A comparison of national cancer registry and direct follow-up in the ascertainment of ovarian cancer.

The National Health Service Central Register (NHSCR) and direct follow-up were used to document ovarian and fallopian tube cancers in 22000 women from 1986 to 1993. Direct follow-up identified 47/49 cases (96%) and the NHSCR 38/49 (78%). NHSCR ascertainment was incomplete and direct follow-up provided additional information. These findings have implications for interpretation of national cancer statistics and for use of the NHSCR in research trials.     

Completeness in an African cancer registry

Objective: A high level of completeness of case-finding is essential if data from cancer registries are to be useful for comparative studies. A large case series, collected independently of the cancer registry case-finding mechanisms, as part of a study of the influence of HIV infection on cancer risk, was used to evaluate the completeness of the registry in Kampala, Uganda, for the years 1994–1996. Results: For adults aged 15 or more, the completeness of registration of diagnosed cancer cases was 89.6% (95% CI 87.0–91.7) overall. It varied with age (better ascertainment of younger cases, aged under 30) and cancer site (with Kaposi sarcoma cases significantly better identified), and cases with a histology report were more likely to be registered than those without (though the difference was not significant). Completeness declined with time, as in most registries, which continue to identify late cases some time after the initial diagnosis. Conclusion: This is the first objective measurement of completeness of cancer registration in Africa, and it gives reassurance that published incidence rates are reasonably accurate (provided that there is not an insistence on the very latest results).     

Completeness of cancer registration: a new method for routine use

We report a new method of estimating the completeness of cancer registration, in which the proportions of unregistered patients are derived from the time distributions of three probabilities, each of which can be directly estimated from the registry's own data--the probabilities of survival, of registration of the cancer during the patient's life, and of the mention of cancer on the death certificate of a cancer patient who dies. This method allows completeness to be assessed routinely by factors such as age, sex, geographical area and tumour type.     

Evaluation of data quality at the Gambia national cancer registry

The Gambia National Cancer Registry (GNCR) is one of the few nationwide population‐based cancer registries in sub‐Saharan Africa. Most registries in sub‐Saharan Africa are limited to cities; therefore, the GNCR is important in providing estimates of cancer incidence in rural Africa. Our study assesses the quality of its data. The methods proposed by Bray and Parkin, and Parkin and Bray (Eur J Cancer 2009;45:747–64) were applied to the registry data from 1990 to 2009 to assess comparability, validity and completeness. The system used for classification and coding of neoplasms followed international standards. The percentage of cases morphologically verified was 18.1% for men and 33.1% for women, and that of death certificate only cases was 6.6 and 3.6%, respectively. Incidence rates in rural regions were lower than in the urban part of the country, except amongst young male adults. Comparison with other West African registries showed that the incidences of liver and uterine cervical cancer were comparable, but those of prostate and breast in The Gambia were relatively low. The overall completeness was estimated at 50.3% using the capture–recapture method. The GNCR applies international standard practices to data collection and handling, providing valuable data on cancer incidence in sub‐Saharan Africa. However, the data are incomplete in the rural and elderly populations probably because of health care access and use.     

Set-up of a population-based familial breast cancer registry in Geneva, Switzerland: validation of first results.

BACKGROUND: This article evaluates the accuracy of family history of breast and ovarian cancer among first-degree relatives of breast cancer patients, retrospectively collected during the setting up of a population-based family breast cancer registry. PATIENTS AND METHODS: Family histories of cancer for all women with breast cancer recorded at the Geneva Cancer Registry from 1990 to 1999 were retrospectively extracted from medical files. The accuracy of these family histories was validated among Swiss women born in Geneva: all 119 with a family history of breast (n = 110) or ovarian (n = 9) cancer and a representative sample of 100 women with no family history of breast or ovarian cancer. We identified the first-degree relatives of these women with information from the Cantonal Population Office. All first-degree relatives, resident in Geneva from 1970 to 1999, were linked to the cancer registry database for breast and ovarian cancer occurrence. Sensitivity, specificity and level of overall agreement (kappa) were calculated. RESULTS: Among 310 first-degree relatives identified, 61 had breast cancer and six had ovarian cancer recorded at the Geneva Cancer Registry. The sensitivity, specificity and kappa of the reported family histories of breast cancer were 98%, 97% and 0.97, respectively. For ovarian cancer, the sensitivity, specificity and kappa were 67%, 99%, and 0.66, respectively. CONCLUSIONS: This study indicates that retrospectively obtained family histories are very accurate for breast cancer. For ovarian cancer, family histories are less precise and may need additional verification.     

