Increasing incidence and constant mortality rates of breast cancer: Time trends in Stockholm County 1961–1973

Summary This study describes trends in breast cancer incidence and survival in Stockholm County during 1961–1973. A discrepancy between increasing incidence and constant mortality rates was reflected in a significantly improved survival of the more recently treated patients. However, no change in survival was found when the patients were classified by axillary node status. The improvement thus seemed entirely the result of a more favorable stage distribution. The shift towards less advanced tumors was mainly caused by an increased agestandardized incidence of node-negative tumors, whereas the incidence of more advanced tumors seemed relatively unchanged. The survival from first distant metastasis was significantly increased; the use of combination chemotherapy might have contributed to this. The increase, however, was only moderate and did not seem to have contributed much to the improved overall survival. It is concluded that several confounding factors must be recognized when time trends in breast cancer are analyzed. A straightforward interpretation of observed changes is therefore not always possible. An increasing detection of tumors with relatively benign biological properties or lead time bias may well contribute to seemingly improved results.     

Meat subtypes and colorectal cancer risk: A pooled analysis of 6 cohort studies in Japan

Red meat and processed meat have been suggested to increase risk of colorectal cancer (CRC), especially colon cancer. However, it remains unclear whether these associations differ according to meat subtypes or colon subsites. The present study addressed this issue by undertaking a pooled analysis of large population‐based cohort studies in Japan: 5 studies comprising 232 403 participants (5694 CRC cases) for analysis based on frequency of meat intake, and 2 studies comprising 123 635 participants (3550 CRC cases) for analysis based on intake quantity. Study‐specific hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using the Cox proportional hazards model and then pooled using the random effect model. Comparing the highest vs lowest quartile, beef intake was associated with an increased risk of colon cancer in women (pooled HR 1.20; 95% CI, 1.01‐1.44) and distal colon cancer (DCC) risk in men (pooled HR 1.30; 95% CI, 1.05‐1.61). Frequent intake of pork was associated with an increased risk of distal colon cancer in women (pooled HR 1.44; 95% CI, 1.10‐1.87) for “3 times/wk or more” vs “less than 1 time/wk”. Frequent intake of processed red meat was associated with an increased risk of colon cancer in women (pooled HR 1.39; 95% CI, 0.97‐2.00; P trend = .04) for “almost every day” vs “less than 1 time/wk”. No association was observed for chicken consumption. The present findings support that intake of beef, pork (women only), and processed red meat (women only) might be associated with a higher risk of colon (distal colon) cancer in Japanese.     

An international comparison of male and female breast cancer incidence rates

Global international trends in female breast cancer incidence have been described previously but no comparable analysis of male breast cancer incidence rates has been conducted. We obtained male and female case and population data using Cancer Incidence in Five Continents (CI5). We calculated age‐adjusted, sex‐specific incidence rates and female‐to‐male incidence rate ratios (FMIRRs) and compared trends of such for the period 1988–2002. This analysis included 8,681 male breast cancer cases and 1.14 million female breast cancer cases. The highest male incidence rate was observed in Israel at 1.24 per 100,000 man‐years, and the highest female incidence rate was observed in the United States at 90.7 per 100,000 woman‐years. The lowest incidence rates for males (0.16) and females (18.0) were observed in Thailand. In general, male breast cancer incidence trends were variable; a minority of countries displayed evidence for an increase. In contrast, female incidence rates have been increasing in a majority of countries. The Pearson correlation coefficient (r) for male and female breast cancer incidence rates by country during 1988–2002 was 0.69. Male breast cancer rates were generally less than 1 per 100,000 man‐years, in contrast to the much higher rates of female breast cancer, providing for an overall FMIRR of 122. The differences in both incidence rates and time trends between males and females may reflect sex differences in underlying risk factors, pathogenesis, and/or overdiagnosis. Conversely, the high correlation between male and female breast cancer incidences may indicate that both sexes share some common risk factors for breast cancer.     

Increasing incidence of rectal cancer in patients aged younger than 40 years

BACKGROUND:

The incidence of rectal cancer in the United States in young patients is considered to be low. Underestimating this incidence may result in a failure to diagnose younger patients with rectal cancer in a timely manner.

METHODS:

The authors conducted a retrospective cohort study using Surveillance, Epidemiology, and End Results (SEER) cancer registry data. A total of 7661 patients with colon, rectal, and rectosigmoid cancer who were diagnosed at age <40 years were identified between 1973 and 2005. The change in incidence over time for colon and rectal/rectosigmoid cancer was calculated and the annual percent change for anatomic subsites of colorectal cancer compared.

