Survival of European women with gynaecological tumours, during the period 1978–1989

This study concerns the survival of European patients diagnosed between 1978 and 1989 with cancer of corpus and cervix uteri and ovary. Variations in survival in relation to age, country and period of diagnosis were examined. Data from the EUROCARE study were supplied by population-based cancer registries in 17 countries to a common protocol. Five years after diagnosis, relative survival rates were 75, 62 and 35% for cancers of the endometrium, cervix and ovary, respectively. Survival decreased markedly with age. The decrease was especially evident for ovarian cancer, which declined from 65% (15–45 years) to 18% (75+ years). In 1985–1989 there were important inter-country differences in survival for European women with gynaecological cancers: Eastern European countries were characterised by low 5-year relative survival whilst in Sweden, Austria, The Netherlands and Switzerland survival was generally higher than for other European countries. From 1978–1989, 5-year relative survival improved slightly for cervical cancer and improved more among the oldest patients. Prognosis also improved slightly for patients with ovarian tumours and this increase (around 20%) was concentrated among patients between 15 and 64 years of age. Intercountry differences in survival did not in general reduce over time, although for ovarian cancer survival differences narrowed probably in relation to the more widespread use of more effective chemotherapy. Intercountry and time differences in survival for cervical cancer are almost certainly related to variations in the effectiveness of cervical screening programmes. For corpus uteri cancer there was no improvement in survival over the period of this study and intercountry survival differences for this cancer are probably related to differences in patient management.     

Survival in patients with primary liver cancer,gallbladder and extrahepatic biliary tract cancer and pancreatic cancer in Europe 1999–2007: Results of EUROCARE-5

BackgroundThe EUROCARE study collects and analyses survival data from population-based cancer registries (CRs) in Europe in order to provide data on between-country differences in survival and time trends in survival.MethodsThis study analyses data on liver cancer, gallbladder and extrahepatic biliary tract cancers (“biliary tract cancers”), and pancreatic cancer diagnosed in 2000–2007 from 88 CRs in 29 countries. Relative survival (RS) was estimated overall, by region, sex, age and period of diagnosis using the complete approach. Time trends in 5-year RS over 1999–2007 were also analysed using the period approach.ResultsThe prognosis of the studied cancers was poor. Age-standardised 5-year RS was 12% for liver cancer, 17% for biliary tract cancers and 7% for pancreatic cancer. There were some between-country differences in survival. In general, RS was low in Eastern Europe and high in Central and Southern Europe. For all sites, 5-year RS was similar in men and women and decreased with advancing age. No substantial changes in survival were reported for pancreatic cancer over the period 1999–2007. On average, there was a crude increase in 5-year RS of 3 percentage points between the periods 1999–2001 and 2005–2007 for liver cancer and biliary tract cancers.ConclusionsThe major changes in imaging techniques over the study period for the diagnosis of the three studied cancers did not result in an improvement in the prognosis of these cancers. In the near future, new innovative treatments might be the best way to improve the prognosis in these cancers.     

Survival of colorectal cancer patients in Europe during the period 1978–1989

This study concerns the survival of European patients diagnosed between 1978 and 1989 with colorectal cancer. Variations in survival in relation to age, country and period of diagnosis were examined. Data from the EUROCARE study were supplied by population-based cancer registries in 17 countries to a common protocol. Five years after diagnosis, relative survival rates were 47 and 43% for cancers of the colon and rectum, respectively. Survival decreased with increasing age: the relative risk of dying for the oldest patients (75+) was 1.39 for rectum and 1.54 for colon compared with the youngest patients (15–44 years). In 1985–1989 survival from colorectal cancer differed significantly between different European countries: the Nordic countries (Denmark excluded), The Netherlands, Switzerland, France and Austria were characterised by high survival, whilst Eastern European countries, the U.K. and Denmark were characterised by low survival. There was a general improvement in survival over the period 1978–1989: from 40 to 48% for colon cancer and 38 to 46% for rectal cancer. For neither cancer site did between-country survival differences narrow over the study period. Intercountry and time differences in survival differences are probably related to stage at diagnosis and postoperative mortality.     

