Testicular cancer incidence to rise by 25% by 2025 in Europe? Model-based predictions in 40 countries using population-based registry data

BackgroundTesticular cancer mainly affects White Caucasian populations, accounts for 1% of all male cancers, and is frequently the most common malignancy among young adult men. In light of the escalating rates of testicular cancer incidence in Europe, and in support of future planning to ensure optimal care of patients with what can be a curable disease, we predict the future burden in 40 European countries around 2025.MethodsCurrent observed trends were extrapolated with the NORDPRED model to estimate the future burden of testicular cancer in the context of changes in risk versus changes in demographics.FindingsDespite substantial heterogeneity in the rates, the vast majority of European countries will see an increasing burden over the next two decades. We estimate there will be 23,000 new cases of testicular cancer annually in Europe by 2025, a rise of 24% from 2005. Some of the most rapid increases in testicular cancer are observed in Croatia, Slovenia, Italy and Spain, and a transition is underway, whereby recent attenuations and declines in rates in certain high-risk countries in Northern Europe contrast with the increasing trends and escalating burden in Southern Europe. According to our estimates for 2025, around one in 100 men will be diagnosed with the disease annually in the highest risk countries of Europe (Croatia, Slovenia and Norway).InterpretationElucidating the key determinants of testicular cancer and the equitable provision of optimal care for patients across Europe are priorities given the steady rise in the number of patients by 2025, and an absence of primary prevention opportunities.FundingNone.     

Patterns and trends in esophageal cancer mortality and incidence in Europe (1980–2011) and predictions to 2015

BackgroundOver the last few decades, esophageal cancer incidence and mortality trends varied substantially across Europe, with important differences between sexes and the two main histological subtypes, squamous cell carcinoma (ESCC) and adenocarcinoma (EAC).Patients and methodsTo monitor recent esophageal cancer mortality trends and to compute short-term predictions in the European Union (EU) and selected European countries, we analyzed data provided by the World Health Organization (WHO) for 1980–2011. We also analyzed incidence trends and relative weights of ESCC and EAC across Europe using data from Cancer Incidence in Five Continents.ResultsLong-term decreasing trends were observed for male esophageal cancer mortality in several southern and western European countries, whereas in central Europe mortality increased until the mid-1990s and started to stabilize or decline over the last years. In some eastern and northern countries, the rates were still increasing. Mortality among European women remained comparatively low and showed stable or decreasing trends in most countries. Between 2000–2004 and 2005–2009, esophageal cancer mortality declined by 7% (from 5.34 to 4.99/100 000) in EU men, and by 3% (from 1.12 to 1.09/100 000) in EU women. Predictions to 2015 show persistent declines in mortality rates for men in the EU overall, and stable rates for EU women, with rates for 2015 of 4.5/100 000 men (about 22 300 deaths) and 1.1/100 000 women (about 7400 deaths). In northern Europe, EAC is now the predominant histological type among men, while for European women ESCC is more common and corresponding rates are still increasing in several countries.Conclusion(s)The observed trends reflect the variations in alcohol drinking, tobacco smoking and overweight across European countries.     

Spatio-temporal analysis of the incidence of colorectal cancer in Guangzhou,2010–2014

Introduction: Colorectal cancer (CRC) is a common type of neoplasm. This study examined the spatio-temporal distribution of the CRC incidence in Guangzhou during 2010–2014. Methods: Colorectal cancer incidence data were obtained from the Guangzhou Cancer Registry System. Spatial autocorrelation analysis and a retrospective spatio-temporal scan were used to assess the spatio-temporal cluster distribution of CRC cases. Results: A total of 14,618 CRC cases were registered in Guangzhou during 2010–2014, with a crude incidence of 35.56/100,000 and an age-standardized rate of incidence by the world standard population (ASRIW) of 23.58/100,000. The crude incidence increased by 19.70% from 2010 (32.88/100,000) to 2014 (39.36/100,000) with an average annual percentage change (AAPC) of 4.33%. The AAPC of ASRIW was not statistically significant. The spatial autocorrelation analysis revealed a CRC incidence hot spot in central urban areas in Guangzhou City, which included 25 streets in southwestern Baiyun District, northwestern Haizhu District, and the border region between Liwan and Yuexiu Dis-tricts. Three high- and five low-incidence clusters were identified according to spatio-temporal scan of CRC incidence clusters. The high-incidence clusters were located in central urban areas including the border regions between Bai-yun, Haizhu, Liwan, and Yuexiu Districts. Conclusions: This study revealed the spatio-temporal cluster pattern of the incidence of CRC in Guangzhou. This information can inform allocation of health resources for CRC screening.     

