Cancer incidence and mortality projections up to 2020 in Catalonia by means of Bayesian models

Purpose

To predict the burden of cancer in Catalonia by 2020 assessing changes in demography and cancer risk during 2010–2020.

Methods/patients

Data were obtained from Tarragona and Girona cancer registries and Catalan mortality registry. Population age distribution was obtained from the Catalan Institute of Statistics. Predicted cases in Catalonia were estimated through autoregressive Bayesian age-period-cohort models.

Results

There will be diagnosed 26,455 incident cases among men and 18,345 among women during 2020, which means an increase of 22.5 and 24.5 % comparing with the cancer incidence figures of 2010. In men, the increase of cases (22.5 %) can be partitioned in three components: 12 % due to ageing, 8 % due to increase in population size and 2 % due to cancer risk. In women, the role of each component was 9, 8 and 8 %, respectively. The increased risk is mainly expected to be observed in tobacco-related tumours among women and in colorectal and liver cancers among men. During 2010–2020 a mortality decline is expected in both sexes.

Conclusion

The expected increase of cancer incidence, mainly due to tobacco-related tumours in women and colorectal in men, reinforces the need to strengthen smoking prevention and the expansion of early detection of colorectal cancer in Catalonia.     

Long-term trends in incidence, survival and mortality of primary penile cancer in England

Purpose

Few population-based studies exist of long-term trends in penile cancer. We report incidence and mortality trends in England over the 31 years 1979–2009 and survival trends over the 40 years 1971–2010.

Methods

We calculated annual incidence and mortality rates per 100,000 by age and calendar period. We estimated incidence and mortality rate ratios for cohorts born since 1890, and one- and five-year relative survival (%) by age and deprivation category.

Results

A total of 9,690 men were diagnosed with penile cancer during 1979–2009. Age-standardized incidence rates increased by 21 %, from 1.10 to 1.33 per 100,000. Mortality rates fell by 20 % after 1994, from 0.39 to 0.31 per 100,000. Survival analyses included 11,478 men diagnosed during 1971–2010. Five-year relative survival increased from 61.4 to 70.2 %. Five-year survival for men diagnosed 2006–2010 was 77 % for men aged under 60 years and 53 % for men aged 80–99 years. The 8 % difference in five-year survival (66–74 %) between men in the most affluent and most deprived groups was not statistically significant.

Conclusions

The 21 % increase in penile cancer incidence in England since the 1970s may be explained by changes in sexual practice, greater exposure to sexually transmitted oncogenic human papilloma viruses, and decreasing rates of childhood circumcision. Improvement in survival is likely due to advances in diagnostic, staging and surgical techniques. There is a need for public health education and potential preventative strategies to address the increasing incidence.     

Garlic consumption and colorectal cancer risk in the CPS-II Nutrition Cohort

Purpose

The World Cancer Research Fund/American Institute for Cancer Research identified a probable role for garlic in colorectal cancer prevention based on preclinical evidence and epidemiologic studies, but prospective data are limited. The purpose of this paper was to contribute additional evidence on this topic for men and women in a large prospective cohort study.

Methods

In 1999, 42,824 men and 56,876 women in the Cancer Prevention Study II Nutrition Cohort completed a questionnaire with information on dietary garlic consumption. Garlic supplement use was assessed in 2001. Cox proportional hazards regression was used to estimate multivariable-adjusted hazard rate ratios (HRs) and 95?% confidence intervals (CIs).

Results

During 7?years of follow-up, 579 men and 551 women were diagnosed with colorectal cancer. Among men, daily garlic consumption was associated with a non-significant higher colorectal cancer risk (HR?=?1.04, 95?% CI 0.99–1.08 for each additional clove or “4 shakes” of garlic per week), whereas the association was borderline inverse in women (HR?=?0.95, 95?% CI 0.91–1.00, p heterogeneity by sex?=?0.03). Garlic supplement use was not related to a lower risk of colorectal cancer, and in men, former use was associated with a higher risk of colorectal cancer (HR?=?1.85, 95?% CI 1.13–3.03).

Conclusions

These results provide weak support for a role of dietary garlic consumption in colorectal cancer prevention in women, but a possible increased risk in men. Further research is needed to confirm different associations by sex.     