An inverse association between ovarian cysts and breast cancer in the breast cancer family registry

Ovarian cysts of several types are common in women of reproductive age. Their etiology is not well understood but is likely related to perturbations in the hypothalamic-pituitary-gonadal axis. The relationship of ovarian cysts to breast cancer risk is not known, although a negative association with polycystic ovarian syndrome has been reported. Incident, invasive female breast cancer cases, population-based controls and unaffected sisters of cases were studied from 3 countries participating in the Breast Cancer Family Registry: Melbourne and Sydney, Australia; the San Francisco Bay Area, USA; and Ontario, Canada. Using the same questionnaire, information was collected on self-reported history of ovarian cysts and other risk factors. Analyses were based on 3,049 cases, 2,344 population controls and 1,934 sister controls from all sites combined. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using both unconditional and conditional logistic regression using an offset term to account for sampling fractions at 2 of the sites. A significantly reduced risk of breast cancer was observed for women reporting a history of ovarian cysts (OR = 0.70, 95% CI 0.59-0.82, among all cases and all controls). This risk estimate was similar regardless of control group used, within all 3 sites and in both premenopausal and postmenopausal women (ORs ranging from 0.68-0.75, all 95% CI excluded 1.00). A self-reported history of ovarian cysts was strongly and consistently associated with a reduced risk of breast cancer. Further study of ovarian cysts may increase our understanding of hormonal and other mechanisms of breast cancer etiology.     

Improving Accuracy and Completeness in the Collaborative Staging System for Stomach Cancer in South Korea

Background: Cancer staging enables planning for the best treatments, evaluation of prognosis, and predictionsfor survival. The Collaborative Stage (CS) system makes it possible to significantly reduce the proportion ofpatients labeled at an “unknown” stage as well as discrepancies among different staging systems. This study aimsto analyze the factors that influence the accuracy and validity of CS data. Materials and Methods: Data wererandomly selected (233 cases) from stomach cancer cases enrolled for CS survey at the Korea Central CancerRegistry. Two questionnaires were used to assess CS values for each case and to review the cancer registrationenvironment for each hospital. Data were analyzed in terms of the relationships between the time spent foracquisition and registration of CS information, environments relating to cancer registration in the hospitals,and document sources of CS information for each item. Results: The time for extracting and registering datawas found to be shorter when the hospitals had prior experience gained from participating in a CS pilot studyand when they were equipped with full-time cancer registrars. Evaluation of the CS information according tomedical record sources found that the percentage of items missing for Site Specific Factor (SSF) was 30% higherthan for other CS variables. Errors in CS coding were found in variables such as “CS Extension,” “CS LymphNodes,” “CS Metastasis at Diagnosis,” and “SSF25 Involvement of Cardia and Distance from EsophagogastricJunction (EGJ).” Conclusions: To build CS system data that are reliable for cancer registration and clinicalresearch, the following components are required: 1) training programs for medical records administrators; 2)supporting materials to promote active participation; and 3) format development to improve registration validity.     

No socioeconomic inequalities in ovarian cancer survival within two randomised clinical trials

Background:

Ovarian cancer is the leading cause of death among cancers of the female genital tract, with poor outcomes despite chemotherapy. There was a persistent socioeconomic gradient in 1-year survival in England and Wales for more than 3 decades (1971–2001). Inequalities in 5-year survival persisted for more than 20 years but have been smaller for women diagnosed around 2000. We explored one possible explanation.

