Cancer Mortality,Early Detection and Treatment among Adult New Zealanders: Changes in Perceptions between 2001 and 2014/5

Background: Beliefs about cancer risk and experience of early detection and treatment can impact on willingness to engage with these initiatives. This study describes changes in perceptions of cancer mortality, early detection and treatment among adult New Zealanders (NZ) between two cross-sectional studies conducted in 2001 and 2014/5. Methods: Data was collected via telephone interviews conducted by trained interviewers in 2001 (231 females and 207 males, 64% response rate) and 2014/5 (588 females and 476 males, 64% response rate). Participants were asked to identify the most common three causes of cancer mortality among women and then men. They were also asked to note their agreement or otherwise with statements about early detection and treatment of cancer. Results: There was an increase in proportions of men who correctly identified prostate cancer as one of the top three causes of cancer mortality among men, and also an increase among women who correctly identified bowel cancer as one of the top three. Most participants agreed that there were benefits from early detection for cancer outcomes. Over time, there was a significant decline in proportions which felt that most cancer treatment is "so terrible it is worse than death" and that alternative therapy has an "equal or better chance of curing cancer." Conclusion: Internationally, there is little information available about changes in cancer perceptions over time, these findings suggest some changes in perceptions of treatment and awareness of types of cancer with the highest mortality in NZ, which should support timely engagement with early detection and treatment services.     

The World Cancer Report and the burden of oral cancer.

The WHO has recently provided the most comprehensive global examination of cancer to date, through the publication of the World Cancer Report (WCR). According to IARC-WHO estimates, cancer rates are set to increase at an alarming rate, from 10 million new cases globally in 2000, to 15 million in 2020. However, the report states that we have the opportunity to stem the predicted sharp increase in new cancer cases by taking action now, especially through planning effective cancer control strategies, such as reducing tobacco consumption, suggesting healthy lifestyle and diet, and performing early detection through screening. Although cancer of the oral cavity is largely related to lifestyle and can be easily detected and diagnosed at early stages through a 5 min visual inspection of the oral mucosa, actual figures concerning its prevention and early detection are dismal. Most oral cancers are detected at a late stage, requiring complex, costly and often ineffective therapies. Similarly, current research, educational and financial resources are focused on procedures burdened by high cost, high morbidity and unacceptable high mortality. Here we suggest that it is time to change this common point of view towards this disease and to alter this trend, stressing that there is no other oncologic specialty in which the WCR preventive guidelines could be applied in such an easy and effective manner, as in the field of oral cancer.     

Krebsfrüherkennung

Scientific evidence for the effectiveness of early detection and screening in cancer has been established in randomized clinical trials for three malignancies: cervix, breast, and colon cancer. In cervix cancer incidence and mortality can be reduced. In breast and colon cancer early detection and screening can only reduce mortality. The German guidelines currently in use for cancer screening have adapted these results. Some of the United States guidelines are less restrictive, leading to an increased incidence of some tumor entities such as prostate cancer. The clinical significance still needs to be established. The theoretical potential for reducing cancer mortality by screening measures is estimated to be 3–6%. However, it is to be expected that improvements in detection methods and better organization of screening program structures will increase the proportion of lives saved by screening measures.     

Biomarker approaches to the development of cancer screening tests: can cancer blood tests become a routine health check-up?

Cancer is a deadly disease associated with high rates of morbidity and mortality. The vast majority of cancers are identified at a late stage, when therapy is rarely successful Morbidity and mortality associated with cancer can be reduced with improved prevention and early detection activities. Identification of cancer biomarkers is one of the most promising approaches for the detection of early-stage malignant or even premalignant lesions with a simple blood test. A large number of research teams are investigating the role of biomarkers in cancer detection and progression, making the dream of early and painless cancer detection become a reality.     

Overexpression of CDC25B and LAMC2 mRNA and protein in esophageal squamous cell carcinomas and premalignant lesions in subjects from a high-risk population in China.

