We aimed to assess the 5-year survival probability of childhood cancer in Iran, utilizing data from eight population-based cancer registries across the country. The study employed data from 1809 childhood cancer patients aged 0-14 years, diagnosed between 2014 and 2016. Patients underwent active and passive follow-up procedures, and cases with uncertain vital status were excluded. We used the relative survival method to estimate age-standardized net survival probability for childhood cancer in Iran. The 5-year net survival for leukemia was 67.85% (95% confidence interval [CI] = 64.57, 70.90), while for central nervous system (CNS) cancers, it was 48.63% (95% CI = 43.21, 53.82). An analysis of regional disparities revealed a significant discrepancy of 14.56% in the 5-year survival of childhood leukemia, from 56.96 % in West Azerbaijan to 71.52% in Fars province. The geographical disparity in the 5-year survival of childhood CNS cancer became more pronounced, with a staggering 57.33% difference ranging from 73.50% in Khuzestan to 16.17% in Isfahan provinces. The study highlights low childhood cancer survival rates in Iran and calls for a robust surveillance system, public awareness campaigns, implementing national clinical practice guidelines, and financial support from government and NGOs to improve patient outcomes.

Familial cancer test referral rates for rare tumors are suboptimal and follow a social gradient; while cancer registries are legally mandated to collect comprehensive clinical pathological data which could be used to inform clinical practice. We aimed to investigate consumer acceptability of and preferred approach for a cancer registry-driven familial cancer testing notification pathway. A qualitative study using semi-structured interviews informed by the Theoretical Framework of Acceptability was conducted. Nineteen individuals recently disclosed to the Victorian Cancer Registry diagnosed with a cancer meeting local familial cancer testing criteria were interviewed. Participants supported being notified directly by the cancer registry to inform them about familial cancer testing, as they welcomed using existing health data in new ways to optimize health care. Key considerations included the timing, tone, language, information provided in the registry communication, and minimizing the onus on the patient. Assuring data security and verifying the legitimacy of the registry were raised. Individuals diagnosed with cancer found the service model acceptable. Participants preferred either to action the findings independently, with supporting resources, or permit the cancer registry to directly inform treating clinicians. Ongoing and consumer-informed work is required to develop processes and resources including digital options.

In India, some occupational diseases are notifiable under the Mines Act, 1952, and the Factories Act, 1948. Mesothelioma, primarily attributable to asbestos exposure, has been listed specifically as one of the notifiable diseases under the Mines Act, 1952, and is notifiable under the category of occupational cancer in the Factories Act, 1948. The total number of cases of mesothelioma notified to the Directorate General of Mines Safety under the mining safety law was zero from 2004 to 2024. Similarly, under the factory safety law, only one case of occupational cancer was notified in one state, in a country of 28 states and 8 union territories (mesothelioma being listed under occupational cancer and not a separate entry under the factories law). This is in sharp contrast to the medical literature, where a large number of cases have been published by researchers and doctors from Indian hospitals. The absence of notified disease may not automatically mean the absence of disease. Further, a parallel National Cancer Registry Program, which is not only for occupational cancers, but which may overlap with occupational cases, covers only 16% of the country's population. With clear lack of notification of cases and underreporting of occupational mesothelioma, and cancer not being declared as universally notifiable at the national level, disease surveillance in India may need to be invigorated so that easily preventable disease is reduced, load on the already strained healthcare infrastructure is decreased, and overall national medical costs are reduced in the future.

