Stomach Cancer Mortality Research Articles

Lack of significant associations between single nucleotide polymorphisms in LPAL2-LPA genetic region and all cancer incidence and mortality in Japanese population: The Japan public health center-based prospective study

BackgroundHigh lipoprotein (a) level is an established cardiovascular risk, but its association with non-cardiovascular diseases, especially cancer, is controversial. Serum lipoprotein (a) levels vary widely by genetic backgrounds and are largely determined by the genetic variations of apolipoprotein (a) gene, LPA. In this study, we investigate the association between SNPs in LPA region and cancer incidence and mortality in Japanese. MethodsA genetic cohort study was conducted utilizing the data from 9923 participants in the Japan Public Health Center-based Prospective Study (JPHC Study). Twenty-five SNPs in the LPAL2-LPA region were selected from the genome-wide genotyped data. Cox regression analysis adjusted for the covariates and competing risks of death from other causes, were used to estimate the relative risk (hazard ratios (HR) with 95% confidence intervals (CI)) of overall and site-specific cancer incidence and mortality, for each SNP. ResultsNo significant association was found between SNPs in the LPAL2-LPA region and cancer incidence or mortality (overall/site-specific cancer). In men, however, HRs for stomach cancer incidence of 18SNPs were estimated higher than 1.5 (e.g., 2.15 for rs13202636, model free, 95%CI: 1.28–3.62) and those for stomach cancer mortality of 2SNPs (rs9365171, rs1367211) were estimated 2.13 (recessive, 95%CI:1.04–4.37) and 1.61 (additive, 95%CI: 1.00–2.59). Additionally, the minor allele for SNP rs3798220 showed increased death risk from colorectal cancer (CRC) in men (HR: 3.29, 95% CI:1.59 – 6.81) and decreased CRC incidence risk in women (HR: 0.46, 95%CI: 0.22–0.94). Minor allele carrier of any of 4SNPs could have risk of prostate cancer incidence (e.g., rs9365171 dominant, HR: 1.71, 95%CI: 1.06–2.77). ConclusionsNone of the 25 SNPs in the LPAL2-LPA region was found to be significantly associated with cancer incidence or mortality. Considering the possible association between SNPs in LPAL2-LPA region and colorectal, prostate and stomach cancer incidence or mortality, further analysis using different cohorts is warranted.

Associations between serum high-density lipoprotein cholesterol levels and cause-specific mortality in a general population of 345000 men and women aged 20-79 years.

Benefits of elevated high-density lipoprotein cholesterol (HDL-C) levels are challenged by reports demonstrating U-shaped relations between HDL-C levels and all-cause mortality; the association with cause-specific mortality is less studied. A total of 344 556 individuals (20-79 years, 52 % women) recruited from population-based health screening during 1985-2003 were followed until the end of 2018 for all-cause and cause-specific mortality by serum HDL-C level at inclusion of <30, 30-39, 40-49, 50-59, 60-69, 70-79, 80-89, 90-99 and >99 mg/dl (< 0.78, 0.78-1.01, 1.04-1.27, 1.30-1.53, 1.55-1.79, 1.81-2.04, 2.07-2.31, 2.33-2.56, >2.56 mmol/L). Hazard ratios (HRs) were adjusted for sex, age, calendar period, smoking, total cholesterol, triglycerides, systolic blood pressure, physical activity, educational length, body mass index and ill health. During a mean follow-up of 22 years, 69505 individuals died. There were U-shaped associations between HDL-C levels and all-cause, cancer and non-cardiovascular disease/non-cancer mortality (non-CVD/non-cancer), whereas for CVD there was increased risk of death only at lower levels. With HDL-C stratum 50-59 mg/dl (1.30-1.53 mmol/L) as reference, HRs [95% confidence intervals (CIs)] for levels >99 mg/dl (>2.56 mmol/L) were 1.32 (1.21-1.43), 1.05 (0.89-1.24), 1.26 (1.09-1.46) and 1.68 (1.48-1.90) for all-cause, CVD, cancer and non-CVD/non-cancer mortality, respectively. For HDL-C levels <30 mg/dl (0.78 mmol/L), the corresponding HRs (95% CIs) were 1.30 (1.24-1.36), 1.55 (1.44-1.67), 1.14 (1.05-1.23) and 1.19 (1.10-1.29). The mortality from alcoholic liver disease, cancers of mouth-oesophagus-liver, chronic liver diseases, chronic obstructive pulmonary disease, accidents and diabetes increased distinctly with increasing HDL-C above the reference level. HDL-C levels lower than the reference level were mainly associated with increased mortality of ischaemic heart disease (IHD), other CVDs, stomach cancer and diabetes. Higher HDL-C levels were associated with increased mortality risk of several diseases which also have been associated with heavy drinking, and lower HDL-C levels were associated with increased mortality from IHD, other CVDs, gastric cancer and diabetes.

