State of cancer in Spain: incidence

It is estimated that at present in Spain around 162,000 cases of cancer are diagnosed each year (without including non-melanoma skin cancer), of which 25,600 correspond to colorectal carcinomas, which is the most frequent of all tumours in absolute terms. The next tumour in terms of frequency is lung cancer with 18,800 new cases, followed by breast cancer in women with 15,979 cases. When the incidence of cancer is compared with that in neighbouring countries, Spain shows adjusted rates in men higher than those of the average for the EU, occupying the 5th place. However, in women, Spain shows the lowest rates together with Greece. Spain occupies the first place for cancer of the bladder in men, with rates that are considerably higher than those of the rest of the countries. It is important to verify the increase underway in the incidence of cancer in Spain and the contrast that this represents facing the evolution of mortality. For many important tumoral localisations (lung, stomach, bladder), the population registers do not cover the provinces where there is a greater mortality.     

Cervical screening in migrants to Australia

OBJECTIVE: To examine differentials and time trends in self-reported Pap test rates by migrant status from the 1989/90 and 1995 Australian National Health Surveys (NHS). METHOD: Unit record data for females with the variables of interest were extracted from the 1989/90 and 1995 NHS and combined. The dichotomous outcome variables were 'ever had a Pap test' and 'had a Pap test within three years'. The principal study factor was country-of-birth, but language spoken at home (English or not) was also examined. The indirect age-standardised screening ratio was used to calculate proportions of 'ever had a Pap test' and 'had a Pap test within three years' and differences were tested statistically using logistic regression analysis for each year of survey by migrant status. RESULTS: Odds ratios for rates of reporting 'ever had a Pap test' were significantly lower in women born in southern Europe, Italy, other countries, southern Asia, Middle East, Greece and South-East Asia compared with Australian-born. Reported rates of 'ever had a Pap test' were significantly higher in the 1995 NHS (p<0.001). There were significant increases in screening for the Australian-born, New Zealand-born, and women born in southern Europe, South-East Asia, South Asia and Italy, and both English and non-English speakers over the 1989/90 and 1995 NHSs. Odds ratios for reporting 'had a Pap test within three years' showed significantly lower ORs for women born in the UK, Other countries, Middle East, Greece, and South-East Asia compared with the Australian-born. CONCLUSIONS: This study reveals differentials in reported Pap test behaviour by country-of-birth in Australia and that reported screening rates have improved from the 1989/90 NHS to 1995 NHS in most country-of-birth groups.     

Cancer survival in Estonian migrants to Sweden.

OBJECTIVE: To quantify the eventual extra loss of life incurred to cancer patients in Estonia compared with those in Sweden that was possibly attributable to differences in society. DESIGN: Population based survival of cancer patients in Estonia was compared with that of Estonian immigrants to Sweden and that of all cancer patients in Sweden. The cancer sites studied were female breast and ovary, male lung and prostate, and male and female stomach and colon. SETTING: Data on incident cases of cancer were obtained from the population based Swedish and Estonian cancer registries. PARTICIPANTS: Data from Estonian patients in Sweden, Estonian patients in Estonia, and patients from the total Swedish population were included in the study. MAIN RESULTS: Differences in survival among the three populations, controlling for follow-up time and age at diagnosis, were observed in breast, colon, lung, ovarian, and prostate cancers. The survival rates of Estonians living in Sweden and the total population of Sweden were better than that of the Estonians living in Estonia. For cancers of the breast and prostate, the excess mortality in the older age group (75 and above) was much greater in Estonia than in the other populations. CONCLUSIONS: Most differences in cancer survival between Estonian and Swedish populations studied could be attributed to a longer delay in diagnosis, and also to inferior treatment (including access to treatment) in Estonia compared with Sweden. Estonia's lag in socioeconomic development, particularly in its public health organisation and funding, is probably the main source of the differences observed.     

Estimating cancer mortality rates from SEER incidence and survival data.

A method to estimate site-specific cancer mortality rates using Surveillance, Epidemiology, and End Results (SEER) Program incidence and survival data is proposed, calculated, and validated. This measure, the life table-derived mortality rate (LTM), is the sum of the product of the probability of being alive at the beginning of an interval times the probability of dying of the cancer of interest during the interval times the annual age-adjusted incidence rate for each year that data have been collected. When the LTM is compared to death certificate mortality rates (DCM) for organ sites with no known misclassification problems, the LTM was within 10 percent of the death certificate rates for 13 of 14 organ sites. In the sites that have problems with the death certificate rates, there were major disagreements between the LTM and DCM. The LTM was systematically lower than the DCM for sites if there was overreporting on the death certificates, and the LTM was higher than the DCM for sites if there was underreporting. The limitations and applications of the LTM are detailed.     

