Total Cancer Incidence Research Articles

Population Trends in Lobular Carcinoma of the Breast: The Ontario Experience.

Invasive lobular carcinoma (ILC) is less common that invasive ductal carcinoma (IDC), and more challenging to diagnose by examination and screening mammography. This study evaluated current trends in ILC incidence, and described the 5-, 10-, and 15-year survival probabilities for women diagnosed with ILC in Ontario, Canada. This retrospective cohort analysis included all women aged 18years and older diagnosed with breast cancer between 1991 and 2015. Health administrative data from the Institute of Clinical Evaluative Sciences and the Ontario Cancer Registry were used to identify breast cancer cases. Age-adjusted incidence was plotted by year. Crude proportions were plotted by year of diagnosis for stage and hormone receptor status. Kaplan-Meier curves were generated to determine the 5-, 10-, and 15-year survival probabilities for ILC and IDC. From 1991 to 2015, there were 194,065 cases of breast cancer in Ontario, 14.7% of which were ILC. The age-adjusted incidence of breast cancer increased 1.04-fold, while ILC rates increased 1.53-fold. All bilateral breast cancers were of lobular origin. The proportion of stage 1 ILC decreased, while the proportion of stage 2-4 ILC increased. The 5-, 10-, and 15-year overall survival probabilities for women diagnosed with ILC were 82.7%, 65.3%, and 50.2%, respectively. This study contains the largest population dataset of ILC evaluated to date. While total breast cancer incidence rates in Ontario are largely unchanged, ILC incidence rates are steadily increasing and there is a trend towards diagnosis of ILC at a later stage. These trends highlight the ongoing diagnostic and treatment challenge ILC presents for patients and clinicians.

Burden of lung cancer attributable to ambient fine particles and potential benefits from air quality improvements in Beijing, China: A population-based study

ObjectiveWe aimed to establish a representative exposure response function between PM2.5 and lung cancer to evaluate the impact on lung cancer burden and the benefits gained in association with the environmental policy change in Beijing, China. MethodsBased on population-based cancer registration data during 2001–2016, using a spatiotemporal Poisson regression model, long-term concentrations of PM2.5 were linked to sex-age adjusted incidence rates of total lung cancer and its pathological subtypes. We calculated the health and monetary benefits associated with air quality improvement using the cost of illness method. ResultsIn the constructed regression model, a 10 μg/m3 increment of PM2.5 was associated with increases of 6.0% (95% confidence interval [95% CI]: 4.3%, 7.7%), 14.8% (10.3%, 19.4%), and 6.5% (3.3%, 9.8%) in the incidence of total lung cancer, squamous cell carcinoma, and adenocarcinoma, respectively. The estimated associations indicate that long-term exposure to PM2.5 contributed 1947 to 3059 incident cases of lung cancer per year among the residents in Beijing during the study period. Clean air actions saved 4978 (95% CI: 2711, 7417) lung cancer cases, which brought a savings of 218 (118, 324) million RMB (~31 [17, 46] million US dollars) in direct inpatient medical expenditures. If air quality had met national standards of long-term PM2.5 (35 μg/m3) in 2014–2016, 10,003 (95% CI: 9325, 10,650) lung cancer cases could have been prevented and direct inpatient medical expenditures of 438 (409, 466) million RMB (~63 [58, 67] million US dollars) could have been saved. ConclusionsThis study enriches epidemiological study, confirming the association between exposure to PM2.5 and lung cancer or its subtypes, and provides novel evidence for the notable reduction in lung cancer burden and medical expenditure savings that were achieved through air quality improvements in Beijing from 2014 to 2016.

Determining generalizability of the Canadian Kidney Cancer information system (CKCis) to the entire Canadian kidney cancer population.

