Spanish Population-based Cancer Registries Research Articles

Incidence and time trends of childhood hematological neoplasms: a 36-year population-based study in the southern European context, 1983-2018.

Hematological neoplasms (HNs) are the first and most common childhood cancers globally. Currently, there is a lack of updated population-based data on the incidence of these cancers in the Spanish pediatric population. This study aimed to describe the incidence and incidence trends of HNs in children (0-14 years) in Spain using data from the Spanish Network of Cancer Registries and to compare the results with other southern European countries. Data were extracted from 15 Spanish population-based cancer registries between 1983 and 2018. Cases were coded according to the International Classification of Diseases for Oncology, third edition, first revision, and grouped according to the International Classification of Childhood Cancer, third edition. Crude rates (CRs), age-specific rates, and age-standardized incidence rates using the 2013 European population (ASRE) were calculated and expressed as cases per 1,000,000 child-years. Incidence trends and annual percentage changes (APCs) were estimated. A total of 4,747 HNs were recorded (59.5% boys). Age distribution [n (%)] was as follows: <1 year, 266 (5.6%); 1-4 years, 1,726 (36.4%); 5-9 years, 1,442 (30.4%); and 10-14 years, 1,313 (27.6%). Leukemias were the most common group, with a CR and an ASRE of 44.0 (95%CI: 42.5; 45.5) and 44.1 (95%CI: 42.6; 45.7), respectively. The CR and ASRE of lymphomas were 20.1 (95%CI: 19.1; 21.1) and 20.0 (95%CI: 19.0; 21.1), respectively. The comparable incidence rates between our results and those of other southern European countries were similar for lymphomas, while some differences were observed for leukemias. From 1988 to 2016, the trend in leukemia incidence was stable for both sexes, with an APC of 0.0 (95%CI: -0.5; 0.7), whereas a constant overall increase was observed for lymphoma in both sexes, with an APC of 1.0 (95%CI: 0.4; 1.6). Leukemias are the most common HNs in children, and their incidence has remained stable since 1988, whereas the incidence of lymphomas has increased every year. Lymphoma incidence is like that of other southern European countries, while leukemia incidence is similar only to that of southwestern European countries. Collaborative cancer registry projects allow for assessing epidemiological indicators for cancers such as HNs, which helps health authorities and clinicians provide more knowledge about these malignancies.

Incidence and survival of lymphoid neoplasms in Spain, 2002-2013: A population-based study from the Spanish Network of Cancer Registries (REDECAN).

The aim of this study was to describe incidence, incidence trends and survival patterns of lymphoid neoplasms (LNs) and its subtypes in Spain in the period 2002-2013 using data from the Spanish Network of Cancer Registries (REDECAN). Data were extracted from 13 Spanish population-based cancer registries. LNs incident cases were codified using the International Classification of Diseases for Oncology, third edition (ICD-O-3) and grouped according to the WHO 2008 classification. Age-standardized incidence rates to the 2013 European standard population (ASIRe) were obtained. Poisson regression models were used to analyze trends in incidence rates and estimate the annual percentage change (APC) for each subtype. The number of cases in Spain for 2023 was estimated by applying the estimated age-specific rates for the year 2023 to the 2023 Spanish population. Observed survival (OS) was estimated by the Kaplan-Meier method and net survival (NS) by the Pohar-Perme method. Sex- and age-specific estimates of 5-year NS were calculated, as well as its changes according to two periods of diagnosis (2002-2007 and 2008-2013). LNs accounted for 69% (n=39,156) of all hematological malignancies (n=56,751) diagnosed during the period of study. Median age at diagnosis was 67 years (interquartile range (IQR) = 52-77). The overall ASIRe was 34.23 (95% confidence interval (CI): 33.89, 34.57) and showed a marked male predominance in almost all subtypes (global sex ratio = 1.45). During the study period, incidence trends of LNs remained stable (APC: 0.3; 95% CI: -0.1, 0.6), nevertheless some subtypes showed statistically significant variations, such as LNs NOS category (APC: -5.6; 95% CI: -6.8, -4.3). Around 17,926 new cases of LNs will be diagnosed in 2023 in Spain. Survival rates differed considerably across age-groups, while they were similar between men and women. Five- year NS was 62.81% (95% CI: 62.1, 63.52) for all LNs, and varied widely across LNs subtypes, ranging from 39.21% to 90.25%. NS for all LNs improved from the first period of diagnosis to the second one, being 61.57% (95% CI: 60.56, 62.61) in 2002-2007 and 64.17% (95% CI: 63.29, 65.07) in 2008-2013. This study presents the first complete and extensive population-based analysis of LNs incidence and survival in Spain. These population-based data provide relevant information to better understand the epidemiology of LNs in Southern Europe and it features some useful points for public health authorities and clinicians. However, additional improvements regarding the registration of these hematological neoplasms can be implemented.

