Five-year Relative Survival Rates Research Articles

Vaginal vault carcinoma as second primary in a treated case of ovarian cancer

With the advances in the treatment of cancer, the chances of survival have increased today. The five-year relative survival rate is about 66%. With the increasing survival rate, it is important to identify the late effects of cancer and its therapy. One of the most serious events experienced by cancer survivors is the diagnosis of a new cancer. Case: A 32-year-old unmarried female diagnosed as ovarian cancer in the year 2010. She was treated with three cycles of chemotherapy followed by surgery. Histopathology was well-differentiated adenocarcinoma. She received three more cycles of chemotherapy after surgery. She was under follow-up and developed vaginal vault carcinoma after a disease-free interval of 2 years. The biopsy was suggestive of squamous cell carcinoma. She was treated with radiation for vaginal cancer successfully. This case indicates that female gynecological cancers with different histology may occur in minimum period of interval even in the absence of any predisposing factors like human papilloma virus infection.

Diverging trends in incidence and mortality, and improved survival of non-Hodgkin's lymphoma, in the Netherlands, 1989–2007

We studied progress in the fight against non-Hodgkin's lymphoma (NHL) in the Netherlands by describing the changes in incidence, treatment, relative survival, and mortality during 1989-2007. We included all adult patients with NHL [i.e. all mature B-, T-, and natural killer (NK) cell neoplasms, with the exception of plasma cell neoplasms], newly diagnosed in the period 1989-2007 and recorded in the Netherlands Cancer Registry (n=55 069). Regular mortality data were derived from Statistics Netherlands. Follow-up was completed up to 1 January 2009. Annual percentages of change in incidence, mortality, and relative survival were calculated. The incidence of indolent B-cell and T- and NK-cell neoplasms rose significantly (estimated annual percentage change=1.2% and 1.3%, respectively); incidence of aggressive B-cell neoplasms remained stable. Mortality due to NHL remained stable between 1989 and 2003, and has decreased since 2003. Five-year relative survival rates rose from 67% to 75%, and from 43% to 52%, respectively, for indolent and aggressive mature B-cell neoplasms, but 5-year survival remained stable at 48% for T- and NK-cell neoplasms. In the Netherlands, incidence of indolent mature B-cell and mature T- and NK-cell neoplasms has increased since 1989 but remained stable for aggressive neoplasms. Survival increased for all mature B-cell neoplasms, preceding a declining mortality and increased prevalence of NHL (17 597 on 1 January 2008).

Abstract B25: Cancer survival by stage among Koreans

Abstract Background: Five-year relative survival rates (5y-RSRs) calculated from the Korean National Cancer Registry (KNCR) data have been reported recently, but the stage distribution among the registered patients is still unknown. We aim to calculate stage-specific 5y-RSRs using a large cancer registry data from one hospital that has contributed 7.1% of the KNCR data between 1999 and 2008. Method: Samsung Medical Center Cancer Registry System has been established since 1994. We identified all cancer patients diagnosed between Nov. 1, 1994 and Dec. 31, 2006 and followed them up through Dec. 31, 2008. We calculated 5y-RSRs using Ederer II expected survival rates. Stage-specific 5y-RSRs were calculated for those cancers that had stage information for more than 50% of the patients. Results: A total of 82,038 cancer records were analyzed. Five-year-RSR had improved with time periods. Five-year-RSR for all cancer was 52.6 % in 1994–1999 and 60.3 % in 2000–2004. During 1999–2006, the highest 5y-RSR was obtained from thyroid, breast and prostate cancers and the lowest from pancreas, gallbladder, and lung cancers. Five-year-RSR for stage I, II, III, and IV cancers were 0.95, 0.80, 0.58, and 0.18, respectively. Site specific 5y-RSR of stomach, liver and lung cancer was 0.99, 0.65, and 0.79, respectively, in stage I, and 0.09, 0.07, and 0.04, respectively, in stage IV. Conclusions: Stage-specific 5y-RSRs among Koreans were comparable to other developed countries, and fairly good for common cancers in Korea such as stomach, liver, and lung cancers. Citation Information: Cancer Prev Res 2011;4(10 Suppl):B25.

