Summary Background Survival and cure rates for childhood cancers in Europe have greatly improved over the past 40 years and are mostly good, although not in all European countries. The EUROCARE-5 ...survival study estimates survival of children diagnosed with cancer between 2000 and 2007, assesses whether survival differences among European countries have changed, and investigates changes from 1999 to 2007. Methods We analysed survival data for 157 499 children (age 0–14 years) diagnosed between Jan 1, 1978 and Dec 31, 2007. They came from 74 population-based cancer registries in 29 countries. We calculated observed, country-weighted 1-year, 3-year, and 5-year survival for major cancers and all cancers combined. For comparison between countries, we used the corrected group prognosis method to provide survival probabilities adjusted for multiple confounders (sex, age, period of diagnosis, and, for all cancers combined without CNS cancers, casemix). Age-adjusted survival differences by area and calendar period were calculated with period analysis and were given for all cancers combined and the major cancers. Findings We analysed 59 579 cases. For all cancers combined for children diagnosed in 2000–07, 1-year survival was 90·6% (95% CI 90·2–90·9), 3-year survival was 81·0 % (95% CI 80·5–81·4), and 5-year survival was 77·9% (95% CI 77·4–78·3). For all cancers combined, 5-year survival rose from 76·1% (74·4–77·7) for 1999–2001, to 79·1% (77·3–80·7) for 2005–07 (hazard ratio 0·973, 95% CI 0·965–0·982, p<0·0001). The greatest improvements were in eastern Europe, where 5-year survival rose from 65·2% (95% CI 63·1–67·3) in 1999–2001, to 70·2% (67·9–72·3) in 2005–07. Europe-wide average yearly change in mortality (hazard ratio) was 0·939 (95% CI 0·919–0·960) for acute lymphoid leukaemia, 0·959 (0·933–0·986) for acute myeloid leukaemia, and 0·940 (0·897–0·984) for non-Hodgkin lymphoma. Mortality for all of Europe did not change significantly for Hodgkin's lymphoma, Burkitt's lymphoma, CNS tumours, neuroblastoma, Wilms' tumour, Ewing's sarcoma, osteosarcoma, and rhabdomyosarcoma. Disparities for 5-year survival persisted between countries and regions, ranging from 70% to 82% (for 2005–07). Interpretation Several reasons might explain persisting inequalities. The lack of health-care resources is probably most important, especially in some eastern European countries with limited drug supply, lack of specialised centres with multidisciplinary teams, delayed diagnosis and treatment, poor management of treatment, and drug toxicity. In the short term, cross-border care and collaborative programmes could help to narrow the survival gaps in Europe. Funding Italian Ministry of Health, European Commission, Compagnia di San Paolo Foundation.
Modern life involves mistimed sleeping and eating patterns that in experimental studies are associated with adverse health effects. We assessed whether timing of meals is associated with breast and ...prostate cancer risk taking into account lifestyle and chronotype, a characteristic correlating with preference for morning or evening activity. We conducted a population‐based case‐control study in Spain, 2008–2013. In this analysis we included 621 cases of prostate and 1,205 of breast cancer and 872 male and 1,321 female population controls who had never worked night shift. Subjects were interviewed on timing of meals, sleep and chronotype and completed a Food Frequency Questionaire. Adherence to the World Cancer Research Fund/American Institute of Cancer Research recommendations for cancer prevention was examined. Compared with subjects sleeping immediately after supper, those sleeping two or more hours after supper had a 20% reduction in cancer risk for breast and prostate cancer combined (adjusted Odds Ratio OR = 0.80, 95%CI 0.67–0.96) and in each cancer individually (prostate cancer OR = 0.74, 0.55–0.99; breast cancer OR = 0.84, 0.67–1.06). A similar protection was observed in subjects having supper before 9 pm compared with supper after 10 pm. The effect of longer supper‐sleep interval was more pronounced among subjects adhering to cancer prevention recommendations (OR both cancers= 0.65, 0.44–0.97) and in morning types (OR both cancers = 0.66, 0.49–0.90). Adherence to diurnal eating patterns and specifically a long interval between last meal and sleep are associated with a lower cancer risk, stressing the importance of evaluating timing in studies on diet and cancer.
