Associations between regional socioeconomic deprivation and cancer risk: Analysis of population-based Cancer Registry data from Bavaria, Germany

ObjectivePrevious research from other countries shows a positive association between cancer risk and regional deprivation. This study explores this association for lung and colorectal cancers in Germany.MethodRegional deprivation was assessed by the ‘Bavarian Index of Multiple Deprivation’. Cancer data were provided by the Cancer Registry of Bavaria (2003–2006). The association between cancer risk and regional deprivation was evaluated by multilevel Poisson regression analysis.ResultsCrude incidence and mortality rates (per 1000 people) in the least deprived areas were 1.46 and 0.92 for lung cancer, 2.82 and 0.69 for colorectal cancer. For lung cancer, the age-adjusted relative risk (RR) for incidence in the most deprived districts (compared with the least deprived) in men was 1.41 (95% CI: 1.28–1.54), for mortality 1.59 (95% CI: 1.40–1.80); in women, an elevated RR was seen for mortality (1.24, 95% CI: 1.06–1.46). For colorectal cancer, the RR for incidence (men: 1.31, 95% CI: 1.17–1.46; women: 1.25, 95% CI: 1.12–1.40) and mortality (men: 1.51, 95% CI: 1.28–1.80; women: 1.49, 95% CI: 1.26–1.77) was always highest in the most deprived districts.ConclusionAt the district level in Bavaria, the risk for lung and colorectal cancers mostly increases with increasing regional deprivation.     

Association between drinking water uranium content and cancer risk in Bavaria, Germany

Objective

To evaluate the possible association between uranium (U) content in public drinking water on the one hand and the risk of cancer of the colorectum, lung, female breast, prostate, kidney, and urinary bladder, total cancer, and leukemia on the other hand in Bavaria, an ecologic study on the level of municipalities was performed.

Methods

Cancer incidence data for the years 2002–2008 were obtained from the population-based cancer registry Bavaria according to sex. Current U content data of public drinking water on the level of municipalities were obtained from a publicly available source. The possible association between drinking water U content and cancer risk adjusted for average socio-economic status was evaluated using Poisson regression.

Results

Drinking water U content was below 20 μg/L in 458 out of 461 included municipalities. We found a significantly increased risk of leukemia in men in the intermediate (U level, 1.00–4.99 μg/L; relative risk [RR], 1.14) and in the highest U exposure category (U level, ≥5 μg/L; RR, 1.28). Moreover, in women, a significantly elevated risk was identified with respect to kidney cancer in the highest exposure category (RR, 1.16) and with respect to lung cancer in the intermediate exposure category (RR, 1.12).

Conclusion

The slightly increased risk of leukemia in men, kidney cancer in women, and lung cancer in women may require further investigation. If an increased cancer risk is confirmed, preventive measures (e.g., introduction of U filters in public water systems) may be considered.     

Isolation and molecular characterization of a tick-borne encephalitis virus strain from a new tick-borne encephalitis focus with severe cases in Bavaria,Germany

Tick-borne encephalitis (TBE) is the most important viral infection transmitted by ticks in Central Europe. In Germany, where TBE was classified as a notifiable disease in 2001, a highly variable number of clinically apparent human cases was reported in the last few years, ranging from the lowest number of 238 in 2007 to a maximum of 546 in 2006. The dynamics of the virus and its vector tick remain poorly understood. We investigated a highly active TBE focus in south-eastern Germany where from 2003 to 2008 a total of 9 clinical human cases was diagnosed. Three out of these 9 cases were fatal indicating an unusually high mortality rate possibly due to a highly virulent TBEV strain. From 2005 till 2008, 2150 Ixodes ricinus ticks were collected and tested for the presence of TBE virus. Five TBEV-positive ticks were detected by real-time RT-PCR. A viable virus strain was isolated from one of the positive ticks sampled in 2005. This is the first TBE virus isolate from a tick in Germany for 30 years. Sequencing of the full-length genome of this virus strain (AS33) revealed 2 unique amino acid substitutions in the envelope protein known to play a role in the pathogenicity of TBE virus. Amplification of the envelope gene using 2 TBEV-PCR-positive ticks from 2006 also showed these particular mutations indicating that this TBE virus strain was present in at least 2 consecutive years. The entire sampling area was divided into smaller sectors for the exact location of TBEV-positive ticks. Virus-positive ticks were found to be randomly distributed throughout the investigated focus, which is used as recreational area by the local people.     