Bayesian variable selection and survival modeling: assessing the Most important comorbidities that impact lung and colorectal cancer survival in Spain

Cancer survival represents one of the main indicators of interest in cancer epidemiology. However, the survival of cancer patients can be affected by several factors, such as comorbidities, that may interact with the cancer biology. Moreover, it is interesting to understand how different cancer sites and tumour stages are affected by different comorbidities. Identifying the comorbidities that affect cancer survival is thus of interest as it can be used to identify factors driving the survival of cancer patients. This information can also be used to identify vulnerable groups of patients with comorbidities that may lead to worst prognosis of cancer. We address these questions and propose a principled selection and evaluation of the effect of comorbidities on the overall survival of cancer patients. In the first step, we apply a Bayesian variable selection method that can be used to identify the comorbidities that predict overall survival. In the second step, we build a general Bayesian survival model that accounts for time-varying effects. In the third step, we derive several posterior predictive measures to quantify the effect of individual comorbidities on the population overall survival. We present applications to data on lung and colorectal cancers from two Spanish population-based cancer registries. The proposed methodology is implemented with a combination of the R-packages mombf and rstan. We provide the code for reproducibility at https://github.com/migariane/BayesVarImpComorbiCancer.

The role of multimorbidity in short-term mortality of lung cancer patients in Spain: a population-based cohort study

AimChronic diseases often occur simultaneously and tend to be associated with adverse health outcomes, but limited research has been undertaken to understand their role in lung cancer mortality. Therefore, this study aims to describe the prevalence and patterns of having one (comorbidity) or ≥ 2 chronic diseases (multimorbidity) among lung cancer patients in Spain, and to examine the association between comorbidity or multimorbidity and short-term mortality risk at six months after cancer diagnosis.MethodsIn this population-based cohort study, data were drawn from two Spanish population-based cancer registries, Girona and Granada, and electronic health records. We identified 1259 adult lung cancer patients, diagnosed from 1st January 2011 to 31st December 2012. We identified the most common patterns of individual comorbidities and their pairwise correlations. We used a flexible parametric modelling approach to assess the overall short-term mortality risk 6 months after cancer diagnosis by levels of comorbidity after adjusting for age, sex, smoking status, province of residence, surgery, cancer stage, histology, and body mass index.ResultsWe found high prevalence of comorbidity in lung cancer patients, especially among the elderly, men, those diagnosed with advanced-stage tumours, smokers, and obese patients. The most frequent comorbidities were chronic obstructive pulmonary disease (36.6%), diabetes (20.7%) and heart failure (16.8%). The strongest pairwise correlation was the combination of heart failure with renal disease (r = 0.20, p < 0.01), and heart failure with diabetes (r = 0.16, p < 0.01). Patients with either one or two or more comorbidities had 40% higher overall mortality risk than those without comorbidities (aHR for comorbidity: 1.4, 95%CI: 1.1–1.7; aHR for multimorbidity: 1.4, 95%CI: 1.1–1.8), when relevant confounding factors were considered.ConclusionsThe presence of comorbid diseases, rather than the number of comorbidities, was associated with increasing the risk of short-term lung cancer mortality in Spain. Comorbidity was a consistent and independent predictor of mortality among lung cancer patients, six months after diagnosis. The most common comorbid conditions were age-, obesity- and tobacco-related diseases. Our findings highlight the need to develop targeted preventive interventions and more personalised clinical guidelines to address the needs of lung cancer patients with one or more comorbidities in Spain.

Lung, Breast and Colorectal Cancer Incidence by Socioeconomic Status in Spain: A Population-Based Multilevel Study.