RESULTS:

SEER data demonstrated an increase in the incidence of rectal cancer without any increase in colon cancer (annual percent change of 2.6% vs ?0.2%). The difference was statistically significant and extended to rectosigmoid cancer, but not cancer of the sigmoid colon or descending colon (annual percent change of 2.2% vs 0.4% and ?2.8%, respectively). Joinpoint analysis of the slope of the curve of rectal and rectosigmoid cancer incidence identified the beginning of the increase to be 1984. All races and both sexes demonstrated similar statistically significant increases in the incidence of rectal and rectosigmoid cancer.

CONCLUSIONS:

The incidence of rectal and rectosigmoid cancer appears to be increasing in patients aged <40 years. Patients presenting with rectal bleeding or other alarming signs or symptoms should be evaluated with this finding in mind. Cancer 2010. © 2010 American Cancer Society.     

Meat consumption and colorectal cancer risk in Japan: The Takayama study

Compared with the abundant data from Western countries, evidence regarding meat consumption and colorectal cancer is limited in the Japanese population. We evaluated colorectal cancer risk in relation to meat consumption in a population‐based prospective cohort study in Japan. Participants were 13 957 men and 16 374 women aged ≥35 years in September 1992. Meat intake, assessed with a validated food frequency questionnaire, was controlled for the total energy intake. The incidence of colorectal cancer was confirmed through regional population‐based cancer registries and histological identification from colonoscopy in two main hospitals in the study area. From September 1992 to March 2008, 429 men and 343 women developed colorectal cancer. After adjustments for multiple confounders, a significantly increased relative risk of colorectal cancer was observed in the highest versus lowest quartile of the intake of total and red meat among men; the estimated hazard ratios were 1.36 (95% CI: 1.03, 1.79) for total meat (P for trend = 0.022), and 1.44 (95% CI: 1.10, 1.89) for red meat (P for trend = 0.009). A positive association between processed meat intake and colon cancer risk was also observed in men. There was no significant association between colorectal cancer and meat consumption in women. These results suggest that the intake of red and processed meat increases the risk of colorectal or colon cancer among Japanese men. Abstaining from excessive consumption of meat might be protective against developing colorectal cancer.     

Trends in testicular cancer incidence and mortality in 22 European countries: continuing increases in incidence and declines in mortality

This study profiles testicular cancer incidence and mortality across Europe, and the effects of age, period and generational influences, using age-period-cohort modeling. Despite a 5-fold variation in incidence rates, there were consistent mean increases in incidence in each of the 12 European countries studied, ranging from around 6% per annum (Spain and Slovenia) to 1-2% (Norway). In contrast, declines in testicular cancer mortality of 3-6% per annum were observed in the 1980s and 1990s for the majority of the 22 countries studied, particularly in Northern and Western Europe. The mortality trends in several European countries were rather stable (Romania and Bulgaria) or increasing (Portugal and Croatia). Short-term attenuations in increasing cohort-specific risk of incidence were indicated among men born between 1940 and 1945 in 7 European countries. In Switzerland, successive generations born from the mid 1960s may have experienced a steadily declining risk of disease occurrence. While the underlying risk factors responsible remain elusive, the temporal and geographical variability in incidence may point to an epidemic in different phases in different countries-the result of country-specific differences in the prevalence of one or several ubiquitous and highly prevalent environmental determinants of the disease. Advances in treatment have led to major declines in mortality in many European countries from the mid 1970s, which has translated to cohorts of men at successively lower risk of death from the disease. Slower progress in the delivery of optimal care is however evident from the mortality trends in several lower-resource countries in Southern and Eastern Europe. The first beneficiaries of therapy in these populations may be those men born--rather than diagnosed--in the era of major breakthrough in testicular cancer care.     

Increasing incidence of non-Hodgkin's lymphoma in Canada, 1970-1996: age-period-cohort analysis

Previous studies have shown that the incidence of non-Hodgkin's lymphoma (NHL) has increased in many parts of the world in recent decades. Using data obtained from the Canadian Cancer Registry, the present study examined time trends in NHL incidence in Canada between 1970 and 1996 and the effects of age, period of diagnosis and birth cohort on incidence patterns for each sex separately. Results showed that overall age-adjusted incidence rates increased substantially, from 7.3 and 5.2 per 100,000 in 1970-1971 to 14.0 and 10.0 per 100,000 in 1995-1996 in males and females, respectively. Diffuse lymphoma was the major histological subtype, accounting for approximately 76% of NHL cases over the 27-year period. The data suggest that period effects have played a major role, although birth cohort effects may also have been involved. Sex-specific patterns of the incidence were similar over the time period of diagnosis but were distinct among recent birth cohorts. In conclusion, there is in fact a marked increase in NHL in Canada which cannot be explained in terms of improvements in diagnosis, changes in NHL classification and the increase in AIDS-associated NHL alone. The birth cohort effect in NHL suggests that changes in risk factors may have contributed to the observed increase.     

