Age-specific Cancer Mortality Research Articles

Age-Specific Cancer Mortality in the US During the COVID-19 Pandemic, March to December 2020.

It is important to understand the impact of the COVID-19 pandemic on cancer death rates in 2020 in the US. We estimated whether there were larger-than-expected changes in cancer mortality rates from March to December 2020 after accounting for temporal and seasonal patterns using data from January 2011 to February 2020 by cancer type and age. We obtained death counts and underlying causes of death by cancer type, month/year (2011-2020), and age group from the National Center for Health Statistics and population estimates from the US Census Bureau. Poisson regression was used to test for significant changes in cancer death rates from March to December 2020 compared with prior years. After accounting for temporal trends and seasonal patterns, total cancer death rates were significantly lower than expected during March to December 2020 among 55- to 64-year-olds and ≥75-year-olds, but not in other age groups. Cancer death rates were 2% lower than expected from March to June among 55- to 64-year-olds and 2% to 3% lower from March to July and December among ≥75-year-olds. Among ≥75-year-olds, colorectal cancer death rates were lower from March to June [rate ratios (RR) = 0.94-0.96; P < 0.05]; however, lung cancer death rates were 5% lower across each month (all RRs = 0.95; P < 0.05). In the US, cancer death rates based on the underlying cause of death were broadly similar to expected rates from March to December 2020. However, cancer death rates were lower than expected among 55- to 64-year-olds and ≥75-year-olds, likely due to COVID-19 as a competing cause of death. Cancer mortality rates from 2020 should be interpreted with caution.

Progress in cancer control leads to a substantial number of cancer deaths avoided in Canada.

It is currently not known how many more cancer deaths would have occurred among Canadians if cancer mortality rates were unchanged following various modern human interventions. The objective of this study was to estimate the number of cancer deaths that have been avoided in Canada since the age-standardized overall cancer mortality rate peaked in 1988. We applied the age-specific overall cancer mortality rates from 1988 to the Canadian population for all subsequent years to estimate the number of expected deaths. Avoided cancer deaths were estimated as the difference between the observed and expected number of cancer deaths for each year. Since 1988, there have been 372 584 (standardized mortality ratio = 0.77) and 120 045 (standardized mortality ratio = 0.90) avoided cancer deaths in males and females, respectively (492 629 total). Nearly half a million cancer deaths have been avoided in Canada since the overall cancer mortality rate peaked, which demonstrates the exceptional progress made in modern cancer control in Canada.

Associations of increasing breast cancer incidence with the current drinking habits and the past smoking habits among Japanese women

Background We have reported that age-specific incidence rates of breast cancer among Japanese women increased from 2005 to 2015 in a bimodal distribution pattern, with two peaks in the pre- and postmenopausal age groups. Objectives The present study aimed to assess the associations of the increasing age-specific breast cancer incidence or mortality with the prevalence of obesity and drinking and smoking habits, compared with those in uterine body, female and male colon and lung cancers. Methods Linear correlations of annual rates from 2005 to 2015 of the 10-year age-specific cancer incidence and mortality with the prevalence of obesity (body mass index, 25 and over) and drinking (alcohol, 20 g and over 3 times or more a week) and smoking habits were assessed by Pearson’s correlation coefficients during the same 10-year period (from 2005 to 2015) or the 10-year period 10 years before the cancer incidence and mortality were noted (from 1995 to 2005). Results Positive correlations (r&gt;0.640) were found between the increasing breast cancer incidence and the drinking habit during the same period or the smoking habit during the period 10 years before. Similar but weaker correlations were found for the breast cancer mortality rate increasing with age. Positive correlations were found between the decreasing male lung cancer mortality rate and the smoking habit rate during the period 10 years before. Conclusions The present ecological study indicated that the breast cancer incidence was associated with the current drinking habits and the past smoking habits among Japanese women.

25, 50 & 75 years ago.

25, 50 & 75 years ago.

