Rates Of Squamous Cell Carcinoma Research Articles

A population-based study of selected demographic characteristics of Israeli-Jewish women with cervical squamous cell carcinoma

The age-standardized incidence rate (ASR) of invasive cervical cancer in Israeli-Jewish women is persistently low compared to many other countries. The aim of the present study was to assess selected demographic characteristics of Israeli-Jewish women with cervical squamous cell carcinoma (SCC) in an attempt to identify current selected risk factors. Included were all histologically confirmed SCC patients diagnosed during 2002-2004 according to the Israel National Cancer Registry. Demographic and population data were obtained from the Central Population Registry and from the Israel Central Bureau of Statistics annual abstract reports. The ASR and incidence rate for each demographic category were computed. During the study period, 350 SCC patients (mean age 50.3 years) were diagnosed (ASR of 3.8/100,000). High SCC incidence rates of single women 40+, of married women 30+ years old and of divorced and widowed women in the 40-49 age group were found. The mean number of children was 2.1 (range 0-9). Compared to the population the rate of childless patients in the 50+ age group, that of patients with 1-2 children in the 40-49 age group and that of North-African-born patients was significantly higher. No excess rate was found for multiparity and low socioeconomic status. High incidence rates of SCC were observed for some age groups of single and married women, for women without children or 1-2 children and for North-Africa-born women. Great differences between age groups within each demographic category were observed.

Dietary freeze-dried black raspberry's effect on cellular antioxidant status during reflux-induced esophagitis in rats

Introduction Esophageal cancer consists of two distinct types, esophageal adenocarcinoma (EAC) and squamous cell carcinoma, both of which differ significantly in their etiology. Freeze-dried black raspberry (BRB) has been consistent in its ability to modulate the biomarkers and reduce the incidence of carcinogen-induced squamous cell carcinoma in rats. In our previous studies in the esophagoduodenal anastomosis (EDA) model, we have shown that the early modulation of manganese superoxide dismutase (MnSOD) significantly correlates with the development of reflux-induced EAC in rats. In this study we looked at the short-term effects of a BRB-supplemented diet on the modulation of antioxidant enzymes in reflux-induced esophagitis. Methods Male SD rats (8 wk old; n = 3–5) were randomized into three groups---sham-operated, fed control AIN-93M diet (SH-CD), EDA operated and fed either control diet (EDA-CD) or 2.5% (w/w) BRB diet (EDA-BRB). The effect of both reflux and dietary supplementation was analyzed 2 and 4 wk after EDA surgery. Results Animals in the EDA groups had significantly lower weight gain and diet intake compared to SH-CD ( P < 0.05). The sham-operated animals received an average esophagitis score of 0.1 ± 0.1; this increased significantly in EDA-CD animals to 1.8 ± 0.14 ( P < 0.001 versus SH-CD) and in EDA-BRB group to 1.7 ± 0.06 ( P < 0.001 versus SH-CD), with BE changes also present. However, dietary supplementation of BRB did not alter or ameliorate the grade of esophagitis or the induction of BE. BRB diet caused a 43% increase in MnSOD levels compared to EDA-CD (0.73 ± 0.16; P = 0.09); however, this effect was not statistically significant and at 4 wk, EDA-CD (0.58 ± 0.12) showed an increase in MnSOD expression compared to SH-CD (0.34 ± 0.01). Conclusions In conclusion, our data suggest that dietary BRB does not increase the levels of cellular antioxidant enzymes or reduce the levels of lipid peroxidation compared to a control diet, in a short-term study of gastroesophageal reflux induction in the EDA animal model. However, it remains to be tested whether this is indicative of its ineffectiveness to inhibit reflux-induced EAC incidence over the long term.