Stomach cancer burden in China: Epidemiology and prevention.

In 2020, stomach cancer was the fifth most commonly diagnosed cancer and the fourth leading cause of cancer-related death worldwide. Due to the relatively huge population base and the poor survival rate, stomach cancer is still a threat in China, and accounts for nearly half of the cases worldwide. Fortunately, in China, the incidence and mortality rates of stomach cancer presented a declining trend owing to the change of individual life styles and the persistent efforts to prevent stomach cancer from the governments at all levels. Helicobacter pylori (H. pylori) infection, poor eating habits, smoking, history of gastrointestinal disorders, and family history of stomach cancer are the main risk factors for stomach cancer in China. As a result, by taking risk factors for stomach cancer into account, specific preventive measures, such as eradicating H. pylori and implementing stomach cancer screening projects, should be taken to better prevent and decrease the burden of stomach cancer.

Cancer situation in China: what does the China cancer map indicate from the first national death survey to the latest cancer registration?

Over the past four decades, the Chinese government has conducted three surveys on the distribution of causes of death and built cancer registration. In order to shine a new light on better cancer prevention strategies in China, we evaluated the profile of cancer mortality over the forty years and analyzed the policies that have been implemented. We described spatial and temporal changes in both cancer mortality and the ranking of major cancer types in China based on the data collected from three national surveys during 1973-1975, 1990-1992, 2004-2005, and the latest cancer registration data published by National Central Cancer Registry of China. The mortality data were compared after conversion to age-standardized mortality rates based on the world standard population (Segi's population). The geographical distribution characteristics were explored by marking hot spots of different cancers on the map of China. From 1973 to 2016, China witnessed an evident decrease in mortality rate of stomach, esophageal, and cervical cancer, while a gradual increase was recorded in lung, colorectal, and female breast cancer. A slight decrease of mortality rate has been observed in liver cancer since 2004. Lung and liver cancer, however, have become the top two leading causes of cancer death for the last twenty years. From the three national surveys, similar profiles of leading causes of cancer death were observed among both urban and rural areas. Lower mortality rates from esophageal and stomach cancer, however, have been demonstrated in urban than in rural areas. Rural areas had similar mortality rates of the five leading causes of cancer death with the small urban areas in 1973-1975. Additionally, rural areas in 2016 also had approximate mortality rates of the five leading causes with urban areas in 2004-2005. Moreover, stomach, esophageal, and liver cancer showed specific geographical distributions. Although mortality rates have decreased at most of the hotspots of these cancers, they were still higher than the national average levels during the same time periods. Building up a strong primary public health system especially among rural areas may be one critical step to reduce cancer burden in China.

Association between trends of mortality and incidence, survival and stage at diagnosis for six digestive and respiratory cancers in United States (2009-2013).

A decrease in cancer mortality has been reported in the USA, possibly due to decreased incidence, downstaging and improved survival. The aim of the present study is to estimate the contribution of these factors on the trend in cancer mortality. Data on incidence, mortality, stage at diagnosis, and overall and stage-specific survival for six common digestive and respiratory cancers (esophagus, stomach, colorectal, liver, pancreas and lung) during 2009-2013 in the USA from the surveillance, epidemiology and end results (SEER) program, was analyzed using generalized linear models separately among men and women. Our study showed a decrease in mortality for esophageal (-0.09/100 000/year and -0.03/100 000/year), stomach (-0.11/100 000/year and -0.05/100 000/year), colorectal (-0.45/100 000/year and -0.29/100 000/year) and lung cancer (-1.89/100 000/year in men and -0.78/100 000/year in women) in men and women, respectively: for all of them, except lung cancer in women, there was a decrease in the incidence of comparable or greater magnitude; stage distribution and survival also contributed to the decrease in mortality for lung and colorectal cancer. Mortality from pancreatic cancer was stable: an increase in incidence was counterbalanced by an improvement in survival. Mortality from liver cancer increased, driven by an increase in mortality that was not offset by favorable trends in stage distribution and survival. Trends in mortality were primarily affected by changes in incidence; an increase in the proportion of local stage at diagnosis and improved survival, although evident for some cancers, played a lesser role in mortality trends.

