Has there been progress in cancer care in Croatia? Assessing outcomes in a partially complete mortality follow-up setting

BackgroundWe examine the possibility of assessing progress in cancer care with partially complete mortality follow-up information, and report outcomes from Croatia.MethodsFollow-up based on death certificates indicating cancer as the cause of death was available from the Croatian National Cancer Registry. The effect of partially complete follow-up was first examined with data from the Saarland Cancer Registry by comparing absolute, relative, and cancer death certificate based survival estimates. Survival changes between 2000 and 2006 are reported for 21 common cancers amongst patients aged 15–49 and 50–59 in Croatia.ResultsSurvival estimates based on cancer death specific follow-up could well approximate absolute and relative survival for patients aged 15–49, and relative survival for patients aged 50–59: overestimation by more than one standard error occurred 1 and 2 and 5 times, respectively, amongst 21 cancers. In Croatia, significant survival increases occurred for patients aged 15–59 with colorectal and breast cancers, patients aged 15–49 with thyroid cancer and patients aged 50–59 with malignant melanoma and prostate cancer.ConclusionsOutcome evaluation is limited with partially complete follow-up information. Internationally comparable cancer information continues to lack from South-Eastern Europe, and the provision thereof remains a highly important public health task.     

State of the epidemiological evidence on physical activity and cancer prevention

BackgroundPhysical activity is a modifiable lifestyle risk factor that has the potential to reduce the risk of most major cancer sites.MethodsWe examined the strength, consistency, dose–response and biological plausibility of an association between physical activity and risk of colon, breast, endometrium, lung, prostate, ovarian, gastric, rectal, pancreatic, bladder, testicular, kidney and haematological cancers. We also estimated the population-attributable risk (PAR) for physical inactivity and cancer in 15 European countries.ResultsThere is convincing or probable evidence for a beneficial effect of physical activity on the risk of colon, breast and endometrial cancers. The evidence is weaker for ovarian, lung and prostate cancers and generally either null or insufficient for all remaining cancers. Several hypothesised biological mechanisms include a likely effect of physical activity on insulin resistance, body composition, sex steroid hormones and a possible effect on vitamin D, adipokines, inflammation and immune function. Somewhere between 165,000 and 330,000 cases of the six major cancers (breast, colon, lung, prostate, endometrium and ovarian) could have been prevented in 2008 in Europe alone if the population had maintained sufficient levels of physical activity.ConclusionThere is strong and consistent evidence that physical activity reduces the risk of several of the major cancer sites, and that between 9% and 19% of cancer cases could be attributed to lack of sufficient physical activity in Europe. Public health recommendations for physical activity and cancer prevention generally suggest 30–60 min of moderate or vigorous-intensity activity done at least 5 d per week.     

Recent trends in cancer survival across Europe between 2000 and 2004: a model-based period analysis from 12 cancer registries

BackgroundMonitoring population-based cancer survival is an essential component in the evaluation of cancer control, but subject to an inherent delay in the reporting of the most recent survival estimates with traditional techniques of analysis.MethodsWe examined survival trends between the years 2000 and 2004 for 20 common cancers based on follow-up data from 12 cancer registries from diverse areas of Europe using model-based period analysis techniques.ResultsBetween 2000 and 2004, marked rises were seen in 5-year relative survival amongst patients with prostate, breast and colorectal cancer, which were statistically significant in 10, 8 and 7 of the 12 participating cancer registries, respectively. For cancer sites amenable to effective early detection and treatment, major geographical differences in patient prognosis still persisted, with a lower survival generally observed in Eastern European countries.ConclusionModel-based period analysis enables the timely monitoring of recent trends in population-based cancer survival. For colorectal and breast cancers, the identified rises in survival are probably (at least partly) explained by the improvements in clinical care and the management of the disease. Nevertheless, persisting geographic differences do point to the potential for a further reduction in the burden of cancer throughout Europe, towards which improvements in diverse areas of care, including secondary prevention, access to advances in treatment as well as subspecialisation and regionalisation of oncologic care may all contribute.     

Recent trends in incidence of five common cancers in 26 European countries since 1988: Analysis of the European Cancer Observatory

BackgroundIndividual country- and cancer site-specific studies suggest that the age-adjusted incidence of many common cancers has increased in European populations over the past two decades. To quantify the extent of these trends and the recent burden of cancer, here we present a comprehensive overview of trends in population-based incidence of the five common cancers across Europe derived from a new web-based portal of the European cancer registries.MethodsData on incidence for cancers of the colon and rectum, prostate, breast, corpus uteri and stomach diagnosed from 1988 to 2008 were obtained from the European Cancer Observatory for cancer registries from 26 countries. Annual age-standardised incidence rates and average annual percentage changes were calculated.ResultsIncidence of four common cancers in eastern and central European countries (prostate, postmenopausal breast, corpus uteri and colorectum) started to approach levels in northern and western Europe, where rates were already high in the past but levelled off in some countries in recent years. Decreases in stomach cancer incidence were seen in all countries.DiscussionIncreasing trends in incidence of the most common cancers, except stomach cancer, are bad news to public health but can largely be explained by well-known changes in society in the past decades. Thus, current and future efforts in primary cancer prevention should not only remain focussed on the further reduction of smoking but engage in the long-term efforts to retain healthy lifestyles, especially avoiding excess weight through balanced diets and regular physical exercise.     