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.     

Increasing incidence in liver cancer in Canada, 1972–2006: Age-period-cohort analysis

Background/Aims

Our study aimed to assess 1) the temporal trends in incidence and mortality of liver cancer and 2) age-period-cohort effects on the incidence in Canada.

Methods

We analyzed data obtained from the Canadian Cancer Registry Database and Canadian Vital Statistics Death Database. We first examined temporal trends by sex, age group, and birth cohort between 1972 and 2006. Three–year period rates and annual percentage change (APC) were calculated to compare the changes over the study period. We used age-period-cohort modelling to estimate underlying effects on the observed trends in incidence.

Results

The overall age-adjusted incidence rates increased from 2.6 and 1.5 per 100 000 in 1972–74 to 6.5 (APC: 2.9) and 2.2 (APC: 1.2) per 100 000 in 2004–06 among males and females, respectively. The age-adjusted mortality rates increased from 3.3 and 2.0 per 100 000 in 1972–74 to 6.0 (APC: 2.3) and 2.6 (APC: 1.2) per 100 000 in 2004–06 among males and females, respectively. The incidence increased most rapidly in men aged 45–54 years (APC: 4.1) and women aged 65–74 years (APC: 1.7) over the period of study.

Conclusions

The age-period-cohort analysis suggests that birth-cohort effect is underlying the increase in incidence. While the exact reason for the increased incidence of liver cancer remains unknown, reported increase in HBV and HCV infections, and immigration from high-risk regions of the world may be important factors.     

Childhood cancer mortality in Europe, 1970–2007

To update trends in childhood cancer mortality in Europe, we analysed mortality data derived from the World Health Organization for all childhood neoplasms, bone and kidney cancers, non-Hodgkin’s lymphomas (NHL) and leukaemias, in 30 European countries up to 2007. Between 1990–1994 and 2005–2007, mortality from all neoplasms steadily declined in most European countries (from 5.2 to 3.5/100,000 boys and from 4.3 to 2.8/100,000 girls in the European Union, EU). In 2005–2007, however, mortality rates from childhood cancers were still higher in countries from Eastern (4.9/100,000 boys and 3.9/100,000 girls) and Southern (4.0/100,000 boys and 3.1/100,000 girls) Europe than in those from Western (3.1/100,000 boys and 2.5/100,000 girls) and Northern (3.2/100,000 boys and 2.5/100,000 girls) Europe. Similar temporal trends and geographic patterns were observed for leukaemias, with declines from 1.7 to 0.9/100,000 boys and from 1.3 to 0.7/100,000 girls between 1990–1994 and 2005–2007 in the EU. For kidney cancer and NHL mortality rates were low and have been declining in larger European countries over the last 15 years. The pattern of trends was less clear for bone cancer, with no systematic downward trends at age 0–14, though some fall was evident at age 15–19. Thus, mortality from childhood cancer continued to decline over more recent years in most European countries. However, the mortality rates in Eastern – but also Southern – European countries in the mid 2000’s were similar to those in the Western and Northern European ones in the early 1990’s. Some further improvement in childhood cancer mortality is therefore achievable through more widespread and better adoption of currently available treatments.     

Worldwide trends in gastric cancer mortality (1980–2011), with predictions to 2015, and incidence by subtype

Gastric cancer incidence and mortality decreased substantially over the last decades in most countries worldwide, with differences in the trends and distribution of the main topographies across regions. To monitor recent mortality trends (1980–2011) and to compute short-term predictions (2015) of gastric cancer mortality in selected countries worldwide, we analysed mortality data provided by the World Health Organization. We also analysed incidence of cardia and non-cardia cancers using data from Cancer Incidence in Five Continents (2003–2007). The joinpoint regression over the most recent calendar periods gave estimated annual percent changes (EAPC) around −3% for the European Union (EU) and major European countries, as well as in Japan and Korea, and around −2% in North America and major Latin American countries. In the United States of America (USA), EU and other major countries worldwide, the EAPC, however, were lower than in previous years. The predictions for 2015 show that a levelling off of rates is expected in the USA and a few other countries. The relative contribution of cardia and non-cardia gastric cancers to the overall number of cases varies widely, with a generally higher proportion of cardia cancers in countries with lower gastric cancer incidence and mortality rates (e.g. the USA, Canada and Denmark). Despite the favourable mortality trends worldwide, in some countries the declines are becoming less marked. There still is the need to control Helicobacter pylori infection and other risk factors, as well as to improve diagnosis and management, to further reduce the burden of gastric cancer.     

