Laryngeal cancer mortality trends in European countries

After a steady increase between the 1950s and the 1970s, laryngeal cancer mortality has been levelling off since the early 1980s in men from most western and southern European countries and since the early 1990s in central and eastern Europe. To update trends in laryngeal cancer mortality, we analyzed data provided by the World Health Organization over the last two decades for 34 European countries and the European Union (EU) as a whole. For major European countries, we also identified significant changes in trends between 1980 and 2012 using joinpoint regression analysis. Male mortality in the EU was approximately constant between 1980 and 1991 (annual percent change, APC=?0.5%) and declined by 3.3% per year in 1991–2012. EU age‐standardized (world population) rates were 4.7/100,000 in 1990–91 and 2.5/100,000 in 2010–2011. Rates declined in most European countries, particularly over the last two decades. In 2010–11, the highest male rates were in Hungary, the Republic of Moldova, and Romania (over 6/100,000), and the lowest ones in Finland, Norway, Sweden, and Switzerland (below 1/100,000). In EU women, mortality was stable around 0.29/100,000 between 1980 and 1994 and slightly decreased thereafter (APC=?1.3%; 0.23/100,000 in 2000–01). We also considered male incidence trends for nine European countries or cancer registration areas. In most of them, declines were observed over recent decades. Laryngeal cancer mortality thus showed favourable trends over the last few decades in most Europe, following favourable changes in tobacco and, mostly for Mediterranean countries, alcohol consumption.     

Villoglandular papillary adenocarcinoma of the uterine cervix. A clinicopathologic analysis of 13 cases

The clinical and pathologic features of 13 cervical papillary adenocarcinomas of villoglandular type were reviewed. They occurred in patients 23 to 54 years of age, with ten patients younger than 40 years of age. Microscopic examination revealed surface papillae that ranged from tall and thin to short and broad and contained central fibrous cores typically containing numerous inflammatory cells. The papillae were usually lined by stratified epithelial cells with slight to moderate nuclear atypicality and mitotic activity and no more than a minor degree of cellular budding. The deeper portions of the tumors were composed of branching tubular glands separated by a fibrous or fibromatous stroma and were more or less sharply demarcated from the adjacent cervical stroma. A hysterectomy was performed in 12 cases and only a cone biopsy in one case. The cone biopsy specimen and four of the hysterectomy specimens contained no residual carcinoma. In six uteri adenocarcinoma was confined to the inner third of the cervical wall whereas in two there was deep invasion. Follow-up of 2 to 14 years' duration including more than 5 years in ten cases has revealed no evidence of recurrent tumor. The excellent prognosis of the patients in this small series and the young age of many of them suggest that this tumor may be managed by a procedure less radical than a hysterectomy provided the tumor is superficial, has been completely excised, does not exhibit vascular space invasion, and close follow-up examination is possible.     

Incidence trends of adult primary intracerebral tumors in four Nordic countries

Brain tumors are some of the most lethal adult cancers and there is a concern that the incidence is increasing. It has been suggested that the reported increased incidence can be explained by improvements in diagnostic procedures, although this has not been totally resolved. The aim of our study was to describe the incidence trends of adult primary intracerebral tumors in four Nordic countries during a period with introduction of new diagnostic procedures and increasing prevalence of mobile phone users. Information about benign and malignant primary intracerebral tumor cases 20-79 years of age was obtained from the national cancer registries in Denmark, Finland, Norway and Sweden for the years 1969-98 and estimates of person-years at risk were calculated from the information obtained from national population registries. Annual age standardized incidence rates per 100,000 person-years were calculated and time trends analyses were carried out using Poisson regression. The overall incidence of all intracerebral tumors ranged from 8.4-11.8 for men and 5.8-9.3 for women, corresponding to an average annual increase of 0.6% for men (95% confidence interval [CI] = 0.4, 0.7) and 0.9% for women (95% CI = 0.7, 1.0). The increase in the incidence was confined to the late 1970s and early 1980s and coinciding with introduction of improved diagnostic methods. This increase was largely confined to the oldest age group. After 1983 and during the period with increasing prevalence of mobile phone users, the incidence has remained relatively stable for both men and women.     

