Time Trend in Breast and Cervix Cancer of Women in India, (1990-2003)

The Indian Council of Medical Research (ICMR) started a National Cancer Registry Programme (NCRP)in the year 1982 with the main objective of generating reliable data on the magnitude and pattern of cancer inIndia. There are about 20 Population Based Cancer Registries (PBCR) which are currently functioning underthe network of NCRP. The present paper aims to provide the time trends in the incidence of breast and cervixcancer among females of India. The incidence data collected by Bangalore, Barshi, Bhopal, Chennai, Delhi andMumbai over the period 1990 to 2003 formed the sources of data. In the year 1990, cervix was the leading site ofcancer followed by breast cancer in the registries of Bangalore (23.0% vs. 15.9%), Bhopal (23.2% vs. 21.4%),Chennai (28.9% vs. 17.7%) and Delhi (21.6% vs. 20.3%), while in Mumbai breast was the leading site of cancer(24.1% vs. 16.0%). By the years 2000-3, the scenario had changed and breast had overtaken as the leading siteof cancer in all the registries except in Barshi (16.9% vs. 36.8%). The time trend analysis for these sites suggesteda significant decreasing trend in the case of cervix in Bangalore and Delhi registries, while the registries ofBhopal, Chennai and Mumbai did not show any significant changes. However, in the case of breast cancer, asignificant increasing trend was observed in Bhopal, Chennai and Delhi registries with Bangalore and Mumbairegistries demonstrating no such significant changes. Histopathologic confirmation for both malignancies wasfound to be more than 80% in these registries. It is concluded that in India the cervix cancer rates are decreasingwhile breast cancer is on the increase.     

Descriptive epidemiology of lymphoid and haemopoietic malignancies in Bangalore,India

Lymphoid and haemopoietic malignancies as a group constitute one of the important cancers in India, as elsewhere in the world. While information on incidence and mortality of these cancers, and that on survival, are available from most developed countries, there are very few reports describing this experience in developing ones. Population-based cancer registration commenced in Bangalore, India, in January 1982, under the auspices of the Indian Council of Medical Research. This source provides fairly complete and reliable incidence data, but, in order to obtain mortality and survival information, active follow-up involving visits of homes of patients was undertaken. Between 1982 and 1989, 1397 cases of lymphoid and haemopoietic malignancies were registered in the Bangalore cancer registry, giving an age-adjusted incidence rate of 7.7 and 4.8 per 100,000 in males and females respectively. Active follow-up provided mortality/survival information in 1267 or 90.7% of these cases. The overall observed 5-year survival for these cancers combined (both sexes) was 26%, and relative survival 28.4%. The 5-year survival rate was lower in all the individual lymphomas and leukaemias as compared with similar reports from the developed countries. Survival in Hodgkin's disease was influenced by clinical stage and age at presentation.     

Stage at Diagnosis and Relative Differences in Breast and Prostate Cancer Incidence in India : Comparison with the United States

Purpose: To examine and reconcile differences in incidence rates and stage-at-initial-presentation of prostate andbreast cancers in India, a country in epidemiologic transition. Methods: Age-adjusted prostate and female breastcancer incidence rates and proportion of cases by stage-at-diagnosis were compared. Data were derived from theNational Cancer Registry Program of India, other Indian registries, the International Agency for Research on Cancer,and the US/ NCI Surveillance, Epidemiology, and End Results (SEER) Program. Results: Average annual cancerincidence rates in India ranged from 5.0 to 9.1 per 100,000/year for prostate and 7.2 to 31.3 per 100,000/year forfemale breast. Comparative rates in the US for prostate cancer are 110.4 for Whites and 180.9 for Blacks; for femalebreast, the rates are 86.6 for Blacks and 96.4 for Whites. Notable differences were observed between rural and urbanareas in India, while such differences by rurality appear to be much smaller in the US. Overall, about 50-55% ofbreast cancer cases and about 85% of prostate cancers were detected at late (III and IV) stage; in contrast to the USwhere 15% of either cancer is diagnosed at late stage. Conclusions: Differences in stage-at-diagnosis help explainvariations in incidence rates among cancer registries in India and rate differences between India and the US. Thesefindings indicate that erroneous inferences will result from incidence-rate comparisons that do not take into accountstage-at-diagnosis. Results also point to epidemiologic studies that could be conducted to deepen understanding ofthe etiology of these cancers. By enhancing data on staging, the Indian cancer registries could widen the scope ofcollaborative, cross-national research.     