The NCC mathematical modeling framework for decision-making of six major cancers

ObjectiveMathematical modeling and simulation is a useful research method to inform decision-making. This article aims to describe the National Cancer Center (NCC) modeling framework and how well it reproduces observed empirical data for six major cancers. MethodsWe developed the NCC modeling framework for six major cancers in China (lung, liver, stomach, colorectal, esophageal, and breast), which simulates the life-histories represented by states among normal, precancerous lesion, stage-specific invasive cancer, and death for six cancers separately. Each NCC simulation model could be illustrated as an integrated framework of 3 modules: a demography module, natural history module, and screening module. Combined with costs and health utilities data, the models could have many detailed outputs for informing decisions, including the harm of screening (e.g., false positives, complications, and overdiagnosis), healthcare costs, and benefits (quality-adjusted life years gained, cancer incidence and mortality, and investment returns). We calibrated the models to Chinese population-based observations on cancer incidence, mortality, and stage distribution. All models are validated by comparing model simulated results to data observed from nationwide cancer registration and a large prospective cohort study. ResultsThe simulated results from the calibrated models consistently match the epidemiological patterns in six major cancer incidence, mortality, and stage distributions in China. Model projected age-specific cancer incidence and mortality were close to the observed data in the national cancer registration. The NCC modeling framework reproduced the cumulative cancer cases and deaths observed in the prospective cohort study at 7.0 and 10.8 years of follow-up. Model estimated net survival rates also consistent with population-based statistics. ConclusionThe NCC modeling framework's ability to reproduce the observed population-level cancer statistics and the cancer cases in a prospective cohort study suggests its results are reliable to inform decision-making related to six major cancers in China.

Recent Increase in the Breast Cancer Incidence Among Japanese Women Seems to Correlate With the Prevalence of Drinking and Smoking Habits, but Not Obesity, as a Modern Lifestyle

ObjectivesWe have recently reported that age-specific incidence rates of breast cancer among Japanese women clearly increased from 2000 to 2015 in a bimodal distribution pattern with two peaks at the age groups of 45 to 49 and 60 to 64 years. The present study aimed to assess the association of age-specific breast cancer incidence rates with the prevalence of obesity and drinking and smoking habits among Japanese women, compared with those of uterine body, colon and lung cancers. MethodsAge-specific cancer incidence and mortality rates and the prevalence of obesity and drinking and smoking habits were obtained from national data published by Cancer Information Services or National Institute of Health and Nutrition of Japan. Linear correlations of annual rates from 2005 to 2015 of the 10-year age-specific cancer incidence and mortality with the prevalence of obesity (body mass index, 25 and over) and drinking (alcohol, 20g and over 3 times or more a week) and smoking habits during the same 10-year period or the 10-year period 10 years before the cancer incidence and mortality were assessed by Pearson’s correlation coefficients. ResultsSignificant (p < 0.05) and positive correlations were found between breast cancer incidence and drinking habits during the same period at the age of 50–59 (r = 0.901), 60–69 (r = 0.808) and 70–79 years (r = 0.643) and during the 10-year-before period at 50–59 (r = 0.676); between the incidence and smoking habits during the 10-year-before period at 40–49 (r = 0.897), 50–59 (r = 0.731) and 60–69 (r = 0.696); between the mortality and drinking habits during the same period at 30–39 (r = 0.739), 60–69 (r = 0.817) and 70–79 (r = 712); and between the mortality and smoking habits during the same period at 30–39 (r = 0.733) and during the 10-year-before period at 60–69 (r = 0.663). Similar but less positive correlations for uterine body cancer or more positive correlations for male lung cancer were found. The prevalence of male drinking and smoking habits was decreasing during the 20 years. No positive correlations were found between the breast cancer incidence or mortality and the prevalence of obesity. ConclusionsThe present ecological study demonstrated that the prevalence of drinking and smoking habits, but not obesity, as a modern lifestyle correlated with the recent increase in the age-specific breast cancer incidence among Japanese women. Funding SourcesNone.

Breast Cancer Mortality Trends and Predictions to 2030 and Its Attributable Risk Factors in East and South Asian Countries.

