Breast cancer (BC) is the leading cause of cancer in sub‐Saharan Africa (SSA) with rapidly increasing incidence rates reported in Uganda and Zimbabwe. However, the magnitude of these rising trends in ...premenopausal and postmenopausal women is unknown in most African countries. We used data from the African Cancer Registry Network on incident breast cancers in women from 11 population‐based cancer registries in 10 countries representing each of the four SSA regions. We explored incidence changes among women before and after age 50 by calendar period and, where possible, generational effects in this unique sub‐Saharan African cohort. Temporal trends revealed increasing incidence rates in all registries during the study period, except in Nairobi where rates stabilised during 2010 to 2014 after rapidly increasing from 2003 to 2010 (APC = 8.5 95%, CI: 3.0‐14.2). The cumulative risk varied between and within regions, with the highest risks observed in Nairobi‐Kenya, Mauritius and the Seychelles. There were similar or more rapidly increasing incidence rates in women aged 50+ compared to women <50 years in all registries except The Gambia. Birth cohort analyses revealed increases in the incidence rates in successive generations of women aged 45 and over in Harare‐Zimbabwe and Kampala‐Uganda. In conclusion, the incidence of BC is increasing rapidly in many parts of Africa; however, the magnitude of these changes differs. These results highlight the need for urgent actions across the cancer continuum from in‐depth risk factor studies to provision of adequate therapy as well as the necessity of supporting the maintenance of good quality population‐based cancer registration in Africa.
What's new?
Breast cancer is the leading cause of cancer in sub‐Saharan Africa (SSA), and may be on the rise. In this study, the authors examined registries from ten SSA countries, and found that this is indeed the case, especially in older women. Changing risk‐factor profiles may account for these trends. These results indicate an urgent need for strengthening the healthcare systems of SSA, including improved public health programs such as screening programs for breast cancer, in‐depth risk‐factor analysis, etc., as well as planning for adequate therapy for an increasing number of patients.
Malignant renal tumours represent 5% of childhood cancers and include types with likely different aetiology: Wilms tumour (WT), rhabdoid renal tumour, kidney sarcomas and renal carcinomas. WT is the ...most common renal tumour in children, previously shown to vary internationally and with ethnicity. Using the comprehensive database of the International Incidence of Childhood Cancer study (IICC), we analysed global variations and time trends in incidence of renal tumour types in children (age 0‐14 years) and adolescents (age 15‐19 years). The results were presented by 14 world regions, and five ethnic groups in the US. We included 15 320 renal tumours in children and 800 in adolescents reported to the 163 contributing registries during 2001‐2010. In children, age‐standardised incidence rate (ASR) of renal tumours was 8.3 per million (95% confidence interval, CI = 8.1, 8.4); it was the highest in North America and Europe (9‐10 per million) and the lowest in most Asian regions (4‐5 per million). In the US, Blacks had the highest ASR (10.9 per million, 95% CI = 10.2, 11.6) and Asian and Pacific Islanders the lowest (4.4 per million, 95% CI = 3.6, 5.1). In adolescents, age‐specific incidence rate of renal tumours was 1.4 per million (95% CI = 1.3, 1.5). WT accounted for over 90% of all renal tumours in each age from 1 to 7 years and the proportion of renal carcinomas increased gradually with age. From 1996 to 2010, incidence remained mostly stable for WT (average annual percent change, AAPC = 0.1) and increased for renal carcinomas in children (AAPC = 3.7) and adolescents (AAPC = 3.2). Our findings warrant further monitoring.
What's new?
Based on more than 16,000 incident cases in the period 2001‐2010, this study offers the most complete overview to date of the worldwide patterns of renal tumours in children and adolescents. Using the comprehensive International Incidence of Childhood Cancer database, the authors also describe the distribution of rare entities such as rhabdoid renal tumour or kidney sarcomas. The results indicate the stable incidence of Wilms tumour, the most common renal tumour in children, consistently with a likely genetic origin. The rising incidence of renal carcinomas with age and over time is likely caused by environmental risk factors, warranting further monitoring.