Simple SummaryDespite political efforts across the world and Europe, social inequalities in cancer incidence are persistent. We studied the association between socioeconomic status (SES) and cancer incidence in nine Spanish provinces. Lower SES was associated with an increased risk of lung cancer among males. Higher SES was associated with an increased risk of breast cancer among females in Spain. Understanding the reasons behind the association between cancer incidence and SES could help develop appropriate public health programs to promote health and reduce socioeconomic inequalities in cancer incidence in Spain.Socioeconomic inequalities in cancer incidence are not well documented in southern Europe. We aim to study the association between socioeconomic status (SES) and colorectal, lung, and breast cancer incidence in Spain. We conducted a multilevel study using data from Spanish population-based cancer registries, including incident cases diagnosed for the period 2010–2013 in nine Spanish provinces. We used Poisson mixed-effects models, including the census tract as a random intercept, to derive cancer incidence rate ratios by SES, adjusted for age and calendar year. Male adults with the lowest SES, compared to those with the highest SES, showed weak evidence of being at increased risk of lung cancer (risk ratio (RR): 1.18, 95% CI: 0.94–1.46) but showed moderate evidence of being at reduced risk of colorectal cancer (RR: 0.84, 95% CI: 0.74–0.97). Female adults with the lowest SES, compared to those with the highest SES, showed strong evidence of lower breast cancer incidence with 24% decreased risk (RR: 0.76, 95% CI: 0.68–0.85). Among females, we did not find evidence of an association between SES and lung or colorectal cancer. The associations found between SES and cancer incidence in Spain are consistent with those obtained in other European countries.

Multimorbidity and short-term overall mortality among colorectal cancer patients in Spain: A population-based cohort study

BackgroundNumerous studies have analysed the effect of comorbidity on cancer outcomes, but evidence on the association between multimorbidity and short-term mortality among colorectal cancer patients is limited. We aimed to assess this association and the most frequent patterns of multimorbidity associated with a higher short-term mortality risk among colorectal cancer patients in Spain. MethodsData were obtained from two Spanish population-based cancer registries and electronic health records. We estimated the unadjusted cumulative incidence of death by comorbidity status at 6 months and 1 year. We used a flexible parametric model to derive the excess mortality hazard ratios (HRs) for multimorbidity after adjusting for sex, age at diagnosis, cancer stage and treatment. We estimated the adjusted cumulative incidence of death by comorbidity status and identified multimorbidity patterns. ResultsAmong the study participants, 1,048 cases were diagnosed with cancers of the colon and rectum, 2 cases with cancer of the anus with overlapping sites of the rectum and 11 cases with anal adenocarcinomas but treated as colorectal cancer patients. Among 1,061 colorectal cancer patients, 171 (16.2%) died before 6 months, 246 (23.3%) died before the 1-year follow-up, and 324 (30.5%) had multimorbidity. Patients with multimorbidity had two times higher mortality risk than those without comorbidities at 6 months (adjusted HR: 2.04; 95% confidence interval [CI]: 1.30–3.20, p = 0.002). The most frequent multimorbidity pattern was congestive heart failure + diabetes. However, patients with rheumatologic disease + diabetes had two times higher 1-year mortality risk than those without comorbidities (HR: 2.23; 95% CI: 1.23–4.07, p = 0.008). ConclusionsMultimorbidity was a strong independent predictor of short-term mortality at 6 months and 1 year among the colorectal cancer patients in Spain. The identified multimorbidity pattern was consistent. Our findings might help identify patients at a higher risk for poor cancer and treatment outcomes.

Estimación de la incidencia del cáncer en la Comunidad de Madrid en 2015

El cáncer es actualmente uno de los principales problemas de salud pública en todo el mundo. Además, el número de casos de cáncer presenta una tendencia creciente, debido al envejecimiento de la población. El objetivo de este trabajo es estimar la incidencia de cáncer en la Comunidad de Madrid en 2015, por tipo de tumor y por sexo. Para ello, se han utilizado los datos de mortalidad para la Comunidad de Madrid y para España correspondientes al año 2015, y la estimación de incidencia de cáncer para España también para 2015 realizada por los registros poblacionales de cáncer españoles. El método utilizado en la estimación de la incidencia de cáncer se basa en aplicar las razones de incidencia/mortalidad de España a la mortalidad de la Comunidad de Madrid, por edad y sexo, globalmente y para los principales tipos de cáncer. Se estima que en 2015 los cánceres más frecuentes en las mujeres madrileñas fueron el cáncer de mama, el cáncer de colon, el de pulmón y el de cuerpo uterino. En varones, los cánceres más frecuentes fueron el cáncer de próstata, el de pulmón, el de colon y el de vejiga urinaria. Globalmente, en comparación con las tasas estimadas para España, la incidencia de cáncer en mujeres y hombres de la Comunidad de Madrid es inferior a la del promedio de España. Para algunos tumores, sin embargo, la Comunidad de Madrid presenta tasas superiores a las de España, siendo el caso del cáncer de pulmón y el melanoma cutáneo en mujeres, y del cáncer de páncreas y el melanoma cutáneo en los varones.