The Canadian Kidney Cancer information system (CKCis) has prospectively collected data on patients with renal tumors since January 1, 2011 from 16 sites within 14 academic centers in six provinces. Canadian kidney cancer experts have used CKCis data to address several research questions. The goal of this study was to determine if the CKCis cohort is representative of the entire Canadian kidney cancer population, specifically regarding demographic and geographic distributions. The CKCis prospective cohort was analyzed up to December 31, 2018. Baseline demographics and tumor characteristics were analyzed, including location of patients' residence at the time of CKCis entry. Geographic data is presented by province, rural vs. urban via postal code information (2nd digit=0) and by Canadian urban boundary files. To determine the proportion of renal cell carcinoma (RCC) patients that CKCis captures, CKCis accruals were compared to projected Canadian Cancer Society RCC incidence in 2016-2017 and the incidence from the 2016 Canadian Cancer Registry. To determine if the CKCis baseline data is representative, it was compared to registry data and other published data when registry data was not available. This CKCis cohort includes 10 298 eligible patients: 66.6% male, median age 62.6 years; 14.6% had metastatic disease at the time of diagnosis and 70.4% had clear-cell carcinomas. The CKCis cohort captures about 1250 patients per year, which represents approximately 20% of the total kidney cancer incidence. The proportion of patients captured per province did vary from 13-43%. Rural patients make up 17% of patients, with some baseline differences between rural and urban patients. There appears to be no major differences between CKCis patient demographics and disease characteristics compared to national data sources. Canadian heat maps detailing patient location are presented. CKCis contains prospective data on >10 000 Canadian kidney cancer patients, making it a valuable resource for kidney cancer research. The baseline demographic and geographic data do appear to include a broad cross-section of patients and seem to be highly representative of the Canadian kidney cancer population. Moving forward, future projects will include determining if CKCis cancer outcomes are also representative of the entire Canadian kidney cancer population and studying variations across provinces and within rural vs. urban areas.

Abstract B096: Responding to stakeholder needs for cancer screening and prevention: Using formative evaluation to tailor outreach and navigation programming in Connecticut

Abstract Background: Total cancer incidence rates in Connecticut are well above the national average, with disproportionate impact on our underserved and minority communities. As part of the Yale Cancer Center's (YCC) Community Outreach and Engagement activities, we translate population research into programmatic innovations designed to reach and address the needs of Connecticut's at-risk populations. Our recently initiated Yale Cancer Disparities Firewall (Firewall) project aims to strengthen population health through expanded outreach, navigation and health systems change. The project seeks to build a cancer disparities firewall around at-risk populations by addressing patient and system level factors across the cancer care continuum. The programmatic model consists of two primary intervention strategies—outreach and patient navigation—and local health infrastructure fortified by diverse partnerships and programmatic change. Prior to launching, a formative, baseline evaluation was conducted between January and May 2018. Findings from this evaluation are presented alongside proposed programmatic translations. Methodology: The baseline evaluation consisted of three components: 1) a review of existing programmatic data and data collection strategies, 2) analysis of current outreach and education activities and partnerships and 3) completion of seven stakeholder interviews. By triangulating findings across qualitative analyses, the evaluation, conducted by an external evaluator, identified potential facilitators for and barriers to project implementation and success. Findings were synthesized for translation into program activities as well as for pre-/post-implementation dissemination. Results and Translation: Baseline evaluation revealed four challenges to successful implementation: 1) limited input from residents “on the ground,” who might be the target of risk reduction and screening services, 2) presence of multiple levels of navigation and coordination for patients during and after cancer diagnoses, 3) few resources for helping would-be patients “navigate” risk reduction and screening services and 4) problematic race/ethnicity data. Despite these challenges, existing outreach and education activities consisted of 14 events, 1,909 contacts and 25 meetings with partner organizations. To incorporate the findings, our project has: 1) complemented existing community advisory board infrastructure with additional neighborhood-level input, 2) piloted community health navigation to draw new patients into cancer screening and risk reduction interventions and 3) initiated high-level meetings about whether and how collection and use of race/ethnicity data may be improved system-wide. Citation Format: Sakinah C. Suttiratana, Roy Herbst, Denise E. Stevens, Beth A. Jones. Responding to stakeholder needs for cancer screening and prevention: Using formative evaluation to tailor outreach and navigation programming in Connecticut [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B096.

Trends of Colorectal Cancer Prevalence in Kazakhstan Related to Screening.

We carried out an analysis of the total incidence of colon cancer throughout Kazakhstan. Retrospectively, according to the regional reports on endoscopic screening, the study showed an increase in the age-related incidence of colorectal cancer (CRC) cases from 2004–2008 to 2009–2014. The peak of morbidity in both periods was noted in the age category of >70 years. The indicators of the territorial distribution of CRC incidence make it possible to divide the regions into areas with low or high rates of CRC. Specific indicators showed newly diagnosed cases of CRC stages I, II, III, and IV in 2004–2018. The incidence rates of stages I and II showed a two-fold increase (35%–67.4%) and the incidence of stage IV showed a decline from 19.3% to 13.1% and of stage III from 45.7% to 19.5% from 2004 to 2018, respectively. An analysis of CRC incidence throughout Kazakhstan showed an increase in the overall incidence. Since population-based CRC screening was introduced in 2011, the morbidity was found to increase for stages I and II.