Survival of male genital cancers (prostate,testis and penis) in Europe 1999–2007: Results from the EUROCARE-5 study

BackgroundWe provide updated estimates of survival and survival trends of male genital tumours (prostate, testicular and penis cancers), in Europe and across European areas.MethodsThe complete approach was used to obtain relative survival estimates for patients diagnosed in 2000–2007, and followed up through 2008 in 29 countries. Data came from 87 cancer registries (CRs) for prostate tumours and from 86 CRs for testis and penis tumours. Relative survival time trends in 1999–2007 were estimated by the period approach. Data came from 49 CRs in 25 countries.ResultsWe analysed 1,021,275 male genital cancer cases. Five-year relative survival was high and decreased with increasing age for all tumours considered. We found limited variation in survival between European regions with Eastern Europe countries having lower survival than the others. Survival for penile cancer patients did not improve from 1999 to 2007. Survival for testicular cancer patients remained stable at high levels since 1999. Survival for prostate cancer patients increased over time.ConclusionsTreatment standardisation and centralisation for very rare diseases such as penile cancers or advanced testicular tumours should be supported. The high survival of testicular cancer makes long-term monitoring of testicular cancer survivors necessary and CRs can be an important resource. Prostate cancer patients’ survival must be interpreted considering incidence and mortality data. The follow-up of the European Randomised Study of Screening for Prostate Cancer should continue to clarify the impact of screening on prostate cancer mortality together with population based studies including information on stage and treatments.     

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.     

Utilisation of Radiotherapy in Rural and Urban Areas in British Columbia Compared with Evidence-based Estimates of Radiotherapy Needs for Patients with Breast,Prostate and Lung Cancer

AimsTo compare the existing model estimates of the appropriate rates of radiotherapy for lung, breast and prostate cancers with actual radiotherapy rates in rural, semi-urban and urban areas, and in areas with short and long drive distances to cancer clinics in British Columbia.Materials and methods: All registered cases of lung, breast and prostate cancer diagnosed in British Columbia between 1997 and 2007 were identified. The proportion of cancers treated within 1 (RT_1Y) and 5 years (RT_5Y) of diagnosis were calculated according to rural, semi-urban and urban area, and areas associated with short and long drive distances to cancer clinics in British Columbia.ResultsRT_1Y for lung, breast and prostate in urban and rural areas were 47/45%, 57/46% and 31/30%, and for short and long drive times were 47/44%, 56/50% and 31/31% compared with model estimates for initial radiotherapy needs of 41–45%, 57–61% and 32–37%, respectively. RT_5Y for lung, breast and prostate in urban and rural areas were 52/47%, 59/48% and 42/39%, and for short and long drive times were 51/47%, 57/50% and 42/42% compared with model estimates for overall radiotherapy needs of 66–83%, 57–61% and 60–61%, respectively.ConclusionsRadiotherapy rates vary between and within urban and rural areas in British Columbia. Radiotherapy rates for breast and lung cancer patients are higher, and closer to model estimates of need, in urban areas and short drive time areas. Radiotherapy rates do not vary with drive time or rural versus urban classification for patients with prostate cancer.     

Recent trends of cancer in Europe: a combined approach of incidence, survival and mortality for 17 cancer sites since the 1990s

IntroductionWe present a comprehensive overview of most recent European trends in population-based incidence of, mortality from and relative survival for patients with cancer since the mid 1990s.MethodsData on incidence, mortality and 5-year relative survival from the mid 1990s to early 2000 for the cancers of the oral cavity and pharynx, oesophagus, stomach, colorectum, pancreas, larynx, lung, skin melanoma, breast, cervix, corpus uteri, ovary, prostate, testis, kidney, bladder, and Hodgkin’s disease were obtained from cancer registries from 21 European countries. Estimated annual percentages change in incidence and mortality were calculated. Survival trends were analyzed by calculating the relative difference in 5-year relative survival between 1990–1994 and 2000–2002 using data from EUROCARE-3 and -4.ResultsTrends in incidence were generally favorable in the more prosperous countries from Northern and Western Europe, except for obesity related cancers. Whereas incidence of and mortality from tobacco-related cancers decreased for males in Northern, Western and Southern Europe, they increased for both sexes in Central Europe and for females nearly everywhere in Europe. Survival rates generally improved, mostly due to better access to specialized diagnostics, staging and treatment. Marked effects of organised or opportunistic screening became visible for breast, prostate and melanoma in the wealthier countries. Mortality trends were generally favourable, except for smoking related cancers.ConclusionCancer prevention and management in Europe is moving in the right direction. Survival increased and mortality decreased through the combination of earlier detection, better access to care and improved treatment. Still, cancer prevention efforts have much to attain, especially in the domain of female smoking prevalence and the emerging obesity epidemic.     