Survival of patients with oesophageal and gastric cancers in Europe

The EUROCARE study is a European Union project to collect survival data from population-based cancer registries and analyse them according to standardised procedures. We investigated and compared oesophageal and gastric cancer survival in 17 countries between 1985 and 1989. Time trends in survival over the 1978–1989 period were also investigated in 13 countries. The overall European 1-year relative survival rates were 33% for oesophageal cancer and 40% for gastric cancer. The corresponding 5-year relative survival rates were 10 and 21%, respectively. Important intercountry survival differences exist within Europe for oesophageal and gastric cancer. Taking the European average as the reference, the relative risk (RR) of death at 5 years was at least 30% higher in Denmark, Poland, Estonia and Slovenia for oesophageal cancer and in Denmark, England, Scotland and Poland for gastric cancer. In the other countries survival figures were close to the European average. Gender had little influence on survival, whilst age at diagnosis was inversely related to prognosis. There was a slight improvement between 1978 and 1989 in 5-year overall relative survival rates for both oesophageal cancer (RR=0.80, 95% confidence interval (CI) 0.72–0.90) and gastric cancer (RR=0.88, 95% CI 0.82–0.94). Differences in quality of care and stage at diagnosis can explain in part the differences in survival found in the EUROCARE countries. Significant improvement in prognosis has still to be achieved.     

Variations in survival from breast cancer in Europe by age and country, 1978–1989

The objective of this study, part of the wider EUROCARE II collaborative project, was to examine variations by age and country in the relative survival of women from breast cancer in Europe, based on data for 145 000 cases in 1985–1989 and trends based on (245 000) cases for 1978–1989. Data were supplied by 42 cancer registries in 17 countries to a common protocol. Results for some countries where the participating registries covered only small proportions of the total population may not be representative of the whole country. In 1985–1989 there were wide differences among the 17 countries: survival was above the European average in Iceland, Finland, Sweden, Switzerland, France and Italy; around average in Denmark, The Netherlands, Germany and Spain; below average in Scotland, England and Slovenia; and well below average in Slovakia, Poland and Estonia. In France, Spain and Italy, but not in the U.K., there were wide differences in survival among the participating registries. Survival generally declined with age, particularly in the elderly (75 years and over)—this was most marked in Denmark, Scotland and England. Over the period 1978–1989, 1-year survival improved by 2% overall and 5-year survival by 6%. There were improvements in 5-year survival in all countries except Iceland, Germany, Switzerland and Estonia, and in all age groups except the youngest (15–44 years). It is likely that differences in the access to and quality of care in the various countries played a large part in explaining the differences in survival.     

Variation in survival of adult patients with haematological malignancies in Europe since 1978

Data on 73 070 patients for seven major haematological malignancies diagnosed in Europe between 1985 and 1989 from 39 population-based cancer registries in 17 countries are included in the EUROCARE database. Relative survival was analysed by country and age between 1985 and 1989 and time trends were analysed from 1978–1989 for 13 countries which collaborated in EUROCARE for this entire period. The European weighted age-standardised 5-year relative survival rate was 72% for patients with Hodgkin’s disease (HD, ranging from 45 to 76% in 13 countries), 63% for chronic lymphocytic leukaemia (CLL, range 51–79%, 14 countries), 46% for patients with non-Hodgkin’s lymphoma (NHL, range 25–63%, 17 countries), 31% for patients with chronic myelocytic leukaemia (CML, range 8–40%, 13 countries), 28% for patients with multiple myeloma (MM, range 18–36%, 14 countries), 25% for patients with acute lymphoblastic leukaemia (ALL, range 19–33%, 7 countries) and 10% for patients with acute myeloblastic leukaemia (AML, range 4–15%, 11 countries). In all countries, relative survival declined with age, most markedly for patients with acute leukaemias. Patients in Northern and Western Europe had better survival rates, particularly in younger patients (15–45 years of age), whilst those in Eastern European countries tended to have poorer rates. Compared with 1978–1979, relative 5-year survival improved in 1987–1989 for most haematological malignancies (relative risk (RR) of death for CLL 0.65, AML 0.75, HD 0.76, ALL 0.79, NHL 0.82), with only CML (RR 0.95) and MM (RR 1.00) showing little or no change. These results suggest that generally and particularly in Eastern Europe there is room for improvement in the diagnosis and treatment of haematological malignancies. The intercountry differences also highlight the importance of socio-economic conditions to health status.     