Projections of Number of Cancer Cases in India (2010-2020) by Cancer Groups

Introduction: Recently, NCRP (ICMR), Bangalore, has published a report on Time Trends in Cancer Incidence Rates. The report also provided projected numbers of cancer cases at the India country level for selected leadingsites. Objective: In the present paper, an attempt has been made to project cancer cases for India by sex, years and cancer groups. Sources of data: The incidence data generated by population-based cancer registries (PBCRs) at Bangalore, Barshi, Bhopal, Chennai, Delhi and Mumbai for the years 2001-2005 formed the sources of data. In addition, the latest incidence data of North Eastern Registries for the year 2005-06 were utilized. Methods: The crude incidence rate (CR) was considered suitable for assessing the future load of cancer cases in the country. The Linear Regression method (IARC 1991) was used to assess the time trend and the projection of rates for the periods 2010-2020. For whichever sites where trends were not found to be significant, their latest rates were taken into consideration and assumed to remain same for the period 2010-2020. Results: The total cancer cases are likely to go up from 979,786 cases in the year 2010 to 1,148,757 cases in the year 2020. The tobacco-related cancers for males are estimated to go up from 190,244 in the year 2010 to 225,241 in the year 2020. Similarly, the female cases will go up from 75,289 in year 2010 to 93,563 in the year 2020. For the year 2010, the number of cancer cases related to digestive system, for both males and females, are estimated to be 107,030 and 86,606 respectively. For, head and neck cancers, the estimates are 122,643 and 53,148 cases, respectively. and for the lymphoid and hematopoietic system (LHS), for the year 2010, are 62,648 for males and 41,591 for females. Gynecological-related cancers are estimated to go up from 153,850 in 2010 to 182,602 in 2020. Among males and females, cancer of breast alone is expected to cross the figure of 100,000 by the year 2020.     

Time Trends in the Incidence of Cancer Cervix in Karachi South, 1995-2002

Introduction: The objective of the study was to determine the trends of cancer cervix in Karachi Southduring an eight (1995-2002) year period. Methodology: Cancer cervix cases recorded at Karachi Cancer Registryduring 1st January 1995 to 31st December 2002 were analyzed. Trends were studied by analyzing the agestandardized incidence rates (ASR)s in 2 time periods, 1995-97 and 1998-2002. Results: Cancer cervix rankedsixth in the 1995-97 period the age standardized incidence rate (ASR) world and crude incidence rate (CIR) per100,000 were 6.81 and 3.22. It reached the fifth ranking in the 1998-2002 period with an ASR and CIR of 7.5and 4.0 per 100,000. Thus between 1995 and 2002, the incidence of cervical cancer registered an approximate10% increase. The mean age of the cancer cases was 53.27 years (SD 11.6; 95% CI 50.58, 55.96; range 32-85years) and 50.68 years (SD 11.7; 95% CI 48.8, 52.5; range 51 years) in period 1 and 2 respectively. Themorphological components of squamous cell carcinoma and adenocarcinoma remained stable during this period,though a marginally higher component and increasing incidence of adenocarcinoma was observed throughout.A negligible down staging was observed in the 1998-2002 period. Localized malignancy was observed in 30.8%in period 2 as compared to 25.7% in period 1 and the component of carcinoma in situ increased from 0%percent in period 1 to 1.3% in the second period. Despite this two thirds of the cases still presented with aregional or distant spread of disease. Conclusion: Pakistan at present falls into a low risk cancer cervix region.The cause of concern is the steadily increasing incidence especially in the younger birth cohorts, the advanceddisease at presentation; insignificant in-situ cancers and no preventive intervention or awareness practices inplace.     