Correlation of dietary intake and colorectal cancer incidence among Mexican-American migrants: the multiethnic cohort study

Studies of migrants, along with geographic and temporal variations in incidence, indicate that colorectal cancer is especially sensitive to changes in environmental factors, including, most importantly, diet. The goal of this research was to examine the changes in dietary practices that may be consistent with the changing incidence of colorectal cancer in the Los Angeles Mexican-American population. Cancer incidence and dietary intake data were available for over 35,000 Latinos of Mexican national origin currently participating in the prospective Multiethnic Cohort Study, representing the largest sample of Mexican-origin Latinos of any such study in the United States. The dataset is unique in that changes in cancer rates and in dietary behaviors across three generations could be examined. Most of the change in colorectal cancer rates occurred between the first and second generations, and, correspondingly, nearly all the dietary change also occurred between the first and second generations. Although some food traditions were retained by Mexican Americans, the dietary changes due to acculturation were significant and support an association between colorectal cancer risk and certain dietary components, notably, alcohol as a risk factor and nonstarch polysaccharides and vegetables as protective factors.     

Time trend and age-period-cohort effects on gastric cancer incidence in Zaragoza and Navarre, Spain.

STUDY OBJECTIVE: To describe time trends in gastric cancer incidence in Zaragoza and Navarre, and to investigate time period and birth cohort as determinants of such trends. DESIGN: Cases from two registries were grouped into five year intervals and the following were calculated: age specific and sex specific incidence rates, and the male to female ratio. Log linear models including age, period of diagnosis, and birth cohort were fitted. SETTING: The Zaragoza Cancer Registry covers the province of Zaragoza, which has a population of 824,776 (403,755 men and 421,021 women). The Navarre Cancer Registry covers the province of Navarre which has 512,512 inhabitants (254,786 men and 257,726 women). In both cases population figures were based on the late census. PATIENTS: These comprised incident cases of gastric cancer reported to the Zaragoza Cancer Registry in 1963-87 and to the Navarre Cancer Registry in 1973-87. MAIN RESULTS: Navarre registered higher adjusted and cumulative rates than Zaragoza for both sexes. In both provinces, there were relative declines in the rates for men and women of 3% and 4% respectively per year. In Zaragoza, the risk of developing stomach cancer fell in generations born between 1888 and 1933, and rose in subsequent birth cohorts in both sexes, while in Navarre the cohort effect showed an approximately linear risk for both sexes. Both provinces recorded increases in risk associated with cohorts born between 1933 and 1943. CONCLUSION: The incidence rates of gastric cancer fell in both Zaragoza and Navarre. The reason for the greater incidence of gastric cancer in Navarre remains unknown. Trends in rates seem to be mainly linked to birth cohort. Increases in risk in generations born after 1933 may be ascribable to nutritional deficiencies in the early years of life.     

Cervical cancer incidence and mortality in the best and worst of worlds

BACKGROUND: Globally speaking, cervical cancer is a common cause of death. The cancer is caused by a human papillomavirus (HPV) infection, and hence is preventable. Pap smear screening allows for the early detection of precancerous lesions that are easily treated in a pre-invasive phase of the disease. New tests and treatment methods have the overall aim of lowering cervix cancer incidence and death. However, whether a woman will or will not develop cervix cancer depends on a complex number of interacting variables. AIM: The aim of the present study was to identify factors that might have an impact on cervix cancer incidence and mortality, and rank them according to the weight of their relative influence. METHODS: By using a forecasting model called the scenario method, factors were identified that could have an impact on cervix cancer development, and their relative importance was ranked by using a special matrix. The figures given for each factor were summed and presented in a System Grid, which made it possible to determine the most important variable. RESULTS: The cultural structure of the female population, as well as women's habits and behaviour, all seem to be more important factors than the Pap smear test or the treatment in relation to cervical cancer incidence and mortality. CONCLUSION: In the endeavour to prevent cervical cancer one must consider the whole chain of events, i.e. population-tests-treatment-outcome. New and improved test methods and treatment procedures are of little use if women refrain from coming for a test when called.     

