Role of the Cancer Registries in Determining Cancer Mortality in Asia ?

Data on incidence, prevalence, and disease specific mortality are frequently incomplete, not very reliable or arelacking in many countries particularly in Asia and Africa. In the absence of dependable data from the Civil RegistrationSystem (CRS), many countries have developed their own Sample Registration System (SRS). Due to several socioeconomicconstraints cause is not adequately noted in the death certificates. Sample registration system practice inIndia helps in this but for correlating with cancer registry data this is not the optimal. When cancer morbidityfigures from SRS system and cancer registry are compared the SRS figures are low. Reasons for fewer cancer deathsin Municipal Corporation reports may be due to that they only look at primary cause of death and overlook thesecondary or underlying causes. There are also a number of reasons for under-registration of cancer deaths incancer registries but they nevertheless give a more accurate picture. Many registries collect follow-up informationfor survival studies, which is also helpful to improve cancer mortality data. Tumour registries also represent importantresources for rapid identification of cancer survivors for research studies.     

Three-Dimensional Conformal Radiotherapy for Rectal Cancer and the Changes in Cancer Multi-biomarkers

OBJECTIVE To investigate the clinical efficacy of three-dimensional conformal radiotherapy(3D-CRT)for local y advanced or postoperatively relapsed rectal cancer,and to examine the changes in cancer multi-biomarkers. METHODS Sixty patients with locally advanced or postoperatively relapsed rectal cancer were randomly divided into two groups after 40 Gy external radiation,namely a late-course 3D-CRT group and a conventional radiotherapy group that served as the control.There were 30 patients in each group.For patients in the 3D-CRT group,multi-biomarkers were measured before and after radiotherapy and after relapse. RESULTS Response rates in the 3D-CRT and the control groups were 86.7%(26/30)and 70%(21/30)respectively,without a significant difference (P>0.05).The 1-,2-and 3-year survival rates were 80%,53.3%and 36.7% in the 3D-CRT group;in the control group the rates were 56.7%,40%and 13.3%respectively,with a significant difference(P=0.0213).CEA,CA19-9, CA242 and FER decreased after radiotherapy in the 3D-CRT group,P<0.01, indicating a significant difference.The values after relapse were higher than those without relapse,P<0.01,indicating a significant difference. CONCLUSION Conventional radiotherapy with a 3D-CRT boost gives better therapeutic effect to patients with locally advanced or postoperatively local y relapsed rectal cancer.A multi-biomarker protein chip diagnosis system can be utilized as an effective tool to determine the therapeutic effect and prognosis.     

Thyroid Cancer in Wales 1985–1996: A Cancer Registry-Based Study

No dedicated clinicopathological database for thyroid cancer exists in Wales to provide information about the incidence, histology, treatment and outcome of this uncommon malignancy. We have used cancer registry data to examine the epidemiology of thyroid cancer in Wales between 1985 and 1996 and have searched the database for clinically relevant data about stage, treatment and survival. A total of 699 cases were identified in this 12-year period, with no significant differences in their distribution between the five health authorities. Further analysis revealed a very wide age range (8–93 years) with a predominance of females (F:M ratio 2.8:1) and survival strongly influenced by gender, age and histological type. There were insufficient data to stage these cancers and only limited data about the surgical procedures undertaken. There was no information on non-surgical treatments (radio-iodine, radiotherapy and chemotherapy) in the database. Cancer registry data is well able to sustain an analysis of the epidemiology of thyroid cancer but further work is necessary to improve the quality of clinically relevant information about stage and treatment that could be used for audit.     

Is Male Breast Cancer Similar or Different than Female Breast Cancer?

