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Turano LM, Laudico AV, Esteban DB, Pisani P, Parkin DM. Reduction of Death Certificate Only (DCO) Registrations by Active Follow Back. Asian Pac J Cancer Prev 2003; 3:133-135. [PMID: 12718591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
Death certificates are an important source of information for cancer registries that help to improve completeness of case finding. In many countries where routine mortality data are considered of poor quality, this source is often regarded as being of little value. We evaluated the contribution of death certificates to the total number of registrations in the years 1993-1997, in the Manila Cancer Registry (MCR). We compared the "standard" practice of retrieving clinical information if the death certificate was completed in a hospital, with active search of additional information from the deceased's relatives when the death was certified at home.The standard procedure allowed us to reduce the proportion of cases registered from a death certificate by 5%. The improvement varied significantly among the most common sites with a reduction of 10% for lymphomas to less than 1% for cancers of the cervix.The proportion of liver cancers registered from a death certificate only (DCO), originally 47%, was reduced to 29% by contacting relatives of the deceased patients. In countries with limited investment in information systems, death certificates, even when recognised as being of poor quality, are an important source of information for cancer registries.
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Pham THA, Nguyen TH, Herrero R, Vaccarella S, Smith JS, Nguyen Thuy TT, Nguyen HN, Nguyen BD, Ashley R, Snijders PJF, Meijer CJLM, Muñoz N, Parkin DM, Franceschi S. Human papillomavirus infection among women in South and North Vietnam. Int J Cancer 2003; 104:213-20. [PMID: 12569577 DOI: 10.1002/ijc.10936] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The incidence rate of invasive cervical carcinoma (ICC) is 4-fold higher in Ho Chi Minh City, in the South of Vietnam, than in Hanoi, in the North. Thus, we explored the prevalence of and the risk factors for human papillomavirus (HPV) infection in these 2 areas. A population-based random sample of married women aged 15-69 years were interviewed and had a gynaecological examination in the urban district of Ho Chi Minh City and in a peri-urban district in Hanoi. HPV DNA detection was performed using a GP5+/6+ primer-mediated PCR enzyme immunoassay. A total of 922 women from Ho Chi Minh and 994 from Hanoi, for whom a Pap smear and HPV-status were available, were evaluated. HPV DNA was detected among 10.9% of women in Ho Chi Minh City and 2.0% in Hanoi (age standardized prevalence, world standard population: 10.6% and 2.3%, respectively). In the 2 areas combined, 30 different HPV types were found, the most common being HPV 16 (in 14 single and 18 multiple infections), followed by HPV 58, 18 and 56. A peak of HPV DNA detection in women younger than age 25 was found in Ho Chi Minh City (22.3%) but not in Hanoi. Major risk factors for HPV DNA detection were indicators of sexual habits, most notably the presence of HSV-2 antibodies, nulliparity and the current use of oral contraceptives. Women in Hanoi showed the lowest HPV prevalence ever reported so far, suggesting that HPV has not spread widely in this population. As expected, HPV prevalence in a population seemed to be closely correlated with ICC incidence rates.
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Sankaranarayanan R, Nene BM, Dinshaw K, Rajkumar R, Shastri S, Wesley R, Basu P, Sharma R, Thara S, Budukh A, Parkin DM. Early detection of cervical cancer with visual inspection methods: a summary of completed and on-going studies in India. SALUD PUBLICA DE MEXICO 2003; 45 Suppl 3:S399-407. [PMID: 14746033 DOI: 10.1590/s0036-36342003000900014] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
India is a high-risk country for cervical cancer which accounts a quarter (126,000 new cases, 71,000 deaths around 2,000) of the world burden. The age-standardized incidence rates range from 16-55 per 100,000 women in different regions with particularly high rates in rural areas. Control of cervical cancer by early detection and treatment is a priority of the National Cancer Control Programme of India. There are no organized cytology screening programmes in the country. The technical and financial constraints to organize cytology screening have encouraged the evaluation of visual inspection approaches as potential alternatives to cervical cytology in India. Four types of visual detection approaches for cervical neoplasia are investigated in India: a) naked eye inspection without acetic acid application, widely known as 'downstaging'; b) naked eye inspection after application of 3-5% acetic acid (VIA); c) VIA using magnification devices (VIAM); d) visual inspection after the application of Lugol's iodine (VILI). Downstaging has been shown to be poorly sensitive and specific to detect cervical neoplasia and is no longer considered as a suitable screening test for cervical cancer. VIA, VIAM and VILI are currently being investigated in multicentre cross-sectional studies (without verification bias), in which cytology and HPV testing are also simultaneously evaluated, and the results of these investigations will be available in 2003. These studies will provide valuable information on the average, comparative test performances in detecting high-grade cervical cancer precursors and cancer. Results from pooled analysis of data from two completed studies indicated an approximate sensitivity of 93.4% and specificity of 85.1% for VIA to detect CIN 2 or worse lesions; the corresponding figures for cytology were 72.1% and 91.6%. The efficacy of VIA in reducing incidence of an mortality from cervical cancer and its cost-effectiveness is currently being investigated in two cluster randomized controlled intervention trials in India. One of these studies is a 4-arm trial addressing the comparative efficacy of VIA, cytology and primary screening with HPV DNA testing. This trial will provide valuable information on comparative detection rates of CIN 2-3 lesions by the middle of 2003. The expected outcomes from the Indian studies will contribute valuable information for guiding the development of public health policies on cervical cancer prevention in countries with different levels of socio-economic and health services development and open up new avenues of research. This paper is available too at: http//www.insp.mx/salud/index.html.
