Stage-specific Incidence Trends Research Articles

Temporal trends in age- and stage-specific incidence of colorectal adenocarcinomas in Germany

BackgroundA national colorectal cancer (CRC) screening programme was launched in 2002 in Germany. A comprehensive evaluation of the programme effectiveness using real-world data is still lacking. In addition, there are regional reports on increasing colorectal cancer incidence in younger populations. Therefore, we aimed to describe and compare the overall, age- and stage-specific incidence trends for colorectal, colon and rectal cancer.MethodsWe used data from seven population-based cancer registries in Germany. We report absolute and relative changes in incidence rates between the early screening phase (2003–2005) and the most recent time period available (2015–2017), as well as annual percent changes. We analysed incidences according to tumour site (colorectum, colon, and rectum) and to six age groups (young adults: 15–34, 35–39, 40–49, screening-entitled/older adults: 50–54, 55–69 and 70 + years old).ResultsIn our sample of 271,011 colorectal adenocarcinomas, about two-thirds were located in the colon and 95% of them occurred in the age group 50+ (50–54: 5%, 55–69: 32.8%, 70+: 57.2%). For the time period 2003–2005 the age-specific incidence rates of individuals in the age group 55–69 were about 76/100,00 for colon and 54/100,000 for rectal cancer (age group 70 + colon: 179/100,000; rectum: 84/100,000). The incidence rates in young adults were less than 13% of that of individuals in the age group 55–69 (< 5% of individuals aged 70+; <33% of individuals aged 50–54).Over time, incidence decreased in individuals at the age of 55+, for all subsites considered as well as for early and late stage cancers (with few exceptions), while incidence of young adult CRC (both early and late stage) increased steepest in the youngest age groups. For late stage rectal cancer, a shift was observed in all age groups from UICC stage IV to stage III being the most frequent stage.ConclusionsSix years after the introduction of the national colonoscopy screening program, late stage CRC incidence began to decline substantially in the screening-eligible age groups (55-69, 70+). It is likely that this decline and the increase in early stage CRC observed in younger age groups can be attributed to the program. Long lasting public awareness campaigns for CRC screening might have led to opportunistic screening in younger adults. Whether these benefits outweigh the possible harm of screening in younger age groups remains unclear.

Stage–specific incidence trends of renal cancers in the East of England, 1999–2016

ObjectivesTo determine stage-specific time-trends in renal cancer incidence. MethodsWe used population-based East Anglia data 1999−2016 (population ∼2 million) on 5,456 primary renal cancer diagnoses, estimating stage-specific annual incidence using Poisson regression, allowing for changing time-trends, and adjusting for sex, age, and socioeconomic deprivation. ResultsRenal cancer incidence increased from 9.8–16.4 cases per 100,000 during 1999−2016. Incidence of Stage I, II, and III cases increased over time, most steeply for Stage I, with annual Incidence Rate Ratio [IRR] for Stage I of 1.09 (95 % CI 1.07–1.12) during 1999−2010; and 1.03 (1.00–1.05) during 2011−2016. In contrast, the annual incidence of Stage IV renal cancer decreased during most years, IRR of 0.99 (0.98–1.00) during 2003−2016. ConclusionThe findings are consistent with both earlier detection of symptomatic renal cancer and increasing identification of asymptomatic lesions. However, the decreasing incidence of late-stage disease suggests genuine shifts towards earlier diagnosis.

Stage-specific incidence trends of melanoma in an English region, 1996-2015: longitudinal analyses of population-based data.

The aim of this study was to examine temporal trends in overall and stage-specific incidence of melanoma. Using population-based data on patients diagnosed with melanoma in East Anglia, England, 1996-2015, we estimated age-standardized time trends in annual incidence rates for each stage at diagnosis. Negative binomial regression was used to model trends over time adjusted for sex, age group and deprivation, and to subsequently examine variation in stage-specific trends by sex and age group. The age-standardized incidence increased from 14 to 29 cases/100 000 persons (i.e. 4% annually). Increasing incidence was apparent across all stages but was steepest for stage I [adjusted annual increase: 5%, 95% confidence interval (CI): 5-6%, and more gradual for stage II-IV disease (stage II: 3%, 95% CI: 2-4%; stage III/IV: 2%, 95% CI: 1-3%)]. Stage II-IV increase was apparent in men across age groups and in women aged 50 years or older. Increases in incidence were steeper in those aged 70 years or older, and in men. The findings suggest that both a genuine increase in the incidence of consequential illness and a degree of overdiagnosis may be responsible for the observed increasing incidence trends in melanoma in our population during the study period. They also suggest the potentially lower effectiveness of public health awareness campaigns in men and older people.

