World Age-standardized Rates Research Articles

Trends and age-period-cohort analysis of leukemia incidence in Qidong from 1972 to 2021

Objective: To describe the epidemiological characteristics and trends of leukemia incidence in Qidong between 1972 and 2021, and provide guidelines for prevention and control measures and strategies. Methods: The cancer registry data was collected and analyzed on leukemia incidence during 1972-2021 in Qidong by sex, age and time. Crude incidence rate (CR), China age-standardized rate (ASRC), world age-standardized rate (ASRW), and average annual change percentage (AAPC) was calculated by Joinpoint software. Age-period-cohort (APC) model was used to analyze the influence of age, period and birth cohort on the changes in the incidence trend of leukemia patients. Results: From 1972 to 2021, there were 2 948 patients with leukemia in Qidong, accounting for 2.00% of all cancer new cases, CR of leukemia was 5.26/105, ASRC was 4.34/105, ASRW was 4.35/105. The truncated incidence of 35-64 years old was 5.29/105, the cumulative incidence rate between the ages of 0 and 74 years old was 0.40%, the cumulative risk was 0.40%. There were 1 608 male patients, the CR, ASRC, and the ASRW were 5.81/105, 4.88/105 and 4.85/105. The number of female patients were 1 340, and the CR, ASRC, and the ASRW were 4.71/105, 3.86/105 and 3.91/105, respectively. Temporal trends indicated significant upward trends in ASRC among both gender, males and females with AAPC values of 1.41% (P＜0.001), 1.15% (P＜0.001), and 1.73% (P＜0.001), respectively. The results of the APC model showed that the average net drift value of leukemia incidence in all age groups was 1.57% (95% CI, 1.24%-1.89%), and the highest value of local drift was 3.20% (95% CI, 1.63%-4.78%) in the 80~ years old group. The incidence of leukemia increased with age. With the passage of time, the risk of leukemia incidence increased gradually compared with the rate ratio of leukemia incidence (risk ratio [RR], 1.00) in 1992-1996, the RR of leukemia incidence increased from 0.70 during 1972-1976 to 1.57 during 2017-2021. The later the cohort was born, the greater the risk of leukemia incidence compared with the relative risk of leukemia incidence (RR, 1.00) in 1952-1956 cohort, the RR of leukemia incidence increased from 0.24 in the 1892-1896 cohort to 2.73 in the 2017-2021 cohort. Conclusions: The incidence of the leukemia has presented a rising trend in the past fifty years. Leukemia incidence increased with age, and the period and cohort effects on the risk of incidence increase. Further research is needed to investigate the risk factors related to leukemia.

Can the sustainable development goals for cancer be met in Brazil? A population-based study.

A one-third reduction in premature mortality (30-69 years) from chronic noncommunicable diseases is goal 3.4 of the United Nations Sustainable Development Goals (UN SDG). The burden of NCDs is expected to continue to increase in low- and middle-income countries, including Brazil. The aim of this study was to assess geographical and temporal patterns in premature cancer mortality in Brazil between 2001 and 2015 and to predict this to 2030 in order to benchmark against the 3.4 SDG target. We used data on deaths from cancer in those aged 30-69, by age group, sex and cancer site, between 2001 and 2015 from the National Mortality Information System of Brazil (SIM). After correcting for ill-defined causes, crude and world age-standardised mortality rates per 100,000 inhabitants were calculated nationally and for the 5 regions. Predictions were calculated using NordPred, up to 2030. The difference in observed (2011-2015) and predicted (2026-2030) mortality was compared against the SDG 3.4 target. Between 2011-2015 and 2026-2030a 12.0% reduction in premature cancer age-standardised mortality rate among males and 4.6% reduction among females is predicted nationally. Across regions this varied from 2.8% among females in North region to 14.7% among males in South region. Lung cancer mortality rates are predicted to decrease among males but not among females nationally (men 28%, females 1.1% increase) and in all regions. Cervical cancer mortality rates are projected to remain very high in the North. Colorectal cancer mortality rates will increase for both sexes in all regions except the Southeast. Cancer premature mortality is expected to decrease in Brazil, but the extent of the decrease will be far from the SDG 3.4 target. Nationally, only male lung cancer will be close to reaching the SDG 3.4 target, reflecting the government's long-term efforts to reduce tobacco consumption. Projected colorectal cancer mortality increases likely reflect the epidemiological transition. This and, cervical cancer control will continue to be major challenges. These results will help inform strategic planning for cancer primary prevention, early detection and treatment programs; such initiatives should take cognizance of the regional differences highlighted here.