Ovarian cancer statistics, 2018

In 2018, there will be approximately 22,240 new cases of ovarian cancer diagnosed and 14,070 ovarian cancer deaths in the United States. Herein, the American Cancer Society provides an overview of ovarian cancer occurrence based on incidence data from nationwide population‐based cancer registries and mortality data from the National Center for Health Statistics. The status of early detection strategies is also reviewed. In the United States, the overall ovarian cancer incidence rate declined from 1985 (16.6 per 100,000) to 2014 (11.8 per 100,000) by 29% and the mortality rate declined between 1976 (10.0 per 100,000) and 2015 (6.7 per 100,000) by 33%. Ovarian cancer encompasses a heterogenous group of malignancies that vary in etiology, molecular biology, and numerous other characteristics. Ninety percent of ovarian cancers are epithelial, the most common being serous carcinoma, for which incidence is highest in non‐Hispanic whites (NHWs) (5.2 per 100,000) and lowest in non‐Hispanic blacks (NHBs) and Asians/Pacific Islanders (APIs) (3.4 per 100,000). Notably, however, APIs have the highest incidence of endometrioid and clear cell carcinomas, which occur at younger ages and help explain comparable epithelial cancer incidence for APIs and NHWs younger than 55 years. Most serous carcinomas are diagnosed at stage III (51%) or IV (29%), for which the 5‐year cause‐specific survival for patients diagnosed during 2007 through 2013 was 42% and 26%, respectively. For all stages of epithelial cancer combined, 5‐year survival is highest in APIs (57%) and lowest in NHBs (35%), who have the lowest survival for almost every stage of diagnosis across cancer subtypes. Moreover, survival has plateaued in NHBs for decades despite increasing in NHWs, from 40% for cases diagnosed during 1992 through 1994 to 47% during 2007 through 2013. Progress in reducing ovarian cancer incidence and mortality can be accelerated by reducing racial disparities and furthering knowledge of etiology and tumorigenesis to facilitate strategies for prevention and early detection. CA Cancer J Clin 2018;68:284–296 . © 2018 American Cancer Society .     

Projection of cancer incidence in five cities and cancer mortality in India

Background: Cancer is second largest non-communicable disease and it has a sizable contribution in the total number of deaths. It is important for the public health professionals to understand the dynamics of cancer incidence for future strategies. Therefore, this paper is attempted with the objective of projecting number of cancer incidence for five cities namely, Bangalore, Chennai, Delhi, Bhopal and Mumbai and to estimate the cancer mortality rate for all India for the year 2008. Materials and Methods: The data were used from the Indian Council of Medical Research's publication of Population-Based Cancer Registry for the year 1999-2000. The population was calculated from the Census reports of 1991 and 2001. Causes-specific mortality report by the Central Bureau of Health Intelligence was used for estimating cancer mortality for all India. The age-specific rate method is utilized to project number of cancer incidence for the cities of Bangalore, Chennai, Delhi, Bhopal and Mumbai and to estimate cancer mortality in 2000 for all India. Results and Conclusion: About 26.6% increase is expected in the registered number of cancer cases in these five cities and 52.68% increase is projected for Delhi which would mean highest number of cases in Delhi among these five cities within a span of eight years. And in Mumbai it is expected to have a marginal decline in the number of cases for the year 2008 (around -3.25%). The age adjusted analysis indicates that Mumbai is experiencing the higher incidence rate among the five cities studied herein. It is estimated about 50% cancer mortality is reported from the age group 55 and above years.     

Descriptive Epidemiology of Female Breast Cancer in Delhi,India

Background: Breast cancer is the most frequently diagnosed cancer in females worldwide. The Population Based Cancer Registry data of Delhi were here used to describe the epidemiology and trends in breast cancer incidence in Delhi. Methods: Crude rate, age-standardized incidence rates (ASR) and age-specific incidence rates were calculated using the data collected by Delhi PBCR for the year 2012. The time trend of breast cancer incidence was evaluated by joinpoint regression using the PBCR data from 1988-2012. Results: A total of 19,746 cancer cases were registered in 2012, 10,148 in males and 9,598 in females. Breast cancer was the leading site of cancer in females accounting for 2,744 (28.6%) of cases with a median age of 50 years. The crude and age standardized incidence rates for breast cancer were 34.8 and 41.0 per 100,000 females, respectively. Age specific incidence rates increased with age and attained a peak in the 70-74 years age group..A statistically significant increase in ASR with an annual percentage change (APC) of 1.44% was observed. Conclusions: The breast, which was the second most common cancer site in Delhi in 1988, has now surpassed cancer of cervix to become the leading site over the years. A similar trend has also been noted for other metropolitan cities viz. Bangalore, Bhopal and Chennai. Though the ASRs in these are comparable, they are still low compared to Western countries. Changing life styles in metropolitan cities like delayed marriage, late age at first child birth, lower parity and higher socio-economic status, may be some of the probable primary cause for higher incidences of breast cancer in urban as opposed to rural areas.     