Cervical cancer incidence among 6 Asian ethnic groups in the United States, 1996 through 2004

Cervical cancer incidence was evaluated by histologic type, age at diagnosis, and disease stage for 6 Asian ethnic groups residing in the United States. Incidence rates were estimated for cervical squamous cell carcinoma (SCC) and adenocarcinoma by age and stage for 6 Asian ethnic groups-Asian Indian/Pakistani, Chinese, Filipino, Japanese, Korean, and Vietnamese-in 5 US cancer registry areas during 1996 through 2004. For comparison, rates among non-Hispanic whites, non-Hispanic blacks, and Hispanics were also calculated. During 1996 through 2004, Vietnamese women had the highest (18.9 per 100,000) and Asian Indian/Pakistani women had the lowest (4.5) incidence of cervical cancer; this pattern was consistent by histologic type. Vietnamese women also had the highest incidence for localized (7.3) and regional (5.7) SCC and for localized (2.4) adenocarcinoma. Contrary to the plateau of SCC incidence apparent among white women by age 45 years, SCC rates continued to rise with age among Chinese, Filipina, Korean, and Vietnamese women. There exists large variation in invasive cervical cancer incidence patterns among Asian ethnic groups in the United States and in comparison with rates for blacks, Hispanics, and whites. Early detection and prevention strategies for cervical cancer among Asians require targeted strategies by ethnic group.

Oesophageal cancer incidence in the United States by race, sex, and histologic type, 1977–2005

Background:In the United States, the rates and temporal trends of oesophageal cancer overall and for the two predominant histologic types – adenocarcinoma (ADC) and squamous cell carcinoma (SCC) – differ between Blacks and Whites, but little is known with regard to the patterns among Asians/Pacific Islanders or Hispanics.Methods:Using the Surveillance, Epidemiology, and End Results programme data, we analysed oesophageal cancer incidence patterns by race, sex, and histologic type for the period 1977–2005.Results:Total oesophageal cancer incidence has been increasing among Whites only; the rates among all other race groups have declined. Moreover, rates among White men surpassed those among Blacks in 2004. Oesophageal SCC rates have been decreasing among virtually all racial/ethnic groups; rates among Hispanic and Asian/Pacific Islander men have been intermediate to those of Blacks and Whites, with rates among women being lower than those among Blacks or Whites. The ADC rates among Hispanic men may be rising, akin to the historical trends among Whites and Blacks. The sex ratios for these cancers also varied markedly.Conclusions:These observations may provide clues for aetiological research.

Squamous cell carcinoma of the anus in a patient with perianal Crohn’s disease

Dear Editor Anal cancer is a rare disease and accounts for approximately 1.86% of all carcinomas originating in the digestive system. The American Cancer Society estimates that in 2008, there will be 5,070 new cases of anal cancer and 680 deaths from anal cancer in the USA. Anal cancer arising in patients with Crohn’s disease is also rare. The incidence or prevalence of anal carcinoma in Crohn’s disease is not sufficiently reported. According to Slater et al., the percentage of anal cancer in colorectal cancer in patients with Crohn’s disease is higher than that in patients with non-inflammatory bowel disease (IBD; 14% versus 1.4%, respectively, p<0.005). On the other hand, Frisch et al. reported one case of anal squamous cell carcinoma (SCC) among 2,723 Crohn’s patients with a median follow-up of 10.2 years and concluded that the rate of anal SCC is not significantly increased, even in IBD patients, as compared with the general population. Incidence rates of IBD diverge geographically. Traditionally, Northern Europe, the UK, and North America have a high prevalence of IBD. The incidence and prevalence rates of IBD in Asia are low compared with the West. According to a recently published epidemiologic study by Thia et al., incidence rates of Crohn’s disease in Japan, South Korea, and Hong Kong are similar, ranging from 1.00 to 1.34 cases per 10 person-years over a combined time period from 1998 to 2005, and interestingly, the incidence of Crohn’s disease is increasing in these areas. Approximately 40 cases of carcinoma that developed from anal lesions or in association with anal or rectal fistulas arising in patients with Crohn’s disease were reported in English literature from 1980 to 2008. Most of these cases were reported from Northern Europe or North America, and as far as we know, reports from East Asia are very rare. Our hospital is a tertiary referral center in South Korea. From 1991 to 2008, 843 patients were treated for IBD. We report the first case of SCC arising in a patient with perianal Crohn’s disease in our hospital. A 43-year-old woman had an 11-year history of Crohn’s disease. She underwent large loop excision of the transformation zone due to cervical cancer (carcinoma in situ) in 1997. Despite regular follow-up with sulfasalazin, steroid, or intermittent infliximab treatment, the patient developed enteroenteric fistulas as well as an anal stricture and multiple perianal fistulas. Even though the patient received conservative medical treatment, a small-bowel fistula did not resolve, and the patient suffered an increasing frequency of low abdominal pain with an engrowing palpable mass in the right lower abdomen. She underwent laparoscopic assisted right hemicolectomy, segmental resection of the small bowel, end ileostomy, and seton drainage for the rectovaginal fistula in January 2008. Fecal diversion was performed to relieve the perianal discomfort induced by J. Kang : B. S. Min :K. Y. Lee :N. K. Kim (*) Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, 250 Seongsanno (134 Sinchon-dong), Seodaemun-gu, Seoul, South Korea 120-752 e-mail: namkyuk@yuhs.ac