40 Years of Change in Age- and Stage-Specific Cancer Incidence Rates in US Women and Men.

BackgroundStudies have documented a temporal increase in incidence for several cancers in US young adults aged 25 to 39-years, including noncardia gastric cancer, colorectal cancer, and distant-stage breast cancer. To further characterize trends in young adults, we assessed age-specific and stage-specific incidence trends from 1975 to 2015, overall (all malignant cancers combined), and for 18 and 16 cancer sites in women and men, respectively.MethodsWe used US population-based data from the Surveillance, Epidemiology, and End Results Program to obtain overall and site-specific cancer incidence rates by sex and age group. We individually analyzed cancer sites with an incidence rate of at least 5 per 100 000 in 2015, accounting for greater than 90% of all cancer diagnoses. We estimated annual percent changes (APCs) using segment log-linear regression performed with joinpoint software; multiple permutation testing was used to identify inflection points. We forecasted overall cancer incidence through 2030 using age-period-cohort regression models.ResultsBased on trends occurring after the most recent joinpoint inflection point, overall cancer incidence increased by 1.15% (95% CI = 1.01% to 1.28%) per year in 25- to 39-year-old women and by 0.46% (95% CI = 0.17% to 0.75%) per year in 25- to 39-year-old men; APCs were of much lower magnitude in the older age groups (eg, 70- to 84-year-old women APC = −0.31%, 95% CI = −0.42% to −0.20%). We forecasted that overall cancer incidence will increase by an additional 11% by 2030 in 25- to 39-year-old women, and by an additional 12% in 25- to 39-year-old men. Ten of the 18 cancers assessed in 25- to 39-year-old women and 7 of the 16 cancers in 25- to 39-year-old men have been statistically significantly increasing over time. We found that the increase in incidence for young adults is stage specific for some cancers (eg, only nonlocalized breast cancer has increased in 25- to 39-year-old women).ConclusionCancer incidence is increasing in young adults, particularly in young women.

Trends in stage at diagnosis for young breast cancer patients in the United States.

Previous studies reported increasing rates of metastatic breast cancer among young US women. However, these studies were based on limited geographic areas and did not account for the sharp decline in unknown-stage disease. In this study, we examined trends in early-onset breast cancer incidence rates by stage at diagnosis in a national dataset, after correcting for temporal changes in unstaged disease. Using data from 42 states, covering 82% of the US population, we examined trends in incidence rates by stage at diagnosis and race/ethnicity in women ages 20-39years. Stage was imputed for non-Hispanic (NH) white and NH black cases with missing information by distributing cases proportionally according to survival statistics. During 2001-2015, incidence rates of early-onset metastatic breast cancer increased sharply among NH white, NH black, Hispanic, and Asian/Pacific Islander (API) women. Increasing trends were also observed for local-stage disease (all racial/ethnic groups) and regional-stage disease (NH white and API). In contrast, rates decreased sharply for unstaged disease among all groups. After imputing stage for cases with missing information, the increasing trends for regional- and distant-stage disease in NH whites and local-stage disease in NH blacks were no longer statistically significant, but the increase in distant-stage disease in NH blacks was unchanged. After accounting for the sharp decline in unstaged cases, the increase in incidence rates for distant-stage disease became non-significant in NH whites but not in NH blacks. Future studies should consider accounting for temporal changes in unstaged disease when examining stage-specific incidence trends.

Colorectal Cancer Incidence Trends by Age, Stage, and Racial/Ethnic Group in California, 1990-2014.