Epidemic characteristics of esophageal cancer mortality in Qidong, 1972-2016

Objective: To describe the epidemic characteristics of esophageal cancer mortality in Qidong from 1972 to 2016, and to provide baseline for making control measures and strategies for prevention. Methods: The cancer registry data were collected and analyzed on mortality of oesophagus cancer during 1972-2016 in Qidong in different sex, age and time. Indices of statistics included crude mortality rate (CR), China age-standardized rate (CASR), world age-standardized rate (WASR), 35-64 years truncated rate, 0-74 years cumulative rate, cumulative risk, average annual percentage change (AAPC), mortality by period and mortality in the birth cohort. Results: A total of 4 795 esophageal cancer cases (male: 3 315, female: 1 480) died during the 45 years, accounting for 4.85% of all cancer deaths. The crude mortality was 9.48/10(5) (CASR: 3.62/10(5,) WASR: 6.30/10(5)) from 1972 to 2016. The crude mortality was significantly increased with age. In 2016, the crude mortality was 11.61/10(5) (CASR: 2.64/10(5,) WASR: 4.89/10(5)), respectively. The average annual percentage change (AAPC) were 0.99%、-2.03%、-1.72%. The mortalities of esophageal cancer in all age groups from 35 to 74 have been decreasing since the 1980s. The age-birth cohort analysis showed a decline in mortality rates in age groups from 40 to 79. Conclusions: The crude mortality rate of esophageal cancer increases slightly in Qidong, while the China age-standardized rate and world age-standardized rate decrease significantly. However, esophageal cancer is still one of the malignant tumors that affects the health of residents and seriously threatens the people's lives and health. The situation of cancer prevention and control is still serious in Qidong.

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

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

An analysis of mortality trends for upper gastrointestinal neoplasms in Qidong, 1972-2016

Objective: To describe the trend of upper gastrointestinal cancer mortality in Qidong between 1972 and 2016, and to provide guidelines for prevention and control measures and strategies. Methods: The upper gastrointestinal data was collected in Qidong cancer registration from 1972 to 2016. Crude mortality rate (CR), China age-standardized rate (CASR), world age-standardized rate (WASR), truncated rate (35-64 years old), cumulative rate (0-74 years old) and cumulative risk were calculated. Annual percent change (APC) was calculated by Joinpoint software. Age-period-cohort model was used to analyze the influence of age, period and birth cohort on the changes in the mortality trend of upper gastrointestinal cancer patients. Results: From 1972 to 2016, there were 20 658 deaths of upper gastrointestinal cancer in Qidong, accounting for 20.89% of all cancer deaths. The CR, CASR, WASR, truncated rate (35-64 years old), cumulative rate (0-74 years old) and cumulative risk were 40.85/100 000, 27.96/100 000, 27.69/100 000, 36.01/100 000, 3.30% and 3.25%, respectively. There were 13 429 male deaths, the CR, CASR, and the WASR were 53.81/100 000, 37.62/100 000, and 39.93/100 000; the female deaths were 7 229, and the CR, CASR, and WASR were 28.23/100 000, 18.87/100 000, 17.25/100 000, respectively. The APCs of the 45-year-old, 55-year-old and 65-year-old age groups were -2.94% (95% CI: -3.32%, -2.56%), -2.94% (95% CI: -3.22%, -2.66%) and -2.04% (95% CI: -2.39%, -1.69%), with significant difference (P<0.05), while without significance of 75-year-old group (P>0.05). From 1972 to 2016, the APCs of CR, CASR, and WASR in the gastrointestinal cancer were 0.65% (95%CI: 0.43%, 0.87%), -2.01% (95%CI: -2.24%, -1.77%) and -2.05% (95%CI: -2.28%, -1.81%). The age-period-cohort model showed that the mortality of upper gastrointestinal cancer was increased with age (P<0.05). Conclusions: The crude mortality of upper gastrointestinal cancer increases slightly in Qidong, while the CASR and WASR decrease significantly. However, with aged tendency of population, the early diagnosis and treatment of upper gastrointestinal cancer is still needed to be paid attention.