What's new?
Evidence shows that long‐term disruption of endogenous circadian rhythms may be associated with cancer. The effects of mistimed sleeping and eating patterns that come with modern life are however less clear. This large Spanish population‐based study examined whether meal timing and sleep patterns are associated with the two most common nightshift‐related cancers. Adherence to a more diurnal eating pattern, and specifically an early supper and a long interval between last meal and sleep were associated with a lower breast and prostate cancer risk, stressing the importance of evaluating circadian rhythms in diet and cancer studies and revisiting recommendations for prevention.
Survival for breast cancer (BC) is lower in eastern than northern/central Europe, and in older than younger women. We analysed how comorbidities at diagnosis affected whether selected standard ...treatments (STs) were given, across Europe and over time, also assessing consequences for survival/relapse. We analysed 7581 stage I/IIA cases diagnosed in 9 European countries in 2009–2013, and 4 STs: surgery; breast‐conserving surgery plus radiotherapy (BCS + RT); reconstruction after mastectomy; and prompt treatment (≤6 weeks after diagnosis). Covariate‐adjusted models estimated odds of receiving STs and risks of death/relapse, according to comorbidities. Pearson's R assessed correlations between odds and risks. The z‐test assessed the significance of time‐trends. Most women received surgery: 72% BCS; 24% mastectomy. Mastectomied patients were older with more comorbidities than BCS patients (p < 0.001). Women given breast reconstruction (25% of mastectomies) were younger with fewer comorbidities than those without reconstruction (p < 0.001). Women treated promptly (45%) were younger than those treated later (p = 0.001), and more often without comorbidities (p < 0.001). Receiving surgery/BCS + RT correlated strongly (R = −0.9), but prompt treatment weakly (R = −0.01/−0.02), with reduced death/relapse risks. The proportion receiving BCS + RT increased significantly (p < 0.001) with time in most countries. This appears to be the first analysis of the influence of comorbidities on receiving STs, and of consequences for outcomes. Increase in BCS + RT with time is encouraging. Although women without comorbidities usually received STs, elderly patients often received non‐standard less prompt treatments, irrespective of comorbidities, with increased risk of mortality/relapse. All women, particularly the elderly, should receive ST wherever possible to maximise the benefits of modern evidence‐based treatments.
What's new?
This is the first Europe‐wide study (37 cancer registries, 9 countries) analysing the effect of comorbidities on whether women with early breast cancer (diagnosed 2009–13) receive standard treatments. Women with no comorbidities usually received standard treatments, but elderly women often received less prompt and non‐standard treatments, irrespective of comorbidities, with increased probability of relapse and mortality. All women, particularly the elderly, should receive standard treatments wherever possible to maximize the benefits of modern evidence‐based approaches.
Summary Background More effective treatments have become available for haematological malignancies from the early 2000s, but few large-scale population-based studies have investigated their effect on ...survival. Using EUROCARE data, and HAEMACARE morphological groupings, we aimed to estimate time trends in population-based survival for 11 lymphoid and myeloid malignancies in 20 European countries, by region and age. Methods In this retrospective observational study, we included patients (aged 15 years and older) diagnosed with haematological malignancies, diagnosed up to Dec 31, 2007, and followed up to Dec 31, 2008. We used data from the 30 cancer registries (across 20 countries) that provided continuous incidence and good quality data from 1992 to 2007. We used a hybrid approach to estimate age-standardised and age-specific 5-year relative survival, for each malignancy, overall and for five regions (UK, and northern, central, southern, and eastern Europe), and four 3-year periods (1997–99, 2000–02, 2003–05, 2006–08). For each malignancy, we also estimated the relative excess risk of death during the 5 years after diagnosis, by period, age, and region. Findings We analysed 560 444 cases. From 1997–99 to 2006–08 survival increased for most malignancies: the largest increases were for diffuse large B-cell