneity was observed within central European countries. For all cancers combined, estimates ranged from 730 per 100 000 in Poland (men) to 3350 per 100 000 in Germany (women). Overall cancer prevalence was the highest in Germany and Switzerland, and the lowest in Poland and Slovenia. In Slovakia, prevalence was higher than average for men and lower than average for women. This was observed for almost all ages. As shown by incidence data, breast cancer was the most frequent malignancy among women in all countries. Among men, prostate cancer was the leading malignancy in Germany, Austria and Switzerland, and lung cancer was the major cancer in Slovenia, Slovakia and Poland. The Netherlands had a high prevalence of both prostate and lung cancer. Time-related magnitude of prevalence within each country and the variability of such proportions across the countries has been estimated and cancer prevalence is given by time since diagnosis (1 year, 1-5 years, 5-10 years, >10 years) for each site. The weight of 1-year prevalence (248 per 100 000 among men and 253 per 100 000 among women) was <15% of total prevalence. Prevalent cases between 1 and 5 years since diagnosis represented between 22% and 34% of the total prevalence. Prevalent cases diagnosed from 5 to 10 years before (335 per 100 000 for men and 505 per 100 000 for women) represented between 17% and 23% of prevalent cancers. Finally, long-term cancer prevalence (diagnosed >10 years before), reflecting long-term survival, and number of people considered as cured from cancer were 490 per 100 000 for men and 1028 per 100 000 for women, with a range between 26% (The Netherlands, men) and 50% (Slovakia, women). CONCLUSION: It is clear from observing countries in Central Europe, that high cancer prevalence is associated with well-developed economies. This burden of cancer could be interpreted as a paradoxical effect of better treatments and thereby survival. It could also be taken as a sign for not being satisfied with the advances in treating patients diagnosed with cancer, and for supporting more primary prevention.     

Second Primary Cancers Following Colon and Rectal Cancer in Osaka, Japan

The frequencies of second primary cancers following colon and rectal cancers were estimated using the Osaka Cancer Registry's population-based data for Osaka, Japan. A series of 7,312 colon and 6,923 rectal cancer cases newly diagnosed in the period of 1966-1986 were followed up until the end of 1986. The average follow-up period was 3.6 years for colon cancer and 3.7 years for rectal cancer. Significantly elevated risks of second primary cancers following colon cancer were observed for cancers of the rectum (O/E= 2.0; 95% confidence interval (CI) = 1.1-3.4 among males, O/E=4.3; 95% CI=2.4-7.2 among females), corpus uteri (O/E=8.2; 95% CI = 3.3-16.9), ovary (O/E=4.3; 95% CI = 1.0-5.0), and female thyroid gland (O/E=4.7; 95% CI=1.7-8.8). These findings were more notable among right-sided colon cancer patients than left-sided colon cancer patients. The elevated risks of second primary cancers were particularly evident among patients younger than 50 years of age at the time of diagnosis of the initial cancer (colon cancer: O/E = 3.1 among males, 3.4 among females, rectal cancer: O/E=1.7 among males, 1.3 among females). These findings suggest that younger colorectal cancer patients should undergo more careful checkups throughout their lives.     

Outcomes of surveillance for contralateral breast cancer in patients less than age 60 at the time of initial diagnosis

Background

After an initial diagnosis of breast cancer, the risk of contralateral breast cancer is approximately 0.5% per year. Annual mammography is recommended to identify local recurrences and contralateral new primaries. Because the sensitivity of mammography tends to be lower in younger women, we conducted a retrospective review of the method of detection and pathologic stage of metachronous contralateral primary breast cancers according to age at diagnosis in a cohort of breast cancer patients.

Methods

The Henrietta Banting Database contains information on cases of breast cancer diagnosed at Women’s College Hospital from 1987 to 2004. From among 1992 women in the database, 71 patients were identified who were initially diagnosed before age 60 and who subsequently developed a contralateral breast cancer. Medical records were obtained for 53 of the 71 patients.