Incidence and mortality of corpus uteri cancer in China, 2015

Objective: To estimate the incidence and mortality of corpus uteri cancer in China, 2015. Methods: Quality audit and evaluation of the data from 2015 cancer registration reported by 501 cancer registries were conducted, and 368 cancer registries were included in the analysis. The incidence rate and mortality rate of corpus uteri cancer were calculated according to the factors of the region (urban, rural, east, central, western), sex and age groups. The incidence and mortality of corpus uteri cancer with the 2015 population were estimated. Chinese standard population in 2000 and world Segi's population were used for the calculation of age-standardized rates (ASR) of incidence and mortality. Results: In 2015, 368 cancer registries included in the analysis covered a total of 309 553 499 populations in China, accounting for 22.52% of the national population. It is estimated that there were about 68 900 new cases of corpus uteri cancer in 2015, the incidence rate was 10.28/10(5), age-standardized incidence rates by Chinese standard population (ASR China) and world standard population (ASR world) were 6.86/10(5) and 6.66/10(5), respectively. The incidence rate of urban area (11.35/10(5)) was higher than that of rural area (8.90/10(5)), and the incidence of eastern region (12.12/10(5)) was higher than the central region (9.94/10(5)) and the western region (8.25/10(5)). It is estimated that in 2015, there were about 16 000 deaths of corpus uteri cancer, the mortality rate was 2.39/10(5), ASR China was 1.49/10(5), ASR world was 1.47/10(5). The mortality in urban areas (2.40/10(5)) is close to rural areas (2.39/10(5)); the mortality in central areas (2.55/10(5)) was higher than the eastern areas (2.32/10(5)) and the western areas (2.31/10(5)). Conclusions: In China, the incidence of corpus uteri cancer is on the rise and has a trend of youth, the burden of disease is gradually increasing, which threatens the health of women. Targeted prevention and control measures should be carried out in the different regions.

An analysis of mortality trends for lung cancer during 1972-2016 in Qidong city of Jiangsu Province

Crude mortality rate (CR) for lung cancer in Qidong increased from 11.50/105 in 1972-1976 to 76.61/105 in 2012-2016, China age-standardized rate (CASR) from 13.11/105 in 1972-1976 to 34.27/105 in 2012-2016, and World age-standardized rate (WASR) from 13.40/105 in 1972-1976 to 34.30/105 in 2012-2016. The average annual percentage change (AAPCs) of CR, CASR, WASR were 4.87% (95%CI: 4.63%-5.12%), 2.17% (95%CI: 1.96%-2.38%), 2.12% (95%CI: 1.92%-2.33%) (all P values<0.001), respectively. AAPCs for 45-54, 55-64, 65-74 and over 75 age groups were 0.74% (95%CI: 0.36%-1.11%), 1.23% (95%CI: 0.92%-1.53%), 2.55% (95%CI: 2.20%-2.90%), 4.26% (95%CI: 3.56%-4.96%) (all P values<0.001), respectively.

Epidemiology of Soft Tissue Sarcoma and Bone Sarcoma inItaly: Analysis of Data from 15 Population-Based Cancer Registries

Sarcomas are a heterogeneous group of rare cancers of mesenchymal origin. In this study, we provide updated, world age-standardised incidence rate (ASR) and European age-standardised incidence rate for malignant soft tissue sarcoma (ICD-O-3 topographic code C47–C49) and bone sarcoma (C40, C41) in Italy, by area (north, centre, and south) and by cancer registry. We also assess morphology in relation to site and area and assess metastases at diagnosis. We analysed 1,112 cases, with incidence 2009–2012, provided by 15 cancer registries (CRs) affiliated to the Association of Italian Cancer Registries (AIRTUM). Overall, ASR was 1.7/100,000/year for soft tissue sarcoma and 0.7 for bone sarcoma. Central Italy had the highest (2.4) ASR and south Italy had the lowest (1.6) ASR for soft tissue sarcoma. Central Italy had the highest (1.1) ASR and north Italy had the lowest (0.7) ASR for bone sarcoma. By CR, ASRs ranged from 1.1 to 2.6 for soft tissue sarcoma and from 0 to 1.4 for bone sarcoma. The most frequent soft tissue sarcomas were sarcoma not otherwise specified (NOS) (29.4%) and liposarcoma (22.2%); the most common bone sarcoma was chondrosarcoma (37.6%). Soft tissue sarcomas occurred most frequently (35.6%) in lower limb connective tissue; bone sarcomas arose mainly (68.8%) in long bones. The frequencies of morphologies arising at different sites varied considerably by Italian area; for example, 20% of hemangiosarcomas occurred in the head and neck in south Italy with 17% at this site in the centre and 6% in the north. For soft tissue sarcoma, the highest ASRs of 2.6 and 2.4 contrast with the lowest ASRs 1.1 and 1.3, suggesting high-risk hot spots that deserve further investigation. The marked variations in morphology distribution with site and geography suggest geographic variation in risk factors that may also repay further investigation particularly since sarcoma etiology is poorly understood.