The COVID‐19 pandemic has caused disruptions to national health systems and impacted health outcomes worldwide. However, the extent to which surveillance systems, such as population‐based cancer ...registration, have been affected was not reported. Here we sought to evaluate the effect of the pandemic on registry operations across different areas and development levels worldwide. We investigated the impact of COVID‐19 on three main areas of cancer registry operations: staffing, financing and data collection. An online survey was administered to 750 member registries of the International Association for Cancer Registries. Among 212 responding registries from 90 countries, 65.6% reported a disruption in operations, ranging between 45% in south‐eastern Asia and 87% in the Latin America and Caribbean. Active data collection was disrupted more than case notifications or hybrid methods. In countries categorized with low Human Development Index (HDI), a greater number of registries reported a negative impact (81.3%) than in very high HDI countries (57.8%). This contrast was highest in term of impact on financing: 9/16 (56%) registries in low HDI countries reported a current or an expected decline in funding, compared to 7/108 (7%) in very high HDI countries. With many cancer registries worldwide reporting disruption to their operations during the early COVID‐19 pandemic, urgent actions are needed to ensure their continuity. Governmental commitment to support future registry operations as an asset to disease control, alongside a move toward electronic reporting systems will help to ensure the sustainability of cancer surveillance worldwide.
What's new?
The COVID‐19 pandemic has caused disruptions to health systems worldwide. Has it also affected surveillance systems, such as population‐based cancer registries? In this study, the authors found that two‐thirds of analyzed cancer registries reported disruption in staffing, finances, and/or data collection. In countries with a low Human Development Index (HDI), a greater number of registries reported a negative impact (81.3%) than in very high HDI countries (57.8%). These results emphasize the need for actionable, strategic plans to ensure the continuity of registry operations globally.
In India, population‐based cancer registries (PBCRs) cover less than 15% of the urban and 1% of the rural population. Our study examines practices of registration in PBCRs in India to understand ...efforts to include rural populations in registries and efforts to measure social inequalities in cancer incidence. We selected a purposive sample of six PBCRs in Maharashtra, Kerala, Punjab and Mizoram and conducted semistructured interviews with staff to understand approaches and challenges to cancer registration, and the sociodemographic information collected by PBCRs. We also conducted a review of peer‐reviewed literature utilizing data from PBCRs in India. Findings show that in a context of poor access to cancer diagnosis and treatment and weak death registration, PBCRs have developed additional approaches to cancer registration, including conducting village and home visits to interview cancer patients in rural areas. Challenges included PBCR funding and staff retention, ion of data in medical records, address verification and responding to cancer stigma and patient migration. Most PBCRs published estimates of cancer outcomes disaggregated by age, sex and geography. Data on education, marital status, mother tongue and religion were collected, but rarely reported. Two PBCRs collected information on income and occupation and none collected information on caste. Most peer‐reviewed studies using PBCR data did not publish estimates of social inequalities in cancer outcomes. Results indicate that collecting and reporting sociodemographic data collected by PBCRs is feasible. Improved PBCR coverage and data will enable India's cancer prevention and control programs to be guided by data on cancer inequities.
What's new?
In India, cancer registries cover less than 15% of the urban and 1% of the rural population. Given this, can such registries reveal how poverty and social inequalities contribute to unequal cancer incidence? In this study, the authors found that, in many cases, the answer is yes. Equity analysis of cancer‐incidence data in India is feasible, as many registries have collected extensive sociodemographic information. These results indicate that improved coverage and information collection will enable India's cancer prevention and control programs to be guided by data on cancer inequities.
We sought to understand the role of stage at diagnosis in observed age disparities in colon cancer survival among people aged 50 to 99 years using population‐based cancer registry data from seven ...high‐income countries: Australia, Canada, Denmark, Ireland, New Zealand, Norway and the United Kingdom. We used colon cancer incidence data for the period 2010 to 2014. We estimated the 3‐year net survival, as well as the 3‐year net survival conditional on surviving at least 6 months and 1 year after diagnosis, by country and stage at diagnosis (categorised as localised, regional or distant) using flexible parametric excess hazard regression models. In all countries, increasing age was associated with lower net survival. For example, 3‐year net survival (95% confidence interval) was 81% (80‐82) for 50 to 64 year olds and 58% (56‐60) for 85 to 99 year olds in Australia, and 74% (73‐74) and 39% (39‐40) in the United Kingdom, respectively. Those with distant stage colon cancer had the largest difference in colon cancer survival between the youngest and the oldest patients. Excess mortality for the oldest patients with localised or regional cancers was observed during the first 6 months after diagnosis. Older patients diagnosed with localised (and in some countries regional) stage colon cancer who survived 6 months after diagnosis experienced the same survival as their younger counterparts. Further studies examining other prognostic clinical factors such as comorbidities and treatment, and socioeconomic factors are warranted to gain further understanding of the age disparities in colon cancer survival.
