Stage is the most important prognostic factor for understanding cancer survival trends. Summary stage (SS) classifies cancer based on the extent of spread: In situ, Localized, Regional, or Distant. ...Continual updating of staging systems poses challenges to stage comparisons over time. We use a consistent summary stage classification and present survival trends for 25 cancer sites using the joinpoint survival (JPSurv) model.
We developed a modified summary stage variable, Long-Term Site-Specific Summary Stage, based on as consistent a definition as possible and applied it to a maximum number of diagnosis years, 1975-2019. We estimated trends by stage by applying JPSurv to relative survival data for 25 cancer sites in SEER-8, 1975-2018, followed through December 31, 2019. To help interpret survival trends, we report incidence and mortality trends using the joinpoint model.
Five-year relative survival improved for nearly all sites and stages. Large improvements were observed for localized pancreatic cancer 4.25 percentage points annually, 2007-2012 (95% confidence interval, 3.40-5.10), distant skin melanoma 2.15 percentage points annually, 2008-2018 (1.73-2.57), and localized esophagus cancer 1.18 percentage points annually, 1975-2018 (1.11-1.26).
This is the first analysis of survival trends by summary stage for multiple cancer sites. The largest survival increases were seen for cancers with a traditionally poor prognosis and no organized screening, which likely reflects clinical management advances.
Our study will be particularly useful for understanding the population-level impact of new treatments and identifying emerging trends in health disparities research.
Lung-cancer incidence has been decreasing in part because of a decrease in smoking. However, the decline in population-based mortality from non–small-cell lung cancer has been greater than can be ...accounted for by cancer screening and a decrease in cancer incidence. Evidence indicates that advances in treatment account for the acceleration in decreased mortality.
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•We show district-level disparities in relative risk and age-adjusted trends in breast cancer incidence for Portugal.•Densely populated coastal districts (Lisboa, Setúbal, Porto) had ...the highest incidence rates.•There is a gradient in age-adjusted trends over time, with steeper trends in the sparsely-populated north of Portugal.•Geographic disparities were especially prevalent among heavily-screened and late-onset age groups.
Breast cancer is the most common malignancy in women world-wide and the most common cause of cancer deaths, which can often be managed with early diagnosis and subsequent treatment. Here, we focus on geographic disparities in incidence within Portugal for three age groups of women (30−49; 50−69; 70−84 years).
Age-period-cohort (APC) models are widely used in cancer surveillance, and these models have recently been extended to allow spatially-varying effects. We apply novel spatial APC models to estimate relative risk and age-adjusted temporal trends at the district level for the 20 districts in Portugal. Our model allows us to report on country-wide trends, but also to investigate geographic disparities between districts and trends within districts.
Age-adjusted breast cancer incidence was increasing over 1998–2011 for all three age groups and in every district in Portugal. However, we detect spatially-structured between-district heterogeneity in relative risk and age-adjusted trends (Net Drifts) for each of the three age groups, which is most pronounced in the highly-screened (50−69yo) and late-onset (70−84yo) groups of women.
We present evidence of disparities in breast cancer incidence at a more granular geographic level than previously reported. Some disparities may be due to latent risk factors, which cannot be accounted for by age, birth year, and geographic location alone.
Our study motivates resuming data collection for breast cancer incidence at the district level in Portugal, as well as the study of exogenous risk factors.
•Age-adjusted breast cancer incidence rates increased in all regions and at all ages.•Southern Portugal presented the highest age-adjusted rate.•Northern Portugal presented the fastest rate of ...increase.•Women under age 45 years have expressed higher EAPCs than women age 45+ years.•Forecasts have shown that Northern rates might soon surpass Southern rates.
Female breast cancer incidence rates have been increasing in Portugal for years. We, therefore, conducted the first nationwide breast cancer study to assess regional differences.
Cases were obtained from population-based cancer registries covering the country’s Mainland (South, North, Centre), as well as the two Autonomous Regions (Azores and Madeira), for the time-period 1998 through 2011. Analyses were restricted to ages 30–84 years and stratified by region. We used the age-period-cohort (APC) framework to complement standard descriptive techniques and to forecast future trends. Estimable APC parameters included net drift, longitudinal age-specific incidence rate curves, and fitted age-specific incidence rate ratios.
There were 71 545 breast cancer cases diagnosed in Portugal at ages 30–84 years from 1998 to 2011. The South presented the highest age-standardized rate (155.8/100 000), while the North presented the fastest rate of increase (3.6%/year). Age-specific statistical interactions were observed between regions. Younger women in the North revealed a decreased risk of developing breast cancer compared to women from the same age group in the South and Centre, while that risk was reversed in older women (p < 0.05). We estimate that from 2014 onwards, the North might rank first among all regions.
