Trends in in-patient Hospital Utilization and Surgical Procedures for Breast,Prostate, Lung and Colorectal Cancers in Canada

Objective: To analyse population-based trends of in-patient surgical procedures for breast (female), prostate, lung and colorectal cancers. Methods: The Hospital Morbidity Files supplied hospital data and the Canadian Cancer Registry, incidence data. Age-adjusted rates were standardized to the 1991 Canadian population. Results: All four cancers showed major changes in trends of surgical procedures. For breast cancer, the rate of in-patient breast conservation surgery (BCS) increased from 1981 to the early 1990s while the rate of mastectomy decreased. Because day surgery was not included, the subsequent in-patient BCS rate stayed level. For prostate cancer, the rate of transurethral prostatectomy was initially high but decreased after 1990, while the rate of radical prostatectomy increased rapidly, only minimally affected by the PSA-related peak in incidence. The lung cancer lobectomy rate in men remained at 10/100,000 after 1986, but in women rose from 3/100,000 to 7/100,000, reflecting increasing lung cancer incidence. For colorectal cancer, right hemicolectomies and anterior resections increased, especially in men. Conclusions: Surgery trends reflected changes in incidence and treatment preferences. Canadian trends were generally similar to US trends, although the timing of some of the changes differed. Canadians tended to use less invasive procedures such as BCS and anterior resection.     

Variation in dermcidin expression in a range of primary human tumours and in hypoxic/oxidatively stressed human cell lines

Dermcidin acts as a survival factor in a variety of cancer cell lines under hypoxia or oxidative stress. The aim of this study was to evaluate dermcidin expression in cell lines following simulation of tumour microenvironmental conditions and in a range of primary tumours. Tumour tissues were collected from patients with oesophageal (28 samples), gastric (20), pancreatic (five), bile duct (one) and prostatic (52) carcinomas as well as 30 benign tissue samples, for assessment of dermcidin mRNA levels using real-time PCR. Dermcidin expression was assessed in prostatic and pancreatic cancer cell lines, with and without induction of hypoxia or oxidative stress. Dermcidin mRNA expression was very low or absent in both unstressed and stressed prostate cell lines. None of the primary prostate tissue, benign or malignant, expressed dermcidin mRNA. Only two (4%) of the gastro-oesophageal cancer samples expressed moderate quantities of dermcidin mRNA. However, three (60%) of the pancreatic cancer samples and the single cholangiocarcinoma specimen had moderate/high levels of dermcidin expression. Of the two pancreatic cancer cell lines, one expressed dermcidin moderately but neither showed a response to hypoxia or oxidative stress. Expression of dermcidin in human primary tumours appears highly variable and is not induced substantially by hypoxia/oxidative stress in cell line model systems. The relationship of these findings to dermcidin protein levels and cell survival remains to be determined.     

Exploring time trends in cancer incidence

We examined incidence time-trends for lung, stomach, intestinal, prostate, and breast cancer among Whites diagnosed in the United States between 1973 and 1987. For each sex and five-year age group, we modeled cancer incidence as a log-linear function of diagnosis-year to permit extrapolation over time and simple summarization of trends. Comparisons with nonparametric estimates show that, except for breast cancer, the model performs well. Plots of the annual percent change in incidence cf age illustrate the way in which time trends depend on age. Between 1973 and 1987, stomach cancer incidence decreased by about two percent per year. The annual change in lung cancer incidence progressed from a two to three percent decrease in persons under age 40 to an increase of two percent in men and eight percent in women by age 80. Intestinal cancer incidence decreased annually by as much as three percent in persons under age 50, remained constant in women aged 50 to 74, and otherwise increased about one percent per year. The annual increase in prostate cancer incidence declined from about six percent in men under age 40 to about two percent in men over age 80. After a surge in female breast-cancer diagnoses in 1974, the annual increase in incidence between 1980 and 1987 stabilized at four to six percent.Authors are with the Statistics and Biomathematics Branch, National Institute of Environmental Health Sciences. Address correspondence to Dr Dinse, Statistics and Biomathematics Branch, B3-02, National Institute of Environmental Health Sciences, P.O. Box 12233, Research Triangle Park, NC 27709, USA.     