lymphoma (42·0% 95% CI 40·7–43·4 to 55·4% 54·6–56·2, p<0·0001), follicular lymphoma (58·9% 57·3–60·6 to 74·3% 72·9–75·5, p<0·0001), chronic myeloid leukaemia (32·3% 30·6–33·9 to 54·4% 52·5–56·2, p<0·0001), and acute promyelocytic leukaemia (50·1% 43·7–56·2 to 61·9% 57·0–66·4, p=0·0038, estimate not age-standardised). Other survival increases were seen for Hodgkin's lymphoma (75·1% 74·1–76·0 to 79·3% 78·4–80·1, p<0·0001), chronic lymphocytic leukaemia/small lymphocytic lymphoma (66·1% 65·1–67·1 to 69·0% 68·1–69·8, p<0·0001), multiple myeloma/plasmacytoma (29·8% 29·0–30·6 to 39·6% 38·8–40·3, p<0·0001), precursor lymphoblastic leukaemia/lymphoma (29·8% 27·7–32·0 to 41·1% 39·0–43·1, p<0·0001), acute myeloid leukaemia (excluding acute promyelocytic leukaemia, 12·6% 11·9–13·3 to 14·8% 14·2–15·4, p<0·0001), and other myeloproliferative neoplasms (excluding chronic myeloid leukaemia, 70·3% 68·7–71·8 to 74·9% 73·8–75·9, p<0·0001). Survival increased slightly in southern Europe, more in the UK, and conspicuously in northern, central, and eastern Europe. However, eastern European survival was lower than that for other regions. Survival decreased with advancing age, and increased with time only slightly in patients aged 75 years or older, although a 10% increase in survival occurred in elderly patients with follicular lymphoma, diffuse large B-cell lymphoma, and chronic myeloid leukaemia. Interpretation These trends are encouraging. Widespread use of new and more effective treatment probably explains much of the increased survival. However, the persistent differences in survival across Europe suggest variations in the quality of care and availability of the new treatments. High-resolution studies that collect data about stage at diagnosis and treatments for representative samples of cases could provide further evidence of treatment effectiveness and explain geographic variations in survival. Funding Compagnia di San Paolo, Fondazione Cariplo, European Commission, and Italian Ministry of Health.
Background
CONCORD‐3 highlighted wide disparities in population‐based 5‐year net survival for cutaneous melanoma during 2000–2014. Clinical evidence suggests marked international differences in the ...proportion of lethal acral and nodular subtypes of cutaneous melanoma.
Objectives
We aimed to assess whether the differences in morphology may explain global variation in survival.
Methods
Patients with melanoma were grouped into the following seven morphological categories: malignant melanoma, not otherwise specified (International Classification of Diseases for Oncology, third revision morphology code 8720), superficial spreading melanoma (8743), lentigo maligna melanoma (8742), nodular melanoma (8721), acral lentiginous melanoma (8744), desmoplastic melanoma (8745) and other morphologies (8722–8723, 8726–8727, 8730, 8740–8741, 8746, 8761, 8770–8774, 8780). We estimated net survival using the nonparametric Pohar Perme estimator, correcting for background mortality by single year of age, sex and calendar year in each country or region. All‐ages survival estimates were standardized using the International Cancer Survival Standard weights. We fitted a flexible parametric model to estimate the effect of morphology on the hazard of death.
Results
Worldwide, the proportion of nodular melanoma ranged between 7% and 13%. Acral lentiginous melanoma accounted for less than 2% of all registrations but was more common in Asia (6%) and Central and South America (7%). Overall, 36% of tumours were classified as superficial spreading melanoma. During 2010–2014, age‐standardized 5‐year net survival for superficial spreading melanoma was 95% or higher in Oceania, North America and most European countries, but was only 71% in Taiwan. Survival for acral lentiginous melanoma ranged between 66% and 95%. Nodular melanoma had the poorest prognosis in all countries. The multivariable analysis of data from registries with complete information on stage and morphology found that sex, age and stage at diagnosis only partially explain the higher risk of death for nodular and acral lentiginous subtypes.
Conclusions
This study provides the broadest picture of distribution and population‐based survival trends for the main morphological subtypes of cutaneous melanoma in 59 countries. The poorer prognosis for nodular and acral lentiginous melanomas, more frequent in Asia and Latin America, suggests the need for health policies aimed at specific populations to improve awareness, early diagnosis and access to treatment.