Breast cancer incidence and mortality trends in 16 European countries

Trends in the incidence of and mortality from breast cancer result from a variety of influences including screening programmes, such as those introduced in several European countries in the late 1980s. Incidence and mortality rates for 16 European countries are analysed. Incidence increased in all countries. The estimated annual percent change (EAPC) varied from 0.8 to 2.8% in prescreening years in 6 'screened' countries and from 1.2 to 3.0% in 10 'non-screened' countries. Screening related temporary increases were visible. Earlier mortality trends were maintained in the most recent decade in Estonia (EAPC +1.8%) and Sweden (-1.2%). In other countries, previously increasing trends changed. Trends flattened in Finland, Denmark, France, Italy and Norway (EAPC 0.0 to -0.3%), while they declined in England and Wales (-3.1%), Scotland (-2.0%), and The Netherlands (-1.0%), all of which have national screening programmes, and in Slovakia (-1.1%), Spain (-0.7%), and Switzerland (-1.1%). In some countries with screening programmes, declines in mortality started before screening was introduced, and declines also occurred in non-screened age groups and in some countries without national screening programmes. This suggests that the major determinants of the observed trends vary among the countries and may include earlier detection through screening in countries where this has been introduced, but also improvements in therapy, in countries with or without screening.     

Childhood central nervous system tumours: Incidence and time trends in 13 Southern and Eastern European cancer registries

AimFollowing completion of the first 5-year nationwide childhood (0–14 years) registration in Greece, central nervous system (CNS) tumour incidence rates are compared with those of 12 registries operating in 10 Southern–Eastern European countries.MethodsAll CNS tumours, as defined by the International Classification of Childhood Cancer (ICCC-3) and registered in any period between 1983 and 2014 were collected from the collaborating cancer registries. Data were evaluated using standard International Agency for Research on Cancer (IARC) criteria. Crude and age-adjusted incidence rates (AIR) by age/gender/diagnostic subgroup were calculated, whereas time trends were assessed through Poisson and Joinpoint regression models.Results6062 CNS tumours were retrieved with non-malignant CNS tumours recorded in eight registries; therefore, the analyses were performed on 5191 malignant tumours. Proportion of death certificate only cases was low and morphologic verification overall high; yet five registries presented >10% unspecified neoplasms. The male/female ratio was 1.3 and incidence decreased gradually with age, apart from Turkey and Ukraine. Overall AIR for malignant tumours was 23/10⁶ children, with the highest rates noted in Croatia and Serbia. A statistically significant AIR increase was noted in Bulgaria, whereas significant decreases were noted in Belarus, Croatia, Cyprus and Serbia. Although astrocytomas were overall the most common subgroup (30%) followed by embryonal tumours (26%), the latter was the predominant subgroup in six registries.ConclusionChildhood cancer registration is expanding in Southern–Eastern Europe. The heterogeneity in registration practices and incidence patterns of CNS tumours necessitates further investigation aiming to provide clues in aetiology and direct investments into surveillance and early tumour detection.     

Testicular cancer incidence in eight northern European countries: secular and recent trends.

OBJECTIVE: Striking geographic variation and marked increasing secular trends characterize the incidence of testicular cancer. However, it is not known whether these patterns have attenuated in recent years and whether they are similar for seminomas and nonseminomas, the two main histologic groups of testicular cancer.METHOD: Cancer registry data, including 27,030 testicular cancer cases, were obtained from Denmark, Estonia, Finland, Latvia, Lithuania, Norway, Poland, and Sweden. Between 57 (Denmark) and 9 (Poland) years of registration were covered. Country-specific temporal trends were estimated, with focus on the last decade and seminomas and nonseminomas. Data from the Nordic countries were further analyzed using an age-period-cohort approach.RESULTS: Age-standardized incidence rates increased annually by 2.6% to 4.9% during the study period, with marginal differences between seminomas and nonseminomas. In the last decade, the increasing trend attenuated only in Denmark (annual change, -0.3%; 95% confidence interval, -1.5 to 0.9). In 1995, the highest and the lowest age-standardized incidence rates (per 10(5)) were 15.2 in Denmark and 2.1 in Lithuania. Incidence rates (i.e., for all cancers and for seminomas and nonseminomas, separately) depended chiefly on birth cohort rather than on calendar period of diagnosis (although both birth cohort and period determined the Danish incidence rates).CONCLUSIONS: Testicular cancer incidence is still increasing, with the exception of Denmark, and a large geographic difference exists. The increasing trend is mainly a birth cohort phenomenon also in recent cohorts. Temporal trends for seminomas and nonseminomas are similar, which suggests that they share important causal factors.     