The cancer registry: a clinical repository of oncology data

Health care institutions need complete and accurate data to plan, monitor, and evaluate their oncology programs. Although financial and discharge data are available, clinical repositories generally are not. For oncology, the cancer registry database serves as a clinical repository. The data in the registry are complete, accurate, and readily available. They can be used to plan new services, evaluate existing programs, and monitor patient care.     

Cancer registry data based estimation of regional cancer incidence: application to breast and colorectal cancer in French administrative regions

STUDY OBJECTIVE: In many countries, cancer registries cover only a small part of the national population. Cancer incidence for the rest of the country has therefore to be estimated. This can be done from mortality data using the relation between incidence and mortality observed in the cancer registry areas. Such an approach was used to study geographical variation and trend of colorectal and breast cancer incidence in France where 10% of the national population is covered by cancer registries. DESIGN: This study applies the incidence/mortality ratios of cancer registry areas to regional mortality data to obtain an estimation of cancer incidence at a given point in time. Age and period effects are included in the statistical models. MAIN RESULTS: The incidence estimations are given for 21 administrative regions and three time points (1985, 1990, 1995). The European standardised incidence rates for breast cancer ranged from 86.8 to 128.8. For colorectal cancer, these rates ranged from 48.2 to 79.6 for men, and from 32.5 to 48.8 for women. Breast cancer incidence has increased considerably between 1985 and 1995 with a higher increase in the north than in the south of France. The incidence of colorectal cancer has also increased, albeit to a lesser extent. CONCLUSION: The incidence estimation method proposed leads to regional incidence rates that are useful for planning health care services on a regional basis and may also be used to study regional differences in incidence. This method is useful when only partial incidence data are available.     

Polypropylene production workers and colorectal cancer in Germany: a brief report.

OBJECTIVE--A retrospective cohort study of 640 male polypropylene production workers in Germany was performed to evaluate the reported association between colorectal cancer and polypropylene. METHOD--The follow up period was 1956 to 1990. Expected numbers of cancers were derived from incidence rates adjusted for age and calendar year from the Saarland cancer registry. RESULTS--Three colorectal cancers were identified compared with 4.0 expected (standardised incidence ration (SIR) = 0.75, 95% confidence interval (95% CI): 0.15-2.19). For total cancers there were 27 cases in the cohort compared with 35.4 expected (SIR = 0.76, 95% CI: 0.50-1.11). DISCUSSION--These results do not support earlier reports of a link between polypropylene production and colorectal cancer, but are consistent with a number of recent investigations of polypropylene production workers that have reported no association with risk of colorectal cancer. Due to the small size of this and other similar studies, however, a small to moderate increase in risk cannot be ruled out.     

Environmental tobacco smoke and lung cancer: a case-control study in Germany

To assess the association between exposure to environmental tobacco smoke (ETS) and lung cancer, the authors personally interviewed 292 lifelong nonsmoking lung cancer cases (recruited from 15 hospitals in the study area) and 1,338 nonsmoking controls (randomly selected by population registries) between 1990 and 1996 in Germany. Subjects were asked by a standardized questionnaire about exposure to ETS in childhood, by spouse, at work, and in transportation and social settings. Several indicators of these different sources of exposure were investigated, using not or low exposed subjects as the reference category. The most informative quantification index was weighted duration of exposure (hours x level of smokiness). No effect of ETS exposure during childhood and no clear effect of spousal ETS were observed. However, for the highest category of exposure, clear effects of ETS at the workplace (odds ratio (OR) = 1.93; 95% confidence interval (CI): 1.04, 3.58), in vehicles (OR = 2.64; 95% CI: 1.30, 5.36), and from all sources combined (OR = 1.39; 95% CI: 0.96, 2.01) were found. Adjustment for occupational carcinogens, radon, and diet did not appreciably change the results. These findings suggest that exposures to high levels of ETS at the workplace and in other public indoor settings appear to be important risk factors for lung cancer risk in nonsmokers.     