Total Antioxidant Capacity and Pancreatic Cancer Incidence and Mortality in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial.

Total antioxidant capacity (TAC) reflects an individual's overall antioxidant intake. We sought to clarify whether higher TAC is associated with lower risks of pancreatic cancer incidence and mortality in the U.S. general population. A total of 96,018 American adults were identified from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. A ferric-reducing ability of plasma score was used to reflect an individual's TAC intake from diet and/or supplements. Cox regression was used to calculate hazard ratios (HR) for pancreatic cancer incidence, and competing risk regression was used to calculate subdistribution HRs for pancreatic cancer mortality. Restricted cubic spline regression was used to test nonlinearity. A total of 393 pancreatic cancer cases and 353 pancreatic cancer-related deaths were documented. Total (diet + supplements) TAC was found to be inversely associated with pancreatic cancer incidence (HR quartile 4 vs. quartile 1 = 0.53; 95% confidence interval, 0.39-0.72; P trend = 0.0002) and mortality (subdistribution HR quartile 4 vs. quartile 1 = 0.52; 95% confidence interval 0.38-0.72; P trend = 0.0003) in a nonlinear dose-response manner (all P nonlinearity < 0.01). Similar results were observed for dietary TAC. No association of supplemental TAC with pancreatic cancer incidence and mortality was found. In the U.S. general population, dietary but not supplemental TAC level is inversely associated with risks of pancreatic cancer incidence and mortality in a nonlinear dose-response pattern. This is the first prospective study indicating that a diet rich in antioxidants may be beneficial in decreasing pancreatic cancer incidence and mortality.

Increased cancer risk in male hunters compared to the general male population in Northern Sweden after the Chernobyl Nuclear Power Plant accident?

Background:Male hunters in Swedish counties with high fallout of 137Cs after the Chernobyl Nuclear Power Plant (NPP) accident have higher radiation exposure due to higher consumption of game compared with the general population.Methods:Cancer incidence in Sweden was studied in 9 counties with different 137Cs fallout after the Chernobyl NPP accident in 1986. In total, 9,267 cancer cases occurred in hunters and 138,909 cancer cases in non-hunters to 31 December 2015. Incidence rate ratios (IRR) with 95% confidence intervals (CI) were calculated using unexposed hunters, or non-hunters, as reference to study internal radiation exposure or hunter life style, respectively.Results:Directly age standardized total cancer incidence showed an increasing trend in non-hunters. For hunters, the total cancer incidence was significantly lower up to 2001 when the total cancer incidence crossed over the weaker non-hunter trend and remained higher for the following 15 years. IRRs for total cancer in hunters versus non-hunters for each county did not show any clear exposure response pattern. IRRs for hunters versus non-hunters were higher regardless of rural/non-rural status with slightly higher risk estimates for the rural settings. The IRR for hunters was 1.06 (95% CI 1.04–1.08) 1986–2015, representing an excess of 531 cancer cases in hunters.Conclusion:An increased total incidence of cancer was identified for male hunters compared with male non-hunters. No obvious association between cancer and 137Cs from the Chernobyl NPP accident could be identified, although the exposure classification was too crude to exclude such an association.

Organoid models of gastrointestinal cancers in basic and translational research.

Cancer is a major public health problem worldwide. Gastrointestinal cancers account for approximately one-third of the total global cancer incidence and mortality. Historically, the mechanisms of tumour initiation and progression in the gastrointestinal tract have been studied using cancer cell lines in vitro and animal models. Traditional cell culture methods are associated with a strong selection of aberrant genomic variants that no longer reflect the original tumours in terms of their (metastatic) behaviour or response to therapy. Organoid technology has emerged as a powerful alternative method for culturing gastrointestinal tumours and the corresponding normal tissues in a manner that preserves their genetic, phenotypic and behavioural traits. Importantly, accumulating evidence suggests that organoid cultures have great value in predicting the outcome of therapy in individual patients. Herein, we review the current literature on organoid models of the most common gastrointestinal cancers, including colorectal cancer, gastric cancer, oesophageal cancer, liver cancer and pancreatic cancer, and their value in modelling tumour initiation, metastatic progression and therapy response. We also explore the limitations of current organoid models and discuss how they could be improved to maximally benefit basic and translational research in the future, especially in the fields of drug discovery and personalized medicine.