Abstract PR3: Exome sequencing of head and neck squamous cell carcinoma reveals a higher frequency of mutations in TP53 among African Americans

Abstract This abstract will be presented as a proffered talk on Wednesday, September 21, in Plenary Session 8. African American (AA) and Puerto Rican (PR) men have a higher oral (OSCC) and head and neck squamous cell carcinoma (HNSCC) burden than White men in the United States (US), but the biological basis for these differences are poorly understood. Overall Five-Year relative survival rates for patients diagnosed with oral cavity cancer increased from 53% in 1975 to 63% in 2005 across all races in the US, an increase that parallels a decline in smoking among males during the same period of time. However, the disparity in overall survival rates between Whites and African American patients has remained, practically unchanged from 1975 (19%) to 2005 (18%). The survival disparity difference in HNSCC among AA may be due, among other factors, to a higher prevalence of genetic alterations. To gain an initial profile of the disparities in genetic alterations between Whites and Non-Whites HNSCC patients we performed a secondary analysis on a convenience sample from an exome-sequencing project that was undertaken at Johns Hopkins School of Medicine. For this project we sequenced ∼18,000 protein-encoding genes in tumors from 17 HNSCC patients which comprised the Discovery set. DNA was purified from these tumors as well as matched non-neoplastic tissue and used to generate libraries suitable for massively parallel sequencing. After capture of the coding sequences with a SureSelect (Agilent) the DNA was sequenced using an Illumina GAIIx/HiSeq instrument. The average coverage of each base in the targeted regions was 77-fold and 92.6% of targeted bases were represented by at least 10 reads in this platform. The majority of patients (82%) in the Discovery setwere White and the remainder were African American (18%). All the African American patients were smokers. The majority of the AA patients were males (60%), over 60 yrs old (80%) with an oropharyngeal cancer (40%). Using stringent criteria for analysis of these data we identified 249 somatic mutations. The range of confirmed mutations per tumor was 2 to 78, with a mean and standard deviation of 19 ± 16.5 mutations per tumor. We selected genes for further analysis if they or closely related genes were altered in at least two of the 17 tumors sequenced. The genes included were PIK3AP1, RIMBP2, SI, NRXN2, NRXN3, EPHA7, RASA1, RXFP3, PIK3CA, HRAS, TP53, CDKN2A, NOTCH1, and FBXW7. We then analyzed the sequences of these genes in additional HNSCC and their corresponding normal tissues. In total, somatic mutations in TP53, NOTCH1, CDKN2A, PIK3CA, FBXW7, and HRAS were identified in 47%, 15%, 9%, 6%, 5% and 4% of patients, respectively. Most of the mutations (84%) were observed in White patients. There was no significant difference in the number of mutations per patient in White (14.6) vs African American (13.7) patients. Breaking down the somatic mutations by race we found that the mutations among African Americans was higher (73%) for TP53, when compared to Whites (55%) or to previously observed frequency of TP53 mutations in HNSCC. The mutations in NOTCH1, CDKN2A, PIK3CA had similar mutation frequency in African Americans and in White patients. African American patients did not have somatic mutations in FBXW7 and HRAS. This is the first exome sequencing study to report HNSCC mutation disparities in African Americans. Although the number of HNSCC African American patients examined in this project is small, the results of this study provide evidence that HNSCCs, although morphologically similar, are comprised of distinct diseases at the molecular level. These results should be examined in a larger cohort of African American patients. Our preliminary findings that HNSCCs have few directly targetable mutations has implications for controlling this disease in the future. In particular, it suggests that prevention, careful surveillance of patients at risk, and early detection are the optimal approaches for reducing cancer health disparities in this disease. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):PR3.