Global and regional estimates of cancer mortality and incidence by site: II. results for the global burden of disease 2000

Background

Mortality estimates alone are not sufficient to understand the true magnitude of cancer burden. We present the detailed estimates of mortality and incidence by site as the basis for the future estimation of cancer burden for the Global Burden of Disease 2000 study.

Methods

Age- and sex- specific mortality envelope for all malignancies by region was derived from the analysis of country life-tables and cause of death. We estimated the site-specific cancer mortality distributions from vital records and cancer survival model. The regional cancer mortality by site is estimated by disaggregating the regional cancer mortality envelope based on the mortality distribution. Estimated incidence-to-mortality rate ratios were used to back calculate the final cancer incidence estimates by site.

Results

In 2000, cancer accounted for over 7 million deaths (13% of total mortality) and there were more than 10 million new cancer cases world wide in 2000. More than 60% of cancer deaths and approximately half of new cases occurred in developing regions. Lung cancer was the most common cancers in the world, followed by cancers of stomach, liver, colon and rectum, and breast. There was a significant variations in the distribution of site-specific cancer mortality and incidence by region.

Conclusions

Despite a regional variation, the most common cancers are potentially preventable. Cancer burden estimation by taking into account both mortality and morbidity is an essential step to set research priorities and policy formulation. Also it can used for setting priorities when combined with data on costs of interventions against cancers.     

Incidence trends and mortality rates of gastric cancer in Israel

Background

Gastric cancer is the fourth most common malignancy worldwide. The incidence trends and mortality rates of gastric cancer in Israel have not been studied in depth. The aim of our study was to try and investigate the aforementioned issues in Israel in different ethnic groups.

Methods

This retrospective study is based on the data of The Israel National Cancer Registry and The Central Bureau of Statistics. Published data from these two institutes were collected, summarized, and analyzed in this study.

Results

Around 650 new cases of gastric cancer are diagnosed yearly in Israel. While we noticed a decline during the period 1990–2007 in the incidence in the Jewish population (13.6–8.9 and 6.75–5.42 cases per 100,000 in Jewish men and women, respectively), an increase in the Arab population was noticed (7.7–10.2 and 3.7–4.2 cases per 100,000 in men and women, respectively). Age-adjusted mortality rates per 10,000 cases of gastric cancer decreased significantly, from 7.21 in 1990 to 5.46 in 2007, in the total population. The 5-year relative survival showed a slight increase for both men and women.

Conclusion

There is a difference in the incidence and outcome of gastric cancer between the Jewish and Arab populations in Israel. The grim prognosis of gastric cancer patients in Israel is probably due to the advanced stage at which gastric cancer is diagnosed in Israel.     

Time trends of cancer incidence and mortality in Catalonia during 1993–2007

Purpose

To describe time trends of cancer in Catalonia, Spain, during the period 1993–2007.

Methods/patients

Data have been provided by two population-based cancer registries, Girona and Tarragona, and the Catalan mortality registry. Cancer incidence in Catalonia has been estimated through modeling methods using data from these health structures.

Results

During 2003–2007, there were 20,042 cancer cases and 9,842 deaths per year among men and 13,673 new cancer cases and 5,882 deaths among women. The most frequent incident cancers among men were prostate (N = 4,258), lung (N = 3,021), colorectal (N = 3,007) and bladder (N = 2,238), whereas among women they were breast (N = 3,907), colorectal (N = 2,088), corpus uteri (N = 734) and lung (N = 527). During 1993–2007, age-standardized incidence rates (ASIRs) rose 1.2 % per year among men [prostate (6.3 %), testis (5.7 %), kidney (2.9 %), liver (2.2 %) and colorectal (2.1 %)]. ASIRs decreased for stomach (?2.9 %), oral cavity and pharynx (?2.8 %), larynx (?2.7 %) and esophagus (?2 %). Among women, ASIRs only rose for lung (5.2 %), kidney (3.1 %), oral cavity and pharynx (2.6 %) and thyroid (1.6 %). ASIRs decreased for corpus uteri (?2.3 %), stomach (?1.7 %) and ovary (?1.6 %). Cancer mortality decreased ?1.3 % per year among men and ?2.1 % among women during the same period.

