Trends in cancer incidence in esophagus, stomach, colon, rectum and liver in males in India.

Time trends in cancers of the esophagus, stomach, colon, rectum and liver cancers among the male population in five Indian urban population based cancer registries (Mumbai, Bangalore, Chennai, Delhi, and Bhopal) were examined over the period of the last two decades. The model applied fits data to the logarithm of Y=ABx. This Linear Regression method showed decreasing trends in age-adjusted incidence rates for cancers of the stomach and esophagus, especially in Bjopal, and increasing trends for colon and rectum and liver, throughout the entire period of observation in most of the registries. The five cancers together constitute more than 80% of the total gastro intestinal cancers and are serious diseases in both sexes. To understand the etiology of these cancers in depth, analytic epidemiological studies should be planned in the near future on a priority basis.     

Trends in cancer incidence in female breast, cervix uteri, corpus uteri, and ovary in India.

Trends in breast, cervix uteri, corpus uteri and ovarian cancers in six population based cancer registries (Mumbai, Bangalore, Chennai, Delhi, Bhopal, and Barshi) were evaluated over a period of the last two decades. For studying trends we used a model that fits this data is the logarithm of Y=ABx which represents a Linear Regression model. This approach showed a decreasing trend for cancer of the cervix and increasing trends for cancers of breast, ovary and corpus uteri throughout the entire period of observation in most of the registries. The four cancers, breast, cervix, corpus uteri and ovary, constitute more than 50% of total cancers in women. As all these cancers are increasing, to understand their etiology in depth, analytic epidemiology studies should be planned in a near future on a priority basis.     

上海市区恶性肿瘤发病趋势分析(1972～1999年)

目的对上海市区1972～1999年肿瘤发病资料进行统计、分析,了解肿瘤发病率的变化趋势.方法病例统一按照国际疾病分类(ICD-9)进行编码.根据人口普查资料中的性别、年龄构成用内插法和外推法估算各年的年龄组平均人口数.用世界标准人口计算标化率.发病率每年变化百分比,用对数直线回归法估计,并用病例数加权.结果 1972～1999年间,男性所有部位肿瘤标化率从250.0/10万降至214.8/10万,女性从175.3/10万降至163.4/10万.男女性结肠癌、胆道癌、肾癌,男性前列腺癌、多发性骨髓瘤以及女性脑和神经系统肿瘤的发病率上升幅度均达到100%及以上.男女性胰腺癌、直肠癌、非何杰金淋巴瘤、男性脑和神经系统肿瘤、女性乳腺癌、宫体癌、卵巢癌的发病率呈明显上升趋势.男女性食管癌和女性宫颈癌的发病率下降幅度达到一半以上,胃癌和肝癌的发病率也呈明显下降趋势,肺癌发病率在男、女性别中均变化不大.结论上述发病率变化趋势提示除了肿瘤诊断和报告情况的改善外,包括居民生活方式在内的环境因素的变化起着重要作用,需要深入开展流行病学研究,明确危险因素,提出有效的预防方法.     

Interrelation between Western type cancers and non-Western type cancers as regards their risk variations in time and space. I. Mathematical linkage among multiple cancer incidences

The present study attempted to clarify the interrelation between multiple cancer risks by comparatively investigating the age-adjusted incidence rates (AAIR) of 8 neoplasias in 20 selected populations of the world for the last 20 years. Cancers of the stomach (for both sexes) and uterine cervix were on the decline in their incidences, and cancers of the colon (for both sexes), lung (for both sexes), breast and endometrium were on the rise in the period 1960 to 1980. Cancers of the esophagus (for both sexes) and ovary exhibited little change in their incidences during this period. A negative linear relationship was detected between the log-transformed AAIR of an increasing (Western type) cancer and that of a decreasing (non-Western type) cancer, and a positive linear relationship was detected between 2 increasing or 2 decreasing cancers regarding the log-transformed AAIR. Mathematical evidence is presented to indicate that the sum of AAIRs of both increasing and decreasing cancers can be minimized within the frame of a competitive relationship. The results obtained are discussed from the view point of cancer etiology.     