Colorectal cancer survival in socioeconomic groups in England: Variation is mainly in the short term after diagnosis

The objective of this study was to examine differences in cancer survival between socioeconomic groups in England, with particular attention to survival in the short term of follow-up. Patients and methods Individuals diagnosed with colorectal cancer between 1996 and 2004 in England were identified from cancer registry records. Five-year cumulative relative survival and excess death rates were computed. Results For colon cancer there was a very high excess death rate in the first month of follow-up, and the excess death rate was highest in the socioeconomically deprived groups. In subsequent periods, excess mortality rates were much lower and there was less socioeconomic variation. The pattern of variation in excess death rates was generally similar in rectal cancer but the socioeconomic difference in death rates persisted several years longer. If the excess death rates in the entire colorectal cancer patient population were the same as those observed in the most affluent socioeconomic quintile, the annual reduction would be 360 deaths in colon cancer and 336 deaths in rectal cancer patients. These deaths occurred almost entirely in the first month and the first year after diagnosis. Conclusion Recent developments in the national cancer control agenda have included an increasing emphasis on outcome measures, with short-term cancer survival an operational measure of variation and progress in cancer control. In providing clues to the nature of the survival differences between socioeconomic groups, the results presented here give strong support for this strategy.

Epidemiología del cáncer de cérvix in situe invasor en la provincia de Girona 1990-2004: incidencia, mortalidad, supervivencia e historial de cribado

The epidemiological vigilance of cervical cancer (CC) should comprise from screening to mortality. The objective of the work is to show a global vision of CC in the Province of Girona (Spain) between the years 1990-2004. It is a longitudinal study that includes incidence for in situ (ISCC) and invasive (ICC) carcinoma of the cervix, mortality, relative survival rates and the screening history of 1/3 of the affected women. The crude and the age-adjusted annual and five years incidence rates for ISCC and ICC and the mortality for ICC were calculated. Regression Joinpointmodels were used to estimate the annual percentage change (APC) and the changes in the trend. The five-year relative survival rate was estimated. Cytology screening smears were reviewed. Three hundred seventy-three incident cases of ICC and 1,093 cases of ISCC were diagnosed. After an initial rise of the incidence in both types, the adjusted rate of ISCC stabilized around 28 cases per 100,000 and that of ICC declined to 5.8 cases per 100,000 women in the period 2000-2004. The mortality remained steady and the survival rate had a non-significant increase. In the cases with screening history almost 50% of the women diagnosed of ICC had no previous cytology in contrast with the high percentage of the women with ISCC that had it done (92% in 200-2004). Cervical cancer incidence is decreasing in Girona, although the dates of the screening histories suggest that it can be further reduced.

Trends in the incidence and management of biliary tract cancer: A French population-based study

The trends in incidence and management of biliary tract cancer (BTC) were investigated in a well-defined French population over a 30-year period (1976-2005). Data were obtained from the Burgundy digestive cancer registry. Age-standardised incidence rates and trends in incidence were determined. Treatment and stage at diagnosis were also investigated. Five-year survival rates were calculated. Six hundred and fifteen cases of BTC were recorded. There was no significant change in BTC incidence over the 30-year period. For extrahepatic BTC age-standardised incidence rates were 1.1/100,000 for 1976-80 and 2001-2005. These rates were respectively 0.3 and 0.2/100,000 for intrahepatic BTC. The proportion of patients undergoing resection for cure increased over time from 4.8% to 14.2% (p<0.001). The proportion of stage I-II cases ranged from 3.2% to 7.1% but did not vary significantly over time (p=0.55). Most cases were metastatic or unresectable at diagnosis. Five-year relative survival rates were 4.5% for 1976-85 and 6.7% for 1996-2005, ranging from 35.1% for stages I-II to 4.3% for advanced BTC. Age and stage at diagnosis were independent prognostic factors. The incidence of BTC has remained stable in Burgundy over the past 30 years. BTC prognosis remains poor and has only improved slightly over time.

