Changes In Cancer Incidence Research Articles

SP-0009: Uncomplicated cures - a paradigm shift in cancer survivorship research

Changes in cancer incidence and mortality have been modest during the past several decades, but the number of cancer survivors has almost tripled during the same period. With the increasing cohort of cancer survivors, efforts to prevent, diagnose and manage adverse effects of cancer therapy, in general, and those of radiation therapy specifically, have intensified. Considerable progress towards reducing toxicity of radiation therapy has been achieved by the introduction of so-called dose-sculpting treatment techniques. Moreover, new insights into the underlying pathophysiology have resulted in an improved understanding of mechanisms of radiation-induced normal tissue toxicity and in development of new diagnostic strategies and management opportunities. However, the risk of normal tissue toxicity still limits the dose of cytotoxic therapy that can be given, thus limiting the curability of cancer. The steadily increasing number of cancer survivors and the demand for uncomplicated cancer cures require a paradigm shift in cancer survivorship research. Research must shift from simply describing and palliating side effects (“doing head-counts”) to adopt a more modern, goal-oriented approach. The new approach encompasses 1) epidemiological, psychosocial, and outcomes research aimed at characterizing and ameliorating the problems that afflict current cancer survivors; 2) applied clinical and preclinical research aimed at developing new treatments or response modifiers to prevent or minimize shortand longterm side effects of cancer therapy; and 3) basic research aimed at improving our understanding of the cellular and molecular mechanisms that are responsible for treatmentrelated toxicities. This three-pronged approach will ensure that progress is made toward our ultimate goal, i.e., to increase the uncomplicated cancer cure rate.

Assessing the Effect of Treatment Duration on the Association between Anti-Diabetic Medication and Cancer Risk

Most studies that have evaluated the association between anti-diabetic medication and cancer risk have suffered from methodological drawbacks. To avoid time-related biases, we evaluated the effect of treatment duration on the cancer risk among naive users of anti-diabetic medication as compared to non-users. In addition, we addressed the influence of common risk factors such as smoking and BMI. The study population comprised 23,394 participants of FINRISK surveys. Data on cancer and anti-diabetic medication were linked with the study cohorts. We applied Lexis tabulation to the data and analyzed split records by using Poisson regression. Changes in cancer incidence in relation to treatment duration were examined by modeling the rate ratio (RR). After a median follow-up of 9 years, 53 cancer cases among users of anti-diabetic medication and 1,028 among non-users were diagnosed. No significant difference in cancer risk between users and non-users was observed after adjustment. The RR for all medication regardless of its duration was 1.01 [95% CI 0.75–1.33], and 1.37 [0.94–1.94] for period of 1–4 years. The results were similar for metformin, sulfonylurea, and insulin. This study demonstrates that evaluation of the variation in cancer risk in relation to treatment duration is of particular importance for enhancing the accuracy of conclusions on the link between exposure to anti-diabetic medication and cancer risk.

Evidence-based Estimates of the Demand for Radiotherapy

There are different methods that may be used to estimate the future demand for radiotherapy services in a population ranging from expert opinion through to complex modelling techniques. This manuscript describes the use of evidence-based treatment guidelines to determine indications for radiotherapy. It also uses epidemiological data to estimate the proportion of the population who have attributes that suggest a benefit from radiotherapy in order to calculate the overall proportion of a population of new cases of cancer who appropriately could be recommended to undergo radiotherapy. Evidence-based methods are transparent and adaptable to different populations but require extensive information about the indications for radiotherapy and the proportion of cancer cases with those indications in the population.In 2003 this method produced an estimate that 52.4% of patients with a registered cancer-type had an indication for radiotherapy. The model was updated in 2012 because of changes in cancer incidence, stage distributions and indications for radiotherapy. The new estimate of the optimal radiotherapy utilisation rate was 48.3%. The decrease was due to changes in the relative frequency of cancer types and some changes in indications for radiotherapy. Actual rates of radiotherapy utilisation in most populations still fall well below this benchmark.