Trends in non-epithelial cancer incidence in Denmark,Finland and Sweden, 1961–1990

Trends in the incidence of non-epithelial cancers are particularly likely to reflect environmental carcinogens, since these malignancies are not commonly the targets of screening efforts, and have generally not been closely associated with life style factors such as cigarette smoking and diet. We used data from nation-wide cancer registries in Denmark, Finland, and Sweden to examine trends in non-epithelial cancers over the period 1961–1990. Linear regression analysis of age-standardized rates, and age-period-cohort models were fit to assess the temporal patterns within each country. Within each of the 3 countries, there were similarly increasing incidence of both hematological malignancies and nervous system/bone/soft-tissue neoplasms. The increases were smallest in children and adolescents (ages 0–14), moderate among young and middle aged adults (ages 15–64), and most pronounced among the elderly (ages 65+). Age-period-cohort modeling suggested that the dominant factor in the increases were birth cohort effects. It is not clear what factors underlie this increase in incidence; it seems most likely that increases both in diagnostic efficiency and in exposure to environmental carcinogens play a role. © 1996 Wiley-Liss, Inc.     

A Joinpoint regression analysis of long-term trends in cancer mortality in Japan (1958-2004)

Cancer is one of the major targets of disease control programs in Japan. A Joinpoint regression model was used to analyze the long-term trends of mortality related to overall cancer and the 15 most common cancers based on published data from the National Vital Statistics of Japan between 1958 and 2004. Since 1996, a decline has been seen in overall cancer for both sexes in Japan. Most of the common sites, including cancers of the stomach, colon, liver, gallbladder and lung and leukemia in both sexes, cancer of esophagus in men and rectal and ovarian cancers in women showed a decreasing trend, and cancers of the rectum, pancreas, prostate and urinary bladder and malignant lymphoma in men and cancers of the esophagus and uterus in women leveled off during the most recent period. However, an increasing trend was confirmed for cancers of the pancreas, breast and urinary bladder and malignant lymphoma in women. An effective cancer control program including prevention, early detection and treatment should be implemented to further reduce the cancer mortality, particularly for cancer sites that show higher mortality rates or increasing trends.     

Kidney and Bladder Cancer in Inuit 1969-1988

The incidence of cancers of the kidney and urinary bladder in Inuit 1969-1988 was studied as part of an international collaboration combining results from cancer registries for Circumpolar Inuit residing in Alaska, Canada and Greenland. Significant high risk of renal cancer was found in Inuit women (SIRs 1.4-2.1) and the age-standardized incidence rate among women was one of the highest on record world-wide. Cancer of the urinary bladder, as opposed to renal cancer, was an uncommon malignancy in both sexes with SIRs of 0.2 to 0.4. No consistent time trend was observed for either renal or bladder cancer in contrast to high and sharply increasing lung cancer rates during the same period. Such results are more likely caused by different latency periods for renal and bladder cancer than for lung cancer following tobacco exposure, possibly combined with the absence of certain occupational exposures relevant to bladder cancer.     

Trends and predictions of cancer incidence cases by site and sex for Mumbai

In order to estimate the resources needed for the diagnosis, treatment, follow-up and rehabilitation services needed for cancer patients, it is important to know the magnitude of common cancers at present and in future. Keeping this view in mind an attempt has been made to predict cancer incidence cases for most common cancers for Greater Bombay upto the year 2002. The trend analysis is carried out for major 30 cancer sites for both the sexes using age incidence data of Greater Bombay for the period 1968 to 1987. The age-period-cohort model which was fitted to the data for studying trends for each site and sex has also been utilized for prediction also. Prediction was based on the assumption that the characteristic features of the model estimated from the observed rates would continue to hold during the prediction periods. Present trend analysis showed that cancers of the tongue, mouth, oropharynx, oesophagus, stomach and larynx in both sexes and cervix for females have registered a decline in incidence over a period of observation. While, during the same period, cancers of the liver, pancreas, bladder, brain and thyroid in both the sexes, breast, endometrium and ovary in females, and testis in males showed increasing trends in incidence, while cancers of the hypopharynx, lung, bone, connective tissue and lymphomas in both the sexes did not show any significant change in the incidence. In males in 1968-1972 cancer of the oesophagus was the leading cancer, followed by lung, larynx, tongue and stomach, while in 1988-2002 cancer of the lung will be the most predominant cancer, followed by hypopharynx, oesophagus, prostate and tongue. It is believed that the results of the present study will provide a sound basis for planning the cancer control, prevention, diagnostics, treatment and rehabilitation in Mumbai for the years to come.     