Survival of colorectal cancer patients in Europe during the period 1978–1989

This study concerns the survival of European patients diagnosed between 1978 and 1989 with colorectal cancer. Variations in survival in relation to age, country and period of diagnosis were examined. Data from the EUROCARE study were supplied by population-based cancer registries in 17 countries to a common protocol. Five years after diagnosis, relative survival rates were 47 and 43% for cancers of the colon and rectum, respectively. Survival decreased with increasing age: the relative risk of dying for the oldest patients (75+) was 1.39 for rectum and 1.54 for colon compared with the youngest patients (15-44 years). In 1985-1989 survival from colorectal cancer differed significantly between different European countries: the Nordic countries (Denmark excluded), The Netherlands, Switzerland, France and Austria were characterised by high survival, whilst Eastern European countries, the U.K. and Denmark were characterised by low survival. There was a general improvement in survival over the period 1978-1989: from 40 to 48% for colon cancer and 38 to 46% for rectal cancer. For neither cancer site did between-country survival differences narrow over the study period. Intercountry and time differences in survival differences are probably related to stage at diagnosis and postoperative mortality.     

Variation in survival of adult patients with thyroid cancer in Europe

The survival of patients with thyroid cancer was analysed using population-based EUROCARE II data from 1978–1989 (trends in survival) and 1985–1989 (cross-sectional comparisons between areas). The data consisted of 7504 patients and covered 37 cancer registration areas in 17 European countries. In 90% of the patients the diagnosis was histologically confirmed. The prognosis of patients with thyroid cancer was relatively favourable. The overall 5-year relative survival rate was 72% for men and 80% for women. Substantial variation in this 5-year rate was observed between countries ranging from 59 to 83% in men and from 72 to 84% in women. Higher than average survival rates were observed in Finland, Iceland, The Netherlands and Sweden. Countries with lower than average rates were Denmark, England, Estonia, Slovakia, Slovenia and Poland (women). Elderly patients had lower survival rates than the younger ones. Time trends in survival (which could be analysed only in selected countries with sufficient numbers of cases) were irregular but generally showed slight increases compared with rates in 1978–1980. Different distributions in the histological subtypes of thyroid cancer is one plausible explanation for the variation in the survival rate. Other likely factors contributing to this are differences in the stage distribution and varying efficacy of treatment. The EUROCARE II data did not permit specific analyses of the roles of various prognostic factors.     

Variation in survival of patients with lung cancer in Europe, 1985–1989

In this study, we report on the variation in the prognosis for adult patients with lung cancer within Europe, by age, histology and country from 1985–1989. We considered trends in survival since 1978 for most countries. Survival analysis was carried out on 173 448 lung cancer cases diagnosed between 1985 and 1989 in 44 population-based cancer registries, participating in the EUROCARE study. Relative 1-year survival rates for patients with lung cancer varied from 24 to 40%, being highest in Finland, France, The Netherlands and Switzerland and lowest in Denmark, England, Poland and Scotland. Half of all patients under the age of 45 years died within 1 year of diagnosis, increasing to almost 80% for those aged 75 years or older. Whilst the prognosis for patients with non-small cell carcinoma remained more or less constant between 1978 and 1989 (25% in Denmark and 44% in Finland), that for patients with small cell carcinoma improved slightly, especially in The Netherlands (Eindhoven from 17 to 24%) and Switzerland (Geneva from 24 to 32%). In conclusion, a fairly large variation in lung cancer relative survival rates existed between European countries. The most likely explanation for the differences is the variation in access to specialised care. Except for a slight improvement in short-term survival for patients with small cell lung cancer, survival has remained poor since 1978.     