Multiple primary cancers in patients with gastric cancer: A retrospective study in China National Cancer Center.

337 Background: Gastric cancer (GC) is common in China. With the total incidence of cancer keeping rising in China, the occurrence of multiple primary cancers with GC is growing. Early detection and diagnosis of second or more primary cancers are vital for patients’ survival. Methods: Patients with multiple primary cancers containing gastric adenocarcinoma treated in China National Cancer Center from January 2010 to December 2017 were included. A 6-month interval was used to separate synchronous and metachronous cancers (according to IARC/IACR criteria). Results: 479 patients met the criteria were included, with 452 (94.4%), 24 (5.0%), 3 (0.6%) patients having two, three or more primary cancer sites respectively, contributing a total of 510 cancer sites besides stomach (Table). Malignancies at 257 (50.4%) sites occurred with GC synchronously, while 253 (49.6%) occurred metachronously. The median age at the diagnosis of first cancer was 59 (interquartile range [IQR], 53-66) years. The median interval between the diagnosis of first primary cancer and metachronous second one was 50.3 (IQR, 23.7-97.0) months. Cancers outside gastrointestinal (GI) tract were more likely to occur with GC metachronously, while GI tract cancers were more likely to occur synchronously (χ²=55.36, p&lt;0.001). Out of 479 patients, there were 352 (73.6%) male and 127 (26.4%) female. The most common associated cancer was esophagus cancer (142, 40.3%) in male, and breast cancer (31, 25.4%) in female. 236 (49.8%) patients were current smokers or ex-smokers, and 190 (40.1%) were regular alcohol consumers. 110 (23.2%) had first-degree relative cancer family history, with 84 (17.7%) having GI tract cancer family history. Conclusions: GI tract including esophagus and colorectum should be carefully scrutinized during GC peri-operation period. Further genetic research is warranted to explore the potential pathogenesis of multiple primary cancers.[Table: see text]

The preventive role of cardiorespiratory fitness in current male smokers who meet the American Cancer Society criteria for lung cancer screening: a prospective pilot study.

Survival benefits could be potentially improved by adding cardiorespiratory fitness (CRF) to lung cancer screening. The current pilot study aimed to assess the association between CRF and adverse outcomes in current male smokers who are meeting the American Cancer Society (ACS) criteria for lung cancer screening. A total of 260 men with a baseline CRF assessment (treadmill exercise test) who are met the ACS lung cancer screening criteria ("current smokers aged 55-74years with ≥ 30 pack/years smoking history") were prospectively studied. Cox proportional hazard models were analyzed for all-cause and cancer mortality, total and lung cancer incidence. Mean age was 63.3 ± 5.4years, smoking history 50.4 ± 26.7 pack/years, and CRF was 7.8 ± 3.2 metabolic equivalents (METs). During a mean of 10.2 ± 6.1years follow-up, 80 participants developed any type of cancer, 19 were diagnosed with lung cancer and 66 died (cancer, n = 39, other causes, n = 27). In multivariable models, only CRF was associated with all-cause and cancer mortality. Each 1-MET higher CRF was associated with a 10% reduced risk for all-cause mortality [0.9, 95% CI (0.83 to 0.98), p = 0.017] and cancer mortality [0.9, 95% CI (0.8 to 0.99), p = 0.048]. CRF was not associated with total cancer incidence (p = 0.59) or lung cancer incidence (p = 0.96). Higher CRF is independently associated with lower risk of all-cause and cancer mortality in current male smokers who meet the ACS criteria for lung cancer screening. Screening for CRF and achieving higher CRF levels could potentially reduce mortality and serve as complementary preventive strategy in heavy smokers.

Long-term aspirin use for primary cancer prevention: An updated systematic review and subgroup meta-analysis of 29 randomized clinical trials.