Bladder cancer in Asturias, Spain: incidence and trends (1982-1993)

OBJECTIVES: To assess epidemiological aspects of bladder cancer in Asturias, as a preliminary step before undertaking epidemiological and genetic research of the etiology and survival of bladder neoplasm. METHODS: cases from the Asturias Regional Cancer Registry, Spain were used to calculated annual incidence rates between 1982 and 1993 for Asturias and all its health areas. It has been Standardized incidence ratios with the indirect method for the Asturian areas and other Spanish regions were obtained our results are also compared with other european countries. RESULTS: The trend in bladder cancer in Asturias has been increasing significantly in the last twelve years (11.03 to 15.10 age standardized rate per 100,000). For the different health areas no differences have been identified, while there were not significant differences between our region and other Spanish regions. Standardized rates for Asturian men are in the highest group among European countries, while women rates are at an intermediate level. CONCLUSIONS: Between 1982 and 1993, bladder cancer incidence has been increasing in Asturias. The different behaviour of incidence ratios between men and women and the similar epidemiological factors between Asturias and other parts of Spain point at the need for further epidemiological research to look at the different occupational factors existing in an industrial area like Asturias.     

The Melbourne colorectal cancer study: incidence findings by age, sex, site, migrants and religion

During a 12-month period, age, sex, site, country of birth and religion data were obtained on all new cases of colorectal cancer (CRC) in Melbourne (population 2.8 million) yielding 1150 cases, this being the incidence study arm of a large-scale epidemiological and clinico-pathological investigation of CRC in Melbourne. The age, sex, site and subsite findings had, as expected, the characteristics of a high-risk population for CRC. Unexpectedly, rectal cancer rates were some of the highest recorded in the world. Incidence was greater in males than in females except for colon cancer between ages 35 and 58 where there was a female excess. There was an increasing male to female ratio from caecum to rectum and the crossover age to male excess had a monotonic pattern as it became younger from caecum to rectum. This site and subsite sex pattern may represent an aetiological difference and warrants further study. The data on first generation migrants supported the concept that with migration from low-risk to high-risk countries for CRC, such as Australia, there is a transition of rates towards the risk levels of the new country. Migrant rates for CRC were lower for each subsite than in the Australian born, but became closer to the Australian rate the further the distance down the bowel. Jews had rates nearly double those of the Melbourne population, a hitherto unreported finding in Australia. The possible causes of the very high rectal rates, the transition in migrant rates and the high Jewish rate will be reported in the case-control arm of the study.     

Cervical cancer in New South Wales women: five-year survival, 1972 to 1991

Abstract: We analysed five-year relative survival of 6992 cases of cervical cancer incident between 1972 and 1991 in New South Wales (NSW) women, using data from the population-based state Cancer Registry. Follow-up was to 1992. Survival was determined by record linkage to death certificates. Relative survival was derived from absolute survival of cases with expected survival of age- and period-matched NSW women. Proportional hazard regression analysis was used for multivariate analysis. Relative survival at five years improved from 64 per cent in 1972–1976 to 72 per cent in 1987–1991, although the only significant increase occurred between 1972–1976 and 1977–1981 (64 to 70 per cent). Survival was better for the age groups 0–39 years (RR 0.51) and 40–49 years (RR 0.63) and worse for the elderly (>65 years) (RR 1.47) than for the referent group (50–64 years). Excess mortality was much less for those with localised disease (referent group), than for those with regional spread (RR 3.47) or metastatic cancer (RR 10.5) at diagnosis. For the most recent period (1987–1991), relative five-year survival for localised disease was 82 per cent, for regional spread at diagnosis it was 49 per cent, and for metastatic cancer 21 per cent. When adjusted for confounding, excess mortality was significantly higher for adenocarcinoma (RR 1.16) than for squamous cell carcinoma. Five-year relative survival for cervical cancer in NSW women for the most recent period is similar to that in South Australia, and both compare favourably with international statistics. The lack of improvement of five-year survival for cervical cancer over 15 years since 1977–1981 reinforces the importance of prevention through regular screening by cytology.     