Results

Of the 53 contralateral cancers, 33 (62%) were detected by mammography, including 4 in 16 patients (25%) diagnosed before age 50 and 29 in 37 patients (78%) diagnosed at age 50 or older (p ≤ 0.001).

Conclusions

Mammography has poor sensitivity for the surveillance of contralateral breast cancer in early-onset breast cancer patients. Other imaging modalities should be evaluated in this setting.     

Survival of women with cancers of breast and genital organs in Europe 1999–2007: Results of the EUROCARE-5 study

BackgroundSurvival differences across Europe for patients with cancers of breast, uterus, cervix, ovary, vagina and vulva have been documented by previous EUROCARE studies. In the present EUROCARE-5 study we update survival estimates and investigate changes in country-specific and over time survival, discussing their relationship with incidence and mortality dynamics for cancers for which organised screening programs are ongoing.MethodsWe analysed cases archived in over 80 population-based cancer registries in 29 countries grouped into five European regions. We used the cohort approach to estimate 5-year relative survival (RS) for adult (⩾15 years) women diagnosed 2000–2007, by age, country and region; and the period approach to estimate time trends (1999–2007) in RS for breast and cervical cancers.ResultsIn 2000–2007, 5-year RS was 57% overall, 82% for women diagnosed with breast, 76% with corpus uteri, 62% with cervical, 38% with ovarian, 40% with vaginal and 62% with vulvar cancer. Survival was low for patients resident in Eastern Europe (34% ovary–74% breast) and Ireland and the United Kingdom [Ireland/UK] (31–79%) and high for those resident in Northern Europe (41–85%) except Denmark. Survival decreased with advancing age: markedly for women with ovarian (71% 15–44 years; 20% ⩾75 years) and breast (86%; 72%) cancers. Survival for patients with breast and cervical cancers increased from 1999–2001 to 2005–2007, remarkably for those resident in countries with initially low survival.ConclusionsDespite increases over time, survival for women’s cancers remained poor in Eastern Europe, likely due to advanced stage at diagnosis and/or suboptimum access to adequate care. Low survival for women living in Ireland/UK and Denmark could indicate late detection, possibly related also to referral delay. Poor survival for ovarian cancer across the continent and over time suggests the need for a major research effort to improve prognosis for this common cancer.     

英国肿瘤预防控制概况

2008年,英国有31万人被诊断为癌症患者,其中,15.6万人死于癌症,占所有死因的27%。乳腺癌、肺癌、结直肠癌和前列腺癌最为常见,占所有癌症的54%。其中,男性最常见的癌症是前列腺癌,女性最常见的癌症是乳腺癌。从历史上来看,英国在癌症控制方面落后于许多其他的欧洲国家和美国。为改变这一状况,英国政府制定并实施了一系列肿瘤服务改善计划。由于国家在癌症治疗和预防等方面所做的努力,英国的癌症防控工作已经取得了很大进步。     

Trends in the incidence of cancer in the Sousse region,Tunisia, 1993–2006

In this article, we analyzed trends in incidence rates of the major cancer sites for a 14‐year period, 1993–2006, in the Sousse region localized in the centre of Tunisia. Five‐year age‐specific rates, crude incidence rates (CR), world age‐standardized rates (ASR), percent change (PC) and annual percent change (APC) were calculated using annual data on population size and its estimated age structure. A total of 6,975 incident cases of cancer were registered, with a male to‐female sex ratio of 1.4:1. ASRs showed stable trends (?0.1% in males, and +1.0% in females). The leading cancer sites in rank were lung, breast, lymphoma, colon‐rectum, bladder, prostate, leukemia, stomach and cervix uteri. For males, the incidence rates of lung, bladder and prostate cancers remained stable over time. While, cancers of colon‐rectum showed a marked increase in incidence (APC: +4.8%; 95% CI: 1.2%, 8.4%) and non‐Hodgkin's lymphoma (NHL) showed a notable decline (APC: ?4.4%; 95% CI: ?8.2, ?0.6). For females, cancers of the breast (APC: +2.2%; 95% CI: 0.4%, 4.0%) and corpus uteri (APC: +7.4%; 95% CI: 2.8%, 12.0%) showed a marked increase in incidence during the study period, while the cervix uteri cancer decreased significantly (APC: ?6.1%; 95% CI: ?9.2%, ?3.0%). The results underline the increasing importance of cancer as a cause of mortality and morbidity in Tunisia. Our findings justify the need to develop effective program aiming at the control and prevention of the spread of cancer amongst Tunisian population.     