Epidemiology of breast cancer in Indian women

Breast cancer has ranked number one cancer among Indian females with age adjusted rate as high as 25.8 per 100,000 women and mortality 12.7 per 100,000 women. Data reports from various latest national cancer registries were compared for incidence, mortality rates. The age adjusted incidence rate of carcinoma of the breast was found as high as 41 per 100,000 women for Delhi, followed by Chennai (37.9), Bangalore (34.4) and Thiruvananthapuram District (33.7). A statistically significant increase in age adjusted rate over time (1982–2014) in all the PBCRs namely Bangalore (annual percentage change: 2.84%), Barshi (1.87%), Bhopal (2.00%), Chennai (2.44%), Delhi (1.44%) and Mumbai (1.42%) was observed. Mortality‐to‐incidence ratio was found to be as high as 66 in rural registries whereas as low as 8 in urban registries. Besides this young age has been found as a major risk factor for breast cancer in Indian women. Breast cancer projection for India during time periods 2020 suggests the number to go as high as 1797900. Better health awareness and availability of breast cancer screening programmes and treatment facilities would cause a favorable and positive clinical picture in the country.     

Cancer Incidence and Mortality: District Cancer Registry,Trivandrum, South India

Background: Cancer is emerging as a major cause of morbidity and mortality in low and middle-income countries. Cancer registry figures help for planning and delivery of health services. This paper provided the first results of cancer incidence and mortality [Crude (CR) and age-standardized (ASR)] rates (world-standard population) of Trivandrum district, South India and compared with other registries under the network of National Cancer Registry Programme (NCRP), Government of India. Materials and Methods: Trivandrum district cancer registry encompasses a population of 3.3 million, compiles data from nearly 75 sources (hospitals and diagnostic laboratories) and included under the NCRP in 2012. During 2012-2014, registry recorded 15,649 incident cases and 5667 deaths. Proportion of microscopic diagnosis was 85% and ‘Death certificate only’ was 8%. Results: Total cancer incidence (CRs) rates were 161 and 154 (ASR: 142.2 and 126) and mortality rates were 66 and 49 (ASR: 54 and 37) per 105 males and females respectively. Common cancers in males were lung (ASR:19), oral cavity (ASR:15), colo-rectum (ASR:11.2), prostate (ASR:10.2) and lymphoma (ASR:7) and in females, breast (ASR:36), thyroid (ASR:13.4), cervix-uteri (ASR:7.3), ovary (ASR:7) and colo-rectum (ASR:7). Nationally, the highest CRs for breast, prostate, colo-rectum, corpus-uteri and urinary bladder cancers and low incidence of cervix-uteri cancer were observed in Trivandrum. Conclusion: Cancer incidence (CR) in Trivandrum was the highest in both genders in India (except Aizwal). This is mainly due to the highest life-expectancy in Kerala. Also, an epidemiologic transition in cancer pattern is taking place and is changing to more similar to "western" jurisdictions.     

Improved Survival of Cervical Cancer Patients in a Screened Population in Rural India

Objectives: To describe the survival experience of cervix cancer patients in a screened rural population in India. Methods: Included 558 cervical cancer patients diagnosed in 2000-2013 in a cohort of 100,258 women invited for screening during 2000-2003. The primary end point was death from cervical cancer. We used the Kaplan-Meier method to estimate cumulative observed survival and Cox proportional hazards regression to assess the effect of patient characteristics on survival after diagnosis. Results: Of the 558 cases included, 143 (26%) and 114 (20%) were diagnosed in stages IA and IB respectively; 252 (45.2%) were dead, and 306 (54.8%) were alive at the last follow-up. The overall 5-year observed survival was 60.5%. The 5-year survival of stage IA patients was 95.1% and 5.3% for stage IV patients. All surgically treated stage IA patients, 94.1% of stage IB patients receiving intracavitary radiotherapy, 62% of stage IIB, 49% of stage III and 25% of stage IV patients receiving radiotherapy survived for 5 years. Conclusion: Higher 5-year survival in our study than elsewhere in India is due to the high proportion of early stage cancers detected by screening combined with adequate treatment, resulting into a favourable prognosis.     

