Age-standardized Cancer Incidence Rates Research Articles

Increased cancer risk in male hunters in Northern Sweden after the Chernobyl Nuclear Power Plant accident?

Background: Hunters have higher internal radiation exposure due to consumption of game in Swedish counties with high fallout of 137Cs after the Chernobyl accident compared with the general population. Methods: Cancer incidence was studied in nine counties with three deposition categories of 137Cs fallout after the Chernobyl accident in 1986. A total of 9,267 cancer cases occurred in male hunters and 138,909 cancer cases in male non-hunters to 31 December 2015. Directly age standardized cancer incidence and Incidence Rate Ratios (IRR) with 95% Confidence Intervals (CI) were calculated for total cancer and radiation associated cancers, respectively. IRR was calculated between hunters, using the lowest deposition counties as reference, and within counties using non-hunters as reference. Hence, cancer risks of internal radiation exposure and the hunting lifestyle, respectively, could be studied. Results: An increasing trend in total cancer incidence was seen in non-hunters. For hunters this trend was significantly lower up to 2001 when the total cancer incidence crossed over the weaker non-hunter trend and remained higher the following 15 years. A weak exposure response trend for radiation associated cancers was found both within hunter and non-hunter category, respectively. No clear exposure response pattern was seen in IRRs for total cancer in hunters versus non-hunters between counties with increasing 137Cs deposition. IRRs for hunters compared with non-hunters were higher regardless of rural/non-rural status with slightly higher risk estimates in rural areas. The overall IRR for hunters was 1.06 (95% CI 1.04 - 1.08) 1986 - 2015, representing an excess of 531 cancer cases in hunters. No confounding effect from tobacco smoking or education level could be identified. Conclusion: Total cancer incidence was increased for hunters versus non-hunters. However, exposure classification was too crude to exclude an association between cancer and 137Cs. Detailed dosimetry is needed to analyse and interpret any trend.

Recent Increasing Incidence of Early-Stage Cervical Cancers of the Squamous Cell Carcinoma Subtype among Young Women.

Few studies have reported on the increase in cervical cancer incidence in Japan. We aimed to determine the relevant trends in the metropolitan regions of Japan and to identify the population with the highest risk, based on histological subtype, cancer stage, and diagnostic processes. Using population-based data (2009–2013), we identified 2110 women, aged ≥20 years, with cervical cancer. We estimated the age-standardized and age-specific incidence rates of cervical cancer for the study period based on the 1985 national model population. The average annual percent change (AAPC) and 95% confidence interval (CI) were calculated using the joinpoint regression analysis. We stratified the analyses based on histological subtypes, stage, and diagnostic process via cancer screening. The increase in the overall age-standardized incidence was not significant. However, the increase was significant for women aged 30–39 years (AAPC 20.0%/year, 95% CI: 9.9–31.1), which was attributable to the increase in the incidence of the squamous cell carcinoma (SCC) subtype (AAPC 23.1%/year, 95% CI: 10.7–36.8). Among younger women, aged <50 years, further stratification showed an increase in the undiagnosed early-stage SCC subtype via cancer screening. In Japan, the incidence of HPV-related cervical cancer has been increasing in undiagnosed younger women.

The Incidence Rate of Colorectal Cancer in Saudi Arabia: An Observational Descriptive Epidemiological Analysis.

IntroductionColorectal cancer (CRC) is the third most commonly diagnosed malignancy and its incidence, as well as mortality rate, is increasing globally. In this paper, the epidemiological analysis of CRC which includes colon cancer (CC) and rectum cancer (RC) is done among the Saudi Arabian population based on the registered cases in the Saudi cancer registry between 2006 and 2016. The study describes the crude incidence rates (CIRs) and age-standardized incidence rates (ASIRs) of colorectal cancer by year of diagnosis, age group, and administrative regions to explore the spread, distribution, trend, and factual state of the disease in Saudi Arabia.MethodologyFor statistical analysis of data, t-test, sex ratio, descriptive statistics, and Kruskal–Wallis were done using IBM Statistical Package for the Social Sciences version 20.0 (SPSS). A total of 7849 and 5164 of colorectal cancer and rectum cancer cases were reported from January 2006 to December 2016, respectively.ResultsResults displayed that CRC is more frequent in males than females and have a high mean number and percentage in the old age group (60–75 and above). Riyadh (for CC and RC), Makkah (CC), and Eastern Province (RC) showed the highest mean CIR and ASIR for males. The highest CIR sex ratio was calculated in Jouf and Madinah for CC whereas Qassim, Jazan, and Tabuk were calculated highest for RC. Highest ASIR sex ratio reported in Jouf (CC) and Tabuk (RC). Lowest CIR and ASIR among males were reported in Baha (CC) and northern region (RC). In females, the highest mean CIR and ASIR were reported in Riyadh (CC and RC) and Makkah (CC). Lowest CIR and ASIR among females were reported in Jazan in both CC and RC.ConclusionRegions of Eastern Province, Northern Region, and Jouf showed the most significant changes of CIRs and ASIRs for both cancers, whereas the least significant change was reported in Jazan from 2006 to 2016.