Survival of colorectal cancer patients in Europe during the period 1978–1989

This study concerns the survival of European patients diagnosed between 1978 and 1989 with colorectal cancer. Variations in survival in relation to age, country and period of diagnosis were examined. Data from the EUROCARE study were supplied by population-based cancer registries in 17 countries to a common protocol. Five years after diagnosis, relative survival rates were 47 and 43% for cancers of the colon and rectum, respectively. Survival decreased with increasing age: the relative risk of dying for the oldest patients (75+) was 1.39 for rectum and 1.54 for colon compared with the youngest patients (15-44 years). In 1985-1989 survival from colorectal cancer differed significantly between different European countries: the Nordic countries (Denmark excluded), The Netherlands, Switzerland, France and Austria were characterised by high survival, whilst Eastern European countries, the U.K. and Denmark were characterised by low survival. There was a general improvement in survival over the period 1978-1989: from 40 to 48% for colon cancer and 38 to 46% for rectal cancer. For neither cancer site did between-country survival differences narrow over the study period. Intercountry and time differences in survival differences are probably related to stage at diagnosis and postoperative mortality.     

结直肠癌的新辅助治疗

新辅助治疗在提高可切除性结直肠癌患者的手术率和生存率方面取得一些可喜结果。以奥沙利铂、依立替康为基础联合化疗,在提高转移性结直肠癌患者手术率与生存率疗效已较为肯定。肝动脉介入治疗(如HAI、TACE等)在新辅助治疗中的应用疗效有待进一步研究。术前PVE和两步肝切除术可提高手术安全性和切除率。     

Trends in colorectal cancer incidence in Norway 1962–2006: an interpretation of the temporal patterns by anatomic subsite

There have been rapid increases in the incidence of colorectal cancer in Norway since the 1960s, and rates rank among the highest worldwide. The primary objectives are to describe trends in left‐ and right‐sided colon cancer and rectal cancer by calendar period and birth cohort and to generate hypotheses as to the etiological factors in operation. Although the age‐adjusted incidence rates of both colon and rectal cancer increased in Norway in both sexes up to the 1980s, subsite‐ and age‐specific analyses reveal a deceleration in the rate of increase thereafter, apparent in the rates of both left‐sided colon and rectal cancer. Overall trends in incidence of right‐sided colon cancer continue to increase in both sexes. Rates in both left‐ and right‐sided colon cancers have tended to stabilize or decrease among successive generations born after 1950, however, while incidence rates of rectal cancer appear to be increasing in recent generations. The all‐ages rates are thus in keeping with the commonly reported “left to right shift” of colon cancer, although standardization masks important observations. The cohort patterns provide further evidence that factors earlier in life are important, and while the complex etiology makes interpretation difficult, modifications in diet, obesity and physical activity in Norway are likely among the drivers of the trends in one or more of the colorectal subsites examined. In summary, the recent downturn in the disease at younger ages provides some reason for optimism, although possible increases in rectal cancer among recent birth cohorts are of concern.     

Coffee drinking and colorectal cancer and its subsites: A pooled analysis of 8 cohort studies in Japan

Coffee is a rich source of bioactive compounds that have potential anticarcinogenic effects. However, it remains unclear whether coffee drinking is associated with colorectal cancer. Also, despite different etiological factors involved in gut physiology, few studies have investigated this association by anatomical site of the lesion. To address these issues, this study examined the association between coffee drinking and colorectal cancer in a pooled analysis from 8 cohort studies conducted in Japan. Among 320,322 participants followed up for 4,503,274 person‐years, 6,711 incident colorectal cancer cases were identified. Study‐specific hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models and then pooled using the random effects model. Coffee drinking was not materially associated with colorectal cancer risk in men or women (pooled HR 0.92, 95% CI 0.82–1.03 in men and pooled HR 0.90, 95% CI 0.76–1.07 in women). Analysis by subsite showed a lower risk of colon cancer among female drinkers of ≥3 cups coffee/day (pooled HR 0.80, 95% CI 0.64–0.99). There was no such association in men. Coffee drinking was not associated with risk of rectal cancer in men or women. Results were virtually the same among never smokers except for an increased risk of rectal cancer associated with frequent coffee consumption. Coffee drinking may be associated with lower risk of colon cancer in Japanese women.     

