AbstractIntroductionSkin cancer is one of the most common malignancies. Despite controversy over its efficacy, skin cancer screening has become widespread although socioeconomic screening ...inequalities have been documented. Switzerland has the highest rate of melanoma in Europe but Swiss trends in skin cancer screening and social disparities have not been investigated. This study aims to evaluate trends in skin cancer screening and its association with socioeconomic indicators in Switzerland between 1997 and 2012. MethodWe used data from four waves (from 1997 to 2012) of the population-based Swiss Health Interview Survey. Multivariable Poisson regressions with robust variance were used to estimate weighted prevalence ratio (PR) and 95% Confidence Intervals (CI) adjusting for demographics, health status and use of healthcare. ResultsThis study included 60,764 participants with a mean age of 49.1 years (standard deviation (SD) 17.2) and 53.6% of women. Between 1997 and 2012, the weighted prevalence of ever life-time skin examination and skin examination in the current year increased by 38.2% and 35.3% respectively (p-value <0.001). Participants with a lower education level, lower income and living in non-metropolitan areas were less often screened than their counterparts. Educational differences in ever life-time skin examination increased over time (p-value for trend = 0.036). ConclusionWhile skin cancer screening prevalence in Switzerland increased from 1997 to 2012, most social inequalities persisted over time and educational inequalities increased. Dermatologists should be alerted that populations with lower education should be given special attention.
Cancer cases among males of at least 25 years of age in five Swiss cantons from 1980 to 1993 were studied for associations between occupation, socioeconomic status, and cancer type. A negative ...correlation between socioeconomic status and cancers related to tobacco and alcohol use and poor nutrition was found. High socioeconomic status was associated with skin cancers, including melanoma; and cancers of testis, kidney, prostate, and colon. The importance of occupation was secondary to the socioeconomic status that went along with the occupation. Occupational factors were more important in some cancers, such as those of the respiratory system. Results for some specific occupations are as follows. Farmers had higher rates of lip and thyroid cancers. Butchers had elevated incidence of chronic lymphatic leukemia. Leather, fur, and pelt workers had high levels of sinus cancers, and leukemia. Workers in stone and earth trades had an elevated risk of mesothelioma and pleural cancers. Mesothelioma incidence and lung cancer incidence was elevated among foundry workers. Electricians had elevated incidence of leukemia, and biliary tract cancer, along high rates of lung cancer and pleural mesothelioma.
Although persons infected with human immunodeficiency virus (HIV), particularly men who have sex with men, are at excess risk for anal cancer, it has been difficult to disentangle the influences of ...anal exposure to human papillomavirus (HPV) infection, immunodeficiency, and combined antiretroviral therapy. A case-control study that included 59 anal cancer cases and 295 individually matched controls was nested in the Swiss HIV Cohort Study (1988-2011). In a subset of 41 cases and 114 controls, HPV antibodies were tested. A majority of anal cancer cases (73%) were men who have sex with men. Current smoking was significantly associated with anal cancer (odds ratio (OR) = 2.59, 95% confidence interval (CI): 1.25, 5.34), as were antibodies against L1 (OR = 4.52, 95% CI: 2.00, 10.20) and E6 (OR = ∞, 95% CI: 4.64, ∞) of HPV16, as well as low CD4+ cell counts, whether measured at nadir (OR per 100-cell/μL decrease = 1.53, 95% CI: 1.18, 2.00) or at cancer diagnosis (OR per 100-cell/μL decrease = 1.24, 95% CI: 1.08, 1.42). However, the influence of CD4+ cell counts appeared to be strongest 6-7 years prior to anal cancer diagnosis (OR for <200 vs. ≥500 cells/μL = 14.0, 95% CI: 3.85, 50.9). Smoking cessation and avoidance of even moderate levels of immunosuppression appear to be important in reducing long-term anal cancer risks.
The steep increase in incidence of cutaneous malignant melanoma in white populations mainly applies to thin lesions with good survival suggesting overdiagnosis. Based on population‐based cancer ...registries (CRs), we have investigated changes in aggressive melanoma, selecting only cases who died within 1 or 3 years after diagnosis in 11 European countries between 1995 and 2012. Trends in fatal cases were analysed by period of diagnosis, sex, tumour thickness, histologic subtype of the lesion, tumour site and CR with a multivariate generalised linear mixed effects model, where geographical area was considered as a random effect. We collected data on 123 360 invasive melanomas, with 5133 fatal cases at 1 year (4%) and 12 330 (10%) at 3 years. The number of fatal cases showed a 16% decrease at 1 year and 8% at 3 years between the first (1995‐2000) and the last (2007‐2012) period. The highest proportion of fatal cases was seen for men, older age (≥65 years), thick lesions (>1 mm), nodular melanoma, melanoma on the trunk and for poorly documented cases, lacking information about thickness and histologic subtype. The mixed‐effects model showed a remarkable variability among European countries. The majority of registries showed a decreasing trend in fatal cases, but a few registries showed an opposite pattern. Trends in fatal melanoma cases, highlighting real changes in risk not related to overdiagnosis, showed a decrease in most European countries, with a few exceptions. Stronger efforts for early detection could lead to a more efficient treatment of melanoma in general.