BackgroundAmidst the rising breast cancer burden in Asia, we aim to predict the future mortality risk due to breast cancer and identify the risk-attributable deaths for breast cancer among East and South Asian countries.MethodsWe used country-level data to predict the trends in the next decade relating to female breast cancer mortality by employing data from 1990 to 2019 from the Global Burden of Disease 2019 study. We used the stochastic mortality modeling and prediction techniques to forecast the age-specific and risk-attributable breast cancer mortality trends at the regional and national levels of East and South Asia.ResultsThe number of deaths caused by the breast cancer is predicted to increase in East and South Asian countries in the next decade (2020–2030). Age-standardized death rate (ASDR) of breast cancer is predicted to increase by 7.0% from 9.20/100,000 (95% CI: 6.04–12.12) in 1990 to 9.88/100,000 (95% CI: 7.12–11.4) in 2030 in East Asia, and about 35% increase from 13.4/100,000 (95% CI: 9.21–16.02) in 1990 to 18.1/100,000 (95% CI: 13.23–21.10) in 2030 in South Asia. At the national level, the highest percent change in ASDR between 1990 and 2030 was reported in Pakistan (a 62% increase) and Nepal (a 47% increase). The highest percent change in breast cancer mortality between 2020 and 2030 for females of age group 80–84 years was observed in Pakistan [21.6, (95% CI, 20.6–94.7)], followed by Afghanistan [13.3 (4.0–80.8)], and Nepal [36.6 (11.1–125.7)] as compared to the other countries. In the females of aged 50–80 years, the predicted death rates were associated with high body mass index, high-fasting plasma glucose, and diet high in red meat, across the majority of countries under study. Furthermore, reductions in percent change in mortality rates occurred in several countries with increases in sociodemographic index (SDI), notably across high SDI countries.ConclusionBreast cancer mortality risk varies substantially across East and South Asian countries with higher mortality risk in low/middle SDI countries. Early detection using screening, awareness among females and health workers, and cost-effective and timely treatment of patients with breast cancer is vital in stemming the tide of breast cancer in the next decade.

Cancer Mortality in Hamburg (Germany) 1872-2019.

For a number of reasons, the cause-of-death statistics of the city of Hamburg are one of the most valid sources of data for the study of secular trends in cancer mortality in Germany. In this article, cancer mortality in Hamburg over the period 1872-2019 is presented. The sex-specific, raw, age-standardized (according to the world standard population), and age-specific cancer mortality rates for Hamburg, the German Empire, and the Federal Republic of Germany were determined from a variety of sources. The percentage of persons aged 60 and above in Hamburg was determined for the periods 1895-1950 and 1956-2019. Raw cancer mortality rates rose in Hamburg from 1872 onward. After standardization for age, cancer mortality rates were nearly constant from 1905 to 1951. In contrast, age-standardized cancer mortality in Germany overall rose over the years 1905-1934, reaching the same level as Hamburg only in 1933. From 1951 onward, cancer mortality rose among men in Hamburg, reaching a maximum of 205 per 100 000 in 1967 and thereafter continually decreasing, down to a value of 120 per 100 000 in 2019. In women, cancer mortality was nearly constant from 1905 to 1958 and then fell continually until 2019 (85 per 100 000). The percentage of persons aged 60 or above was only 6% in 1895, 17% in 1950, and 23% in 2019. The high validity of cause-of-death statistics in Hamburg enabled an estimation of secular trends in cancer mortality. A steady decline in cancer mortality in all age groups and in both sexes was found in Hamburg, beginning in approximately 1990 at the latest.

Predicting Confidence Intervals for the Age-Period-Cohort Model

Forecasting incidence and/or mortality rates of cancer is of special inter est to epidemiologists, health researchers and other planners in predicting the demand for health care. This paper proposes a methodology for devel oping prediction intervals using forecasts from Poisson APC models. The annual Canadian age-specific prostate cancer mortality rates among males aged 45 years or older for the period between 1950 and 1990 are calculated using 5-year intervals. The data were analyzed by fitting an APC model to the logarithm of the mortality rate. Based on the fit of the 1950 to 1979 data, the known prostate mortality in 1980 to 1990 is estimated. The period effects, for 1970-1979, are extended linearly to estimate the next ten period effects. With the aims of parsimony, scientific validity, and a reasonable fit to existing data two different possible forms are evaluated namely, the age period and the age-period-cohort models. The asymptotic 95% prediction intervals are based on the standard errors using an assumption of normality (estimate ±1.96× standard error of the estimate)

Trend in age-specific cancer mortality and cancer-free life expectancy in China, 2008–17: a cross-sectional survey of nationwide data

