All-site Cancer Incidence Research Articles

Revising cancer incidence in a Central European country: a Hungarian nationwide study between 2011-2019 based on a health insurance fund database.

The nationwide HUN-CANCER EPI study examined cancer incidence and mortality rates in Hungary from 2011 to 2019. Using data from the National Health Insurance Fund (NHIF) and Hungarian Central Statistical Office (HCSO), our retrospective study analyzed newly diagnosed malignancies between Jan 1, 2011, and Dec 31, 2019. Age-standardized incidence and mortality rates were calculated for all and for different tumor types using both the 1976 and 2013 European Standard Populations (ESP). The number of newly diagnosed cancer cases decreased from 60,554 to 56,675 between 2011-2019. Age-standardized incidence rates were much lower in 2018, than previously estimated (475.5 vs. 580.5/100,000 person-years [PYs] in males and 383.6 vs. 438.5/100,000 PYs in females; ESP 1976). All-site cancer incidence showed a mean annual decrease of 1.9% (95% CI: 2.4%-1.4%) in men and 1.0% (95% CI:1.42%-0.66%) in women, parallel to mortality trends (-1.6% in males and -0.6% in females; ESP 2013). In 2018, the highest age-standardized incidence rates were found for lung (88.3), colorectal (82.2), and prostate cancer (62.3) in men, and breast (104.6), lung (47.7), and colorectal cancer (45.8) in women. The most significant decreases in incidence rates were observed for stomach (4.7%), laryngeal (4.4%), and gallbladder cancers (3.5%), with parallel decreases in mortality rates (3.9%, 2.7% and 3.2%, respectively). We found a lower incidence of newly diagnosed cancer cases for Hungary compared to previous estimates, and decreasing trends in cancer incidence and mortality, in line with global findings and the declining prevalence of smoking.

Undiagnosed Cancer Cases in the US During the First 10 Months of the COVID-19 Pandemic

The COVID-19 pandemic disrupted the normal course of cancer screening and detection in the US. A nationwide analysis of the extent of this disruption using cancer registry data has not been conducted. To assess the observed and expected cancer rate trends for March through December 2020 using data from all 50 US states and the District of Columbia. This was a population-based cross-sectional analysis of cancer incidence trends using data on cases of invasive cancer diagnosis reported to the US Cancer Statistics from January 1, 2018, through December 31, 2020. Data analyses were performed from July 6 to 28, 2023. Age, sex, race, urbanicity, and state-level response to the COVID-19 pandemic at the time of cancer diagnosis. Used time-series forecasting methods to calculate expected cancer incidence rates for March 1 through December 31, 2020, from prepandemic trends (January 2018-February 2020). Measured relative difference between observed and expected cancer incidence rates and numbers of potentially missed cancer cases. This study included 1 297 874 cancer cases reported in the US from March 1 through December 31, 2020, with an age-adjusted incidence rate of 326.5 cases per 100 000 population. Of the observed cases, 657 743 (50.7%) occurred in male patients, 757 106 (58.3%) in persons 65 years or older, and 1 066 566 (82.2%) in White individuals. Observed rates of all-sites cancer incidence in the US were 28.6% (95% prediction interval [PI], 25.4%-31.7%) lower than expected during the height of the COVID-19 pandemic response (March-May 2020); 6.3% (95% PI, 3.8%-8.8%) lower in June to December 2020; and overall, 13.0% (95% PI, 11.2%-14.9%) lower during the first 10 months of the pandemic. These differences indicate that there were potentially 134 395 (95% PI, 112 544-156 680) undiagnosed cancers during that time frame. Prostate cancer accounted for the largest number of potentially missed cases (22 950), followed by female breast (16 870) and lung (16 333) cancers. Screenable cancers saw a total rate reduction of 13.9% (95% PI, 12.2%-15.6%) compared with the expected rate. The rate of female breast cancer showed evidence of recovery to previous trends after the first 3 months of the pandemic, but levels remained low for colorectal, cervical, and lung cancers. From March to May 2020, states with more restrictive COVID-19 responses had significantly greater disruptions, yet by December 2020, these differences were nonsignificant for all sites except lung, kidney, and pancreatic cancer. This cross-sectional analysis of cancer incidence trends found a substantial disruption to cancer diagnoses in the US during the first 10 months of the COVID-19 pandemic. The overall and differential findings can be used to inform where the US health care system should be looking to make up ground in cancer screening and detection.