Variation in survival of patients with prostate cancer in Europe since 1978

Since the incidence of prostate cancer has increased considerably over the past two decades in most European countries, knowledge of the variation in survival is pertinent. The collaboration across Europe in the EUROCARE study has now been extended to 45 registries in 17 countries. We report on variation in relative survival according to age of 65 728 patients diagnosed with prostate cancer between 1985 and 1989 and also explore time trends since 1978 for most countries. Considerable variation in survival was found within and between countries, with the highest survival in Switzerland (5-year relative survival 72%), followed by Germany (67%) and the Nordic countries (except Denmark). The lowest survival was found in Estonia (39%), preceded by Slovenia (40%), Denmark (41%) and England (45%). Between 1978 and 1986, relative survival barely changed over time, but it improved from 55% (95% confidence interval [CI] 53–57) during 1984–1986 to 59% (CI 56–61) during 1987–1989. A small but unexpected deterioration of survival for patients aged between 45 and 54 years from 61% to 56% was observed in the early 1980s. It is likely that variation in both detection methods and treatment plays a role in the observed variation in survival, but more information is needed to assess each contribution.     

Survival rates for primary malignant brain tumours in Europe

In the framework of EUROCARE, a concerted action between 45 population-based cancer registries, in 17 European countries, survival of patients with primary malignant brain tumours was investigated. Survival analysis was carried out on 16 268 patients diagnosed between 1985 and 1989 and followed-up for at least 5 years. The mean European age-standardised 5-year relative survival was 17% in men and 20% in women, with minimal intercountry variations, except for markedly lower rates in Scotland, Estonia and Poland. The age-specific analysis showed a relatively uniform survival in patients aged more than 65 years at diagnosis, but there were more marked intercountry differences in younger patients. In the 15–44 year age group (25% of the total study population) 5-year relative survival ranged between 55% (Finland and Sweden) and 27% (Poland). Generally, survival decreased with increasing age at diagnosis. The analysis of a temporal trend in survival was carried out on a subset of registries with available data from 1978–1989. Overall, there was an increase in survival over the considered study period, mostly confined to 1-year survival, suggesting that it was mostly related to improved diagnostic techniques. The most important survival increase occurred in the younger patients, both for 1- and 5-year survival, suggesting that younger patients have less biologically aggressive tumours, benefiting from the combined effect of diagnostic accuracy and effective therapies. The most marked survival increase was seen in England and Denmark, countries with low survival rates at the beginning of the study period, whereas in Finland and Germany, where survival was relatively high to begin with, no important temporal trend was seen.     

Improved survival for patients with testicular cancer in Europe since 1978

Within the framework of EUROCARE, a population-based study on survival and care of cancer patients in Europe, we analysed survival of 7426 men with testicular cancer diagnosed between 1985 and 1989 in 17 countries. For comparison between the countries, survival rates were age-standardised to the age structure of the entire study population. Among the participating countries of Northern, Western, Central and Southern Europe and the U.K., the age-standardised 5-year relative survival rate varied from 89% (Finland) to 93% (Spain, Germany). In Eastern Europe, the rate ranged from 48% (Estonia) to 84% (Slovenia). Rates in Poland, Slovakia and Estonia were significantly lower than the summary rate for Europe (P<0.05). Relative survival generally decreased with the age of patients at diagnosis. Based on the weighted analysis of pooled European data, the 5-year relative survival rate was 91% for patients aged 15-44 years; 85% for patients aged 55-64 years; and 59% for patients aged 75 years and over. The time trend in survival by 3-year periods between 1978 and 1989 was studied on the basis of 12 084 cases provided by 12 countries. From 1978-1980 to 1987-1989, the 5-year relative survival rate for Europe increased from 79 to 93% (P<0.05). The inequalities in survival between the more developed European countries were more notable in the 1970s than in the 1980s, suggesting that the treatment for testicular cancer became standardised in the latter period. Poorer survival in Eastern Europe and particularly in Estonia, could be related to later introduction of the effective cytotoxic treatments, but also to longer diagnostic delay and limited availability of modern staging procedures.     