Population-based incidence and mortality cancer trends (1986-1997) from the network of Italian cancer registries.

The objective of this study was to analyse incidence and mortality cancer trends in the Italian Network of Cancer Registries (about 8,000,000 inhabitants) during the period 1986-1997. Included were 525,645 newly diagnosed cancers and 269,902 cancer deaths (subjects > 14 years). Joinpoints (points in time where trend significantly changes from linearity) were found and estimated annual percentage changes (EAPC) used to summarize tendencies. Overall cancer incidence increased in both sexes and cancer mortality significantly decreased (since 1991 among men). Lung cancer showed significantly decreasing incidence (EAPC = -1.4%) and mortality (EAPC = -1.6%) among men and increasing trends among women. In women, breast cancer incidence significantly increased (EAPC= +1.7%) and mortality decreased since 1989 (EAPC= -2.0%). Stomach cancer incidence and mortality decreased in both sexes. Prostate incidence sharply increased since 1991 and mortality decreased. Colon cancer incidence increased and rectum mortality decreased significantly in both sexes. Significant increases in incidence were also found for kidney (up to 1991 among men), urinary bladder, skin epithelioma, melanoma, liver (up to 1993 among men), pancreas, mesothelioma, Kaposi's sarcoma (up to 1995 among men), testis, thyroid, non-Hodgkin's lymphomas and multiple myeloma. Mortality significantly decreased for cancers of the oral cavity and pharynx, oesophagus, liver (women), larynx (men), bone, cervix (since 1990), central nervous system, urinary bladder, thyroid, Hodgkin's lymphomas and leukaemias (men). Non-Hodgkin's lymphoma mortality increased in both sexes. In conclusion, most of the changes seen can be explained as the effect of changes in smoking habits and of the extension of secondary prevention activities. The Italian health care system will also have to cope with growing cancer diagnostic and therapeutic needs due to population ageing.     

Leukemia in Iran: Epidemiology and Morphology Trends

Background: Leukemia accounts for 8% of total cancer cases and involves all age groups with different prevalence and incidence rates in Iran and the entire world and causes a significant death toll and heavy expenses for diagnosis and treatment processes. This study was done to evaluate epidemiology and morphology of blood cancer during 2003-2008. Materials and Methods: This cross- sectional study was carried out based on reanalysis of the Cancer Registry Center report of the Health Deputy in Iran during a 6-year period (2003 - 2008). Statistical analysis for incidence time trends and morphology change percentage was performed with joinpoint regression analysis using the software Joinpoint Regression Program. Results: During the studied years a total of 18,353 hematopoietic and reticuloendothelial system cancers were recorded. Chi square test showed significant difference between sex and morphological types of blood cancer (P-value<0.001). Joinpoint analysis showed a significant increasing trend for the adjusted standard incidence rate (ASIR) for both sexes (P-value<0.05). Annual percent changes (APC) for women and men were 18.7 and 19.9, respectively. The most common morphological blood cancers were ALL, ALM, MM and CLL which accounted for 60% of total hematopoietic system cancers. Joinpoint analyze showed a significant decreasing trend for ALM in both sexes (P-value<0.05). Conclusions: Hematopoietic system cancers in Iran demonstrate an increasing trend for incidence rate and decreasing trend for ALL, ALM and CLL morphology.     