OBJECTIVE. To determine if male breast carcinogenesis was similar to its more common female counterpart, we compared incidence patterns among men and women with breast cancer. METHODS. Breast cancer records were obtained from the SEER database. Women were stratified by age < 50 and > or = 50 years to simulate premenopausal and postmenopausal breast cancer. RESULTS. Age-adjusted incidence trends were stable among men but increased among women. Male to female breast cancer ratio was higher for blacks than for whites. Favorable prognostic factors reflective of tumor biology (nuclear grade and hormone receptor expression) were more common for men and postmenopausal women than for premenopausal women. For example, low nuclear grade, estrogen and progesterone receptor-positive expression were more common among men and postmenopausal women than among premenopausal women. The age-specific incidence rate curve for men increased steadily for all ages with a constant slope. On the other hand, age-specific rates for women increased rapidly until age 50 years then rose at a slower rate for postmenopausal women. Age-frequency distribution for male breast cancer was unimodal, with peak incidence at age 71 years. Age-frequency distribution for women was bimodal with early-onset and late-onset incidence at 52 and 71 years, respectively. CONCLUSIONS. Gender-specific incidence trends differed, most likely reflective of female-related changes in surveillance and/or reproductive risk factors. On the other hand, similar prognostic factor profiles reflective of tumor biology, age-specific incidence rate patterns, and age-frequency distributions suggested that male breast cancer was more like postmenopausal than premenopausal female breast cancer.     

Living With Cancer Alone? The Experiences of Singles Diagnosed With Colorectal Cancer

This paper seeks to understand the experiences of single colorectal cancer patients. This study consisted of 12 semi-structured interviews that were digitally voice-recorded, transcribed, and analyzed. Six main themes emerged: (a) gradual shift in view of cancer diagnosis from fatalistic to normalized, (b) perception of cancer as a nadir experience, (c) concerns of singlehood, (d) factors influencing cancer experiences, (e) factors influencing coping with cancer, and (f) range of responses towards cancer diagnosis. Singles with colorectal cancer require short- to long-term individualized care plans, and psycho-emotional support. This may help enhance their individual coping and adjustment to the diagnosis.     

A “Stem Cells in Cancer” special issue in Translational Cancer Research

Somatic stem cells （SSCs）, being essential in maintaining homeostasis of normal tissue, replenish dying cells and regenerate damaged tissues for organism. On the other hand, with the self-renewed ability, SSCs are ideal cellular targets to be acquired in multiple mutations transforming SSCs to cancer stem cells （CSCs） which cause malignancies and even recurrence after cancer treatment if CSCs fail to be eradicated （1）.     

Seaweed Prevents Breast Cancer?

To investigate the chemopreventive effects of seaweed on breast cancer, we have been studying the relationship between iodine and breast cancer. We found earlier that the seaweed, wakame , showed a suppressive effect on the proliferation of DMBA (dimethylbenz(a)anthracene)-induced rat mammary tumors, possibly via apoptosis induction. In the present study, powdered mekabu was placed in distilled water, and left to stand for 24 h at 4°C. The filtered supernatant was used as mekabu solution. It showed an extremely strong suppressive effect on rat mammary carcinogenesis when used in daily drinking water, without toxicity. In vitro, mekabu solution strongly induced apoptosis in 3 kinds of human breast cancer cells. These effects were stronger than those of a chemothera-peutic agent widely used to treat human breast cancer. Furthermore, no apoptosis induction was observed in normal human mammary cells. In Japan, mekabu is widely consumed as a safe, inexpensive food. Our results suggest that mekabu has potential for chemoprevention of human breast     

Cancer de l’estomac

Radiochemotherapy Gatrointestinal intergroup study have demonstrated a convincing local control and overall survival benefit. Oncologists and GI workshops have in the present not had a major interest in the radiotherapy treatment of gastric cancer due to a number of factors. Primary because toxicities may be severe, second physicians may have low experience in definition of clinical target volume and in third perioperative chemotherapy is widely used in this indication. In Summary this issue should be used as guides for defining appropriate radiation planning treatment for the adjuvant postoperative therapy of gastric cancer.     

Molecular Biology of Esophageal Cancer

There have been many new developments in our understanding of esophageal carcinoma biologyover the past several years.Information regarding both of the major forms of this disease,adenocarcinomaand squamous cell carcinoma,has accumulated in conjunction with data on precursor conditions such asBarrett's esophagus.Interesting and promising findings have included overexpression of proto-oncogenes,loss of heterozygosity at multiple chromosomal loci,tumor suppressor gene inactivation,epigenetic silenc-ing by DNA methylation,and mutations and deletions involving the tumor suppressor gene p53.Importantcancer pathways,the cyclin kinase inhibitor cascade and the DNA mismatch repair process,implicatedin the genesis of multiple tumor types have also been inculpated in esophageal carcinogenesis.Alterationsin the p16 and p15 cyclin kinase inhibitors including point mutations and homozygous deletions havebeen reported in primary esophageal tumors.Further developments in the field of molecular carcinogen-esis of esophageal malignancies promise to yield improvements in prevention,early detection,prognosticcategorization,and perhaps gene-based therapy of this deadly disease.     