Methods:

We analysed data on 1406 women diagnosed with ovarian cancer during 1991–1998 and recruited to one of two randomised clinical trials. In the second International Collaborative Ovarian Neoplasm (ICON2) trial, women diagnosed between 1991 and 1996 were randomised to receive either the three-drug combination cyclophosphamide, doxorubicin and cisplatin (CAP) or single-agent carboplatin given at optimal dose. In the ICON3 trial, women diagnosed during 1995–1998 were randomised to receive either the same treatments as ICON2, or paclitaxel plus carboplatin.Relative survival at 1, 5 and 10 years was estimated for women in five categories of socioeconomic deprivation. The excess hazard of death over and above background mortality was estimated by fitting multivariable regression models with Poisson error structure and a dedicated link function in a generalised linear model framework, adjusting for the duration of follow-up and the confounding effects of age, Federation of Gynecology and Obstetrics (FIGO) stage and calendar period.

Results:

Unlike women with ovarian cancer in the general population, no statistically significant socioeconomic gradient was seen for women with ovarian cancer treated in the two randomised controlled trials. The deprivation gap in 1-year relative survival in the general population was statistically significant at −6.7% (95% CI (−8.1, −5.3)), compared with −3.6% (95% CI (−10.4, +3.2)) in the trial population.

Conclusions:

Although ovarian cancer survival is significantly lower among poor women than rich women in England and Wales, there was no evidence of an association between socioeconomic deprivation and survival among women with ovarian cancer who were treated and followed up consistently in two well-conducted randomised controlled trials. We conclude that the persistent socioeconomic gradient in survival among women with ovarian cancer, at least for 1-year survival, may be due to differences in access to treatment and standards of care.     

Cytopathological diagnosis in a cancer registry

BACKGROUND.

To assess the role of cytology in tumor diagnosis and to explore the potential of this technique to improve tumor registry quality, the authors investigated the role of cytology as a diagnostic tool in registry databases.

METHODS.

Through the Italian Network of Cancer Registry (AIRTum) archive, the authors retrieved tumors diagnosed during the years 1983–2002 from several registries, Varese, Torino, Ragusa, Ferrara, Genova, and the Tuscan Cancer Registry. The authors then analyzed the amount of morphological confirmation by topographic code, distinguishing cytological from histological diagnosis. The authors analyzed, only for the Tuscan Cancer Registry, the amount of morphological confirmation by both histological and cytological diagnosis and demonstrated the variation of cytological confirmation with stage of tumor.

RESULTS.

The better morphological modality for diagnosis was rarely cytology, particularly among lung and pleural tumors; when considered together with histological analysis, cytology examination was often reported in cervical uterine and breast tumors. The usefulness of cytology increases with tumor stage, particularly in sites where biopsy is performed with difficulty.

CONCLUSIONS.

Cytology may be useful to improve tumoral characterization in advanced stages or in sites inaccessible for histology; moreover, cytology is useful as an initial detector of pathology, prior to histology. A prospect of improvement in diagnostic cytopathology and the use of ancillary techniques, such as molecular biology, could help clinicians and could increase the accuracy of cancer registration. Cancer (Cancer Cytopathol) 2007. © 2007 American Cancer Society.     

Familial breast cancer registry program in patients referred to the cancer institute of Iran

Introduction: Annually a considerable number of people die because of breast cancer, a common diseaseamong women also in Iran. Identifying risk factors and susceptible people can lead to prevention or at leastearly diagnosis. Among susceptibility risks, 5-10% of patients have a family history predisposing factor whichcan influence the risk of incidence among the family. Having a registry program can be a more practical wayto screen high risk families for preventive planning. Method: Based on inclusion criteria, a questionnaire wasprepared and after a pilot study on a small number of patients, actual data were collected on 400 patients andprocessed in SPSS 16.0. Results: Totally, 28.2%of the patients were younger than 40 years old and 36.8% hadthe included criteria for familial breast cancer (FBC). 102 patient’s samples could be compared for receptorpresentation. Similar to other studies, the number of triple negative breast cancers increased as the age decreased.Conclusion: The high percentage of patients with FBC among 400 cases in this study demonstrates that in orderto design an infrastructural diagnostic protocol and screening of patients with FBC, a precise survey related tofrequency and founder mutations of FBC is needed nationwide.     