Divergent Patterns and Trends in Breast Cancer Incidence, Mortality and Survival Among Older Women in Germany and the United States.

Background: Breast cancer treatment has changed tremendously over the last decades. In addition, the use of mammography screening for early detection has increased strongly. To evaluate the impact of these developments, long-term trends in incidence, mortality, stage distribution and survival were investigated for Germany and the United States (US). Methods: Using population-based cancer registry data, long-term incidence and mortality trends (1975–2015), shifts in stage distributions (1998–2015), and trends in five-year relative survival (1979–2015) were estimated. Additionally, trends in five-year relative survival after standardization for stage were explored (2004–2015). Results: Age-standardized breast cancer incidence rates were much higher in the US than in Germany in all periods, whereas age-standardized mortality began to lower in the US from the 1990s on. The largest and increasing differences were observed for patients aged 70+ years with a 19% lower incidence but 45% higher mortality in Germany in 2015. For this age group, large differences in stage distributions were observed, with 29% (Germany) compared to 15% (US) stage III and IV patients. Age-standardized five-year relative survival increased strongly between 1979–1983 and 2013–2015 in Germany (+17% units) and the US (+19% units) but was 9% units lower in German patients aged 70+ years in 2013–2015. This difference was entirely explained by differences in stage distributions. Conclusions: Overall, our results are in line with a later uptake and less extensive utilization of mammography screening in Germany. Further studies and efforts are highly needed to further explore and overcome the increased breast cancer mortality among elderly women in Germany.

Incidence Trends of Breast Cancer Molecular Subtypes by Age and Race/Ethnicity in the US From 2010 to 2016

Breast cancer incidence trends by age and race/ethnicity have been documented; it is less clear whether incidence trends of breast cancer molecular subtypes, which differ in risk factors and prognosis, also vary by age and race/ethnicity. To estimate annual percentage changes and trends in breast cancer molecular subtype-specific incidence rates by age at diagnosis and race/ethnicity in the US. This population-based cross-sectional study included data from 18 cancer registries in the Surveillance, Epidemiology and End Results database, capturing 27.8% of the US population. Hispanic and non-Hispanic White, Black, and Asian/Pacific Islander women aged 25 to 84 years who were diagnosed with invasive breast cancer from 2010 to 2016 were included. Data were analyzed from September 2019 to February 2020. Age and racial/ethnic groups. Annual percentage change (APC) and 95% CIs for age-standardized breast cancer incidence rates stratified by 15-year age groups at diagnosis and race/ethnicity. Of 320 124 women diagnosed with breast cancer from 2010 to 2016, 232 558 (72.6%) had luminal A, 35 869 (11.2%) had luminal B, 15 472 (4.8%) had ERBB2-enriched, and 36 225 (11.3%) had triple-negative breast cancer subtypes. Luminal A breast cancer incidence rates increased in non-Hispanic White (APC from 2010-2014, 2.3%; 95% CI, 0.3% to 4.2%) and non-Hispanic Asian/Pacific Islander (APC from 2010-2016, 2.5%; 95% CI, 0.6% to 4.5%) women aged 40 to 54 years, and in non-Hispanic Black women aged 55 to 69 years women (APC from 2010-2012, 4.9%; 95% CI, 4.0% to 5.7%). Luminal B breast cancer incidence rates increased in all age groups for non-Hispanic White women (age 25-39 years: APC, 4.3%; 95% CI, 1.5% to 7.%2; age 40-54 years: APC, 3.5%; 95% CI, 1.4% to 5.6%; age 55-69 years: APC, 3.3%; 95% CI, 1.6% to 5.0%; age 70-84 years: APC, 3.9%; 95% CI, 1.9% to 6.0%) and Hispanic women (age 25-39 years: APC, 8.4%; 95% CI, 5.8% to 11.2%; age 40-54 years: APC, 6.1%; 95% CI, 4.2% to 8.0%; age 55-69 years: APC, 5.1%; 95% CI, 1.5% to 8.8%; age 70-84 years: APC, 7.1%; 95% CI, 4.6% to 9.6%) and in non-Hispanic Asian/Pacific Islander women aged 55 to 69 years (APC, 6.1%; 95% CI, 3.2% to 9.0%). ERBB2-enriched breast cancer incidence rates increased in non-Hispanic White women aged 25 to 39 years (APC, 4.7%; 95% CI, 1.5% to 8.0%). Triple-negative breast cancer incidence rates decreased in non-Hispanic White women aged 40 to 54 years (APC, -2.3%; 95% CI, -3.8% to -0.7%) and 55 to 69 years (APC, -3.6%; 95% CI, -5.1% to -2.1%) and in non-Hispanic Black women aged 55 to 69 years (APC, -1.4%; 95% CI, -2.2% to -0.7%). The findings of this cross-sectional study suggest that between 2010 and 2016, luminal A and luminal B breast cancer incidence rates increased for many racial/ethnic and age groups, with the largest increases observed for luminal B breast cancer. ERBB2-enriched breast cancer incidence rates increased for young non-Hispanic White women, while triple-negative breast cancer incidence rates decreased for midlife non-Hispanic White and non-Hispanic Black women. These trends may suggest changes in breast cancer risk factor profiles across age and racial/ethnic groups.