The global, regional and national burden of stomach cancer and its attributable risk factors from 1990 to 2019

We aimed to estimate the incidence, mortality, and disability-adjusted life-years (DALYs) of stomach cancer at the global, regional, and national levels. Stomach cancer resulted in 1.3 million (1.2–1.4 million) incident cases, 9.5 hundred thousand (8.7–10.4 hundred thousand) deaths, and 22.2 million (20.3–24.1 million) DALYs in 2019. The age-standardized incidence rate, death rate and DALY rate were 15.6 (14.1–17.2), 11.9 (10.8–12.8), and 268.4 (245.5–290.6) per 100,000 person-years, respectively. Between 1990 and 2019, the global age-standardized incidence rate, death rate, and DALY rate decreased by − 30.5% (− 36.7 to − 22.9), − 41.9% (− 47.2 to − 36.3), and − 45.6% (− 50.8 to − 39.8), respectively. In 2019, most of the global numbers of incidence, death and DALYs were higher among males than females. A considerable burden of stomach cancer was attributable to smoking and a high-sodium diet. Although the global age-standardized incidence and death rates have decreased, continued growth in absolute numbers in some regions, especially in East Asia, poses a major global public health challenge. To address this, public health responses should be tailored to fit each country’s unique situation. Primary and secondary prevention strategies with increased effectiveness are required to reduce the incidence and mortality of stomach cancer, particularly in populations with a high disease burden.

Evolution of stomach cancer mortality in Brazil and its regions, by sex, 2011-2015

To describe the distribution pattern of the stomach cancer mortality rate in Brazil and its regions, according to sex, between the year 2011 and 2015. Mortality values were described by the DATASUS atlas mortality and stratified by sex in the year 2011 and 2015 and analyzed by the Two-Way Anova test. It was observed that there was a higher mortality incidence in the Southeast and lower in the Midwest for both sexes. The Northeastern region presented a high number of cases standing out in relation to the North, Center-west and South regions (P &lt;0.05). Regarding the incidence of male mortality, the North and Northeast regions showed continuous growth over the 5 years studied in this study. On the other hand, the Central-West, South and Southeast regions showed small variations, with 2013 being the most affected in the Midwest and Southeast and 2012 in the South. However, these variations were not significant in terms of statistical test. It is important to know these mortality rates in the regions to identify and define priority regions for early interventions that increase survival and reduce mortality in these populations.

Changing trend of incidence and mortality of stomach cancer during 2010-2016 in Henan Province, China

Objective: To estimate stomach cancer incidence and mortality in Henan, 2016 and analyze the trend of stomach cancer incidence and mortality from 2010 to 2016. Methods: Stomach cancer related data in 2016 was extracted from Henan cancer registration and follow-up system. All data were qualified in validity, reliability and completeness according to the Guideline on Cancer Registration in China and International Agency for Research on Cancer (IARC/IACR). The incidence and mortality of stomach cancer were estimated by areas, gender and age based on the quality data and the registered population data of Henan province in 2016. The epidemic trend of stomach cancer was also been evaluated based on the age-standardized incidence and mortality by Chinese population (ASR China) from 2010 to 2016. Results: In 2016, the estimated incident cases of stomach cancer were 44 311. The incidence was 41.07/100 000, ASR China was 30.17/100 000, ASR by world population (ASR world) was 30.36/100 000, and the cumulative incidence rate was 3.84%. The incidences of male and female were 55.65/100 000 and 25.35/100 000, respectively. Meanwhile, 32 927 people died of stomach cancer in Henan. The mortality was 30.52/100 000, ASR China was 21.45/100 000, ASR world was 21.54/100 000, and the cumulative mortality was 2.53%. From 2010 to 2016, both the ASR China for incidence and mortality of stomach cancer in Henan showed a steady downward trend. In rural, the ASR China for incidence and mortality decreased rapidly, while the stable trend was observed in urban. Nevertheless, the incidence and mortality of stomach cancer in rural were still higher than those in urban. Conclusions: The incidence and mortality of stomach cancer in Henan province showed steadily declining trend from 2010 to 2016, and the geographical distribution difference between rural and urban areas was gradually narrowing. However, the disease burden was still high in 2016.