Variation in survival of patients with head and neck cancer in Europe by the site of origin of the tumours

The study describes the prognosis of head and neck cancer in Europe on the basis of information available to population-based cancer registries collaborating in the EUROCARE II project. Variation in survival in relation to country and the anatomical site/sub-site of origin of the tumours was examined. Survival analysis was carried out on 35 004 head and neck cancer cases (ICD 141, 143–148 and 161) diagnosed between 1985 and 1989 in 17 European countries. Prognosis varied considerably according to anatomical site: the best 5-year survival rates were seen for cancer of the larynx (63% in men) and the worst for cancer of the hypopharynx (22% in men). Five-year relative survival of male patients with cancer of the tongue, mouth and pharynx (ICD 141, 143–148) was 34% and ranged from over 45% in Iceland, Sweden, The Netherlands and Austria to less than 25% in Eastern European countries. Survival for larynx cancer ranged from over 70% in Iceland, Sweden, The Netherlands and Germany to less than 50% in Slovakia, Poland and Estonia. Apparently, France had the lowest survival (relative risk (RR) of dying versus Finland=1.29) in Western Europe; after adjustment for ICD 3-digit anatomical sites the difference disappeared (RR=1.04). Eastern European countries remained at the bottom of the survival range (RR>1.4). The analyses adjusting by sub-site (ICD fourth digit) were confined to registries for which the proportion of unspecified sub-sites was less than 20%. Geographical differences in survival between Western European countries were largely due to a difference in case mix of anatomical sub-sites. However, after correcting for different sub-site distribution, differences persisted between Eastern and Western European countries. This is likely to be due to late diagnosis and to late referral or poor access of patients to adequately equipped treatment centres.     

Improvement in survival of patients with cancer of the kidney in Europe

Survival of adult patients with cancer of the kidney, renal pelvis, ureter and urethra (ICD-9 189) was analysed using data from the EUROCARE II study, a collaborative project of 45 population-based cancer registries in 17 European countries. For the period 1985-1989, more than 24000 patients were included and 5-year relative survival was 48%. Large variations were observed between countries with 5-year relative survival ranging from 57% in France, 53% in Italy and 51% in Spain to 35% in Denmark, 33% in Poland and 30% in Estonia. A number of registries also provided information on previous years and survival was seen to improve with time from 44% in 1978-1980 to 50% in 1987-1989. Age was an important determinant of survival with 5 year survival rates decreasing from 63% in patients aged 15-44 years to 36% in patients aged 75 years and older. Variation in survival rates by country or time is probably related to differences in the distribution of tumour stage at diagnosis. Evidence to confirm this theory is, however, lacking.     

Age-related differences in cancer relative survival in the United States: A SEER-18 analysis

Cancer survival has improved since the 1990s, but to different extents across age groups, with a disadvantage for older adults. We aimed to quantify age-related differences in relative survival (RS—1-year and 1-year conditioning on surviving 1 year) for 10 common cancer types by stage at diagnosis. We used data from 18 United States Surveillance Epidemiology and End Results cancer registries and included cancers diagnosed in 2012 to 2016 followed until December 31, 2017. We estimated absolute differences in RS between the 50 to 64 age group and the 75 to 84 age group. The smallest differences were observed for prostate and breast cancers (1.8%-points [95% confidence interval (CI): 1.5-2.1] and 1.9%-points [95% CI: 1.5-2.3], respectively). The largest was for ovarian cancer (27%-points, 95% CI: 24-29). For other cancers, differences ranged between 7 (95% CI: 5-9, esophagus) and 18%-points (95% CI: 17-19, pancreas). Except for pancreatic cancer, cancer type and stage combinations with very high (>95%) or very low (<40%) 1-year RS tended to have smaller age-related differences in survival than those with mid-range prognoses. Age-related differences in 1-year survival conditioning on having survived 1-year were small for most cancer and stage combinations. The broad variation in survival differences by age across cancer types and stages, especially in the first year, age-related differences in survival are likely influenced by amenability to treatment. Future work to measure the extent of age-related differences that are avoidable, and identify how to narrow the survival gap, may have most benefit by prioritizing cancers with relatively large age-related differences in survival (eg, stomach, esophagus, liver and pancreas).     