Abstract 5754: Spatial clustering of sex ratio variations of cancer incidence: A modified Moran's index approach

Abstract Background: Moran's index (I) is one of the most common correlation measurements to investigate spatial process of geographical evolution of disease development and progression. Geospatial variations of sex ratios (male-to-female age-standardized incidence rates) of cancers can be used to postulate on genetic and environmental underpinnings of cancer etiology. The study explored through improved version of Moran's I whether geographic contiguous regions tend to have similar sex-ratios or not, and how SRs of different types of cancers are geographically clustered. Methods: A simplified approach of computing spatial autocorrelation through Moran's Index (I) was applied to global cancer incidence data. Detailed data on 28 cancer subtypes were retrieved from the tenth volume (2003-07) of the International Agency for Research on Cancer's ‘Cancer Incidence in Five Continents'. Using a publicly available world geolocation database, we geocoded 102 and 52 cancer registry-based regions in Europe and Asia, and linked these to cancer incidence data. For each type of cancer, the spatial clustering of SR in geographically contiguous areas were ranked according to the degree of clustering based on values of Moran's I (dispersed [-1] to highly clustered [+1]). Results: In Europe, Moran's I values for SRs of cancer incidence ranged from dispersed patterns such as -0.09 for melanoma, to moderate clustering for esophageal (0.115), liver (0.115), and kidney (0.114) cancers. In contrast in Asia, the SRs for esophageal cancer showed a high degree of spatial clustering (0.597). However, despite these spatial patterns being different in Europe and Asia, the degree of clustering for many of the 28 cancers analyzed were comparable. Among top 10 high incident cancers in Europe and Asia (&amp;gt;5 cases per 100,000), those that have relatively similar clustering include cancers of the esophagus, thyroid, pancreas, rectum and anus, stomach, and kidney. For lung, colon, non-Hodgkin's lymphoma, leukemia, skin melanoma, and brain cancers, we observed different spatial patterns across the two continents. Among the low incident cancers (&amp;lt;2 cases per 100,000) such as nose and sinus, pharynx and gallbladder, there were substantial differences in the degree of geospatial clustering between Europe and Asia, whereas rankings were closer in larynx, eye, multiple myeloma, Hodgkin's lymphoma, and small-intestinal cancers. Conclusions: The findings may help to generate etiological hypotheses of cancer causation. A spatially clustered pattern of cancer suggests exogenous or avoidable causes of cancers, whereas dispersed patterns suggest endogenous causes. Cancers of the esophagus, liver and stomach showed clustered SR patterns in both Europe and Asia. For cancers in which endogenous causes may be reasonably hypothesized, more of high dispersed patterns of SR are observed in Europe (e.g., cancer of the eye). Secondarily, our findings can also be used to identify spatial anomalies that may be reflective of quality concerns for cancer registries. Citation Format: Syed-Ahsan Raza. Spatial clustering of sex ratio variations of cancer incidence: A modified Moran's index approach [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5754.

Historical and projected hysterectomy rates in the USA: Implications for future observed cervical cancer rates and evaluating prevention interventions

BackgroundSEER-reported cervical cancer incidence rates reflect the total female population including women no longer at risk due to hysterectomy. Hysterectomy rates have been declining in the United States as alternative treatments have become available, which could result in an apparent increase in SEER-reported cervical cancer rates. We aimed to obtain nationally representative historical data on hysterectomy rates in USA, use trends analysis to project rates back to 1935 and forward to 2035, and then predict the impact of changing hysterectomy rates on SEER-reported cervical cancer rates. MethodsWe performed a systematic search of Medline, Embase, Premedline, Cochrane Central databases and extracted nationally-representative hysterectomy incidence data from 1965 to 2009, including data on the number of cervix-preserving (subtotal) procedures. We then projected rates back to 1935, and forward to 2035 based on trends from joinpoint regression. These rates were then used to estimate hysterectomy prevalence out to 2035, and then to predict the impact of changing hysterectomy rates on SEER-reported cervical cancer rates to 2035. We examined alternative assumptions regarding projected hysterectomy incidence rates out to 2035, including a scenario in which rates decline no further from 2009 rates, and a scenario where rates decline at twice the baseline rate. ResultsEstimated age-standardized hysterectomy incidence increased from 2.4 to 10.6 per 1000 women between 1935 and 1975. Thereafter, rates are predicted to fall to 3.9 per 1000 by 2035. Subtotal hysterectomy procedures declined from being the predominant method in 1935 to less than 12% of procedures from 1970 onwards. Consequently, holding all else constant, an increase in SEER-reported age-standardized cervical cancer incidence rates (ages 0–85+) of 9% is expected from 2009 to 2035. The predictions were minimally impacted by alternative scenarios for future hysterectomy rates. ConclusionsDeclining hysterectomy rates have implications for the interpretation of SEER-reported cervical cancer rates. A background increase in cervical cancer rates due to decreasing population hysterectomy exposure may partially offset expected decreases from recent cervical screening changes recommended by the US Preventive Services Task Force. Evaluations of new cervical cancer prevention opportunities should consider the background impact of historical and projected hysterectomy rates.