Association between brown sugar intake and decreased risk of cancer in the Amami islands region, Japan.

Although excess white sugar intake imposes various health burdens, brown sugar is high in minerals, polyphenols, and polycosanol. However, few epidemiological studies have assessed brown sugar intake for health benefit. People in the Amami islands region, with a relatively high proportion of individuals with longevity, consume brown sugar as a type of refreshment. This cohort study was conducted in Amami to clarify the association of brown sugar intake with mortality risk and cancer incidence. Participants were recruited from the general population of Amami as part of the Japan Multi-Institutional Collaborative Cohort Study. The number of eligible participants was 5004 (2057 men and 2947 women). During the median follow-up period of 13.4 years, 274 deaths and 338 cases of cancer were observed. HRs and 95% CIs were estimated using the Cox proportional hazard model, after adjusting for sugar-related and other variables. After adjusting for their related confounding factors, brown sugar intake was associated with decreased HRs and a decreasing trend for all-site and stomach cancer incidence (p = 0.001 and 0.017, respectively) in women and men, and for breast cancer incidence (p = 0.034) in women. Additionally, a decreasing trend in the HRs for lung cancer incidence was observed among never and ex-smokers (p = 0.039). Decreased HRs for overall death, cancer, and cardiovascular disease were not apparent. Brown sugar intake was associated with decreased risk of all-site, stomach, and breast cancer incidences in the Amami population.

Cancer disparities in Appalachian Kentucky.

Cancer is the second leading cause of death in the United States, and the disease burden is elevated in Appalachian Kentucky, due in part to health behaviors and inequities in social determinants of health. This study's goal was to evaluate Appalachian Kentucky's cancer burden compared to non-Appalachian Kentucky, and Kentucky compared to the United States (excluding Kentucky). The following data were analyzed: annual all-cause and all-site cancer mortality rates from 1968 to 2018; 5-year all-site and site-specific cancer incidence and mortality rates from 2014 to 2018; aggregated screening and risk factor data from 2016 to 2018 for the United States (excluding Kentucky), Kentucky, non-Appalachian Kentucky, and Appalachian Kentucky; and human papilloma virus vaccination prevalence by sex from 2018 for the United States and Kentucky. Since 1968, the United States has experienced a large decrease in all-cause and cancer mortality, but the reduction in Kentucky has been smaller and slower, driven by even smaller and slower reductions within Appalachian Kentucky. Appalachian Kentucky has higher overall cancer incidence and mortality rates and higher rates for several site-specific cancers compared to non-Appalachian Kentucky. Contributing factors include screening rate disparities and increased rates of obesity and smoking. Appalachian Kentucky has experienced persistent cancer disparities, including elevated all-cause and cancer mortality rates for 50+ years, widening the gap between this region and the rest of the country. In addition to addressing social determinants of health, increased efforts aimed at improving health behaviors and increased access to health care resources could help reduce this disparity.