Conclusion

Among men, the decrease of incidence/mortality of tobacco-related tumors was related to a reduction of smoking prevalence. Among women, the stabilization of breast cancer incidence and the rise of lung cancer incidence are similar to that observed in most European regions. These results allow assessing the effectiveness of public health strategies and they pose new frontiers for cancer control in Catalonia.     

Twenty-first century cancer patterns in small island nations: Grenada and the English-speaking Caribbean

Purpose

Grenada is a small island nation of 105,000 in the Caribbean with one single general hospital and pathology laboratory. This study assesses cancer incidence on the island based on existing pathology reports, and compares the cancer mortality burden between Grenada and other Caribbean nations.

Methods

Age-adjusted overall and site-specific cancer “incidence” rates (based on pathology reports) and mortality rates were calculated and compared for 2000–2009. Next, mortality rates for a more recent period, 2007–2013, were calculated for Grenada and a pool of English-speaking, majority African-ancestry Caribbean island nations. Lastly, for direct mortality comparisons by cancer site, mortality rate ratios were computed using negative binomial regression modeling.

Results

The pathology reports alone do not suffice to calculate national incidence rates but cancer mortality rates are rapidly increasing in Grenada. The leading causes of cancer mortality were prostate and lung cancers among men, and breast and cervical cancers among women. Overall cancer mortality is significantly higher for both male and female Grenadians than their Caribbean counterparts: RR 1.43 (95% CI 1.32–1.55) and RR 1.26 (95% CI 1.15–1.38), respectively. High prostate and non-Hodgkin’s lymphoma rates are concerning.

Conclusions

Given the small existing cancer infrastructure, excessive mortality in Grenada compared to its neighbors may be disproportionately more attributable to low survival than a high cancer risk. Global solutions will be required to meet the cancer control needs of geographically isolated small nations such as Grenada.

     

Components of the metabolic syndrome and risk of prostate cancer: the HUNT 2 cohort, Norway

Background

The metabolic syndrome has been suggested as a unifying link between a “western” lifestyle and an increased prostate cancer risk.

Methods

We assessed the associations of components of the metabolic syndrome with prostate cancer in a prospective cohort based on 29,364 Norwegian men followed up for prostate cancer incidence and mortality from 1995–1997 to the end of 2005 in the second Nord Trøndelag Health Study (HUNT 2).

Results

During a mean 9.3 years follow-up, 687 incident prostate cancers were diagnosed, and 110 men died from prostate cancer. There was little evidence that baseline BMI, waist circumference, waist–hip ratio, total or HDL-cholesterol, triglycerides, presence of the metabolic syndrome, diabetes, antihypertensive use, or cardiovascular disease were associated with incident or fatal prostate cancer. There was weak evidence that raised blood pressure was associated with an increased risk: for each SD (12 mm) increase in diastolic blood pressure, there was an 8% (95% CI = 1–17%; p = 0.04) increased risk of incident prostate cancer.

Conclusions

We found little evidence to support the hypothesis that the metabolic syndrome or its components explains higher prostate cancer mortality rates in countries with a “western” diet and lifestyle. The positive association of blood pressure with prostate cancer warrants further investigation.     

Recreational physical activity, body mass index, and survival in women with colorectal cancer

Background and purpose

Previous studies have shown that physical inactivity and obesity are risk factors for the development of colorectal cancer. However, controversy exists regarding the influence of these factors on survival in colorectal cancer patients. We evaluated the impact of recreational physical activity and body mass index (BMI) before and after colorectal cancer diagnosis on disease-specific mortality and all-cause mortality.

Patients and methods

This prospective cohort study included 1,339 women enrolled in the Women’s Health Initiative study who were diagnosed with colorectal cancer subsequent to study enrollment. BMI and recreational physical activity were measured before cancer diagnosis at study entry (pre-diagnostic) and after diagnosis at study follow-up interviews (post-diagnostic). We used Cox regression to estimate the association between pre- and post-diagnostic exposures and survival after colorectal cancer diagnosis.