Cancer survival in adult patients in Spain. Results from nine population-based cancer registries.

With the aim of providing cancer control indicators, this work presents cancer survival in adult (≥15years) patients in Spain diagnosed during the period 2000-2007 from Spanish cancer registries participating in the EUROCARE project. Cancer cases from nine Spanish population-based cancer registries were included and analysed as a whole. All primary malignant neoplasms diagnosed in adult patients were eligible for the analysis. Cancer patients were followed until 31 December 2008. For each type of cancer, 1-, 3- and 5-year observed and relative survival were estimated by sex, age and years from diagnosis. Furthermore, age-standardized 5-year relative survival for the period 2000-2007 has been compared with that of the period 1995-1999. Skin melanoma (84.6 95% CI 83.0-86.2), prostate (84.6% 95% CI 83.6-85.6) and thyroid (84.2% CI 95% 82.0-86.6) cancers showed the highest 5-year relative survival, whereas the worst prognosis was observed in pancreatic (6% 95% CI 5.1-7.0) and oesophageal (9.4% 95% CI 7.9-11.1) cancers. Overall, survival is higher in women (58.0%) than in men (48.9%). The absolute difference in relative survival between 2000-2007 and 1995-1999 was positive for all cancers as a whole (+4.8% in men, +1.6% in women) and for most types of tumours. Survival increased significantly for chronic myeloid leukaemia, non-Hodgkin's lymphoma and rectum cancer in both sexes, and for acute lymphoid leukaemia, prostate, liver and colon cancers in men and Hodgkin's lymphoma and breast cancer in women. Survival patterns by age were similar in Europe and Spain. A decline in survival by age was observed in all tumours, being more pronounced for ovarian, corpus uteri, prostate and urinary bladder and less for head and neck and rectum cancers. High variability and differences have been observed in survival among adults in Spain according to the type of cancer diagnosed, from above 84% to below 10%, reflecting high heterogeneity. The differences in prognosis by age, sex and period of diagnosis reveal opportunities for improving cancer care in Spain.

Incidence and survival time trends for Spanish children and adolescents with leukaemia from 1983 to 2007.

We have analysed incidence and survival trends of children and adolescents with leukaemia registered in Spanish population-based cancer registries during the period 1983-2007. Childhood and adolescent leukaemia cases were drawn from the 11 Spanish population-based cancer registries. For survival, registries with data for the period 1991-2005 and follow-up until 31-12-2010 were included. Overall incidence trends were evaluated using joinpoint analysis. Observed survival rates were estimated using Kaplan-Meier, and trends were tested using the log-rank test. Based on 2606 cases (2274 children and 332 adolescents), the overall age-adjusted incidence rate (ASRw) of leukaemia was 47.9 cases per million child-years in children and 23.8 in adolescents. The ASRw of leukaemia increased with an annual percentage change of 9.6% (95% CI: 2.2-17.6) until 1990 followed by a stabilisation of rates. In adolescents, incidence did not increase. Five-year survival increased from 66% in 1991-1995 to 76% in 2001-2005. By age, survival was dramatically lower in infants (0) and adolescents (15-19) than in the other age groups and no improvement was observed. In both children and adolescents, differences in 5-year survival rates among major subgroups of leukaemias were significant. The increasing incidence trends observed in childhood leukaemias during the study period were confined to the beginning of the period. Remarkable improvements in survival have been observed in Spanish children with leukaemias. However, this improvement was not observed in infants and adolescents.

Incidence Patterns and Trends of non-Central Nervous System Solid Tumours in Children and Adolescents. A Collaborative Study of the Spanish Population Based Cancer Registries.