Immunotherapy in ovarian cancer

Immunotherapy aims to develop combination approaches that simultaneously augment immunity while preventing local immune suppression. Despite advances in combinatorial chemotherapy regimens and the advent of intraperitoneal chemotherapy administration, current therapeutic options for patients with ovarian cancer are inadequate. Advances in immunotherapy offer a promising frontier for treating ovarian tumors. Multiple immunotherapeutic modalities are currently developed and tested in clinical trials. Antibody-based therapies, immune checkpoint blockade, cancer vaccines, and chimeric antigen receptor–modified T cells have demonstrated preclinical success and entered clinical testing. In this review, we discuss these promising immunotherapeutic approaches and emphasize the importance of combinatorial treatment strategies and biomarker discovery.     

Characterization of ovarian cancer survival by histotype and stage: A nationwide study in Norway

Contemporary population-based data on ovarian cancer survival using current subtype classifications and by surgical status are sparse. We evaluated 1-, 3-, 5- and 7-year relative (and overall) survival, and excess hazards in patients with borderline tumors or invasive epithelial ovarian cancer diagnosed 2012 to 2021 in a nationwide registry-based cohort in Norway. Outcomes were evaluated by histotype, FIGO stage, cytoreduction surgery and residual disease. Overall survival was evaluated for non-epithelial ovarian cancer. Survival of women with borderline ovarian tumors was excellent (≥98.0% 7-year relative survival). Across all evaluated invasive epithelial ovarian cancer histotypes, 7-year relative survival for cases diagnosed with stages I or II disease was ≥78.3% (stage II high-grade serous). Survival for ovarian cancers diagnosed at stage ≥III differed substantially by histotype and time since diagnosis (eg, stage III, 5-year relative survival from 27.7% [carcinosarcomas] to 76.2% [endometrioid]). Overall survival for non-epithelial cases was good (91.8% 5-year overall survival). Women diagnosed with stage III or IV invasive epithelial ovarian cancer and with residual disease following cytoreduction surgery had substantially better survival than women not operated. These findings were robust to restriction to women with high reported functional status scores. Patterns for overall survival were similar to those for relative survival. We observed relatively good survival with early stage at diagnosis even for the high grade serous histotype. Survival for patients diagnosed at stage ≥III invasive epithelial ovarian cancer was poor for all but endometrioid disease. There remains an urgent need for strategies for risk reduction and earlier detection, together with effective targeted treatments.     

An Independent Survey to Assess Completeness of Registration: Population Based Cancer Registry,Chennai, India

Cancer registration in the population based cancer registry (PBCR), Chennai, India, is carried out by activemethods. It undertakes re-screening of cases in government hospitals and Cancer Institute (WIA), trace back deathcertificate notifications and collect information on all the deaths, irrespective of the stated cause on the deathcertificate, occurring in the registry area routinely to reduce the under-registration of incident cancer cases andassociated mortality. The completeness of registration during 1982-95 was assessed by conducting an independentsurvey in randomly selected areas in Chennai. The total number of households covered in the survey was 7737 andwere collected which constituted 1% of the Chennai city population. The response rate to the survey was 96%. Atotal of 42,502 incident cancer cases were registered in Chennai PBCR during 1982-95. The total number of cancercases that were already registered in PBCR from the survey area during 1982-95 was 208. Out of 208 cases, 91 (44%)were identified in the survey; the families of the remaining 117 had migrated out of the surveyed area. Two newcancer cases hitherto unregistered in the PBCR during 1982-95 were identified from the survey. Based on the survey,it is estimated that the completeness of cancer registration in Chennai PBCR is 96%, which is comparable to those ofother registries in the world.     