Conundrums in screening for cancer

Screening for cancer has to be carefully organized for maximum effectiveness, and introduced in full understanding of the natural history of the disease. There are major potential harms as well as benefits from screening. The current state of art for breast, cervix and prostate cancer screening is reviewed, only for breast and cervix are policies of screening in the population justified.     

Macrophage colony-stimulating factor (M-CSF) production in vivo and in vitro in gynecologic malignancies

Background. Macrophage colony-stimulating factor (M-CSF) secreted by malignant cells may regulate cell proliferation via an autocrine and paracrine loop, and M-CSF may be useful as a potential tumor marker. We evaluated the diagnostic significance of M-CSF levels in gynecologic patients. Methods. Serum samples were obtained from 20 healthy women and from 102 gynecologic patients undergoing primary laparotomy, and culture media were obtained from cell lines of gynecologic malignancies (oranian cancer, endometrial cancer, cervical cancer, and choriocarcinoma). M-CSF levels were measured by enzyme-linked immunosorbent assay. Results. M-CSF levels in the sera of patients with ovarian cancer and advanced uterine cancer were significantly higher than those in healthy women and in patients with benign tumors (P < 0.001). M-CSF levels 7 days after operation were significantly higher than those before operation (P < 0.001; paired t-test). But there were no differences between M-CSF levels before and after operation in patients with ovarian cancer. M-CSF levels 3 months after the cessation of treatment had decreased to within the normal range in patients with benign tumor and in cancer patients with no residual tumor. Cell lines of gynecologic malignancies produced M-CSF at various concentrations. Conclusion. These findings suggest that M-CSF, produced not only by cancer cells but also by immune cells in ascites and around tumor tissue and by connective tissue may reflect increased serum M-CSF levels in patients with ovarian cancer, advanced uterine cancer, and benign ovarian tumor, associated with ascites. It seems that operation, because of tissue damage, tissue repair, and various physiological responses, may itself, stimulate M-CSF production. Received: April 27, 1998 / Accepted: December 15, 1998     

Variation in survival of adult patients with thyroid cancer in Europe

The survival of patients with thyroid cancer was analysed using population-based EUROCARE II data from 1978–1989 (trends in survival) and 1985–1989 (cross-sectional comparisons between areas). The data consisted of 7504 patients and covered 37 cancer registration areas in 17 European countries. In 90% of the patients the diagnosis was histologically confirmed. The prognosis of patients with thyroid cancer was relatively favourable. The overall 5-year relative survival rate was 72% for men and 80% for women. Substantial variation in this 5-year rate was observed between countries ranging from 59 to 83% in men and from 72 to 84% in women. Higher than average survival rates were observed in Finland, Iceland, The Netherlands and Sweden. Countries with lower than average rates were Denmark, England, Estonia, Slovakia, Slovenia and Poland (women). Elderly patients had lower survival rates than the younger ones. Time trends in survival (which could be analysed only in selected countries with sufficient numbers of cases) were irregular but generally showed slight increases compared with rates in 1978–1980. Different distributions in the histological subtypes of thyroid cancer is one plausible explanation for the variation in the survival rate. Other likely factors contributing to this are differences in the stage distribution and varying efficacy of treatment. The EUROCARE II data did not permit specific analyses of the roles of various prognostic factors.     

Improvement in survival of patients with cancer of the kidney in Europe

Survival of adult patients with cancer of the kidney, renal pelvis, ureter and urethra (ICD-9 189) was analysed using data from the EUROCARE II study, a collaborative project of 45 population-based cancer registries in 17 European countries. For the period 1985-1989, more than 24000 patients were included and 5-year relative survival was 48%. Large variations were observed between countries with 5-year relative survival ranging from 57% in France, 53% in Italy and 51% in Spain to 35% in Denmark, 33% in Poland and 30% in Estonia. A number of registries also provided information on previous years and survival was seen to improve with time from 44% in 1978-1980 to 50% in 1987-1989. Age was an important determinant of survival with 5 year survival rates decreasing from 63% in patients aged 15-44 years to 36% in patients aged 75 years and older. Variation in survival rates by country or time is probably related to differences in the distribution of tumour stage at diagnosis. Evidence to confirm this theory is, however, lacking.     