Cancer Incidence Characteristic Evolution Based on the National Cancer Registry in Taiwan.

Introduction Taiwan has committed itself to cancer prevention. This study investigates the impact of cancer prevention on cancer incidence in Taiwan. Objective This study describes the secular trends and present status of cancer incidence in Taiwan during the years of 1988 to 2016. Methods Age-standardized incidence rates (ASRs), age-specific incidence, and sex ratios for all cancers were calculated using data from the Taiwan Cancer Registry System for the years 1988 to 2016. Results and Conclusions. ASRs of cancer for males increased from 150.93 per 105 individuals in 1988 to 330.03 per 105 individuals in 2016, and, for females, they increased from 124.18 per 105 individuals in 1988 to 269.5 per 105 individuals in 2016. We found that cancer incidence has begun at younger ages and that the rates of cancer incidence are increasing faster. This study shows that the incidence of cancer in males has decreased slightly in recent years, while the incidence of cancer in females has continued to increase. The continuous promotion of health literacy, lifestyle modification, HBV and HPV vaccination, and cancer early screening can improve the effectiveness of cancer prevention.

Secular Trend of Cancer Death and Incidence in 29 Cancer Groups in China, 1990-2017: A Joinpoint and Age-Period-Cohort Analysis.

PurposeChina has a heavy cancer burden. We aimed to quantitatively estimate the secular trend of cancer mortality and incidence in China.MethodsWe extracted numbers, age-specific and age-standardized rates of 29 cancer groups (from 1990 to 2017) from the Global Burden of Disease (GBD) study in 2017. We estimated rates of major cancer types for annual percent change by Joinpoint regression, and for age, period, and cohort effect by an age–period–cohort model.ResultsIn 2017, breast cancer had the highest incidence rate in females. Lung cancer had the highest mortality and incidence rates in males. Although the age-standardized incidence rate of prostate cancer ranked second highest in males, it increased by 112% from 1990 to 2017. Individuals aged over 50 years were at high risk of developing cancer, and the number of deaths at this age accounted for over 89% of all cancers in all age groups. When compared with the global average level, the age-standardized mortality and incidence rates of both liver and esophageal cancers were 2.1 times higher in China, and stomach, lung and nasopharyngeal cancers in China also had high levels (more than 1.5 times higher). During 1990–2017, most of the 29 cancers exhibited an increasing incidence trend, and Joinpoint regression demonstrated increasing mortality of some major cancers. The period effect indicated that the risk of mortality and incidence due to the main cancers generally increased during 1992–2017.ConclusionTrend analysis provided information on the effects of prevention strategies and targeted interventions on the occurrence of different cancers. Etiological studies need to be conducted on some major cancers in the Chinese population.

National and Subnational Trends of Incidence and Mortality of Female Genital Cancers in Iran; 1990-2016.

The present study aims to assess the incidence and mortality rates of gynecological cancers and their changes from 1990 to 2016 at national and subnational levels in Iran. Annual estimates of incidence and mortality for gynecological cancers from 1990 to 2016 at national and subnational levels were generated as part of a larger project entitled National and Subnational Burden of Diseases, Injuries, and Risk Factors (NASBOD). After the precise processing of data extracted from the Iran Cancer Registry, annual age-standardized incidence and mortality rates were calculated for each cancer, province, year and age group during the period of the study. In 2016, gynecological cancers constituted 8.0% of new cancer cases among women of all ages compared to 3.7% of new cases of cancer among women in 1990. The incidence rate of gynecological cancers has increased from 2.5 (0.9-5.6) per 100000 women in 1990 to 12.3 (9.3-15.7) per 100000 women in 2016, and the most common gynecological cancer has changed from cervical cancer in 1990 to corpus uteri cancer in 2016. Age-standardized incidence rates of ovarian, corpus uteri and vulvovaginal cancers increased from 1.3 (0.5-2.4), 1.7 (0.6-3.0), and 0.3 (0.0-0.7) in 1990 to 4.4 (3.6-5.2), 9.9 (6.8-13.4), and 0.6 (0.2-1.0) in 2016, respectively, showing a 3.3, 5.8 and 1.7-fold increase during this period. Age-standardized incidence rate of cervical cancer was 2.4 (1.7-3.3) cases per 100000 women in 2016 and did not differ significantly from the beginning of the study. An overall reduction was seen in national mortality to incidence ratios (MIR) from 2000 to 2015. The incidence rates of all gynecological cancers in different provinces have shown a converging trend that could indicate that attempts toward health equality have been effective. The declining trend of MIR could be interpreted as advancements in detection of cancer in its early stages and also improvements in treatments, in turn reflecting improvements in access to and quality of care.