Treatment of primary adenocarcinoma of the cervix.

Between 1956 and 1971, a total of 74 cases of adenocarcinoma of the cervix was treatedin the Division of Radiation Therapy of the University of Maryland Hospital. Radical radiation therapy was followed by routine surgery early in the study;after 1967, surgery was used only for radiation failure. The likelihood of local control and 5-year survival was not improved by the routine addition of surgery to radical radiation, although the incidence of serious complications was markedly elevated. The results of treatment of adenocarcinoma of the cervix by radiation therapy alone are not significantly different from those achieved with squamous cell carcinoma. Surgery should be used as a salvage procedure in case of failure, rather than on a routine basis.     

Combination chemotherapy for advanced adenocarcinoma of the cervix.

A patient with advanced adenocarcinoma of the cervix was treated only with cisplatin and mitomycin C (MMC). The regimen achieved a complete response, confirmed by chest radiograph and computed axial tomography scan, lasting 50 months. The patient is alive with recurrent disease 59 months after diagnosis. No severe drug-related toxicity occurred.     

Incidence of non-Hodgkin's lymphoma in children between 1970 and 1990 in nine European countries

Data from population-based cancer registries in Europe (nine countries) were used to monitor the incidence of non-Hodgkin's lymphoma in children aged 0-14 years over the 20 year period 1970-1990. The overall annual change in incidence was small--an increase of 0.76% annually, and there was no change at all in infants under one year of age. This differs markedly from the pattern in adults, where quite large increases have occurred.     

Screening and adenocarcinoma of the cervix

Screening has had a major impact on cervical cancer in many countries. Although there can be no doubt about its effectiveness in preventing squamous‐cell carcinoma, there is little evidence of any benefit on adenocarcinoma and adenosquamous carcinoma of the cervix, and many authors have concluded that it is ineffective. A population‐based case–control design was used in women aged 20–69 in the United Kingdom, with information on screening obtained from routine databases. Among 3,305 cases with known histology, 641 had adenocarcinoma and 133 adenosquamous carcinoma. The risk reduction associated with 3‐yearly screening was greater for squamous carcinoma (75%, 95%CI 71–79%) and adenosquamous carcinoma (83%, 95%CI 68–91%) than for adenocarcinoma (43%, 95%CI 24–58%). Among stage 1B+ cases, 83% (335/406) of women with adenocarcinoma had been screened within 10 years of diagnosis. This is very similar to controls (82%, 3,292/3,965), but much higher than in women with squamous carcinoma (57%, 852/1,493). Incidence of adenocarcinoma was low within 2.5 years of a negative smear (OR 2.3, 95%CI 0.15–0.34), but was no different from the background rates 4.5–5.5 years after a negative smear. We conclude that screening has reduced the incidence of adenocarcinoma of the cervix, but the prognostic value of cytology is less (in both magnitude and duration) for adenocarcinoma than for squamous carcinoma. The impact of screening on adenosquamous carcinoma is similar to its impact on squamous carcinoma. © 2009 UICC     

Incidence trends in invasive uterine cervix cancer and carcinoma in situ in Incheon, South Korea

