Blinded and uniform cause of death verification in a lung cancer CT screening trial

Disease-specific mortality is the final outcome of a lung cancer screening trial, therefore cause of death verification is crucial. The use of death certificates for this purpose is debated because of bias, inaccurate completion and incorrect ante mortem diagnoses. A cause of death evaluation process was designed to ensure a uniform and unbiased determination of the graduation of certainty that lung cancer was the underlying cause of death. An independent clinical expert committee will review the medical files of all deceased participants once diagnosed with lung cancer and will make use of a flow chart and predetermined criteria. A pilot study of fifty cases was conducted to determine the performance of this process and to compare the outcome with the official death certificates. The independent review has shown an agreement of 90% (kappa 0.65), which demonstrates a uniform classification. The sensitivity and specificity of the death certificates for lung cancer specific mortality were 95.2 and 62.5%. This demonstrates a limited distinctive character of the death certification process in lung cancer patients. Our results imply that the final outcome of a lung cancer screening trial cannot reliably be established without predetermined criteria and an independent review of blinded cases.     

Frequency of cancer in France

The most recent cancer mortality and morbidity data available for France are presented. In 1999, tumours are the first cause of death among men (87,000 deaths) and the second most common among women (57,000 deaths) after cardiovascular diseases. It is also the most common cause of death in both the male and female populations aged 35 to 74. Lung cancer is the most common cause of cancer death (21,000) in the male population, and breast cancer is the most common cause of death (11,000) in the female population. Cancer mortality rates decrease both in the male population since 1987 and in the female population since 1950, but the different sites present different trends. The total number of cancers diagnosed in 2000 is estimated to be equal to 260,000: 149,000 in the male population and 108,000 in the female population. The most frequent cancer sites are prostate among men (28,000 cases) and breast among women (37,000 cases), two sites for which screening activities are in widespread use.     

Causes of death in elderly prostate cancer patients and in a comparison nonprostate cancer cohort

BACKGROUND: Prostate cancer tends to affect older men and to progress relatively slowly. Since the prevalence of comorbidity increases with advancing age, competing causes of death are important contributors to death rates among prostate cancer patients. Accurate determination of the underlying causes of death in older men dying with prostate cancer may thus also be more difficult. METHODS: We compared the distribution of underlying causes of death in decedents from a population-based cohort of elderly prostate cancer patients to that from a population-based comparison cohort of elderly men without prostate cancer. Among decedents from the prostate cancer patient cohort, we examined associations of patient demographics, disease stage, and initial treatment, with assignment of a prostate cancer underlying cause of death (versus any other cause) by use of multivariable logistic regression. In the subgroup of prostate cancer patient decedents having underlying causes of death other than prostate cancer, the underlying cause distribution was compared with that in nonprostate cancer cohort decedents. RESULTS: Prostate cancer was the underlying cause for 39% (95% confidence interval [CI] = 36.3-41.9) of the decedents in the prostate cancer cohort. Causes of death among prostate cancer patients not dying of prostate cancer were similar to those among the nonprostate cancer cohort decedents. However, in those who were aggressively treated, the adjusted odds of other cancer causes of death were 51% higher (odds ratio [OR] = 1.51; 95% CI = 1.08-2.10) than that in nonprostate cancer patient decedents, while in those treated with watchful waiting the adjusted odds were 34% lower (OR = 0.66; 95% CI = 0.47-0.93). CONCLUSIONS: Initial treatment may influence the underlying cause of death reported in vital statistics for prostate cancer patients.     