Objective: To describe incidence patterns and trends in children (0-14 years) and adolescents (15-19 age-range) with solid tumours, except those of central nervous system (CNS), in Spain.Methods: Cases were drawn from eleven Spanish population-based cancer registries. Incidence was estimated for the period 1983-2007 and trends were evaluated using Joinpoint regression analysis.Results: The studied tumour groups accounted for 36% of total childhood cancers and 47.6% of those diagnosed in adolescence with annual rates per million of 53.5 and 89.3 respectively. In children 0 to 14 years of age, Neuroblastoma (NB) was the commonest (7.8%) followed by Soft-tissue sarcomas (STS) (6.3%), bone tumours (BT) (6.2%) and renal tumours (RT) (4.5%). NB was the most frequently diagnosed tumour before the 5th birthday, while STS and BT were the commonest at 5-9 years of age, and BT and Carcinoma and other epithelial tumours (COET) at 10-14. COET presented the highest incidence in adolescents, followed by germ-cell tumours (GCT), BT and STS. These four diagnostic groups accounted for 94% of total non-CNS solid tumours, in adolescents. Overall incidence rates increased significantly in children up to 1996 with an annual percentage change (APC) of 2.6% (95%CI: 1.7; 3.6). NB and COET showed significant time trend (APCs: 1.4% and 3.8% respectively) while other tumour groups such as RT, STS, BT or GCT had no significant changes over time. A significant increase was present in NB under the age of 5 and in BT and STS in children aged 10-14 years. In adolescents there were significant increases for all tumours combined (APC=2.7; 95%CI: 1.8-3.6) and for STS, GCT and COET (APCs: 3.2%, 4.4% and 3.5% respectively), while other tumour groups such as hepatic tumours, BT or thyroid carcinomas showed a decreasing trend or no increase.Conclusions: Overall, the incidence of the studied cancers in children increased along the period 1983-1996 with no posterior significant rise, while the incidence in adolescents increased significantly over the whole period 1983-2007. Several specific tumour groups showed significant rises or decrements in childhood or adolescence, although the small number of cases precludes showing significant trends or inflexion points.

Gender differences in the incidence of laryngeal and hypopharyngeal cancers in Spain

Objective: The present ecological study analyzed gender differences in the incidences and trends of laryngeal and hypopharyngeal cancers in Spain and compared these with smoking prevalence and alcohol consumption in the period. Methods: Data were evaluated from seven Spanish Population-Based Cancer Registries, selected with a minimum follow-up period of 10 years. Information on smoking prevalence and trends were collected from National Health Surveys; for alcohol consumption the Global Alcohol Database was utilized. Trends in the incidences of cancer, smoking and alcohol consumption were analyzed by log-linear joinpoint regression. Results: Analysis of the seven groups of registries revealed a statistically significant reduction in the incidence of laryngeal cancer in men (APC = −4.2) over time and a non-significant increase in women (APC = 0.6), with data on prevalence of smoking revealing similar trends. For hypopharyngeal cancer in men an initial increase of 10.6% per year was observed, followed by a reduction of −7.2%; however in women a constant increase of 2.8% per year was observed in the evaluated period. Conclusions: In recent years, the incidence of laryngeal and hypopharyngeal cancers have increased in Spanish women and decreased in Spanish men, narrowing the gap between genders for this neoplasm. The identified trends are probably related to the consumption of tobacco and alcohol; however other risk factors should also be addressed.

Rising trends in incidence of cutaneous malignant melanoma and their future projections in Catalonia, Spain: increasing impact or future epidemic?

During the past decades, there has been a substantial increase in the incidence of cutaneous malignant melanoma (CMM) among all Caucasian populations. Spain presents one of Europe's lowest incidence and mortality rates. The aim of this study was to analyse the recent trends of CMM incidence and mortality in a region with lower incidence as well as to project their future trends. Cutaneous malignant melanoma incidence data were provided by the Tarragona and Girona population-based cancer registries and mortality data were provided by the Mortality Registry of Catalonia. Time trends of incidence and mortality rates by CMM were assessed through the estimated annual percentages of change of the incidence and mortality age-standardized rates to the World Standard Population. Projections were based on a Bayesian age-period-cohort model using second order autoregressive effects on age. During the last 20 years CMM incidence has increased substantially at a faster rate than any other neoplasms in Catalonia, particularly among women and this trend will probably continue for the next several years. Nevertheless, CMM mortality trends have been and probably will remain stable during this period. Improvements in preventive activities should be implemented to decrease incidence and mortality from this cancer. Monitoring stage-specific trends in CMM incidence can assess the impact of preventive strategies; for this reason more complete information on diagnostic features of CMM patients in the Spanish population-based cancer registries are necessary.