Incidence rates of oesophageal cancer (EC), predominantly oesophageal squamous cell carcinoma (ESCC), in areas of China are the highest worldwide. Selenium, a trace element linked to ESCC risk, likely plays a role in ESCC's enigmatic spatial distribution. We investigated the association between soil selenium and EC incidence in China. We conducted a large ecological study using 2016 population-based EC incidence data from 486 cancer registry catchments covering 380 million people and 74,000 EC cases. We assigned mean soil selenium concentrations to each area from geospatial maps. Age-standardized EC incidence rates (ASRs) were computed. We used linear regression models to estimate approximate incidence rate ratios (IRRs) for ASRs across soil selenium quintiles and for areas classified as deficient (≤ 0.2mg/kg). The distribution of ASRs differed above and below the selenium deficiency threshold (0.2mg/kg). Above, 100% of ASRs in females and 87% in males were < 15/100,000. Below, 81% of ASRs in females and 36% in males were < 15/100,000, with ASRs having a wide range (0 - 117.5 per 100,000 person-years). Soil selenium-deficient areas were linked to more than twofold increased EC incidence among males (IRR: 2.45; 95% CI: 2.13, 2.81) and threefold among females (IRR: 3.35; 95% CI: 2.67, 4.19). These findings support the hypothesis of selenium's role in the incidence of EC, which may arise from increased susceptibility to the carcinogenic effects of other exposures in selenium-deficient areas. In China, all EC hotspots occur in selenium deficient areas, yet there are selenium deficient areas with low EC rates.

Surveillance, Epidemiology, and End Results (SEER) multiple myeloma (MM) survival statistics (https://seer.cancer.gov/statfacts/html/mulmy.html) that have been used to guide MM management and control have been systematically overestimated due to the inclusion of smoldering multiple myeloma (SMM), a premalignant condition of MM. Using the latest SEER release, we estimated the extent of such overestimation in the survival statistics. In 2016, 77.9% out of 5,495 patients reported as overall MM were symptomatic MM and 10.9% were SMM. Median survival was 65.8 months for overall MM versus 56.8 months for symptomatic MM (p < .001). Inclusion of SMM overestimated MM survival by 9 months. Five-year relative survival estimates from 2015-2021 were 61.6% for overall MM, 57.9% for symptomatic MM, and 88.3% for SMM, versus SEER's reported 62.4%. Survival statistics for symptomatic MM and SMM should be reported separately to guide MM management and prevention at the population level.

Multiple imputation for missing values in ordinal variables from cancer registry data when performing Cox proportional hazards regression.

An aspect of interest in surveillance of diseases is whether the survival time distribution changes over time. By following data in health registries over time, this can be monitored, either in real time or retrospectively. With relevant risk factors registered, these can be taken into account in the monitoring as well. A challenge in monitoring survival times based on registry data is that the information related to cause of death might either be missing or uncertain. To quantify the burden of disease in such cases, relative survival methods can be used, where the total hazard is modelled as the population hazard plus the excess hazard due to the disease.We propose a cumulative sum (CUSUM) procedure for monitoring for changes in the survival time distribution in cases where theuse of excess hazard models is relevant. The CUSUM chart is based on a survival log-likelihood ratio and extends previously suggested methods for monitoring of time to event data to the excess hazard setting. The procedure takes into account changes in the population risk over time, as well as changes in the excess hazard which is explained by observed covariates. Properties, challenges and an application to cancer registry data will be presented.

Study DesignRetrospective cohort study.ObjectiveSpinal metastases are common in patients with breast cancer, and accurate estimation of postoperative survival is crucial for selecting appropriate candidates for metastasis surgery. This study investigated the association between breast cancer subtype, according to the St. Gallen classification, and survival after surgery for spinal metastases with the aim of improving prognostic assessment and supporting informed patient counselling.MethodsThis study included 110 patients with breast cancer who underwent surgery for spinal metastases identified from the Swedish Spine Register and the Swedish National Quality Register of Breast Cancer. Patients were categorized in terms of the breast cancer subtype according to the St. Gallen classification. Postoperative survival was analysed using Kaplan-Meier estimates and a Cox proportional hazards model.Results: The overall median survival following spinal surgery was 25months (95% CI 19-31), while the median postoperative survival by subtype was 39months (95% CI 28-50) for luminal A patients, 20months (95% CI 9-31) for luminal B patients, and 48months (95% CI 20-76) for luminal B/HER2+ patients. The median survival was not reached for the nonluminal HER2+ group, whereas patients with triple-negative breast cancer had a median survival of only 5months (95% CI 4-6). The St. Gallen subtype was significantly associated with postoperative survival according to univariable (P<0.001) and multivariable analyses (P = 0.011).ConclusionsBreast cancer subtype according to the St. Gallen classification was significantly associated with survival after surgery for spinal metastases. These findings indicate that the St. Gallen classification may serve as a valuable prognostic tool in the metastatic spine setting. Incorporation of molecular subtype information may improve estimation of postoperative survival and support informed patient counselling, expectation management, and individualized surgical decision-making in patients with breast cancer spinal metastases.