Breast Cancer in Megapolises of Kazakhstan: Epidemiological Assessment of Incidence and Mortality

Breast cancer is the most common malignant disease among the female population of Kazakhstan like in many developed countries of the world (Canada, UK, US, Western Europe), and it accounts for every 5th tumor. We aimed to assess the epidemiological aspects of breast cancer incidence and mortality among Almaty and Astana (Now Nur-Sultan), Kazakhstan residents in 2009-2018. A retrospective study using modern descriptive and analytical methods of epidemiology was conducted to evaluate the breast cancer incidence and mortality in megapolises of Kazakhstan. The average annual age-standardized incidence rate of breast cancer amounted to 61.9 (95% CI=56.2-67.6) in Almaty and 61.2 (95% CI=56.765.7) in Astana. The average age-standardized mortality was 19.2 (95% CI=17.3-21.1) in Almaty and 19.3 (95% CI=17.1-21.4) in Astana. The standardized incidence in the megapolises tended to increase (Tgr=+0.8% in Almaty and Tgr=+1.4% in Astana), while the mortality was decreasing (Tdec=-4.2% in Almaty and Tdec=-1.1% in Astana). According to the component analysis, the growth in the number of breast cancer cases was due to a population increase (ΔP=+130.4% in Almaty and ΔP=+93.2% in Astana), with a notable decrease of factors related to the risk of getting sick (ΔR=-27.9% in Almaty, ΔR=-6.1% in Astana). This is the first epidemiological study to assess the changes in incidence and mortality from breast cancer in megapolises of Kazakhstan because of screening. The results of this study can be used to improve the government program to combat breast cancer.

Cancer Incidence Trends in the Oil Shale Industrial Region in Estonia.

Large oil shale resources are found in Eastern Estonia, where the mineral resource is mined, excavated, and used for electricity generation and shale oil extraction. During industrial activities in the last 100 years, pollutants have been emitted in large amounts, some of which are toxic and carcinogenic. The current study aims to analyse time trends in cancer incidence in the oil shale industry-affected areas and compare them with overall cancer incidence rates and trends in Estonia. We analysed Estonian Cancer Registry data on selected cancer sites that have been previously indicated to have relationships with industrial activities like oil shale extraction. We included lung cancer, kidney cancer, urinary bladder cancer, leukaemia, breast cancer, and non-Hodgkin’s lymphoma. A statistically significantly higher lung cancer age-standardized incidence rate (ASIR) was found during the study period (1992—2015) only in males in the oil shale areas as compared to males in Estonia overall: 133.6 and 95.5 per 100,000, respectively. However, there appeared to be a statistically significant (p < 0.05) decrease in the lung cancer ASIR in males in the oil shale areas (overall decrease 28.9%), whereas at the same time, there was a significant increase (p < 0.05) in non-oil shale areas (13.3%) and in Estonia overall (1.5%). Other cancer sites did not show higher ASIRs in the oil shale industrial areas compared to other areas in Estonia. Possible explanations could be improved environmental quality, socio-economic factors, and other morbidities.

The Global Burden of Cervical Cancer Associated with HIV – A Meta-Analysis and Modelling Study

Background: The contribution of HIV infection to cervical cancer burden at a population-level has not been systematically quantified. We aimed to investigate cervical cancer risk among women living with HIV (WLHIV), and to estimate the global cervical cancer burden associated with HIV. Methods: We conducted a systematic literature search and a meta-analysis to estimate the pooled risk ratio (RR) of cervical cancer among WLHIV. The RR was combined with country-specific UNAIDS estimates of HIV prevalence and GLOBOCAN 2018 estimates of cervical cancer, to calculate the proportion of WLHIV among women with cervical cancer, as well as population attributable fractions and age-standardized incidence rates (ASIR) of HIV-attributable cervical cancer. Findings: In all, 24 studies met our inclusion criteria including a total of 236 127 WLHIV, providing a pooled cervical cancer RR of 6·07 (95% CI, 4·40–8·37). Globally, 5·8% (33 000) of all cervical cancers in 2018 were diagnosed in WLHIV and 4·9% (28 000 cases) were attributable to HIV infection. The most affected regions were eastern and southern Africa, and western and central Africa where 35·5% (24 000) and 10·0% (4 300) of cervical cancers were diagnosed among WLHIV, respectively. ASIRs of HIV-attributable cervical cancer were over 20 per 100 000 in 6 countries, all in eastern and southern Africa. Interpretation: WLHIV have a significantly elevated risk of cervical cancer. HPV vaccination and cervical cancer screening for WLHIV are particularly critical for sub-Saharan African countries where a substantial HIV-attributable cervical cancer burden has added to the existing cervical cancer burden. Funding: Support for this project was provided by the World Health Organization (WHO) through funding made possible by United States Agency for International Development (USAID) under the U.S. President's Emergency Plan for AIDS Relief (PEPFAR). The contents in this article are the sole responsibility of the authors, and do not necessarily represent the decisions, policy or views of WHO, IARC, USAID, PEPFAR or the United States Government. Conflict of Interest: DS: Nothing to declare LFT: Nothing to declare KKL: Nothing to declare IB: Nothing to declare AIK: Nothing to declare ASVS: Nothing to declare DAM: Nothing to declare SLG: Nothing to declare SJK: Nothing to declare ASW: Nothing to declare RB: Nothing to declare GC: Nothing to declare NB: Nothing to declare SD: Nothing to declare