What's new?
Survival rates for colon cancer have improved over the past few decades. However, survival rates can vary by as much as 35% between younger and older patients. In this study, the authors found that this “age gap” occurred primarily within the first year after diagnosis. Stage at diagnosis also had a greater impact for older patients. Early diagnosis and individualized management should thus help to reduce early mortality in older patients. Further studies on additional prognostic factors such as comorbidities, etc., are also warranted.
We examined trends in childhood cancer incidence in sub‐Saharan Africa using data from two population‐based cancer registries in Harare (Zimbabwe) and Kyadondo (Uganda) with cases classified ...according to the International Classification of Childhood Cancer and explored reasons for observed variations and changes. Over the whole 25‐year period (1991‐2015) studied, there were only small, and nonsignificant overall trends in incidence. Nevertheless, within the period, peaks in incidence occurred from 1996 to 2001 in Harare (Zimbabwe) and from 2003 to 2006 in Kyadondo (Uganda). Kaposi sarcoma and non‐Hodgkin lymphoma accounted for the majority of the cases during these periods. These fluctuations in incidence rates in both registries can be linked to similar trends in the prevalence of HIV, and the availability of antiretroviral therapy. In addition, we noted that, in Harare, incidence rates dropped from 2003 to 2004 and 2007 to 2008, correlating with declines in national gross domestic product. The results indicate that the registration of childhood cancer cases in resource‐poor settings is linked to the availability of diagnostic services mediated by economic developments. The findings highlight the need for specialised diagnostic and treatment programmes for childhood cancer patients as well as positive effects of HIV programmes on certain childhood cancers.
What's new?
These authors tracked childhood cancer rates in sub‐Saharan Africa over a 25‐year period, from 1991 to 2015. They analyzed data collected in Harare, Zimbabwe, and Kyadondo, Uganda. Compared with high‐income countries, these regions had markedly lower rates of childhood cancers, particularly leukemia. The incidence did not trend upward or downward overall, but peaks in incidence corresponded with HIV prevalence, while dips coincided with decline in national GDP, when families might be unable to afford consultation and treatment. This data suggests it will be challenging to meet the WHO's target of over 60% childhood cancer survival by 2030.
Rare cancers collectively account for a significant proportion of the overall cancer burden in Japan. We aimed to describe and examine the incidence of each rare cancer and the temporal changes using ...the internationally agreed rare cancer classification. Cancer cases registered in regional population-based cancer registries from 2011 to 2015 and the National Cancer Registry (NCR) from 2016 to 2018 were classified into 18 families, 68 Tier-1 cancer groupings, and 216 single cancer entities based on the RARECAREnet list. Crude incidence rates and age-standardized incidence rates (ASR) were calculated for Tier-1 and Tier-2 cancers. The annual percent change and the 95% and 99% confidence limits for annual ASR for each of the 68 Tier-1 cancers were estimated using the log-linear regression of the weighted least squares method. The differences in ASRs between 2011 and 2018 were evaluated as an absolute change. A total of 5,640,879 cases were classified into Tier-1 and Tier-2 cancers. The ASRs of 18 out of 52 Tier-1 cancers in the rare cancer families increased, whereas the ASR for epithelial tumors of gallbladder decreased. The ASRs of 6 out of the 16 Tier-1 cancers in the common cancer families increased, whereas those of epithelial tumors of stomach and liver decreased. There was no significant change in the incidence of the other 40 Tier-1 cancers. The incidence of several cancers increased due to the dissemination of diagnostic concepts, improved diagnostic techniques, changes in coding practice, and the initiation of the NCR.