Trends in breast cancer incidence and mortality in France 1990–2008

The objective of this work was to detail the incidence and mortality trends of invasive and in situ breast cancer (BC) in France, especially regarding the development of screening, over the 1990–2008 period. Data issued from nine population-based cancer registries were studied. The incidence of invasive BC increased annually by 0.8 % from 1990 to 1996 and more markedly by 3.2 % from 1996 to 2003, and then sharply decreased until 2006 (?2.3 % per year), especially among women aged 50–69 years (?4.9 % per year). This trend was similar whatever the introduction date of the organized screening (OS) program in the different areas. The incidence of ductal carcinoma in situ steadily increased between 1990 and 2005, particularly among women aged 50–69 years and 70 and older. At the same time, the mortality from BC decreased annually by 1.1 % over the entire study period. This decrease was more pronounced in women aged 40–49 and 50–69 and, during the 1990–1999 period, in the areas where OS began in 1989–1991. The similarity in the incidence trends for all periods of implementation of OS in the different areas was striking. This suggests that OS alone does not explain the changes observed in incidence rate. Our study highlights the importance of closely monitoring the changes in incidence and mortality indicators, and of better understanding the factors causing variation.     

Impact of screening on cervical cancer incidence: A population-based case–control study in the United States

Cervical cancer is widely preventable through screening, but little is known about the duration of protection offered by a negative screen in North America. A case–control study was conducted with records from population-based registries in New Mexico. Cases were women diagnosed with cervical cancer in 2006–2016, obtained from the Tumor Registry. Five controls per case from the New Mexico HPV Pap Registry were matched to cases by sex, age and place of residence. Dates and results of all cervical screening and diagnostic tests since 2006 were identified from the pap registry. We estimated the odds ratio of nonlocalized (Stage II+) and localized (Stage I) cervical cancer associated with attending screening in the 3 years prior to case-diagnosis compared to women not screened in 5 years. Of 876 cases, 527 were aged 25–64 years with ≥3 years of potential screening data. Only 38% of cases and 61% of controls attended screening in a 3-year period. Women screened in the 3 years prior to diagnosis had 83% lower risk of nonlocalized cancer (odds ratio [OR] = 0.17, 95% CI: 0.12–0.24) and 48% lower odds of localized cancer (OR = 0.52, 95% CI: 0.38–0.72), compared to women not screened in the 5 years prior to diagnosis. Women remained at low risk of nonlocalized cancer for 3.5–5 years after a negative screen compared to women with no negative screens in the 5 years prior to diagnosis. Routine cervical screening is effective at preventing localized and nonlocalized cervical cancers; 3 yearly screening prevents 83% of nonlocalized cancers, with no additional benefit of more frequent screening. Increasing screening coverage remains essential to further reduce cervical cancer incidence.     

Long-term survival expectations of cancer patients in Europe in 2000–2002

Period analysis has been shown to provide more up-to-date estimates of long-term cancer survival rates than traditional cohort-based analysis. Here, we provide detailed period estimates of 5- and 10-year relative survival by cancer site, country, sex and age for calendar years 2000–2002. In addition, pan-European estimates of 1-, 5- and 10-year relative survival are provided. Overall, survival estimates were mostly higher than previously available cohort estimates. For most cancer sites, survival in countries from Northern Europe, Central Europe and Southern Europe was substantially higher than in the United Kingdom and Ireland and in countries from Eastern Europe. Furthermore, relative survival was also better in female than in male patients and decreased with age for most cancer sites.     

Trends in smoking-related cancer incidence in Tarragona, Spain, 1980–96

Objectives: To analyze recent trends (1980–96) in the incidence of smoking-related cancers among men and women in Tarragona, Spain. Methods: Data were obtained from a population-based cancer registry. Age-standardized incidence rates were computed. Secular trends, between 1980 and 1996, were estimated using a Poisson regression model. From these figures, age, period, and cohort effects were assessed using the method proposed by Holford. Results: The incidence of all smoking-related cancers combined increased significantly in both sexes. The annual increase was 3.0% in men and 4.5% in women. By sites the annual increase was 4.3% in oral cavity, 5.1% in pancreas, 2.5% in lung, 3.2% in bladder, and 7.7% in kidney cancers among men. Among women the corresponding increments were 7.0% in oral cavity, 7.3% in pancreas, 3.1% in lung, 2.1% in bladder, and 6.9% in kidney cancers. The increasing incidence of lung cancer in women was mostly due to the adenocarcinoma histological type. No increase was observed in esophagus and larynx cancer either in men or women. It was not possible to determine whether the increases are due to a period or cohort effect since the curvature analysis was found to be non-significant. Conclusions: All smoking-related cancers combined, except larynx and esophagus, are increasing in both sexes. The effect of tobacco, alcohol, and occupational exposure to carcinogens could explain the high rates of larynx, bladder, and upper digestive tract cancer in men. The rising incidence rates of lung cancer observed in younger women indicate a change in recent trends that is consistent with changes observed in smoking prevalence. Unless recent upward smoking trends in young women can be reversed, lung cancer in women will rise rapidly in the next few years. New smoking prevention strategies aimed at Spanish women, especially in the younger age groups, should be developed.     