Epidemic characteristics of stomach cancer mortality in Qidong during 1972-2016

Objective: To describe the epidemic characteristics of stomach cancer mortality in Qidong between 1972 and 2016. Methods: The cancer registry data of stomach cancer death and population during 1972-2016 in Qidong was collected. The mortality of crude rate (CR), China age-standardized rate (CASR), world age-standardized rate (WASR), 35-64 years truncated rate, 0-74 years cumulative rate, cumulative risk, percentage change (PC), annual percent change (APC) were calculated. Results: During 1972-2016, a total of 15 863 (male: 10 114, female: 5 749) deaths occurred attributed to stomach cancer, accounting for 16.04% of all cancers, with CR of 31.37/100 000 (CASR: 12.97/100 000, WASR: 21.39/100 000). The truncated rate of 35-64, cumulative rate of 0-74, and cumulative risk were 28.86/100 000, 2.54%, and 2.51%, respectively. For male, the CR, CASR, WASR were 40.53/100 000, 17.98/100 000, 30.13/100 000, respectively, and for female, the CR, CASR, WASR were 22.45/100 000, 8.52/100 000, 13.92/100 000, respectively. Age-specific mortality analysis showed that the mortality of each age group under 25-year-old group was less than 1/100 000. The CR increased with age. The 50-year-old group reached and exceeded the average mortality of the population, and more than 80-year-old group reached the peak of death. During 1972-2016 in Qidong, The PCs in CR, CASR, and WASR of stomach cancer were 55.43%, -52.02%, -43.60%. The APC were 0.54%, -2.30%, -2.08%, respectively. Period mortality analysis showed that except for the 75-year-old group, the mortality of stomach cancer decreased significantly. Conclusions: The crude mortality of stomach cancer increases slightly in Qidong, while the CASR and WASR decrease significantly. However, stomach cancer is still one of the malignant tumors that most affect health and seriously threat lives.

Stomach cancer incidence and mortality in Greater Cuiabá, Mato Grosso, Brazil, 2000-2016.

To analyze the incidence and mortality trend of stomach cancer in the Greater Cuiabá, in the state of Mato Grosso, Brazil, from 2000 to 2016. The incidence information was obtained from the Population-Based Cancer Registry, and the mortality information from the Mortality Information System. Crude and standardized rates were calculated using the direct method, with the world population as reference. The trends were estimated using the Joinpoint regression method, according to sex and age group, and evaluated through the Annual Percent Change (APC) and the Average Annual Percent Change (AAPC). The Joinpoint Regression Program software, version 4.9.0.0, was used. There was a decreasing incidence trend of stomach cancer in males (AAPC=-5.2; 95% confidence interval - 95%CI -7.7--2.6), in men aged 60 to 69 years (AAPC=-3.7; 95%CI -5.6--1.8) and in 70-79 years (AAPC=-3.7; 95%CI -5.6--1.8), as well as in women aged 50 to 59 years (AAPC=-5.2; 95%CI -7.8--2.6) and 80 years or older (AAPC=-5.2; 95%IC -7.8--2.6). The mortality initially increased in women aged 60-69 years (AAPC=28.4; 95%CI 9.7-50.4), decreased for 80 years or older (AAPC=-26.4; 95%CI -38.0--12.6) and stable for the other age groups and males. A decreasing incidence trend of stomach cancer was found among men and, when analyzed by age, among elderly males and adults and elderly females, as well as a stability in the mortality, with an initial variation in elderly women. The production of regional information supports the planning of local policies aimed at reducing the burden of disease and deaths, considering unequal risk conditions and access to health services.

Global Burden and Trends in Incidence, Mortality, and Disability of Stomach Cancer From 1990 to 2017.