Rare cancers epidemiology is better known compared to the other rare diseases. Thanks to the long history of the European population-based cancer registries and to the EUROCARE huge database, the ...burden of rare cancers has been estimated the European (EU28) population. A considerable fraction of all cancers is represented by rare cancers (24%). They are a heterogeneous group of diseases, but they share similar problems: uncertainty of diagnosis, lack of therapies, poor research opportunities, difficulties in clinical trials, lack of expertise and of centres of reference. This paper analyses the major epidemiological indicators of frequency (incidence and prevalence) and outcome (5-year survival) of all rare cancers combined and of selected rare cancers that will be in depth treated in this monographic issue. Source of the results is the RARECAREnet search tool, a database publicly available. Disparities both in incidence and survival, and consequently in prevalence of rare cancers were reported across European countries. Major differences were shown in outcome: 5-year relative survival for all rare cancers together, adjusted by age and case-mix, varied from 55% or more (Italy, Germany, Belgium and Iceland) and less than 40% (Bulgaria, Lithuania and Slovakia). Similarly, for all the analyzed rare cancers, a large survival gap was observed between the Eastern and the Nordic and Central European regions. Dramatic geographical variations were assessed for curable cancers like testicular and non epithelial ovarian cancers. Geographical difference in the annual age-adjusted incidence rates for all rare cancers together varied between >140 per 100,000 (Italy, Scotland, France, Germany, and Switzerland) and <100 (Finland, Portugal, Malta, and Poland). Prevalence, the major indicator of public health resources needs, was about 7–8 times larger than incidence. Most of rare cancers require complex surgical treatment, thus a multidisciplinary approach is essential and treatment should be provided in centres of expertise and/or in networks including expert centres. Networking is the most appropriate answer to the issues pertaining to rare cancers. Actually, in Europe, an opportunity to improve outcome and reduce disparities is provided by the creation of the European Reference Networks for rare diseases (ERNs). The Joint Action of rare cancers (JARC) is a major European initiative aimed to support the mission of the ERNs. The role of population based cancer registries still remains crucial to describe rare cancers management and outcome in the real word and to evaluate progresses made at the country and at the European level.
Distant metastasis remains the major cause of treatment failure in esophageal cancer, though there have been few large-scale studies of the patterns of distant metastasis in different histological ...types. We investigated the patterns of distant metastasis in esophageal adenocarcinoma (AC) and squamous cell carcinoma (SCC) using a population-based approach.
Patients with
stage IV esophageal cancer at diagnosis were identified using the Surveillance, Epidemiology, and End Results database. Multivariable logistic regression was performed to identify potential risk factors for site-specific distant metastasis to the distant lymph nodes, bone, liver, brain, and lung at diagnosis.
We identified 1,470 patients with complete data for analysis including 1,096 (74.6%) patients with AC and 374 (25.4%) patients with SCC. A total of 2,243 sites of distant metastasis were observed, the liver was the most common site of distant metastasis (727, 32.4%), followed by the distant lymph nodes (637, 28.4%), lung (459, 20.5%), bone (344, 15.3%), and brain (76, 3.4%). Multivariable logistic regression showed that compared to patients with SCC, patients with AC were more likely to have metastasis to the brain (odds ratio OR 3.026, 95% confidence interval CI 1.441-6.357,
= 0.003) and liver (OR 1.848, 95% CI 1.394-2.451,
< 0.001), and less likely to have metastasis to the lung (OR 0.404, 95% CI 0.316-0.516,
< 0.001). Histological type had no effect on metastasis to the distant lymph nodes or bone.
Patients with esophageal AC are more likely to present with liver and brain metastases, and less likely to present with lung metastasis than patients with esophageal SCC.
In this retrospective study, we aimed to clarify the risk of developing a second primary cancer and to determine the periods of high risk of second primary cancers. Subjects were all patients who had ...been diagnosed with a first primary cancer and registered with the Nagasaki Prefecture Cancer Registry between 1985 and 2007. We calculated the standardized incidence ratio (SIR) of second primary cancer according to site and years after diagnosis of the first primary cancer. A second primary cancer developed in 14 167 of 174 477 subjects (8.1%) during a median follow‐up of 1.8 years. The SIR of all cancer was 1.10 (95% confidence interval, 1.08–1.11). Some specific relationships were observed between sites with risk factors in common, such as smoking, drinking, and hormone status. The SIRs were relatively high after approximately 10 years for all sites, and trends differ among cancer sites. We showed that cancer patients are at higher risk of a second primary cancer than the general population. In respect of the risk of a second primary cancer, physicians should be alert for cancers that have risk factors in common with the first primary cancer.
We examined the risk of developing a second primary cancer and the optimal duration of follow‐up for cancer patients in regard to multiple primary cancers. The results showed that medical scrutiny for second primary cancers that have risk factors in common with the first primary cancer is important, and follow‐up for 10 years for some sites is needed.
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