Results

Among women diagnosed with colorectal cancer, 265 (13?%) deaths occurred during a median study follow-up of 11.9?years, of which 171 (65?%) were attributed to colorectal cancer. Compared with women reporting no pre-diagnostic recreational physical activity, those reporting activity levels of ≥18 MET-h/week had significantly lower colorectal cancer-specific mortality (hazard ratio (HR)?=?0.68; 95?% confidence interval (CI): 0.41–1.13) and all-cause mortality (HR?=?0.63; 95?% CI: 0.42–0.96). Similar inverse associations were seen for post-diagnostic recreational physical activity. Neither pre- nor post-diagnostic BMI were associated with mortality after colorectal cancer diagnosis.

Conclusion

Recreational physical activity before and after colorectal cancer diagnosis, but not BMI, is associated with more favorable survival.     

Prospective cohort studies of bowel movement frequency and laxative use and colorectal cancer incidence in US women and men

Purpose

The associations between bowel movement frequency, laxative use, and colorectal cancer incidence remain uncertain. No published studies have accounted for potential latency between these factors and colorectal cancer onset.

Methods

We prospectively examined these associations among 88,173 women in the Nurses’ Health Study (NHS, 1982–2010) and 23,722 men in the Health Professionals Follow-up Study (HPFS, 2000–2010). Cox proportional hazards regression models were used to estimate multivariable hazard ratios (HRs, 95 % CIs). We conducted time lagged analyses to evaluate the potential latency in the NHS.

Results

We documented 2,012 incident colorectal cancer cases. The HRs (95 % CIs) for infrequent bowel movement relative to daily were 0.86 (95 % CI 0.71–1.04) in women and 0.81 (95 % CI 0.48–1.37) in men. The HRs for weekly to daily relative to never laxative use were 0.98 (95 % CI 0.81–1.20) in women and 1.41 (95 % CI 0.96–2.06) in men. In women, the HRs for every 3 days or less bowel movement relative to daily were 0.87 (95 % CI 0.59–1.27) for colorectal cancers that developed within 10 years of assessment, 1.03 (95 % CI 0.85–1.26) for 11–18 years after assessment, and 0.73 (95 % CI 0.54–1.01) for 19–28 years after assessment. The corresponding HRs for weekly to daily relative to never laxative use were 0.93 (95 % CI 0.63–1.37), 1.03 (95 % CI 0.74–1.44), and 0.98 (95 % CI 0.71–1.35), respectively.

Conclusion

Bowel movement frequency and laxative use appear not to be associated with colorectal cancer risk in this study.     

Bilateral oophorectomy and risk of cancer in African American women

Purpose

African American women are more likely to undergo hysterectomy, with or without bilateral oophorectomy, at younger ages than white women. It is well established that women who have a bilateral oophorectomy at younger ages are at reduced risk of breast cancer, and there is some evidence of an increased risk of colorectal and lung cancer.

Methods

Using data from 44,514 women in the Black Women’s Health Study, we prospectively investigated the relation of hysterectomy and oophorectomy to incidence of breast, colorectal, and lung cancer and to mortality from cancer. Hazard ratios (HRs) and 95 % confidence intervals (CIs) were estimated using Cox proportional hazards regression with control for confounding factors.

Results

During 16 years of follow-up, hysterectomy alone, relative to no hysterectomy, was not associated with risk of breast, lung, or colorectal cancer. Bilateral oophorectomy, relative to hysterectomy with ovarian conservation, was inversely associated with risk of estrogen receptor-positive (ER+) breast cancer (HR 0.62; 95 % CI 0.45–0.85) but not with ER-negative breast cancer; age at surgery and menopausal hormone use did not modify the associations. HRs for the association of bilateral oophorectomy with incidence of colorectal and lung cancer were nonsignificantly increased for women who had surgery before age 40 years and had used menopausal hormones for less than 2 years (HR 1.65; 95 % CI 0.73–3.73 for colorectal cancer and HR 1.71; 95 % CI 0.68–4.31 for lung cancer). Bilateral oophorectomy was not associated with cancer mortality.

Conclusions

Bilateral oophorectomy was associated with reduced risk of ER+ breast cancer regardless of age at surgery and use of menopausal hormones. There were nonsignificant increases in risk of colorectal and lung cancer for women with oophorectomy at younger ages and short duration of menopausal hormone use.     