Molecular events associated with the initiation and progression of esophageal squamous cell carcinoma (ESCC) remain poorly understood but likely hold the key to effective early detection approaches for this almost invariably fatal cancer. CDC25B and LAMC2 are two promising early detection candidates emerging from new molecular studies of ESCC. To further elucidate the role of these two genes in esophageal carcinogenesis, we did a series of studies to (a) confirm RNA overexpression, (b) establish the prevalence of protein overexpression, (c) relate protein overexpression to survival, and (d) explore their potential as early detection biomarkers. Results of these studies indicated that CDC25B mRNA was overexpressed (>/=2-fold overexpression in tumor compared with normal) in 64% of the 73 ESCC cases evaluated, whereas LAMC2 mRNA was overexpressed in 89% of cases. CDC25B protein expression was categorized as positive in 59% (144 of 243) of ESCC cases on a tumor tissue microarray, and nonnegative LAMC2 patterns of protein expression were observed in 82% (225 of 275) of cases. Multivariate-adjusted proportional hazard regression models showed no association between CDC25B protein expression score and risk of death [hazard ratio (HR) for each unit increase in expression score, 1.00; P = 0.90]; however, several of the LAMC2 protein expression patterns strongly predicted survival. Using the cytoplasmic pattern as the reference (the pattern with the lowest mortality), cases with a diffuse pattern had a 254% increased risk of death (HR, 3.52; P = 0.007), cases with no LAMC2 expression had a 169% increased risk of death (HR, 2.69; P = 0.009), and cases with a peripheral pattern had a 130% greater risk of death (HR, 2.30; P = 0.02). CDC25B protein expression scores in subjects with esophageal biopsies diagnosed as normal (n = 35), dysplastic (n = 23), or ESCC (n = 32) increased significantly with morphologic progression. For LAMC2, all normal and dysplastic patients had a continuous pattern of protein expression, whereas all ESCCs showed alternative, noncontinuous patterns. This series of studies showed that both CDC25B and LAMC2 overexpress RNA and protein in a significant majority of ESCC cases. The strong relation of LAMC2 pattern of protein expression to survival suggests a role in prognosis, whereas the association of CDC25B with morphologic progression indicates a potential role as an early detection marker.     

Incidence and mortality trends for prostate cancer in 5 French areas from 1982 to 1996.

After an increase in the 1980s, incidence and mortality for prostate cancer in North America or England and Wales started to decrease in the early 1990s. The reasons for this evolution are widely debated, notably the importance of early detection. This study describes trends of prostate cancer incidence and mortality in 5 areas in France, where practices of early detection for this cancer are widely used. The 5 French administrative areas, covered by a population-based registry, have a total population of approximately 1,700,000 men. Incidence data from these registries were studied for the period 1982-1995, and mortality data were provided by the Institut National de la Santé et de la Recherche Médicale (INSERM) for the period 1982-1996. Age-Period-Cohort models by Poisson regression were created to characterize these trends. Between 1982 and 1995, 14,699 cases of prostate cancer were registered by the 5 registries under consideration. After a little intensification of the increase in 1987, undoubtedly due to early detection (notably using Prostate-Specific Antigen), the trend of the incidence seems to reverse from 1993. Mortality increased monotonically from 1982-1990 by an average of 1.8% per year, before decreasing annually by an average of 3.3% until 1996. Poisson regressions indicated a period effect on both incidence and mortality data; a small, but significant, cohort effect exists for incidence evolution, showing that elements such as etiologic factors may have an influence. Until results of randomized studies on mass screening are available, the question of individual screening remains; improved knowledge of risk factors could be interesting.     

Mass screening for gastric cancer by X-ray examination

The characteristics of early gastric cancer detected by gastricmass survey were examined. The progress of the screening testusing the indirect X-ray examination and the tendency towardreduction in mortality from stomach cancer were evaluated. In1981 the number of examinees in the gastric mass surveys amountedto over four millions in all Japan. From the data of the gastricmass survey in Miyagi Prefecture the rate of detection of gastriccancer was approximately 0.18% and the ratio of early cancerto surgically treated gastric cancer was 59.4% for 1980–1982.Furthermore, the number of in cancer, small cancer and minutecancer cases detected by the survey has increased year by year.These results are due to various advanced screening tests orclose examination techniques. From our long-term follow-up studyit is clearly indicated that the rate of deaths from stomachcancer in the screened individuals was half of the rate in theunscreened individuals.     