The variant patterns observed could be due to a combination of different screening practices and/or exposure to risk factors across regions. Disease heterogeneity among younger and older women may also explain part of the differences in age-specific rates. These results justify continued monitoring of breast cancer incidence by region.
The basis of diagnosis recommendations for population-based cancer registries aim to provide a standardized coding tool that reflects the certainty of cancer diagnosis, especially when pathological ...confirmation is lacking. The proportion of clinical diagnoses serves as an indicator of data quality. Given the evolving nature of diagnostic techniques, regular revision of the basis of diagnosis rules is crucial. To address this, a working group comprising representatives from the steering committee and member registries of the European Network of Cancer Registries was established. The original 1999 recommendations were comprehensively reviewed, resulting in the publication of an updated version. These new recommendations came into effect for incident cancer cases starting from January 1, 2023. The updated recommendations comprise an adapted code list for the basis of diagnosis, optional codes for histology cases, revisions related to flow cytometry, liquid biopsy, and cytogenetic/molecular testing, consolidation of histology codes 6 and 7, introduction of a new code 8 for cytogenetic/molecular confirmation, and establishment of new criteria for registering specific morphology codes in cancers lacking pathological confirmation.
ObjectivesThis study aims to estimate the proportion of lung cancer cases and deaths attributable to tobacco smoking in Portugal in 2018, complemented by trends in incidence and mortality, by sex and ...region.DesignCancer cases for 1998–2011 and cancer deaths for 1991–2018 were obtained from population-based registries and Statistics Portugal, respectively. We projected cases for 2018 and used reported deaths for the same year to estimate, using Peto’s method, the number and proportion of lung cancer cases and deaths caused by tobacco smoking in 2018. We calculated the age-adjusted incidence and mortality rates in each year of diagnosis and death. We fitted a joinpoint regression to the observed data to estimate the annual percentage change (APC) in the rates.SettingPortugal.ResultsIn 2018, an estimated 3859 cases and 3192 deaths from lung cancer were attributable to tobacco smoking in Portugal, with men presenting a population attributable fraction (PAF) of 82.6% (n=3064) for incidence and 84.1% (n=2749) for mortality, while in women those values were 51.0% (n=795) and 42.7% (n=443), respectively. In both sexes and metrics, the Azores were the region with the highest PAF and the Centre with the lowest. During 1998–2011, the APC for incidence ranged from 0.6% to 3.0% in men and 3.6% to 7.9% in women, depending on region, with mortality presenting a similar pattern between sexes.ConclusionExposure to tobacco smoking has accounted for most of the lung cancer cases and deaths estimated in Portugal in 2018. Differential patterns of tobacco consumption across the country, varying implementation of primary prevention programmes and differences in personal cancer awareness may have contributed to the disparities observed. Primary prevention of lung cancer remains a public health priority, particularly among women.
•This is the first study in which incidence, survival, and mortality are interpreted concomitantly to evaluate progress against cancer in a specific region of Portugal, the Azores archipelago.•Much ...of the progress has been driven by treatment advances, as seen by survival improvements and decreases in mortality.•Incidence and mortality increased for colorectal cancer in men and lung cancer in women.•Reducing tobacco use and obesity are cancer control priorities within the region.
Measuring progress against cancer is more accurate when trends in incidence, survival, and mortality are interpreted simultaneously. Our study aims to analyze how these key metrics have evolved over time in the Azores, Portugal.
Data for incident cases diagnosed in 1997–2016 and followed up through December 31, 2017 were obtained from the Azores Cancer Registry. Data for cancer deaths that occurred in 1991–2016 were obtained from Statistics Portugal. To estimate temporal trends, we applied a joinpoint model to age-adjusted rates. We estimated five-year net survival within the framework of relative survival using the Pohar-Perme estimator and predicted the number of cases and deaths in 2025.
In men, incidence and mortality decreased for stomach, larynx, and prostate cancer. In women, mortality decreased for breast and cervical cancer. Five-year relative survival improved for several cancers, with the most pronounced improvements for prostate cancer in men and colorectal cancer in women (24.1 and 27.9 percentage point absolute increase, respectively). Conversely, incidence and mortality increased for colorectal cancer in men and lung cancer in women. The incidence and mortality burdens are both expected to increase in 2025.