What's new?
Melanoma lesion thickness is highly correlated with mortality. In this large European study, the authors asked whether the risk of aggressive, lethal melanoma has changed in recent years. They found that the number of melanoma‐related fatalities decreased by 16% at 1 year and by 8% at 3 years in the period from 2007‐2012, compared with the period from 1995‐2000. These trends in melanoma prognosis highlight real changes in outcome for more aggressive lesions, and support even stronger efforts for education and early detection.
Background
Considering the low incidence of colon cancer after an initial episode of colonic diverticulitis in some categories of patients, some authors suggested to exempt them from colonoscopy. ...However, this incidence has never been compared to that of a reference population, and predictors of cancer are still poorly investigated. We aimed to determine the 1-year incidence of colon cancer at the site of diverticulitis in patients diagnosed with left colonic or sigmoid acute diverticulitis, to compare this incidence to a reference population to state whether endoscopy is required or not, and to identify predicting factors of cancer to better target subpopulations needing that examination.
Methods
All patients admitted at the University Hospitals of Geneva for left colonic or sigmoid acute diverticulitis were included. Patients with a previous history of colon cancer or non-available for follow-up were excluded. Demographic data, haemoglobin values, and the Hinchey score were documented. This cohort was matched with the Geneva Cancer Registry to look for cancer occurrence at the site of diverticulitis within 1 year. Predictors of cancer were assessed using univariate logistic regression and the risk of cancer by comparing observed cases to a reference population using standardized incidence ratios.
Results
The final cohort included 506 patients. Eleven (2.2 %) had a diagnosis of cancer at the site of diverticulitis within 1 year. The mean age was significantly different between patients with cancer and others. No predictor of cancer could be identified, except a trend for an increased risk with advancing age (
p
= 0.067). The standardized incidence ratios showed a 44-fold increased risk of cancer among the cohort compared to the reference population.
Conclusions
Colonoscopy should be continued after an initial diagnosis of left colonic or sigmoid acute diverticulitis, irrespective of the clinical or radiological presentations.
HIV‐infected women are at increased risk of cervical intraepithelial neoplasia (CIN) and invasive cervical cancer (ICC), but it has been difficult to disentangle the influences of heavy exposure to ...HPV infection, inadequate screening and immunodeficiency. A case‐control study including 364 CIN2/3 and 20 ICC cases matched to 1,147 controls was nested in the Swiss HIV Cohort Study (1985–2013). CIN2/3 risk was significantly associated with low CD4+ cell counts, whether measured as nadir odds ratio (OR) per 100‐cell/μL decrease = 1.15, 95% CI: 1.08, 1.22, or at CIN2/3 diagnosis (1.10, 95% CI: 1.04, 1.16). An association was evident even for nadir CD4+ 200–349 versus ≥350 cells/μL (OR = 1.57, 95% CI: 1.09, 2.25). After adjustment for nadir CD4+, a protective effect of >2‐year cART use was seen against CIN2/3 (OR versus never cART use = 0.64, 95% CI: 0.42, 0.98). Despite low study power, similar associations were seen for ICC, notably with nadir CD4+ (OR for 50 vs. >350 cells/μL= 11.10, 95% CI: 1.24, 100). HPV16‐L1 antibodies were significantly associated with CIN2/3, but HPV16‐E6 antibodies were nearly exclusively detected in ICC. In conclusion, worsening immunodeficiency, even at only moderately decreased CD4+ cell counts, is a significant risk factor for CIN2/3 and cervical cancer.
What's new?
Women infected with human immunodeficiency virus (HIV) suffer from precancerous cervical lesions and severe invasive cervical cancer (ICC) at rates that far exceed those of their HIV‐free counterparts. Our case‐control study nested in the Swiss HIV Cohort Study demonstrated the role of immunodeficiency and notably CD4+ cell nadir in the onset of CIN2/3 and ICC. Even moderate declines in CD4+ cell counts substantially increased the risk of cervical intraepithelial neoplasia grade 2/3. The findings emphasize a key role for early HIV detection and combined antiretroviral therapy initiation in cervical cancer prevention for HIV‐infected women.