BackgroundCancer is the main chronic disease that affects the health of Chinese residents; however, there have been few systematic studies on cancer-free life expectancy in China. We aimed to explore age-specific cancer mortality and changes in population lifespan after accounting for the removal of the burden of cancer to provide important insights and a basic reference on the development of relevant health policies, such as cancer control or elderly care. MethodsWe used population data from the National Bureau of Statistics and data on cancer mortality from the China Health Statistics Yearbook to produce estimates of the number of deaths from 2008 to 2017 for 18 different age groups, female and male individuals, urban areas and rural areas, and different cancer types. We analysed the change in mortality for the 18 different age groups from 2008 to 2017 and inputted the population mortality and deaths caused by cancer into a life table system to calculate life expectancy for all age groups and cancer-free life expectancy for all age groups. FindingsFrom 2008 to 2017, total mortality associated with cancer in China decreased at a steady trend per year in urban areas and increased in rural areas. Mortality of the various age groups decreased during the 10-year period, whereas overall mortality rate increased due to population ageing. Lung cancer in rural areas increased by 2·8% (SD 1·2–4·4) per year, and liver cancer and stomach cancer significantly decreased by 2·1–2·2% per year in rural areas (p<0·0001). Life expectancy of the entire population increased from 74·6 years in 2008 to 75·6 years in 2017. Life expectancy in women (77·5–78·4 years) was higher than in men (72·0–73·1 years) from 2008 to 2017, and life expectancy in urban areas (76·0–76·2 years) was higher than rural areas (73·1–75·0 years). After removing the effects of cancer, life expectancy of the total population increased by about 3 years. Lung cancer had a greater effect on life expectancy than other types of cancer, and predominantly affects the male population younger than 54 years. If cancer were to be effectively controlled, the life expectancy of the population aged 50–84 years would be significantly improved. InterpretationCancer is a serious disease that harms the health of the population in China. The development of medicine is the main reason for the rapid increase in life expectancy in rural areas. Increased smoking and obesity are the main factors affecting the life expectancy of the Chinese population, although the development of new drugs and some new vaccines can effectively control cancer deaths. The study of life expectancy and healthy life expectancy will be important topics of research in the future. FundingNational High-tech R&D Program (863 Program) for High-end Electronic Medical Record Technology Development and System Application Demonstration (2012AA02A607).

Trend in Age-Specific Cancer Mortality and Cancer-Free Life Expectancy in China, 2008-2017: An Analysis of Nationwide Data

Background: Cancer is the main chronic disease that affects the health of Chinese residents, however, less systematic study on cancer-free life expectancy in China. We aimed to explore age-specific cancer mortality and changes in population lifespan after removal of cancer to provide important insights and a basic reference on the development of relevant health policies such as cancer control or elderly care. Methods: We use the available data to produce estimates of the number of deaths from 2008 to 2017 for 18 age groups, both sexes, urban areas and rural areas, cancer and the three high-incidence cancers. Data used include the population data from the National Bureau of Statistics and cancer mortality from China Health Statistics Yearbook. We analyzed the change in mortality over the years, and at the same time input the population and deaths into the life table system to calculate life expectancy for all ages and cancer-free. Findings: From 2008 to 2017, the total mortality rate of cancers in China decreased at a steady trend per year in urban areas and increased in rural areas. The mortality rate of the different age groups decreased during the 10-year period while the overall mortality rate increased. The lung cancer in rural areas increased by 2.8% per year, and liver cancer and stomach cancer significantly decrease by 2.1-2.2% per year (P<0.05). Life expectancy of the entire population from 74.6 years in 2008 to 75.6 years in 2017, nearly increases about 1 year. Life expectancy in female is higher than male, urban areas are higher than rural areas. After removing the effects of cancer, life expectancy of the population increases by about 3 years. Lung cancer has a greater impact on life expectancy of the population, mainly concentrated in the male population under 54 years old. If the cancer is effectively controlled, life expectancy of population in 50-84 years will be significantly improved. Interpretation: Cancer is a seriously disease harms the health of the population in China. The development of medical is the main reason for the rapid increase in life expectancy in rural areas. Increasing smoking and obesity are the main factors affecting life expectancy of people, meanwhile, the development of new drugs and some new vaccines can effectively control cancer deaths. The study on life expectancy and healthy life expectancy are important trends in the future. Funding Statement: National High-tech R&D Program (863 Program) for High-end Electronic Medical Record Technology Development and System Application Demonstration (2012AA02A607) Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: Missing.

Polygenic risk-tailored screening for prostate cancer: A benefit-harm and cost-effectiveness modelling study.