What is already known about this topic?
The histopathological features of cutaneous melanoma vary markedly worldwide.
The proportion of melanomas with the more aggressive acral lentiginous or nodular histological subtypes is higher in populations with predominantly dark skin than in populations with predominantly fair skin.
What does this study add?
We aimed to assess the extent to which these differences in morphology may explain international variation in survival when all histological subtypes are combined.
This study provides, for the first time, international comparisons of population‐based survival at 5 years for the main histological subtypes of melanoma for over 1.5 million adults diagnosed during 2000–2014.
This study highlights the less favourable distribution of histological subtypes in Asia and Central and South America, and the poorer prognosis for nodular and acral lentiginous melanomas.
We found that later stage at diagnosis does not fully explain the higher excess risk of death for nodular and acral lentiginous melanoma compared with superficial spreading melanoma.
Linked Comment: C.M. Olsen. Br J Dermatol 2022; 187:284.
Recurrence after colorectal cancer resection is rarely documented in the general population while a key clinical determinant for patient survival. We identified 8785 patients with colorectal cancer ...diagnosed between 2010 and 2013 and clinically followed up to 2020 in 15 cancer registries from seven European countries (Bulgaria, Switzerland, Germany, Estonia, France, Italy, and Spain). We estimated world age‐standardized net survival using a flexible cumulative excess hazard model. Recurrence rates were calculated for patients with initially resected stage I, II, or III cancer in six countries, using the actuarial survival method. The proportion of nonmetastatic resected colorectal cancers varied from 58.6% to 78.5% according to countries. The overall 5‐year net survival by country ranged between 60.8% and 74.5%. The absolute difference between the 5‐year survival extremes was 12.8 points for stage II (Bulgaria vs Switzerland), 19.7 points for stage III (Bulgaria vs. Switzerland) and 14.8 points for Stage IV and unresected cases (Bulgaria vs. Switzerland or France). Five‐year cumulative rate of recurrence among resected patients with stage I–III was 17.7%. As compared to the mean of the whole cohort, the risk of developing a recurrence did not differ between countries except a lower risk in Italy for both stage I/II and stage III cancers and a higher risk in Spain for stage III. Survival after colorectal cancer differed across the concerned European countries while there were slight differences in recurrence rates. Population‐based collection of cancer recurrence information is crucial to enhance efforts for evidence‐based management of colorectal cancer follow up.
What's new?
Although a key clinical determinant for patient survival, recurrence after colorectal cancer resection is rarely documented in the general population. Within the EUROCARE project, this population‐based study compared the 5‐year recurrence and survival rates after colorectal cancer resection across several European countries according to stage at diagnosis. Survival after colorectal cancer differed across the European countries, while slight differences were found in recurrence rates. The study may provide healthcare planners with relevant information to improve cancer control.
Purpose
Despite an increasing understanding of the pathology and genetics of non-Hodgkin lymphoma (NHL), global reports on variations in the incidence of NHL remain limited in their number and scope.
...Methods
To provide a situation analysis, national incidence estimates for NHL in 185 countries for the year 2018 were obtained from the GLOBOCAN database. We also used recorded incidence data from
Cancer Incidence in Five Continents
(CI5) plus for years of diagnosis 1980–2012 to examine temporal trends.
Results
NHL ranked as the 5th to 9th most common cancer in most countries worldwide, with almost 510,000 new cases estimated in 2018. Observed incidence rates of NHL 2008–2012 varied markedly by world region: among males, rates were highest among Israel Jews age-standardized (world) rate of 17.6 per 100,000), Australia (15.3), US whites (14.5), Canada (13.7), and Portugal (13.3). Where data were available, most populations exhibited stable or slightly increasing incidence rates; in North America, parts of Europe, and Oceania the rising incidence rates were generally observed until the 1990s, with a stabilization seen thereafter.
Conclusion
Marked variations in NHL incidence rates remain in populations in each world region. Special attention should be given to further etiological research on the role of endemic infections and environmental exposures, particularly in Africa, Asia, and Latin America. To permit internationally comparable statistics, an equal focus on addressing the quality of hematological information in population-based registries is also warranted.
