ObjectiveThe global burden of colorectal cancer (CRC) is expected to increase by 60% to more than 2.2 million new cases and 1.1 million deaths by 2030. In this study, we aim to describe the recent ...CRC incidence and mortality patterns and trends linking the findings to the prospects of reducing the burden through cancer prevention and care.DesignEstimates of sex-specific CRC incidence and mortality rates in 2012 were extracted from the GLOBOCAN database. Temporal patterns were assessed for 37 countries using data from Cancer Incidence in Five Continents (CI5) volumes I–X and the WHO mortality database. Trends were assessed via the annual percentage change using joinpoint regression and discussed in relation to human development levels.ResultsCRC incidence and mortality rates vary up to 10-fold worldwide, with distinct gradients across human development levels, pointing towards widening disparities and an increasing burden in countries in transition. Generally, CRC incidence and mortality rates are still rising rapidly in many low-income and middle-income countries; stabilising or decreasing trends tend to be seen in highly developed countries where rates remain among the highest in the world.ConclusionsPatterns and trends in CRC incidence and mortality correlate with present human development levels and their incremental changes might reflect the adoption of more western lifestyles. Targeted resource-dependent interventions, including primary prevention in low-income, supplemented with early detection in high-income settings, are needed to reduce the number of patients with CRC in future decades.
Abstract
Background
The authors investigated the durability of vaccine efficacy (VE) against human papillomavirus (HPV)16 or 18 infections and antibody response among nonrandomly assigned women who ...received a single dose of the bivalent HPV vaccine compared with women who received multiple doses and unvaccinated women.
Methods
HPV infections were compared between HPV16 or 18-vaccinated women aged 18 to 25 years who received one (N = 112), two (N = 62), or three (N = 1365) doses, and age- and geography-matched unvaccinated women (N = 1783) in the long-term follow-up of the Costa Rica HPV Vaccine Trial. Cervical HPV infections were measured at two study visits, approximately 9 and 11 years after initial HPV vaccination, using National Cancer Institute next-generation sequencing TypeSeq1 assay. VE and 95% confidence intervals (CIs) were estimated. HPV16 or 18 antibody levels were measured in all one- and two-dose women, and a subset of three-dose women, using a virus-like particle-based enzyme-linked immunosorbent assay (n = 448).
Results
Median follow-up for the HPV-vaccinated group was 11.3 years (interquartile range = 10.9–11.7 years) and did not vary by dose group. VE against prevalent HPV16 or 18 infection was 80.2% (95% CI = 70.7% to 87.0%) among three-dose, 83.8% (95% CI = 19.5% to 99.2%) among two-dose, and 82.1% (95% CI = 40.2% to 97.0%) among single-dose women. HPV16 or 18 antibody levels did not qualitatively decline between years four and 11 regardless of the number of doses given, although one-dose titers continue to be statistically significantly lower compared with two- and three-dose titers.
Conclusion
More than a decade after HPV vaccination, single-dose VE against HPV16 or 18 infection remained high and HPV16 or 18 antibodies remained stable. A single dose of bivalent HPV vaccine may induce sufficiently durable protection that obviates the need for more doses.
Highlights • Cervical cancer remains a major public health problem in Central and South America. • However, several countries in the region have reduced cervical cancer mortality. • Most countries ...require significant improvements in screening program organization. • HPV vaccination is a major opportunity for cervical cancer control given limitations in screening. • The availability of population-based data benefits program evaluation.
Data on social inequalities in cancer mortality are sparse, especially in low- and middle-income countries. We aimed to analyze the socioeconomic inequalities in cancer mortality in Costa Rica ...between 2010 and 2018.
We linked 9-years of data from the National Electoral Rolls, National Birth Index and National Death Index to classify deaths due to cancer and socioeconomic characteristics of the district of residence, as measured by levels of urbanicity and wealth. We analyzed the fifteen most frequent cancer sites in Costa Rica among the 2.7 million inhabitants aged 20 years and older. We used a parametric survival model based on a Gompertz distribution.