Epidemiological characteristics of gastric cancer in China, 2015

Objective: To estimate the morbidity and mortality of gastric cancer and its distribution in China in 2015 and provide information for future cancer prevention and control study and policy decision. Methods: In 2018, a total of 501 cancer registry systems reported data to the office of National Central Cancer Registry, and the data from 368 cancer registry systems met the criteria. The overall, gender specific, age specific and area specific morbidity and mortality rates of gastric cancer in China were estimated based on national population data in 2015. Chinese standard population in 2000 and World Segi's population data were used to calculate the age-standardized rates (ASR) of morbidity and mortality, including ASR of China and the world. Results: In 2015, the qualified 368 cancer registry system covered a total of 309 553 499 population in China, including 156 934 140 males and 152 619 359 females. We estimated that there were 403 000 new gastric cancer cases, with the crude morbidity rate of 29.31 per 100 000, ASR China of 18.68 per 100 000, ASR world of 18.57 per 100 000, and a cumulative rate of 2.29% for 0-74 years. There were 290 900 new gastric cancer deaths, with the crude mortality rate of 21.16 per 100 000, ASR China of 13.08 per 100 000, ASR world of 12.92 per 100 000, and a cumulative rate of 1.5% for 0-74 years. Gastric cancer ranked second as the most common cancers and third as the most common cancer causes of death in China. In general, both the morbidity rate (ASR China, male: 26.54 per 100 000; female: 11.09 per 100 000; rural area: 21.82 per 100 000; urban area: 16.37 per 100 000) and mortality rate (ASR China, male: 18.75 per 100 000; female: 7.72 per 100 000; rural area: 15.84 per 100 000; urban area: 11.05 per 100 000) were higher in males than those in females, and higher in rural area than those in urban area. The morbidity and mortality rates of gastric cancer increased from the age of 40 years and peaked in age group of 80-years. The case number of gastric cancer significantly increased from the age group of 50-years, peaked at 60-70 years, and the majority of cases occured in age group of 55-80 years. There was an overall consistent trend of the age-specific morbidity and mortality rates across different subgroups by sex and geographic areas, with the rates were higher in males than those in females, and higher in rural area than that in urban area. Conclusions: The incidence of gastric cancer varied with sex, age and areas (urban area and rural area). The present analysis provides the latest data on the prevalence of gastric cancer in China, which can help optimize the current screening guidelines and the prevention and control strategies of gastric cancer to reduce the disease burden caused by gastric cancer in China.