Cancer Incidence in Thailand, 1995-1997

There are five population-based cancer registries in Thailand in different regions of the country. Four of them ‍(Chiang Mai, Khon Kaen, Bangkok, and Songkhla) have been operating since 1988 and the other (Lampang) since ‍the early 1990’s. These registries have published regular 3-year cancer incidence reports since the first in 1993 for ‍the period 1989-1991. The objective of this article is to summarize the figures of cancer incidence in Thailand during ‍1995-1997. The population of Thailand in 1996, at the middle of the period, was 27 million males and 27.5 million ‍females. Information of cancer cases residing in the five provinces was collected and abstracted from different ‍sources. Age-standardized incidence rate (ASR) of cancer in males and females was calculated for each registry and ‍that for the whole country was estimated using the five registries as representatives for the four geographical regions ‍of Thailand. The estimated number of new cancer cases in 1996 for the whole country was 35,539 men and 38,476 ‍women and the ASRs were 149.2 and 125.0 per 105 population in men and women respectively. Cancer incidences ‍greatly differed from region to region. Lung cancer was the commonest in Chiang Mai and Lampang in the Northern ‍region in both sexes. The incidence of liver cancer in Khon Kaen in the Northeastern region outnumbered all the ‍others in both sexes; cholangiocarcinoma was the major type of liver cancer. In Bangkok, lung cancer was the most ‍important cancer in males and breast cancer was in females. Though it was lung and cervix uteri cancer that ranked ‍the first in men and women in Songkhla, the rate of oral and pharyngeal cancer was exceptionally higher than in ‍other registries. The geographical variability in cancer patterns in Thailand reflects exposure of the population to ‍different risk factors unique to the different regions. In the study as a whole, there are some methodological weak ‍points in estimating the ASRs and number of cancer cases for the whole country, but the results are the most reliable ‍cancer statistics from Thailand at the moment. In conclusion, both a country-wide and region-specific cancer control ‍programmes are needed for Thailand. The national one would be for the cancers common to all regions, and the ‍provincial-level emphasis should be on cancers which are the major problems in the area.     

Cancer Incidence Trends in Thailand , 1989-2000

Through 2004, five cancer registries in Thailand have collected data for more than ten years. Three-year cancerincidence in Thailand covering the years 1989-1997 has been regularly reported in three volumes of ‘Cancer inThailand’. Since the data for the last decade of the 20th century have been collected, the trends in incidence of somecancer sites were analyzed. Data sources were registry data from Chiang Mai, Lampang, Khon Kaen, Bangkok, andSongkhla, which are representative of the four major geographic regions of Thailand. The data drawn in 2002covered the years 1989 to 1997 for Bangkok, the other four registries drew data from 1989 to 2000. The populationdenominators were estimated from the two censuses in 1990 and 2000. Only cancers of the liver, lung, colon-rectum,female breast, uterine cervix, and all cancer sites were analyzed since cancers of these sites may have major publichealth impacts. Age-specific incidence rates of different 5-year age groups were projected through the period 2007-2009 using a linear regression model if the rates were increasing, and a log-linear model to prevent prediction of anegative rate if the rates were decreasing. During the past decade, colorectal and breast cancers showed a statisticalsignificant increasing trend, while the trend was generally stable for cancer of other sites. The number of new cancercases of all sites is expected to be approximately 125,000 by the year 2008, compared with 81,000 in 1999. However,the accuracy of projections depends very much on the quality of the cancer registries’ data. The Bangkok registrysignificantly improved case ascertainment in recent years, while the Chiang Mai registry had a consistent drop inincidence of cancer at many sites. In-depth investigation of some cancer sites and age period cohort modeling arerequired for better understanding of cancer trends in Thailand.     