Cutaneous Appendageal Carcinoma Incidence and Survival Patterns in the United States

To examine incidence patterns of patients diagnosed as having cutaneous appendageal carcinoma (CAC). Population-based study using the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute data from 1978 through 2005. A total of 1801 subjects from SEER 16 registries (2001-2005) for incidence analyses, 2228 from SEER 9 registries (1987-2005) for trend analysis, and 1984 subjects (1992-2004) for survival analysis. Incidence rates (IRs) per 1 million person-years according to anatomic site, race, sex, age, and histologic type. Cutaneous appendageal carcinomas are uncommon (age-adjusted IR, 5.1 per 1 million person-years), with the IR among men statistically significantly higher than women (6.3 vs 4.2, respectively; male to female IR ratio 1.51; P < .001). Hispanic whites (IR, 3.7), blacks (IR, 3.5), and Asian/Pacific Islanders (IR, 2.5) all had significantly lower IRs than non-Hispanic whites (IR, 5.7) (P < .001). Apocrine-eccrine carcinoma overall was the most common category (IR, 2.6), and the IR was highest among non-Hispanic white (IR, 2.8) compared with other ethnic/racial groups (P < .001). Cutaneous appendageal carcinomas IRs rose 100-fold with age, from 0.37 among those aged 20 to 29 years to 37.3 among those 80 years or older. From 1978-1982 to 2002-2005, the CAC IRs increased 150%, from 2.0 to 5.0; the apocrine-eccrine carcinoma and the sebaceous carcinoma IRs rose 170%, from 1.0 to 2.7, and 217%, from 0.6 to 1.9, respectively. Five-year relative survival rates overall were 99% for localized and 43% for distant disease. Cutaneous appendageal carcinomas are rare tumors with IRs that vary by sex and racial/ethnic group. Cutaneous appendageal carcinoma IRs are increasing in the United States, especially for sebaceous carcinoma, perhaps related to improved recognition and classification, but factors such as UV exposure and immunosuppression may also play a role.

Abstract 877: Impact of histology and gender on lung cancer survival: a population based study

Abstract Purpose: The magnitude of the lung cancer epidemic combined with a change in proportion of gender and histological subtypes underscore the need to identify survival trends with a focus on underlying gender and histology variations as to better target prevention, screening, research and treatment efforts. Materials and Methods: We present complete national data on 40,118 lung cancer cases prospectively collected in The Cancer Registry of Norway the last 20 years (1988-2007). One and 5-year overall relative survival rates (RSR) were computed with 95% confidence intervals (CI) for each of the four successive 5-year periods of diagnosis stratified by gender, histological subgroups, age and stage. Results: A significant increase in overall 5-year RSR from the first to last 5-year period was observed for both men and women, in women from 10.1% (95% CI: 8.8% − 11.4%) to 15.4% (95% CI: 14% − 16.9%), and in men from 7.9% (95% CI: 7.1% − 8.7%) to 11.6% (95% CI: 10.5% − 12.8%). Five-year RSR were significantly higher for women than for men in all periods. Also 1-year RSR increased significantly, in women from 30.6% (95% CI: 28.7% − 32.5%) in 1988-1992 to 40.9% (95% CI: 39.5% − 42.4) in 2003-2007. In men, the corresponding rates were 28.2% (95% CI: 27%-29.4%) and 35.3% (95% CI: 34.2%-36.5%), respectively. Five-year RSR were lowest in patients diagnosed with small cell carcinoma, with no significant survival improvement over time in either gender, whereas in adenocarcinoma in women, and squamous cell carcinomas in both genders long-term relative survival rates improved significantly. Women diagnosed with adenocarcinoma had significantly higher 5-year RSR compared to men the three last 5-year periods studied. This gender difference was not significant in other histological subtypes. In both men and women, increasing age was associated with decreasing 1- and 5-year RSR. In women, a significant improvement in 5-year RSR was observed in all age groups from 50-79 years over the 20-year period. Women with localized disease at time of diagnosis had significantly better 5-year relative survival compared to men with localized disease throughout the period studied. In 2003-2007, 5-year RSR for localized disease were 51.8% (95% CI: 46.5%-56.8%) in women and 40.9% (95% CI: 36.1%-45.9%) in men. Conclusion: These complete national data highlight important prognostic characteristics of the lung cancer epidemic in Norway that presumably can be extrapolated to most developed countries. Improvements in short-term survival rates and modest but statistically significant improvements in long-term survival rates are encouraging; however long-time survival still remains poor. The apparent gender differences in survival should be a focus of further research. Note: This abstract was not presented at the AACR 101st Annual Meeting 2010 because the presenter was unable to attend. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 877.