The prevalence of tumors of the breast and female genital tract in Italy

Data from 10 Italian population-based cancer registries were used to estimate the prevalence of female tumors of the breast and genital tract. The total prevalence, expressed in number per 100,000, was highest for breast cancer (1,117), followed by cancer of the corpus (264) and cervix uteri (146), ovary (110), and vagina and vulva (23). For all tumors the prevalence increased with age at diagnosis. The cancer prevalence was divided into intervals from diagnosis, expressing different health needs in terms of therapy and intensity of clinical follow-up. For all tumors considered, 1-year prevalence was higher than 1-2-year prevalence, reflecting a high death risk due to perioperative mortality and to the proportion of patients diagnosed at advanced stages. The prevalence decreased in the following intervals considered. Noticeable geographic variability was observed in the prevalence across Italy, with higher proportions being registered in the northern-central regions than in the South. The two extreme 0-5-year prevalence figures (per 100,000) were: for breast cancer 568 (Genova) and 259 (Ragusa); for corpus uteri cancer 94 (Romagna) and 21 (Latina); for cervix uteri cancer 63 (Romagna) and 26 (Latina); for ovarian cancer 49 (Parma) and 21 (Latina); for cancer of the vagina and vulva 17 (Genova) and 5 (Ragusa). This variability depends mainly on incidence and on the proportion of elderly in the general population. From 1987 to 1992 there was an increase in the prevalence of tumors of the breast, ovary and vagina and vulva, especially in the elderly. The prevalence of corpus uteri cancer decreased slightly in the elderly only, whereas that of cervix uteri cancer decreased at all ages.     

Cancer incidence and mortality in young adults in vaud,Switzerland, 1974-1992

Trends in cancer incidence and mortality in young adults (aged 20 to 44 years) over the period 1974-1992 were analyzed using data from the Vaud Cancer Registry, Switzerland. A total of 1,497 cancers were registered in males, after excluding non melanomatous skin cancers. The most common neoplasms were testis, lymphomas, lung, skin melanoma and oral cavity and pharynx. The overall age-standardized (world population) incidence was 750 per million males, and increased from 676 in 1974-1979 to 808 in 1986-1992. These upward trends were due mainly to cancers of the oral cavity and pharynx, lung, skin melanoma and colorectum, while testicular cancer rates remained stable. For females, a total of 1,899 malignant neoplasms was notified, corresponding to an overall age-standardized incidence of 914 per million. The overall rate increased from 818 in 1974-1979 to 1,003 in 1986-1992. The most frequent neoplasms were breast, skin melanoma, ovary, thyroid and lymphomas. The major types of cancer responsible for these upward trends were breast cancer, skin melanoma and lung cancer. In the period studied there were 458 cancer deaths in males and 408 in females, corresponding to an overall age-standardized rate of 227 per million males and 193 per million females. Death rates in males tended to decline, to reach 194 per million in 1986-1992, but no consistent trend was observed in females. The decline in males was essentially due to the fall in rates for testicular cancer and Hodgkin's disease. In females, falls in death rates were observed for cancer of the cervix uteri, ovary and Hodgkin's disease. Death rates were upwards for lung cancer in both sexes, and for skin melanoma and breast cancer in females. © 1995 Wiley-Liss, Inc.     