Social class and the black/white crossover in the age-specific incidence of breast cancer: a study linking census-derived data to population-based registry records

An unexplained racial crossover in breast cancer rates in the United States has been apparent since 1969: among women over age 40 years, the rate is higher among white compared with black women, while among women under age 40, the reverse is true. To explore the contribution of social class to this phenomenon, the present study used 1980 census block-group data to generate population-based age-specific breast cancer rates stratified by race and class. Cancer data included all black women (n = 405) and white women (n = 4,259) diagnosed with primary breast cancer during 1979-1981 in the San Francisco Bay Area Resource for Cancer Control registry. Among women under age 40, the black/white incidence ratio among women from predominantly working class block-groups was 1.08 (95% confidence interval (CI) 0.74-1.56), but among those from non-working class block-groups, the black/white ratio equaled 1.96 (95% CI 1.17-3.26). Among women age 40 years or over, the black/white incidence ratio among women from working class block-groups was 0.78 (95% CI 0.68-0.89), but was 0.98 (95% CI 0.78-1.23) among women from non-working class block-groups. These findings underscore the class-based nature of the observed crossover and pose a challenge to accepted theories of breast cancer etiology. Possible risk factors contributing to these findings are discussed, including induced abortion and oral contraceptive use prior to first full-term pregnancy.     

Predicting the absolute risk of dying from colorectal cancer and from other causes using population-based cancer registry data

This paper describes how population cancer registry data from the Surveillance, Epidemiology, and End Results program of the National Cancer Institute can be used to develop a prognostic model to predict the absolute risk of mortality from cancer and from other causes for an individual with specific covariates. It incorporates previously developed methods for competing risk modeling along with an imputation method to address missing cause of death information. We illustrate these approaches with colorectal cancer and evaluate the model discriminatory and calibration accuracy by time-dependent area under the receiver operating characteristic curve and calibration plot.     

Cost-effective interventions for breast cancer,cervical cancer,and colorectal cancer: new results from WHO-CHOICE

Background

Following the adoption of the Global Action Plan for the Prevention and Control of NCDs 2013–2020, an update to the Appendix 3 of the action plan was requested by Member States in 2016, endorsed by the Seventieth World Health Assembly in May 2017 and provides a list of recommended NCD interventions. The main contribution of this paper is to present results of analyses identifying how decision makers can achieve maximum health gain using the cancer interventions listed in the Appendix 3. We also present methods used to calculate new WHO-CHOICE cost-effectiveness results for breast cancer, cervical cancer, and colorectal cancer in Southeast Asia and eastern sub-Saharan Africa.

Methods

We used “Generalized Cost-Effectiveness Analysis” for our analysis which uses a hypothetical null reference case, where the impacts of all current interventions are removed, in order to identify the optimal package of interventions. All health system costs, regardless of payer, were included. Health outcomes are reported as the gain in healthy life years due to a specific intervention scenario and were estimated using a deterministic state-transition cohort simulation (Markov model).

Results

Vaccination against human papillomavirus (two doses) for 9–13-year-old girls (in eastern sub-Saharan Africa) and HPV vaccination combined with prevention of cervical cancer by screening of women aged 30–49 years through visual inspection with acetic acid linked with timely treatment of pre-cancerous lesions (in Southeast Asia) were found to be the most cost effective interventions. For breast cancer, in both regions the treatment of breast cancer, stages I and II, with surgery?±?systemic therapy, at 95% coverage, was found to be the most cost-effective intervention. For colorectal cancer, treatment of colorectal cancer, stages I and II, with surgery?±?chemotherapy and radiotherapy, at 95% coverage, was found to be the most cost-effective intervention.