Regression analyses of prognostic factors in colorectal cancer

In a follow-up study of 110 patients with colorectal cancer, age, sex, erythrocyte sedimentation rate (ESR), hemoglobin (Hb), leukocyte count, emergency operation, tumor site, Dukes' stage, and histologic grade were tested in survival analyses. Dukes' stage was a highly superior prognostic discriminator. In multivariate survival analysis (Cox model) elevated ESR and leukocytosis were significant prognostic factors in addition to the Dukes' stage, indicating high-risk patients with shorter survival.     

Dietary glycemic load and colorectal cancer risk

Background:Insulin and insulin-like growth factors can stimulateproliferation of colorectal cells. High intake of refined carbohydrates andmarkers of insulin resistance are associated with colorectal cancer. To testthe insulin/colon cancer hypothesis, we determined whether the dietaryglycemic index and the glycemic load are associated with colorectal cancerrisk. Design:A case-control study on colorectal cancer conducted inItaly. Cases included 1125 men and 828 women with histologically confirmedincident cancer of the colon or rectum. Controls were 2073 men and 2081 womenhospitalized for acute conditions. We calculated average daily dietaryglycemic index and glycemic load, and fiber intake from a validated foodfrequency questionnaire. Results:Direct associations with colorectal cancer risk emergedfor glycemic index (odds ratio (OR) in highest vs. lowest quintile = 1.7;95% confidence interval (CI): 1.4–2.0) and glycemic load (OR =1.8; 95% CI: 1.5–2.2), after allowance for sociodemographicfactors, physical activity, number of daily meals, and intakes of fiber,alcohol and energy. ORs were more elevated for cancer of the colon thanrectum. Overweight and low intake of fiber from vegetables and fruit appearedto amplify the adverse consequences of high glycemic load. Conclusions:The positive associations of glycemic index and loadwith colorectal cancer suggest a detrimental role of refined carbohydrates inthe etiology of the disease.     

结直肠癌中K-ras基因突变研究

目的研究K-ras基因突变表达与结直肠癌的相关性。方法采用实时荧光定量PCR方法检测89例患者结直肠癌组织中K-ras基因2号外显子12与13编码子突变情况,并结合病理资料进行分析。结果89例患者结直肠癌组织中K-ras基因突变者为37例,突变率为41．6％。其中12编码子突变为29例,突变率为32．6％。13编码子突变为8例,突变率为9．O％。K-ras基因突变与肿瘤位置、分化程度无明显相关性（P〉0．05）,与浸润深度、淋巴结转移、肝转移有相关性（P〈0．05）。淋巴结转移越多K-ras基因突变率越高,有肝转移者K-ras基因突变率高。结论K-ras基因突变在结直肠癌的发生、发展中起重要作用,与浸润深度、淋巴结转移和肝转移密切相关。     

Infection,antibiotic therapy and risk of colorectal cancer: A nationwide nested case–control study in patients with Type 2 diabetes mellitus

Patients with Type 2 diabetes mellitus are at a higher risk of colorectal cancer (CRC). The objective of our study was to examine the inter‐relationship among infection sites, systemic antibiotic use and risk of CRC among patients with Type 2 diabetes mellitus. From a diabetic cohort from the Taiwan's National Health Insurance claims database, we identified 3,593 incident colon cancer cases, 1,979 rectal cancer cases and 22,288 controls and conducted a nested case–control study to examine the association between antibiotic use and CRC incidence. Logistic regression models were applied to estimate the odds ratio (OR) and the 95% confidence interval (95% CI) between infection sites, antibiotic use and CRC incidence. Patients with intra‐abdominal infection were significantly associated with increased risk for colon cancer (OR = 2.01, 95% CI = 1.73–2.35) and rectal cancer (OR = 1.59, 95% CI = 1.26–2.00). Any antianaerobic antibiotic use was associated with a higher risk of colon cancer (OR = 2.31, 95% CI = 2.12–2.52) and rectal cancer (OR = 1.69, 95% CI = 1.50–1.90) but without an obvious dose–response relationship for cumulative use. Antianaerobic antibiotics also increased the risks for those with nonintra‐abdominal infection. No association was found between antiaerobic agent use and the CRC risk. The results suggest intra‐abdominal infections and antianaerobic antibiotic use may be a marker for precancerous lesions or early CRC, although the possibility of antianaerobic antibiotics playing an additional role cannot be excluded. Further research examining the relationship between intra‐abdominal infection, antianaerobic antibiotics use and possible change of microbiota leading to colorectal carcinogenesis is warranted.