Estimation of an Optimal Chemotherapy Utilisation Rate for Cancer: Setting an Evidence-based Benchmark for Quality Cancer Care

There is wide variation in the proportion of newly diagnosed cancer patients who receive chemotherapy, indicating the need for a benchmark rate of chemotherapy utilisation. This study describes an evidence-based model that estimates the proportion of new cancer patients in whom chemotherapy is indicated at least once (defined as the optimal chemotherapy utilisation rate). The optimal chemotherapy utilisation rate can act as a benchmark for measuring and improving the quality of care. Models of optimal chemotherapy utilisation were constructed for each cancer site based on indications for chemotherapy identified from evidence-based treatment guidelines. Data on the proportion of patient- and tumour-related attributes for which chemotherapy was indicated were obtained, using population-based data where possible. Treatment indications and epidemiological data were merged to calculate the optimal chemotherapy utilisation rate. Monte Carlo simulations and sensitivity analyses were used to assess the effect of controversial chemotherapy indications and variations in epidemiological data on our model. Chemotherapy is indicated at least once in 49.1% (95% confidence interval 48.8–49.6%) of all new cancer patients in Australia. The optimal chemotherapy utilisation rates for individual tumour sites ranged from a low of 13% in thyroid cancers to a high of 94% in myeloma. The optimal chemotherapy utilisation rate can serve as a benchmark for planning chemotherapy services on a population basis. The model can be used to evaluate service delivery by comparing the benchmark rate with patterns of care data. The overall estimate for other countries can be obtained by substituting the relevant distribution of cancer types. It can also be used to predict future chemotherapy workload and can be easily modified to take into account future changes in cancer incidence, presentation stage or chemotherapy indications.

Abstract 4140: Secular trends in incidence and mortality of female cancers in Shanghai, China (1973-2009)

Abstract Socioeconomic development and urbanization have resulted in dramatic changes in cancer incidence and mortality in China. As one of the largest and most developed cities in China, Shanghai's cancer rates reflect the changing burden of cancer in China. This study was undertaken to evaluate trends and quantify changes in the incidence and mortality of breast, ovarian, endometrial, and cervical cancers among female residents of urban Shanghai from 1973 to 2009. Data on cancer incidence and mortality were collected by the Shanghai Cancer Registry. International Classification of Disease version 10 codes for breast (C50), cervical (C53), endometrial (corpus uteri and uterus unspecified; C54 and C55), and ovarian cancer (C56) were included in the current analysis. Annual population data was provided by the Department of Vital Statistics, Shanghai Municipal Center for Disease Control and Prevention. A total of 73,755 female cancers and 28,274 related deaths were documented between 1973 and 2009. Age-standardized incidence and mortality rates were calculated using the Segi/Doll 1960 world standard. Joinpoint regression models were used to fit joined straight lines on a log-scale for annual age-standardized rates and to calculate annual percent changes (APC). Between 1973 and 2009, the incidence of breast, ovarian, and endometrial cancers increased, with overall APCs of 2.93, 2.20, and 1.66, respectively. Significant trends were found for breast cancer between 1979 and 1998 (APC 3.07) and for ovarian cancer between 1983 and 2009 (APC 2.83). For endometrial cancer a significant decrease occurred from 1973 to 1983 (APC -4.27), followed by a significant increase from 1983 to 1996 (APC 2.58). The incidence of cervical cancer decreased, with an overall APC of -3.91; this included three significant decreasing trends between 1973 and 1996, followed by a significant increase through 2009 (APC 8.49). The mortality of breast and ovarian cancers increased, with overall APCs of 0.70 and 0.58, respectively. Significant trends were found for breast cancer between 1982 and 2004 (APC 1.55) and for ovarian cancer during the entire time period. The mortality of cervical and endometrial cancers decreased, with overall APCs of -5.36 and -2.33, respectively. For cervical cancer, this included a significant decrease between 1973 and 1999 (APC -7.34), followed by a significant increase through 2009 (APC 3.24). For endometrial cancer, this included a significant decrease between 1973 and 1988 (APC -5.59). In summary, increasing trends were found for breast, ovarian and endometrial cancer incidence, and for breast and ovarian cancer mortality, while decreasing trends were found for cervical cancer incidence and cervical and endometrial cancer mortality among women in urban Shanghai. Additional analyses to identify age-period-cohort effects in this data are underway. This study lays the ground work for the establishment of cancer prevention and control priorities in China. Citation Format: Zhezhou Huang, Alicia C. Beeghly-Fadiel, Ying Zheng, Wanqing Wen, Yutang Gao, Chunxiao Wu, Pingping Bao, Weijian Zhong, Fan Jin, Yongbing Xiang, Wei Zheng, Xiao Ou Shu, Wei Lu. Secular trends in incidence and mortality of female cancers in Shanghai, China (1973-2009). [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 4140. doi:10.1158/1538-7445.AM2014-4140

