Adverse birth outcomes related to air pollution are well documented; however, few studies have accounted for infant sex. There is also scientific evidence that the neighborhood socioeconomic profile ...may modify this association even after adjusting for individual socioeconomic characteristics. The objective is to analyze the association between air pollution and birth weight by infant sex and neighborhood socioeconomic index. All birth weights (2008-2011) were geocoded at census block level. Each census block was assigned a socioeconomic deprivation level, as well as daily NO2 and PM10 concentrations. We performed a multilevel model with a multiple statistical test and sensible analysis using the spline function. Our findings suggest the existence of a differential association between air pollution and BW according to both neighborhood socioeconomic level and infant sex. However, due to multiple statistical tests and controlling the false discovery rate (FDR), all significant associations became either not statistically significant or borderline. Our findings reinforce the need for additional studies to investigate the role of the neighborhood socioeconomic which could differentially modify the air pollution effect.
Learning Objectives
After completing this course, the reader will be able to:
Compare quality of life in long‐term colorectal cancer survivors with quality of life in the general population.
Identify ...cancer complications that affect quality of life in long‐term colorectal cancer survivors.
This article is available for continuing medical education credit at CME.TheOncologist.com
Background.
The number of long‐term colorectal cancer survivors is increasing. Cancer and its treatment can cause physical and psychological complications, but little is known about how it impacts quality of life (QOL) over the long term—5, 10, and 15 years after diagnosis.
Methods.
Cancer survivors were randomly selected from three tumor registries in France, diagnosed in 1990 (±1 year), 1995 (±1 year), and 2000 (±1 year). Controls were randomly selected from electoral rolls, stratifying on gender, age group, and residence area. Participants completed two QOL questionnaires, a fatigue questionnaire, an anxiety questionnaire, and a life conditions questionnaire. An analysis of variance was used to compare QOL scores of cancer survivors by period of diagnosis (5, 10, and 15 years) with those of controls, adjusted for sociodemographic data and comorbidities.
Results.
We included 344 colon cancer and 198 rectal cancer survivors and 1,181 controls. In a global analysis, survivors reported a statistically and clinically significant lower score in social functioning 5 years after diagnosis and higher scores in diarrhea symptoms 5 and 10 years after diagnosis. In subgroup analyses, rectal cancer affected QOL in the physical dimensions at 5 years and in the fatigue dimensions at 5 and 10 years.
Conclusion.
Survivors of colorectal cancer may experience the effects of cancer and its treatment up to 10 years after diagnosis, particularly for rectal cancer. Clinicians, psychologists, and social workers must pay special attention to rectal cancer survivors to improve overall management.
摘要
背景
结直肠癌长期幸存者的数量与日俱增。癌症及其治疗可引发生理上与心理上的并发症，但对确诊后长期‐‐5、10、15年生活质量（QOL）的影响却知之甚少。
方法
从法国3所肿瘤登记处随机化选择癌症幸存者，这些患者确诊时间为1990年（±1年）、1995年（±1年）、2000年（±1年）。从选民名册中随机化选择对照组病例，根据性别、年龄组以及居住区域进行分层。参与者完成2份QOL问卷、1份疲劳问卷、1份焦虑问卷以及1份生活条件问卷。经社会人口学数据与共病情况校正后，通过方差分析比较癌症幸存者与对照组在各个诊断期（5、10、15年）的QOL评分。
结果
本研究入组了344例结肠癌、198例直肠癌幸存者以及1181例对照病例。全局分析显示，幸存者确诊后5年时的社会功能评分显著低于对照组，而确诊后5年与10年时的腹泻症状评分则显著高于对照组，且以上评分均具有统计学意义与临床意义。亚组分析显示，直肠癌于5年时在生理维度、5年与10年时在疲倦维度对QOL具有影响。
结论
结直肠癌，尤其是直肠癌幸存者可能在确诊后长达10年内经受癌症及其治疗的影响。为全面改善直肠癌幸存者的管理状况，临床医生、心理医生以及社会工作者必须对这部分患者予以特别的关注。
Health‐related quality of life was examined in long‐term colorectal cancer survivors, 5, 10, and 15 years after diagnosis, in comparison with a control group from the general population. Effects were found up to 10 years after diagnosis, particularly for rectal cancer survivors.
To date, few epidemiologic studies have examined the relationship between environmental PCDD/F exposure and breast cancer in human populations. Dioxin emissions from municipal solid waste ...incinerators (MSWIs) are one of the major sources of environmental dioxins and are therefore an exposure source of public concern. The purpose of this study was to examine the association between dioxins emitted from a polluting MSWI and invasive breast cancer risk among women residing in the area under direct influence of the facility.