Cohort study of workers employed in an Italian tire manufacturing plant, 1962–2004

Purpose

To investigate mortality and bladder cancer incidence among workers of a tire manufacturing plant where antioxidants severely contaminated by beta-naphthylamine were never used.

Methods

Mortality follow-up was performed of 9,501 workers first hired between 1962 when the plant started operations and 2000. Person-years of observation from 1962 to 2004, expected deaths, and standardized mortality ratios (SMR) were calculated. Follow-up for bladder cancer incidence from 1988 to 2003 was carried out, and standardized incidence ratios (SIR) were calculated. Multivariable (Poisson) analyses of bladder cancer incidence and mortality by duration of employment (DOE) and time since first employment (TSFE) were performed.

Results

Among men, SMRs were significantly reduced for all causes, all cancers, lung cancer, cardiovascular, and ischemic heart diseases. Bladder cancer mortality and leukemia mortality were close to expectation but increased with TSFE. Seventy-two incident cases of bladder cancer were observed (SIR?=?1.15; 95?% confidence interval 0.90–1.44), and multivariable analysis suggested a possible increase in rate ratios with DOE. Among women, mortality was close to expectation, but the limited number of observed deaths prevented detailed analyses.

Conclusions

No significant cancer excess was observed. A suggestion of increased risks of bladder cancer and leukemias after extended TSFE was present in men, deserving consideration as exposure to carcinogens possibly occurred early in plant operation. Furthermore, this cohort of workers is still relatively young and less than 10?% have died. There was, thus, limited power to detect small increases in risk at rare cancer sites. Further epidemiological surveillance of this cohort is planned.     

Prediagnostic plasma vitamin B6 (pyridoxal 5′-phosphate) and survival in patients with colorectal cancer

Purpose

Higher plasma pyridoxal 5′-phosphate (PLP) levels are associated with a decreased incidence of colorectal cancer, but the influence of plasma PLP on survival of patients with colorectal cancer is unknown. We prospectively examined whether prediagnostic plasma PLP levels are associated with mortality among colorectal cancer patients.

Methods

We included 472 incident cases of colorectal cancer identified in the Nurses’ Health Study, the Health Professionals Follow-up Study, and the Physicians’ Health Study from 1984 to 2002. The patients provided blood samples two or more years before cancer diagnosis. Stratified Cox proportional hazards models were used to calculate hazard ratios (HR) with 95 % confidence intervals (CI) adjusted for other risk factors for cancer survival.

Results

Higher plasma PLP levels were not associated with a significant reduction in colorectal cancer-specific (169 deaths) or overall mortality (259 deaths). Compared with patients who had less than 45 pmol/ml of plasma PLP (median: 33.6 pmol/ml), those who had 110 pmol/ml or higher levels (median: 158.8 pmol/ml) had multivariable HRs of 0.85 (95 % CI 0.50–1.45, p trend = 0.37) and 0.87 (95 % CI 0.56–1.35, p trend = 0.24) for colorectal cancer-specific and overall mortality. Higher plasma PLP levels, however, seemed to be associated with better survival among patients who had lower circulating 25-hydroxyvitamin D₃ levels (<26.5 ng/ml) (p interaction ≤.005).

Conclusions

Higher prediagnostic plasma PLP levels were not associated with an improvement on colorectal cancer survival overall. Further research is needed to clarify the influence of vitamin B6 on colorectal cancer progression and survival.     

Impact of PSA testing and prostatic biopsy on cancer incidence and mortality: comparative study between the Republic of Ireland and Northern Ireland

Objectives

To investigate the impact of different PSA testing policies and health-care systems on prostate cancer incidence and mortality in two countries with similar populations, the Republic of Ireland (RoI) and Northern Ireland (NI).

Methods

Population-level data on PSA tests, prostate biopsies and prostate cancer cases 1993–2005 and prostate cancer deaths 1979–2006 were compiled. Annual percentage change (APC) was estimated by joinpoint regression.