Liver cancer epidemiology in China, 2015

Objective: Using updated population-based cancer registration (PBCR) data, we estimated nation-wide liver cancer statistics overall, by sex and by areas in China. Methods: Qualified PBCR data of liver cancer in 2015 which met the data quality criteria were stratified by geographical locations, sex, and age groups. Age-specific incidence and mortality rates by sex and area were calculated. The burden of liver cancer was evaluated by multiplying these rates by the year of 2015 population. Chinese standard population in 2000 and World Segi's population were used for the calculation of age-standardized rates (ASR) of incidence and mortality. Results: Qualified 368 cancer registries covered a total of 309 553 499 populations in China, accounting for 22.52% of the national population. It is estimated that there were 370 000 new cases (274 000 males and 96 000 females) of liver cancer in China. The age-standardized incidence rates by Chinese standard population (ASR China) and World Segi's population (ASR World) were 17.64 per 100 000 and 17.35 per 100 000, respectively. Rural areas showed higher incidence (ASR China: 20.07 per 100 000, ASR World: 19.67 per 100 000) than urban areas (ASR China: 15.90 per 100 000, ASR world: 15.67 per 100 000). Subgroup analysis showed that western areas of China had highest incidence rate of liver cancer, with the ASR China of 20.65 per 100 000 and 20.22 per 100 000 for ASR world, respectively. For new cases of liver cancer deaths, there were 326 000 new deaths (242 000 males and 84 000 females) in China, with age-standardized mortality rate by Chinese standard population and World Segi's population of 15.33 per 100 000 and 15.09 per 100 000, respectively. Rural areas showed higher mortality (ASR China: 17.17 per 100 000, ASR world: 16.86 per 100 000) than urban areas (ASR China: 14.00 per 100 000, ASR World: 13.81 per 100 000). Conclusions: There is still a heavy burden of liver cancer in China. Rural residents have higher incidence and mortality of liver cancer compared with urban counterparts. It is likely that many factors such as hepatitis virus infection, and aflatoxin exposure play a dominating role. Prevention and control strategies should be enhanced in the future.

Upper gastrointestinal cancer burden in Hebei Province, China: A population-based study.

AIMTo investigate the incidence and mortality rates of upper gastrointestinal cancer (UGIC) in Hebei Province, China, and to identify high-risk populations to improve UGIC prevention and control.METHODSData for UGIC patients were collected from 21 population-based cancer registries covering 15.25% of the population in Hebei Province. Mortality data were extracted from three national retrospective death surveys (1973-1975, 1990-1992 and 2004-2005). The data were stratified by 5-year age groups, gender and area (high-risk/non-high-risk areas) for analysis. The age-period-cohort and grey system model were used.RESULTSThe crude incidence rate of UGIC was 55.47/100000, and the adjusted rate (Segi’s population) was 44.90/100000. Males in rural areas had the highest incidence rate (world age-standardized rate = 87.89/100000). The crude mortality rate of UGIC displayed a decreasing trend in Hebei Province from the 1970s to 2013, and the adjusted rate decreased by 43.81% from the 1970s (58.07/100000) to 2013 (32.63/100000). The mortality rate declined more significantly in the high-risk areas (57.26%) than in the non-high-risk areas (55.02%) from the 1970s to 2013. The median age at diagnosis of UGIC was 65.06 years in 2013. There was a notable delay in the median age at death from the 1970s (66.15 years) to 2013 (70.39 years), especially in the high-risk areas. In Cixian, the total trend of the cohort effect declined, and people aged 65-69 years were a population at relatively high risk for UGIC. We predicted that the crude mortality rates of UGIC in Cixian and Shexian would decrease to 98.80 and 133.99 per 100000 in 2018, respectively.CONCLUSIONUGIC was the major cause of cancer death in Hebei Province, and males in rural areas were a high-risk population. We should strengthen early detection and treatment of UGIC in this population.

Epidemiology of basal and squamous cell carcinoma in Belgium: the need for a uniform and compulsory registration.

Non-melanoma skin cancer (NMSC) is the most common type of cancer among Caucasians, however, few data exist on its incidence. Because of a sheer volume of these tumours, NMSC is often not systematically registered. To describe and analyse the incidence of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) in Belgium. Incidence data of BCC and SCC, including multiple primary skin tumours in the same patient, were extracted from the Belgian Cancer Registry from 2004 to 2012 (predominantly coming from pathology notifications). Belgian legislation makes cancer registration compulsory for oncological care programmes and for all pathological anatomy laboratories. Between 2004 and 2012, 113 254 BCC and 33 153 SCC cases were reported in Belgium. A total of 130 339 patients had 146 407 tumours. Approximately, 10% of the patients (12 759 patients) had multiple tumours. The world age-standardised incidence rate (WSR) for BCC increased from 36.9 in 2004 to 98.4 per 100 000 person years in 2012 for males and from 34.2 in 2004 to 102.0 in 2012 for females. For SCC, the WSR increased from 14.9 in 2004 to 24.7 in 2012 for males and from 6.8 in 2004 to 13.5 in 2012 for females. From 2004 to 2012, the incidence of BCC and SCC markedly rose in Belgium, as also seen worldwide. Known causes are increased sun exposure caused by changed sunlight-related behaviour (increased outdoor activities and holidays, use of tanning beds and changes in clothing style), ageing and improved registration. Because of their high and increasing incidence, these cancers will have major implications on healthcare planning and preventive measures. Therefore, we recommend compulsory registration, whenever is possible, of BCC and SCC, although it is an ambitious objective, especially in countries with a high burden of these tumours and in countries where registration is currently unavailable.