Experimental evidence indicates that exercise performed at different times of the day may affect circadian rhythms and circadian disruption has been linked to breast and prostate cancer. We examined ...in a population‐based case‐control study (MCC‐Spain) if the time‐of‐day when physical activity is done affects prostate and breast cancer risk. Lifetime recreational and household physical activity was assessed by in‐person interviews. Information on time‐of‐day of activity (assessed approximately 3 years after the assessment of lifetime physical activity and confounders) was available for 781 breast cancer cases, 865 population female controls, 504 prostate cases and 645 population male controls from 10 Spanish regions, 2008‐2013. We estimated odds ratios (ORs) and 95% confidence intervals (95% CI) for different activity timings compared to inactive subjects using unconditional logistic regression adjusting for confounders. Early morning (8‐10 am) activity was associated with a protective effect compared to no physical activity for both breast (OR = 0.74, 95% CI = 0.48‐1.15) and prostate cancer (OR = 0.73, 95% CI = 0.44‐1.20); meta‐OR for the two cancers combined 0.74 (95%CI = 0.53‐1.02). There was no effect observed for breast or prostate cancer for late morning to afternoon activity while a protective effect was also observed for evening activity only for prostate cancer (OR = 0.75, 95% CI = 0.45‐1.24). Protective effects of early morning activity were more pronounced for intermediate/evening chronotypes for both cancers. This is the first population‐based investigation identifying a differential effect of timing of physical activity on cancer risk with more pronounced effects for morning hour activity. Our results, if confirmed, may improve current physical activity recommendations for cancer prevention.
What's new?
Exercise protects against a variety of cancers, but does time of day matter? Disrupting the body's circadian rhythm can boost cancer risk. Here, the authors compared breast and prostate cancer risk among people who exercised in the early morning, late morning, afternoon, and evening. They conducted a population‐based case‐control study, in which participants filled out a questionnaire about their patterns of sleeping, eating, and exercising. Exercising in the early morning appeared to be more strongly protective against breast and prostate cancer than exercising later in the day. Evening exercise appeared to have a moderate protective effect on prostate cancer.
Objective
To analyze the incidence, incidence trends, and survival of marginal zone lymphomas (MZLs) in Girona and to describe these indicators based on the location in the case of extranodal MZLs.
...Methods
Population‐based study of MZL collected in the Girona Cancer Registry, 1994–2018. Sociodemographic data, tumor location, and stage were obtained from clinical records. Crude (CR) and age‐adjusted (ASRE) incidence rates expressed per 100,000 person‐years (p‐y) were calculated. Joinpoint regression models were used for the trend analysis according to the MZL group. Five‐year observed and net survival were analyzed.
Results
A total of 472 MZLs were included, 44 (9.3%) were nodal, 288 (61.0%) extranodal, 122 (25.9%) splenic, and the rest (n = 18) MZL, NOS. The CR for the MZL was 2.89 × 100,000 p‐y (95% CI: 2.63–3.15), the ASRE was 3.26 × 100,000 p‐y (95% CI: 2.97–3.57), and the annual percentage change (APC) was 1.6 (95% CI: 0.5–2.7). The ASRE for nodal MZL was 0.30 × 100,000 p‐y (95% CI: 0.22–0.41) and showed an APC of 2.9% (95% CI: −16.4–26.6). For extranodal MZL, the ASRE was 1.98 × 100,000 p‐y (95% CI: 1.76–2.23) and the APC was −0.4 (95% CI: −2.0–1.2). The most frequent locations of this type of MZL were the gastric (35.4%), skin (13.2%), and respiratory system (11.8%). The ASRE of the splenic MZL was 0.85 (95% CI: 0.71–1.02) with an APC of 12.8 (95% CI: 2.5–24.0). The 5‐year net survival of MZL was 82.1% (95% CI: 76.3–86.5).
Conclusions
This study reveals differences in the incidence and trend of the incidence of MZL according to the subgroup, showing a significant increase in the overall MZL mainly due to splenic MZL type.
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