Background and objective: Long-term aspirin use for the primary prevention of cancer remains controversial, and variations in the effect of aspirin use on cancer outcomes by aspirin dose, follow-up duration, or study population have never been systematically evaluated. The objective of this study was to evaluate the effect of aspirin on primary cancer prevention and to determine whether the effect differed according to aspirin dose, follow-up duration, or study population.Materials and methods: Seven electronic databases were searched from inception to September 30, 2019. Randomized clinical trials (RCTs) that compared aspirin use versus no aspirin use in participants without pre-existing cancer and reported cancer outcomes were selected. Data were screened and extracted by different investigators. Analyses were performed using Review Manager 5.3 and Comprehensive Meta-Analysis 2.0. Total cancer incidence was defined as the primary clinical endpoint. Total cancer mortality, all-cause mortality, major bleeding, and total bleeding events were the secondary outcomes. Subgroup analyses were conducted based on aspirin dose, follow-up duration, and study populations.Results: Twenty-nine RCTs that randomized 200,679 participants were included. Compared with no aspirin, aspirin use was not associated with significant reductions in total cancer incidence (RR = 1.01, 95% CI: 0.97 to 1.04, P = 0.72), total cancer mortality (RR = 1.00, 95% CI: 0.93 to 1.07, P = 0.90), or all-cause mortality (RR = 0.98, 95% CI: 0.94 to 1.02, P =0.31); however, aspirin use was associated with a 44% increase in the risk of major bleeding (RR = 1.44, 95% CI: 1.32 to 1.57, P < 0.00001) and a 52% increase in the risk of total bleeding events (RR = 1.52, 95% CI: 1.33 to 1.74, P < 0.00001). Subgroup analyses demonstrated consistent results.Conclusions: Long-term aspirin use in individuals without pre-existing cancer was not associated with a significant reduction in total cancer incidence, cancer mortality, or all-cause mortality; however, aspirin use was associated with a significant increase in the risk of bleeding. Therefore, aspirin is not an appropriate choice for the primary cancer prevention.

Incidence and long-term effects of treatment of malignant germ cell neoplasms in Ukraine.

To describe incidence of malignant germ cell neoplasms (GCNs) in Ukraine and assess the medical care to patients with GCNs and its efficacy. Records on 6495males and 1038females with malignant GCNs diagnosed in 2000-2013extracted from the database of National Cancer Registry of Ukraine have been analyzed using methods of descriptive epidemiology and survival evaluation. In Ukraine, GCNs covered 79.1% of testicular cancers and 48.9% of ovarian cancers in patients aged 0-19 years, while their proportions in total cancer incidence did not exceed 0.7% in males and 0.1% in females. Most of GCNs in males (75.9%) were diagnosed at the reproductive age (20-49) and in females 72.2% of GCNs were diagnosed at the age of 0-44 years. Female gonadal GCNs were divided by germinomatous and nongerminomatous as 49.3% vs 50.7% while in males this proportion was 65.3% vs 34.7%. Age-specific incidence of genital GCNs in Ukraine reached peak values in males aged 25-39years and in females aged 10-24years. Nonseminomatous testicular GCN cases were more common than seminomatous cases in males until the age of 30years with an incidence of seminomas peaked 10years later than non-seminomas. Ovarian germinomas were more common than non-germinomas in females aged 15-29. Total GCN incidence rate in 2013was 1.99 ± 0.090/0000in males and 0.32±0.040/0000in females, being closer to that in the countries of Eastern Europe and Asia. In Ukraine, 5-year survival of patients with testicular GCN of stage I who received surgery combined with chemotherapy or radiotherapy was lower than that reported for Europe and USA, and substantially lower in patients with stages II-IV. Five-year survival of patients with ovarian GCN treated with surgery plus chemotherapy was close to that reported in a study for populations of European countries. The trends and patterns of GCN incidence in Ukraine are similar to those in other European countries, while patterns of treatment and survival in Ukraine are closer to that in countries in transition. Further research and analysis are impossible without due registration of both the diagnosis and the treatment undertaken as well as close follow-up of patients' life status.

A Study on Comparison of Lung Cancer Prediction Using Ensemble Machine Learning

Lung cancer is a chronic disease which ranks fourth in cancer incidence with 11 percent of the total cancer incidence in Korea. To deal with such issues, there is an active study on the usefulness and utilization of the Clinical Decision Support System (CDSS) which utilizes machine learning. Thus, this study reviews existing studies on artificial intelligence technology that can be used in determining the lung cancer, and conducted a study on the applicability of machine learning in determination of the lung cancer by comparison and analysis using Azure ML provided by Microsoft. The results of this study show different predictions yielded by three algorithms: Support Vector Machine (SVM), Two-Class Support Decision Jungle and Multiclass Decision Jungle. This study has its limitations in the size of the Big data used in Machine Learning. Although the data provided by Kaggle is the most suitable one for this study, it is assumed that there is a limit in learning the data fully due to the lack of absolute figures. Therefore, it is claimed that if the agency's cooperation in the subsequent research is used to compare and analyze various kinds of algorithms other than those used in this study, a more accurate screening machine for lung cancer could be created.