We compared 434 incident cases of invasive breast cancer diagnosed between 1996 and 2002, and 2170 controls randomly selected from the 1999 population census. A validated dispersion model was used as a proxy for dioxin exposure, yielding four exposure categories. The latter were linked to individual places of residence, using Geographic Information System technology.
The age distribution at diagnosis for all cases combined showed a bimodal pattern with incidence peaks near 50 and 70 years old. This prompted us to run models separately for women aged 20-59 years, and women aged 60 years or older. Among women younger than 60 years old, no increased or decreased risk was found for any dioxin exposure category. Conversely, women over 60 years old living in the highest exposed zone were 0.31 time less likely (95% confidence interval, 0.08-0.89) to develop invasive breast cancer.
Before speculating that this decreased risk reflects a dioxin anti-estrogenic activity with greater effect on late-onset acquired breast cancer, some residual confounding must be envisaged.
The incidence of non-Hodgkin's lymphoma (NHL) has risen steadily during the last few decades in all geographic regions covered by cancer registration for reasons that remain unknown. The aims of this ...study were to assess the relative contributions of age, period and cohort effects to NHL incidence patterns and therefore to provide clues to explain the increasing incidence.
Population and NHL incidence data were provided for the Doubs region (France) during the 1980-2005 period. NHL counts and person-years were tabulated into one-year classes by age (from 20 to 89) and calendar time period. Age-period-cohort models with parametric smooth functions (natural splines) were fitted to the data by assuming a Poisson distribution for the observed number of NHL cases.
The age-standardised incidence rate increased from 4.7 in 1980 to 11.9 per 100,000 person-years at risk in 1992 (corresponding to a 2.5-fold increase) and stabilised afterwards (11.1 per 100,000 in 2005). Age effects showed a steadily increasing slope up to the age of 80 and levelled off for older ages. Large period curvature effects, both adjusted for cohort effects and non-adjusted (p < 10-4 and p < 10-5, respectively), showed departure from linear periodic trends; period effects jumped markedly in 1983 and stabilised in 1992 after a 2.4-fold increase (compared to the 1980 period). In both the age-period-cohort model and the age-cohort model, cohort curvature effects were not statistically significant (p = 0.46 and p = 0.08, respectively).
The increased NHL incidence in the Doubs region is mostly dependent on factors associated with age and calendar periods instead of cohorts. We found evidence for a levelling off in both incidence rates and period effects beginning in 1992. It is unlikely that the changes in classification (which occurred after 1995) and the improvements of diagnostic accuracy could largely account for the 1983-1992 period-effect increase, giving way to an increased exposure to widely distributed risk factors including persistent organic pollutants and pesticides. Continued NHL incidence and careful analysis of period effects are of utmost importance to elucidate the enigmatic epidemiology of NHL.
Summary Background Traditional cancer-survival analyses provide data on cancer management at the beginning of a study period, and are often not relevant to current practice because they refer to ...survival of patients treated with older regimens that might no longer be used. Therefore, shortening the delay in providing survival estimates is desirable. Period analysis can estimate cancer survival by the use of recent data. We aimed to apply the period-analysis method to data that were collected by European cancer registries to estimate recent survival by country and cancer site, and to assess survival changes in Europe. We also compared our findings with data on cancer survival in the USA from the US SEER (Surveillance, Epidemiology, and End Results) programme. Methods We analysed survival data for patients diagnosed with cancer in 2000–02, collected from 47 of the European cancer registries participating in the EUROCARE-4 study. 5-year period relative survival for patients diagnosed in 2000–02 was estimated as the product of interval-specific relative survival values of cohorts with different lengths of follow-up. 5-year survival profiles for patients diagnosed in 2000–02 were estimated for the European mean and for five European regions, and findings were compared with US SEER registry data for patients diagnosed in 2000–02. A 5-year survival profile for patients diagnosed in 1991–2002 and a 10-year survival profile for patients diagnosed in 1997–2002 were also estimated by the period method for all malignancies, by geographical area, and by cancer site. Findings For all cancers, age-adjusted 5-year period survival improved for patients diagnosed in 2000–02, especially for patients with colorectal, breast, prostate, and thyroid cancer, Hodgkin's disease, and non-Hodgkin lymphoma. The European mean age-adjusted 5-year survival calculated by the period method for 2000–02 was high for testicular cancer (97·3% 95% CI 96·4–98·2), melanoma (86·1% 84·3–88·0), thyroid cancer (83·2% 80·9–85·6), Hodgkin's disease (81·4% 78·9–84·1), female breast cancer (79·0% 78·1–80·0), corpus uteri (78·0% 76·2–79·9), and prostate cancer (77·5% 76·5–78·6); and low for stomach cancer (24·9% 23·7–26·2), chronic myeloid leukaemia (32·2% 29·0–35·7), acute myeloid leukaemia (14·8% 13·4–16·4), and lung cancer (10·9% 10·5–11·4). Survival for patients diagnosed in 2000–02 was generally highest for those in northern European countries and lowest for those in eastern European countries, although, patients in eastern European had the highest improvement in survival for major cancer sites during 1991–2002 (colorectal cancer from 30·3% 28·3–32·5 to 44·7% 42·8–46·7; breast cancer from 60% 57·2–63·0 to 73·9% 71·7–76·2; for prostate cancer from 39·5% 35·0–44·6 to 68·0% 64·2–72·1). For all solid tumours, with the exception of stomach, testicular, and soft-tissue cancers, survival for patients diagnosed in 2000–02 was higher in the US SEER registries than for the European mean. For haematological malignancies, data from US SEER registries and the European mean were comparable in 2000–02, except for non-Hodgkin lymphoma. Interpretation Cancer-service infrastructure, prevention and screening programmes, access to diagnostic and treatment facilities, tumour-site-specific protocols, multidisciplinary management, application of evidence-based clinical guidelines, and recruitment to clinical trials probably account for most of the differences that we noted in outcomes.