Great success, further progress.

The “Report of cancer incidence and mortality in China, 2010” written by the staff of National Central Cancer Registry (NCCR) of China now is published in Annals of Translational Medicine (ATM) (1). In this report the authors described the development of cancer registration in China, methods of data collection and analysis as well as quality control measures in some detail. The information on cancer incidence and mortality in China for 2010 has been presented not only by sex and age groups, but also by urban and rural areas as well as east, middle and west regions with different extent of socio-economic development in this country. The data involved in this Report are important for health leaders, decision makers of China to understand cancer burden in China as a whole and different regions as well for establishing cancer control strategy and plans, the data are also useful for readers within China and abroad who are interested in cancer status in this country. In 1982 the cancer incidence data of urban Shanghai, China for 1975 have appeared in “Cancer Incidence in Five Continents Vol. IV”. After then till 2000 cancer incidence data of Beijing, Shanghai, and several counties of China were presented in the IARC’s publications. In 2008 the National Cancer Registry Program has been set up by the National Health and Family Planning Commission (NHFPC, former Ministry of Health). Up to now 250 local cancer registries have been established as stated in this Report, covering more than 200 million people in China. A total of 145 registries with relatively high quality of cancer data are involved in this report. The great progress of cancer registration achieved in China within a relatively short period of about 30 years is deeply impressive. A few points should be mentioned. Firstly, for the accuracy of estimation of cancer burden for China as a whole, the representative and reliable estimates of sex- and age-specific cancer rates in east, middle and west regions are crucial. So the distributions of demographic, social and economic characteristics of the population covered by the cancer registries, where sex- and age-specific rates for the region are estimated, should be representative for the whole region. If say more cities and urban areas are involved in estimation of regional cancer rates, then the estimated cancer incidence rates for the region would be biased toward upwards. Secondly, rigorously and consistently supervising of cancer data reported is critical for keeping high quality of the data. Data on clinicopathological characteristics of the cases registered should be checked with the medical records of medical institutions where the cases were diagnosed and treated. In the 4th table of this report the proportion of cases with morphological verification (MV%) for pancreatic cancer was 44.40% (45.22% for males, 42.72% for females), which obviously was over-estimated. In more developed areas of China such as urban Shanghai the proportion of cases of pancreatic cancer surgically operated usually is between 20% and 25%. Due to low proportion of cases surgically operated and lack of autopsy estimated MV% for pancreatic cancer should not exceed 20% (even be lower) for the whole country. Temporal trends of cancer incidence and mortality rates are meaningful not only for evaluating effectiveness of and planning cancer control measures, but also for generating hypotheses on etiology and risk factors of cancers to be tested. With the rapid socio-economic development the cancer patterns in different regions of China now are changing remarkably, which creates favorable conditions for investigating role of environmental risk factors including life style in the change of cancer pattern. In addition to annual reports there is an urgent need to accumulate cancer incidence and mortality data collected from some typical registries which are representative for different regions of China and already have cancer data for a relatively long period. Analysis of cancer data by birth cohorts should be applied especially among people of young and middle ages, since at the beginning phase of changing cancer pattern the change in cancer incidence or mortality rates will firstly appear in people of young and middle ages, while rates in old age groups will be still unchanged or even changed in opposite direction. Congratulate the great success in cancer registration in China and expect further progress in this regard.