The United States Preventive Services Task Force supports individualised decision-making for prostate-specific antigen (PSA)-based screening in men aged 55-69. Knowing how the potential benefits and harms of screening vary by an individual's risk of developing prostate cancer could inform decision-making about screening at both an individual and population level. This modelling study examined the benefit-harm tradeoffs and the cost-effectiveness of a risk-tailored screening programme compared to age-based and no screening. A life-table model, projecting age-specific prostate cancer incidence and mortality, was developed of a hypothetical cohort of 4.48 million men in England aged 55 to 69 years with follow-up to age 90. Risk thresholds were based on age and polygenic profile. We compared no screening, age-based screening (quadrennial PSA testing from 55 to 69), and risk-tailored screening (men aged 55 to 69 years with a 10-year absolute risk greater than a threshold receive quadrennial PSA testing from the age they reach the risk threshold). The analysis was undertaken from the health service perspective, including direct costs borne by the health system for risk assessment, screening, diagnosis, and treatment. We used probabilistic sensitivity analyses to account for parameter uncertainty and discounted future costs and benefits at 3.5% per year. Our analysis should be considered cautiously in light of limitations related to our model's cohort-based structure and the uncertainty of input parameters in mathematical models. Compared to no screening over 35 years follow-up, age-based screening prevented the most deaths from prostate cancer (39,272, 95% uncertainty interval [UI]: 16,792-59,685) at the expense of 94,831 (95% UI: 84,827-105,630) overdiagnosed cancers. Age-based screening was the least cost-effective strategy studied. The greatest number of quality-adjusted life-years (QALYs) was generated by risk-based screening at a 10-year absolute risk threshold of 4%. At this threshold, risk-based screening led to one-third fewer overdiagnosed cancers (64,384, 95% UI: 57,382-72,050) but averted 6.3% fewer (9,695, 95% UI: 2,853-15,851) deaths from prostate cancer by comparison with age-based screening. Relative to no screening, risk-based screening at a 4% 10-year absolute risk threshold was cost-effective in 48.4% and 57.4% of the simulations at willingness-to-pay thresholds of GBP£20,000 (US$26,000) and £30,000 ($39,386) per QALY, respectively. The cost-effectiveness of risk-tailored screening improved as the threshold rose. Based on the results of this modelling study, offering screening to men at higher risk could potentially reduce overdiagnosis and improve the benefit-harm tradeoff and the cost-effectiveness of a prostate cancer screening program. The optimal threshold will depend on societal judgements of the appropriate balance of benefits-harms and cost-effectiveness.

Is the risk of cancer in Australia overstated? The importance of competing mortality for estimating lifetime risk.

To calculate lifetime risks of cancer diagnosis and cancer-specific death, adjusted for competing mortality, and to compare these estimates with the corresponding risks published by the Australian Institute of Health and Welfare (AIHW). Analysis of publicly available annual AIHW data on age-specific cancer incidence and mortality - for breast cancer, colorectal cancer, prostate cancer, melanoma of the skin, and lung cancer - and all-cause mortality in Australia, 1982-2013. Lifetime risks of cancer diagnosis and mortality (to age 85), adjusted for competing mortality. During 1982-2013, AIHW estimates were consistently higher than our competing mortality-adjusted estimates of lifetime risks of diagnosis and death for all five cancers. Differences between AIHW and adjusted estimates declined with time for breast cancer, prostate cancer, colorectal cancer, and lung cancer (for men only), but remained steady for lung cancer (women only) and melanoma of the skin. In 2013, the respective estimated lifetime risks of diagnosis (AIHW and adjusted) were 12.7% and 12.1% for breast cancer, 18.7% and 16.2% for prostate cancer, 9.0% and 7.0% (men) and 6.4% and 5.5% (women) for colorectal cancer, 7.5% and 6.0% (men) and 4.4% and 4.0% (women) for melanoma of the skin, and 7.6% and 5.8% (men) and 4.5% and 3.9% (women) for lung cancer. The method employed in Australia to calculate the lifetime risks of cancer diagnosis and mortality overestimates these risks, especially for men.

Health impact of delayed implementation of cervical cancer screening programs in India: A modeling analysis.