Prevalence of Oncogenic Human Papillomavirus 16 and 18 in the Palatine Tonsils of the General Adult Population

To determine whether there has been a demonstrable increase in the prevalence of human papillomavirus (HPV)-infected palatine tonsils corresponding to the increase in incidence of HPV-positive oropharyngeal squamous cell carcinoma (SCC) over time. Review of archived, paraffin-embedded, noncancerous palatine tonsils. A single institution in El Paso County, Colorado. Age- and sex-matched patients 21 years and older from 2 different periods: January 1, 1979, to December 31, 1982, (group A) and January 1, 1997, to December 31, 2001 (group B). Prevalence of oncogenic HPV-16 and HPV-18 in noncancerous palatine tonsils in relation to the incidence of HPV-positive oropharyngeal SCC. All specimens in both groups were negative for HPV-16 and HPV-18. Thus, the prevalence of HPV infection in the palatine tonsils of the general adult population was zero in both group A and group B. This analysis shows a low prevalence of HPV infection in the palatine tonsils of the general adult population in a single county in Colorado known to have an increasing rate of HPV-positive oropharyngeal SCC. Analysis of oropharyngeal tissues from individuals at highest risk of developing HPV-positive oropharyngeal SCC (middle-aged men) is likely to provide a higher prevalence rate.

Efficacy of capecitabine in secondary prevention of skin cancer in solid organ-transplanted recipients (OTR)

1519 Background: Skin cancers are the most common malignancies in OTR. Topical 5% 5-FU has been used to successfully treat squamous cell carcinoma (SCC) in situ and actinic keratosis (AK). Capecitabine, an orally-administered prodrug of 5-FU, in combination with interferon was shown to be effective in the treatment of advanced SCC of the skin. This study was to determine the efficacy of low-dose capecitabine in secondary prevention of the skin cancers in OTR. Methods: OTR who developed recurrent skin cancers, SCC, and/or basal cell carcinoma (BCC), were given low-dose capecitabine 1g/m2 divided in two daily doses, day 1–14 of 21-day treatment cycle. Skin surveillances were performed by dermatologists every 1 to 3 months. Cumulative incidence rates of SCC, BCC, and AK before and after treatment were scored and statistically compared for each patient with a non-parametric Wilcoxon signed-rank test. Age and number of transplants were assessed with the Spearman non-parametric correlation analysis for their impact on the outcome. Results: 14 patients (12 males and 2 females) were enrolled with median age of 55 (range 40–73). 11 patients received kidney, two lung and one liver, one heart and one pancreas transplant. Two patients received double organ transplants. Mean incidence rates of SCC, BCC, and AK before treatment were 0.45, 0.05, and 4.99 lesions per month, respectively. Mean incidence rates of SCC, BCC, and AK after treatment were 0.22, 0.04, and 2.80 lesions per month, respectively. The differences in incidence rates of SCC, BCC, and AK before and after treatment were 0.24, 0.02, and 2.08 lesions per month with p value of 0.048, 0.844, and 0.151, respectively. Age and the number of transplants were not significantly related to the change in incidence rates for all skin lesion types. Six of the total of 14 patients experienced grade 3/4 toxicities, including mucositis (2), hand-foot syndrome (3), fatigue (2), nausea (1), diarrhea (2), hyperuricemia (1), and anemia (1), and all six needed capecitabine dose reduction or stopping therapy. Conclusions: Oral capecitabine significantly decreases the incidence rates of recurrent SCC in OTR and has manageable toxicity. No significant financial relationships to disclose.

Understanding the burden of human papillomavirus-associated anal cancers in the US.