Background: The incidence of colorectal cancer in the United States declined substantially over the past 20 years, but evidence suggests that among younger adults (under 50 years at diagnosis), incidence is increasing. However, data on age- and stage-specific incidence trends across racial/ethnic groups are limited.Methods: All incident cases of colorectal cancer diagnosed from 1990 through 2014 in adults aged 20 years and older were obtained from the California Cancer Registry. Incidence rates (per 100,000), incidence rate ratios, and triannual percent changes in incidence were estimated for each age group at diagnosis (20-49, 50-74, 75+ years), sex, stage, and race/ethnicity (non-Hispanic white, non-Hispanic black, Hispanic, and 7 Asian American groups).Results: Of 349,176 incident colorectal cancer cases diagnosed from 1990 through 2014, 9% were in adults younger than 50 years. Increases in incidence of early-onset colorectal cancer, especially in regional/distant stage disease, were observed in most racial/ethnic groups (statistically significant for non-Hispanic whites and Hispanics, ranging from 0.9% to 2.9% every 3 years). Incidence also increased in Vietnamese and other Southeast Asian groups of screening age (50-74 years). The incidence of colorectal cancer in non-Hispanic blacks aged 50+ declined over the 25-year period, but remained significantly higher than in non-Hispanic whites.Conclusions: Further research is needed to understand the causes of the increasing incidence of early-onset colorectal cancer. The rising incidence of colorectal cancer among Southeast Asians of screening age and the persistently high incidence in non-Hispanic blacks also warrant attention.Impact: Our findings may have implications for revisiting screening guidelines in the United States. Cancer Epidemiol Biomarkers Prev; 27(9); 1011-8. ©2018 AACR.

Stage-specific incidence and survival of breast cancer in Norway: The implications of changes in coding and classification practice

To describe the association between coding and classification practices and observed stage-specific incidence and survival trends in Norway over time.We identified all women diagnosed with invasive breast cancer in the period between 1980 and 2015. Changes in the coding and classification of breast cancer in the study period were described, and stage-specific incidence rates and relative survival were calculated.A total of 90 362 women were diagnosed with primary breast cancer, stage I–IV, or unknown stage, in the study period. Stage-specific incidence was significantly influenced by changes in coding practice, classification systems and the implementation of the screening program. These changes have mostly affected the proportion of stage I and “unknown”, but also stages II, III and IV. The proportion of stage I showed a clear increase during the implementation period of the national screening program, and was most pronounced within the age group 50–69. Stage-specific trends for relative survival were less influenced by changes in coding and classification of stage.Our study showed that the stage-specific incidence trends in Norway were influenced by changes in the coding and classification practice. These findings should be taken into consideration in future research and evaluation related to stage-specific trends and stage migration of breast cancer in Norway.

Trends in stage-specific breast cancer incidence in New South Wales, Australia: insights into the effects of 25years of screening mammography.

Screening mammography aims to improve breast cancer (BC) prognosis by increasing the incidence of early-stage tumours in order to decrease the incidence of late-stage cancer, but no reports have investigated these potential effects in an Australian population. Therefore we aimed to identify temporal trends in stage-specific BC in New South Wales (NSW), Australia, between 1972 and 2012. An observational study of women who received a diagnosis of BC from 1972-2012 as recorded in the NSW Cancer Registry, a population-based registry with almost complete coverage and high rates of histological verification. We analysed trends in stage-specific incidence before screening and compared them to periods after screening began. Our primary group of interest was women in the target age range of 50-69years, though trends in women outside the target age were also assessed. Screening was not associated with lower incidence of late-stage BC at diagnosis. Incidence for all stages remained higher than prescreening levels. In women aged 50-69years, the incidence of carcinoma in situ (CIS), localised and regional BC has more than doubled compared to the prescreening era, with incidence rate ratios ranging from 2.0 for regional (95% CI 1.95-2.13) to 121.8 for CIS (95% CI 82.58-179.72). Before the introduction of screening, there was a downward trend in distant metastatic BC incidence, and after the introduction of screening there was an increase (IRR 1.8; 95% CI 1.62-2.00). In women too young to screen the incidence of late-stage BC at diagnosis also increased, whereas localised disease was stable. The incidence of all stages of BC has increased over the past 40 years, with the greatest rise seen during the established screening period for women aged 50-69years. Our findings suggest that some of the expected benefits of screening may not have been realised and are consistent with overdiagnosis.