Abstract EUROCARE-4 analysed about three million adult cancer cases from 82 cancer registries in 23 European countries, diagnosed in 1995–1999 and followed to December 2003. For each cancer site, the ...mean European area-weighted observed and relative survival at 1-, 3-, and 5-years by age and sex are presented. Country-specific 1- and 5-year relative survival is also shown, together with 5-year relative survival conditional to surviving 1-year. Within-country variation in survival is analysed for selected cancers. Survival for most solid cancers, whose prognosis depends largely on stage at diagnosis (breast, colorectum, stomach, skin melanoma), was highest in Finland, Sweden, Norway and Iceland, lower in the UK and Denmark, and lowest in the Czech Republic, Poland and Slovenia. France, Switzerland and Italy generally had high survival, slightly below that in the northern countries. There were between-region differences in the survival for haematologic malignancies, possibly due to differences in the availability of effective treatments. Survival of elderly patients was low probably due to advanced stage at diagnosis, comorbidities, difficult access or lack of availability of appropriate care. For all cancers, 5-year survival conditional to surviving 1-year was higher and varied less with region, than the overall relative survival.
Summary Background EUROCARE is the largest population-based cooperative study on survival of patients with cancer. The EUROCARE project aims to regularly monitor, analyse, and explain survival trends ...and between-country differences in survival. This report (EUROCARE-4) presents survival data for eight selected cancer sites and for all cancers combined, diagnosed in adult (aged ≥15 years) Europeans in 1995–99 and followed up until the end of 2003. Methods We analysed data from 83 cancer registries in 23 European countries on 2 699 086 adult cancer cases that were diagnosed in 1995–99 and followed up to December, 2003. We calculated country-specific and mean-weighted age-adjusted 5-year relative survival for eight major cancers. Additionally, case-mix-adjusted 5-year survival for all cancers combined was calculated by countries ranked by total national expenditure on health (TNEH). Changes to survival were analysed relative to cases diagnosed in 1990–94. Findings Mean age-adjusted 5-year relative survival for colorectal (53·8% 95% CI 53·3–54·1), lung (12·3% 12·1–12·5), breast (78·9% 78·6–79·2), prostate (75·7% 75·2–76·2), and ovarian (36·3% 35·7–37·0) cancer was highest in Nordic countries (except Denmark) and central Europe, intermediate in southern Europe, lower in the UK and Ireland, and worst in eastern Europe. Survival for melanoma (81·6% 81·0–82·3), cancer of the testis (94·2% 93·4–95·0), and Hodgkin's disease (80·0% 79·0–81·0) varied little with geography. All-cancer survival correlated with TNEH for most countries. Denmark and UK had lower all-cancer survival than countries with similar TNEH; Finland had high all-cancer survival, but moderate TNEH. Survival increased and intercountry survival differences narrowed between the data for 1990–94 and 1995–99 for, notably, Hodgkin's disease (range 66·1–82·9 IQR 72·2–78·6 vs 74·0–83·9 78·6–81·9), colorectal (29·4–56·7 45·8–54·1 vs 38·8–59·7 50·7–57·5), and breast (61·7–82·7 72·3–78·3 vs 69·3–87·6 76·6–82·7) sites. Interpretation Increases in survival and decreases in geographic differences over time, which are mainly due to improvements in health-care services in countries with poor survival, might indicate better cancer care. Wealthy countries with high TNEH generally had good cancer outcomes, but those with conspicuously worse outcomes than those with similar TNEH might not be allocating health resources efficiently.