Acral melanoma (AM), localized to the palms, soles, and nail units, is a unique melanoma subtype less associated with UV radiation. Few studies have evaluated AM risk factors in a population of US veterans. To identify AM risk factors in US veterans. Nested case-control study (2000-2024) in the Veterans Affairs (VA) health care system. Individuals with AM were identified using the VA Cancer Registry and a validated natural language processing pipeline applied to pathology reports. Each AM case was matched to 4 nonacral cutaneous melanoma (CM) controls and 4 controls with no melanoma diagnoses at any time by diagnosis year and outpatient visit frequency. Controls with acral, mucosal, or ocular melanoma diagnoses at any time were excluded. Participants were veterans with histologically confirmed AM, nonacral CM controls, and controls with no melanoma diagnoses at any time. Age, sex, race and ethnicity, rurality, region, military branch, comorbidities (National Cancer Institute Comorbidity Index), smoking status, unhealthy alcohol use as measured by the Alcohol Use Disorders Identification Test-Consumption, body mass index, Agent Orange exposure (AOE), prior photosensitizing medications, nevi, keratinocyte carcinoma (KC), actinic keratosis (AK), and number of dermatology visits in the 2 years before diagnosis. Adjusted odds ratios (AORs) comparing AM with controls using conditional logistic regression. Secondary outcomes included analyses limited to Vietnam Era veterans and AM localized to palmoplantar and subungual sites. In total, 1292 individuals with AM (median age, 70.13 [IQR, 61.87-78.66] years; 1215 [94.0%] male) were matched to 5168 controls without melanoma (median age, 73.97 [IQR, 65.53-82.08] years; 5044 [97.6%] male), and 1286 individuals with AM (median age, 70.13 [IQR, 61.97-78.67] years; 1210 [94.1%] male) were matched to 5144 CM controls (median age, 74.58 [IQR, 66.86-82.05] years; 5068 [98.5%] male); 6 individuals with AM were excluded from AM vs CM analyses due to lack of matches. AOE was significantly associated with higher odds of AM vs CM (AOR, 1.31; 95% CI, 1.06-1.62) and vs controls without melanoma (AOR, 1.27; 95% CI, 1.04-1.56). Current smoking was associated with lower odds of AM (vs CM: AOR, 0.65; 95% CI, 0.52-0.81; vs controls without melanoma: AOR, 0.50; 95% CI, 0.40-0.62). Prior KC and AK were associated with higher odds vs controls without melanoma but lower odds vs CM. Prior nevus was associated with higher odds of AM vs controls without melanoma. Results of this study suggest that several factors were associated with AM in veterans and a need for continued investigation of AM as a distinct entity from CM and may inform future evaluations of the associations between AOE and AM in veteran populations.

Is EQ-5D-5L sensitive enough to detect treatment-related changes in health status of prostate cancer patients? A nationwide Norwegian longitudinal study from the prostate cancer registry.