Anal cancer is an uncommon malignancy in the US; up to 93% of anal cancers are associated with human papillomavirus. Cases diagnosed between 1998 and 2003 from 39 population-based cancer registries were analyzed. The following anal cancer histologies were included in the analysis: squamous cell, adenocarcinoma, and small cell/neuroendocrine carcinomas. Incidence rates were age-adjusted to the 2000 US standard population. From 1998 through 2003, the annual age-adjusted invasive anal cancer incidence rate was 1.5 per 100,000 persons. Squamous cell carcinoma (SCC) was the most common histology overall, accounting for 18,105 of 21,395 (84.6%) cases of anal cancer. Women had a higher rate of SCC (1.5 per 100,000) than men (1.0). Whites and blacks had the highest incidence rate (1.3), whereas Asians/Pacific Islanders (API) had the lowest rate (0.3). Incidence rates of anal SCC increased 2.6% per year on average. The majority of SCC cases were diagnosed at the in situ or localized stage (58.1%). API were more likely to be diagnosed with regional or distant stage disease than were other racial/ethnic groups (27.5% and 11.8%, respectively). Males had lower 5-year relative survival than females for all stages of disease. Rates of anal SCC varied by sex, race, and ethnicity. A higher proportion of API were diagnosed at regional/distant stage. Men had lower 5-year survival rates than women. Continued surveillance and additional research are needed to assess the potential impact of the HPV vaccine on the anal cancer burden in the US.

Descriptive epidemiology of vaginal cancer incidence and survival by race, ethnicity, and age in the United States

Vaginal cancer is a rare malignancy. It has many of the same risk factors as cervical cancer, including a strong association with persistent human papillomavirus infection. Descriptive studies of the epidemiology of vaginal cancer are scarce in the literature. The 1998 through 2003 incidence data from 39 population-based cancer registries were used, covering up to 83% of the US population. The 1996 through 2003 data from 17 cancer registries were used for survival analysis. Incidence rates, disease stage, and 5-year relative survival rates were calculated by race, ethnicity, and age group. Data analysis focused mainly on squamous cell carcinoma (SCC). Incidence rates for all vaginal cancers combined were 0.18 per 100,000 female population for in situ cases and 0.69 for invasive cases. The median age of invasive cases was older than that of in situ cases (aged 68 years vs 58 years). SCC was the most common histologic type (71% of in situ cases and 66% of invasive cases). Compared with the rate for white women, the age-adjusted incidence rate of invasive SCC was 72% higher (P < .05) among black women, whereas the rate among Asian/Pacific Islander (API) women was 34% lower (P < .05). Hispanic women had a 38% higher rate than non-Hispanic women (P < .05) of invasive SCC. The rates for in situ SCC peaked at age 70 years and then declined, whereas the rates of invasive SCC increased continuously with advancing age. Black, API, and Hispanic women as well as older women were more likely to be diagnosed with late-stage disease, and these groups had lower 5-year relative survival rates than their white, non-Hispanic, and younger counterparts. Incidence rates of vaginal SCC varied significantly by race, ethnicity, and age group. Black, API, and Hispanic women as well as older women had a high proportion of late-stage disease and a low 5-year survival rate.

Association of ACE Inhibitors and Angiotensin Receptor Blockers with Keratinocyte Cancer Prevention in the Randomized VATTC Trial

