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Use of a case-mix approach to study the trends in the incidence of second primary cancers
Authors:Boris Gass  Emilie Marrer  Simona Bara  Karine Ligier  Florence Molinié  Marc Colonna  Laetitia Daubisse-Marliac  Brigitte Trétarre  Bénédicte Lapôtre-Ledoux  Anne-Sophie Woronoff  Anne-Valérie Guizard  Véronique Bouvier  Xavier Troussard  Christian Gaiddon  Delphine Klein  Michel Velten  Jérémie Jégu
Affiliation:1. Registre des cancers du Bas-Rhin, Laboratoire d’Épidémiologie et de Santé Publique, U1113, FMTS, Université de Strasbourg, Strasbourg, France;2. Registre des cancers du Haut-Rhin, Mulhouse, France;3. Registre des cancers de la Manche, Centre Hospitalier Public du Cotentin, Cherbourg-Octeville, France;4. Registre général des cancers de Lille et de sa région, GCS C2RC, Centre Hospitalier Régional Universitaire de Lille Hôpital Calmette, Lille, France;5. Registre des cancers de Loire-Atlantique et Vendée, Centre Hospitalier Universitaire de Nantes, Nantes, France;6. Registre des cancers de l’Isère, Centre Hospitalier Universitaire de Grenoble Pavillon E, Grenoble, France;g. Registre des cancers du Tarn, Albi, France;h. Institut Claudius Regaud, IUCT-O, LEASP – UMR 1027 Inserm – Université Toulouse III, Toulouse, France;i. Registre des tumeurs de l''Hérault, Centre de Recherche, Montpellier, France;j. Registre du cancer de la Somme, Service Épidémiologie, Hygiène et Santé Publique, Centre Hospitalier Universitaire Nord, Amiens, France;k. Registre des tumeurs du Doubs et du Territoire de Belfort ? EA3181, Centre Hospitalier Régional Universitaire de Besançon Saint-Jacques, Besançon, France;l. Registre général des tumeurs du Calvados, Cancers & Préventions – U 1086 Inserm, Centre François Baclesse, Caen, France;m. Registre des tumeurs digestives du Calvados, Cancers & Préventions – U 1086 Inserm, Centre François Baclesse, Caen, France;n. Registre des hémopathies malignes de Basse-Normandie, Unité Fonctionnelle Hospitalo-Universitaire n°0350, Centre Hospitalier Universitaire Nord, Caen, France;o. Service d’épidémiologie et de biostatistique, Centre Paul Strauss, Strasbourg, France;p. Service de Santé Publique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
Abstract:

Purpose

To analyze trends in second primary cancer (SPC) incidence by using a case-mix approach to standardize on first cancer site distribution.

Methods

Cases registered by 13 French cancer registries between 1989 and 2010 and followed-up until June 2013 were included. The person-year approach was used to compute standardized incidence ratios (SIRs) of metachronous SPC. Usual SIRs and cancer site–specific weighted SIRs called “case-mix SIRs” (cmSIRs) were estimated by sex and calendar period of first cancer diagnosis. Calendar trends in SIRs and cmSIRs were compared.

Results

More than 2.9 million person-years at risk were included. Among males, SIRs dropped from 1.49 to 1.23 between 1989–1994 and 2005–2010, while cmSIRs decreased from 1.40 to 1.27. This difference seems mainly related to a stronger representation of prostate cancers (at lower risk of SPC) and a weaker contribution of bladder and head and neck cancers (at higher risk of SPC) in recent periods of diagnosis. Among females, both SIRs and cmSIRs have remained stable at around 1.22 and 1.21, respectively.

Conclusions

The cmSIR is an indicator that is not influenced by changes in first cancer site distribution. Its use should be encouraged to assess second cancer incidence control.
Keywords:Risk assessment  Neoplasms  Second primary  Confounding factors  Reference standards  Registries
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