Long-term survival trends in solid cancers in the Nordic countries marking timing of improvements

Survival studies are an important indicator of the success of cancer control. We analyzed the 5-year relative survival in 23 solid cancers in Denmark, Finland, Norway and Sweden over a 50-year period (1970-2019) at the NORDCAN database accessed from the International Agency for Research on Cancer website. We plotted survival curves in 5-year periods and showed 5-year periodic survival. The survival results were summarized in four groups: (1) cancers with historically good survival (>50% in 1970-1974) which include melanoma and breast, endometrial and thyroid cancers; (2) cancers which constantly improved survival at least 20% units over the 50 year period, including cancers of the stomach, colon, rectum, kidney, brain and ovary; (3) cancer with increase in survival >20% units with changes taking place in a narrow time window, including oral, oropharyngeal, testicular and prostate cancers; (4) the remaining cancers with <20% unit improvement in survival including lung, esophageal, liver, pancreatic, bladder, soft tissue, penile, cervical and vulvar cancers. For cancers in groups 1 and 2, the constant development implied multiple improvements in therapy, diagnosis and patient care. Cancers in group 3 included testicular cancers with known therapeutic improvements but for the others large incidence changes probably implied that cancer stage (prostate) or etiology (oropharynx) changed into a more tractable form. Group 4 cancers included those with dismal survival 50 years ago but a clear tendency upwards. In 17 cancers 5-year survival reached between 50% and 100% while in only six cancers it remained at below 50%.     

Socioeconomic environment and disparities in cancer survival for 19 solid tumor sites: An analysis of the French Network of Cancer Registries (FRANCIM) data

Social inequalities are concerning along the cancer continuum. In France, social gradient in health is particularly marked but little is known about social gradient in cancer survival. We aimed to investigate the influence of socioeconomic environment on cancer survival, for all cancers reported in the French Network of Cancer Registries. We analyzed 189,657 solid tumors diagnosed between 2006 and 2009, recorded in 18 registries. The European Deprivation Index (EDI), an ecological index measuring relative poverty in small geographic areas, assessed social environment. The EDI was categorized into quintiles of the national distribution. One- and five-year age-standardized net survival (ASNS) were estimated for each solid tumor site and deprivation quintile, among men and among women. We found that 5-year ASNS was lower among patients living in the most deprived areas compared to those living in the least deprived ones for 14/16 cancers among men and 16/18 cancers among women. The extent of cancer survival disparities according to deprivation varied substantially across the cancer sites. The reduction in ASNS between the least and the most deprived quintile reached 34% for liver cancer among men and 59% for bile duct cancer among women. For pancreas, stomach and esophagus cancer (among men), and ovary and stomach cancer (among women), deprivation gaps were larger at 1-year than 5-year survival. In conclusion, survival was worse in the most deprived areas for almost all cancers. Our results from population-based cancer registries data highlight the need for implementing actions to reduce social inequalities in cancer survival in France.     

Survival of cancer patients diagnosed between 1993 and 1996: a collaborative study of population-based cancer registries in Japan

BACKGROUND: Survival of cancer patients has been measured only in some limited areas in Japan until recently. The purpose of the present study was to collect data of fairly high quality on the population-based cancer registries and to estimate relative 5-year survival of cancer patients in Japan. METHODS: We requested 11 population-based cancer registries within the research group to submit individual data of the patients diagnosed from 1993 to 1996, together with the prognosis after 5 years, to the collaborative study secretariat. Ten population-based cancer registries (Miyagi, Yamagata, Niigata, Chiba, Kanagawa, Fukui, Aichi, Osaka, Tottori and Nagasaki) then accepted data submission (373,000 data). Among 10 registries, only 7 registries met the required standards for the quality of registration data and prognosis investigation. The relative 5-year survival calculated by pooling 279,000 data from seven registries was taken as the national estimate of that of cancer patients in Japan. RESULTS: The relative 5-year survival was 53.6% for all cancers (males: 49.2%, females: 59.4%); the survivals of stomach, large bowel, prostate and kidney cancer patients were from 62 to 68%; those of breast, uterus, larynx, skin, testis, bladder and thyroid cancer patients were from 74 to 92%; those of liver, gall bladder and bile duct, pancreas and lung cancer patients ranged from 6 to 23%. CONCLUSION: On the basis of the data from seven population-based cancer registries in Japan, we calculated the relative 5-year survival of cancer patients diagnosed from 1993 to 1996 for the first time.     