Conclusion

The results demonstrate that cancer prevention and control interventions are cost-effective and can be implemented through a step-wise approach to achieve maximum health benefits. As the global community moves toward universal health coverage, this analysis can support decision makers in identifying a core package of cancer services, ensuring treatment and palliative care for all.

     

Variability in date of prostate cancer diagnosis: a comparison of cancer registry,pathology report,and electronic health data sources

PurposeThe date of cancer diagnosis is a critical data element for clinical care and research. Because this date can be abstracted from various data sources, its comparability from source to source is unclear. This study compared the date of diagnosis from multiple sources within the same population of prostate cancer patients.MethodsWe linked cancer registry, pathology report, and electronic health data sources from the Kaiser Permanente Southern California health data systems for a cohort of 22,666 members diagnosed with prostate cancer between 2000 and 2010. The magnitude and direction of the differences in date of diagnosis were assessed for each date pairwise comparison. We reviewed 454 medical records to determine reasons for date discrepancies.ResultsAmong the date pairwise comparisons, differences in date of diagnosis spanned from 9.6 years earlier to 10 years later than each other. However, the overall median difference ranged from 1 to 16 days, thus suggesting that the vast majority of the date differences were small. Chart review results identified major categories of date discrepancies.ConclusionsThese data demonstrate variability in date of diagnosis across these data sources. This variability may have implications for epidemiologic estimates or patient identification in research studies using different data sources.     

Validity of self-reported cancer history: a comparison of health interview data and cancer registry records

Few studies have addressed the accuracy of self-reported cancer history, although epidemiologic studies routinely use self-reported information as the sole source of exposure or outcome data or as a criterion for exclusion from study participation. In this paper, false-negative reporting of cancer history is examined in a community-based sample by comparing interview data with tumor registry records. Subjects were participants in the 1980 New Haven Epidemiologic Catchment Area study; in 1995, cancer records (from 1935 onward) were obtained by linking the sample to the Connecticut Tumor Registry. Analyses focused on 263 individuals who had at least one tumor reported to the Connecticut Tumor Registry prior to participation in the Epidemiologic Catchment Area study. The overall rate of false-negative reporting was 39.2%. Logistic regression analysis revealed that false-negative reporting was significantly associated with non-White race, older age, increased time since cancer diagnosis, number of previous tumors, and type of cancer treatment received. In addition, false-negative reporting varied widely by cancer site, ranging from 0% for melanoma skin cancer to 83.3% for central nervous system cancers. The false-negative rate for breast cancer was 20.8%, that for colon and prostate cancers was 42.1%, and that for bladder cancer was 61.5%. Implications of these findings for prevalence estimation and future epidemiologic studies are discussed.     

Occupational lung cancer risk for men in Germany: results from a pooled case-control study

Occupational exposures such as crystalline silica, diesel engine exhaust, polycyclic aromatic hydrocarbons, and man-made mineral fibers are strongly suspected to increase lung cancer risk. Two case-control studies in Germany conducted between 1988 and 1996 were pooled for a joint analysis. A total of 3,498 male cases and 3,541 male population controls, frequency matched for age and region, were included in the study. The lifelong history of all jobs and industries was coded and occupational exposures were evaluated by expert rating. Odds ratios, crude and adjusted for smoking and asbestos exposure, were calculated by conditional logistic regression. Job-related evaluation showed a statistically significant increased odds ratio adjusted for smoking among farmers; forestry workers, fishermen, and livestock workers; miners and quarrymen; chemical processors; cabinet makers and related wood workers; metal producers and processors; bricklayers and carpenters; road construction workers, pipelayers and well diggers; plasterers, insulators, and upholsterers; painters and lacquerers; stationary engine and heavy equipment operators; transport workers and freight handlers; and service workers. With regard to specific occupational exposures, elevated odds ratios (OR) (95% confidence intervals (CI)) for lung cancer risk adjusted for smoking and asbestos exposure were observed for man-made mineral fibers (OR = 1.48, 95% CI 1.17, 1.88); crystalline silica (OR = 1.41, 95% CI 1.22, 1.62); diesel engine exhaust (OR = 1.43, 95% CI 1.23, 1.67); and polycyclic aromatic hydrocarbons (OR = 1.53, 95% CI 1.14, 2.04). The risk of asbestos exposure, adjusted for smoking was also increased (OR = 1.41, 95% CI 1.24, 1.60).     