Ovarian cancer in Western Australia (1982-98): incidence, mortality and survival

OBJECTIVES: To investigate the trends in incidence and mortality and estimate survival for women diagnosed with ovarian cancer in Western Australia. CASE SELECTION AND METHODS: There were 1,336 women diagnosed with ovarian cancer in 1982-98. Age-standardised rates were calculated by the direct method. Age-period and age-cohort models were analysed by Poisson regression. The Kaplan-Meier method was used to estimate survival and Cox proportional hazards regression evaluated the relative risk of dying. RESULTS: Trends in age-adjusted incidence and mortality rates showed little changed over the three time periods of diagnosis. A significant birth cohort effect showed a peak in the risk in the 1924 (mid-year) cohort followed by a general decrease in both incidence and mortality risk. Survival at five years was 34% (95% CI 31.3-36.5) overall, but was only 27% (95% CI 17.4-36.7) among women with stage III and IV disease. Aboriginal women showed a risk of dying twice that of non-Aboriginal women. CONCLUSIONS: The birth cohort analysis of ovarian cancer proved better at explaining disease trends than was time period of diagnosis. Survival continues to be poor, but Aboriginal women and those with serous and unspecified adenocarcinoma tumours fair much worse. IMPLICATIONS: As the leading cause of death from a gynaecological malignancy, ovarian cancer is of public health importance. Historical trends in birth rates and the use of oral contraceptives help to explain at least some of the observed birth cohort trends in this study. In the long term, an effective diagnostic technique needs to be developed or this disease will continue to be diagnosed at an advanced stage when treatment options for cure are limited.     

Geographical pattern of brain cancer incidence in the Navarre and Basque Country regions of Spain

Background: The study of the distribution of brain cancer mortality in Spain shows a grouping of highest risk provinces corresponding to the autonomous regions of Navarre and the Basque Country.

Aim: To explore the possible existence of geographical patterns in these areas.

Methods: Municipal maps of brain cancer incidence were drawn up and the influence of land use related variables on the distribution of the disease duly analysed. Autoregressive conditional models were used to plot smoothed municipal maps. The influence of explanatory land use variables, ascertained by remote sensing, was assessed.

Results: The maps revealed that certain towns situated in the "Media" and "Cantábrica-Baja Montaña" districts of Navarre were areas of highest risk. Among the towns in question, those in the "Media" district lie very close to the city of Pamplona. However, the pattern of brain cancer incidence in Navarre and the Basque Country could not be conclusively said to be determined by any specific type of land cover and/or crop.

Conclusions: Results suggest a possible increase of risk linked to areas devoted to a high percentage of non-irrigated arable land.

     

Accompanied child irregular migrants who arrive to Spain in small boats: Experiences and health needs

ABSTRACT

The European Union is the preferred destination of child irregular migrants arrived from northern Africa, who risk their lives crossing the Mediterranean Sea in small boats. Accompanied Child Irregular Migrants (AChIMs) are exposed to physical and psychological risk. The objective of our study is to describe and understand the experiences and health needs of AChIMs who arrive to Spain in small boats, through the testimony of adults who accompany them on the journey. A qualitative study, based on Gadamer’s hermeneutic phenomenology, was performed. After obtaining approval from the Ethics and Research Committee, we conducted in-depth interviews on 32 adults who travelled with AChIMs. Two main themes emerged: (1) The journey a child should never have to take, with the subthemes ‘AChIMs as a paradigm of vulnerability’ and ‘Crossing the sea, playing with death’ and (2) Characterising emergency care to AChIMs, with the subthemes ‘Prioritising specific care’, ‘Identifying high-risk situations’ and ‘The detaining of innocent children’. AChIMs, along with adults, risk their lives in such a dangerous and perilous journey, therefore, finding out about their experiences may contribute to improving the treatment of their specific health needs during the phases of rescue and emergency care.     

Socioeconomic differences in incidence and relative survival after a first acute myocardial infarction in the Basque Country, Spain

Objective

To estimate the incidence and 28-day and 5-year survival rates after a first acute myocardial infarction (AMI) in relation to socioeconomic status in the Basque Country (Spain) between 1999 and 2000.

Methods

Data from a population-based registry of AMI were used. The study included 3,619 patients to calculate age-standardized incidence by the direct method and 2,003 patients (out-of-hospital deaths were excluded) to calculate observed and relative survival using the Kaplan-Meier and Hakulinen methods, respectively. Socioeconomic status was quantified using a deprivation index ecologically assigned to each patient according to the census tract of residence at diagnosis of AMI and was categorized into quintiles.

Results

Among men, the risk of AMI was higher in the lowest socioeconomic group than in the highest socioeconomic group (RR = 1.17; 95%CI: 1.02-1.34). In men, a higher risk of death was observed in the middle (Q3; HR = 1.60; 95%CI: 1.02-2.51) and low (Q5; HR = 1.65; 95%CI: 1.02-2.69) quintiles compared with the least deprived group for age-adjusted survival during the acute phase. In the fully adjusted model, this effect was attenuated and no significant differences were observed in long-term survival. Among women, no significant differences were observed either in incidence or in short- and long-term survival.

Conclusions

Socioeconomic inequalities were only observed in men in incidence and in survival during the acute phase after an AMI.