DNA methylation-based biomarkers for early detection of non-small cell lung cancer: an update

Lung cancer is the number one cancer killer in the United States. This disease is clinically divided into two sub-types, small cell lung cancer, (10–15% of lung cancer cases), and non-small cell lung cancer (NSCLC; 85–90% of cases). Early detection of NSCLC, which is the more common and less aggressive of the two sub-types, has the highest potential for saving lives. As yet, no routine screening method that enables early detection exists, and this is a key factor in the high mortality rate of this disease. Imaging and cytology-based screening strategies have been employed for early detection, and while some are sensitive, none have been demonstrated to reduce lung cancer mortality. However, mortality might be reduced by developing specific molecular markers that can complement imaging techniques. DNA methylation has emerged as a highly promising biomarker and is being actively studied in multiple cancers. The analysis of DNA methylation-based biomarkers is rapidly advancing, and a large number of potential biomarkers have been identified. Here we present a detailed review of the literature, focusing on DNA methylation-based markers developed using primary NSCLC tissue. Viable markers for clinical diagnosis must be detectable in 'remote media' such as blood, sputum, bronchoalveolar lavage, or even exhaled breath condensate. We discuss progress on their detection in such media and the sensitivity and specificity of the molecular marker panels identified to date. Lastly, we look to future advancements that will be made possible with the interrogation of the epigenome.     

Recent trends in breast cancer incidence,mortality, and mammography

Summary The recent trends in mammography, and in breast cancer incidence and mortality, demonstrate the impact of an effective cancer control effort. The number of women over age 40 years who have ever had mammography has increased over 200% since 1980. Concomitantly, breast cancer incidence has increased about 32%, with nearly all of the increase in early stage disease. Analytic studies of these changes have demonstrated persuasively that the vast majority of this increase is temporary and is attributable to the lead-time afforded by mammography. As a result of this early detection and treatment of breast cancer, mortality has begun to decline in 1991–92. Although the search for practical preventive measures should continue, the benefits of early detection can be realized now. Further research is needed to define age groups most appropriately screened and the optimum intervals for screening.     

Screening for Breast Cancer - is There an Alternative to Mammography?

Given the continuing increase in mammary cancer incidence and in many cases also mortality across the world, ‍as well as the difficulty with primary prevention, the question of whether screening for early detection is effective is ‍of prime importance. If there is a real benefit in terms of reduced mortality then attention should clearly be focused ‍on the modality which should be recommended in different resource settings. In the developed world where ‍mammography is generally available the results are less than conclusive. It seems possible that there is a segment of ‍breast cancer benefited both by screening and by treatment, and that far from these effects being additive, they ‍affect the same spectrum of cases, so that as treatment improves, the benefit we can expect to see from screening ‍falls. In the Asian Pacific setting, randomized trials on the basis of the cost and benefit should be a high priority. ‍However, the lesson from all programmes of breast screening, is that for success, attention has to be paid to all ‍aspects of the programme, compliance with screening, high quality screening tests, quality in the referral, diagnosis ‍and treatment process, as well as adequate follow-up.     

Diverging trends in incidence and mortality of testicular cancer in Denmark, 1943-1982

Between 1943 and 1982, 5,140 new cases of testicular cancer were diagnosed in Denmark. The age-standardized incidence rate more than doubled in the period. Striking variations is seen in the age-relationship over time with a four-fold increase in incidence for men aged 15-24 years while no increment was observed for those above 65 years of age. The increase with time in the risk could be accounted for by a cohort effect. The mortality rate did not parallel the incidence rate and a 50% decrease in mortality rate appeared in the period 1978-1982. Introduction of combination chemotherapy including cis-platinum is one of the main factors responsible for this beneficial development. The observed pattern of diverging trends in incidence and mortality of testicular cancer implies that mortality rates do not reflect the incidence and will accordingly be unsuited as a basis for aetiological considerations based on trends. The brisk increase in the risk of testicular cancer, especially among young men is in accordance with trends in other western countries, and prompts an enforced search for suspected or new risk factors.     

Analysis of the role of cancer prevention and control measures in reducing cancer mortality.

One goal of the war against cancer is to create declines in cancer mortality rates. A decrease in these rates can only occur in two ways: 1) a decrease in incidence rates and 2) a real increase in overall survival rates. Reductions in incidence rates can be envisioned to occur through three mechanisms (in order of the time course of cancer): 1) reduction or amelioration of environmental or lifestyle risk factors, 2) use of agents that prevent the occurrence of cancer by blocking the progression to cancer, and 3) early detection at a preneoplastic state combined with treatment that prevents or delays progression to invasive cancer. "True" increases in overall survival can occur by two mechanisms (in order of the time course of cancer): 1) early detection of cancer by screening tests and subsequent effective treatment and 2) advancements in treatment. Unique patterns or "fingerprints" of stage-specific incidence and overall incidence and of survival rates characterize the various cancer prevention and control mechanisms that can decrease mortality rates. The rates are presented for five organ sites that have shown reduced cancer mortality. The patterns of rates for breast cancer for women under the age of 65 years were most consistent with early detection. The testicular cancer fingerprints were most consistent with advances in treatment, whereas cervical cancer rates were most consistent with the detection of preneoplastic lesions. The stomach cancer fingerprints were indicative of reductions in lifestyle or environmental risks, and colorectal cancer rates were indicative of a combination of treatment advances and early detection. These fingerprint patterns can be extended to other situations in which mortality trends are changing in order to suggest possible causes of observed changes. Limitations of this model are also discussed.     

