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     

Incidence of colorectal cancer following adenomatous polyps of the large intestine

An association between adenomatous polyps of the large bowel and colorectal cancer has been reported, in the absence, however, of population-based estimates of risk. Subjects with histologically confirmed first diagnosis of large-bowel polyps notified to the population-based Cancer Registry of the Swiss Canton of Vaud (about 600,000 inhabitants) during the calendar period 1979-1990 were actively followed up to the end of 1990 for the subsequent occurrence of malignant neoplasms. Among 2,496 individuals with intestinal polyps, followed for a total of 10,310 person-years at risk (6,201 among males and 4,109 among females), 150 malignant neoplasms were registered versus 152 expected. Thus, the standardized incidence ratio (SIR) for all cancers combined was 0.99. A significant excess was observed for colorectal cancer, with 35 cases observed (19 males, 16 females) versus 17.0 expected (SIR = 2.1; 95% CI: 1.5–3.0). There was also an excess, although not significant, for small-bowel cancer (2 cases observed vs. 0.4 expected; SIR = 5.4). In none of the other cancer sites was SIR significantly or appreciably elevated: in subjects with colorectal polyps the SIR was 1.6 for stomach, 1.0 for lung, 0.9 for breast and 1.2 for prostate. The SIR of colorectal cancer was 3.1 in the first year since polyp registration, and declined thereafter to 1.8, in the absence, however, of any further trend with time since diagnosis. The cumulative risk of colorectal cancer in subjects with colorectal polyps was 2% at 5 years and 3% at 10 years. The quantitative estimates of this study are of interest for their population-based nature, and are potentially useful for defining and targeting screening colonoscopy programmes.     

Prognosis of bilateral synchronous breast cancer in Vaud, Switzerland

Out of 6084 first breast cancers registered between 1974 and 1993 in the Cancer Registry of the Swiss Canton of Vaud, 81 (1.3%) were synchronous bilateral breast cancers (BBCs). The 5-year relative survival rates were 73% for women with unilateral breast cancer (UBC) and 65% for those with synchronous BBC. The corresponding 10-year figures were 59% and 51%. This large, population-based series indicates that women with synchronous BBC have a moderately lower long-term survival than women with UBC.     

Second primary tumors after prostate carcinoma.

BACKGROUND: Several large datasets have shown a reduced risk of all neoplasms after a diagnosis of prostate carcinoma but an increased incidence rate of urologic carcinoma has been suggested. METHODS: Data collected by the Cancer Registries of the Swiss Cantons of Vaud and Neuchatel (approximately 760,000 inhabitants) were used to estimate the incidence rate of a second primary tumor after a diagnosis of prostate carcinoma. A total of 4503 cases registered between 1974 and 1994 were followed until the end of 1996 (17,065 person-years). RESULTS: A total of 380 second primary neoplasms were observed versus 534.1 expected primary neoplasms (standardized incidence ratio [SIR] = 0.7; 95% confidence interval, 0.6-0.8). SIRs were significantly below unity for lung carcinoma (SIR = 0.7) and other major tobacco-related neoplasms, including those of the mouth or pharynx (SIR = 0.5), esophagus (SIR = 0.4), pancreas (SIR = 0.5), and larynx (SIR = 0.8). There was no excess rate of subsequent urologic carcinoma (SIR = 1.0) or colorectal carcinoma (SIR = 0.9). The reduced SIRs for lung carcinoma were stronger in elderly men (age >/= 75 years) and in patients with a shorter period since diagnosis (< 5 years). CONCLUSIONS: The incidence of all neoplasms was reduced significantly in men diagnosed with prostate carcinoma. Selection of the population, under-registration of second primary tumors, and reduced surveillance in elderly men with prostate carcinoma may, at least in part, explain this reduction in risk. No excess risk was observed for the complex of urologic neoplasms nor for tobacco-related neoplasms. This finding would not support an association between cigarette smoking and prostate carcinoma.