The observation that angiotensin II is a potent angiogenic and growth factor raises the possibility that blocking its effects could reduce the incidence of cancer. We evaluated associations between use of angiotensin-converting enzyme (ACE) inhibitors and of angiotensin receptor blockers (ARBs) and keratinocyte cancer incidence in a population at high risk of the disease. A cohort study design was conducted using data on 1051 participants in the randomized Department of Veterans Affairs Topical Tretinoin Chemoprevention (VATTC) Trial, all of whom were at increased risk of basal cell carcinoma (BCC) or squamous cell carcinoma (SCC). We followed participants from enrollment (November 1998 through January 2003) until first BCC or SCC. Study participants were examined every 6 months by a study dermatologist; biopsies were taken on all suspicious lesions and centrally reviewed. Use of ACE inhibitors and ARBs was ascertained from VA pharmacy records. Cox proportional hazards models were used to estimate adjusted incidence rate ratios (IRRs) and 95% confidence intervals (CIs) of BCC and SCC with use of ACE inhibitors or ARBs. During a median follow-up of 3.4 years, 472 incident BCCs, 309 SCCs, and 200 deaths from any cause were observed. Compared with nonusers, users of ACE inhibitors or ARBs had statistically significantly reduced risks of BCC (IRR(BCC) = 0.61, 95% CI = 0.50 to 0.76) and SCC (IRR(SCC) = 0.67, 95% CI = 0.52 to 0.87). The combined absolute incidence rates of BCC and SCC were 237 per 1000 person-years among users of ACE inhibitors or ARBs and 374 per 1000 person-years among nonusers. The greatest reduction in keratinocyte cancer was seen among people who initiated use of ACE inhibitors or ARBs during the study period (IRR(BCC) = 0.45 [95% CI = 0.34 to 0.59]; IRR(SCC) = 0.48 [95% CI = 0.35 to 0.67]). Among a high-risk group of veterans, users of ACE inhibitors or ARBs had a lower incidence of keratinocyte cancers than nonusers. The more pronounced reduction among those who initiated use during the study may indicate an immediate effect.

A Longitudinal Swedish Study on Screening for Squamous Cell Carcinoma and Adenocarcinoma: Evidence of Effectiveness and Overtreatment

Organized Papanicolaou (Pap) screening has markedly reduced the incidence of cervical squamous cell carcinoma (SCC). However, the potential for overtreatment of precursor lesions is quite high for SCC, and the effectiveness of Pap screening for prevention of cervical adenocarcinoma is questionable. Using the nationwide, virtually complete Swedish Cancer Register, we analyzed standardized incidence rates for SCC in situ (CIS), SCC, adenocarcinoma in situ (AIS) and adenocarcinoma, between 1968 and 2002. For each county, we calculated Spearman correlations between incidence of in situ lesions and incidence of invasive cancer, 5, 10, and 15 years later. We also used generalized estimating equation (GEE) models to compare adjusted estimates for associations between in situ incidences and invasive carcinomas over counties. The overall decrease in SCC incidence in Sweden following the introduction of cervical screening confirms the beneficial nature of cervical screening on SCC incidence over the last 30 years. A similar benefit was not apparent for adenocarcinoma. GEE estimates for the relative change in SCC for an increase of 100 CIS cases per 100,000 women-years were 1.05 for the 5-year and 1.02 for the 10-year lag periods. For adenocarcinoma and AIS, similar analyses gave corresponding estimates of 1.17 for the 5-year and 1.08 for the 10-year lag periods. The lack of an inverse correlation suggests that increased reported incidence of CIS in certain counties did not forecast a reduction in SCC for those counties. Our data confirm the effectiveness of Pap smear screening in reducing the incidence of SCC, but suggest no clear benefit on adenocarcinoma. Our data also suggest that relaxed histopathologic criteria for diagnosis of cervical CIS may increase its recorded incidence with no measurable benefit in the reduction of invasive cancer.

Racial and ethnic disparities in cervical cancer incidence rates in the United States, 1992−2003

Differences in cervical cancer incidence rates by race/ethnicity persist in the United States. We examined these differences by histologic type and by various patient and socioeconomic characteristics. Thirteen U.S. cancer registries were used to identify women 20-79 years of age diagnosed from 1992 to 2003 with invasive cervical cancer. Age-adjusted incidence rates and annual percent changes were calculated for four different races/ethnicities (Non-Hispanic whites, Hispanic whites, African-Americans, and Asians/Pacific Islanders) for cervical cancer overall, squamous cell carcinoma (SCC), and adenocarcinoma (AC). Hispanic whites had the highest incidence rate of cervical cancer overall (24.2/100,000), SCC (18.3/100,000), and AC (4.6/100,000). Non-Hispanic whites had the lowest rates of cervical cancer overall (10.8/100,000) and SCC (7.2/100,000), while African-Americans had the lowest rate of AC (2.3/100,000). Incidence rates of cervical cancer overall and SCC declined across all racial/ethnic groups. Numerous variations in incidence rates and annual percent changes were observed when analyses were stratified by county level socioeconomic characteristics. Variations in screening utilization and socioeconomic status may account for the majority of racial/ethnic disparities in cervical cancer incidence. Targeting groups with the greatest burdens of cervical cancer is of public health importance, particularly as we enter the human papillomavirus vaccine era.