Germline mutation rates in young adults\xa0predict longevity and reproductive lifespan

Ageing may be due to mutation accumulation across the lifespan, leading to tissue dysfunction, disease, and death. We tested whether germline autosomal mutation rates in young adults predict their remaining survival, and, for women, their reproductive lifespans. Age-adjusted mutation rates (AAMRs) in 61 women and 61 men from the Utah CEPH (Centre d’Etude du Polymorphisme Humain) families were determined. Age at death, cause of death, all-site cancer incidence, and reproductive histories were provided by the Utah Population Database, Utah Cancer Registry, and Utah Genetic Reference Project. Higher AAMRs were significantly associated with higher all-cause mortality in both sexes combined. Subjects in the top quartile of AAMRs experienced more than twice the mortality of bottom quartile subjects (hazard ratio [HR], 2.07; 95% confidence interval [CI], 1.21–3.56; p = 0.008; median survival difference = 4.7 years). Fertility analyses were restricted to women whose age at last birth (ALB) was ≥ 30 years, the age when fertility begins to decline. Women with higher AAMRs had significantly fewer live births and a younger ALB. Adult germline mutation accumulation rates are established in adolescence, and later menarche in women is associated with delayed mutation accumulation. We conclude that germline mutation rates in healthy young adults may provide a measure of both reproductive and systemic ageing. Puberty may induce the establishment of adult mutation accumulation rates, just when DNA repair systems begin their lifelong decline.

Long-term exposure to black carbon in outdoor air pollution is associated with cancer incidence

PDS 76: Source specific outdoor air pollution studies, Exhibition Hall (PDS), Ground floor, August 26, 2019, 4:30 PM - 5:30 PM Background/Aim: There is growing evidence that outdoor fine particles (PM2.5) cause cancer, but the individual effects of their many components remain to be understood. We investigated the relationships between black carbon (a by-product of combustion mainly from anthropogenic sources) and cancer incidence in Gazel, a large French population-based cohort. Methods: Gazel included 19,349 participants followed up until 2015, among which we identified 4,042 cases of incident all-site cancer and 342 for lung cancer. We estimated exposure to black carbon and PM2.5 using a land-use regression developed for 2010, which we extrapolated yearly to each participant address between 1990 and 2015. Our main exposure metric was the log-transformed cumulative exposure to black carbon with a 10-year lag; we did the same for PM2.5 for subsequent adjustment. We used extended Cox models with attained age as underlying time-scale and time-dependent exposures. The main model included black carbon and adjusted for relevant confounders (including sex, tobacco, alcohol consumption, socio-economic status, calendar time). As secondary model, since black carbon is a component of PM2.5, we used the black carbon:PM2.5 ratio plus an interaction with PM2.5. Results: We found positive associations with all-site and lung cancer incidence, with respective hazard ratios of 1.17 (95% confidence interval 1.06-1.29) and 1.41 (1.03-1.94) per increase in log-transformed cumulative black carbon exposure. When adjusted for PM2.5, we found hazard ratios of 1.51 (1.12-2.02) and 2.22 (0.74-6.71) for a 10% increase in the black carbon:PM2.5 ratio for all-site and lung cancer incidence, respectively. Conclusions: These findings highlight black carbon as a potential candidate to better understand the effects of air pollution on cancer incidence.

Cancer incidence and associations with known risk and protective factors: the Alaska EARTH study.

Cancer is the leading cause of mortality among Alaska Native (AN) people. The Alaska Education and Research Towards Health (EARTH) cohort was established to examine risk and protective factors for chronic diseases, including cancer, among AN people. Here, we describe the cancer experience of the Alaska EARTH cohort in relation to statewide- and region-specific tumor registry data, and assess associations with key cancer risk factors. AN participants were recruited into the Alaska EARTH cohort during 2004-2006. Data collected included patient demographic, anthropometric, medical and family history, and lifestyle information. This study linked the Alaska EARTH data with cancer diagnoses recorded by the Alaska Native Tumor Registry (ANTR) through 12/31/15. We compared EARTH incidence to ANTR statewide incidence. We examined independent associations of smoking status, diet, BMI, and physical activity with incident all-site cancers using multivariable-adjusted Cox proportional hazards models. Between study enrollment and 2015, 171 of 3,712 (4.7%) Alaska EARTH study participants were diagnosed with cancer. The leading cancers among Alaska EARTH participants were female breast, lung, and colorectal cancer, which reflected those observed among AN people statewide. Incidence (95% CI) of cancer (all sites) among Alaska EARTH participants was 629.7 (510.9-748.6) per 100,000 person-years; this was comparable to statewide rates [680.5 (660.0-701.5) per 100,000 population]. We observed lower risk of all-sites cancer incidence among never smokers. Cancer incidence in the Alaska EARTH cohort was similar to incidence observed statewide. Risk and protective factors for leading cancers among AN people mirror those observed among other populations.