Cancer Incidence and Survival in Metro Manila and Rizal Province, Philippines

The database of two population-based cancer registries (Philippine Cancer Society-Manila Cancer Registry and Department of Health-Rizal Cancer Registry) was used to generate age-standardized incidence rates of cancer during 1980-2002. Five-year relative survival rates were obtained for incident cases from 1993 to 2002 using a period analysis method. Overall incidence had increased in both males and females. Among males, lung cancer was the leading cancer and reached a peak in 1988-92. Colorectal and prostate cancers showed rising trends and became more common than liver cancer, with stable incidence over time. Stomach cancer incidence fell steeply. Among females, there was a steady increase in incidence of breast cancer. There was a slight decrease in the incidence of the second common cancer, cervical cancer, and colorectal cancer became equally common. Lung cancer incidence in females also reached a peak by 1998-2002 and then slightly decreased. Oral cavity cancer decreased strongly in the last period. In general, survival rates among Philippine residents were one-third lower than among Filipino-Americans and Whites in the USA especially in cancer sites wherein effective early detection methods may be available such as breast, cervix, colorectal and thyroid cancers. Survival was also lower in Philippine leukemia cases, a disease wherein effective treatment is proven in some types but is quite expensive. Lifestyle factors such as smoking, unhealthy diet, physical inactivity, and human papillomavirus and hepatitis B virus infections were associated with some incidence patterns. Late stage at diagnosis was largely responsible for low survival.

Incidence, Patterns of Failure, and Prognosis of Perforated Colorectal Cancers in a Well-Defined Population

Few population-based studies investigate perforated colorectal cancers. This study was designed to compare the epidemiologic characteristics of perforated CRC with those of uncomplicated CRC and to determine patterns of failure and prognosis in a well-defined French population. Between 1976 and 2000, 89 patients who received an emergency operation caused by perforation and 5,462 who underwent elective surgery were registered in the digestive cancer registry of Burgundy (France). Perforated colorectal cancers represented 1.6 percent of registered colorectal cancers. The five-year cumulative local recurrence rate was higher for perforated (15.7 percent) than for uncomplicated cancers (7.8 percent; P = 0.021), as well as for the peritoneal carcinomatosis rate (respectively 13.8 and 6.3 percent; P = 0.036). In multivariate analysis, perforation was an independent risk factor for local recurrence or peritoneal carcinomatosis (odds ratio, 2.17; P = 0.004). Operative mortality was higher among perforated cancers (20.2 percent) than after elective surgery (6.6 percent, P < 0.001). The five-year relative survival rates were 37 percent after emergency surgery and 49.2 percent after elective surgery (P = 0.036). After adjustment for sex, stage, and age, perforation remained significantly associated with a poor prognosis. After exclusion of operative mortality, perforation was no more significant. Perforation is a rare complication of colorectal cancer. The prognosis is poor because of high operative mortality and high risk of local recurrence and peritoneal carcinomatosis.