Is there an association between air pollution levels and lung cancer incidence?

e13584 Background: PM2.5 particles are an indicator of air pollution levels associated with various respiratory illnesses. We sought to determine the association between air pollution levels and lung cancer incidence across different countries. Methods: Country-specific data for median PM2.5 levels and age-standardized lung cancer incidence rates (ASLCIR) were collected for the year 2016 from the World Health Organization and the Global Cancer Observatory, respectively. Country-specific data for median age and proportion of smokers were collected from the Central Intelligence Agency and Our World in Data, respectively. Statistical analyses were performed using SPSS Version 26.0. Results: Across 105 countries, the median PM2.5 level was 18 ug/m3 (range; 6-94 ug/m3). The WHO has set 10 ug/m3 as the upper limit for PM2.5 levels; 91 (86.7%) of countries had rates higher than this. The ASLCIR was surprisingly higher in countries with PM2.5 ≤ 10 ug/m3 (median 28.7 vs. 13.9 per 100,000 population, Pearson correlation coefficient -0.386, p &lt; 0.001). Countries with PM2.5 levels ≤ 10 ug/m3 tended to have a higher GDP (median $55,709 vs. $5,931, p &lt; 0.001), and an older population (median 41.5 vs. 30.4, p &lt; 0.001); however, the proportion of population who smoked was no different in countries with low vs. high PM2.5 levels (20.3% vs. 22.5%, p = 0.847). Controlling for age, GDP, and proportion of the population who smoke in a multiple linear regression model, ASLCIR were not influenced by median PM2.5 (see linear regression table below, p = 0.888). Removing PM2.5 levels from the model did not significantly affect the model fit (R2= 0.749 in both models). Conclusions: These results demonstrate that air pollution levels do not significantly impact lung cancer incidence rates, which are more related to age, tobacco use, and GDP. [Table: see text]

Trends in the incidence rate of genitourinary system cancers in Turkey: 2004-2015.

To analyze age-standardized urological cancer incidence rates in Turkey during the last twelve years based on the available published data (2004-2015). Cancer data were obtained from the reports of Turkish Directorate of Public Health Cancer Department for 2004-2015. A trend analysis was conducted using the joinpoint regression analysis to observe the change in the trends over time. The average annual percentage of change, annual percent change, and the corresponding 95% confidence interval were calculated. Throughout the observed period, cancer incidence rates in men significantly increased by 3.04%, 4.70%, 4.03%, and 2.97% for all the genital organs, kidney, testis, and prostate, respectively. A significant increase of 3.11% and 1.91% was observed for the urinary system organs and bladder, respectively, of women during the same period. The increase in the incidence rate of urinary system cancers was more prominent than that of all cancers types in general. The total incidence rate of urinary system cancers (bladder and kidney) tends to increase more in women than in men. While there was no cancer with decreased incidence during the entire study period, similar decreases in some urogenital cancer types tended to occur during the second trend period.

Evaluation of Medical Surveillance and Incidence of Post-September 11, 2001, Thyroid Cancer in World Trade Center–Exposed Firefighters and Emergency Medical Service Workers