Cancer risk after renal transplantation in the nordic countries, 1964–1986

The theory that cancer may arise under conditions of reduced immune capacity is supported by observations of humans with immune deficiencies such as occur following organ transplants. However, no study on humans has been done in which the reference population was the same as that in which the cancer cases arose and in which there was a sufficiently long period of follow-up. Information on 5,692 Nordic recipients of renal transplants in 1964–1982 was linked with the national cancer registries (1964-1986) and population registries. Person-years at risk were calculated from the date of first transplantation until death or the end of the study period and were multiplied by the appropriate age- and calender-specific incidence rates to obtain the expected numbers of cancers. Standardized incidence ratios (SIR) were calculated after stratification by a number of recorded variables. Altogether, 32,392 person-years were accrued, and 471 cancers occurred, yielding overall SIR of 4.6 (95% CI, 4.0 to 5.2) for males and 4.5 (95% CI, 4.0 to 5.2) for females. Significant overall 2- to 5-fold excess risks in both sexes were seen for cancers of the colon, larynx, lung and bladder, and in men also for cancers of the prostate and testis. Notably high risks, 10-fold to 30-fold above expectation, were associated with cancers of the lip, skin (non-melanoma), kidney and endocrine glands, also with non-Hodgkin's lymphoma, and in women also with cancers of the cervix and vulva-vagina. Among a number of donor and recipient variables studied, including tissue types and compatibility (ABO, HLA, DR), age below 45 years at the time of transplantation was the most important determinant for increased risk at most sites. Kidney transplantation increases the risk of cancer in the short and in the long term, consistent with the theory that an impaired immune system allows carcinogenic factors to act. The tumor risk is small in comparison with the benefits of transplants, but patients should be followed up for signs of cancer. © 1995 Wiley-Liss. Inc.     

National estimates of cancer patients survival in Italy: a model-based method

AIMS AND BACKGROUND: To provide model-based estimates of all cancers patient survival in Italy and in Italian large geographical areas (North-West, North-East, Center, South), where only partial coverage of cancer registries data is available, and to describe them in terms of time trends. Moreover, to measure the degree of representativeness of cancer patient survival obtained from Italian cancer registries data. METHODS: Relative survival in the four main Italian geographical areas was estimated by a parametric mixture model belonging to the class of "cure" survival models. Data used are from Italian cancer registries, stratified by sex, period of diagnosis and age. The Italian national survival was obtained as a weighted average of these area-specific estimates, with weights proportional to the number of estimated incident cases in every area. The model takes into account also differences in survival temporal trends between the areas. RESULTS: Relative survival for all cancers combined in Italian patients diagnosed in 1990-1994 was estimated to be higher in women (53%) than in men (38%) at 5 years from the diagnosis. The survival trend is increasing by period and decreasing by age, both for men and women. The greatest gain in terms of survival was obtained by the elderly, with annual mean growth rates in the period 1978-1994 equal to 3.5% and 3.2% for men and women, respectively. More than 50% of the youngest cancer patients were "cured", whereas for the elderly this proportion dropped to 15% and 25% for men and women, respectively. The South of Italy had the lowest survival and the North the most pronounced increase. CONCLUSIONS: The obtained national survival estimates are similar, but not identical, to previously published estimates, in which Italian registries' data were pooled without any adjustment for geographical representativeness. The four Italian areas have different survival levels and trends, showing variability within the country. The differences in survival between men and women may be explained by the different proportion of lethal cancers. Among males, most cases had a poor prognosis (lung and stomach cancers), whereas among females the largest proportion was made up of curable and less lethal cancers (breast cancer).     

Descriptive study of gallbladder,extrahepatic bile duct,and ampullary cancers in the United States, 1997–2002

OBJECTIVE: Few investigations of biliary tract (gallbladder, extrahepatic bile duct, ampulla of Vater) cancers have been conducted because of the relative rarity of these malignancies. The objective of this analysis was to compare the demographic, pathological, and clinical features of biliary tract cancers among men and women. METHODS: Biliary tract cancers among 11,261 men and 15,722 women were identified through 33 US population-based registries during the period 1997-2002. These registries were estimated to represent 61% of the US population. Age-adjusted incidence rates (AAIR) were calculated per 100,000 population using counts derived from the 2000 US census. RESULTS: The AAIR for gallbladder cancer among men (0.82 per 100,000) was significantly lower than the AAIR among women (1.45 per 100,000). By contrast, rates for extrahepatic bile duct and ampullary cancers were significantly higher among men (0.93 per 100,000 and 0.70 per 100,000, respectively) than among women (0.61 per 100,000 and 0.45 per 100,000, respectively). White men and women had significantly lower AAIRs for gallbladder cancer compared with other racial-ethnic groups, with the highest rates among Hispanics, American Indian-Alaska Natives, and Asian-Pacific Islanders. Asian-Pacific Islanders and Hispanics of both sexes had the highest AAIRs for extrahepatic bile duct and ampullary cancers. Ampullary tumors were more likely to be diagnosed at a localized or regional stage than were cancers of the gallbladder and extrahepatic bile duct. Asian-Pacific Islander men and women tended to have more unstaged cancers than other groups. CONCLUSIONS: This population-based study suggests distinct etiologies of anatomic subsites of biliary tract cancer and caution against analytic investigations of all biliary tract cancers combined.     