Misclassification of breast cancer as cause of death in a service screening area

Objective  The aim of this study was to assess the misclassification of cause of death for breast cancer cases, and to evaluate the differential misclassification between cases detected in an organized screening program and cases found in current clinical practice. Methods  All deaths occurring between 1999 and 2002 within breast cancer cases were linked to hospital discharge records. Death certificates and latest available hospital discharge notes were classified into various categories. We created a classification algorithm defining which combinations of categories (of death certificates and hospital discharge notes) suggested the probability of misclassification and the need for an in-depth diagnostic review. Questionable cases were reviewed by a team of experts in order to reach a consensus on cause of death. Based on our algorithmic classification and diagnostic review results, the agreement between original cause of death and that resulting from the assessment process was analyzed stratifying for every variable of interest. Results  According to death certificates, breast cancer was the cause of death in 66.9% of subjects, and after assessment this figure changed to 65.7%. The misclassification rate was 4.3% and did not differ significantly between screen-detected (4.7%) and non-screen-detected (4.3%) cases. Higher misclassification rates in favor of false positivity (cause of death wrongly attributed to breast cancer in death certificates) was observed for subjects with multiple cancers (6.5% vs. 1.9%), with no admission in the year before death (4.6% vs. 2.4%) and with an unknown cancer stage (4.9% vs 2.4% or 2.3%). Conclusions  The cause of death misclassification rate is modest, causing a slight overestimate of deaths attributed to breast cancer, and is not affected by modality of diagnosis. The study confirmed the validity of using cause-specific mortality for service screening evaluation. For the members of the working group, see Appendix     

全球肿瘤预防控制概况

癌症是全球人口的第一位死因。2007年,全球有790万人死于癌症,约占全死因的13%。其中,72%发生在中低收入国家。预计到2015年,将有900万人死于癌症;到2030年,将有1200万人死于癌症。其中,肺癌、胃癌、肝癌、大肠癌和乳腺癌是引起死亡的主要癌症。男性和女性的癌症谱不同。吸烟是癌症最重要的危险因素。事实证明,将近40%的癌症是可以通过减少烟草使用、提高饮食质量、增加体力活动、降低酒精摄入、消除工作场所致癌物、接种乙肝疫苗和人乳头瘤病毒疫苗而预防的。另外,还有相当一部分癌症是可以通过早期发现和早诊早治而得到治愈的。而且,所有的癌症患者都是需要关爱的。     

乳腺癌治疗相关心血管不良事件的诊治进展

乳腺癌是全球女性最常见的恶性肿瘤，是女性癌症死亡的主要原因，在过去的40年中，随着诊疗手段不断提升，早期乳腺癌的死亡率下降近40%，人们越来越关注乳腺癌患者早期治疗的心脏毒性及长期的预后水平。与治疗相关的心血管不良事件已成为癌症患者死亡的常见原因，且心血管疾病（cardiovascular disease，CVD）是50岁以上乳腺癌患者死亡的主要原因，临床上乳腺癌患者心血管不良事件风险的早期筛查和管理，对提高患者生存率及生活质量尤为重要。本文对乳腺癌治疗相关心血管不良事件的早期诊断及治疗进展作一综述。     

如皋市2008-2012年居民恶性肿瘤死亡分析

背景与目的：随着生活方式的改变,恶性肿瘤的死亡分布发生改变。该研究旨在探讨2008—2012年如皋市居民恶性肿瘤死亡状况,为政府制定政策提供科学依据。方法：采用描述流行病学方法对2008—2012年居民死亡资料进行分析,用EXCEL、SPSS统计分析。结果：如皋市恶性肿瘤死亡占全死因首位,死亡率为264.55/10万,标化死亡率为155.04/10万,男性高于女性。恶性肿瘤前5位死因依次为食管癌、肝癌、肺癌、胃癌和胰腺癌。胰腺癌、结直肠肛管癌在男性及女性均居于第5、6位。神经系统肿瘤在恶性肿瘤居于第8位,骨肿瘤居于恶性肿瘤第10位。男性前列腺癌居于男性恶性肿瘤死因第9位,老年人恶性肿瘤死亡率明显高于其他年龄组,对青少年危害较大的肿瘤为白血病、神经系统肿瘤和骨肿瘤。期望寿命损失年(potential years of life lost,PYLL)居前5位的分别为肝癌、食管癌、肺癌、胃癌和白血病;人均寿命损失年(average years of life lost, AYLL)居前5位的分别为白血病、神经系统肿瘤、肝癌、乳腺癌和骨肿瘤。结论：恶性肿瘤为如皋市居民的主要死亡原因,男性恶性肿瘤死亡率高于女性,老年组高于其他年龄组,胰腺癌居于恶性肿瘤第5位,神经系统肿瘤居于恶性肿瘤第8位。应加强防癌宣传,提高居民抗癌意识,在预防传统肿瘤的同时,加强对胰腺癌、神经系统肿瘤及骨肿瘤防控。开展癌症早诊早治工作,加强对高危人群的筛查,提高居民生活质量。     