INTRODUCTION:Stomach cancer is a serious global public health problem. The current burden of stomach cancer and its trends across time and location need to be understood to develop effective preventive strategies.METHODS:Data were obtained from the Global Burden of Disease study. The burden of stomach cancer and variations in time and geographical regions were assessed according to the age-standardized rate and estimated annual percentage change (EAPC) of the incidence and mortality rate between 1991 and 2017. We also investigated the associations between the relevant rates and sociodemographic index (SDI).RESULTS:Overall, the age-standardized incidence rate (EAPC = −1.36, 95% confidence interval [CI]: −1.47 to −1.25), age-standardized mortality rate (EAPC = −2.2, 95% CI: −2.29 to −2.12), and age-standardized disability-adjusted life years rate (EAPC = −2.52, 95% CI: −2.63 to −2.43) decreased worldwide from 1990 to 2017. This trend varied across different countries and regions and according to sex and age. SDI had a significant negative correlation with the age-standardized mortality rate (P < 0.01, r = −0.28) and age-standardized disability-adjusted life years rate (P < 0.01, r = −0.31). Similar negative correlations were observed between SDI and the EAPC.DISCUSSION:The observed correlation between SDI and disease burden suggests that strategically implementing the screening and eradication of Helicobacter pylori, improving the medical level in countries with low SDI, and promoting the implementation of tobacco cessation policies would help reduce the disease burden of stomach cancer.

International comparison of trends in cancer mortality: Japan has fallen behind in screening-related cancers.

While the age-standardized mortality rate in Japan is decreasing for all cancers as a whole, this is not the case for some major site-specific cancers. We descriptively compared trends in all-cancer and site-specific cancer mortality in Japan and selected countries. Data on age-standardized cancer mortality rates in six countries (Japan, the USA, the UK, Canada, Australia and the Republic of Korea) in 1980–2016 were obtained from the World Health Organization mortality database. While stomach and liver cancer mortality rates in Japan and Korea were initially much higher than those in non-Asian countries, they have rapidly decreased over the long term. By contrast, colorectal, pancreatic and cervical cancer mortality rates in Japan, which were initially lower than those in other countries, have increased such that they are now similar or higher than the rates in non-Asian countries. For male lung cancer, Japan’s initially lower mortality rate is now comparable to that in non-Asian countries as a result of slower decline. Meanwhile, the mortality rate of female breast cancer in Japan and Korea has increased and is nearing the rates observed in non-Asian countries, which by contrast have shown a steady decrease. Thus, while Japan has been successful in reducing the burden of stomach and liver cancers, it is falling behind in reducing the mortality rate of screening-related cancers such as colorectal, female breast and cervical cancers. Control measures for these cancers need to be strengthened.

Are the Temporal Trends of Stomach Cancer Mortality in Brazil Similar to the Low, Middle, and High-Income Countries?

Stomach cancer is the fourth most common malignant tumor in the world, and although numbers have fallen in recent years, mortality from this cause is still high (1–3). In Brazil, some studies have shown a reduction in mortality from stomach cancer since the 1980s (4, 5), which can be attributed to improved eating habits, food preservation, and treatment of Helicobacter pylori infection (6, 7). In addition, there were significant advances related to socioeconomic development and the reduction of inequalities and socioeconomic inequities, which improved the population's access to health care and reduced the morbidity and mortality of diseases such as breast cancer (8–10). Brazil is a middle-income country characterized by great internal heterogeneity (11, 12). It is notorious that poverty in Brazil has a location (13) and, in terms of disparities, the country has a very striking feature that is the regional inequalities, where the north and northeast regions have the worst indicators. The central region has intermediate rates, and the south and southeast are the best conditions, regardless of the socioeconomic indicator being evaluated (14). These social inequalities in the country still today directly reflect on health inequality, explaining the unfavorable scenarios for the north and northeast, and a very evident polarization in relation to the south and southeast (15). The country presents regions with different socioeconomic characteristics, which impacts health services, lifestyle, and socio-cultural aspects. In other words, there are developed regions with high technology for cancer-oriented health services and underdeveloped regions that cannot properly treat and diagnose its citizens (16). Thus, considering that Brazil is a country with territorial extension of continental characteristics and high socioeconomic plurality, and that the mortality due to stomach cancer is related to the socioeconomic status of the site, what level of development does the behavior of stomach cancer mortality in Brazil follow? Thus, the aim of this study was to describe the temporal trend of stomach cancer mortality in Brazil from 1990 to 2016, analyzing its behavior in relation to low, middle, and high income countries.