Cancer incidence and mortality among teenagers in vaud,switzerland, 1974–1992

Data from the Vaud Cancer Registry, Switzerland, were used to analyse incidence and mortality from cancer in teenagers (aged 10 to 19 years) over the period 1974–1992. A total of 113 males and 87 females were registered. Of these, 23% were lymphomas, 16% leukaemias, about 15% central nervous system neoplasms, 10% germ cell tumours and bone neoplasms and 8% soft tissue sarcomas. The overall incidence rate (age-adjusted, world standard population) for all cancers combined was 167 per million boys and 128 per million girls. In both sexes, there was some indication of rising trends over time, to reach 196 per million males and 141 per million females in 1986–1992. The only types of cancer showing consistent upward trends in both sexes were lymphomas. A total of 53 cancer deaths were certified, due to leukaemias in about 40% of cases in both sexes and to lymphomas and brain tumours in 15%–20%. The overall mortality rate at age 10–19 years (age-standardised, world standard) was 47 per million boys and 31 per million girls, and no trend in mortality was observed over time. The 2 main findings of our analysis are (i) the absence of major trends in cancer incidence in adolescents, with the sole exception of a possible increasing incidence of lymphomas, and (ii) the lack of appreciable trends in mortality, in view of the declines in cancer mortality observed in children and young adults over the same calendar period. © 1995 Wiley-Liss, Inc.     

Model‐based projections for deriving up‐to‐date cancer survival estimates: An international evaluation

Model‐based projections were shown to be useful for deriving most up‐to‐date population‐based cancer survival estimates. However, the performance of these projections, which can be derived by various approaches, has only been evaluated in very few cancer patient populations. Using incidence and follow‐up data for 22 common cancers from 9 long‐standing population‐based cancer registries from diverse parts of Europe, we compared the performance of model‐based period and cohort analysis for predicting 5‐year relative survival of patients diagnosed in 1996–2000 against standard survival analysis approaches (cohort, complete and period analysis). Overall, model‐based predictions provided a best estimate of the later observed actual survival in 135 of 198 occasions, compared to 25, 18 and 33 occasions for cohort, complete and period analysis, respectively. Projections based on cohort and period type modeling performed essentially equally well on average, and their performance was better for more common cancers, in registries with larger population bases, and for cancers subjected to continuous clinical progress and/or ongoing screening efforts. Projections from model‐based analysis may contribute to improved timeliness of monitoring of concurrent trends in population‐based cancer survival in cancer registries operating in different populations and socioeconomic environments. © 2009 UICC     

1972—1998年上海市区小儿恶性肿瘤发病趋势

目的：对上海市区1972－1998年儿童恶性肿瘤发病率进行统计、分析,了解其变化趋势。方法：病例皆按照国际疾病分类（ICD－9）三位数字进行编码。根据有关年份人口普查资料中的性别、年龄构成估算各年的年龄组平均人口数。用世界标准人口计算标化率、发病率每年变化百分比。用病例数加权计算,线性回归法计算。结果：1972－1998年儿童肿瘤新病例共计2971例（男性1663人,女性1308人）。白血病、脑和神经系统、淋巴瘤是最常见的三种儿童恶性肿瘤,分别占儿童肿瘤总数的35．8％、17．8％和11．4％。1972－1998年男、女性小儿肿瘤的发病率均呈下降趋势,分别降低3．9％和5．7％。男性小儿白血病率均呈下降趋势,分别降低3．9％和15．75。男性小儿白血病发病率变化不很明显,但淋巴细胞性白血病发病率呈上升趋势,上升57．8％。每年增加1．4％。小儿女性白血病发病率降低25．3％,但淋巴细胞性白血病发病率变化不大。儿童髓性白血病发病率有所降低,男、女性分别下降25．4％和57．1％。27年间儿童脑和神经系统肿瘤发病率变化不大。男性儿童非霍奇金淋巴瘤发病率比较稳定;而女性则呈持续上升趋势,增加105．3％。霍奇金氏病发病率一直处于较低水平,男性病例数远多于女性。结论;上述发病趋势变化,提示除了肿瘤诊断和报告情况的改善外,居民生活方式和某些环境因素的变化在儿童肿瘤的发生中起着一定的作用。因此在儿童肿瘤防治、危险因素的研究中,应结合小儿各部位肿瘤的发病特点,确定研究的重点和防治对策。     