Introduction: This study examined trends of invasive and carcinoma in situ(CIS) in terms of the incidence and mortality of uterine cervix cancer in Incheon over a twelve year period. Methods: Uterine cervical cancer data were retrieved from the Incheon Cancer Registry(ICR) and Korea Central Cancer Registry(KCCR) from 1997 to 2008. The time trend in age-standardized incidence rates (ASR) of invasive uterine cervix cancer and CIS were calculated and compared with the nation-wide cancer registry data for each year. Mortality/incidence (M/I) ratios according to age and the incidence of pathological subtype in Incheon each year were also examined, along with an international comparison. Results: A total of 3,096 cases of invasive cervical cancer and 2,079 cases of carcinoma in situ were analyzed from 1997 to 2008. The time trend incidence of the total ASR in uterine cervical cancer decreased from 25.7 in 1997 to 13.4 in 2008, but incidence of CIS increased from 7.6 to 15.8 in same period. In invasive cancers, the age-specific incidence rates were highest in those in their sixties and patients in their forties showed highest incidence of CIS. The mortality rate in ICR was 3.7 from 1998 to 2002. Compared to the other countries which have high risk factors for cervix cancer, the peak incidence zone was different in Incheon. Conclusion: The ICR showed a decrease in the incidence of invasive cervical cancer that was similar to the nation-wide data. An early increase zone is a characteristic pattern in the age specific incidence curve. Early screening and a vaccination program should be activated for prevention of young age cervical cancer.     

Early invasive adenocarcinoma of the cervix

BACKGROUND: Adenocarcinoma of the cervix is increasing in frequency. There is a dearth of specific detail concerning the histomorphology, histogenesis, and associated findings in early invasive cervical adenocarcinoma. METHODS: Forty cases of cervical adenocarcinoma invasive to 5 mm or less were examined in detail. RESULTS: Mean patient age was 40.9 years. In 78% of the cases, the midpoint of the invasive focus was in the region of the squamocolumnar junction or transformation zone; more than 1 invasive focus was present in 4 cases. Eighty-five percent of cases also had adenocarcinoma in situ (AIS). In 9 of 10 minimally invasive cases, small invasive glands were present in the stroma adjacent to AIS. In some of these, the AIS had preinvasive buds that were still attached. Endometrioid adenocarcinomas were associated with AIS but were located higher in the canal than the more common endocervical type. All three adenosquamous carcinomas were associated with both squamous intraepithelial neoplasia and AIS. Vascular space invasion was observed in two cases, microglandular hyperplasia in four. CONCLUSIONS: Adenocarcinoma in situ is the precursor to most adenocarcinomas of the cervix with an average interval between clinically detected AIS and early invasion of approximately 5 years, supporting the potential for Papanicolaou test screening to prevent this disease. However, the existence of small carcinomas in the absence of AIS suggests the possibility of rapid progression in some cases. Invasion occurs by budding from or expansion of AIS glands, usually in the region of the squamocolumnar junction. Multifocal invasion is uncommon, as is vascular invasion in early lesions. The endometrioid variant has the same histogenesis as the endocervical type but may arise higher in the canal. The precursor of adenosquamous carcinoma has a similar bimorphic differentiation potential. Microglandular hyperplasia is not related to early invasive adenocarcinoma.     

Prostate cancer incidence and mortality trends in 37 European countries: an overview

Prostate cancer has emerged as the most frequent cancer amongst men in Europe, with incidence increasing rapidly over the past two decades. Incidence has been uniformly increasing in the 24 countries with comparable data available, although in a few countries with very high rates (Sweden, Finland and The Netherlands), incidence has begun to fall during the last 3-4 years. The highest prostate cancer mortality rates are in the Baltic region (Estonia, Latvia and Lithuania) and in Denmark, Norway and Sweden. Prostate cancer mortality has been decreasing in 13 of the 37 European countries considered - predominantly in higher-resource countries within each region - beginning in England and Wales (1992) and more recently in the Czech Republic (2004). There was considerable variability in the magnitude of the annual declines, varying from approximately 1% in Scotland (from 1994) to over 4% for the more recent declines in Hungary, France and the Czech Republic. There appears little relation between the extent of the increases in incidence (in the late 1990s) and the recent mortality declines. It remains unclear to what extent the increasing trends in incidence indicate true risk and how much is due to detection of latent disease. The decreasing mortality after 1990 may be attributable to improvements in treatment and to an effect of prostate specific antigen (PSA) testing. The increase in mortality observed in the Baltic region and in several Central and Eastern European countries appear to reflect a real increase in risk and requires further monitoring.     