Childhood and adolescent cancer survival in the US by race and ethnicity for the diagnostic period 1975‐1999

Survival trends provide a measure of improvement in detection and treatment over time. In the current study, updated childhood and adolescent cancer survival statistics are presented, overall and among demographic subgroups, including Hispanics, for whom to the authors' knowledge national rates have not been previously reported. These results extend those provided by the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program in their detail and interpretation. Survival trends of primary cancers in children and adolescents (ages birth to 19 years) were evaluated using SEER 9 data. Five-year and 10-year relative survival rates across 5-year (1975-1979, 1985-1989, and 1995-1999) and 10-year (1975-1984 and 1985-1994) cohorts were compared via Z-tests. Annual percent change (APC) in survival was computed via weighted least-squares regression. Rates in Hispanic children and adolescents were compared with those in non-Hispanic whites and blacks (SEER 13, 1995-1999). Five-year survival rates increased significantly overall (1975-1979: 63% vs 1995-1999: 79%; P< .0001) and for nearly all histologic types examined; increases were greatest for ependymoma (+37%; P< .0001) and non-Hodgkin lymphoma (+34%; P< .0001). Hispanic children and adolescents had somewhat poorer 5-year rates than non-Hispanic whites overall (74% vs 81%; P< .0001) and for Ewing sarcoma, leukemia, central nervous system tumors, and melanoma. Ten-year rates also increased significantly overall (1975-1984: 61% vs 1985-1994: 72%; P< .0001) and for a majority of cancer types. The largest improvements were noted for acute lymphoblastic leukemia (+19%; P< .0001) and non-Hodgkin lymphoma (+19%; P< .0001). Observed trends reinforce the need for resources devoted to advancing treatment modalities, reducing disparities among racial/ethnic groups and adolescents, and providing long-term care of survivors.

Health Status, Health Care and Inequality: Canada vs. the U.S.

It is often alleged that Canada's publicly-funded, single payer health care system, delivers better health outcomes, and distributes health resources more fairly than the mainly private U.S. multi-payer system. Our findings contradict these allegations. Differences between the U.S. and Canada in infant mortality and life expectancy --the two indicators most commonly used as evidence of better health outcomes in Canada—cannot be attributed to differences in the effectiveness of the two health care systems because they are strongly influenced by differences in cultural and behavioral factors such as the relatively high U.S. incidence of obesity and of accidents and homicides. Moreover, direct measures of the effectiveness of medical care, show that five-year relative survival rates for individuals diagnosed with various types of cancer are higher in the U.S. than in Canada as are infant survival rates of low-birth weight babies. These successes are consistent with the greater U.S. availability of high level technology, higher rates of screening for cancers, and higher treatment rates of the chronically ill. The need to ration when care is delivered "free" ultimately leads to long waits. Waiting times for medical services are a major problem in Canada and a source of unmet needs. In the U.S. costs are more often cited as a source of unmet needs. Nonetheless, with respect to the issue of inequality, we find that the health-income gradient is at least as prominent in Canada as it is in the U.S. When asked about satisfaction with health services and the ranking of the quality of services recently received, more U.S. residents than Canadians respond that they are fully satisfied and rank quality of care as excellent. To address these issues we use the Joint Canada/ U.S. Survey of Health (JCUSH) along with other data sources.

Tumour location is a prognostic factor for survival in colonic cancer patients

To evaluate survival and prognostic factors in a consecutive series of colon cancer patients from a defined city population in Norway. All patients with adenocarcinoma of the colon diagnosed between 1993 and 2000 were registered prospectively. Five-year actuarial survival and 5-year relative survival rates were calculated. Cox regression analyses were used to study the effect of prognostic factors on survival. In the study period 627 patients were admitted. Overall 5-year relative survival was 50% in females and 52% in males. Five-year relative survival in 410 (65%) patients operated with curative intent, was 74% for females and 79% for males. Tumour location in the transverse colon, splenic flexure and descending colon (OR = 1.8), emergency operation (OR = 1.7), TNM stage (OR = 1.8-2.9), blood transfusion of more than two units (OR = 1.8) and age (OR = 4.0-7.1) were independent negative prognostic factors. Colon cancer located in the transverse and descending colon is associated with poor prognosis. Comparison of results from different centres is difficult due to selection and classification differences, and different methods used for calculation of survival.