Frequency of cancer in France: 2004 update

The most recent cancer mortality and morbidity data available for France are presented. In 1999, cancers are the first cause of death among men (87,000 deaths) and the second most common among women (57,000 deaths) after cardiovascular diseases. Lung cancer is the most common cause of cancer death (21,000) in the male population, and breast cancer is the most common cause of death (11 000) in the female population. Cancer mortality rates decrease both in the male population since 1987 and in the female population since 1950, but the different sites present different trends. The total number of cancers diagnosed in 2000 is estimated to be equal to 280,000, 160,000 in the male population and 120,000 in the female population. The most frequent cancer sites are prostate among men (40,000 cases) and breast among women (42,000 cases), two sites for which screening activities are in widespread use. The tobacco-related lung cancer epidemic is accelerating markedly in the female population and is beginning to decrease in the male population.     

Contemporary accuracy of death certificates for coding prostate cancer as a cause of death: Is reliance on death certification good enough? A comparison with blinded review by an independent cause of death evaluation committee

Background:

Accurate cause of death assignment is crucial for prostate cancer epidemiology and trials reporting prostate cancer-specific mortality outcomes.

Methods:

We compared death certificate information with independent cause of death evaluation by an expert committee within a prostate cancer trial (2002–2015).

Results:

Of 1236 deaths assessed, expert committee evaluation attributed 523 (42%) to prostate cancer, agreeing with death certificate cause of death in 1134 cases (92%, 95% CI: 90%, 93%). The sensitivity of death certificates in identifying prostate cancer deaths as classified by the committee was 91% (95% CI: 89%, 94%); specificity was 92% (95% CI: 90%, 94%). Sensitivity and specificity were lower where death occurred within 1 year of diagnosis, and where there was another primary cancer diagnosis.

Conclusions:

UK death certificates accurately identify cause of death in men with prostate cancer, supporting their use in routine statistics. Possible differential misattribution by trial arm supports independent evaluation in randomised trials.     

Calculation of Life-Time Death Probability due Malignant Tumors Based on a Sampling Survey Area in China

Purpose: To calculate the probability of one person’s life-time death caused by a malignant tumor andprovide theoretical basis for cancer prevention. Materials and Methods: The probability of one person’s deathcaused by a tumor was calculated by a probability additive formula and based on an abridged life table. Alldata for age-specific mortality were from the third retrospective investigation of death cause in China. Results:The probability of one person’s death caused by malignant tumor was 18.7% calculated by the probabilityadditive formula. On the same way, the life-time death probability caused by lung cancer, gastric cancer, livercancer, esophageal cancer, colorectal and anal cancer were 4.47%, 3.62%, 3.25%, 2.25%, 1.11%, respectively.Conclusions: Malignant tumor is still the main cause of death in one’s life time and the most common causesof cancer death were lung, gastric, liver, esophageal, colorectal and anal cancers. Targeted forms of cancerprevention and treatment strategies should be worked out to improve people’s health and prolong life in China.The probability additive formula is a more scientific and objective method to calculate the probability of oneperson’s life-time death than cumulative death probability .     

女性肺癌的临床特征及治疗策略

肺癌是全球恶性肿瘤死亡的首要原因，在我国，肺癌是男性和女性癌症死亡的第一原因。肺癌的发生是一个复杂的过程，涉及遗传、环境等多种因素，约90％的肺癌可能由吸烟引起。由于女性肺癌有其独特的分子表达谱、组织病理学及激素代谢特征，因此被认为是独立于男性肺癌的疾病。本文综述了女性肺癌的主要发病危险因素、临床特点及治疗策略。     

Cumulative cancer mortality risk and potential years of life lost to 64 years of age in Ireland, 1953-2002.