Incidence and survival of chronic myelomonocytic leukemia in Girona (Spain): A population-based study, 1993-2007

Chronic myelomonocytic leukemia is a very rare blood cancer observed mostly in the elderly. Here we report the incidence trends and survival of patients with chronic myelomonocytic leukemia over a 15-year period (1993-2007). Cases were provided by the population-based Girona Cancer Registry. The crude incidence rate was 0.72/100,000 inhabitants/year. No statistically significant increase in trends was detected over the 15 years. Median overall survival was 28 months although survival markedly decreased with advancing age. The 5-years observed and relative survivals were 20% and 29%, respectively. This is the first population-based study that reports the incidence and survival of chronic myelomonocytic leukemia in Spain.     

Cancer of the uterine cervix in Norway by histologic type, 1970-84

A total of 6,202 patients with cancer of the uterine cervix was reported to the Cancer Registry in Norway from 1970 to 1984. Squamous cell carcinoma was reported in 86.1% of all cases, adenocarcinoma in 9.5%, and undifferentiated cancer in 3.6%; the heterogeneous group of "other malignant neoplasms" was 0.8% of all cases, most of which were sarcomas. During the 15-year period the average annual age-adjusted incidence rates for both squamous cell carcinoma and undifferentiated cancer decreased by 30 and 79%, respectively, whereas adenocarcinoma increased by 38%. The increase of adenocarcinoma was mostly confined to females 20-34 years of age. The decrease in incidence rates of undifferentiated cancer was observed in all age groups, whereas the fall in incidence rates for squamous cell carcinoma was demonstrated in females above 35 years of age only. Of all patients with squamous cell carcinoma, 55% were diagnosed in clinical stage I. Females with adenocarcinoma and undifferentiated cancer were diagnosed in stage I in 60 and 38% of the cases, respectively. The 5- and 10-year relative survival rates were highest for patients with squamous cell carcinoma at all stages, whereas a significantly less favorable prognosis was found for females with adenocarcinoma and undifferentiated cancer of the uterine cervix.     

A Model Approach to Calculate Cancer Prevalence from 5 Years Survival Data for Selected Cancer Sites in India – Part II

Objective: Prevalence is a statistic of primary interest in public health. In the absence of good follow-upfacilities, it is often difficult to assess the complete prevalence of cancer for a given registry area. An attemptis made to arrive at the complete prevalence including limited duration prevalence with respect of selectedsites of cancer for India by fitting appropriate models to 1, 3 and 5 year cancer survival data available forselected registries of India. Methodology: Cancer survival data, available for the registries of Bhopal, Chennai,Karunagappally, and Mumbai was pooled to generate survival for the selected cancer sites. With the availabledata on survival for 1, 3 and 5 years, a model was fitted and the survival curve was extended beyond 5 years (upto 30 years) for each of the selected sites. This helped in generation of survival proportions by single year andthereby survival of cancer cases. With the help of estimated survived cases available year wise and the incidence,the prevalence figures were arrived for selected cancer sites and for selected periods. In our previous paper, wehave dealt with the cancer sites of breast, cervix, ovary, lung, stomach and mouth (Takiar and Jayant, 2013).Results: The prevalence to incidence ratio (PI ratio) was calculated for 30 years duration for all the selectedcancer sites using the model approach showing that from the knowledge of incidence and P/I ratio, the prevalencecan be calculated. The validity of the approach was shown in our previous paper (Takiar and Jayant, 2013). TheP/I ratios for the cancer sites of lip, tongue, oral cavity, hypopharynx, oesophagus, larynx, nhl, colon, prostate,lymphoid leukemia, myeloid leukemia were observed to be 10.26, 4.15, 5.89, 2.81, 1.87, 5.43, 5.48, 5.24, 4.61,3.42 and 2.65, respectively. Conclusion: Cancer prevalence can be readily estimated with use of survival andincidence data.     

Incidence, mortality and survival from invasive cervical cancer in Vaud, Switzerland, 1974-1991