Neoadjuvant Treatment for Esophageal Cancer

Because the conflicting data currently available from the performed randomized trials it is verydifficult to provide strict guidelines for the treatment of patients with locoregional advanced esophagealcancers.Surgery however,remains the standard of care for potentially resectable disease.Preoperativechemotherapy is still controversial with two large randomized trials resulting in two different conclusionsregarding the survival benefit.Preoperative chemoradiation is also controversial since only one randomizedtrial showed a clear survival benefit however,the patients treated with surgery alone in this trial had anunusually poor outcome.And the study by Urba et al was not powered enough to show a clear survivalbenefit for patients treated with neoadjuvant chemoradiation.The results of three metaanalysis of theserandomized studies show lower rate of resection,higher rate of RO-resection,more often postoperativemortality and better prognosis for patients with neoadjuvant radiochemotherapy.As a consequence one mayconsider offering neoadjuvant chemotherapy or neoadjuvant radiochemotherapy to patients with locally-advanced disease under the premise that patients have a good performance status and understand thecontroversies about this therapeutic option.Larger trials with sufficient power to clearly detect survivalbenefits for patients treated with neoadjuvant chemotherapy or radiochemotherapy are necessary beforethis therapeutic option will be the standard of care.     

Cancer de l’oropharynx

Cancers of the oropharynx are common lesions. Their treatment often includes radiation therapy either exclusively or in combination with chemotherapy or after surgery. The definition of target volumes is made difficult by the complex anatomy of this area. The aim of this work is to clarify the principles of 3D conformal radiation illustrated by a case report.     

Adaptive Radiotherapy for Lung Cancer

The concept of adaptive radiotherapy (ART) was proposed 20 years ago, and since then a variety of methodologies and techniques have been developed to accommodate different clinical requirements, including both online and offline plan adaptations. Compared with pre-treatment planning, plan adaptation involves more computational tasks and consequently has increased complexity and computational burden. While ART can benefit many cancer patients, challenges still exist in development and implementation of high-quality ART programs. In this short review, we will focus on the development of offline ART for lung cancer. We will also discuss the advantages and disadvantages of different clinical implementations of ART.     

Cancer du pancréas

About 7200 new cases of pancreatic adenocarcinomas are diagnosed each year in France. At the time of diagnosis, an efficient carcinologic surgery will not be possible for nearly 80 % of patients, in relation to loco-regional extension or metastatic dissemination. After surgical resection, the median survival of resected patients ranges from 12 to 20 months, with a high rate of relapses. Currently, the use of radiotherapy for patients with pancreatic cancer is controversial. In adjuvant setting, the standard treatment is six months of chemotherapy with FUFOL or gemcitabine. Chemoradiation (CRT) may improve the survival of patients with incompletely resected tumors (R1). This must be validated in a prospective trial. Neoadjuvant CRT is a promising treatment but always under evaluation. For the treatment of patients with locally advanced tumors, there is not a standart treatment. A strategy of initial chemotherapy followed by CRT for non progressive patients is under evaluation. Whereas in the first trials of CRT large fields were used, the current trend is to reduce the treated volumes to improve tolerance. The delineation of target volumes has been improved by the use of simulation CT. The aims of this work are to precise the radio-anatomical particularities, the pattern of spread of pancreatic cancer and the principles of 3D conformal radiotherapy illustrated with a clinical case.     