Omission of radiotherapy after breast conserving surgery among elderly women with favorable prognosis tumors

9034 Background: Adjuvant radiotherapy after breast-conserving surgery is a standard therapy for invasive breast carcinoma. Controversy exists regarding the benefit of adjuvant radiotherapy for elderly women with favorable prognosis tumors. Methods: Using data from the Surveillance Epidemiology and End Results (SEER) registry, data were analyzed for 28,808 women ages = 65 years, with stage I and II, who underwent breast conservation therapy between 1998 and 2002. Relative survival rates (observed survival/expected survival) were calculated using Kaplan-Meier method for women who underwent radiotherapy and those for whom radiotherapy was omitted. Results: Among women = 65 years with stage I breast cancer who underwent breast conserving surgery (n = 20,400), 71.7% received adjuvant radiotherapy. Among those with stage II breast cancer (n = 8,408), 66.0% received adjuvant radiotherapy. Five-year relative survival rates among stage I patients were 1.000 (95% CI: 0.990, 1.010) for those receiving adjuvant radiotherapy, and 0.959 (95% CI: 0.932, 0.986) for those without adjuvant radiotherapy. Among stage II patients, the 5-year survival rates were 0.998 (95% CI: 0.978, 1.018) for those receiving adjuvant radiotherapy, and 0.832 (95% CI: 0.791, 0.873) for those without adjuvant radiotherapy. Conclusions: Adjuvant radiotherapy following breast conserving surgery may be safely omitted for elderly women with stage I breast carcinoma, especially for women ages 85–94 years. [Table: see text] No significant financial relationships to disclose.

Quantitative exploration of possible reasons for the recent improvement in breast cancer survival

Breast cancer mortality has been declining in many countries including Canada because of improvements in survival. This study attempts to explain observed trends in breast cancer survival with special attention given to the role of improvements in early detection and treatment. This study is based on 4,312 women diagnosed with primary invasive breast carcinoma treated in a Canadian breast center between 1976 and 2000 and followed to the end of 2001. Observed and relative survival rates were calculated. Multivariate relative survival regression models were used to assess trends in breast cancer survival over the study period. The proportion of women with small tumors (< or = 10 mm) was higher in late 1990s, while that of women with regional involvement was lower compared to earlier periods. Adjuvant chemotherapy or endocrine therapy use increased steadily from 6.6% to 84.0% during the study period. Five-year relative survival rates ranged between 82.1% and 83.7% between 1976 and 1990, and increased thereafter to reach 87.6% in 1991-95, and 92.1% in 1996-2000. During the first five years after diagnosis, women diagnosed in 1991-95 and 1996-2000 experienced a reduction in breast cancer mortality of 28% (Relative Risk (RR)= 0.72; 95% CI: 0.59-0.89) and 49% (RR = 0.51; 95% CI: 0.39-0.68) respectively compared to women diagnosed in 1976-90. Improvement in breast cancer survival in 1990's could not be explained by characteristics of women, biology of the tumor, advancements in early detection and type of initial treatments. A substantial increase in breast cancer survival was observed in the 1990s but the reasons for this improvement remain elusive. Better knowledge of these reasons could help not only to further reduce the burden related to breast cancer but also the burden related to other major cancer sites.

Cancer Survival in Korea 1993-2002: A Population-Based Study

Population-based survival reflect the average prognosis of unselected patients with a variety of natural histories as well as treatment patterns and are also useful for evaluating effectiveness and efficiency of cancer-directed health services in a given region. Although survival data have been reported based on hospital data, the survival data from population-based registry have been rarely reported in Korea. Based on the Korea National Cancer Incidence Database, we report the results from survival analysis for cancer patients diagnosed during 1993-2002 and followed up until 31 December 2005 at primary cancer sites. The five-year relative survival rates (RSR) were calculated using the Ederer II method. The Kaplan-Meier method was used to estimate median survival and the 95% confidence intervals. In males, the five-year RSR for all cancers was 32.5% during 1993-1997 and was 37.8% during 1998-2002. In females, the five-year RSR for all cancers was 53.7% during 1993-1997 and was 57.0% during 1998-2002. The largest improvement in survival was shown in prostate cancer in males and breast and stomach cancer in females. The median survival durations were 16.3 months in males and 81.6 months in females. This result will be useful for evaluation of cancer treatment outcomes in Korea.