BACKGROUND: Several factors have contributed to the substantial declinein mortality from cervical cancer registered in most areas ofthe world, i.e., improved sexual hygiene, changes in reproductivefactors, cervical screening, and, possibly, improved treatment.Each of these components is evaluated through a systematic inspectionof trends in incidence, mortality and survival rates registeredfor a well-defined population. PATIENTS AND METHODS: Trends in incidence, mortality and survival from invasive cervicalcancer over the period 1974– 1991 were analysed for threeseparate age groups (<55, 55–64, >65 years), histologicaltype and stage using data from the Cancer Registry of the SwissCanton of Vaud. RESULTS: Below age 55, the age-standardized (world standard) incidencerate was 9.3/100,000 women in 1974–76, it declined steadilythereafter down to 2.9 in 1986–88, but increased to 4.3in 1989–91. In the age group 55–64, cervical cancerincidence remained around 40/100,000 to the end of the 1970s,but thereafter declined to 10.9 in 1989–91. No consistenttrend was observed in elderly women, and the rate in 1989–91(26.7/100,000) was similar to that in 1974–76 (33.7).The overall age-standardized cervical cancer incidence declinedfrom 13.5/100,000 in 1974–76 to 5.8 in 1986–88,but rose to 6.4 in 1989–91. A similar pattern was observedfor mortality, with a fall in rates in younger women between1974 and 1985 (from 2.1 to 0.6/100,000), and a subsequent riseto 1.1/100,000 in 1989–91. A substantial decline in mortalitywas observed in women aged 55 to 64 since the early 1980's,from 17.2 in 1980–82 to 3.3 in 1989–91. No clearmortality trend was evident in older women. Overall, cervicalcancer mortality declined from 4.3/100,000 in 1974–76to 2.3 in 1989–91. The five-year relative survival rateswere around 0.70–0.75 for younger women, around 0.60 forthose aged 55 to 64, and 0.50 for elderly ones. In a Cox proportionalhazard model, age and clinical stage were significantly relatedto survival, but not histological type and calendar period ofdiagnosis. No substantial change in survival from invasive cervicalcancer was observed over the 18-year period considered, norwas there any notable change in the stage distribution overtime. The proportion of adenocarcinomas, however, appears tohave increased in the most recent calendar period. CONCLUSIONS: These data reflect the impact of screening on cervical cancerrates, which, however, appeared restricted to women below age65. An upward trend in cervical cancer incidence and mortalityrates for younger women was also apparent, and there was noindication from these data of an improved survival for invasivecervical cancer patients over the last two decades. Extentionof screening to elderly women appears to be a priority for reducingcervical cancer rates in this population. cervix uteri, neoplasms, epidemiology, incidence, mortality, screening, survival, time trends     

Trends in oral cavity cancer incidence,mortality, survival and treatment in the Netherlands

Information on epidemiology is essential to evaluate care for the growing group of oral cancer patients. We investigated trends in incidence, mortality and relative survival rates for oral cavity cancer (OCC) and its subsites in the Netherlands from 1991 to 2010, and relate these to changes in stage and treatment. Patient (age, sex), tumour (subsite, stage) and treatment characteristics of patients diagnosed with OCC (ICD‐O‐3: C02‐C06) in 1991–2010 were extracted from the Netherlands Cancer Registry. Incidence, mortality and 5‐year relative survival rates over time are presented, as well as trends in type of treatment. The incidence of OCC increased with +1.2% (95%CI: +0.9%;+1.6%) per year: more strongly in women, stage I and IV disease, and in cancers of the tongue and gum. The mortality rate slightly rose (+0.8%, 95%CI: +0.3%;+1.3% per year), but differed by subsite. The 5‐year relative survival improved from 57% in 1991–1995 to 62% in 2006–2010. The 5‐year relative survival was better for women compared with men (64% and 55%, respectively), decreased with increasing stage, was the best for tongue cancer (63%) and the worst for cancer of the gum (56%) and floor of mouth cancer (55%). The relative excess risk of dying was higher for non‐surgery‐based treatments. Surgery was the main treatment option and the proportion of “surgery only” rose in stage I and III disease. The incidence and, to a lesser extent, mortality of OCC are increasing and therefore, even with slightly improving survival rates, OCC is an increasingly important health problem.     

Trends in cancer incidence in rural Eastern Cape Province; South Africa, 1998–2012