Radiation enteropathy—pathogenesis, treatment and prevention

Changes in cancer incidence and mortality have been modest during the past several decades, but the number of cancer survivors has almost tripled during the same period. With an increasing cohort of cancer survivors, efforts to prevent, diagnose and manage adverse effects of cancer therapy, in general, and those of radiation therapy specifically, have intensified. Many cancer survivors have undergone radiation therapy of tumours in the pelvis or abdomen, thus rendering the bowel at risk of injury. In fact, the current prevalence of patients who have long-term radiation-induced intestinal adverse effects exceeds that of IBD. Considerable progress towards reducing toxicity of radiation therapy has been made by the introduction of so-called dose-sculpting treatment techniques, which enable precise delivery of the radiation beam. Moreover, new insights into the underlying pathophysiology have resulted in an improved understanding of mechanisms of radiation-induced bowel toxicity and in development of new diagnostic strategies and management opportunities. This Review discusses the pathogenesis of early and delayed radiation-induced bowel toxicity, presents current management options and outlines priorities for future research. By adding insight into molecular and cellular mechanisms of related bowel disorders, gastroenterologists can substantially strengthen these efforts.

Recent cancer trends in HIV-infected individuals in the United States

Recent cancer trends in HIV-infected individuals in the United States

Cancer incidence and mortality in France over the 1980–2012 period: Solid tumors

BackgroundCancer incidence and mortality estimates for 19 cancers (among solid tumors) are presented for France between 1980 and 2012. MethodsIncidence data were collected from 21 local registries and correspond to invasive cancers diagnosed between 1975 and 2009. Mortality data for the same period were provided by the Institut national de la santé et de la recherche médicale. The national incidence estimates were based on the use of mortality as a correlate of incidence. The observed incidence and mortality data were modeled using an age-period-cohort model. The numbers of incident cases and deaths for 2010–2012 are the result of short-term projections. ResultsIn 2012, the study estimated that 355,000 new cases of cancer (excluding non-melanoma skin cancer) and 148,000 deaths from cancer occurred in France. The incidence trend was not linear over the study period. After a constant increase from 1980 onwards, the incidence of cancer in men declined between 2005 and 2012. This recent decrease is largely related to the reduction in the incidence of prostate cancer. In women, the rates stabilized, mainly due to a change in breast cancer incidence. Mortality from most cancer types declined over the study period. A combined analysis of incidence and mortality by cancer site distinguished cancers with declining incidence and mortality (e.g., stomach) and cancers with increasing incidence and mortality (e.g., lung cancer in women). Some other cancers had rising incidence but declining mortality (e.g., thyroid). ConclusionThis study reveals recent changes in cancer incidence trends, particularly regarding breast and prostate cancers.

Advances in cancer epidemiology in Japan

Epidemiologists in Japan have been performing calculations to estimate nationwide cancer incidence rates as well as 5-year survival rates using population-based cancer registry data. There have been remarkable changes in cancer incidence and/or mortality in cancers of the lung, liver and stomach, which were thought to be attributed to the changing impact of exposure to cigarette smoking, chronic hepatitis C virus infection and Helicobacter pylori infection, respectively. In systematic reviews providing evidence in risk/protective factors for cancer sites using case-control and cohort studies of the Japanese population, there were associations between cancer sites (esophagus, stomach, colo-rectum, liver, pancreas, lung and breast) and various lifestyle factors. In the past 10 years, a hospital-based case-control study at Aichi Cancer Center provided valuable evidence of gene-environment interaction on the development of cancer [i.e., the effects of aldehyde dehydrogenase-2 (ALDH2) polymorphism and heavy alcohol drinking on esophageal cancer, ALDH2 polymorphism and smoking on lung cancer, methylenetetrahydrofolate reductase polymorphism and heavy alcohol drinking on pancreatic cancer]. The database with stored DNA was also used and identified seven loci containing significant but low-penetrance polymorphisms associated with the development of breast cancer. These findings together with established risk factors are likely to be useful to predict personalized breast cancer risk in East Asian women. In 2005, the Japan Multi-Institution Collaborative Cohort (J-MICC) study was launched to elucidate gene-environment interactions as well as to confirm preclinical diagnostic biomarkers of cancer. J-MICC, which has recruited 92,000 healthy individuals by the end of 2012, will follow the individuals until 2025.