A 5-Year Continued Follow-up of Cancer Risk and All-Cause Mortality Among Norwegian Military Peacekeepers Deployed to Kosovo During 1999-2016.

In 2012, Norwegian news media reported on cases of brain cancer among Norwegian peacekeeping troops who served in Kosovo, allegedly caused by exposure to depleted uranium fired during airstrikes before the peacekeepers arrived in 1999. A first study followed 6076 military men and women with peacekeeping service in Kosovo during 1999-2011 for cancers and deaths throughout 2011. The study did not support to the idea that peacekeeping service in Kosovo could lead to increased risk of brain cancer or other cancers. However, the average time of follow-up (10.6 years) was rather short for cancer development; therefore the aim of the present study was to evaluate cancer risk and general mortality in an updated cohort after 5 years of additional follow-up. The updated cohort consisted of 6,159 peacekeepers (5,884 men and 275 women) who served in Kosovo during 1999-2016 and were followed for cancer incidence and mortality from all causes combined throughout 2016. We calculated standardized incidence ratios (SIR) for cancer and standardized mortality ratios (SMR) from national population rates. Poisson regression was used to assess the effect of length of service (<1 year vs. ≥1 year) on cancer risk. We observed 149 cancer cases and 75 deaths in the updated cohort. Observed cancer incidence did not exceed national rates. In men, the SIR for brain cancer was 0.73 (95% confidence interval (CI) 0.32-1.44), based on eight cases, while the risk of colon cancer was lowered (SIR = 0.14, 95% CI 0.00-0.79). The Poisson regression showed no effect of service duration on all-site cancer incidence. Mortality from all causes combined was lower than expected (SMR = 0.62, 95% CI 0.49-0.78) and in accordance with a "healthy soldier effect". The extended follow-up did not give support to the suggestion that peacekeeping service in Kosovo could lead to increased risk of cancer.

Glycated Hemoglobin and Cancer Risk in Korean Adults: Results from Korean Genome and Epidemiology Study.

The purpose of this study was to test whether elevated glycated hemoglobin A1c (HbA1c) levels are associated with cancer incidence in the Korean population. In cohorts of the Korea Genome and Epidemiology Study (KoGES) consortium, we tested whether plasma levels of HbA1c were associated with all-site cancer incidence in 7,822 participants without any known history of cancer or diabetes. Cancer developed in 117 participants during the follow-up period. Subjects were subdivided into 3 categories according observed levels of HbA1c (< 5.7%, low; ≥ 5.7% and < 6.5%, mid; and ≥ 6.5%, high). The adjusted hazard ratio for all-site cancer was 3.03 (95% confidence intervals, 1.54–5.96) for the high HbA1c group relative to the low HbA1c group after adjusting for covariates. Higher circulating HbA1c levels were associated with an increased risk of all-site cancer in Korean population.

Association between coffee consumption and all-sites cancer incidence and mortality.