Availability of stage at diagnosis,cancer treatment delay and compliance with cancer guidelines as cancer registry indicators for cancer care in Europe: Results of EUROCHIP‐3 survey

EUROCHIP (European Cancer Health Indicators Project) focuses on understanding inequalities in the cancer burden, care and survival by the indicators “stage at diagnosis,” “cancer treatment delay” and “compliance with cancer guidelines” as the most important indicators. Our study aims at providing insight in whether cancer registries collect well‐defined variables to determine these indicators in a comparative way. Eighty‐six general European population‐based cancer registries (PBCR) from 32 countries responded to the questionnaire, which was developed by EUROCHIP in collaboration with ENCR (European Network of Cancer Registries) and EUROCOURSE. Only 15% of all the PBCR in EU had all three indicators available. The indicator “stage at diagnosis” was gathered for at least one cancer site by 81% (using TNM in 39%). Variables for the indicator “cancer treatment delay” were collected by 37%. Availability of type of treatment (30%), surgery date (36%), starting date of radiotherapy (26%) and starting date of chemotherapy (23%) resulted in 15% of the PBCRs to be able to gather the indicator “compliance to guidelines”. Lack of data source access and qualified staff were the major reasons for not collecting all the variables. In conclusion, based on self‐reporting, a few of the participating PBCRs had data available which could be used for clinical audits, evaluation of cancer care projects, survival and for monitoring national cancer control strategies. Extra efforts should be made to improve this very efficient tool to compare cancer burden and the effects of the national cancer plans over Europe and to learn from each other.     

Role of cytoreductive surgery in recurrent ovarian cancer

Cytoreductive surgery is well established in patients with primary ovarian cancer. The benefit of surgery in patients with recurrent ovarian cancer remains a controversial matter. There is a large heterogeneity in surgical results published in the literature, possibly caused by infrastructure, surgeons’ philosophy and belief in adding various surgical skills. This might also be a result of different preoperative selection procedures. Further questions to be addressed are the definition of surgical end points and whether there are predictive factors for a successful surgery. The surgical end point in recurrent ovarian cancer should be complete resection. Predictive factors could help identify patients in whom complete resection is possible.     

BRCA1 mutations in ovarian cancer and borderline tumours in Norway: a nested case-control study

The aims of the present study were to find the frequency of the most common BRCA1 mutations in women with ovarian tumours identified from a population-based cancer registry and in the general population, to estimate the relative risk of ovarian tumours among the mutation carriers, and to explore the value of using CA125 as a prediagnostic test. The study was designed as a nested case-control study within a cohort mainly consisting of participants in population-based health examinations. The data files of The Cancer Registry of Norway and the Janus serum bank were linked to identify cases with ovarian cancer and borderline tumours. Hereditary BRCA1 mutations were determined using archived serum samples and capillary electrophoresis. Altogether 478 ovarian cancer patients and 190 patients with borderline tumours were identified, and 1421 and 568 matching controls were selected. Odds ratios (OR) of developing ovarian cancer and borderline tumours in the presence of BRCA1 mutations and CA125 level were derived from conditional logistic regression models. Among the 478 ovarian cancer patients, 19 BRCA1 mutations were identified (1675delA, 1135insA, 816delGT and 3347delAG), none among the patients with borderline tumours. Only two of the 1989 controls were BRCA1 mutation carriers (0.10%). The risk of ovarian cancer among the mutation carriers was strongly elevated (OR=29, 95% CI=6.6-120). CA125 was a marker for ovarian cancer, but the sensitivity was low. This study showed that BRCA1 mutation carriers have a very high risk of ovarian cancer. However, since the prevalence of BRCA1 mutations in the Norwegian population was low, the proportion of ovarian cancers due to BRCA1 mutations seemed to be low, about 4%. The sensitivity of using CA125 only as a screening test for ovarian cancer was low.     

2000—2015年中国肿瘤登记地区胃癌发病趋势及年龄变化

目的 了解中国胃癌发病趋势及年龄变化,为胃癌防控提供依据。方法 基于22个有连续数据的登记处,整理2000—2015年胃癌发病数据,利用Joinpoint软件进行发病趋势分析。分析2000—2015年平均发病年龄,2000及2015年标化年龄别发病构成,构建出生队列并计算1920—2015年出生人群发病率、年龄别发病率。结果 2000—2015年中国22个肿瘤登记地区胃癌标化发病率呈现下降趋势,平均每年下降3.0%(-3.5~-2.4%)。人群出现发病年龄后移趋势,人口结构标化后除农村地区外各人群发病年龄的后移趋势消失。农村地区发病年龄上升趋势明显,高年龄发病患者占比增加。结论 胃癌发病率出现下降趋势,平均发病年龄出现后移趋势。     