Abstract Background Despite important controversy in its efficacy, prostate cancer (PCa) screening has become widespread. Important socioeconomic screening disparities have been reported. However, ...trends in PCa screening and social disparities have not been investigated in Switzerland, a high risk country for PCa. We used data from five waves (from 1992-2012) of the population-based Swiss Health Interview Survey to evaluate trends in PCa screening and its association with socioeconomic indicators. Methods We used multivariable Poisson regression to estimate prevalence ratios (PR) and 95% Confidence Intervals (CI) adjusting for demographics, health status, and use of healthcare. Results The study included 12,034 men aged ≥50 years (mean age: 63.9). Between 1992 and 2012, ever use of PCa screening increased from 55.3% to 70.0% and its use within the last two years from 32.6% to 42.4% (p-value < 0.05). Income, education, and occupational class were independently associated with PCa screening. PCa screening within the last two years was greater in men with the highest (> $6,000/month) vs. lowest income (≤$2,000) (46.5% vs. 38.7% in 2012, PR for overall period =1.29, 95%CI: 1.13-1.48). These socioeconomic disparities did not significantly change over time. Conclusions This study shows that about half of Swiss men had performed at least one PCa screening. Men belonging to high socioeconomic status are clearly more frequently screened than those less favored. Given the uncertainty of the usefulness of PCa screening, men, including those with high socioeconomic status, should be clearly informed about benefits and harms of PCa screening, in particular, the adverse effect of over-diagnosis and of associated over-treatment.
Purpose
We investigated whether the relationship between family history (FH) of breast cancer and survival of women with breast cancer is related to the quality of care received, once adjusted for ...other prognostic variables using data from the Geneva population-based cancer registry and quality of care indicators defined by the European Society of breast cancer specialists (EUSOMA).
Methods
We included non-metastatic malignant breast tumor patients who had their surgery between 2001 and 2010. We assessed the association between FH and patient and tumor characteristics on one hand, and each quality of care indicator and an overall score of quality of care, on the other hand, through logistic regression. We assessed the impact of FH and the quality of care-score on 5-year survival with Cox regression adjusting for patient and tumor characteristics.
Results
2,672 patients were included in the study. Women with a positive FH were younger, more likely from Switzerland, screen detected, had positive estrogen and progesterone receptor status, and had smaller and ductal tumors. A positive FH was also associated with better management for several quality indicators. Women with a positive FH had a better crude survival (Hazard Ratio 0.61,
p
= 0.006). This association was not substantially affected when adjusting for quality of care. However, the effect of FH did not persist when also adjusting for patient and tumor characteristics.
Conclusions
A positive FH of breast cancer is associated with earlier breast cancer diagnosis, better tumor features, and higher quality of care. These factors explain the better survival observed among breast cancer women with a positive FH as compared to women without positive FH.
Organised mammography screening programmes may reduce socioeconomic inequalities in breast cancer screening, but evidence is contradictory. Switzerland has no national organised mammography screening ...programme, but regional programmes were progressively introduced since 1999, giving the opportunity to conduct a nationwide quasi-experimental study. We examined the evolution of socioeconomic inequalities in mammography screening in Switzerland and if exposure to regional organised programmes reduced socioeconomic inequalities. Data of 10,927 women aged 50 to 70 years old were collected from the Swiss Health Interview Survey, a nationally representative cross-sectional survey repeated 5 times (1992–2012). Socioeconomic characteristics were assessed using education, income, employment status, and occupational class. Adjusted prevalence ratios of up-to-date mammography screening were estimated with Poisson regressions and weighted for sampling strategy and non-participation bias. In the absence of organised screening programmes (1992–1997), prevalence of mammography screening increased by 23% and was associated with tertiary education and working part time. During the period of progressive introduction of regionally organised programmes (2002−2012), prevalence of mammography screening increased by 19% every 5 years and was associated with exposure to regional programmes and with independent/artisan occupations. Tertiary education and working part time were no longer associated. Exposure to organised programmes did not modify socioeconomic inequalities except for employment status: not employed women benefitted more from organised programmes compared to women working full time. In conclusion, socioeconomic inequalities in mammography screening decreased over time but organised programmes did not greatly modify them, except women not employed whose prevalence passed employed women.
•Socioeconomic inequalities in mammography decreased over time in Switzerland.•This decrease was not due to the implementation of mammography programmes.•Mammography among women not employed increased rapidly and passed employed women.•Specific approaches to reach women working full time may be beneficial.
Activity of some enzymes implicated in the metabolism of tobacco carcinogens presents a great variability between individuals due to the existence of a polymorphism in gene coding for these enzymes. ...Individual susceptibility to develop lung cancer could therefore depend not only on exposure to tobacco smoking, but also on genetic capacity to activate or inactivate tobacco carcinogens. This article summarizes the state of knowledge on metabolic polymorphisms and lung cancer susceptibility, and opens the discussion on the future direction of this promising way of research.
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