Causative Relationship between Diabetes Mellitus and Breast Cancer in Various Regions of Saudi Arabia: An Overview

The unwarranted connection between diabetes mellitus and breast cancer has gained new ground in recentyears. Breast cancer in Saudi females accounts for approximately 21% of all cancers and the prevalence ofdiabetes mellitus (DM) in Saudi females is also 21.5%. DM is diagnosed in the age group of 30+ years withpossible exposure to predisposing factors like hyperinsulinemia and obesity at younger age. Further, 12% of thebreast cancer cases are diagnosed in the young females aged 20-34 years. Despite the readily available access tohealthcare facilities in the Kingdom, a large number of diabetics, approximately 27.9%, were unaware of havingdiabetes mellitus. This subpopulation is quite susceptible of developing breast cancer at later age. This reviewdiscusses common etiological and predisposing factors for breast cancer and diabetes, regional distribution andpossible correlation of diabetes and cancer in Saudi Arabia.     

Carcinoma of the Male Breast: a Study of 141 cases from Northern Pakistan

Carcinoma of the male breast, histologically identical to that seen in females, is a rare malignant epithelial tumour. ‍We retrospectively studied 141 cases of male breast carcinoma diagnosed during a ten year period (1992-2001). ‍These tumours comprised 0.7% of all cancers, 1.1% of all malignancies in males and 5.9% of all breast carcinomas ‍in both genders. A male to female ratio of 1:16 was observed. The peak incidence was in the age group between 50- ‍60 years and majority of the patients were below 60 years. Most of the patients presented with a painless lump and ‍infiltrating ductal carcinoma was the main histological type. While compared with our previous similar analysis, a ‍highly significant increase (p<0.0001) was found for total numbers of breast carcinoma in both sexes and total ‍number of malignancies in males.     

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.     

Second primary cancers following colon and rectal cancer in Osaka, Japan.

The frequencies of second primary cancers following colon and rectal cancers were estimated using the Osaka Cancer Registry's population-based data for Osaka, Japan. A series of 7,312 colon and 6,923 rectal cancer cases newly diagnosed in the period of 1966-1986 were followed up until the end of 1986. The average follow-up period was 3.6 years for colon cancer and 3.7 years for rectal cancer. Significantly elevated risks of second primary cancers following colon cancer were observed for cancers of the rectum (O/E = 2.0; 95% confidence interval (CI) = 1.1-3.4 among males, O/E = 4.3; 95% CI = 2.4-7.2 among females), corpus uteri (O/E = 8.2; 95% CI = 3.3-16.9), ovary (O/E = 4.3; 95% CI = 1.0-5.0), and female thyroid gland (O/E = 4.7; 95% CI = 1.7-8.8). These findings were more notable among right-sided colon cancer patients than left-sided colon cancer patients. The elevated risks of second primary cancers were particularly evident among patients younger than 50 years of age at the time of diagnosis of the initial cancer (colon cancer: O/E = 3.1 among males, 3.4 among females, rectal cancer: O/E = 1.7 among males, 1.3 among females). These findings suggest that younger colorectal cancer patients should undergo more careful checkups throughout their lives.     

Patterns of cancer incidence among the population of qatar: a worldwide comparative study.

Background: Cancer is a major public health problem all over the world. Monitoring the evolution of the cancer burden in the State of Qatar is of great value but has never been explored in depth. Aims: The aim of the study was to determine the incidence patterns of cancer cases, assess trends during the period 1991 - 2006 and make comparisons with other countries. Methods: This was a retrospective cohort study based on the Cancer disease registry of Al Amal Cancer hospital, State of Qatar, from 1991 - 2006. All Qataris and non-Qataris, males and females, who were diagnosed with any type of cancer were included in this study. The diagnostic classification of definite cancer cases was made according to the International Classification of Disease 10th revision (ICD-10). Results: A total of 5,825 cancer cases were registered in Qatar during the period 1991 - 2006 with 56.7% in males and 43.3% in females, 35.6% in Qataris and 64.4% in non-Qataris. Incidence rates per 100,000 population showed that lung (5.9), lymph node (5.9), bone marrow (4.1) and connective tissue (3.9) were the top major cancers in men. In women, breast (30.1), genital organs (9), lymph node (6.8), rectum (6.1) and thyroid (5.7) cancers were the leading cancers. There was a sharp rise in the total number of cancer cases during the period 2002-2006 of 57.1% compared to the period 1991-1996. The incidence rate of cancer cases increased with increasing age in all cancer types except for breast cancer in women above 65 years old. During the study period, the five most common cancers among women were different from those in men. The incidence rate per 100,000 population of all cancer types in Qatar (63.1) was remarkably lower than the other Middle East countries and the UK. Conclusions: Cancer is an important public health problem in Qatar, with increase in incidence with age. Incidence rates of all cancers were higher across all age groups of women compared to men. Lung cancer was the most frequent cancer diagnosed in men and breast cancer in women. More epidemiological studies are now required to elucidate the patterns of cancer and related risk factors.     