Urinary tract cancer survival in Europe 1999–2007: Results of the population-based study EUROCARE-5

BackgroundThis work presents relative survival estimates regarding urinary tract tumours among adult patients (age ⩾ 15 years) diagnosed in Europe. It reports on survival estimates of cases diagnosed in 2000–2007, and on survival time trends from 1999–2001 to 2005–2007.MethodsData on 677,340 adult urinary tract tumour patients, (429,154 cases of invasive and non-invasive bladder and 248,186 cases of invasive kidney cancers) diagnosed between 2000 and 2007 were provided by 86 population-based cancer registries from 29 European countries.The complete approach was used to estimate survival in 2000–2007; the period approach was used to estimate survival over time.ResultsThe age-standardised 5-year relative survival for patients with kidney tumours diagnosed in Europe during 2000–2007 was 60%. The best prognosis was observed in Southern and Central Europe and prognosis improved in all regions along the time period. For invasive and non-invasive patients with bladder tumours combined the age-standardised 5-year relative survival in Europe was 68%. The best prognosis was observed in Southern and Northern Europe. However, in Scotland and The Netherlands the relative survival was significantly lower, although the survival estimates for these two countries were based on invasive tumours only.ConclusionsDifferences in registration practices affect comparisons of survival values between European countries, especially in patients with urinary bladder cancers. The between-country variation in survival is influenced by the varying use of diagnostic investigation in urinary tract tumours. Further data on stage at diagnosis can help to elucidate the influence of diagnostic intensity or early diagnosis on the survival patterns.     

Risk of cancer in a large cohort of U.S. veterans with diabetes

Prior studies of cancer risk among diabetic men have reported inconsistent findings. The aim of this study was to assess the risk of cancer among a large cohort (n = 4,501,578) of black and white U.S. veterans admitted to Veterans Affairs hospitals. The cancer risk among men with diabetes (n = 594,815) was compared to the risk among men without diabetes (n = 3,906,763). Poisson regression was used to estimate adjusted relative risks (RRs) and 95% confidence intervals (CIs). Overall, men with diabetes had a significantly lower risk of cancer (RR = 0.93, 95%CI = 0.93–0.94). Men with diabetes, however, had increased risks of cancers of the liver (RR = 1.95, 95%CI = 1.82–2.09), pancreas (RR = 1.50, 95%CI = 1.42–1.59), biliary tract (RR = 1.41, 95%CI = 1.22–1.62), colon (RR = 1.20, 95%CI = 1.16–1.25), rectum (RR = 1.12, 95%CI = 1.07–1.18), and kidney (RR = 1.09, 95%CI = 1.03–1.16), as well as leukemia (RR = 1.14, 95%CI = 1.08–1.21) and melanoma (RR = 1.13, 95%CI = 1.03–1.24). In contrast, men with diabetes had decreased risks of cancers of the prostate (RR = 0.89, 95%CI = 0.87–0.91), brain (RR = 0.91, 95% CI = 0.82–0.99), buccal cavity (RR = 0.85, 95%CI = 0.82–0.89), lung (RR = 0.79, 95%CI = 0.77–0.80), esophagus (RR = 0.77, 95%CI = 0.72–0.82), and larynx (RR = 0.76, 95%CI = 0.71–0.80). These findings indicate that black and white men with diabetes are at significantly lower risk of total cancer and of two of the most common cancers among U.S. males; lung and prostate cancers. These decreased risks were offset, however, by increased risks of cancer at several sites. Hyperinsulinemia may explain the increased risks of the digestive cancers, while lower testosterone levels, in the case of prostate cancer, and higher BMI, in the case of lung cancer, may explain the decreased risks of those tumors.