India has the highest burden of cervical cancer in the world. To estimate the consequences of delaying implementation of organized cervical cancer screening, we projected the avertable burden of disease under different implementation scenarios of a screening program. We used an individual‐based microsimulation model of human papillomavirus (HPV) infection and cervical cancer calibrated to epidemiologic data from India to project age‐specific cancer incidence and mortality reductions associated with screening (once‐in‐a‐lifetime among women aged 30–34 years) with one‐visit visual inspection with acetic acid (VIA) and one‐ and two‐visit HPV DNA testing. We then applied these reductions to a population model to project the lifetime cervical cancer cases and deaths averted under different implementation scenarios taking place from 2017 to 2026: (1) immediate implementation of screening with currently available screening tests (one‐visit VIA, two‐visit HPV testing); (2) immediate implementation of screening with currently available screening tests, with a switch to point‐of‐care one‐visit HPV testing in 5 years; and (3) 5‐year delayed implementation of screening with current screening tests or point‐of‐care HPV testing. Immediate implementation of two‐visit HPV testing with a switch to one‐visit HPV testing averted 574,100 cases and 382,500 deaths over the lifetimes of 81.4 million 30‐ to 34‐year‐old women screened once between 2017 and 2026. Delayed implementation with a one‐visit HPV test averted 209,300 cases and 139,100 deaths. Delaying implementation of screening programs in high‐burden settings will result in substantial morbidity and mortality among women beyond the age for adolescent HPV vaccination.

Temporal Associations of Alcohol and Tobacco Consumption With Cancer Mortality

Understanding whether the population-level consumption of alcohol and tobacco is associated with cancer mortality is a crucial question for public health policy that has not been answered by previous studies. To examine temporal associations of alcohol and tobacco consumption with overall cancer mortality in the Australian population, looking across different sex and age groups. This population-based cohort study conducted a time series analysis (autoregressive integrated moving average models) using aggregate-level annual time series data from multiple sources. Data on alcohol consumption and tobacco consumption per capita between 1935 and 2014 among the Australian population aged 15 years and older were collected from the Australian Bureau of Statistics and Cancer Council Victoria. Analysis was conducted from June 1, 2017, to October 30, 2017. Sex- and age-specific cancer mortality rates from 1968 to 2014 were collected from the Australian Institute Health and Welfare. Population-level cancer mortality in different sex and age groups in Australia, controlling for the effects of health expenditure. Among the Australian total population aged 15 years and older in this study, 50.5% were women. Cancer death rates per 100 000 persons increased from 199 in 1968 to 214 in 1989 and then decreased steadily to 162 in 2014. Taking into account lagged effects, 1-L decreases in alcohol consumption per capita were associated with a decline of 3.9% in overall cancer mortality over a 20-year period, and 1-kg decreases in tobacco consumption per capita were associated with a 16% reduction. Alcohol consumption per capita was significantly associated with overall cancer mortality among men aged 50 to 69 years and women aged 50 years and older. Tobacco consumption per capita was found to be significantly associated with overall cancer mortality only among men aged 50 years and older. In this study, alcohol consumption per capita was positively associated with overall cancer mortality among older men and women, and tobacco consumption per capita was positively associated with overall cancer mortality among older men over a 20-year period. This study provides evidence that a decrease in population-level drinking and tobacco smoking could lead to a reduction in cancer mortality.

Frailty in Hematologic Malignancy.

Older adults with hematologic malignancy are a growing demographic. Estimating risk of chemotherapy toxicity based on age alone is an unreliable estimate of quality of life, functional capacity, or risk of treatment complications. Dedicated geriatric assessment tools can aid the clinician in identifying geriatric syndromes such as frailty, resulting in improved prognostication to decrease morbidity and mortality. Frailty is not synonymous with individual performance status and is dynamic. Establishing the patient goals, values, and preferences is central to the consideration of malignant hematology decision process. Careful considerations of available data on the patient's prognosis based on estimated life expectancy, geriatric assessment data, and age-specific cancer mortality, with and without treatment, can reconcile the risks and benefits. Assessments of frailty can aid the clinical feasibility and burden of the treatment to the patient and family in the context of each patient's unique needs.

Age-specific cancer mortality trends in 16 countries.

This study explored previously little-known cancer mortality trends with a focus on changes with age and sex differences in 16 countries. Time series age-sex-specific cancer mortality, deaths from all causes, and population data were used for statistical description. The cancer mortality rate (CMR) peaked and declined with age in 11 countries. CMRs appeared to peak earlier and decline more dramatically in earlier time periods rather than later periods and for males rather than females. CMR peaking could have possibly been historically delayed. Moreover, "percentage of deaths from cancer" (PDC) in all 16 countries plunged after about age 60. Middle-aged women may have higher CMRs than men. Premenopausal women may have higher PDCs than postmenopausal women. The findings make significant contributions to the literature, though their interpretation and application have limitations due to data quality and availability. Future research should explore if and how the findings apply to other countries and time periods. Public health practitioners and policy makers should consider age-sex-specific strategies for more effective cancer control.