Results

Prostate cancer rates were similar in both areas in 1994 but increased rapidly in RoI compared to NI. The PSA testing rate increased sharply in RoI (APC = +23.3%), and to a lesser degree in NI (APC = +9.7%) to reach 412 and 177 tests per 1,000 men in 2004, respectively. Prostatic biopsy rates rose in both countries, but were twofold higher in RoI. Cancer incidence rates rose significantly, mirroring biopsy trends, in both countries reaching 440 per 100,000 men in RoI in 2004 compared to 294 in NI. Median age at diagnosis was lower in RoI (71 years) compared to NI (73 years) (p < 0.01) and decreased significantly over time in both countries. Mortality rates declined from 1995 in both countries (APC = ?1.5% in RoI, ?1.3% in NI) at a time when PSA testing was not widespread.

Conclusions

Prostatic biopsy rates, rather than PSA testing per se, were the main driver of prostate cancer incidence. Because mortality decreases started before screening became widespread in RoI, and mortality remained low in NI, PSA testing is unlikely to be the explanation for declining mortality.     

Disparities in cancer incidence by area-level socioeconomic status in the French West Indies

Purpose

Social inequalities in cancer incidence and mortality have been reported in France, but no data are available for the French overseas territories. Our objective was to explore the association between cancer incidence and the socioeconomic level of the residence area in the French West Indies.

Methods

Cancer incidence data were obtained from the cancer registries of Guadeloupe and Martinique (2009–2010). To assess socioeconomic status, we developed a specific index of social deprivation from census data at a small area level. We used Bayesian methods to evaluate the association between cancer incidence and the deprivation index, for all cancers combined and for the major cancer sites.

Results

There was no clear association between area-based deprivation and the incidence of all cancers combined. In men, higher area deprivation was associated with a higher incidence of prostate cancer (relative risk (RR) 1.25, 95% credible interval (CI) 1.04–1.49; RR 1.08, CI 0.91–1.29 in the categories of intermediate and high deprivation, respectively, compared to low deprivation), but was not associated with respiratory cancer. Women living in the most deprived areas had a higher incidence of stomach (RR 1.77, CI 1.12–2.89), breast (RR 1.15, CI 0.90–1.45), and cervical (RR 1.13, CI 0.63–2.01) cancers and a lower incidence of respiratory cancer (RR 0.65, CI 0.38–1.11).

Conclusion

These first results in the French West Indies suggest specific patterns for some cancer sites that need to be further investigated.

     

Cancer incidence in Spain, 2015

Purpose

Periodic cancer incidence estimates of Spain from all existing population-based cancer registries at any given time are required. The objective of this study was to present the current situation of cancer incidence in Spain.

Methods

The Spanish Network of Cancer Registries (REDECAN) estimated the numbers of new cancer cases occurred in Spain in 2015 by applying the incidence-mortality ratios method. In the calculus, incidence data from population-based cancer registries and mortality data of all Spain were used.

Results

In 2015, nearly a quarter of a million new invasive cancer cases were diagnosed in Spain, almost 149,000 in men (60.0%) and 99,000 in women. Globally, the five most common cancers were those of colon–rectum, prostate, lung, breast and urinary bladder. By gender, the four most common cancers in men were those of prostate (22.4%), colon–rectum (16.6%), lung (15.1%) and urinary bladder (11.7%). In women, the most common ones were those of breast (28.0%), colon–rectum (16.9%), corpus uteri (6.2%) and lung (6.0%). In recent years, cancer incidence in men seems to have stabilized due to the fact that the decrease in tobacco-related cancers compensates for the increase in other types of cancer like those of colon and prostate. In women, despite the stabilization of breast cancer incidence, increased incidence is due, above all, to the rise of colorectal and tobacco-related cancers.

Conclusion

To reduce these incident cancer cases, improvement of smoking control policies and extension of colorectal cancer screening should be the two priorities in cancer prevention for the next years.

     

Type 2 diabetes and the risk of mortality among patients with prostate cancer

Purpose

The aim of this study was to determine whether type 2 diabetes is associated with the incidence of prostate cancer mortality and all-cause mortality.