A reversal in the long-term increase in deaths attributable to malignant melanoma.

For a few years in the 1980s, United States mortality rates suggested a plateau in the long-term increase for malignant melanoma. However, temporary plateaus in the increase of the age-adjusted rate by year of death have occurred in previous decades, only to be followed by a continued upward increase, with a long-term rise of about 2% per year. To determine whether a cessation in the long-term increase might be in progress, death rates were analyzed by year of birth, age at death, and year of death: (1) the long-term patterns of change are best described by birth cohort rather than by time period of death, indicating that analyses by a year of birth are key to a better understanding of the long-term trends; (2) in both men and women, evidence for a change in slope begins among those born in the early 1930s; (3) the decline in the rates begins among women born since the early 1930s and among men born since the early 1950s: the slope for men is -0.2661 (95% confidence limits [CL] = -0.380 to -0.152), and, for women, the slope is -0.02354 (95% CL = -0.041 to -0.005); (4) long-term Connecticut and US mortality trends were similar in pattern and direction, and long-term Connecticut incidence rates showed a persistent increase through the 1955 to 1965 birth cohorts. These analyses suggest a persistent cessation in the long-term increase and a downward trend in death rates from this cancer.     

Colorectal cancer burden and trends: Comparison between China and major burden countries in the world

Objective:To summarize the colorectal cancer(CRC)burden and trend in the world,and compare the difference of CRC burden between other countries and China.Methods:Incidence and mortality data were extracted from the GLOBOCAN2018 and Cancer Incidence in Five Continents.Age-specific incidence trend was conducted by Joinpoint analysis and average annual percent changes were calculated.Results:About 1.85 million new cases and 0.88 million deaths were expected in 2018 worldwide,including 0.52 million(28.20%)new cases and 0.25 million(28.11%)deaths in China.Hungary had the highest age-standardized incidence and mortality rates in the world,while for China,the incidence and mortality rates were only half of that.CRC incidence and mortality were highly correlated with human development index(HDI).Unlike the rapid increase in Republic of Korea and the downward trend in Canada and Australia,the age-standardized incidence rates by world standard population in China and Norway were rising gradually.The age-specific incidence rate in the age group of 50-59 years in China was increasing rapidly,while in Republic of Korea and Canada,the fastest growing age group was 30-39 years.Conclusions:The variations of CRC burden reflect the difference of risk factors,as well as levels of HDI and screening(early detection activities).The burden of CRC in China is high,and the incidence of CRC continues to increase,which may lead to a sustained increase in the burden of CRC in China in the future.Screening should be expanded to control CRC,and focused on young people in China.     

High Mortality Rate of Stomach Cancer Caused Not by High Incidence but Delays in Diagnosis in Aomori Prefecture,Japan

Background: There are substantial differences in the mortality rates of stomach cancer among the 47 prefectures in Japan, and Aomori prefecture is one of the most severely impacted. The aims of this study were to determine the incidence and mortality rates of stomach cancer in Aomori prefecture in comparison with Japan as a whole and cast light on reasons underlying variation. Methods: Data on stomach cancer cases were extracted from the Aomori Cancer Registry Database. Incidence rates for specific stages at the time of diagnosis were cited from Monitoring of Cancer Incidence in Japan, and mortality rates for stomach cancer in Aomori prefecture and the whole of Japan were obtained from Vital Statistics. Age-standardised incidence and mortality rates were calculated using the direct method. Results: The age-standardised incidence rate of stomach cancer in Aomori prefecture was higher than in the whole of Japan for males but lower for females. However, the age-standardised mortality rates were higher in Aomori prefecture in both sexes. The proportion of localised cancers was lower in Aomori prefecture than in the whole of Japan for most age groups. Conclusions: The lower rate for localised cancer suggests that higher age-standardised mortality rates are due to delays in diagnosis, despite an attendance rate for stomach cancer screening was higher in Aomori prefecture than in the whole of Japan. One plausible explanation for the failure of successful early detection might be poor quality control during screening implementation that impedes early detection.     