Abstract This study analyses survival in 40,392 children (age 0–14 years) and 30,187 adolescents/young adults (age 15–24 years) diagnosed with cancer between 1995 and 2002. The cases were from 83 ...European population-based cancer registries in 23 countries participating in EUROCARE-4. Five-year survival in countries and in regional groupings of countries was compared for all cancers combined and for major cancers. Survival for 15 rare cancers in children was also analysed. Five-year survival for all cancers combined was 81% in children and 87% in adolescents/young adults. Between-country survival differences narrowed for both children and adolescents/young adults. Relative risk of death reduced significantly, by 8% in children and by 13% in adolescents/young adults, from 1995–1999 to 2000–2002. Survival improved significantly over time for acute lymphoid leukaemia and primitive neuroectodermal tumours in children and for non-Hodgkin lymphoma in adolescents/young adults. Cancer survival in patients <25 years is poorly documented in Eastern European countries. Complete cancer registration should be a priority for these countries as an essential part of a policy for effective cancer control in Europe.
Incidence of uveal melanoma in Europe Virgili, Gianni; Gatta, Gemma; Ciccolallo, Laura ...
Ophthalmology (Rochester, Minn.),
12/2007, Volume:
114, Issue:
12
Journal Article
Peer reviewed
To estimate incidence rates of uveal melanoma in Europe from 1983 to 1994.
Incidence analysis of data from cancer registries adhering to the European Cancer Registry-based study on survival and care ...of cancer patients (EUROCARE) (cases diagnosed from 1983 to 1994).
Data of 6673 patients with ocular melanoma (as defined by International Classification of Diseases for Oncology morphology codes 8720 to 8780 melanoma and International Classification of Diseases 9 (ICD9) codes 190.0 iris and ciliary body, 190.5 retina, 190.6 choroid, and 190.9 unspecified ocular location) from 33 cancer registries of 16 European countries.
Incidence rate ratios (IRRs) were obtained from a multilevel Poisson regression model.
Incidence rates and IRRs associated with demographic and geographic variables.
Standardized incidence rates increased from south to north across registries, from a minimum of <2 per million in registries of Spain and southern Italy up to >8 per million in Norway and Denmark. The inclusion of tumors with unspecified ocular location (code 190.9) increased incidence rates in most United Kingdom registries, but not in the other geographic areas, where this code was seldom used for uveal melanomas. Incidence increased noticeably up to age 55 (IRR, 1.46 per 5 years; 95% confidence interval CI, 1.36-1.57) but leveled off after age 75 (IRR, 0.99 per 5 years; 95% CI, 0.93-1.05), with intermediate levels midway (IRR, 1.18 per 5 years; 95% CI, 1.12-1.23). It was also higher in males (IRR, 1.22; 95% CI, 1.16-1.28). Rates were stable during the study period, but a cohort effect was evidenced, accounting for higher incidence rates in people born during the period 1910 to 1935 (P = 0.005). Incidence increased with latitude (P = 0.008), which explained most differences in rates among areas.
In this large series of uveal melanomas, we found stable incidence during the years 1983 to 1994. The north-to-south decreasing gradient supports the protective role of ocular pigmentation. European ophthalmologists should develop guidelines to standardize the coding of tumors treated conservatively using the ICD classification to improve the registration and surveillance of uveal melanoma by cancer registries.
Summary Adenoid cystic carcinoma (ACC) of salivary gland origin is rare. The EUROCARE data provide a good opportunity to study the survival of this uncommon cancer in a large population. A total of ...2611 cases, aged 15 to 99 years, diagnosed between 1983 and 1994 with primary salivary gland ACC were analyzed. Thirty-two population based cancer registries from seventeen countries participating in EUROCARE contributed the data. Relative survival by sex, age, period of diagnosis, region, site and stage, and the adjusted relative excess risk (RER) of death were estimated. Survival since diagnosis was 94%, 78% and 65% at 1, 5 and ten years, respectively. Ten-year survival was best (69%) in patients of the youngest age group (15–54 years) and from Northern Europe (69%). In the UK was higher (65%) than in Western (62%) and Eastern (56%) Europe. ACCs in nasal cavity (RER 2.6), pharynx (RER 3.5) and larynx and bronchus (RER 3.9) had a worse prognosis compared to those of oral cavity. A strong effect of stage at diagnosis on RERs and some worsening of survival at five years over time (80% in 1983–1985, 76% in 1992–1994) were also evident. The findings of the present study, as those from clinical studies, confirm the important impact of primary site and stage at diagnosis on survival. Furthermore, we could demonstrate that survival for ACC did not improve over time and that cases from Eastern countries had a significant worse prognosis. Improvements in the disease detection in its early stage and international collaborative research should be encouraged.
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