Disparities in oral and pharyngeal cancer incidence, mortality and survival among black and white Americans

The authors present statistics and long-term trends in oral and pharyngeal cancer (OPC) incidence, mortality and survival among U.S. blacks and whites. The authors obtained incidence, mortality and five-year relative survival rates via the Surveillance, Epidemiology and End Results (SEER) Program Web site. Current rates and time trends for 1975 through 2002 are presented. From 1975 through 2002, age-adjusted incidence rates (AAIRs) and mortality rates (AAMRs) were higher among males than among females and highest for black males. By the mid-1980s, incidence and mortality rates were declining for black and white males and females; however, disparities persisted. During the period 1998-2002, AAIRs were more than 20 percent higher for black males compared with white males, while the difference in rates for black and white females was small. AAMRs were 82 percent higher for black males compared with white males, but rates were similar for black and white females. Five-year relative survival rates for patients diagnosed during the period 1995-2001 were higher for whites than for blacks and lowest for black males. Despite recent declines in OPC incidence and mortality rates, disparities persist. Disparities in survival also exist. Black males bear the brunt of these disparities. Dentists can aid in reducing OPC incidence and mortality by assisting patients in the prevention and cessation of tobacco use and alcohol abuse. Five-year relative survival may be improved through early detection.

Ovarian Cancer Screening: A Look at the Evidence

In 2005, more than 22,000 American women were diagnosed with ovarian cancer and 16,000 women died from the disease. The five-year relative survival rate for stage III and IV disease is 31%, and the five-year relative survival rate for stage I is 95%. Early diagnosis should lower the fatality rate. Unfortunately, early diagnosis is difficult because of the physically inaccessible location of the ovaries, the lack of specific symptoms in early disease, and the limited understanding of ovarian oncogenesis. Screening tests for ovarian cancer need high sensitivity and specificity to be useful because of the low prevalence of undiagnosed ovarian cancer. Because currently available screening tests do not achieve high levels of sensitivity and specificity, screening is not recommended for the general population. The theoretical advantage of screening is much higher for women at high risk (such as those with a strong family history of ovarian cancer and those with BRCA 1 or BRCA 2 mutations). However, even for women at high risk, no prospective studies have shown benefits of screening. The public health challenge is that 90% of ovarian cancer occurs in women who are not in an identifiable high-risk group, and most women are diagnosed with advanced-stage disease. Currently available tests (CA-125, transvaginal ultrasound, or a combination of both) lack the sensitivity and specificity to be useful in screening the general population. Ongoing clinical trials are assessing whether new tumor markers, including those generated by proteomic and genomic studies, will prove useful.

Survival Patterns for the Top Four Cancers in Canada: The Effects of Age, Region and Period

This study examined the variations in survival rates (1989-1991) and the trends (1969-1991), by sex, age and province, for patients diagnosed with breast, colorectal, lung or prostate cancer in Canada and compared the Canadian rates with those of nine American SEER registries. Five-year age-standardized relative survival rates (ASRs) were calculated, and the trends were estimated from variance-weighted linear regression of the ASRs for five periods of diagnosis (1969-1973, 1974-1978, 1979-1983, 1984-1988 and 1989-1991). In 1989-1991, the ASR varied among provinces for each cancer except female colorectal cancer. The lowest survival rates were observed in the youngest patients (15-44) for breast and prostate cancers, and in the oldest patients (75-99) of both sexes for lung and colorectal cancers. Over the five periods, a major trend toward improved survival was observed for breast, prostate and colorectal cancers (P<0.008), whereas no changes were seen for lung cancer. The ASRs in the western region were higher than in the Atlantic region over time (P<0.02) for each cancer. From the third period onward, the ASRs for Canadian patients with lung cancer were similar to those for the US patients and lower than for Canadian patients with breast, prostate or colorectal cancer. The observed increases in ASR for breast and prostate cancer are likely due to the increased use of screenings and the improved treatment modalities.