The burden of malignant melanoma – Lessons to be learned from Austria

Aim of studyIncidence rates of melanoma, generated by cancer registries (CRs), are susceptible to reporting inconsistencies due to increasing decentralisation of diagnosis. We therefore independently assessed the burden of melanoma in Austria. MethodsWe collected histopathological reports on melanoma of all patients diagnosed in Austria in 2011. Demographic and clinical characteristics, histopathological tumour stages were assessed. Their regional distributions and incidence rates were analysed and compared with data of national and international CRs. ResultsA total of 5246 patients were diagnosed with 1951 in-situ and 3295 invasive melanomas in Austria in 2011 (population 8.4 million). Age, sex and anatomic distribution corresponded to findings in other European countries, however, the incidence of 25/100,000 (world age-standardised rate) for invasive melanomas was two-fold higher than published by the Austrian CR (12/100,000). Varying frequencies in diagnosing thin melanomas (≤1 mm; n = 4415) accounted exclusively for significant regional disparities, while advanced tumours (>1 mm; n = 761) were evenly distributed. Western Austria showed the highest rates (36/100,000). Patients from eastern Austria whose melanomas were diagnosed in laboratories in western Austria (n = 76) showed significantly higher proportions of in-situ lesions (n = 43; 57%) compared to those whose tumours were diagnosed in eastern Austria (n = 4014; in-situ = 1369; 34%) (p < 0.0001). ConclusionsIn Austria, the melanoma burden and its potential socio-economic implications are significantly underestimated. Similarities of incidences indicate this could affect other European countries with well-established CRs and compromise international comparability of data. Austrian regional disparities suggest overdiagnosis of thin melanomas due to the variability of pathologists' thresholds for the diagnosis of early stage tumours.

Prostate cancer trends in Barbados: An analysis of the Barbados Urologic Diseases Survey database

ObjectivesTo describe the burden and trend of prostate cancer (CaP) in the Caribbean island of Barbados. MethodsAll urologic pathology reports in Barbados between 1990 and 2009 were entered into the Barbados Urologic Diseases Survey (BUDS) database. All new cases of CaP were identified and the database was used to assess trends in CaP epidemiology over the study period. Results3066 new cases of CaP were identified between 1990 and 2009. The world age-standardized rate increased steadily from 71.8 (95% CI 57.8–88.4) per 100 000 in 1990 to 112.4 (95% CI 94.0–133.7) per 100,000 in 2009, with a peak rate of 148.9 (95% CI 127.0–172.8) in 2004. The cumulative risk up to 74 years of age also increased from 11.1% in 1990 to 23.8% in 2009 with a peak of 29.9% in 2004. The mean age at diagnosis decreased from 73.1 years in 1990 to a nadir of 66.2 years in 2009. The rate of high-grade cancer (Gleason score ≥8) and intermediate-grade cancer (Gleason score=7) at presentation rose between 2000 and 2009 while the rate of low-grade cancer (Gleason score ≤6) decreased. ConclusionsBarbados suffers an unusually high burden of CaP with a trend towards more aggressive disease over the last decade. The results are important as they highlight the utility of the BUDS initiative in epidemiologic evaluation, but should be looked at cautiously due to a lack of specific details regarding screening practices in this population.