Incidence of cancer of the lung stomach,breast, and cervix in the USSR: pattern and trends

The most frequent fatal malignant tumors in the Soviet Union are cancers of the lung, stomach, breast, and cervix uteri. From incidence statistics and population estimates provided by the Department of Statistics of the Ministry of Health, age-adjusted incidence rates for the period 1971–87, using the World standard population, have been computed for the USSR as a whole and for each of the 15 Soviet republics. For six republics believed to have the highest quality of data and relatively homogeneous populations, time-trends are examined over the period. There is important geographical variation in the incidence of malignant tumors in the Soviet Union. The differences between high and low incidence areas are four-fold for cancer of the lung and stomach, three-fold for cancer of the breast and two-fold for cancer of the cervix. Overall in the six republics for which time-trends are examined, cancers of the lung and breast have increased, cancers of the stomach and cervix have decreased. There are some variations in specific age groups in some republics.The authors are in the Institute of Carcinogenesis, Department of Epidemiology of the All-Union Cancer Research Centre of the Academy of Medical Sciences of the USSR, Moscow. Address reprint requests to Dr Zaridze at Kashirskoye sh. 24, Moscow 115478, USSR.     

Recent trends in incidence of five common cancers in 26 European countries since 1988: Analysis of the European Cancer Observatory

BackgroundIndividual country- and cancer site-specific studies suggest that the age-adjusted incidence of many common cancers has increased in European populations over the past two decades. To quantify the extent of these trends and the recent burden of cancer, here we present a comprehensive overview of trends in population-based incidence of the five common cancers across Europe derived from a new web-based portal of the European cancer registries.MethodsData on incidence for cancers of the colon and rectum, prostate, breast, corpus uteri and stomach diagnosed from 1988 to 2008 were obtained from the European Cancer Observatory for cancer registries from 26 countries. Annual age-standardised incidence rates and average annual percentage changes were calculated.ResultsIncidence of four common cancers in eastern and central European countries (prostate, postmenopausal breast, corpus uteri and colorectum) started to approach levels in northern and western Europe, where rates were already high in the past but levelled off in some countries in recent years. Decreases in stomach cancer incidence were seen in all countries.DiscussionIncreasing trends in incidence of the most common cancers, except stomach cancer, are bad news to public health but can largely be explained by well-known changes in society in the past decades. Thus, current and future efforts in primary cancer prevention should not only remain focussed on the further reduction of smoking but engage in the long-term efforts to retain healthy lifestyles, especially avoiding excess weight through balanced diets and regular physical exercise.     

Prognostic factors in adenocarcinoma of the uterine cervix

A group of 136 female patients with adenocarcinoma of the uterine cervix, treated at Memorial Sloan-Kettering Cancer Center between 1949 and 1981, with slides available for review, formed the basis for this study. They ranged in age from 10 to 91 years. Most (73%) had abnormal bleeding, either alone or in combination with other symptoms; 15% were asymptomatic. Eighty percent had a visible abnormality, most commonly an exophytic mass. Clinical stages were: 0 (3%), IB (61%), IIA (14%), IIB (10%), III (4%). There were four major histologic subtypes: mucinous (47%), endometrioid (24%), adenosquamous (15%), and clear cell (9%) carcinoma. Of the many clinicopathologic variables evaluated for prognosis, the most significant was stage of disease (P less than 0.0001). Those with Stage IB disease had a survival probability of 76% at 5 years compared with 49% for those with Stage IIA and 34% with Stage IIB. The endometrioid pattern was associated with a more favorable prognosis than any other histologic subtype (P = 0.02). The presence of lymphatic tumor emboli and/or metastatic carcinoma in any lymph node group was associated with a less favorable prognosis for patients with Stage IB and IIA disease (P less than 0.0001).     

Incidence of invasive cancers following carcinoma in situ of the cervix.