Innovations in health care and mortality trends from five cancers in seven European countries between 1970 and 2005

Although the contribution of health care to survival from cancer has been studied extensively, much less is known about its contribution to population health. We examine how medical innovations have influenced trends in cause-specific mortality at the national level. Based on literature reviews, we selected six innovations with proven effectiveness against cervical cancer, Hodgkin's disease, breast cancer, testicular cancer, and leukaemia. With data on the timing of innovations and cause-specific mortality (1970-2005) from seven European countries we identified associations between innovations and favourable changes in mortality. For none of the five specific cancers, sufficient evidence for an association between introduction of innovations and a positive change in mortality could be found. The highest association was found between the introduction of Tamoxifen and breast cancer mortality. The lack of evidence of health care effectiveness may be due to gradual improvements in treatment, to effects limited to certain age groups or cancer subtypes, and to contemporaneous changes in cancer incidence. Research on the impact of health care innovations on population health is limited by unreliable data on their introduction.

Overdiagnosis and Overtreatment in Cancer

Over the past 30 years, awareness and screening have led to an emphasis on early diagnosis of cancer. Although the goals of these efforts were to reduce the rate of late-stage disease and decrease cancer mortality, secular trends and clinical trials suggest that these goals have not been met; national data demonstrate significant increases in early-stage disease, without a proportional decline in later-stage disease. What has emerged has been an appreciation of the complexity of the pathologic condition called cancer. The word “cancer” often invokes the specter of an inexorably lethal process; however, cancers are heterogeneous and can follow multiple paths, not all of which progress to metastases and death, and include indolent disease that causes no harm during the patient’s lifetime. Better biology alone can explain better outcomes. Although this complexity complicates the goal of early diagnosis, its recognition provides an opportunity to adapt cancer screening with a focus on identifying and treating those conditions most likely associated with morbidity and mortality. Changes in cancer incidence and mortality 1 reveal

Radiotherapy Demand and Activity in England 2006–2020

AimsThis paper compares the predictions of radiotherapy demand for England from the Malthus model with those from the earlier National Radiotherapy Advisory Group (NRAG) model, from the international literature and also with observed radiotherapy usage in England as a whole as recorded in the English radiotherapy dataset (RTDS). Materials and methodsWe reviewed the evidence base for radiotherapy for each type and stage of cancer using national and international guidelines, meta-analyses, systematic reviews and key clinical trials. Twenty-two decision trees were constructed and radiotherapy demand was calculated using English cancer incidence data for 2007, 2008 and 2009, accurate to the Primary Care Trust (PCT) level (population 91 500–1 282 384). The stage at presentation was obtained from English cancer registry data. In predictive mode, the model can take account of changes in cancer incidence as the population grows and ages. ResultsThe Malthus model indicates reduced indications for radiotherapy, principally for lung cancer and rarer tumours. Our estimate of the proportion of patients who should receive radiotherapy at some stage of their illness is 40.6%. This is lower than previous estimates of about 50%. Nevertheless, the overall estimate of demand in terms of attendances is similar for the NRAG and Malthus models. The latter models that 48 827 attendances should have been delivered per million population in 2011. National data from RTDS show 32 071 attendances per million in 2011. A 50% increase in activity would be required to match estimated demand. This underprovision extends across all cancers and represents reduced access and the use of dose fractionation at odds with international norms of evidence-based practice. By 2016, demand is predicted to grow to about 55 206 attendances per million and by 2020 to 60 057. DiscussionServices have increased their activity by 14% between 2006 and 2011, but estimated demand has increased by 11%. Access remains low and English radiotherapy dose fractionation still does not comply with international evidence-based practice.