PTH-169 Global inverse associations between gastric and oesophageal adenocarcinoma supports h. pylori infection protecting from latter

<h3>Introduction</h3> H.pylori atrophic gastritis and associated hypochlorhydria have been suggested to protect against oesophageal adenocarcinoma (OAD), so that the falling incidence of the former might be linked to the rising incidence of the latter seen recently. If so, a negative association should exist between the incidences of OAD and non-cardia gastric cancer, mediated by atrophic gastritis. <h3>Method</h3> In a cross-sectional study, world age-standardised incidences rates (WASR), for the period 2003–07, were abstracted from “Cancer Incidence in Five Continents” Volume X together with 2012 estimates from GLOBOCAN 2012. Relevant ICD-10 codes were used to locate oesophageal and gastric cancers anatomically, and ICD-O3 codes for the histological diagnosis of OAD. In a longitudinal study, trends in WASRs of OAD and total gastric cancer (TGC) were extracted from Cancer in Five Continents Plus (CI5C-Plus). Average annual percentage change (AAPC) in WASRs were calculated for the period 1989–2007 using joinpoint regression. <h3>Results</h3> WASRs for the year 2012 were available for 51 countries and showed a negative correlation between OAD and both TGC (men: CC=-0.38, p = 0.006, women: CC=-0.41, p = 0.003) and non-cardia gastric cancer (men: CC=-0.41, p = 0.003 and women: CC=-0.43, p = 0.005). AAPCs were analysed for 38 populations and showed a significant decrease of TGC in 89% and increase of OAD in 66% of the populations, with no population showing a fall in the latter. Significant negative correlations between the incidences of the two cancers were observed in 28 of the 39 populations over the 18–49 years of available observation time. Super-imposition of the longitudinal and cross-sectional data indicated that populations with currently high incidence of OAD and low incidence of gastric cancer had previously resembled countries with high incidence of gastric cancer and low incidence of oesophageal adenocarcinoma. <h3>Conclusion</h3> The negative association between OAD and gastric cancer in both recent incidence and over time supports the hypothesis of atrophic gastritis protecting against OAD and also the falling incidence of the gastritis contributing to the rise in the incidence of OAD. Our study also demonstrates the value of the global cancer registry network in identifying disease trends and their implications. <h3>Disclosure of interest</h3> None Declared.

Incidence and time trends of cancer in Cyprus over 11 years (1998-2008).

Cyprus maintains a population-based cancer registry that allows for in-depth study of cancer in a culturally and environmentally unique setting. Using 11 years of collected data (1998-2008), we present the first comprehensive analysis of cancer in Cyprus. We calculated gender-specific, world age-adjusted incidence rates and time trends for the 26 most incident cancers. This study revealed that overall world age-standardized rates among men increased from 195.4 cases per 100,000 in 1998-2002 to 239.0 cases per 100,000 in 2006-2008. For the entire 11-year period, prostate, lung, colorectal and bladder cancers were the most incident cancers among men. Among women, the overall world age-standardized rate increased from 180.6 cases per 100,000 in 1998-2002 to 217.1 cases per 100,000 in 2006-2008. Over the entire period, breast, colorectal, uterine and thyroid cancers were the most incident cancers in women. There were 16 sex-specific cancers showing statistically significantly increasing incidence trends over the study period and no types for which the rate was significantly decreasing. Thyroid cancer illustrated rapid increases in rates. Results were compared to other Mediterranean European registries using the Cancer Incidence in 5 Continents reports for 1997-2002. Overall cancer incidence in Cyprus is lower than that of many southern Mediterranean countries, and given the known environmental risk factors in Cyprus, the low rate of lung cancer is especially interesting. The epidemiologic patterns reported in this study open the door for future etiologic studies to elucidate the role of environmental and lifestyle factors in this population and highlight opportunities for cancer prevention and control.

Glioma epidemiology in the central Tunisian population: 1993-2012.

Glioma is a heterogeneous central nervous system (CNS) tumor group that encompasses different histological subtypes with high variability in prognosis. The lesions account for almost 80% of primary malignant brain tumors. The aim of this study is to extend our understanding of the glioma epidemiology in the central Tunisian region. We analyzed 393 gliomas recorded in cancer registry of central Tunisia from 1993 to 2012. Crude incidence rates (CR) and world age-standardized rates (ASR) were estimated using annual population data size and age structure. Statistic correlations were established using Chi-square and Kaplan-Meier test. Tunisian glioma patients were identified with a mean age at diagnosis of 48 years and 1.5 sex ratio (male/female). During the 19 years period of study the highest incidence value was observed in male group between 1998 and 2002 (CR: 0.28, ASR: 0.3). Incidence results underline increasing high grade glioma occurring in the adulthood in the last period (2007-2012). Median survival was 27 months, with 1-, 2- and 5-year survival rates of 42%, 30% and 26%, respectively. Survival was greater in patients with younger age, lower tumor grade, infratentrial tumor location and undergoing a palliative treatment. This central Tunisia gliomas registry study provides important information that could improve glioma management and healthcare practice.