Compared to urban areas, mixed and rural area residents had lower mortality from pancreas, lung, breast, prostate, kidney, and bladder cancers, and higher mortality from stomach cancer. Mortality from stomach, lung and cervical cancer was higher, and mortality from colorectal cancer, non-Hodgkin lymphoma and leukemia was lower in the most disadvantaged districts, compared to the wealthiest ones.
We observed marked disparities in cancer mortality in Costa Rica in particular from infection- and lifestyle- related cancers. There are important opportunities to reduce disparities in cancer mortality by targeting cancer prevention, early detection and opportune treatment, mainly in urban and disadvantaged districts.
•Lower mortality in rural compared to urban area for most cancer sites.•Stomach cancer mortality was higher in rural areas.•Disparities according to wealth depended on cancer site.
Highlights • Prostate cancer incidence rates varied between and within country by 6 and 3-fold, respectively. • Incidence of prostate cancer increased by 3–5% annually in Argentina, Brazil, Chile and ...Costa Rica. • Mortality rates were constant in Argentina, Brazil, Chile and Costa Rica between 1997 and 2008. • Variation in incidence rates in the region is largely due to differences in diagnostic practices. • Variation in mortality rates partly reflects differences in death certifications & access to care.
Highlights • Thyroid cancer incidence and mortality rates varied by 8–12 fold and 2–6-fold, respectively. • Females had 4–6 times higher incidence rates and 1–3 times higher mortality rates than ...males. • Papillary thyroid carcinoma is the most frequent histological type diagnosed in females and males. • Incidence of thyroid cancer is increasing rapidly in Argentina, Brazil, Chile and Costa Rica.
Highlights • Lung cancer is the leading cause of cancer death in Central and South America among both sexes. • In the region, Cuba, Argentina, Chile and Uruguay have the highest lung cancer burden. • ...Adenocarcinoma is currently the most frequent histological diagnosis of lung cancer in the region. • There is a need to improve long term data on burden and smoking prevalence. • Smoke-free tobacco policies are the most widely implemented tobacco control measures.
Abstract Rationale and objective The burden of breast cancer has increased worldwide. Breast cancer mortality has been increasing in Central and South America (CSA) in the last few decades. We ...describe the current burden of breast cancer in CSA and review the current status of disease control. Methods We obtained regional- and national-level incidence data from 48 population-based cancer registries in 13 countries and cancer deaths from the WHO mortality database for 18 countries. We estimated world population age-standardized incidence and mortality rates per 100,000 person-years for 2003–2007 and the estimated annual percentage change to describe time trends. Results In the most recent 5-year period, Argentina, Brazil, and Uruguay had the highest incidence rates (67.7–71.9) and Bolivia and El Salvador had the lowest (7.9–12.7). For most countries, mortality rates were ≤12.3, except in Uruguay, Argentina and Cuba (14.9-20.5). Age-specific rates increased after the age of 40–50 years and reached a maximum after age 65 years (mean age at diagnosis 56–62 years). Most countries have developed national screening guidelines; however, there is limited capacity for screening. Conclusion The geographic variation of breast cancer rates may be explained by differences in the prevalence of reproductive patterns, lifestyle factors, early detection, and healthcare access. Extending early-detection programs is challenging because of inequalities in healthcare access and coverage, limited funding, and inadequate infrastructure, and thus it may not be feasible. Given the current status of breast cancer in CSA, data generated by population-based cancer registries is urgently needed for effective planning for cancer control.
Highlights • Brazil, Uruguay, Colombia and Cuba have highest brain and CNS cancer incidence rates in both sexes, reaching rates of intermediate level. • Males have 10–50% higher brain and CNS cancer ...incidence and mortality rates than females. • Differences in incidence rates among countries could be due to underreporting and under ascertainment of cases. • Gliomas are the most frequently diagnosed brain and CNS cancers in the region. • The percentage of unspecified malignant tumors of brain and CNS is remarkably high (33%) in Central and South America.
Highlights • 60% (53/88) cancer registries responded to the data call to participate in this project. • 41% (22/53) of the registries had been accepted in Cancer Incidence in Five Continents Vol X. • ...The quality of the incidence data from some registries is suboptimal. • 60–97% of all cancer cases combined (except non-melanoma skin cancer) were MV in most registries. • 0–45% of all cancer cases combined were DCO; 11 registries recorded <2% DCO cases.
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