凋亡抑制蛋白与卵巢癌化疗耐药

卵巢癌是严重威胁妇女健康的恶性肿瘤之一,其病死率在妇科肿瘤中占第一位.化疗耐药是导致其治疗失败、病死率居高不下的重要原因.已有的研究表明,抗凋亡机制在肿瘤细胞发生、发展及化疗耐药中起重要作用.凋亡抑制蛋白(IAPs)是重要的细胞凋亡调节因子,在细胞凋亡中起关键作用.本文主要综述IAPs与卵巢癌化疗耐药的相关进展.     

Second primary cancer among 217702 colorectal cancer survivors: An analysis of national German cancer registry data

With improvements in survival after colorectal cancer (CRC), more survivors are at risk of developing a second cancer, particularly in younger populations where CRC incidence is increasing. We estimated the incidence of second primary cancer (SPC) in CRC survivors and its potential risk factors. We identified CRC cases diagnosed between 1990 and 2011 and SPCs until 2013 from nine German cancer registries. Standardized incidence ratios (SIR) and absolute excess risk (AER) per 10 000 person-years were calculated and were stratified by index site: colon cancer (CC) and rectal cancer (RC), age and sex. Cox regression assessed potential SPC risk factors, including primary tumor-related therapy considering death as a competing risk. We included 217 202 primary CRC cases. SPC occurred in 18 751 CRC survivors (8.6%; median age: 69 years). Risk of cancer was significantly higher in CRC survivors than in the general population (SIR males 1.14, 95% confidence interval [CI] 1.12-1.17, AER = 24.7; SIR females 1.20, 95% CI 1.17-1.23, AER = 22.8). Increased risks of SPCs were observed for the digestive system, urinary system and female and male reproductive organs. CRC incidence increased in younger persons (<50 years) and SPC incidence was 4-fold in this group (SIR males 4.51, 95% CI 4.04-5.01, AER = 64.2; SIR females 4.03, 95% CI 3.62-4.48, AER = 77.0). Primary tumor-related factors associated with SPC risk were right-sided cancer and smaller primary tumor size. Treatment and risk of SPC differed for CC (no effect) and RC (lower risk after chemotherapy). CRC survivors have excess risk of developing SPC, with particular characteristics that could guide targeted surveillance.     

2010-2014年浙江省肿瘤登记地区子宫体癌发病与死亡分析

目的近年来子宫体癌发病呈现明显上升趋势,为了解浙江省近年来女性子宫体癌流行现状,现分析2010-2014年浙江省肿瘤登记地区子宫体癌的发病与死亡情况。方法数据来源于浙江省肿瘤防治办公室14个登记处(浙江省)上报的子宫体癌发病、死亡和人口资料,分别计算发病(死亡)例数、粗发病率(死亡率)、构成比和顺位、中国标准人口构成(中标率)、Segi’s标准人口构成(世标率)、累积率、截缩率、年龄别发病率(死亡率)、发病率(死亡率)年度变化百分比(annual change percent change,APC)及95%CI等指标。结果2010-2014年浙江省14个肿瘤登记地区共报告子宫体癌新发病例2767例,占女性癌症新发病例的3.08%。子宫体癌发病率为9.46/10万,中标率为6.11/10万,位居女性癌症发病顺位的第8位。子宫体癌发病率呈波动增长趋势,从2010年的9.31/10万上升至2014年的10.28/10万,APC为1.89%(95%CI:-2.90~6.91)。2010-2014年共报告子宫体癌死亡病例797例,占女性癌症死亡病例的2.10%。子宫体癌死亡率为2.72/10万,中标率为1.58/10万,位居女性癌症死因顺位的第13位。子宫体癌死亡率呈现波动下降趋势,由2010年的2.76/10万降至2014年的2.52/10万,APC为-4.28%(95%CI:-13.82~6.33)。结论浙江省子宫体癌发病率呈波动上升趋势,但死亡率呈波动下降趋势,应通过提高早诊早治比例、提高女性自我防护意识和倡导健康生活方式等综合措施做好子宫体癌防控。