European cancer mortality predictions for the year 2011

BackgroundMortality figures become available after some years.Materials and methodsUsing the World Health Organization mortality and population data, we estimated numbers of deaths in 2011 from all cancers and selected sites for the European Union (EU) and six major countries, by fitting a joinpoint model to 5-year age-specific numbers of deaths. Age-standardized rates were computed using EUROSTAT population estimates.ResultsThe predicted number of cancer deaths in the EU in 2011 was 1 281 436, with standardized rates of 143/100 000 men and 85/100 000 women. Poland had the highest rates, with smaller falls over recent periods. Declines in mortality for major sites including stomach, colorectum, breast, uterus, prostate and leukemias, plus male lung cancer, will continue until 2011, and a trend reversal or a leveling off is predicted where upward trends were previously observed. Female lung cancer rates are increasing in all major EU countries except the UK, where it is the first cause of cancer death, as now in Poland. The increasing pancreatic cancer trends in women observed up to 2004 have likely leveled off.ConclusionsDespite falls in rates, absolute numbers of cancer deaths are stable in Europe. The gap between Western and former nonmarket economy countries will likely persist.     

Cancer prevalence in France: time trend, situation in 2002 and extrapolation to 2012

BackgroundCancer prevalence is a basic indicator of the cancer burden in a population and essential to estimate the resources needed for care of cancer patients. This paper provides a prevalence estimate for 2002 and 2012 in France and an assessment of the trend in prevalence over the period 1993–2002.MethodIncidence and survival data from French cancer registries were used to estimate specific 5-year partial prevalence rates that were then applied to the whole French population.ResultsIn 2002, the 5-year partial prevalence was over 427,000 in men and 409,000 in women. The most frequent cancer site among men was prostate (35% of the cases) and breast in women (45% of the cases). In 2002, in France, more than 3.5% of men over 74 years old are alive with a prostatic cancer diagnosed within 5 years. The increase in the number of cases between 1993 and 2002 was about 40% and was mainly due to prostate and breast cancers. The demographic variations alone induce an increase of the number of prevalent cases of 75,000 among men and 54,500 among women if both incidence and survival are considered as stable during the period 2002–2012.ConclusionThis study uses a large amount of information from cancer registries which makes it possible to assess the cancer burden. Five-year prevalence is very sensitive to changes in incidence and demographic changes. Prevalence has to be estimated regularly in order to ensure accurate medical care meets demand.     

Risk for incident and fatal prostate cancer in men with a family history of any incident and fatal cancer

BackgroundFamilial clustering of incident prostate cancer and some cancers at other discordant sites has been reported. Less is known about familial clustering of fatal prostate cancer with any fatal discordant cancers. Estimates on familial aggregation based on mortality are free from bias of overdiagnosis.Patients and methodsWe used the nationwide Swedish Family-Cancer Database to calculate standardized incidence ratios (SIRs) for incident prostate cancer for relatives of patients with any common cancer and standardized mortality ratios (SMRs) for death in prostate cancer for relatives of individuals who died from cancer. Similar risks were determined for any common cancer when relatives were affected by prostate cancer.ResultsWe observed familial aggregation of incident and fatal prostate cancers. Familial clustering (SIRs increased) of prostate cancer and of cancers at discordant sites was found for breast, ovarian, and kidney cancers and melanoma. Also, fatal prostate cancer clustered with these and cervical cancers (SMRs increased).ConclusionsOur findings demonstrate that familial aggregation of prostate and breast cancers are not due to shared screening habits. The data on the association of cancers at discordant sites might be useful for clinical counseling and for mechanistic studies searching explanations to the familial clustering between discordant cancers.     