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Newton R, Ziegler J, Ateenyi-Agaba C, Bousarghin L, Casabonne D, Beral V, Mbidde E, Carpenter L, Reeves G, Parkin DM, Wabinga H, Mbulaiteye S, Jaffe H, Bourboulia D, Boshoff C, Touzé A, Coursaget P. The epidemiology of conjunctival squamous cell carcinoma in Uganda. Br J Cancer 2002; 87:301-8. [PMID: 12177799 PMCID: PMC2364227 DOI: 10.1038/sj.bjc.6600451] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2002] [Revised: 04/19/2002] [Accepted: 04/22/2002] [Indexed: 11/08/2022] Open
Abstract
As part of a larger investigation of cancer in Uganda, we conducted a case-control study of conjunctival squamous cell carcinoma in adults presenting at hospitals in Kampala. Participants were interviewed about social and lifestyle factors and had blood tested for antibodies to HIV, KSHV and HPV-16, -18 and -45. The odds of each factor among 60 people with conjunctival cancer was compared to that among 1214 controls with other cancer sites or types, using odds ratios, estimated with unconditional logistic regression. Conjunctival cancer was associated with HIV infection (OR 10.1, 95% confidence intervals [CI] 5.2-19.4; P<0.001), and was less common in those with a higher personal income (OR=0.4, 95% CI 0.3-0.7; P<0.001)[corrected]. The risk of conjunctival cancer increased with increasing time spent in cultivation and therefore in direct sunlight (chi2 trend=3.9, P=0.05), but decreased with decreasing age at leaving home (chi2 trend=3.9, P=0.05), perhaps reflecting less exposure to sunlight consequent to working in towns, although both results were of borderline statistical significance. To reduce confounding, sexual and reproductive variables were examined among HIV seropositive individuals only. Cases were more likely than controls to report that they had given or received gifts for sex (OR 3.5, 95% CI 1.2-10.4; P=0.03), but this may have been a chance finding as no other sexual or reproductive variable was associated with conjunctival cancer, including the number of self-reported lifetime sexual partners (P=0.4). The seroprevalence of antibodies against HPV-18 and -45 was too low to make reliable conclusions. The presence of anti-HPV-16 antibodies was not significantly associated with squamous cell carcinoma of the conjunctiva (OR 1.5, 95% CI 0.5-4.3; P=0.5) and nor were anti-KSHV antibodies (OR 0.9, 95% CI 0.4-2.1; P=0.8). The 10-fold increased risk of conjunctival cancer in HIV infected individuals is similar to results from other studies. The role of other oncogenic viral infections is unclear.