Incidence of multiple primary cancers in a cohort of women diagnosed with breast cancer in southeast England

Among women in the Thames Cancer Registry database with a first breast cancer diagnosed between 1961-1995 observed numbers of subsequent cancers were compared with expected numbers and standardized incidence ratios were calculated. The occurrence of breast cancers subsequent to cancers at other sites was also examined. Women diagnosed with breast cancer before age 50 had significantly elevated risks for 9 cancer sites namely, oesophagus, stomach, lung, bone, connective tissue, breast, corpus uteri, ovary and myeloid leukaemia compared with 2 sites (corpus uteri and myeloid leukaemia) in women diagnosed at age 50 and above. Some of these associations are consistent with the effects of known inherited cancer susceptibility genes, shared environmental factors, or therapy.     

Trends and Analysis of Cancer Incidence for Common Male and Female Cancers in the Population of Punjab Province of Pakistan during 1984 to 2014

Background: The Pakistan Atomic Energy Commission Cancer Registry (PAECCR) program has madeavailability of a common cancer incidence database possible in Pakistan. The cancer incidence data from nuclearmedicine and oncology institutes were gathered and presented. Materials and Methods: The cancer incidencedata for the last 30 years (1984-2014) are included to describe a data set of male and female patients. The dataanalysis concerning occurrence, trends of common cancers in male and female patients, stage-wise distribution,and mortality/follow-up cases is also incorporated for the last 10 years (2004-2014). Results: The total populationof provincial capital Lahore is 9,800,000. The total number of cancer cases was 80,390 (males 32,156, females48,134). The crude incidence rates in PAECCR areas were 580.8/105 during 2010 to 885.4/105 in 2014 (males354.1/105, females 530.1/105). The cancer incidence rates for head and neck (15.70%), brain tumors (10.5%),and non-Hodgkin lymphoma (NHL, 9.53%) were found to be the highest in male patients, whereas breastcancer (46.7%), ovary tumors (6.80%), and cervix (6.31%) cancer incidence rates were observed to be the mostcommon in female patients. The age range distribution of diagnosed and treated patients in conjunction with thepercentage contribution of cancer patients from 15 different cities of Punjab province treated at the Institute ofNuclear Medicine and Oncology, Lahore are also included. Leukemia was found to be the most common cancerfor the age group of 1-12 years. It has been identified that the maximum number of diagnosed cases were foundin the age range of 51-60 years for males and 41-50 years for female cancer patients. Conclusions: Overallcancer incidence of the thirty years demonstrated that head and neck and breast cancers in males and in femalesrespectively are the most common cancers in Punjab province in Pakistan, at rates almost the highest in Asia,requiring especial attention. The incidence of brain, NHL, and prostate cancers among males and ovarian andcervix cancers among females have increased rapidly. These data from a major population of Punjab provinceshould be helpful for implementation of appropriate planning, prevention and cancer control measures and fordetermination of risk factors within the country.     