The preventive effect of coffee on cancer at different sites has been reported, but the effect on all‐sites cancer incidence has not been extensively investigated. We evaluated the association between frequency of coffee consumption and risk of all‐sites cancer incidence and mortality among 39 685 men and 43 124 women (age 40–79 years, at baseline), in the Three‐Prefecture Cohort Study. The association between frequency of coffee consumption and risk of all‐sites cancer incidence and mortality was assessed by a Cox proportional hazards regression model, adjusted for potential confounders. During 411 341 person‐years among men and 472 433 person‐years among women, a total of 4244 men and 2601 women developed cancer at different sites and a total of 3021 men and 1635 women died of cancer at different sites. We showed an inverse association between frequency of coffee consumption and all‐sites cancer incidence in both men and women. Comparing participants who consumed coffee with those who never drank coffee, the adjusted hazard ratios (95% confidential interval) for all‐sites cancer incidence was 0.74 (0.62–0.88) for coffee consumption of ≥5 cups/day in men (P for trend < 0.001) and 0.76 (0.58–1.02) in women (P for trend = 0.020). Coffee consumption frequency was inversely associated with mortality from all‐sites cancer. In this population, increasing coffee consumption resulted in a decreased risk of all‐sites cancer incidence and mortality.

County-level cumulative environmental quality associated with cancer incidence.

Individual environmental exposures are associated with cancer development; however, environmental exposures occur simultaneously. The Environmental Quality Index (EQI) is a county-level measure of cumulative environmental exposures that occur in 5 domains. The EQI was linked to county-level annual age-adjusted cancer incidence rates from the Surveillance, Epidemiology, and End Results (SEER) Program state cancer profiles. All-site cancer and the top 3 site-specific cancers for male and female subjects were considered. Incident rate differences (IRDs; annual rate difference per 100,000 persons) and 95% confidence intervals (CIs) were estimated using fixed-slope, random intercept multilevel linear regression models. Associations were assessed with domain-specific indices and analyses were stratified by rural/urban status. Comparing the highest quintile/poorest environmental quality with the lowest quintile/best environmental quality for overall EQI, all-site county-level cancer incidence rate was positively associated with poor environmental quality overall (IRD, 38.55; 95% CI, 29.57-47.53) and for male (IRD, 32.60; 95% CI, 16.28-48.91) and female (IRD, 30.34; 95% CI, 20.47-40.21) subjects, indicating a potential increase in cancer incidence with decreasing environmental quality. Rural/urban stratified models demonstrated positive associations comparing the highest with the lowest quintiles for all strata, except the thinly populated/rural stratum and in the metropolitan/urbanized stratum. Prostate and breast cancer demonstrated the strongest positive associations with poor environmental quality. We observed strong positive associations between the EQI and all-site cancer incidence rates, and associations differed by rural/urban status and environmental domain. Research focusing on single environmental exposures in cancer development may not address the broader environmental context in which cancers develop, and future research should address cumulative environmental exposures. Cancer 2017;123:2901-8. © 2017 American Cancer Society.

Early Origins of Adult Cancer Risk Among Men and Women: Influence of Childhood Misfortune?

To examine the effect of five childhood misfortune domains-parental behavior, socioeconomic status, infectious diseases, chronic diseases, and impairments-on all-site and selected site-specific cancer prevalence and all-site cancer incidence. Panel data from the Health and Retirement Study (2004-2012) were used to investigate cancer risk among adults above the age of 50. Risky parental behavior and impairment in childhood were associated with higher odds of all-site cancer prevalence, and childhood chronic disease was associated with prostate cancer, even after adjusting for adult health and socioeconomic factors. Moreover, having one infectious disease in childhood lowered the odds of colon cancer. Cancer trends varied by race and ethnicity, most notably, higher prostate cancer prevalence among Black men and lower all-site cancer among Hispanic adults. These findings underscore the importance of examining multiple domains of misfortune because the type and amount of misfortune influence cancer risk in different ways.

Cancer incidence in Holocaust male survivors-An Israeli cohort study.