Breast cancer incidence in Spain before, during and after the implementation of screening programmes

Background: A downturn in breast cancer (BC) incidence among Spanish women has been recently reported and attributed to screening saturation. This article analyses BC trends and their relationship with the introduction of the screening programme in all Spanish regions having available information.Material and methods: The study covers the period 1980–2004. All Spanish population-based cancer registries with 10 years of uninterrupted registration furnished data on invasive BC. Trends in BC incidence among women aged <45 years and among those aged ≥45 years were assessed using Poisson transition models to estimate the existence of a change-point in the overall trend. Furthermore, in those regions that had registered BC incidence before implementing the screening programme, the annual percentage change in women aged ≥45 years was computed before screening, during the first round of screening and after full coverage had been achieved.Results: The study included 82 699 incident cases. Whereas BC increased during the 1980s and 1990s, from 2001 onwards a decline was observed among women aged ≥45 years. This phenomenon was clearly visible in regions that had implemented BC screening before 2000 and attained high participation rates. In such areas, BC incidence rose sharply during screening implementation, with an overall increase of ∼20%–30%. BC incidence fell once full coverage was achieved and tended to level off or even increase thereafter, as was the case in Navarre. In women aged <45 years, BC increased by 1.7% per annum across the period.Conclusions: Screening has strongly influenced recent BC trends among Spanish women aged ≥45 years. Our results support the influence of screening saturation on the recent decline of BC. Among younger women, incidence is still rising, probably reflecting the lifestyle changes observed in younger generations.

The moderate decrease in invasive cervical cancer incidence rates in Spain (1980–2004): limited success of opportunistic screening?

Background: Despite its low incidence, invasive cervical cancer (ICC) is still a public health concern in Spain, due to its being perceived as an avoidable neoplasm. Social changes in recent decades may have increased the risk of ICC among Spanish females. This study sought to update incidence trends in Spanish registries.Patients and methods: We studied the ICC incidence time trend over the period 1980–2004 using data from 13 Spanish population-based cancer registries, analysing all cases and the two main histological types, i.e. squamous cell carcinoma (SCC) and adenocarcinoma (AC). Change-point Poisson regression models were fitted for all women and for the following three age groups: 25–44, 45–64 and ≥65 years. Age–period–cohort models were used to study cohort and period effect.Results: ICC incidence showed a moderate decrease (annual percentage change: –0.9%; 95% CI –1.3% to –0.5%). Whereas rates among younger women rose sharply by 5.5% until 1990, when they began to descend by 1.2% annually, among women aged ≥45 years they declined by 1.5% per annum. In the last decade of the study period, divergent trends were found for SCC and AC, i.e. downward versus upward, respectively. Risk increased with birth cohort after 1940–45 but the period effect showed opposite trends for the two histological types.Conclusion: Cervical cancer incidence rates have decreased moderately in Spain, a trend consistent with the preventive effect of widespread opportunistic screening.

Prostate cancer incidence trends in Spain before and during the prostate-specific antigen era: impact on mortality

Background: Although prostate cancer has recently registered increasing incidence and decreasing mortality in Spain, no analysis has yet been made of these two indicators to ascertain the magnitude of and reasons for these trends.Materials and methods: The time trend in invasive prostate cancer incidence from 1975 to 2004 was studied by combining data from 13 Spanish population-based cancer registries. Change-point Poisson regression models were fitted for all men and for two age groups (45–64 and 65+ years). Age–period–cohort models were used to study cohort and period effects. In addition, we studied the time trend in prostate cancer mortality in Spain for the period 1980–2007.Results: Incidence increased annually by 1.3% from 1975 to 1990 and by 7.3% thereafter. Until 1990, the percentage increase was low and indeed similar for both age groups. While the subsequent increase in the two age groups was greater, this was particularly marked among the youngest men, with a decrease being observed in age groups >85 years in the last quinquennium. Mortality increased by an annual figure of 0.7% until 1998, after which it decreased by 3.6% per annum until 2007.Conclusions: Despite the dramatic rise in incidence from 1990 onwards, mainly due to opportunistic screening, prostate cancer mortality was only observed to decline slowly from 1998. If prostate-specific antigen screening remains at a similar level in Spain, overdiagnosis may well become an important chronic side-effect and health problem.