Newly diagnosed mantle cell lymphoma (MCL) is commonly treated with rituximab (R) combined with anthracycline-based chemotherapy, with or without autologous stem-cell transplantation (ASCT). While rituximab maintenance (RM) in clinical trials has been shown to prolong overall survival (OS), its impact at population level remains largely unknown. This study evaluates the effect of RM on outcome of patients with MCL. Patients aged ≥18 years diagnosed with MCL between 1989-2020 were identified using the Netherlands Cancer Registry, and categorized into periods reflecting R and RM implementation (1989-2000, 2001-2014, 2015-2020). Treatment strategies were categorized as R-CHOP, R-CHOP followed by high-dose cytarabine (intensive) and ASCT, and other. The primary endpoint was 5-year OS. Multivariable analysis (MVA) was performed using Cox regression. Among 4,751 patients, 5-year relative survival (RS) improved from 38% (1989-2000) to 47% (2001-2014) and 60% (2015-2020) (p<0.01), irrespective of age (≤65 years: 32% and >65 years: 20% increase over time. Patients with progression (POD) within 12 months had 2-year OS of 25%. Since 2014, RM implementation reached 80% in younger and 50% in older patients. RM was associated with improved OS especially for patients in partial remission (PR), after induction treatment with R-CHOP. In MVA patients with R-CHOP, RM was independently associated with reduced mortality (hazard ratio 0.69; 95% CI, 0.53 - 0.90). Relative survival in MCL improved by more than 20% over the past 30 years. Early disease progression remains associated with poor outcome. RM was associated with improved survival, especially for patients achieving PR following R-CHOP.

Introduction Pediatric cancer patients suffer mental health deficits. Patients who are vulnerable with respect to socioeconomic or other sociodemographic factors may be at heightened risk for worse mental health outcomes during cancer for many reasons including entering treatment with an existing mental health disorder. The purpose of this study was to describe the prevalence and trajectory of mental health before and after a childhood cancer diagnosis in a socio-demographically at-risk sample. Methods Data from the Kentucky Cancer Registry was utilized to identify patients aged 19 or under with a first primary childhood cancer diagnosis during 2001–2017. Linking KCR data with Medicaid claims, we included patients with continuous Medicaid enrollment 12 months before and after their cancer diagnosis. MHDs were identified using both International Classification of Diseases (ICD)-9 and ICD-10 diagnosis codes in Medicaid claims. Results Of the 978 patients, 54% were male, and 39% were from Appalachian counties. The most common cancers diagnosed were leukemias ( n = 238), brain and central nervous system ( n = 220), and lymphomas ( n = 147). For the 12-month pre-cancer diagnosis period, 32% ( n = 310) of the patients had a MHD, increasing to 55% ( n = 540) in the 12 months post-diagnosis period. The most frequent MHDs were mood disorder (before n = 120; after n = 311) and neuropsychiatric/developmental disorders (before n = 228; after n = 267). Mood disorders increased from 12% pre-cancer diagnosis to 32% post-cancer diagnosis, from 10 to 37% for lymphoma patients, and from 15 to 64% for bone cancer patients. Conclusion Over half of the Medicaid-enrolled childhood cancer patients in Kentucky diagnosed with MHDs within a year of their cancer diagnosis, with a notable increase from pre-diagnosis levels. This increased prevalence post-diagnosis may result from the identification of pre-existing MHDs during cancer treatment, or the emergence of new MHD because of the cancer diagnosis and treatment. Our study highlights the psychosocial needs that extend beyond standard cancer treatment and underscores the importance of psychosocial services during and after the cancer treatment period.

Population-based cancer registry (PBCR) of Bhutan was established in Jigme Dorji Wangchuk National Referral Hospital (JDWNRH) in 2014 with the support of the Ministry of Health (Bhutan) and IARC Regional Hub, Tata Memorial Centre (TMC), Mumbai, India. This PBCR provides nationwide coverage (0.7 million population). We aim to present the cancer patterns in Bhutan for the years 2014-2022 using PBCR data. Trained registry staff collect cancer patient information by visiting various sources such as hospitals and diagnostic facilities. Data is entered into CanReg5 software. Data quality and consistency are checked by the IARC Regional Hub-TMC, Mumbai. The age-specific rate and age-adjusted rate were calculated using CanReg5 software. In the 9-year period (2014-2022), the PBCR registered 5906 incidence cancer cases, of which 2659 (45%) were males and 3247 (55%) were females. The age-adjusted incidence rate for males and females was 88.3 and 113.2 per 100,000 population, respectively. Age-adjusted mortality rates for males and females were 42.7 and 44.6 per 100,000 population, respectively. The leading cancer sites among males are stomach, esophagus, liver, lung, and rectum, and for females, cervix uteri, stomach, breast, lung, and thyroid. Cancer registry will play a pivotal role in boosting and monitoring screening program initiatives in Bhutan. Through effective linkages, it will build a robust database providing a cancer profile of the Bhutanese population which can be employed to devise effective cancer control activities in Bhutan.