Breast cancer in European Union: an update of screening programmes as of March 2014 (review).

Breast cancer, a major cause of female morbidity and mortality, is a global health problem; 2008 data show an incidence of ~450,000 new cases and 140,000 deaths (mean incidence rate 70.7 and mortality rate 16.7, world age-standardized rate per 100,000 women) in European Union Member States. Incidence rates in Western Europe are among the highest in the world. We review the situation of BC screening programmes in European Union. Up to date information on active BC screening programmes was obtained by reviewing the literature and searching national health ministries and cancer service websites. Although BC screening programmes are in place in nearly all European Union countries there are still considerable differences in target population coverage and age and in the techniques deployed. Screening is a mainstay of early BC detection whose main weakness is the rate of participation of the target population. National policies and healthcare planning should aim at maximizing participation in controlled organized screening programmes by identifying and lowering any barriers to adhesion, also with a view to reducing healthcare costs.

Trend analysis of cervical cancer incidence and mortality rates in Chinese women during 1989-2008

To evaluate the trend of cervical cancer incidence and mortality rates during 1989-2008 in Chinese women, so as to inform the development of relevant policies and strategies in China. The incidence and mortality rates of cervical cancer during 1989-2008 in urban and rural areas were calculated based on the data from the National Cancer Registry Database. Age-standardized rates were calculated using the Chinese population of 1982 and World Segi's population of 1985. Joinpoint regression analysis was performed to obtain annual percentage changes (APC) so as to assess the trend of incidence and mortality rates over the period from 1989 to 2008. The crude incidence rate of cervical cancer in Chinese women increased from 3.06/10(5) in 1989-1990 to 11.87/10(5) in 2007-2008 (from 4.96/10(5) to 11.98/10(5) in urban registration areas and from 2.39/10(5) to 11.77/10(5) in rural registration areas).The crude mortality rate slightly increased from 2.19/10(5) in 1989-1990 to 3.20/10(5) in 2007-2008 (from 3.21/10(5) to 2.56/10(5) in urban registration areas and from 1.82/10(5) to 3.75/10(5) in rural registration areas). Generally, the upward trends of crude incidence rates were shown over the year 1989-2008, with an APC of 14.4% after 1997 in urban areas and 22.5% after 1999 in rural areas.After age standardization of world population, the APC of incidence rates in recent decade in urban areas remained stable, and the one in rural areas slightly decreased.Although the overall crude and world age-standardized mortality rates had no significant changes during 1989-2008, the crude mortality rates increased by 8.1% annually after 1999.The upward trends were also shown for crude and world age-standardized mortality rates in urban areas after 2001 with an APC of 7.3%.The crude mortality rates in rural areas increased by 3.9% annually during 1989-2008, but no significant change was found after age standardization. Over the last decade, the cervical cancer incidence and mortality rates ascended by year in China. It is particularly urgent to establish a comprehensive prevention and control system that combines cervical cancer screening and human papillomavirus vaccination, so as to reduce the burden of cervical cancer in Chinese women.

Preservation of lower incidence of chronic lymphocytic leukemia in Chinese residents in British Columbia: a 26-year survey from 1983 to 2008

The incidence of chronic lymphocytic leukemia (CLL) in the Asian population is up to 10 times lower than that in Caucasians. Studies on CLL in Asian residents in North America may help to determine the relative genetic and environmental causes of such a difference. Computerized records of CLL incidence from the combined British Columbia (BC) databases (n = 2736) and the Hong Kong Cancer Registry (HKCR, n = 572) were traced. Ethnic Chinese cases of CLL in BC were identified (n = 35). The world age standardized rates (WASRs) of CLL (per 100 000) were calculated in BC (1.71), HK (0.28) and BC Chinese (0.4), respectively. Using standard incidence ratios (SIRs), the observed BC Chinese case number was comparable to the figure projected from HK rates (SIR 1.3, p = 0.1) but significantly lower than the figure following BC rates (SIR 0.22, p < 0.0001). The difference was maintained over both genders, in all age groups and through the years. Our data over three decades suggest that genetic factors outplay environmental factors to give lower CLL rates in Chinese.