Trends in cancer survival in 11 European populations from 1990 to 2009: a model-based analysis

Background: The timely provision and interpretation of trendsin population-based cancer survival estimates is an importantclinical and public health priority. Materials and methods: We examined survival trends between 1990–1994and 2000–2004 for 15 common cancers in 10 countries fromdiverse areas of Europe and provide projected survival estimatesfor 2005–2009, using novel techniques of model-based periodanalysis. Results: Between 1990–1994 and 2000–2004, the 5-yearrelative survival increased significantly in all participatingregistries among patients with prostate, breast, and colorectalcancers and in at least 7 of 11 registries for stomach, corpusuteri, ovarian, kidney, and thyroid cancers, as well as fornon-Hodgkin’s lymphoma. Projections suggest further substantialincreases in survival in the calendar period 2005–2009.For most cancer sites amenable to effective early detectionand treatment, major geographical differences persist with lowersurvival in Eastern European countries. Conclusions: Model-based period analysis may be useful in providingpopulation-based cancer survival estimates for currently diagnosedcancer patients. Concerted efforts in the organisation and qualitycontrol of cancer care will be very important to achieving furtherimprovements in cancer control in Europe, and improving outcomesin Eastern European populations remains a priority. Key words: cancer registries, neoplasms, survival Received for publication July 11, 2008. Accepted for publication August 25, 2008.     

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.     

Survival from common and rare cancers in Germany in the early 21st century

BackgroundUntil recently, population-based data of cancer survival in Germany mostly relied on one registry covering ∼1 million people (1.3% of the German population). Here, we provide up-to-date cancer survival estimates for Germany based on data from 11 population-based cancer registries, covering 33 million people and compare them to survival estimates from the United States.Patients and methodsCancer patients diagnosed in 1997–2006 were included. Period analysis was employed to calculate 5-year relative survival for 38 cancers for 2002–2006. German and USA survival rates were compared utilizing the Surveillance, Epidemiology and End Results 13 database.ResultsFive-year relative survival >80% was observed for testicular cancer (93.5%), skin melanoma (89.4%), cancers of the prostate (89.1%) and thyroid (87.8%), Hodgkin’s lymphoma (84.5%) and cancers of the breast (83.7%) and endometrium (81.0%), which together account for almost 40% of cases. For the majority of cancers, German survival estimates were close to or below those in the United States. Exceptions with higher survival in Germany were cancers of the stomach, pancreas and kidney and Hodgkin’s lymphoma.ConclusionsGerman cancer survival estimates are mostly higher than the 2000–2002 pan-European estimates. Further research is needed to investigate causes responsible for differences between German and USA cancer survival rates.     

Familial risks of breast and prostate cancers: Does the definition of the at risk period matter?

Aim‘Being at familial risk’ may have different connotations in studies on familial risk of cancer. The register-based definition of a family history considers individuals with an affected relative at familial risk independently of the family member’s diagnostic time. Alternatively, the individuals are classified to be at familial risk only after the diagnosis date of their relative, relevant to clinical counselling and screening situations. The aim of this study was to compare familial breast and prostate cancer risks according to the two definitions.Patients and methodsThe nationwide Swedish Family-Cancer Database with information on cancers from 1958 to 2006 was used to calculate the hazard ratio of breast and prostate cancers according to family history using Cox regression. Family history was defined considering the number and type of affected relatives and the relative’s diagnostic age, respectively. Individuals were considered at familial risk from their entry to the study or, alternatively, from the diagnostic time of the relative.ResultsHazard ratios were equal whether individuals were considered at risk independent of the relative’s diagnostic date or only after the relative’s diagnostic date.ConclusionThese results indicate that studies on familial breast or prostate cancer risk which do not take the relative’s diagnosis date into account are applicable to screening and clinical counselling situations. The estimates according to the register-based definition are based on larger numbers of patients, which may be crucial for analysis of small groups such as families of multiple cases.     

Incidence, prevalence and survival of patients with rare epithelial digestive cancers diagnosed in Europe in 1995-2002

Background and aimsLittle is known about the epidemiology of rare epithelial digestive cancers. The aim of this study was to report on their incidence, prevalence and survival across Europe.MethodsThe analysis was carried out on 50,646 cases diagnosed from 1995 to 2002 within a population of 162,000,000 in 21 European countries. Age-standardised incidence rates were computed using the European standard population. Prevalence rates, relative survival and period survival indicators for the years 2000–2002 were calculated. The expected number of new cases per year and of prevalent cases in Europe was estimated.ResultsThere were large variations in gallbladder epithelial cancer incidence rates: the incidence in Eastern Europe was 7 times higher than in the UK &; Ireland. Differences between incidence rates were smaller for the other sites. The estimated number of new epithelial cancers arising in the EU each year was estimated to be 11,050 for extrahepatic bile duct cancer, 10,713 for gallbladder cancer, 5427 for anal cancer and 3595 for small intestine cancer. The corresponding estimated number of total prevalent cases was 18,483, 15,620, 40,589 and 13,276. There was also a large variation in the 5-year relative survival rate. For epithelial cancer of the anal canal, this varied between 66% (Central Europe) and 44% (Eastern Europe). The corresponding rates for small intestine cancers were 33% and 20%, for extrahepatic bile duct cancers, 17% and 12% and for gallbladder cancer 13% and 10%.ConclusionThere are large variations within Europe in the incidence and survival of rare digestive cancers according to geographic area.