The continuing increase in the incidence of primary central nervous system non-Hodgkin lymphoma: a surveillance,epidemiology, and end results analysis

BACKGROUND: Primary central nervous system lymphoma (PCNSL) is an extranodal form of non-Hodgkin lymphoma arising in the craniospinal axis. The incidence of PCNSL appears to be increasing. METHODS: PCNSL incidence data from 1973-1997 were obtained from the nine Surveillance, Epidemiology and End Results (SEER) registries. To limit the influence of the human immunodeficiency virus on incidence rates, data of never-married males and females and persons of unknown marital status were excluded. As a surrogate for new technology, SEER data were reviewed by dates of diagnosis (surrogate for imaging) and compared with glioma incidence (surrogate for stereotactic neurosurgery and improved diagnostic neuropathology). Age-adjusted incidence rates were estimated and compared for the period prior to computed tomography (CT) (1973-1984) and the magnetic resonance imaging (MRI) period (1985-1997). The estimated annual percent change was calculated based on linear regression analyses using SEER*STAT. RESULTS: The incidence of PCNSL appears to be increasing in all SEER registries examined. All age groups demonstrated an increase over time. This increase was observed both in the CT era as well as in the MRI era. PCNSL age-adjusted incidence (0.15 to 0.48, a 3-fold increase) outpaced that of systemic lymphoma (14.1 to 18.5, a 33% increase) for the same registries over the same time periods. The rate of increase has begun to slow since 1985; the estimated annual percent change for PCNSL was three-fold higher during the period 1973-1985 compared with 1986-1997. CONCLUSION: The incidence rate of PCNSL continues to rise. The increase is evident in all age groups and in both genders. Data from the current study suggest that improved diagnostic tools, such as CT or MRI, cannot explain this increase.     

Incidence of Childhood Cancer in Osaka, Japan, 1971–1988: Reclassification of Registered Cases by Birch's Scheme Using Information on Clinical Diagnosis, Histology and Primary Site

In 1971–1988, 4,021 malignant tumors occurring among children under 15 years of age were registered in the Osaka Cancer Registry, a population-based registry which covers Osaka Prefecture, Japan. These patients were reclassified into 12 diagnostic groups by Birch's scheme using information on clinical diagnosis, histology and primary site. The annual age-standardized incidence rate for childhood cancer per million children was 130.3 for males and 104.9 for females in 1971–88. Comparing the incidence rates for both sexes in 1981–88 with those in 1971–80 in Osaka, we observed a significant decrease of acute non-lymphocytic leukemia (ANLL) and a significant increase of all cancers, acute lymphocytic leukemia, non-Hodgkin lymphoma, sympathetic nervous system tumors, soft-tissue sarcomas, and gonadal and germ-cell tumors. Age-standardized incidence rates in around 1971–80 of the above-mentioned diagnostic groups were compared among 4 population-based registries; Osaka, Miyagi (Japan), SEER (U.S.), and the National Registry of Childhood Tumors (England and Wales). Rates for ANLL and gonadal and germ-cell tumors were higher and those for other diagnostic groups were lower in Osaka, especially for Hodgkin's disease. Thus, in 1980–88 in Osaka, rates for Hodgkin's disease remained low and rates for gonadal and germ-cell tumors increased, though rates for other cancers appeared to resemble the levels in caucasian populations. The incidence of childhood cancer in Japan was estimated according to the diagnostic groups in Birch's scheme.