Previous studies, often using proxy exposure assessment and not controlling for individual risk factors, suggested higher cancer risk in Holocaust survivors. We have used individual-level data from a male cohort of Israeli civil servants recruited in 1963 to investigate cancer incidence in Holocaust survivors, controlling for potential confounders. The analysis included 4,669 Europe-born subjects; 689 exposed = E (immigrated to Israel after 1939 and reported of being in Nazi camps during World War II); 2,307 potentially exposed = PE (immigrated to Israel after 1939 and reported of not being in Nazi camps); and 1,673 non-exposed = NE (immigrated to Israel prior to 1939). Vital status and cancer incidence in the cohort were determined based on national registries. Socioeconomic level, health behaviors and cancer incidence were compared between the groups and Cox proportional hazards regression models adjusting for potential confounders assessed hazard risk ratios for cancer by exposure status. All-cause mortality was studied as a competing risk. In total, 241, 682, and 522 cancer cases were diagnosed in the E, PE, and NE, respectively. Compared with the NE, all-site cancer incidence was higher in the E (HR = 1.13, 95%CI 0.97-1.32) but not in the PE. All-cause mortality competed with all-site invasive cancer incidence in the E group (HR = 1.18, 95%CI 1.02-1.38). Colorectal and lung cancer seemed to be positively though non-significantly associated with the exposure while prostate cancer was not. Male Holocaust survivors may be at a weakly increased risk for all-site, colorectal and lung cancer. The role of age at exposure and residual confounding should be further investigated.

Time-Dependent Risk of Cancer After a Diabetes Diagnosis in a Cohort of 2.3 Million Adults.

Using a time-dependent approach, we investigated all-site and site-specific cancer incidence in a large population stratified by diabetes status. The study analyzed a closed cohort comprised of Israelis aged 21-89 years, enrolled in a health fund, and followed from 2002 to 2012. Adjusting for age, ethnicity, and socioeconomic status, we calculated hazard ratios for cancer incidence using Cox regression separately for participants with prevalent and incident diabetes; the latter was further divided by time since diabetes diagnosis. Of the 2,186,196 individuals included in the analysis, 159,104 were classified as having prevalent diabetes, 408,243 as having incident diabetes, and 1,618,849 as free of diabetes. In both men and women, diabetes posed an increased risk of cancers of the liver, pancreas, gallbladder, endometrium, stomach, kidney, brain (benign), brain (malignant), colon/rectum, lung (all, adenocarcinoma, and squamous cell carcinoma), ovary, and bladder, as well as leukemia, multiple myeloma, non-Hodgkin lymphoma, and breast cancer in postmenopausal women. No excess risk was observed for breast cancer in premenopausal women or for thyroid cancer. Diabetes was associated with a reduced risk of prostate cancer. Hazard ratios for all-site and site-specific cancers were particularly elevated during the first year following diabetes diagnosis. The findings of this large study with a time-dependent approach are consistent with those of previous studies that have observed associations between diabetes and cancer incidence.

County-Level Environmental Quality and Associations with Cancer Incidence

Cancer has been associated with individual ambient environmental exposures such as PM2.5 and arsenic. However, the role of the overall ambient environment is not well-understood. A novel county-level Environmental Quality Index (EQI) was developed for all U.S. counties (n=3,141) from 2000-2005 data representing five environmental domains: air, water, land, built, and sociodemographic. We linked the EQI to Surveillance, Epidemiology, and End Results Program county-level annual age-adjusted cancer incidence rates for 2006-2010. Sex-stratified random intercept multi-level linear regression models, clustered by state, estimated fixed effects of EQI quintiles on all-site cancer incidence, adjusting for county percentage ever smoked (both sexes) and percentage to have had a mammogram and pap smear (females). Results are reported as incidence rate difference (95% confidence interval) comparing highest quintile/worst environmental quality to lowest/best. All cause cancer was strongly positively associated with EQI in both sexes (males: 32.60(16.28,48.91), females: 30.34(20.47,40.21)). In rural- urban continuum codes (RUCC)-stratified models, ranging from metropolitan urbanized (RUCC1) to rural (RUCC4), we observed positive associations between environmental quality and all-cause cancer for most strata of males (RUCC1: 27.01(11.29, 42.74); RUCC2: 11.29(-18.10,40.67), RUCC3: 25.66(3.85,47.47), RUCC4: -12.12(-50.65,26.42)) and all strata of females (RUCC1: 21.76(8.26,35.26); RUCC2: 2.34(1.62,3.06), RUCC3: 1.77(1.19,2.35), RUCC4: 2.06(0.93,3.19)). Associations in the most urbanized areas were strongest. We also examined the top 3 causes of cancer in each sex. Subtype incidence demonstrated results similar to all-cause cancer. Associations by individual environmental domains will also be presented. These results suggest that environmental exposures can greatly influence cancer risk, and associations vary by urbanicity. This abstract does not necessarily reflect EPA policy.