Racial Disparities in Prostate Cancer–Specific Mortality in Men With Low-Risk Prostate Cancer

BackgroundMen with low-risk prostate cancer (CaP) are considered unlikely to die of CaP and have the option of active surveillance. This study evaluated whether African American (AA) men who present with low-risk disease are at higher risk for death from CaP than white men.Patients and MethodsThe authors identified 56,045 men with low-risk CaP (T1-T2a, Gleason score ≤ 6, prostate-specific antigen ≤ 10 ng/mL) diagnosed between 2004 and 2009 using the Surveillance, Epidemiology, and End Results (SEER) database. Fine-Gray competing-risks regression analyses were used to analyze the effect of race on prostate cancer–specific mortality (PCSM) after adjusting for known prognostic and sociodemographic factors in 51,315 men (43,792 white; 7523 AA) with clinical follow-up information available.ResultsAfter a median follow-up of 46 months, 258 patients (209 [0.48%] white and 49 [0.65%] AA men) died from CaP. Both AA race (adjusted hazard ratio [AHR], 1.45; 95% CI, 1.03-2.05; P = .032) and noncurative management (AHR, 1.49; 95% CI, 1.15-1.95; P = .003) were significantly associated with an increased risk of PCSM. When analyzing only patients who underwent curative treatment, AA race (AHR, 1.62; 95% CI, 1.04-2.53; P = .034) remained significantly associated with increased PCSM.ConclusionAmong men with low-risk prostate cancer, AA race compared with white race was associated with a higher risk of PCSM, raising the possibility that clinicians may need to exercise caution when recommending active surveillance for AA men with low-risk disease. Further studies are needed to ultimately determine whether guidelines for active surveillance should take race into account.     

Karachi Cancer Registry Data – Implications for the National Cancer Control Program of Pakistan

Cancer registries play a major role in providing the data to justify establishment, implementation and monitoring of ‍cancer control programs, therefore stability in cancer registration is of pivotal importance. An erroneous assessment of the ‍cancer burden can have long-term negative implications for the limited health resources of a country. Thus, registries ‍starting simultaneously with cancer control programs clearly cannot be adequate for the purpose. The Karachi Cancer ‍Registry (KCR) is the first population-based registry of Pakistan, with 9 years proven data stability (1995-2003) for Karachi ‍South (KS), a location with a population distribution similar to that for the country in general as regards age, gender, and ‍religion. It also has the distinction of being the only district in the country with representation of all ethnic and socioeconomic ‍groups of the country. The primary recommended strategy for the ‘National Cancer Control Program’ (NCCP), ‍Pakistan based on the assessment of eight common cancers in Karachi and the WHO estimates would be identical. A curb ‍on the epidemic levels of tobacco and areca nut use would reduce malignancies in males by 43.7% and in females by ‍17.8% . WHO estimates put these figures at 45% and 18.5% for males and females respectively. Primary prevention in the ‍form of diet control, checks on preservatives, dyes, and pesticides; protection from occupational hazards, control of biological ‍agents and solar UV protection would help control of another half of the malignancies. ‍Resource restrictions put high technology methods beyond the scope of Pakistan today. Early detection of cancers of ‍accessible sites, though not an urgent requirement, would be warranted for oral, cervical and breast cancer, after sufficient ‍capacity building, initially in the high-risk groups. In females, this could help target 47.6% (approximately half) of the ‍malignancies and in men 13% of the total. Establishment of equitable pain control and a palliative care network throughout ‍the country is an urgent and essential measure as more than 70% of cancer patients report with very advanced stages of ‍malignancy. The estimated annual incident cancer cases for Pakistan, year 2000 on the basis of KCR data were 138,343 for ‍males and 135,054 for females; approximately twice the number cited by WHO for the same year. The argument that higher ‍KCR estimates reflect an urban catchment population may be justified, the urban: rural ratio being 2:1 in Pakistan. Evidencebased ‍strategies, however ,support the counter argument, that the rising incidence of cancer in Pakistan is primarily attributable ‍to risk factors equally prevalent in the rural and urban areas viz. increasing tobacco use, low socio-economic conditions, ‍dietary deficiencies and prevalence of oncogenic viruses. ‍Pakistan has a significant cancer burden and rising trends of risk factors - it is a country in dire need of a Cancer Control ‍Program. KCR data along with WHO estimates can form the initial framework of a NCCP in Pakistan; the lack of a national ‍cancer registration should not deter initiatives. Benefits of an immediate, prompt and targeted implementation established ‍today will be realized after 20–30 years. Otherwise the country should be prepared to face epidemic proportions of the ‍disease in the next decade or two. Prerequisite ‘qualification criteria’ or ‘sincerity of intent test’ for NCCP funding by ‍international donors should be legislation against tobacco and areca nuts in Pakistan and stringent evaluative criteria.