Lower risk of smoking-related cancer in individuals with familial hypercholesterolemia compared with controls: a prospective matched cohort study

According to guidelines, individuals with familial hypercholesterolemia (FH) shall receive lifestyle intervention and intensive lipid-lowering treatment from early in life to reduce the risk of coronary heart disease. Our aim was to study if treatment of FH also could affect risk of lifestyle-related cancer. We presented cumulative incidence of total cancer and lifestyle-related cancer sites in individuals with genetically verified FH (n = 5531) compared with age and sex matched controls (n = 108354). Individuals with FH had 20% lower risk of smoking-related cancer compared with the control population [HR 0.80 (95% CI, 0.65–0.98)], in particular men with FH at 40–69 years at age of diagnosis with HR 0.69 (95% CI, 0.49–0.97). The FH population and controls had similar rates of total cancer [HR 0.97 (95% CI, 0.86–1.09)], cancer related to poor diet [HR 0.82 (95% CI, 0.59–1.15)], cancer related to physical inactivity [HR 0.93 (95% CI, 0.73–1.18)], alcohol-related cancer [HR 0.98 (95% CI, 0.80–1.22)] and cancer related to obesity [HR 1.03 (95% CI, 0.89–1.21)]. In summary, we found reduced risk of smoking-related cancer in individuals with FH, most likely due to a lower prevalence of smoking. Implications of these findings can be increased motivation and thus compliance to treatment of hypercholesterolemia.

Changes in the incidence of cervical tumours by disease stage in a cytology-based screening programme.

To report changes in incidence of cervical tumours by disease stage, following the introduction of an organized cytology-based screening programme. An intention-to-screen study of a cytology-based screening programme targeting 1,219,000 women aged 25-64 in northern Italy was carried out. Based on the previously reported trend in total incidence of cervical cancer, the study period 1995-2014 was divided into 1995-1996 (pre-screening, or reference, years), 1997-1998 (screening implementation phase), 1999-2006 (transition phase, when incidence decreased), and 2007-2014 (steady-state phase, when incidence stabilized again). Tumour stage was categorized as preinvasive (cervical intraepithelial neoplasia grade 3 (CIN3) and adenocarcinoma in situ), early (pT1a), advanced (pT1b or greater, ypT), and unknown (pT1 not otherwise specified, pTx, missing information). Average annual incidence rates observed in each phase were compared with the expected (reference) rates, using the incidence rate ratio, calculated with a Poisson regression model. In the steady-state phase, incidence rate ratios were: CIN3, 1.55 (95% confidence interval, 1.41-1.70); early-stage squamous carcinoma, 0.49 (0.36-0.67); advanced-stage squamous carcinoma, 0.44 (0.33-0.57); unknown-stage squamous carcinoma, 0.69 (0.48-0.99); adenocarcinoma in situ, 1.44 (0.72-2.88); early-stage adenocarcinoma, 2.65 (0.82-8.53); advanced-stage adenocarcinoma, 1.03 (0.56-1.91); and unknown-stage adenocarcinoma, 0.46 (0.23-0.92). After stabilization, changes in incidence by tumour stage included a 55% increase for CIN3 and a 50-55% decrease both for early- and advanced-stage squamous carcinoma, but no significant changes for glandular tumours. These data will serve to quantify the incremental impact of the implementation of human papillomavirus-based screening, introduced in 2015.

25-Hydroxyvitamin D and Total Cancer Incidence and Mortality: A Meta-Analysis of Prospective Cohort Studies.