Variation in survival of patients with lung cancer in Europe, 1985–1989

In this study, we report on the variation in the prognosis for adult patients with lung cancer within Europe, by age, histology and country from 1985–1989. We considered trends in survival since 1978 for most countries. Survival analysis was carried out on 173 448 lung cancer cases diagnosed between 1985 and 1989 in 44 population-based cancer registries, participating in the EUROCARE study. Relative 1-year survival rates for patients with lung cancer varied from 24 to 40%, being highest in Finland, France, The Netherlands and Switzerland and lowest in Denmark, England, Poland and Scotland. Half of all patients under the age of 45 years died within 1 year of diagnosis, increasing to almost 80% for those aged 75 years or older. Whilst the prognosis for patients with non-small cell carcinoma remained more or less constant between 1978 and 1989 (25% in Denmark and 44% in Finland), that for patients with small cell carcinoma improved slightly, especially in The Netherlands (Eindhoven from 17 to 24%) and Switzerland (Geneva from 24 to 32%). In conclusion, a fairly large variation in lung cancer relative survival rates existed between European countries. The most likely explanation for the differences is the variation in access to specialised care. Except for a slight improvement in short-term survival for patients with small cell lung cancer, survival has remained poor since 1978.     

Socio-economic differences in incidence rates of cancers of the male genital organs in Finland, 1971-95

We studied social class variation in the incidence of cancers of the prostate, testis, penis and scrotum among 1.1 million Finnish men (45-69 years of age) during 1971-95. The incidence of prostate cancer (6,972 cases) was increasing during the study period; the highest at all the times occurred in Social Class I (highest social class), 40-50% higher than in Social Class IV (lowest). The social class gradient was strongest in localized disease but there was some variation in incidence of non-localized prostate cancer. A total of 174 testicular cancer cases were diagnosed during the study period. In the early 1970s, the incidence of testicular cancer in Social Class I was 5-fold compared to Social Classes III and IV. Thereafter, the incidence rate decreased in Social Class I, but increased in the lower classes. The positive social class gradient was similar for seminomas and non-seminomas. For penile cancer (n = 128), the incidence decreased over time and social class variation was small. Only 6 cases of scrotum cancer were observed. In testicular cancer the strong positive social class association in the early 1970s is disappearing along with converging incidence trend slopes in different social classes. The difference diminished to less than 2-fold in the 1990s. Reasons for this observation remain open.     

Disparities in cancer screening in individuals with a family history of breast or colorectal cancer

BACKGROUND:

Understanding racial/ethnic disparities in cancer screening by family history risk could identify critical opportunities for patient and provider interventions tailored to specific racial/ethnic groups. The authors evaluated whether breast cancer (BC) and colorectal cancer (CRC) disparities varied by family history risk using a large, multiethnic population‐based survey.

METHODS:

By using the 2005 California Health Interview Survey, BC and CRC screening were evaluated separately with weighted multivariate regression analyses, and stratified by family history risk. Screening was defined for BC as mammogram within the past 2 years for women aged 40 to 64 years; for CRC, screening was defined as annual fecal occult blood test, sigmoidoscopy within the past 5 years, or colonoscopy within the past 10 years for adults aged 50 to 64 years.

RESULTS:

The authors found no significant BC screening disparities by race/ethnicity or income in the family history risk groups. Racial/ethnic disparities were more evident in CRC screening, and the Latino‐white gap widened among individuals with family history risk. Among adults with a family history for CRC, the magnitude of the Latino‐white difference in CRC screening (odds ratio [OR], 0.28; 95% confidence interval [CI], 0.11‐0.60) was more substantial than that for individuals with no family history (OR, 0.74; 95% CI, 0.59‐0.92).

CONCLUSIONS:

Knowledge of their family history widened the Latino‐white gap in CRC screening among adults. More aggressive interventions that enhance the communication between Latinos and their physicians about family history and cancer risk could reduce the substantial Latino‐white screening disparity in Latinos most susceptible to CRC. Cancer 2011;. © 2011 American Cancer Society.     