Prostate cancer: Trends in incidence,survival and mortality in the Netherlands, 1989–2006

BackgroundProstate cancer occurrence and stage distribution changed dramatically during the end of the 20th century. This study aimed to quantify and explain trends in incidence, stage distribution, survival and mortality in the Netherlands between 1989 and 2006.MethodsPopulation-based data from the nationwide Netherlands Cancer Registry and Causes of Death Registry were used. Annual incidence and mortality rates were calculated and age-adjusted to the European Standard Population. Trends in rates were evaluated by age, clinical stage and differentiation grade.Results120,965 men were newly diagnosed with prostate cancer between 1989 and 2006. Age-adjusted incidence rates increased from 63 to 104 per 100,000 person-years in this period. Two periods of increasing incidence rates could be distinguished with increases predominantly in cT2-tumours between 1989 and 1995 and predominantly in cT1c-tumours since 2001. cT4/N+/M+-tumour incidence rates decreased from 23 in 1993 to 18 in 2006. The trend towards earlier detection was accompanied by a lower mean age at diagnosis (from 74 in 1989 to 70 in 2006), increased frequency of treatment with curative intent and improved 5-year relative survival. Mortality rates decreased from 34 in 1996 to 26 in 2007.ConclusionsThe increase of prostate cancer incidence in the early 1990s was probably caused by increased prostate cancer awareness combined with diagnostic improvements (transrectal ultrasound, (thin) needle biopsies), but not PSA testing. The subsequent peak since 2001 is probably attributable to PSA testing. The decline in prostate cancer mortality from 1996 onwards may be the consequence of increased detection of cT2-tumours between 1989 and 1995. Unfortunately, data on the use of PSA tests and other prostate cancer diagnostics to support these conclusions are lacking.     

Chronic disease burden among cancer survivors in the California Behavioral Risk Factor Surveillance System, 2009–2010

Purpose

The California Behavioral Risk Factor Surveillance System estimates that 56.6 % of cancer survivors report ever being diagnosed with a chronic disease. Few studies have assessed potential variability in comorbidity by cancer type.

Methods

We used data collected from a representative sample of adult participants in the 2009 and 2010 California Behavioral Risk Factor Surveillance System (n?=?18,807). Chronic diseases were examined with cancer survivorship in case/non-case and case/case analyses. Prevalence ratios (PR) and corresponding 95 % confidence intervals (95 % CI) were estimated using Cox proportional hazards models, with adjustment on race, sex, age, education, smoking, and drinking.

Results

Obesity was associated with gynecological cancers (PR 1.74; 95 % CI 1.26–2.41), and being overweight was associated with gynecological (PR 1.40; 95 % CI 1.05–1.86) and urinary (PR 2.19; 95 % CI 1.21–3.95) cancers. Arthritis was associated with infection-related (PR 1.78; 95 % CI 1.12–2.83) and hormone-related (PR 1.20; 95 % CI 1.01–1.42) cancers. Asthma was associated with infection- (PR 2.26; 95 % CI 1.49–3.43), hormone- (PR 1.46; 95 % CI 1.21–1.77), and tobacco- (PR 1.86; 95 % CI 1.25–2.77) related cancers. Chronic obstructive pulmonary disease (COPD) was associated with infection- (PR 2.16; 95 % CI 1.22–3.83) and tobacco-related (PR 2.24; 95 % CI 1.37–3.66) cancers and with gynecological cancers (PR 1.60; 95 % 1.00–2.56).

Conclusions

This is the first study to examine chronic disease burden among cancer survivors in California. Our findings suggest that the chronic disease burden varies by cancer etiology.

Implications for Cancer Survivors

A clear need has emerged for future biological and epidemiological studies of the interaction between chronic disease and cancer etiology in survivors.