Methods

This study was conducted by linking four databases from the United Kingdom: the National Cancer Data Repository, the Clinical Practice Research Datalink, the Hospital Episodes Statistics database, and the Office for National Statistics database. The cohort consisted of men newly diagnosed with non-metastatic prostate cancer between 1 April 1998 and 31 December 2009, followed until 1 October 2012. Cox proportional hazard models were used to estimate adjusted hazard ratios with 95 % confidence intervals (CIs) of prostate cancer mortality and all-cause mortality comparing patients with to without type 2 diabetes. All models were adjusted for a number of potential confounders, which included excessive alcohol use, smoking, comorbidities, and prostate cancer-related variables.

Results

The cohort consisted of 11,920 patients, which included 1,132 (9.5 %) with preexisting type 2 diabetes. During a mean follow-up of 4.7 (SD 3.0) years, there were 3,605 deaths (incidence rate: 6.4 %/year) including 1,792 from prostate cancer (incidence rate: 3.3 %/year). Type 2 diabetes was associated with a 23 % increased risk of prostate cancer mortality (HR 1.23, 95 % CI 1.04–1.46) and a 25 % increased risk in all-cause mortality (HR 1.25, 95 % CI 1.11–1.40).

Conclusions

The results of this large population-based study indicate that type 2 diabetes is associated with an increased risk of prostate cancer mortality and all-cause mortality, which may signal an association between hyperinsulinemia or other diabetes-associated metabolic derangements and cancer aggressivity.     

Educational inequality in cancer mortality: a record linkage study of over 35 million Italians

Purpose

Large studies are needed to evaluate socioeconomic inequality for site-specific cancer mortality. We conducted a longitudinal census-based national study to quantify the relative inequality in cancer mortality among educational levels in Italy.

Methods

We linked the 2011 Italian census with the 2012 and 2013 death registries. Educational inequality in overall cancer and site-specific cancer mortality were evaluated by computing the mortality rate ratio (MRR).

Results

A total of 35,708,445 subjects aged 30–74 years and 147,981 cancer deaths were registered. Compared to the lowest level of education (none or primary school), the MRR for all cancers in the highest level (university) was 0.57 (95% CI 0.55; 0.58) in men and 0.84 (95% CI 0.81; 0.87) in women. Higher education was associated with reduced risk of mortality from lip, oral cavity, pharynx, oesophagus, stomach, colon and liver in both sexes. Higher education (university) was associated with decreased risk of lung cancer in men (MRR: 0.43, 95% CI 0.41; 0.46), but not in women (MRR: 1.00, 95% CI 0.92; 1.10). Highly educated women had a reduced risk of mortality from cervical cancer than lower educated women (MRR: 0.39, 95% CI 0.27; 0.56), but they had a similar risk for breast cancer (MRR: 1.01, 95% CI 0.94; 1.09).

Conclusions

Education is inversely associated with total cancer mortality, and the association was stronger in men. Different patterns and trends in tobacco smoking in men and women account for at least most of the gender differences.

     

Metastatic Colorectal Cancer to the Small Bowel—an Uncommon Cause of Obscure GI Bleeding: a Three-Case Experience with Review of the Literature

Purpose

Metastatic colorectal cancer to the small intestine is a rare condition presenting with nonspecific symptoms such as obscure gastrointestinal bleeding (OGIB). We report our experience with the use of capsule endoscopy (CE) and double-balloon enteroscopy (DBE) to identify and diagnose the metastatic colorectal cancer to the small bowel. The aim was to demonstrate the approach to the diagnosis of metastatic colorectal cancer to the small bowel including literature review.

Methods

This is a retrospective case series from an academic tertiary referral center. Three patients with a history of colorectal cancer referred for OGIB underwent CE and subsequent DBE.

Results

All patients underwent evaluation including esophagogastroduodenoscopy and colonoscopy prior to referral. In each case, CE was performed revealing the source of bleeding which was confirmed as metastatic colorectal cancer to the small bowel by DBE. Significant lag time was noted from the initial diagnosis of colorectal cancer to the onset of symptomatic small bowel metastasis in this series (1.3–7 years).

Conclusions

We found the incidence of metastatic colorectal cancer to the small intestine of those with small intestine tumors to be 6%. Clinicians should be suspicious of this condition in any patient with OGIB and prior history of colorectal cancer. The approach to this diagnosis is varied but one algorithm includes the combined use of CE for tumor localization and balloon-assisted enteroscopy for confirmation.