Epidemiological studies have suggested inconclusive associations between 25-hydroxyvitamin D and total cancer incidence and mortality. The aim of this study was to quantitatively assess these associations by combining results from prospective cohort studies. A systematic literature search was implemented in PubMed and Scopus databases in April 2019. Comparing the highest with the lowest categories, the multivariate-adjusted relative risks (RRs) and the corresponding 95% confidence intervals (CIs) were pooled using a random-effects model. A trend estimation was performed using a two-stage, dose-response, meta-analysis method. Twenty-three independent prospective studies were included for data synthesis. Eight studies investigated the association between 25-hydroxyvitamin D and the risk of cancer incidence (7511 events and 70,018 participants), and the summary estimate showed that 25-hydroxyvitamin D is marginally associated with cancer risk (Summary RR = 0.86; 95% CI: 0.73, 1.02; I2 = 70.8%; p = 0.001). Sixteen studies investigated the association between 25-hydroxyvitamin D and the risk of cancer mortality (8729 events and 101,794 participants), and a higher 25-hydroxyvitamin D concentration was inversely associated with the risk of cancer mortality (Summary RR = 0.81; 95% CI: 0.71, 0.93; I2 = 48.8%, p = 0.012). Dose-response analysis indicated that the risk of cancer incidence was reduced by 7% (RRs = 0.93; 95% CI: 0.91, 0.96), and the risk of cancer mortality was reduced by 2% (RRs = 0.98; 95% CI: 0.97, 0.99), with each 20 nmol/L increment of 25-hydroxyvitamin D concentration. This meta-analysis provides evidence that a higher 25-hydroxyvitamin D concentration is associated with a lower cancer incidence and cancer mortality.

Long-term aspirin use for cancer primary prevention: A protocol for updated systematic review and subgroup meta-analysis of randomized clinical trials.

Background:Long-term use of aspirin for primary prevention of cancer remains inconclusive, and variation in the effects of aspirin use on cancer outcomes by cancer site, aspirin dose, follow-up duration, or different populations has never been systematically evaluated.Methods:Seven electronic databases (PubMed, EMBASE, ClinicalTrials.gov, etc) will be searched from inception to September 30, 2019. Randomized clinical trials (RCTs) comparing aspirin versus no aspirin in participants without pre-existing cancer and reporting cancer incidence, and/or cancer mortality outcomes will be selected and assessed for inclusion. The Cochrane's Risk of Bias Tool and the Jadad scale will be used to evaluate the risk of bias and the methodologic quality of the RCTs. Data will be screened and extracted by independent investigators. Total cancer incidence will be defined as the primary clinical endpoint, and total cancer mortality, all-cause mortality, and the risk of major bleeding will be the secondary outcomes. Subgroup analyses based on cancer site, aspirin dose, follow-up duration, or different populations will be conducted. Analyses will be performed using Review Manager 5.3, Comprehensive Meta-Analysis 2.0, and Trial Sequential Analysis (TSA) software.Results:This study will systematically evaluate the effects of long-term aspirin use on total cancer incidence, cancer mortality, all-cause mortality, and the risk of major bleeding. Subgroup analyses will indicate whether the effects of aspirin on cancer outcomes are associated with cancer site, daily dose of aspirin, follow-up duration, or different subgroup of participants. The results will be submitted and published in a peer-reviewed scientific journal.Conclusions:This systematic review will systematically evaluate the efficacy and safety of long-term use of aspirin for primary prevention of cancer and determine whether there are some potential influencing factors affecting the effects of aspirin on cancer outcomes, thus strengthening the evidence base for the clinical practice and future research of this intervention.