An analysis of the temporal, age, and gender trends in human papillomavirus virus (HPV)-related versus non-HPV-related head and neck cancers (HNC) in Alberta, Canada.

e12505 Background: Recent epidemiologic studies have suggested that the incidence of HPV-associated HNC is increasing. This study assessed temporal, age-specific and gender specific changes in cancer incidence for HPV- versus non-HPV associated HNC compared with other HPV versus non-HPV associated malignancies in a population-based setting. Methods: We used the Alberta Cancer Registry, a population-based registry of all cancers diagnosed in the province of Alberta, Canada (population est. 3.6 million), to identify patients diagnosed with cancers of the oropharynx, cervix, vulva, vagina, anus, and penis (HPV-associated group) and compared this with non-oropharyngeal cancers of the head and neck and lung cancer (non-HPV associated, modifiable risk group) between January 1, 1975 and December 31, 2009. The age-standardized incidence rates (ASIR) for each cancer by gender and age-specific incidence was estimated with the annual percentage change (APC) assessed using Joinpoint regression. Results: The ASIR for oropharyngeal cancers (OPC) increased over time for both men (APC 3.5) and women (APC 1.5) with rapid increases seen in men under 35 (APC 27.3). Non-oropharyngeal squamous cell carcinomas of the head and neck had a higher ASIR overall with moderate temporal increases (APC 2.5) and age-specific increases highest in those aged 55 to 74. ASIR for anal canal cancers also increased over time, with greater increases amongst younger females, in contrast to OPC. By comparison, the ASIR of cervix cancer declined with more significant decreases in younger females; while the rates of other HPV-associated cancers (vulva, vagina, penile) showed little change. The ASIR for lung cancer decreased after 1987 (APC -1.5) for men and continued to moderately increase for women. Conclusions: Our findings suggest the greatest increases in OPC are occurring in younger men. Programs of HPV prevention such as vaccination should be explored to reduce the incidence of OPC in males.

Long-term cancer risk among people diagnosed with AIDS during childhood.

Highly active antiretroviral therapy (HAART) results in partial immune restoration for people with AIDS, but its impact on cancer risk among children is unknown. Data from the U.S. HIV/AIDS Cancer Match Study were used to evaluate cancer risk for people diagnosed with AIDS as children (diagnosed with AIDS at ages 0-14 years, during 1980-2007, followed for up to 10 years; N = 5,850). We calculated standardized incidence ratios (SIR) to compare cancer risk to the general population. Poisson regression evaluated changes in cancer incidence between the pre-HAART (1980-1995) and HAART eras (1996-2007). There were 106 cancers observed with significantly elevated risks for the two major AIDS-defining cancers: Kaposi sarcoma [KS; N = 20, SIR = 1,694; 95% confidence interval (CI), 986-2,712 and SIR = 1,146; 95% CI, 236-3,349] during the pre-HAART and HAART eras, respectively, and non-Hodgkin lymphoma (NHL; N = 64, SIR = 338; 95% CI, 242-458 and SIR = 116; 95% CI, 74-175). Incidence of both cancers declined 87% and 60%, respectively, in the HAART era (P < 0.05). Of non-AIDS-defining cancers, leiomyosarcoma risk (N = 9) was elevated during both time periods (SIR = 863; 95% CI, 235-2,211 and SIR = 533; 95% CI, 173-1,243). People diagnosed with AIDS during childhood remain at elevated risk for KS, NHL, and leiomyosarcoma in the HAART era. Incidence of KS and NHL declined relative to widespread HAART use, but there was no change in the incidence of other cancers. People diagnosed with AIDS during childhood remain at elevated risk for certain cancers. Continued monitoring is warranted as this immunosuppressed population ages into adulthood where cancer risks generally increase.