Association of Methylenetetrahydrofolate Reductase Polymorphism and the Risk of Squamous Cell Carcinoma in Renal Transplant Patients

The relative risk of developing cutaneous squamous cell carcinoma (SCC) is significantly increased after organ transplantation. We investigated the genetic association of SCC in two pathways associated with cancer risks, with the potential for modification by vitamin supplementation. A total of 367 renal transplant recipients (117 with SCC and 250 without any skin cancer) were genotyped for key polymorphisms in the folate pathway (methylene tetrahydrofolate reductase; MTHFR:C677T), and the vitamin D pathway (vitamin D receptor: Intron8G/T;). Individuals carrying the MTHFR 677T allele had a marked increase in risk of SCC (adjusted odds ratio=2.54, P=0.002, after adjustment for age, ender, skin type, sun exposure score, and immunosuppression duration; lower 95% confidence boundary odds ratio of 1.41). In contrast, vitamin D receptor polymorphisms were not significantly associated. Folate-sensitive pathways may play a critical role in the elevated rate of SCC in renal transplant recipients.

Malignant melanoma and nonmelanoma skin cancers in Northrhine‐Westphalia, Germany: a patient‐ vs. diagnosis‐based incidence approach

Dermatologists have repeatedly criticized that the public health importance of nonmelanoma skin cancers is not appropriately reflected by the patient-based cancer incidence rates of population-based cancer registries. The aims of this study were to estimate the patient incidence rates of squamous cell carcinoma (SCC), basal cell carcinoma (BCC), and skin melanoma, and to study the effect of multiple primary skin tumors on the incidence rates. We used a network of physicians covering a population of about 75,000 individuals to register all newly diagnosed invasive skin cancers (996 diagnoses in 796 patients), including BCC, SCC, and skin melanoma, from July 1998 to June 2003. We calculated age-standardized (world standard population) incidence rates (cases per 100,000 person-years) for the first diagnoses (called "patient incidence") and for any diagnoses of BCC, SCC, and skin melanoma (called "case incidence"). The patient incidence rates of BCC were 63.6 in men and 54.0 in women, and the case incidence rates of BCC were 82.7 and 71.1, respectively. The patient incidence rates of SCC were 17.4 in men and 9.7 in women, and the case incidence rates were 20.4 and 10.2, respectively. The patient and case incidence rates of skin melanoma were about the same at 13.6 in men and 18.5 in women. Twenty-five per cent of the BCC patients and 14% of the SCC patients suffered from more than one BCC and SCC, respectively, during the 5-year period. Patient incidence rates of BCC and SCC substantially underestimate the burden of nonmelanoma skin cancer in the population.

Recent trends in incidence of nonmelanoma skin cancers in the East of Scotland, 1992–2003

Historically, ascertainment of nonmelanoma skin cancer (NMSC) by cancer registries in the U.K. has been shown to be incomplete in several studies. However, recent evidence suggesting that almost all clinically diagnosed NMSCs are verified histologically, coupled with the increasing availability of electronic histopathology data to cancer registries, raises the possibility that this situation may have improved. To assess recent trends in incidence of the main types of NMSC and carcinoma in situ (CIS) of the skin in Scotland. The study was restricted to selected health board areas in the East of Scotland for which pathology data have been used routinely to support cancer registration since the early 1990s. Incident cases of squamous cell carcinoma (SCC) of the skin, CIS of the skin, and first ever basal cell carcinoma (BCC) were extracted from the Scottish Cancer Registry covering the period of diagnosis 1992-2003. Sex-specific, age-standardized and age-specific incidence rates were calculated for four consecutive 3-year periods of diagnosis. Estimated annual percentage changes (EAPCs) in incidence were calculated by Poisson regression modelling, with adjustment for age. The percentage distribution of SCC, BCC and CIS of the skin by anatomical site and sex was calculated for the period of diagnosis 1997-2003. The crude incidence of SCC for the period 1995-97 was 34.7 per 100,000, comparable with the best existing Scottish estimate of 32.2 derived from a prospective survey in Glasgow during March 1995. Age-adjusted rates of SCC, first ever BCC, and CIS of the skin have all increased significantly in both sexes between 1992 and 2003 (all P < 0.001), with EAPCs ranging in magnitude from +1.4% (first ever BCC in males) to +5.1% (CIS in males). The majority of lesions arose on the head and neck area, with the exception of CIS, which in females was more commonly located on the limbs. Ascertainment of NMSC has probably improved since the advent and use of electronic pathology data. Ongoing increases in age-adjusted incidence, combined with ageing of the population, will have major implications for the clinical workload associated with NMSC for the foreseeable future.