Cancer in American Indian and Alaska Native young adults (ages 20-44 years): US, 1999-2004

An examination of cancer incidence patterns in American Indians and Alaska Native (AI/AN) young adults may provide insight into their present and future cancer burden. To reduce racial misclassification, incidence data were linked with the Indian Health Service (IHS) patient services database. Age-adjusted cancer incidence rates per 100,000 (AAR) and corresponding rate ratios (RR) for young adults (ages 20-44 years) were compared across IHS regions and for selected cancers within Contract Health Service Delivery Area counties by race (AI/AN vs non-Hispanic whites [NHW]) and sex. The all-sites cancer incidence rate was lower for AI/ANs (AAR of 83.8) than for NHWs (AAR of 111.2) (RR of 0.75) but varied by IHS regions. Among the leading cancers in AI/AN females the risk was elevated for stomach (RR of 3.22), colorectal (RR of 1.30), uterine (RR of 1.61), and kidney (RR of 1.39) cancers and was lower for breast (RR of 0.70) and thyroid (RR of 0.71) cancers. Among AI/AN young adult males the risk was elevated for stomach (RR of 2.62), liver (RR of 1.89), and kidney (RR of 1.59) cancers and lower for testicular germ cell cancer (RR of 0.64) and lymphoma (RR of 0.60). The risk for these and other cancers varied across IHS regions. Many of the cancer patterns that characterize the AI/AN population overall are apparent among young adults. Compared with NHW young adults, the overall cancer burden among AI/AN young adults was lower but varied for selected cancers and across IHS regions. Cancer control and research strategies are needed to address the unique genetic, social, cultural, and lifestyle aspects of AI/AN young adults.

Cancer incidence and causes of death among total hip replacement patients: A review based on Nordic cohorts with a special emphasis on metal-on-metal bearings

All patients with total hip arthroplasty (THA) are exposed to soluble or particulate forms of Co and Cr. Adverse effects of these wear products are not known. Data from Nordic registries is used to estimate adverse effects on a large scale, based mostly on metal-on-polyethylene bearings. Cancer incidence was in line with the general population when the patients were operated on for all indications and significantly decreased when the indication was primary osteoarthritis. Stomach cancer and colorectal cancers were significantly reduced and prostate cancer and skin melanoma significantly increased. There was no significant excess of cancer in target organs, i.e. liver, kidney, or haematopoietic cancers. THA patients had reduced mortality and extended life expectancy compared with standard Nordic populations. All-site cancer incidence of the first-generation metal-on-metal McKee-Farrar patients operated on for primary osteoarthritis was in line with the general population after follow-up for up to 28 years. General mortality of these patients was also reduced and they also had an extended life expectancy. Temporary increases in haematopoietic cancers at different follow-up periods were seen in some cohorts. This malignancy deserves a special record linkage monitoring while large numbers of young patients are provided with the second generation of metal-on-metal prostheses.