Evolving routines: preventing fatigue associated with lung and colorectal cancer

Some individuals with cancer develop fatigue whereas others do not. To begin the development of a biobehavioral model that could explain this phenomenon, the authors interviewed 29 individuals with lung and colorectal cancer before, during, and after treatment and obtained evaluable data for 18. Blood samples and body weight were obtained at the time of each interview. A three-stage process, evolving routines, and an adaptive behavioral mode labeled gliding characterized those who reported little or no fatigue, even when hemoglobin levels were low. Three other nonadaptive behavioral modes (inertia, disorganization, and overexertion) characterized those who reported fatigue. Individuals with similar disease and treatment profiles seldom demonstrated the same behavioral or biological response patterns.     

Reliability of data of the Thames cancer registry on 673 cases of colorectal cancer: effect of the registration process.

OBJECTIVE--To measure the reliability of data collected by the Thames cancer registry and to identify factors in the registration process affecting reliability. DESIGN--A retrospective study of data from the registry, including death certificate only registrations, and hospital case notes on cases of colorectal cancer diagnosed in 1983 or 1988. SETTING--Four districts in South Thames region. SUBJECTS--673 cases of colorectal cancer in resident patients. MAIN MEASURES--Dates of birth, diagnosis of cancer, and death; sex; tumour site; whether treatment was given; type of treatment; and district of residence. RESULTS--Among the 416 (62%) case notes retrieved, including 66 death certificate only registrations, full or high agreement between registry data and hospital notes was recorded for sex, district of residence, and dates of birth and death. Only 12% of cases had the same date of diagnosis, which may be due to failure of registry policy. Lower agreement rates occurred for tumour site (87%), whether treatment occurred (84%), and treatments administered (80%, 1983; 72%, 1988). 20% of surgical treatments and 37% of adjuvant therapy, radiotherapy, and chemotherapy were not recorded by the registry. Disagreements were common among death certificate only registrations. Such registrations accounted for 16(32%) disagreements over tumour site, 33(41%) major disagreements over date of diagnosis (difference > 30 days), and 47(44%) disagreements over treatment. In 65 cases the registry failed to capture all treatments carried out within the six month follow up period, 38(58%) of which were for death certificate only registrations. In 36% of death certificate only registrations the patients survived more than one year from diagnosis, indicating a failure of registry policy over retrospective follow up. CONCLUSIONS--Registry data on district of residence; sex; dates of birth, diagnosis, and death are highly reliable, but treatment and tumour site data are less so. Lack of follow up in death certificate only registrations and failure to monitor treatments during follow up period seemed to be associated with disagreements.     

Race, occupation, and lung cancer: detecting disparities with death certificate data

OBJECTIVES: To determine whether the analysis of death certificate data would reveal the same relationship among race, occupational exposure, and lung cancer mortality observed by a large cohort study. METHODS: An occupation-specific mortality odds ratio (MOR) for lung cancer (ICD-162) versus all other causes was calculated for 218,341 black men and white men who had been employed in the metal industries. RESULTS: Black men were at increased risk for lung cancer mortality when compared with white men among the 4668 oven workers (MOR = 1.38, 95% CI = 1.10 to 1.73), but not among the 33,605 white-collar workers (MOR = 0.95, 95% CI = 0.74 to 1.23). CONCLUSIONS: Our findings corroborate a previously demonstrated association among exposure to carcinogenic coke oven emissions, race, and lung cancer mortality, and support the use of death certificate data to help identify occupations with racial disparities in lung cancer mortality.