Incidence of Nonmelanoma Skin Cancer in New Brunswick, Canada, 1992 to 2001

Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), collectively referred to as nonmelanoma skin cancer (NMSC), cause significant morbidity and generate a substantial cost to the health care system. Canadian data on the incidence of NMSC are lacking. To study the incidence and characteristics of NMSC in New Brunswick, Canada (population 729,498 people in 2001), by using the Provincial Cancer Registry. Data were obtained from 1992 to 2001 from the New Brunswick Provincial Cancer Registry, to which reporting of all cancers is mandatory. Multiple tumors of a given histologic type are recorded only once in the registry per individual per lifetime. A descriptive analysis of incidence rates of BCC and invasive SCC of the skin was performed in relation to gender, age, and anatomic location. The main outcome measures were the age- and sex-specific incidence rates of BCC and SCC. Age standardization was performed using the Canadian, US, and world standard populations. When adjusted to the world standard population, the age-standardized incidence rates (ASIRs) per 100,000 population for BCC from 1992 through 2001 were 87 for males and 68 for females. For invasive SCC, the ASIRs per 100,000 population were 34 for males and 16 for females. There was an increasing incidence trend for both BCC and invasive SCC over the 10-year study period, with minimal change in the incidence of SCC in women. The overall ratio of BCC to invasive SCC in the population was 2.8 to 1. The approximate lifetime probabilities of developing BCC and invasive SCC were 13% and 5%, respectively. The incidence of NMSC in the province of New Brunswick is similar to that reported from 1973 through 1987 in the province of British Columbia, higher than those reported in most parts of Europe, and lower than all published rates in the United States and Australia. Owing to the inability of the registry to account for tumor multiplicity, the actual annual number of all NMSC lesions in this population is likely much higher.

Comparison of biological behavior between early-stage adenocarcinoma and squamous cell carcinoma of the uterine cervix

Objectives (1) To compare the anatomopathological variables and recurrence rates in patients with early-stage adenocarcinoma (AC) and squamous cell carcinoma (SCC) of the uterine cervix; (2) to identify the independent risk factors for recurrence. Study design This historical cohort study assessed 238 patients with carcinoma of the uterine cervix (IB and IIA), who underwent radical hysterectomy with pelvic lymph node dissection between 1980 and 1999. Comparison of category variables between the two histological types was carried out using the Pearson's χ 2-test or Fisher exact test. Disease-free survival rates for AC and SCC were calculated using the Kaplan–Meier method and the curves were compared using the log-rank test. The Cox proportional hazards model was used to identify the independent risk factors for recurrence. Results There were 35 cases of AC (14.7%) and 203 of SCC (85.3%). AC presented lower histological grade than did SCC (grade 1: 68.6% versus 9.4%; p < 0.001), lower rate of lymphovascular space involvement (25.7% versus 53.7%; p = 0.002), lower rate of invasion into the middle or deep thirds of the uterine cervix (40.0% versus 80.8%; p < 0.001) and lower rate of lymph node metastasis (2.9% versus 16.3%; p = 0.036). Although the recurrence rate was lower for AC than for SCC (11.4% versus 15.8%), this difference was not statistically significant ( p = 0.509). Multivariate analysis identified three independent risk factors for recurrence: presence of metastases in the pelvic lymph nodes, invasion of the deep third of the uterine cervix and absence of or slight inflammatory reaction in the cervix. When these variables were adjusted for the histological type and radiotherapy status, they remained in the model as independent risk factors. Conclusion The AC group showed less aggressive histological behavior than did the SCC group, but no difference in the disease-free survival rates was noted.

Decreasing incidence of cervical adenocarcinoma in Ontario: Is this related to improved endocervical Pap test sampling?