Trends of Stomach Cancer in Central Serbia.

Background and Objectives: Somach cancer is the third most common cause of cancer-related deaths worldwide. The objective of the paper was to analyze the incidence and mortality trends of stomach cancer in Central Serbia in the period between 1999–2017. Materials and Methods: trends and annual percentage change (APC) of the incidence and mortality rate with corresponding 95% confidence intervals (CI) were calculated by joinpoint regression analyses. The optimal number of Joinpoints was identified using the Monte Carlo permutation method. The trend was considered to be significantly increasing (positive change) or decreasing (negative change) when the p-value was below 0.05 (p < 0.05). Results: the total number of new cases was 16,914 (10,873 males and 6041 females) and the total number of mortality cases was 14,790 (9348 in and 5442 in females). Almost one third (30.8%) of new cases were registered in the 60–69-year age group, and new cases were significantly more frequent in males than in females (30.8% vs. 29.02%, p < 0.001). Joinpoint regression analysis showed a significant decrease of incidence trend in females during the 2000–2015 period with APC of −2.13% (95% CI: −3.8 to −0.5, p < 0.001). An insignificant decrease in incidence trend was in males with APC of −0.72% (95% CI: −2.3 to 0.9, p = 0.30). According to the joinpoint analysis, a significant decrease of mortality trends both in males during 2000–2015 with APC of −2.21% (95% CI: −1.6 to −7.5, p ≤ 0.001 and in females, during the same period, with APC of −1.75% (95% CI: −2.9 to −0.6, p < 0.001) was registered. From 2015 to 2017, a significant increase of mortality was registered with APC of 44.5% (95% CI: from 24.2 to −68.1, p ≤ 0.001) in females and in males with APC of 53.15% (95% CI: 13.5 to −106.6, p ≤ 0.001). Conclusion: a significant decrease of stomach cancer incidence trend in females and insignificant decrease of incidence trend in males were determined in Central Serbia. Based on presented results, the mortality trend decreased significantly both in males and in females during 2000–2015, and from 2015 to 2017 we recorded a significant increase in mortality in both sexes. We found significantly more new cases in women than in men in the age group of 40–49, and the mortality of stomach cancer was significantly more frequent among females compared to males in the age groups 30–39, as well as in the 50–59 age group. There is a need for improving recording and registration of new cases of stomach cancer, especially in females. Urgent primary and secondary preventive measures are needed—introducing stomach cancer screening and early detection of premalignant changes. Urgent primary and secondary preventive measures are needed.

Trends and age-period-cohort analysis of upper aerodigestive tract and stomach cancer mortality in Lithuania, 1987–2016

ObjectivesLithuania has among the highest mortality rates for upper aerodigestive tract (UADT) and stomach cancer in Europe. The aim of this study was to analyze trends during the period 1987–2016 in Lithuania, evaluating the effect of birth-cohort, period, and age. Study designObservational time trends study. MethodsData on numbers of deaths and population size by each calendar year in 5-year age groups in 1987–2016 were obtained from the WHO mortality database. Joinpoint regression analysis was used to evaluate changes in time trends. Age-period-cohort analysis was performed to assess age, calendar period of death, and birth-cohort effects. ResultsUADT cancer mortality in men increased between 1987 and 1993, annual percentage change (APC) = 6.6% (95% confidence interval [CI]: 3.8, 9.4), and was stable thereafter, APC = 0.3% (95% CI: 0.0, 0.6). The age-standardized mortality rate (ASMR) was 23.6/100,000 in 2016. In women, rates increased steadily by 1.6% (95% CI: 0.9%, 2.3%) per year from 1987 to 2016, ASMR = 2.3/100,000 in 2016. Age-period-cohort analysis showed statistically significant cohort effects in both sexes. In men, rates peaked in birth-cohorts born around 1952, declined in 1957–1962 birth-cohorts, and fluctuated in later birth-cohorts. In women, rates started rising in 1947 birth cohort and peaked in the 1967 birth cohort. Stomach cancer mortality declined throughout the study period in men by −2.4%, (95% CI: −2.6%, −2.1%) annually, and women by −2.8% (95% CI: −3.1%, −2.4%), ASMR = 16.1/100,000 and 6.0/100,000 in 2016, respectively. Birth-cohort effects were significant in both sexes. Rates decreased in cohorts born around 1920 onwards, but declines in the youngest generations have slowed in men and reversed in women. ConclusionsThe birth-cohort effects in UADT and stomach cancer mortality trends imply that the elevated burden in Lithuania could be reduced by effective strategies targeting known risk factors. Further research in causes of unfavorable trends in younger cohorts is warranted.