消化道癌辅助化疗新进展

消化道癌的发病率及死亡率均较高,手术后易复发、转移,故许多学者致力于辅助化疗研究,以期提高疗效。本文分析结直肠癌、胰腺癌及胃癌辅助化疗的几宗临床研究结果。一些资料显示,辅助化疗可减少复发、延长存活时间,但结果并不一致。肿瘤的病理分期、化疗方案的选择、药物毒副作用所致的依从性降低可能是影响其效果的主要因素。     

Decreasing the cancer burden in developing countries: concerns and recommendations

Although the close of the 20th century witnessed advances in cancer detection and treatment, cancer morbidity and mortality rates steadily increase across the globe within the 21st century. The majority of this cancer burden can be found in underdeveloped and developing countries. A growing concern can be seen regarding this issue, with the research community as well as governmental and non-governmental organizations considering efforts that need to be developed and implemented. In this article, we propose several strategies to reduce cancer burden in developing countries that involve not only governmental and non-governmental organizations in such developing countries but also the research community. Such measures may prove helpful in gaining a better understanding of cancer burden and assist in clinical decision making and the design of prevention strategies for developing countries.     

Cancer incidence in people with AIDS in Italy

People with HIV/AIDS (PWHA) have increased risk of some cancers. The introduction of highly active antiretroviral therapies (HAART) has improved their life expectancy, exposing them to the combined consequences of aging and of a prolonged exposure to cancer risk factors. The aim of this study was to estimate incidence rates (IR) in PWHA in Italy, before and after the introduction of HAART, after adjusting for sex and age through direct standardization. An anonymous record linkage between Italian AIDS Registry (21,951 cases) and Cancer Registries (17.3 million, 30% of Italian population) was performed. In PWHA, crude IR, sex‐ and age‐standardized IR and age‐specific IR were estimated. The standardized IR for Kaposi sarcoma and non‐Hodgkin lymphoma greatly declined in the HAART period. Although the crude IR for all non‐AIDS‐defining cancers increased in the HAART period, standardized IR did not significantly differ in the 2 periods (352 and 379/100,000, respectively). Increases were seen only for cancer of the liver (IR ratio = 4.6, 95% CI: 1.3–17.0) and lung (IR ratio = 1.8, 95% CI: 1.0–3.2). Age‐specific IRs for liver and lung cancers, however, largely overlapped in the 2 periods pointing to the strong influence of the shift in the age distribution of PWHA on the observed upward trends. In conclusion, standardized IRs for non‐AIDS‐defining cancers have not risen in the HAART period, even if crude IRs of these cancers increased. This scenario calls, however, for the intensification of cancer‐prevention strategies, notably smoking cessation and screening programs, in middle‐aged HIV‐patients.     

Interhospital Differences in Cancer Survivals in Japan

The present study was an investigation of variations in cancersurvival rates among hospitals in Japan, focusing in particularon the number of hospital beds as an institutional characteristic.Using data from 11 population-based cancer registries, the three-yearsurvival rates for stomach cancer (n 1665), colorectal cancer(n 1090) and lung cancer (n 895) patients diagnosed in 1985were calculated according to three different hospital categories(100–299, 300–499, 500+ beds). Cox's proportionalhazards model was conducted, with adjustments for sex, age,clinical stage at diagnosis and treatment status, excludingpatients who had been detected by screening (asymptomatic cases).The stomach and lung cancer patients treated in small hospitals(100–299 beds) were at a significantly higher risk ofdeath than those treated in large hospitals (500+ beds) (hazardratio (HR)=1.36, 95% confidence interval (CI)= 1.11–1.65;HR=1.41, 95% CI = 1.13–1.77, respectively). Similar findingswere observed among colorectal cancer patients although theywere not statistically significant. The findings can providesome information useful for the development of future publichealth policies aimed at controlling cancer mortality ratesin our country.     