Elevated incidence rates of thyroid cancer among World Trade Center (WTC)-exposed individuals may be associated with the identification of asymptomatic cancers during medical surveillance. To examine the association between WTC exposure and thyroid cancer among Fire Department of the City of New York (hereafter, Fire Department) rescue/recovery workers as well as the association with medical surveillance. This closed-cohort study classified the method of detection (asymptomatic and symptomatic) of thyroid cancers in 14 987 men monitored through the Fire Department-WTC Health Program diagnosed from September 12, 2001, to December 31, 2018. Age-, sex-, and histologic-specific Fire Department incidence rates were calculated and compared with demographically similar men in Olmsted County, Minnesota, from the Rochester Epidemiology Project using age-standardized rates, relative rates (RRs), and 95% CIs. The secondary analysis was restricted to papillary carcinomas. World Trade Center exposure was defined as rescue/recovery work at the WTC site from September 11, 2001, to July 25, 2002. The outcomes evaluated comprised (1) number of incident thyroid cancers and their detection method categorizations in the Fire Department and Rochester Epidemiology Project cohorts; (2) Fire Department, Rochester Epidemiology Project, and Surveillance, Epidemiology, and End Results-21 age-standardized incidence rates of thyroid cancer; and (3) RRs comparing Fire Department and Rochester Epidemiology Project overall and by detection method categorization. Seventy-two post-9/11 Fire Department cases of thyroid cancer were identified. Among the 65 cases (90.3%) with a categorized detection method, 53 cases (81.5%) were asymptomatic and 12 cases (18.5%) were symptomatic. Median (interquartile range) age at diagnosis was 50.2 (44.0-58.6) vs 46.6 (43.9-52.9) years for asymptomatic vs symptomatic cases. Associated primarily with asymptomatic cancers, the overall age-standardized incidence of Fire Department thyroid cancers (24.7; 95% CI, 17.4-52.3) was significantly higher than the Rochester Epidemiology Project (10.4; 95% CI, 8.5-12.7) and Surveillance, Epidemiology, and End Results-21 (9.1; 95% CI, 9.0-9.1) per 100 000 person-years. Furthermore, the RR of thyroid cancer among symptomatic men in Fire Department cases was not significantly different from that of men in the Rochester Epidemiology Project (0.8; 95% CI, 0.4-1.5); however, the rate of asymptomatic cancers was more than 3-fold that of the Rochester Epidemiology Project rate (RR, 3.1; 95% CI, 2.1-4.7). Excess asymptomatic thyroid cancer in Fire Department WTC-exposed rescue/recovery workers is apparently attributable to the identification of occult lesions during medical surveillance. Among WTC-exposed cohorts and the general population, these findings appear to have important implications for how thyroid cancer incidence rates are interpreted and how diagnoses should be managed.

Oral cavity cancer incidence rates in Osaka, Japan between 2000 and 2014.

We investigated trends in oral cavity cancer incidence from 2000 to 2014 in Osaka, Japan. Using Osaka Cancer Registry (OCR) data, oral cavity cancer incidence number and age-standardized incidence rates were calculated according to three 5-year-time-periods: 2000-2004, 2005-2009 and 2010-2014. We calculated the distribution of clinical stage for each 5-year period and the proportion of oral cavity cancer among all cancers. A total of 6,086 oral cavity cancers were registered in OCR in 2000-2014. Across the period, between 55.6% and 65.0% were 65years+and approximately 60% were men. Tongue cancer accounted for 30.4% to 43.8% of the registrations, while gum accounted for 30.7% to 34.7%. 36.3% to 37.3% were regional, while 1.8% to 2.8% were distant. The age-standardized incidence rate of oral cavity cancer increased from 2.1/100,000 in 2000 to 3.8/100,000 in 2014, although the proportion of oral cavity cancer among all cancers only increased slightly from 0.71% in 2000 to 0.92% in 2014. Proportion of localized stage cancer was 60.8%-67.5% for tongue and 31.0%-49.5% for gum or floor of mouth. Proportion of distant stage cancer was 0.3%-1.0% for tongue and 2.5%-4.2% for gum or floor of mouth. Age-standardized incidence rate of oral cavity cancer increased, but was not higher than other countries. The proportion of localized stage tongue cancer was higher, while that of distant stage cancer was lower than other sites. Tongue cancer might be easier to detect in its earlier stages than other sites.

Temporal trends of bladder cancer incidence and mortality from 1990 to 2016 and projections to 2030.

BackgroundBladder cancer is a leading cause of cancer-related deaths all over the world. Epidemiological studies of bladder cancer are therefore crucial for policy making. This study was carried out to describe the characteristics of changes in the incidence and mortality of bladder cancer from 1990 to 2016 by age group, gender, geographical region, and sociodemographic index (SDI) and to simultaneously project future trends up to 2030.MethodsIncidence and mortality trends in bladder cancer from 1990 to 2016 were described based on data and methodologies from the Global Burden of Disease (GBD) Study. The data also allowed the future trends of bladder cancer incidence and mortality to be predicted by ARIMA model. Trends were analyzed by age group, gender, and SDI. Projections to 2030 were sub-analyzed by SDI countries. R software (x64 version 3.5.1), SAS (version 9.3), and SPSS (version 22.0) were used throughout the process.ResultsGlobally, in 2016, there were 437,442 [95% uncertainty interval (UI), 426,709–447,912] new bladder cancer cases and 186,199 (95% UI, 180,453–191,686) bladder cancer-associated deaths. Between 1990 and 2016, changes in the age-standardized incidence rate (ASIR) of bladder cancer decreased by 5.91% from 7.11 (95% UI, 6.93–7.27) in 1990 to 6.69 (95% UI, 6.52–6.85) in 2016. The age-standardized death rate (ASDR) decreased from 3.58 (95% UI, 3.49–3.68) to 2.94 (95% UI, 2.85–3.03) over the same period of time. In future, the greatest occurrence of bladder cancer will be in high SDI countries, followed by high-middle SDI countries. Moreover, bladder cancer incidence rates may increase substantially in middle SDI countries, while the incidence rates will remain relatively stable for men and women in other SDI countries. From 2017 to 2030, bladder cancer deaths will continue to increase in low SDI countries, while deaths in other SDI countries will continue to decrease.ConclusionsThere was a regional difference in the incidence and mortality trends of bladder cancer between 1990 and 2016. Overall, the situation is not optimistic. From 2017 to 2030, the incidence of bladder cancer will continue to rise, especially in high and high-middle SDI countries, where decision-makers should propose appropriate policies on the screening and prevention of bladder cancer.