Effect of healthcare fragmentation on breast, stomach, and colorectal cancer mortality in Colombia: A measurement estimated through administrative databases.

e18808 Background: Fragmentation in healthcare leads to adverse outcomes in cancer patients. Currently there is no fragmentation measurement that has been acknowledged to reliably assess healthcare fragmentation across different health systems. We aimed to measure cancer healthcare fragmentation through administrative databases in Colombia and to calculate its effect on breast, stomach and colorectal cancer mortality. Methods: We conducted a cohort study based on health administrative databases from 2013 to 2017. We combined data from two Colombian national health databases (Capitation Payment Unit database and Vital Statistics from DANE). We developed an algorithm based on ICD-10 codes and oncological procedures to select incident cases of breast, stomach and colorectal cancer. To measure healthcare fragmentation, we identified the number of providers between the dates of the first and last registered services. For patients who died during observation we adjusted the number of providers for survival time in days, otherwise survival time was set to 31 december, 2017. We categorized fragmentation in quartiles and evaluated its effect on mortality rate by Kaplan Meier estimates. Results: We identified three cohorts of patients based on primary tumor site. Age distribution was similar in stomach and colorectal cancer. Fragmentation measured as a continuous variable has a non-parametric distribution in all cohorts. The median of follow-up time ranged between 2.4 to 4.4 years. All-cause mortality rates were highest in stomach cancer, lowest in breast cancer. When measured as quartiles, fragmentation has a consistent dose-response effect increasing all-cause mortality rates. Conclusions: Healthcare fragmentation can be measured through algorithms applied to administrative databases in Colombia. Fragmentation is a predictor for all-cause mortality across different oncologic populations. This measurement based on real-world national administrative data could be used as an indicator of high-quality oncological healthcare for the Colombian healthcare system.[Table: see text]

Causes of death among women with breast cancer: A follow-up study of 50 481 women with breast cancer in Finland.

Our study aims to assess mortality from causes other than breast cancer among women with breast cancer with focus on indications of joint aetiology. Data on female breast cancer patients were obtained from the Finnish Cancer Registry and their underlying causes of death in 54 categories from the Statistics Finland. Standardised mortality ratios (SMR) and their 95% confidence intervals (CIs) were calculated for 50 481 patients diagnosed between 1971 and 2000 and followed until December 2012, stratified by histology, age at diagnosis and time since diagnosis. The expected numbers of deaths were based on respective mortality rates among the Finnish general population. Hazard ratio (HR) was estimated from Poisson regression model to compare risks of cause of death by histology. 41% of 30 841 deaths were due to causes other than breast cancer. Significant excess mortality was observed for stomach cancer (SMR 1.43, 95% CI 1.26-1.62), circulatory system diseases (SMR 1.17, 95% CI 1.14-1.20) and suicide (SMR 1.51, 95% CI 1.28-1.78). In an age-adjusted analysis, significantly higher relative risk of stomach cancer mortality was observed for lobular vs ductal subtype (HR 2.00, 95% CI 1.32-3.02). Significantly increased SMRs were observed for cancers of respiratory organs among premenopausal women, and for other respiratory system diseases, dementia and Alzheimer disease among postmenopausal women. We conclude that female breast cancer patients are at increased risk of death from causes other than the breast cancer diagnosis including circulatory and respiratory system diseases and cancer of stomach, ovary and respiratory systems. The excess mortality because of different causes varies based on menopausal status and histology. There might be shared aetiological factors between the diagnosis of breast cancer and the causes of death among these patients.

Stomach Cancer Incidence and Mortality Trends among Circumpolar Nations.