Survival of male breast cancer patients: a population-based study in Osaka, Japan

BACKGROUND: Little information is available on the survival of male breast cancer patients because the disease is extremely rare in men. Recent studies indicated there were no gender-differences in the 5-year survival if patients' age and stage were matched. However, this problem has rarely been studied in Japan. METHODS: Using the Osaka Cancer Registry's data, the 5-year survival was analyzed based on the reported 19,869 cases who lived in Osaka Prefecture excluding Osaka City and were diagnosed in 1975-1997, or who resided in Osaka City and were diagnosed in 1993-1997, because reliable follow-up information was available for them. RESULTS: Breast cancer in males accounted for 0.49% of all cases during 1975-1997. The 5-year relative survivals were 71.1% in men and 81.6% in women. The survival in males decreased over older groups due to a lower proportion of localized stage, but not in females. The survival of males in the regional stage was significantly lower than that of females (49.1 versus 73.7%, P<0.05). Survival of males has increased since 1980-1984, while it has been stable in females. Compared with the survival of patients diagnosed in 1975-1979, male patients diagnosed in 1995-1997 had a noticeably lower risk of death after adjusting for age and cancer stage. CONCLUSIONS: The results suggest male breast cancer patients at the regional stage had a worse 5-year survival rate compared to females. However, this gender-related difference seems to have disappeared with the increased survival of males during the 1990s. Further population-based studies are required with a greater number of male patients diagnosed after 1990.     

Cost of managing women presenting with stage IV breast cancer in the United Kingdom

This study estimated lifetime cost of treatment for patients in the United Kingdom (UK) presenting with stage IV breast cancer. To determine patterns of treatment and resource use in the absence of direct observational data, a cancer physician panel was surveyed. The survey questionnaire described four predefined treatment phases: active treatment; follow-up after active treatment until disease progression; active supportive care after progression; and end-of-life care. Physicians were asked their major treatment strategies for each phase. Monthly cost and average lifetime cost per patient were calculated. Only five cancer registries in the UK document the proportion of breast cancer patients diagnosed with stage IV disease. Their data was used to estimate the incidence of metastatic breast cancer at presentation throughout the UK. This value, together with lifetime cost per patient and projected survival time, allowed approximation of the overall cost for this population of cancer patients in the UK. Annual incidence of stage IV breast cancer at presentation in the UK is approximately 2100; according to treatment practice in 2002, lifetime cost per patient is pound 12 500 and total population cost is approximately pound 26 million. The substantial economic burden associated with patients diagnosed with metastatic breast cancer should be considered when developing strategies for reducing its incidence such as increased awareness, screening and preventative measures.     

A comparative analysis of cancer prevalence in cancer registry areas of France, Italy and Spain.

A comparative analysis of cancer prevalence in France, Spain and Italy is presented as part of the EUROPREVAL project. The three countries are culturally and sociologically relatively homogeneous compared with Europe as a whole. However, in all three countries, the cancer registries (CRs) providing the data for prevalence calculation cover only small fractions of the populations, and have been operating for relatively short periods. This leads to problems of representativity and to prevalence underestimates as surviving cases diagnosed before operation of the CR are not recorded. Partial prevalences obtained directly from CR data were therefore corrected using a completeness index obtained by modelling to provide estimates of the complete prevalence. For CRs operating for only 5 years, only approximately half the prevalence was observed. Thus, due to the rather recent start of most of southern European CRs, the role of correction is very important. The prevalence of all cancers was highest in Italy for women and in France for men, while lowest in Spain. Differences in the age structures of the populations were the major cause of these discrepancies and after age adjustment only the prevalence of stomach cancer remained highest in Italy, although differences in incidence also contributed to the prevalence differences. Survival varied little between the three countries and differences in incidence are more important determinants of prevalence. Prevalence of cancer in the elderly represents an increasing load for the community, particularly for France, Italy and Spain due to the ageing population in these countries. Elderly patients with cancer frequently suffer from problems of co-morbidity and disability factors, thus placing a burden on the local medical system where this proportion is high. Prevalent cases diagnosed 1-5 years before the prevalence date formed approximately one-third of the total prevalence, with higher proportions for melanoma, and prostate cancer in males and breast and colorectal cancer in females, and lower proportions for uterine cancer. This subset of the prevalent population consists of those probably on intensive follow-up, or being treated for cancer recurrence or sequelae to primary therapy.