BackgroundThe aim is to determine the effects of obesity and metformin-use in predicting prostate cancer (PC) risk.MethodsWe used male participants from the Sax Institute’s 45 and Up Study (Australia), recruited between 2005-2009. Participants completed a questionnaire at recruitment which included information on self-reported body mass index (BMI; kg/m2). Participants’ baseline data were linked by the Centre for Health Record Linkage to the NSW Cancer Registry and to Services Australia to identify index prescription claims for diabetic medications between January 2012 and December 2019. Multivariable Joint Cox regression analyses were used to examine associations between BMI, diabetic medications, and PC risk by cancer spread.ResultsOf the 94,674 eligible participants, there were 5265 incident PC cases (localised n = 2638, regional n = 925, metastatic n = 1514 and unknown; n = 1514) diagnosed between January 2012 and December 2019. BMI ≥ 30 kg/m2 was associated with increased risk of metastatic PC (versus <30 kg/m2; HRadjusted = 1.67;95%CI:1.10–2.54); metformin-use was associated with reduced risk of localised PC (versus non-users; HR-metformin-only = 0.65;95%CI:0.50–0.84; HRmetformin-combination = 0.51;95%CI:0.34–0.77). Reduced risk of localised PC diagnosis in metformin-users (versus non-users) was evident across all BMI categories.ConclusionMetformin-use in obese men is associated with reduced PC risk, if detected early. Further research could inform the repurposing of metformin for PC control.

Little is known about the barriers to care and resources needed for adolescents and young adults (AYAs, 15-39) with cancer in low- and middle-income countries, where most of these patients live. We aimed to address this gap through interviews with pediatric and adult hematologists/oncologists. We enrolled physicians from nine countries in Central America, Mexico, the Caribbean, and Peru. Semistructured interviews were conducted in Spanish, recorded, transcribed, and translated into English. Twenty-eight respondents provided over 26 hours of data, and 46% were adult hematologists/oncologists. We identified multiple barriers in caring for AYA patients, including clinical, psychosocial, financial, and educational barriers. These include a lack of a multidisciplinary team focused on AYA patients, mental health support, a dedicated space for this patient population, high treatment costs, travel distance to the hospital, and discontinuity of care due to age limits. In addition, there are competing demands for resources with adult oncology, delays in diagnosis, and patients' abandonment of treatment. Potential opportunities for improvement included having multidisciplinary AYA oncology teams, standardized treatment protocols, AYA-specific cancer registry, dedicated space, mental health support (e.g., support groups), improving access to health insurance, patient and physician education, and vocational assistance. This study identifies substantial barriers to the care of AYA patients with cancer in Central America, Mexico, the Caribbean, and Peru. It also highlights key areas for potential intervention to improve outcomes in this population. These key findings can guide cancer control programs in Latin America as they begin to include AYAs.

Gastric cancer is the fifth most common cancer globally and the fourth leading cause of cancer-related mortality. While gender and sex differences in gastric cancer care are underexplored in Germany, international studies have revealed disparities in aspects such as histology, comorbidities, treatment approaches and survival outcomes. This study aims to explore gender/sex-specific variations in clinical management and their impact on mortality, complications and survival rates in gastric carcinoma patients in Germany. The findings may inform revisions to clinical guidelines and support the development of more personalised treatment strategies. This study aims to improve the quality of care for gastric cancer patients and promote more individualised, sex-sensitive medical practices. This nationwide, retrospective cohort study will analyse data from the German Diagnosis-Related Groups statistic and regional clinical cancer registries from 2017 to 2021. The study will evaluate both datasets separately, providing a comprehensive view of sex differences in gastric cancer care. Primary outcomes include hospital mortality and survival rates, while secondary endpoints include surgical complications, treatment modalities and postoperative outcomes. The analysis will investigate whether sex influences tumour characteristics, access to treatment and therapy effectiveness. Statistical methods such as descriptive analysis, regression models and survival analysis will be applied to identify sex-related variations in diagnosis, treatment and outcomes. This study uses anonymised secondary data; thus, ethics approval is not necessary. Findings will be submitted to a peer-reviewed journal, reported to the Innovation Fund of the Federal Joint Committee of Germany, and a patient leaflet for the involved self-help groups will be made. NCT06902337.