Stomach cancer incidence and mortality rates are declining across circumpolar nations, but the burden may not be distributed equally across subpopulations, including Indigenous peoples. Our objective was to examine stomach cancer incidence and mortality trends across circumpolar populations. Cancer incidence and mortality data from 1999-2016 were obtained from the Canadian Cancer Registry, Canadian Vital Statistics, CDC WONDER, NORDCAN, Northwestern Russian cancer registries, and National Cancer Reports. The direct method was used to calculate 10-year rolling age-standardized incidence and mortality rates to the world (WHO 2000-2025) and 2011 Canadian standard populations. Standardized incidence rate ratios (SRR) were calculated. Data were stratified by sex, year, and region. U.S. data were broken down by race [White; American Indian/Alaska Native (AIAN)]. Race data were not available from non-U.S. cancer registries. Most populations showed declining incidence and mortality rates over time. Incidence rates among Greenland males and females, Alaska AIAN males and females, and Northern Canadian both sexes were elevated compared with regional counterparts and remained stable. The largest male SRR was observed among Alaska AIAN versus Alaska Whites [SRR = 3.82; 95% confidence interval (95% CI), 2.71-5.37]. The largest female SRR was observed among Alaska AIAN versus Alaska Whites (SRR = 4.10; 95% CI, 2.62-6.43). Despite stomach cancer incidence and mortality rates declining overall, some northern and Indigenous populations experience elevated and stable incidence and mortality rates. There is a need to address disparities observed among circumpolar subpopulations. Given similarities in incidence, mortality, and risk factor prevalence across circumpolar regions, addressing disparities could benefit from coordinated international action.

Dealing with risk discontinuities to estimate cancer mortality risks when the number of small areas is large

Many statistical models have been developed during the last years to smooth risks in disease mapping. However, most of these modeling approaches do not take possible local discontinuities into consideration or if they do, they are computationally prohibitive or simply do not work when the number of small areas is large. In this paper, we propose a two-step method to deal with discontinuities and to smooth noisy risks in small areas. In a first stage, a novel density-based clustering algorithm is used. In contrast to previous proposals, this algorithm is able to automatically detect the number of spatial clusters, thus providing a single cluster structure. In the second stage, a Bayesian hierarchical spatial model that takes the cluster configuration into account is fitted, which accounts for the discontinuities in disease risk. To evaluate the performance of this new procedure in comparison to previous proposals, a simulation study has been conducted. Results show competitive risk estimates at a much better computational cost. The new methodology is used to analyze stomach cancer mortality data in Spanish municipalities.

An age-period-cohort analysis of mortality rates for stomach, colorectal, liver, and lung cancer among prefectures in Japan, 1999\u20132018

BackgroundAlthough change in the birth cohort effect on cancer mortality rates is known to be highly associated with the decreasing rates of age-standardized cancer mortality rates in Japan, the differences in the trends of cohort effect for representative cancer types among the prefectures remain unknown. This study aimed to investigate the differences in the decreasing rate of cohort effects among the prefectures for representative cancer types using age-period-cohort (APC) analysis.MethodsData on stomach, colorectal, liver, and lung cancer mortality for each prefecture and the population data from 1999 to 2018 were obtained from the Vital Statistics in Japan. Mortality data for individuals aged 50 to 79 years grouped in 5-year increments were used, and corresponding birth cohorts born 1920–1924 through 1964–1978 were used for analysis. We estimated the effects of age, period, and cohort on each type of mortality rate for each prefecture by sex. Then, we calculated the decreasing rates of cohort effects for each prefecture. We also calculated the mortality rate ratio of each prefecture compared with all of Japan for cohorts using the estimates.ResultsAs a result of APC analysis, we found that the decreasing rates of period effects were small and that there was a little difference in the decreasing rates among prefectures for all types of cancer among both sexes. On the other hand, there was a large difference in the decreasing rates of cohort effects for stomach and liver cancer mortality rates among prefectures, particularly for men. For men, the decreasing rates of cohort effects in cohorts born between 1920–1924 and 1964–1978 varied among prefectures, ranging from 4.1 to 84.0% for stomach cancer and from 20.2 to 92.4% for liver cancers, respectively. On the other hand, the differences in the decreasing rates of cohort effects among prefectures for colorectal and lung cancer were relatively smaller.ConclusionsThe decreasing rates of cohort effects for stomach and liver cancer varied widely among prefectures. It is possible that this will influence cancer mortality rates in each prefecture in the future.