Trends in oesophago-gastric cancer incidence in Spain: analysis by subsite and histology

Background: During recent decades, an increase in the incidence of certain oesophago-gastric cancer subtypes has been reported in some countries. This study sought to analyse oesophageal and gastric cancer incidence trends in Spain by sex, site and morphology for the period 1980–2004.Patients and methods: Oesophageal and gastric cancer cases were drawn from 13 Spanish population-based cancer registries. Time trends in sex- and age-standardised cancer incidence rates were analysed by subsite and histology over the study period, using change-point Poisson models.Results: Age-standardised oesophageal cancer incidence rates failed to register a significant trend over the study period. Overall, gastric cancer decreased from 27.21 and 13.44 cases per 100 000 person-years in 1980–84 to 20.21 and 8.68 in 2000–04, among men and women, respectively. Whereas oesophageal adenocarcinomas increased by ∼5% per annum in both sexes, gastric cardia cancer increased during the study period in males only, though this increase was less pronounced. Among men, oesophageal squamous cell cancer and non-cardia cancer rates declined steadily from the mid-1980s onwards. Over the same period, there was a marked decrease in the incidence of oesophago-gastric cancer presenting with unspecified subsite or morphology.Conclusions: Changes in the prevalence of the main risk factors for these tumours might only partly explain oesophageal and gastric cancer rate trends by subtype. Reclassification, however, would appear to account for most of the divergence in oesophageal and gastric cancer trends by subtype over the study period.

Is hospital discharge administrative data an appropriate source of information for cancer registries purposes? Some insights from four Spanish registries

BackgroundThe use of hospital discharge administrative data (HDAD) has been recommended for automating, improving, even substituting, population-based cancer registries. The frequency of false positive and false negative cases recommends local validation.MethodsThe aim of this study was to detect newly diagnosed, false positive and false negative cases of cancer from hospital discharge claims, using four Spanish population-based cancer registries as the gold standard. Prostate cancer was used as a case study.ResultsA total of 2286 incident cases of prostate cancer registered in 2000 were used for validation. In the most sensitive algorithm (that using five diagnostic codes), estimates for Sensitivity ranged from 14.5% (CI95% 10.3-19.6) to 45.7% (CI95% 41.4-50.1). In the most predictive algorithm (that using five diagnostic and five surgical codes) Positive Predictive Value estimates ranged from 55.9% (CI95% 42.4-68.8) to 74.3% (CI95% 67.0-80.6). The most frequent reason for false positive cases was the number of prevalent cases inadequately considered as newly diagnosed cancers, ranging from 61.1% to 82.3% of false positive cases. The most frequent reason for false negative cases was related to the number of cases not attended in hospital settings. In this case, figures ranged from 34.4% to 69.7% of false negative cases, in the most predictive algorithm.ConclusionsHDAD might be a helpful tool for cancer registries to reach their goals. The findings suggest that, for automating cancer registries, algorithms combining diagnoses and procedures are the best option. However, for cancer surveillance purposes, in those cancers like prostate cancer in which care is not only hospital-based, combining inpatient and outpatient information will be required.

Estimación de la incidencia de cáncer en España: período 1993–1996

To estimate the number of incident cases of cancer in Spain between 1993 and 1996. We used data on the incidence of cancer from nine Spanish population-based cancer registries published in the monograph Cancer incidence in Five Continents, vols. VI and VII (period 1983-92). The National Institute of Statistics provided mortality data (period 1983-96). Generalized linear mixed models were used to estimate the number of incident cases. The incidence/mortality ratio was modeled. To account for heterogeneity, the providence of residence was considered as a random effect. Other factors analyzed were sex, age and period. Model parameters were estimated using a Bayesian approach with BUGS software. Estimates were valdated by comparing the observed number of cases with those predicted by the model in the regions with cancer registry data. The average number of incident cases per annum for all cancer sites except non-melanoma skin cancer was 78,440 for men and 55,480 for women. The most frequent neoplasm in men was lung with 15,480 cases followed by bladder with 9,445 cases and colorectal with 8,876 cases. In women the most frequent cancer was breast with 13,490 cases followed by colorectal with 8,274 cases. These absolute frequencies showed an increasing time trend for all cancers and for the most frequent sites, with the exception of stomach and uterine cervix. Internal validation of the estimates allowed calculation of a relative error smaller than 10%. This is the first time that the number of incident cases of cancer in Spain has been estimated with methods that account for heterogeneity. These figures show the importance of cancer as a public health problem in our community.