Women with carcinoma in situ (CIS) of the cervix uteri, notified to the population-based Cancer Registry of the Swiss Canton of Vaud between 1974 and 1993, were actively followed up to 31 December 1993 for the occurrence of subsequent invasive neoplasms. Among 2190 incident cases of CIS, followed for a total of 22,225 person-years, 95 metachronous cancers were observed vs 77.9 expected, corresponding to a significant standardised incidence ratio (SIR) of 1.2. Ten cases of invasive cervical cancer were observed vs 3.0 expected (SIR = 3.4, P < 0.01), the excess being larger in the first 10 years since CIS diagnosis. A total of 11 cases of four major tobacco-related sites (lung, mouth or pharynx, oesophagus and urinary bladder) were observed vs 5.1 expected, corresponding to a significant SIR of 2.2. The excess was observed > or = 10 years after CIS diagnosis. There was also an excess of non-melanomatous skin cancers (29 observed, 16.9 expected, SIR = 1.7; P < 0.01), but not of skin melanoma and of any of the other neoplasms considered, including breast and corpus uteri. This population-based study, therefore, finds an excess of invasive cervical cancer in the short term after CIS diagnosis, and a medium- to long-term excess risk of tobacco-related and non-melanomatous skin neoplasms. These findings are discussed in terms of increased surveillance and case ascertainment after CIS, and of potential shared risk factors (tobacco and/or viral infections).     

Oestrogen receptor protein and mRNA in adenocarcinoma of the uterine cervix.

We have investigated the oestrogen receptor (ER) status of 20 cervical adenocarcinomas by immunocytochemistry for ER protein and non-isotopic in situ hybridisation for ER mRNA. Both methods, which are applicable to paraffin sections, were developed and validated in breast carcinomas with known ER content. Six cervical adenocarcinomas contained immunocytochemically demonstrable ER protein; all contained ER mRNA, but staining was less intense in poorly differentiated areas of four tumours. This disparity between protein and mRNA detection needs further investigation as does the possibility that oestrogens may play a role in the pathogenesis of cervical adenocarcinoma.     

Trends in cervical squamous cell carcinoma incidence in 13 European countries: changing risk and the effects of screening.

Despite there being sufficient evidence for the effectiveness of screening by cytology in preventing cancer of the cervix uteri, screening policies vary widely among European countries, and incidence is increasing in younger women. This study analyzes trends in squamous cell carcinoma (SCC) of the cervix uteri in 13 European countries to evaluate effectiveness of screening against a background of changing risk. Age-period-cohort models were fitted and period and cohort effects were estimated; these were considered as primarily indicative of screening interventions and changing etiology, respectively. A unique set of estimates was derived by fixing age slopes to one of several plausible age curves under the assumption that the relation between age and cervical cancer incidence is biologically determined. There were period-specific declines in cervical SCC in several countries, with the largest decreases seen in northern Europe. A pattern emerged across Europe of escalating risk in successive generations born after 1930. In the western European countries, a decrease followed by a stabilization of risk by cohort was accompanied by period-specific declines. In southern Europe, stable period, but increasing cohort trends, were observed. Substantial changes have occurred in cervical SCC incidence in Europe and well-organized screening programs have been highly effective in reducing the incidence of cervical SCC. Screening and changing sexual mores largely explain the changing period- and cohort-specific patterns, respectively. The increasing risk in recent cohorts is of obvious concern particularly in countries where no screening programs are in place. Further investigation of the effectiveness of opportunistic screening is warranted as is the observation of differing risk patterns in young cohorts in countries with relatively similar societal structures.     

Recent trends in cervix uteri cancer

Since the prevalence of several risk factors for cervix uteri cancer, such as sexual activity patterns, cigarette smoking, and contraceptive use, has changed over time, the authors analyzed US trends for this cancer during the 1970s to 1980s to search for corresponding variations. Invasive cervical cancer incidence and mortality rates continued to decrease among blacks and whites, although declines are moderating or plateauing among young whites. Carcinoma in situ rates have not changed greatly or have declined, more so among blacks than whites. Excess risks among blacks are less evident among younger than older age groups. Increasing trends were seen only among whites in certain age groups or with certain histologic types. Declining trends in cervical cancer appear related to the widespread use of cervical cytologic screening programs, which have counteracted increases anticipated from changes in risk factor prevalence. Continued surveillance is warranted, however, with special attention to the trends in cervical adenocarcinoma.