Physical Activity in Relation to All-Site and Lung Cancer Incidence and Mortality in Current and Former Smokers

Abstract Increased physical activity has been associated with a reduction in the incidence and mortality from all-site cancer and some site-specific cancers in samples of primarily nonsmoking individuals; however, little is known about whether physical activity is associated with similar risk reductions among smokers and ex-smokers. This study examined physical activity in relation to all-site cancer and lung cancer incidence and mortality in a sample of current and former smokers (n = 7,045; 59% male; 95% Caucasian; mean age, 63 years) drawn from the β-Carotene and Retinol Efficacy Trial, a lung cancer chemoprevention trial. Hazard rate ratios and 95% confidence intervals associated with a 1 SD increase in physical activity were 0.86 (0.80-0.94) for all-site cancer only among men, 0.84 (0.69-1.03) for lung cancer only for younger participants, 0.75 (0.59-0.94) for cancer mortality among younger participants and 0.68 (0.53-0.89) among women, and 0.69 (0.53-0.90) for lung cancer mortality only among women. These results suggest that incidence may be more attenuated by physical activity for men and mortality more attenuated for women. Effects may be more pronounced for younger people and may differ inconsistently by pack-years of smoking. Physical activity may play a role in reducing cancer risk and mortality among those with significant tobacco exposure. Prospective studies using more sophisticated measures of physical activity assessed at multiple time points during follow-up are needed to corroborate these associations.

Cancer incidence in eighteen cities of the State of São Paulo, Brazil.

As in Brazil cancer registries are mostly based on large cities, there are no estimates per state or per region and information on the disease incidence in the vast in-land areas is very scarce. An incidence survey was conducted in 18 major cities of the state of São Paulo, excluding the capital, aiming to collect information about cancer incidence in the state of São Paulo. Of the 18 cities in state of São Paulo included in the survey, all had available resources for cancer management. Data from the year of 1991 were collected by the personnel of the Instituto Brasileiro de Geografia e Estatística (Brazilian Institute of Statistics), who were especially trained by the study coordinators at the Fundação Oncocentro de São Paulo (Cancer Center of São Paulo). The collected data were processed and analyzed at the Oncocentro. Data collection, processing, and analyses were performed according to the recommendations of the International Agency for Research on Cancer. Although some discrepancies were observed in cancer incidence rates between the cities, results obtained for all 18 cities combined were remarkably close to those recently found for the city of São Paulo in the year 1993. One remarkable finding was the relatively high cancer incidence rates in both sexes in the city of Santos. The very similar all-sites cancer incidence rates found in the year 1991, when compared to those for the city of São Paulo in the year 1993, are suggestive that all regions have common cancer-related factors. Nevertheless, other explanations, such as the inclusion in the study of prevalent cases, as well as of non-residents, may have occurred in both studies, biasing the results. There is a need of further studies to confirm the high cancer incidence in Santos.

Declining cancer rates in the 1990s.

To provide evidence of a substantial decline in cancer rates for the period 1991 through 1995 and characterize major risk factors that seem to be driving secular trends in cancer mortality and incidence. Incidence and mortality rates were calculated using national surveillance data collected through the Surveillance, Epidemiology, and End Results (SEER) program and the National Center for Health Statistics. All-sites cancer incidence and mortality fell in the period 1991 through 1995; this decline is largely attributable to decreases in the smoking-related cancers, especially lung cancer. Of the 20 leading incident cancers today, both incidence and mortality are decreasing among 11 sites for men and 12 for women. In men, the decline in mortality has been notable and is especially apparent for the smoking-related cancers, including those of the lung, oral cavity and pharynx, larynx, and, to a lesser extent, bladder. In women, all-sites mortality decreased only approximately 0.4% from 1991 through 1995. Three cancers continued to show substantial increases in mortality through 1995 for both men and women (liver, multiple myeloma, and non-Hodgkin's lymphoma), while incidence rates continued to climb for liver cancer, non-Hodgkin's lymphoma, and melanoma. Data from the SEER program on recent trends in cancer incidence and mortality show that cancer rates are generally on the decline, largely because of reductions in smoking-related cancers. A consistent increase in mortality rates due to liver cancer poses a new health care challenge, one that will require the development of an effective treatment for individuals currently infected with hepatitis C or B to prevent mortality rates from continuing to increase.