FEATURES OF LOCALIZATION OF BRAIN TUMORS WITH DIFFERENT HISTOLOGICAL STRUCTURE

Brain tumors are a heterogeneous group of various intracranial tumors, benign or malignant, primary and secondary, which develop due to the launch of the process of abnormal uncontrolled division of cells. In the structure of the total cancer incidence, brain tumors account for 0.7-1.5 % cases. The distribution of primary brain tumors in the population ranges to 14 (more often 5-7) per 100 thousand population. Whereby, in Ukraine the incidence of brain tumors in men is 10.2 per 100 thousand population, and among women 7.6 per 100 thousand population. The mortality rate ranks 3rd among all causes of death. Most often, the detection of this pathology is observed at the age of 20 to 50 years. A sample analysis of 37 medical records of patients with brain tumors of different localization, who were having inpatient treatment in neurological departments of the Municipal Institution of the Regional Council Sumy Regional and the Municipal Non-profit Enterprise Clinical Hospital No. 4 of the City Council in 2015-2017, was carried out. Among the patients there were 14 (37.8 %) women and 23 (62.2 %) men. The mean age was 45.5 ± 3.8 years. Instrumental examination was carried out over time using magnetic resonance imaging (1.5 T) and computer tomography with intravenous contrast enhancement over time (before and after surgery). The condition of the brain tissues was evaluated before and after surgical intervention, the localization and the presence/absence of secondary swelling of the brain tissue was determined. The pathohistological study was conducted in the conditions of the certified laboratory of the Regional Municipal Institution of Regional Oncological Dispensary. Processing of statistical data was carried out using the licensed version of IBM SPSS Statistics 17 program. Purpose and objectives of the study: to analyze topographic, histological and clinical peculiarities of brain tumors. Our study established that space occupying lesions of the brain significantly more often were localized in the temporal lobes (16 patients – 43.2 %), most often was diagnosed astrocytoma, localized in the frontal areas (7 patients – 18.9 %). During the analysis of the results of neurological examination of patients it was found that focal syndrome was significantly predominant in 20 (54.1 %) patients, among whom astrocytoma was verified in 18 (48.6 %) of the examined. We have not found the dependence of the development of leading focal or hypertensive syndromes on the localization of brain tumors (р ˃ 0.5). Secondary edema of peripheral brain tissues was diagnosed in 21 (56.8 %) patients. Astrocytoma – 11 (52.4% of the total number of patients with edema), was significantly more aggressive in terms of development of the studied complication.

Predicting future cancer incidence by age and gender.

1559 Background: Cancer remains a substantial and unique burden on society. While the impact of changing demographics on cancer incidence has previously been characterized (Smith et al, JCO, 2009), this has not been done with updated population data. Our objective was to update projections on the number of new cancer diagnoses in the United States by age and gender through 2040. Methods: Population-based cancer incidence data were obtained using SEER 18 delay-adjusted data. Population estimates were made by age, race, and gender using the 2010 US Census data population projections to calculate future cancer incidence rates. Trends in age- adjusted incidence rates for 23 cancer types were calculated as previously described (Edwards et al, Cancer, 2014). Results: From 2020 to 2040 the projected total cancer incidence will increase by almost 30% from 1.86 million to 2.4 million. This increase is due to the projected increase in population growth, particularly in older individuals. The population of older adults will represent a growing proportion of total cancer diagnoses. Specifically, patients ≥65 years old will make up 69% of all new cancer diagnoses, while 13% of new diagnoses will be in patients ≥85 years old by 2040 (see Table). Cancer diagnoses in females are projected to rise 27%, while male cancer diagnoses are projected to increase by 32% from 2020 to 2040. The incidence rates for lung, colorectal, and prostate cancer are expected to decline, while those for thyroid, liver, melanoma and myeloma are expected to increase. Conclusions: The landscape of cancer care will continue to change over the next several decades. The burden of disease will remain substantial and will continue to disproportionately affect older adults. The growing proportion of older cancer patients and changes in site-specific cancer incidence rates remain of particular interest. These projections should help guide future health policy and research priorities. [Table: see text]

Investigation on potential associations of oxidatively generated DNA/RNA damage with lung, colorectal, breast, prostate and total cancer incidence

Oxidative stress has been linked to cancer development in previous studies. However, the association between pre-diagnostic oxidatively generated DNA/RNA damage levels and incident cancer has rarely been investigated. Urinary oxidized guanine/guanosine (OxGua) concentrations, including 8-hydroxy-2′-deoxyguanosine, were assessed in 8,793 older adults in a population-based German cohort. 1,540 incident cancer cases, including 207 lung, 196 colorectal, 218 breast and 245 prostate cancer cases were diagnosed during over 14 years of follow-up. Associations of OxGua levels with cancer outcomes were not observed in the total population in multi-variable adjusted Cox regression models. However, in subgroup analyses, colorectal cancer incidence increased by 8%, 9% and 8% with one standard deviation increase in OxGua levels among current non-smokers, female and non-obese participants, respectively. Additionally, among non-smokers, overall and prostate cancer incidences statistically significantly increased by 5% and 13% per 1 standard deviation increase in OxGua levels, respectively. In contrast, OxGua levels were inversely associated with the risk of prostate cancer among current smokers. However, none of the subgroup analyses had p-values below a threshold for statistical significance after correction for multiple testing. Thus, results need to be validated in further studies. There might be a pattern that oxidatively generated DNA/RNA damage is a weak cancer risk factor in the absence of other strong risk factors, such as smoking, obesity and male sex.