Height as a mediator of sex differences in cancer risk

Globally, age-standardized incidence rates for most cancers at shared sites are substantially and consistently higher in men than in women. Differences in established risk factors are unable to account for much of the sex disparity. We hypothesized that variability in height may be important in explaining sex differences in cancer risk. We included 49372 men from the Health Professionals Follow-up Study (1986-2014) and 115612 women from the Nurses' Health Study (1980-2014). Height was reported at baseline and biennial questionnaires were used to collect information on cancer risk factors. We examined the association between sex and cancer incidence at shared anatomic sites using Cox proportional hazards models and performed mediation analysis to determine the percent of the association that was accounted for by height. Over up to 34 years of follow-up, 21307 incident cases of cancers at shared sites (7705 men, 13602 women) were documented. After adjusting for major cancer risk factors, men had a 39% increased risk of shared cancers overall (hazard ratio= 1.39; 95% confidence interval= 1.33-1.45) of which 35% (95% confidence interval= 24-46) was mediated by height. The excess risk of cancer for men was also partially explained by height for several specific cancers (gastrointestinal, melanoma, kidney, brain, hematologic). Mediation by height tended to be stronger among never smokers or those who adhered to a healthy lifestyle, and for cancers with fewer known environmental risk factors. Differences in height among men and women partially mediated the association between sex and cancer incidence at several shared sites. Hence, mechanisms underlying the relationship between height and cancer may be important determinants of sex disparities in cancer incidence.

Abstract P2-08-14: Trends in the incidence of breast cancer following the radiological accident in Goiânia, Brazil: A 25-year analysis

Abstract Background: The largest radiological accident to occur in any urban area happened in a Brazilian state capital city in 1987 to the detriment of the population and the environment. One major concern regarding deleterious effects in the population was a possible increase in breast cancer incidence rates, since the literature shows that exposure of an individual to ionizing radiation is one of the risk factors for cancer. This study analyzed trends in the incidence of breast cancer over the 25-year period following the radiological accident. Methods: This ecological, population-based study was conducted to determine the incidence of breast cancer in female residents of Goiânia, Goiás, Brazil, between 1988 and 2012. The data were collected from the Goiânia population-based cancer registry. Crude and age-standardized incidence rates were calculated. The Joinpoint software program was used to calculate annual percent changes (APC) in the incidence of breast cancer. Results: Overall, 7,365 new cases of breast cancer were identified, with an annual crude incidence rate of 23.09/100,000 women in 1988 and of 71.65/100,000 women in 2012. The age-standardized incidence rate was 35.63/100,000 women in 1988 and 65.63/100,000 women in 2012. Analysis of the APC showed a significant annual increase of 4.8% in the incidence between 1988 and 2005 (p&amp;lt;0.0001) followed by stabilization in 2005-2012, with an APC of -3.5% (p=0.1). Conclusion: There was an increase in the incidence of breast cancer in the female residents of Goiânia, Goiás in the first 17 years of evaluation (1988-2004) followed by a period of stabilization until 2012. Keywords: breast cancer; epidemiology; incidence; age group; Goiânia; Brazil. Table 1. Annual percent change in the age-standardized incidence rate of female breast cancer by age in the city of Goiânia, Goiás, Brazil between 1988 and 2012.Age Group (years)Trend 1 (Years)APC^*(95%CI)pTrend 2 (Years)APC ^*(95%CI)p≤391988-20075.53.9 - 7.20.0012007-2012-7.0-15.3 - 20.140 - 491988-20054.63.6 - 5.60.00012005-2012-3.7-6.5 - -0.80.000150 - 691988-20046.34.6 - 80.00012004-2012-3.4-6.5 - -0.30.0001≥701988-20120.9-0.1 – 1.90.1–---^Significance: p &amp;gt;0.05; * Annual percent change (APC); * Coefficient of the incidence per 100,000 women; CI: Confidence interval. Citation Format: Marina E Rocha, Rosemar MS Rahal, Ruffo Freitas-Junior, Rosangela S Correa, Danielle CN Rodrigues, Edesio Martins, Leonardo R Soares, Jose C Oliveira. Trends in the incidence of breast cancer following the radiological accident in Goiânia, Brazil: A 25-year analysis [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-08-14.