In many developed countries, the incidence of cervical cancer has decreased. These reductions have been specific to squamous cell carcinoma (SCC) and have not included adenocarcinoma (AC). Incidence of AC has increased steadily over the last 20 years. The intent of this article is to examine trends in cervical adenocarcinoma incidence in Ontario over a 20-year period in relation to screening practices. All cases of cervical cancer between 1981 and 2002 were extracted from the Ontario Cancer Registry (a population-based, provincial-wide database). Age-standardized incidence rates were calculated overall, by broad age groups and by morphological type (SCC and AC). Time trends were assessed using JoinPoint methodology. In Ontario, opportunistic cervical cancer screening has been accompanied by significantly decreased rates of SCC since at least 1981. Conversely, the incidence of AC rose by 3.1% per year (95% CI: 1.6%, 4.6%) between 1981 and 1995, and subsequently declined by 4.0% per year (95% CI: -7.4%, -0.5%). From the mid- to late-1990s, instructions were distributed to clinicians, reinforcing the importance of dual specimen collection (i.e., using both spatula and endocervical brush). At the same time, laboratories routinely provided physicians with kits that included both spatula and brush. The subsequent decline in AC incidence may be due, in part, to improved specimen collection. As well, the decline may be partly due to increased awareness of AC precursors among cytopathologists and clinicians, and/or improvements in laboratory training and quality assurance.

Changes in risk of death from breast cancer with season and latitude

The Norwegian counties can conveniently be divided in three groups with different annual UV exposures and different incidence rates of squamous cell carcinoma (SCC) of the skin. In view of the hypothesis that latitude and season of diagnosis may play a role for breast cancer progression, the prognosis of breast cancer as determined for summer and winter diagnosis, were evaluated in the three residential regions. Two age groups were analysed separately (stratification at 50 years). For all regions, and for all ages, the prognosis was best for women diagnosed in the summer season (Relative risk (RR) of death was 15-25% lower for summer diagnosis versus winter diagnosis). There was no significant seasonal variation of the number of new cases. For women diagnosed before the age of 50, a geographical gradient in cancer prognosis was also found (RR of death 0.6, 95% CI: 0.5-0.7 for cases diagnosed in southeast Norway and RR of death 0.8, 95% CI: 0.6-1.1 for diagnosis in the north of Norway). This is in agreement with a 1.5 times larger annual UV exposures and 3-4 times larger incidence rates of SCC in the southeast region when compared with the north region. For women diagnosed after the age of 50, no significant difference was found between the three regions. Despite a 17% higher vitamin D intake from food in north of Norway no difference in cancer survival was found for diagnosis during winter (when no significant differences in the levels of UV exposure can be detected between regions). The overall data support our earlier hypothesis that season of diagnosis and therapy start improves the survival for breast cancer.

Opposing Trends in Incidence of Esophageal Squamous Cell Carcinoma and Adenocarcinoma in a Multi-Ethnic Asian Country

To describe the incidence trends in esophageal squamous cell carcinoma (SCC) and adenocarcinoma among the three major ethnic groups in Singapore from 1968 to 2002. Esophageal cancer cases in Singapore citizens and permanent residents obtained from the Singapore Cancer Registry and population data derived from the national census were used to calculate the incidence rates from 1968 to 2002. The age-standardized incidence rates (ASRs) for SCC decreased progressively from 8.31 to 3.85 per 100,000 men (p = 0.017) and from 3.43 to 0.81 per 100,000 women (p = 0.027). The rates fell for all three ethnic groups. The ASR for adenocarcinoma rose from 0 to 0.54 per 100,000 men and from 0.03 to 0.13 per 100,000 women, although these time trends did not achieve statistical significance. The frequency of regular smoking in the population decreased from 23% in 1966/1977 to 12.6% in 2004. The percentage of obesity in adults rose from 4.3% in 1982-1985 to 6.9% in 2004. The frequency of esophagitis in Singapore based on endoscopic findings increased from 3.9% in 1992 to 9.8% in 2001. The decline in the incidence of SCC is likely to be associated with the known decrease in the frequency of smoking among Singaporeans. In contrast, there appears to be a trend toward an increase in the incidence of adenocarcinoma in Singapore, although the absolute incidence remains relatively low. This may be due to the associated rise in the frequency of reflux esophagitis and obesity in Singapore.