Overall, progress against cancer in the Azores has been mixed, and much of the progress has been driven by advances in treatment. Statistics for lung cancer in women and colorectal cancer in men are a call to action for policymakers. Reducing tobacco use and tackling the obesity epidemic are the two public health priorities for cancer control within the region.
The Instituto Angolano de Controlo do Cancer (IACC) Cancer Registry in Luanda, Angola is the most ancient and organized hospital-based cancer registry in Angola and provides data on cancer cases ...treated in several hospital facilities in Luanda.
Newly-diagnosed cancer cases (2012-2016) of IACC were collected. A total of 6638 malignant neoplasms were recorded. After excluding duplicates, missing data and non-melanoma skin cancers cases, a final number of 5609 cancer cases was considered valid for analysis.
From 5609 new cases, 2059 were males and 3550 females. Of all cases, 9.7% was in children below the age of 15 years. Most of the cases were residents from the Luanda district. The five most common cancers for all periods were breast (21.4%), cervix (16.8%), prostate (7.1%), non-Hodgkin lymphoma (4.5%) and Kaposi sarcoma (4.3%). For men, 19.3% of the cancers were prostate, 7.5% Kaposi sarcoma and 7.5% non-Hodgkin lymphoma. Cancers of the breast and cervix together accounted 60% of all cancers in females. Comparison of our data onto the 5 most frequent tumours, by sex, according to GLOBOCAN 2018 estimations for Angola, highlights the potential deviation from reality that estimates may have and reinforces the urgent need to build a truly population-based cancer registry in Luanda.
To accomplish that task, it is mandatory to implement a more rigorous quality control program at the hospital-based cancer registry at IACC and to optimize the network of health institutions that actively working on and contributing to the cancer registry, in Luanda.
Abstract
Background
There are over 100 histologically distinct types of primary malignant and nonmalignant brain and other central nervous system (CNS) tumors. Our study presents recent trends in the ...incidence of these tumors using an updated histology recode that incorporates major diagnostic categories listed in the 2016 World Health Organization Classification of Tumours of the CNS.
Methods
We used data from the SEER-21 registries for patients of all ages diagnosed in 2000–2017. We calculated age-adjusted incidence rates and fitted a joinpoint regression to the observed data to estimate the Annual Percent Change and 95% confidence intervals over the period 2000–2017.
Results
There were 315,184 new malignant (34.2%; 107,890) and nonmalignant (65.8%; 207,294) brain tumor cases during 2004–2017. Nonmalignant meningioma represented 46.5% (146,498) of all brain tumors (malignant and nonmalignant), while glioblastoma represented 50.8% (54,832) of all malignant tumors. Temporal trends were stable or declining except for nonmalignant meningioma (0.7% per year during 2004–2017). Several subtypes presented decreases in trends in the most recent period (2013–2017): diffuse/anaplastic astrocytoma (−1.3% per year, oligodendroglioma (−2.6%), pilocytic astrocytoma (−3.8%), and malignant meningioma (−5.9%).
Conclusions
Declining trends observed in our study may be attributable to recent changes in diagnostic classification and the coding practices stemming from those changes. The recode used in this study enables histology reporting to reflect the changes. It also provides a first step toward the reporting of malignant and nonmalignant brain and other CNS tumors in the Surveillance, Epidemiology, and End Results (SEER) Program by clinically relevant histology groupings.
We investigated differences in net cancer survival (survival observed if the only possible cause of death was the cancer under study) estimated using new approaches for relative survival (RS) and ...cause-specific survival (CSS).
We used SEER data for patients diagnosed in 2000 to 2013, followed-up through December 31, 2014. For RS, we used new life tables accounting for geography and socio-economic status. For CSS, we used the SEER cause of death algorithm for attributing cancer-specific death. Estimates were compared by site, age, stage, race, and time since diagnosis.
Differences between 5-year RS and CSS were generally small. RS was always higher in screen-detectable cancers, for example, female breast (89.2% vs. 87.8%) and prostate (98.5% vs. 93.7%) cancers; differences increased with age or time since diagnosis. CSS was usually higher in the remaining cancer sites, particularly those related to specific risk factors, for example, cervix (70.9% vs. 68.3%) and liver (20.7% vs. 17.1%) cancers. For most cancer sites, the gap between estimates was smaller with more advanced stage.
RS is the preferred approach to report cancer survival from registry data because cause of death may be inaccurate, particularly for older patients and long-term survivors as comorbidities increase challenges in determining cause of death. However, CSS proved to be more reliable in patients diagnosed with localized disease or cancers related to specific risk factors as general population life tables may not capture other causes of mortality.
Different approaches for net survival estimation should be considered depending on cancer under study.
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