Disparities in breast cancer mortality trends in a middle income country

In recent decades, breast cancer cases have increased steadily worldwide. However, the increases do not hold across all demographics and breast cancer cases in low and middle income countries have increased much faster than the global trend. Colombia is not an exception. Breast cancer was the most frequent tumor and the second cause of cancer-related deaths in women in 2008, with an estimated of 6,700 new cases and 2,100 deaths. We present here an analysis of breast cancer mortality rates and trends in Colombia, over the period 1985-2008. We studied overall and age-specific changes in breast cancer mortality using change-point Poisson regression models. Between 1985 and 2008, there were 32,375 breast cancer deaths in women in Colombia. Breast cancer mortality increased since 1985, although the annual increase varied between age groups and socioeconomic levels. Only in women aged 45-64 years old that live in areas of high socioeconomic levels, breast cancer mortality was stable or decreasing. Hence, successful cancer control is possible in middle income countries, as shown by the progress observed in certain groups. The development of an integrated strategy of early detection and early access to proper treatment, suitable for areas with limited resources, is an urgent necessity.     

Burden of Hepatocellular Carcinoma in Iran; Bayesian Projection and Trend Analysis

Background: Hepatocellular carcinoma (HCC) is the sixth most prevalent cancer worldwide. Iran is located in a low risk area but, while the true prevalence of HCC in Iran is unknown, it is not an uncommon malignancy. The aim of this study was to provide quantitative estimations of the burden of death due to HCC cancer in Iran and its trend during over recent decades for the Iranian population. Methods: National death statistics reported by the Ministry of Health and Medical Education (MOH&ME) from 1999 to 2004, stratified by age group, sex, and cause of death (ICD-9) were used to generate HCC mortality (ICD-9; 20) expressed as the mortality rate per 100,000 people. The Bayesian approach to correct for misclassification was employed and a time series model was applied to predict mortality. The burden of HCC, including years of life lost (YLL), was calculated using Iranian life expectancy. Results: The rate of HCC mortality and YLL moderately increased from 1999 to 2004 but according to our prediction it seems that these rates are going to level off. Also HCC mortality and YLL was higher for older age, and was considerably greater in men than in women. Conclusion: Burden of HCC is low in Iran because most of cases are due to HBV and this infection is less common in Iran than Southeast Asia and Africa and there is nomajor increase projected for the future. However, up to 40% of its death statistics are underreported. Screening can be advised for early HCC detection in chronic HCV and HBV carriers.     

Epidemiological pattern and time trends in testicular germ-cell tumors: a single institution 20-year experience

Introduction Recent studies have suggested a rise in the incidence of testicular germ-cell tumors (TGTs) in the last years, mainly due to an increase of early stage cases. We analysed the time trends in biological features of these patients in order to confirm this tendency in our environment. Materials and methods The clinical records of 136 consecutive patients with TGTs treated at a single institutions over a 20-year period (1984–2003) were retrospectively reviewed. Pathological, clinical, therapeutic and outcome data were collected. Patients were allocated into four consecutive 5-year intervals and their characteristics were compared by means of the chi-squared test. The survival analysis was performed with the method of Kaplan and Meier. Results A progressive increase in the incidence of new cases, and a more frequent diagnosis of stage I versus stage II–IV disease was confirmed within this time period. It was also observed a greater use of postorchiectomy chemotherapy, mainly due to an increase in the adjuvant indications. A significant decrease in the recurrence rate was noted. Ten-year overall survival was 86.5%. There was a trend for improved outcome, but the differences among the two decades were not statistically significant. Conclusions A real increase in the incidence of TGTs and in the proportion of early stages was confirmed. This may be due to an epidemiological change or to an earlier diagnosis. This new pattern is associated with a more frequent use of adjuvant chemotherapy and with a reduction in the relapse rate.     

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.     

Lung cancer screening--present status and the problems

For the counter measure having been indicated against increasing mortality rate in lung cancer cases, indication of lung cancer screening was started in 1987 in line with the law of insurance established for old aged people. In order to decrease the death rate in cases with lung cancer, methods of the counter measure were established for early detection of lung cancer by Chest X-ray and sputum cytology as well as early operative indication. Although results of these procedures have suggested effectiveness attained by mass screening, standard of efficiency have not been same in all the areas, where the screening having been performed, but there has been difference between respective areas, therefore, in order to make the every result of mass screening carried out in areas similar, it is necessary to make the indication of mass screening being done with careful attention for lung cancer cases.