Age‐ and time‐dependent changes in cancer incidence among immigrants to Sweden: colorectal, lung, breast and prostate cancers

To examine the role of gender, age at immigration and length of stay on incidence trends of common cancers, we studied risk of colorectal, lung, breast and prostate cancers in immigrants to Sweden from 1958 to 2008. The nationwide Swedish Family-Cancer Database was used to calculate standardized incidence ratios for common cancers among immigrants compared to Swedes. Immigrants were classified into "high-risk" countries when their risk was increased, into "low-risk" when their risk was decreased and into "other" when their risk was nonsignificant. Among those who immigrated at younger age (<30 years), we found an increasing trend for colorectal cancer risk in low-risk men and high-risk women. Among those who immigrated at older age (≥ 30 years), a decreasing lung cancer risk in high-risk men and an increasing breast cancer risk in low-risk women were observed. The increasing trend of prostate cancer risk was independent of age at immigration. The risk trends for "other" immigrants were between the risks of low- and high-risk countries. The gender-specific shifts in cancer risks in immigrants toward the risk in natives indicate a major role of sex, age at immigration and environmental exposures in colorectal and lung cancers risks. In contrast, the unchanged trend of breast cancer among those who immigrated at younger ages and an increasing trend for those who migrated at older ages may suggest a limited effect for environmental exposures, especially at younger age. Our study points out a role of age at immigration on the risk trend of cancer.

Changes in causes of death and risk of cancer in Danish patients with autosomal dominant polycystic kidney disease and end-stage renal disease

With the improved prognosis in patients with autosomal dominant polycystic kidney disease (ADPKD), causes of death and the risk of cancer might have changed. This was investigated in a Danish population with ADPKD and end-stage renal disease (ESRD) between 1 January 1993 and 31 December 2008. Data were retrieved from three Danish national registries and a total of 823 patients were identified of which 431 had died during the study period. The 16 years were divided into two 8-year periods and the causes of death were divided into six categories: cancer, cardiovascular, cerebrovascular, infection, other and unknown. Cardiovascular disease was the major cause of death. A multivariate competing risk model comparing the two 8-year periods, adjusted for age at ESRD, gender and treatment modality, showed that deaths from cardiovascular disease decreased by 35% [hazard ratios (HR) 0.65, P=0.008] and deaths from cerebrovascular disease decreased by 69% (HR 0.31, P=0.0003) from the first to the second time period. There were no significant changes between the time periods in death from cancer, infection, other or unknown. From the first to the second 8-year interval, the prevalence of cancer increased by 35% (P=0.0002) while the cancer incidence was stable. In Danish patients with ADPKD and ESRD, there was a significant reduction in cardiovascular and cerebrovascular deaths from 1993 to 2008. The prevalence of cancer increased without significant change in cancer incidence or deaths from cancer.

P1-301 A comparison of two methods to estimate the cancer incidence and mortality burden in China in 2005

IntroductionKnowledge of the cancer profile is an important step in planning rational cancer control programs and the evaluation of their impact. Due to rapid changes in cancer incidence over in...

Prevalence of main cancer lifestyle risk factors in Europe in 2000

Background Estimation of changes in cancer incidence possibly induced by primary prevention policies requires knowledge of the level of exposure to risk factors targeted by these policies. Materials and methods We collected comparable exposure data from 30 European countries for five lifestyle cancer risk factors: tobacco smoking, alcohol drinking, overweight and obesity, physical activity and fruit and vegetable consumption. We obtained original reports for years 1995–2005 and the present manuscript reports results around year 2000. Results This work revealed the important heterogeneity in the quality and possibility to compare data between and within countries. Overall, we observed a clustering of lifestyle factors: highest tobacco consumption in Eastern Europe up to 61.6% in men in Latvia; high alcohol consumption in central Europe, particularly in Czech Republic in which the average daily consumption was 56.9 g/l in men and 14.6 g/l in women; low fruit and vegetable consumption (less than 150 g/d) in Finland, Sweden, Norway and United Kingdom. Obesity was the most prevalent and exceeded 18% for men in United Kingdom, Malta and Greece; and for women in UK, Greece, Luxembourg and Hungary. Conclusion We conclude that data on tobacco smoking and alcohol consumption are reasonably comparable and match the pattern of cancer incidence. Interpretation of data related to physical activity and fruit and vegetable consumption should be cautious because of considerable between-country variations in the way these data were collected. Recent efforts for harmonisation of health survey questionnaires and sampling methods across European countries should be pursued in order to increase comparability of results.

Assessing Cancer Prevention Studies—A Matter of Time

Assessing Cancer Prevention Studies—A Matter of Time