Ferroptosis’s Role in Genitourinary System Cancer

A cell is the basic unit of life, and death is inevitable for any cell. However, cancer cells that deviate from the normal track can resist death and survive. Ferroptosis is recently discovered as a modulated cell death different from other known forms of cell death in morphology, biochemistry, and genetics. It is characterized by iron-dependent lipid peroxidation regulated by various metabolic pathways. The incidence and mortality of genitourinary system cancer have been increasing recently. Although clinical practice therapy techniques have improved, no plan with a positive prognosis has been identified. For the therapy of cancer, ferroptosis opens up new avenues. Many studies have shown a complex link between ferroptosis and cancer, while some studies have also found the role of ferroptosis in genitourinary system-related cancers and therapeutic prospects. This article reviews the ferroptosis research progress in genitourinary system cancers, including bladder cancer, prostate cancer, ovarian cancer, and cervical cancer. It will also provide new ideas for the treatment of these cancers.     

No further increase in the incidence of esophageal adenocarcinoma in Sweden

Since 1970, the incidence of esophageal adenocarcinoma has increased rapidly in Western populations, whereas the incidences of gastric cardia and gastric non-cardia adenocarcinoma have increased moderately and declined, respectively. The Swedish Cancer Register and Total Population Register provided opportunities for a valid update of incidence trends of these tumors including the year 2008. Joinpoint regression was used to assess any shifts in trends with calendar time. The esophageal adenocarcinoma incidence reached a peak in 2005, and then showed a decrease. During the period 2001-2008, the joinpoint regression analysis indicates a virtually stable incidence (annual percentage increase 1.1, 95% confidence interval [CI] -2.7 to 5.1). The cardia adenocarcinoma incidence has slightly decreased after 1990 (annual percentage decrease -1.0, 95% CI -1.6 to -0.3). The decreasing incidence of gastric non-cardia adenocarcinoma has continued steadily during recent years (annual percentage decrease -4.9 (95% CI -5.2 to -4.7). Thus, an encouraging break in the rising incidence of esophageal adenocarcinoma has been seen in Sweden since 2005, whereas the corresponding incidences of gastric cardia and non-cardia adenocarcinoma have been stable and decreasing, respectively.     

Predisposing,Reinforcing and Enabling Factors Associated with Hepatitis B Testing in Chinese Canadians in British Columbia

Background: Liver cancer, a significant health problem in Chinese, can be controlled through HBV bloodtesting, vaccination, and community education about HBV. The PRECEDE framework has been very helpful inidentifying factors associated with health practices. Objectives: The objective was to identify factors associatedwith HBV testing in Chinese Canadians, using the PRECEDE framework. Methods: Five hundred and thirtythreerandomly selected Chinese Canadian adults were interviewed about HBV blood testing practices. Factorswere grouped as predisposing, reinforcing and enabling. Results: Fifty-five percent had received HBV bloodtesting. Several predisposing factors, all reinforcing factors and one enabling factor were associated with HBVtesting in bivariate analysis. A physician’s recommendation for testing was the strongest factor associated withtesting in multiple logistic regression analysis (OR=4.4, p<0.0001). Interpretation: Many Chinese Canadian adultsin Vancouver have not been tested for HBV. Continuing educational efforts are needed and the PRECEDEframework can inform the development of health education interventions.     

Development in incidence of breast cancer in non-screened Danish women, 1973-2002--a population-based study

The authors report on the incidence rates of breast cancer overall and by histology in a population of unscreened women constituting approximately 80% of the total population of women in Denmark from 1973-2002, utilizing the files of the nationwide Danish Cancer Registry. The age-specific incidence rates of breast cancer increased throughout the period, and further, marked changes in the age-specific incidence pattern were observed, where the plateau and change of slope around the age of 46-48 in 1973-1981 shifted to around age 64-66 years in 1994-2002. Age-period-cohort modeling indicated that these changes were not attributable to a birth cohort effect. Although lobular breast cancer incidence increased more than ductal breast cancer incidence, this was only observed in the first decade after the introduction of the ICD-O system in Denmark and probably is attributable to this, whereas we observed no disproportionate changes by histology in any age group from 1988-2002. Thus, previous reports of a disproportionate increase in lobular breast cancer could not be confirmed in a non-screened population, whereas important changes over the past decade in the age-specific incidence pattern of breast cancer particular around the time of menopause were indicated.