Premature cancer mortality trends were examined by reviewing cumulative mortality risk ('cumulative risk' hereafter) and potential years of life lost (PYLL) up to and including 64 years of age between 1953 and 2002 in Ireland. Trends were assessed quantitatively by Joinpoint analysis of both measures (with PYLL expressed as an age-standardized rate). The age of 64 years was used for these summary measures to reflect the focus of the Irish Government's cancer strategy on cancer in the under-65 population. Some differences emerged when ranking the significant types of cancer using cumulative risk and PYLL values. In general, however, the two methods generated similar overall trends, although PYLL rates tended to show steeper or longer-term declines, presumably reflecting the greater weight given to deaths at younger ages. Most cancers have, in recent years, shown a downward, or levelling-off of, trend for both sexes. The only exceptions were significant increases for oesophageal cancer in men (both measures), and prostate cancer (cumulative risk), cervical cancer (PYLL rate) and lymphoma in both sexes (cumulative risk). Rankings based on both cumulative risk and PYLL showed that male lung cancer is still the leading cause of premature death from cancer in Ireland, despite recent falls in mortality rates. Breast cancer has consistently been the leading cause of premature cancer death in women since the 1950s. Stomach cancer was once the second leading cause of premature cancer death in women, but since the 1960s it has been replaced by lung cancer. Ovarian cancer, having had a middle ranking for many years has, since the early 1990s, become the third leading cause of premature cancer death for women.     

胃肠癌分子靶向治疗

Gastrointestinal cancer is one of the highly prevalent malignant diseases worldwide which is a major cause of morbidity and mortality. Gastric cancer is the second leading cause of cancer mortality in the world and its management, especially in advanced stages, has evolved relatively little [1]. Colorectal cancer (CRC) remains the third most common ma-lignancy and the third leading cause of cancer death worldwide [2]. The surgical treatment is still the most effective therapy for the gastrointestinal cancer...     

The excess mortality rate. A useful concept in cancer epidemiology

Death cause registers and cancer incidence registers are often used to elucidate progress (or lack of progress) in the battle against cancer. Trends in the age-adjusted mortality rate of cancer or of specific cancer types may thus mirror the overall effect of anticancer interventions (prevention, early diagnostics, treatment), but are often influenced by changes in the death cause diagnostics or in the coding routines at the registers. Relative survival rate (or its inversion, relative mortality rate) is sometimes used in order to elucidate improvement due to treatment. It is independent of the death cause diagnoses but often seriously influenced by changes in diagnostics of incident cancer; earlier diagnosis and increased detection of non-fatal cases may thus give an improved relative survival rate, quite unrelated to any improvement in the treatment. In the present paper the excess mortality rate is introduced as a measure which can give additional information concerning effects of anticancer interventions. In contrast to age-adjusted mortality rate it is not dependent on death cause diagnoses or coding routines, and in contrast to relative survival it is independent of the rate of non-fatal incident cancer cases.     

四川省肿瘤医院16年恶性肿瘤住院患者死因构成及变化趋势

目的:回顾性分析四川省肿瘤医院16年来恶性肿瘤住院患者主要死因构成及年代变化趋势。方法:回顾性收集四川省肿瘤医院2004年01月至2019年12月收治的恶性肿瘤住院患者及死亡病例,分析恶性肿瘤住院患者的主要死亡原因,性别、年龄分布,死因构成的年代变化以及死亡患者占同期住院患者比例的年代变化。结果:2004年-2019年16年间我院收治恶性肿瘤住院患者总数280 042例,恶性肿瘤死亡5 213例,恶性肿瘤住院患者和恶性肿瘤死亡患者数量呈逐年上升趋势。前10位死因顺位依次为:肺癌(34.5%)、肝癌(9.8%)、食管癌(8.2%)、结直肠癌(7.4%)、胃癌(5.5%)、淋巴瘤(3.9%)、乳腺癌(3.8%)、胰腺癌(3.6%)、前列腺癌(2.5%)和胆囊癌(2.0%),合计占总死亡数的81.2%。男性病死率明显高于女性(2.1% vs 1.6%,P＜0.001)。<40岁、40~49岁、50~59岁和≥60岁4个年龄组恶性肿瘤住院患者的病死率分别为0.8%、1.4%、1.8%、2.8%,随着年龄的增长,恶性肿瘤的病死率呈明显上升趋势(P＜0.001)。肺癌始终是第一大死因,3个年代的构成比逐年上升。食管癌和胃癌的死亡构成比明显下降,而肝癌和结直肠癌的死亡构成比明显上升。恶性肿瘤死亡患者占同期住院患者比例为1.86%。其中2004年恶性肿瘤死亡患者占同期住院患者比例为12.6%,2019年下降至1.4%,随时间呈明显下降趋势(P＜0.001)。结论:恶性肿瘤住院患者逐年增加,死亡患者占同期住院患者的比例逐年下降,肺癌仍是恶性肿瘤第一大死因,食管癌和胃癌的死亡构成比随时间呈下降趋势。     