Trends in prostate cancer incidence and mortality in Canada during the era of prostate-specific antigen screening.

Widespread use of prostate-specific antigen (PSA) to screen for prostate cancer began in the early 1990s. Advocates for screening assert that this has caused a decrease in prostate cancer mortality. We sought to describe secular changes in prostate cancer incidence and mortality in Canada in relation to the onset of PSA screening. Age-standardized and age-specific prostate cancer incidence (1969-2007) and mortality (1969-2009) from Public Health Agency of Canada databases were analyzed by joinpoint regression. Changes in incidence and mortality were related to introduction of PSA screening. Prior to PSA screening, prostate cancer incidence increased from 54.2 to 99.8 per 100 000 between 1969 and 1990. Thereafter, incidence increased sharply (12.8% per year) to peak at 140.8/100 000 in 1993. After decreasing in all age groups between 1993 and 1996, incidence continued to increase for men aged less than 70 years, but decreased for older men. Age-standardized mortality was stable from 1969 to 1977, increased 1.4% per year to peak in 1995 and subsequently decreased at 3.3% per year; the decline started from 1987 in younger men (age < 60 yr). Incidence was increasing before PSA screening occurred, but rose further after it was introduced. Reductions in prostate cancer mortality began before PSA screening was widely used and were larger than could be anticipated from screening alone. These findings suggest that screening caused artifactual increase in incidence, but no more than a part of reductions in prostate cancer mortality. The reduction may be due to changing treatment or certification of death.

Esophageal cancer statistics in China, 2011: Estimates based on 177 cancer registries.

Esophageal cancer has been a common cancer in China for many years. Using the most recent data collected from the National Central Cancer Registry, we present estimates of the esophageal cancer burden in China in 2011. Age-specific incidence and mortality rates by gender and area for 18 age groups were calculated based on data from 177 qualified population-based cancer registries. The number of new cases of esophageal cancer and cancer deaths were computed by multiplying these rates by the 2011 population. Crude incidence and mortality rates of esophageal cancer were estimated. The estimated number of new esophageal cancer cases and deaths were 291 238 and 218 957, respectively. The crude incidence and mortality rates for esophageal cancer were 21.62/100 000 and 16.25/100 000, respectively. The age-standardized incidence and mortality rates by world population were 15.83/100 000 and 11.62/100 000, respectively. Both the incidence and mortality rates of esophageal cancer were higher in rural areas than in urban areas, and in men than in women. The age-specific esophageal cancer incidence and mortality rates increased with age. In China, squamous cell cancer was the most common pathological type of the disease. Esophageal cancer remains a major public health issue in China. Primary and secondary prevention are essential for disease control.

Cancer surveillance using registry data: Results and recommendations for the Lithuanian national prostate cancer early detection programme

IntroductionWe describe long term trends in prostate cancer epidemiology in Lithuania, where a national prostate specific antigen (PSA) test based early detection programme has been running since 2006. MethodsWe used population-based cancer registry data, supplemented by information on PSA testing, life expectancy and mortality from Lithuania to examine age-specific prostate cancer incidence, mortality and survival trends among men aged 40+ between 1978 and 2009, as well as life expectancy of screening-eligible men, and the proportion of men with a first PSA test per year since the programme started. ResultsThe number of prostate cancer patients rose from 2.237 in 1990–1994 to 15.294 in 2005–2009. By 2010, around 70% of the eligible population was tested, on average around two times. The early detection programme brought about the highest prostate cancer incidence peaks ever seen in a country to date. Recent incidence and survival rises in the age groups 75–84 suggest PSA testing in the elderly non-eligible population. Life expectancy of men aged 70–74 indicates that less than 30% of patients will live for 15years and may have a chance to benefit from early detection. ConclusionsEarly detection among men aged 70–74, and particularly among the elderly (75+) may have to be reconsidered. Life expectancy assessment before testing, avoiding a second test among men with low PSA values and increasing the threshold for further evaluation and the screening interval may help reducing harm. Publishing information on treatment modalities, side-effects and patient reported quality of life is recommended.