IntroductionRadiation therapy after breast‐conserving surgery reduces local recurrence and improves survival. The new standard set forth by the Commission on Cancer (CoC) requires that radiation be initiated in less than or equal to 60 days of definitive surgery for patients receiving breast‐conserving surgery for Stages I–III breast cancer who do not undergo adjuvant chemo or immunotherapy. Timely access to radiation is critical, and yet there still exists a modest number of patients who experience delays in the initiation of radiation. We aim to highlight this disparity at our institution and identify the socioeconomic factors that contribute to it.MethodsUsing the Breast Cancer Registry, we conducted a retrospective analysis of women diagnosed with Stages I–III breast cancer, who underwent breast‐conserving surgery between 2011 and 2021. Women who received chemotherapy were excluded. We stratified patients based on socioeconomic and other factors and examined which factors attributed to an increased interval from surgery to initiation of radiation greater than the current standard of 60 days.ResultsA cohort of 427 women meeting the inclusion criteria was identified. Most patients received adjuvant radiation within the new standard of 60 days from definitive surgery (72.4%). However, patients of White race were significantly more likely to receive adjuvant radiation within 60 days of final surgery (74.7%) compared to patients of Black race (55.6%). In addition, patients with private insurance or Medicare were more likely to receive adjuvant radiation within the current set standard (74.9% and 74.5%, respectively) in comparison to patients with Medicaid (50.0%).ConclusionThis analysis identifies disparities in breast cancer treatment among minority populations at our institution. It also suggests that insurance status can affect the receipt of treatment in a recommended time frame. There is research that shows a delay in radiation impairs survival. These results indicate that improving access to timely adjuvant radiation may be leveraged to lessen disparities experienced by minority races regardless of insurance status.

A clinical rule-based indicator to identify recurrence of colorectal cancer after curative resection using linked routinely collected national data.

The analysis of cancer incidence trends in adolescents and young adults reveals a concerning increase. This observational study aims to investigate cancer incidence trends among young adults under 50, compared to older age trends, using the population-based Cancer Registry of the Veneto Region (Northeastern Italy) from 1987 to 2019. Yearly age-standardized cancer incidence rates per 100,000 individuals were obtained from the Veneto Tumour Registry for 24 tumor sites and all cancers combined. Temporal trends from 1987 to 2019 were analyzed for each cancer type, stratified by sex and age group at diagnosis (0-49, 50-64, and 65+ years). Significant changes in incidence trends were assessed by the annual percent change (APC), calculated through joinpoint regression analysis. Since 1987, the incidence rate of cancers among young adults decreased in males, while among females it increased until 2014 and then stabilized. One cancer showed increasing incidence in both sexes (invasive cutaneous melanoma), two in males (testicular, and multiple myeloma), and two more in females (breast, and Hodgkin disease). Four cancer sites showed a decline in both sexes (oral cavity, stomach, lung, and bladder), and four further cancers only in males (esophagus, rectum, larynx, and non-Hodgkin lymphoma). Two cancers showed complex trends (Corpus uteri, and thyroid in women). Eight cancers showed no significant changes in APCs. Cancer incidence data for young adults reveal a heterogeneous landscape. These findings provide valuable insights into the expected evolution of cancer epidemiology in young populations.

Gastric cancer surgery in high volume university medical centers influences long-term survival.