There are few cancer trend data reported in sub‐Saharan Africa notably due to the scarcity of population‐based cancer registries (PBCRs). The Eastern Cape Province PBCR is amongst the few registries in sub‐Saharan Africa that reports data for a rural population. Trends in cancer incidence are reported for the period 1998–2012. Registered cases, age‐standardized rates (ASRs) and standardized rate ratios are presented for the most common cancers in both males and females in three periods (1998–2002, 2003–2007 and 2008–2012). In males, the most commonly diagnosed cancer during the 15 year period was cancer of the oesophagus; incidence rates showed a significant decline over the 15 year period, entirely due to a 30% decrease between 2003–2007 and 2008–2012, to an ASR of 23.2 per 100,000 population. This was followed by prostate cancer, the incidence of which was more than doubled to a level of 9.9/100,000. In women, cancer of the cervix uteri has become the most common malignancy, with a significant increase in incidence during the period to 29.0/100,000. Oesophageal cancer is second in frequency, with (as in males) a significant decline in the final 10 years to an incidence of 14.5/100,000 in 2008–2012. The incidence of breast cancer increased by 61%, although the absolute rate remains low (12.2/100,000). The incidence rates of colorectal cancer are low, and the increases in incidence, although relatively large (35% in men, 63% in women) were not statistically significant. Kaposi sarcoma showed a dramatic increase in incidence in both sexes (3.5‐fold in men, 11‐fold in women) although the incidence remains relatively low by southern African standards. Cancer prevention and control activities in the area need to be informed by these data and strengthened.     

Leads to cancer control based on cancer patterns in a rural population in South India

Objective: Cancer patterns and incidence rates for a rural population (359,674) resident in 384 villages spread over 2058 km² in Palani and Oddanchathram taluks of Dindigul District, Tamil Nadu, in South India, are described in this paper. Methods: A population-based cancer registry was established in 1995 to register incident invasive and in-situ cancers. Cases were found and details abstracted by cancer registry staff visiting 26 data sources, comprising cancer hospitals, tertiary and secondary care hospitals, pathology laboratories and death registration offices. A customized version of CANREG-3 software was used for data entry and analysis. Results: During the period 1996–1998, 783 invasive cancers (310 male and 473 females) were registered, yielding an all-cancer crude incidence rate of 56.8/100,000 males and 88.5/100,000 females; the corresponding age standardized incidence rates (ASR) were 83.3 and 122.3 respectively. In males, mouth cancer (ASR 11.5) was the most frequently recorded malignancy followed by tongue (ASR 8.6), hypopharynx (ASR 7.8), esophagus (ASR 7.8) and larynx (ASR 7.8). Thus head and neck cancers accounted for half of the male cases. In females, cervical cancer (ASR 65.4) accounted for more than half of the cancers followed by breast (ASR 14.2) and mouth (ASR 10.2). Ambillikai Cancer Registry (ACR) reports the second highest incidence of cervical cancer in the world. More than four-fifths of cervical cancer cases were diagnosed in stages II B and III B; a third of these cancer patients either did not have, or did not complete, treatment. Conclusions: The observed cancer patterns in this population establish that measures directed at prevention and early detection (linked with treatment) of cervix and head and neck cancers are of paramount importance for cancer control in this and other rural populations of India where three-fourths of the total population live.     

上海市区女性生殖系统恶性肿瘤发病趋势分析

目的对1972～1999年上海市区常见的女性生殖系统恶性肿瘤的发病率进行统计,分析其发病趋势及变化原因,为防治措施的制定提供依据.方法根据上海市肿瘤发病登记处收集的1972～1999年的上海市区卵巢癌、宫颈癌、宫体癌和不明部位子宫癌的病例资料和相应年份的人口资料,分别计算各年龄组的年龄别发病率.并采用直接法计算世界人口标化发病率,对数线性回归法计算标化率的年变化率(Annual percentage change,APC),并对病例数进行加权计算.结果1972～1999年上海市肿瘤登记处共登记卵巢癌6106例、宫颈癌8063例,宫体癌3 933例和不明部位子宫癌1 312例.28年来,宫体癌和卵巢癌的标化发病率呈上升趋势,分别从1972～1974年的2.49/10万和4.77/10万上升至1996～1999年的4.75/10万和6.88/10万,年增长率分别为3.0%和2.0%.同期宫颈癌的标化发病率从26.66/10万快速下降至2.18/10万,年下降率达10.5%.不明部位子宫癌的标化发病率亦呈下降趋势(P＜0.01).宫体癌以55～64和65～74岁组发病率上升最快,年增长率分别为2.5%和3.3%.卵巢癌各年龄组的发病率均有上升趋势,年变化率都在1.0%以上.宫颈癌发病率下降最快的年龄组是45～54和55～64岁组,25～34和35～44岁组的发病率在近几年有升高趋势.结论上述肿瘤的发病率及年龄别发病率的变化趋势提示,上海女性生活方式和环境因素的改变可能是导致这种变化的重要原因.