江苏省2012年胰腺癌死亡特征分析

[目的]分析江苏省居民胰腺癌死亡情况,为胰腺癌的预防和控制提供参考依据。[方法]利用2012年江苏省死因监测资料,以死亡率、潜在减寿年数（PYLL）、潜在减寿率（PYLLR）和平均减寿年数（AYLL）为主要指标分析胰腺癌的死亡特征。[结果]2012年江苏省居民恶性肿瘤死亡率为197.24/10万,占全人群死亡的28.81%,居全死因第1位。胰腺癌粗死亡率为8.38/10万,占恶性肿瘤的构成比为4.25%,居恶性肿瘤死亡的第6位。江苏省居民因胰腺癌死亡导致的PYLL、PYLLR和AYLL分别为27 212.5人年、0.44‰和10.43人年。[结论]胰腺癌成为导致江苏省居民死亡的主要恶性肿瘤,应当采取适当的预防控制措施,减少胰腺癌对江苏省居民寿命损失的影响。     

Assessing Cancer Burden in Rural India : An Analysis by Cause of Death Statistics

India lacks nationwide cancer registration and systematic death registration. Gaining insight into the magnitude ‍of the cancer problem in India depends mainly on14 population based cancer registries, which provide relatively ‍accurate statistics although the area and population cover by these registries is minimal at about 7% (20% Urban ‍and 1 % Rural). With estimation of cancer burden from other sources, paucity of adequate data on the one hand ‍and the complex pathogenesis of disease on other makes for complexity in dealing with rural populations. However, ‍surveys of cause of death do reveal some interesting patterns that may very well be of use for international comparisons. ‍In this paper an attempt has been made to estimate the cancer burden in rural India using the information available ‍from surveys of cause of death for rural populations conducted by the Government of India. ‍     

Activation of growth factor receptors in esophageal cancer--implications for therapy

Esophageal cancer is a highly aggressive disease and is the seventh most common cause of cancer-related death in the western world. Worldwide, it ranks as the sixth most frequent cause of cancer death. Despite advances in surgical techniques and treatment, the prognosis of esophageal cancer remains poor, with very few long-term survivors. The need for novel strategies to detect esophageal cancer earlier and to improve current therapy is urgent. It is well established that growth factors and growth factor receptor-mediated signaling pathways are important components of the transformation process in many forms of cancer, including esophageal cancer. With the recent advances in drug development, there are emerging possibilities to use growth factor signal transduction pathways in targeted therapy. This review provides a summary of the role of growth factors and their receptors in esophageal cancer and discusses their potential roles as biomarkers and as targets in therapy.     

Global cancer statistics, 2012

Cancer constitutes an enormous burden on society in more and less economically developed countries alike. The occurrence of cancer is increasing because of the growth and aging of the population, as well as an increasing prevalence of established risk factors such as smoking, overweight, physical inactivity, and changing reproductive patterns associated with urbanization and economic development. Based on GLOBOCAN estimates, about 14.1 million new cancer cases and 8.2 million deaths occurred in 2012 worldwide. Over the years, the burden has shifted to less developed countries, which currently account for about 57% of cases and 65% of cancer deaths worldwide. Lung cancer is the leading cause of cancer death among males in both more and less developed countries, and has surpassed breast cancer as the leading cause of cancer death among females in more developed countries; breast cancer remains the leading cause of cancer death among females in less developed countries. Other leading causes of cancer death in more developed countries include colorectal cancer among males and females and prostate cancer among males. In less developed countries, liver and stomach cancer among males and cervical cancer among females are also leading causes of cancer death. Although incidence rates for all cancers combined are nearly twice as high in more developed than in less developed countries in both males and females, mortality rates are only 8% to 15% higher in more developed countries. This disparity reflects regional differences in the mix of cancers, which is affected by risk factors and detection practices, and/or the availability of treatment. Risk factors associated with the leading causes of cancer death include tobacco use (lung, colorectal, stomach, and liver cancer), overweight/obesity and physical inactivity (breast and colorectal cancer), and infection (liver, stomach, and cervical cancer). A substantial portion of cancer cases and deaths could be prevented by broadly applying effective prevention measures, such as tobacco control, vaccination, and the use of early detection tests. CA Cancer J Clin 2015;65: 87–108. © 2015 American Cancer Society.