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Abstract
Cancer incidence and mortality estimates for 1995 are presented for the 38 countries in the four United Nations-defined areas of Europe, using World Health Organization mortality data and published estimates of incidence from national cancer registries. Additional estimation was required where national incidence data was not available, and the method involved incorporating the high quality incidence and mortality data available from the expanding number of population-based cancer registries in Europe. There were an estimated 2.6 million new cases of cancer in Europe in 1995, representing over one-quarter of the world burden of cancer. The corresponding number of deaths from cancer was approximately 1.6 million. After adjusting for differing population age structures, overall incidence rates in men were highest in the Western European countries (420.9 per 100,000), with only Austria having a rate under 400. Eastern European men had the second highest rates of cancer (414.2), with extremely high rates being observed in Hungary (566.6) and in the Czech Republic (480.5). The lowest male all-cancer rate by area was observed in the Northern European countries, with fairly low rates seen in Sweden (356.6) and the UK (377.8). In contrast to men, the highest rates in women were observed in Northern Europe (315.9) and were particularly high in Denmark (396.2) and the other Nordic countries excepting Finland. The rates of cancer in Eastern European women were lower than in the other three areas, although as with men, female rates were very high in Hungary (357.2) and in the Czech Republic (333.6). There was greater disparity in the mortality rates within Europe--generally, rates were highest in Eastern European countries, notably in Hungary, reflecting a combination of poorer cancer survival rates and a higher incidence of the more lethal neoplasms, notably cancer of the lung. Lung cancer, with an estimated 377,000 cases, was the most common cancer in Europe in 1995. Rates were particularly high in much of Eastern Europe reflecting current and past tobacco smoking habits of many of its inhabitants. Together with cancers of colon and rectum (334,000), and female breast (321,000), the three cancers represented approximately 40% of new cases in Europe. In men, the most common primary sites were lung (22% of all cancer cases), colon and rectum (12%) and prostate (11%), and in females, breast (26%), colon and rectum (14%) and stomach (7%). The number of deaths is determined by survival, as well as incidence; by far the most common cause of death was lung cancer (330,000)--about one-fifth of the total number of cancer deaths in Europe in 1995. Deaths from cancers of the colon and rectum (189,000) ranked second, followed by deaths from stomach cancer (152,000), which due to poorer survival ranked higher than breast cancer (124,000). Lung cancer was the most common cause of death from cancer in men (29%). Breast cancer was the leading cause of death in females (17%). Cancer registries are a unique source of information on cancer incidence and survival, and are used here with national mortality to demonstrate the very substantial burden of cancer in Europe, and the scope for prevention. Despite some provisos about data quality, the general patterns which emerge in Europe verify the role of past exposures and interventions, and more importantly, firmly establish the need for cancer control measures which target specific populations. In particular, there is a clear urgency to combat the ongoing tobacco epidemic, now prevalent in much of Europe, particularly in the Eastern countries.
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Parkin DM, Bray F, Ferlay J, Pisani P. Estimating the world cancer burden: Globocan 2000. Int J Cancer 2001; 94:153-6. [PMID: 11668491 DOI: 10.1002/ijc.1440] [Citation(s) in RCA: 2570] [Impact Index Per Article: 111.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Abstract
Estimation of the burden of cancer in terms of incidence, mortality, and prevalence is a first step to appreciating appropriate control measures in a global context. The latest results of such an exercise, based on the most recent available international data, show that there were 10 million new cases, 6 million deaths, and 22 million people living with cancer in 2000. The most common cancers in terms of new cases were lung (1.2 million), breast (1.05 million), colorectal (945,000), stomach (876,000), and liver (564,000). The profile varies greatly in different populations, and the evidence suggests that this variation is mainly a consequence of different lifestyle and environmental factors, which should be amenable to preventive interventions. World population growth and ageing imply a progressive increase in the cancer burden--15 million new cases and 10 million new deaths are expected in 2020, even if current rates remain unchanged.
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Yeole BB, Sunny L, Swaminathan R, Sankaranarayanan R, Parkin DM. Population-based survival from colorectal cancer in Mumbai, (Bombay) India. Eur J Cancer 2001; 37:1402-8. [PMID: 11435072 DOI: 10.1016/s0959-8049(01)00108-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Survival estimates of patients registered by population-based cancer registries reflect the average prognosis from a given cancer as they are based on unselected patients with a wide range of natural histories and treatment patterns. In this paper, we report the survival experience of colorectal cancer patients in Mumbai (Bombay), India. Follow-up information on 1642 colorectal cancer patients registered by the Bombay Population-based Cancer Registry for the period 1987-1991 was obtained by matching with death certificates from the Bombay vital statistics registration system, postal/telephone enquiries, home visits and scrutiny of medical records. Cumulative observed and relative survival proportions were calculated by Hakulinen's method. For comparison of results with other populations, age-standardised relative survival (ASRS) was calculated by directly standardising age-specific relative survival to the specific age distributions of the world standard cancer patient population in 1985. The log-rank test was used to identify the potential prognostic variables which were introduced step-wise into a Cox regression model to identify the independent predictors of survival. The 5-year relative survival was 36.6% for colon and 42.2% for rectal cancer. Age, site of cancer and clinical stage of disease emerged as independent predictors of survival. Age-specific 5-year relative survival declined with advancing age. Survival at 5 years was 61.2% for localised colon cancer; 31.9% for regional and 9.0% for distant metastatic disease. These were 65.7, 25.6 and 4.3%, respectively for rectal cancers. Comparison of the results with other populations revealed significant variations, which seem to be related to differences in detection and treatment. The prognosis from colorectal cancer in Mumbai and developing countries, may be further improved through early detection linked with treatment.
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Abstract
In this paper, we report the first results from the population-based cancer registry for Blantyre district, Malawi, for the period 1994-1998. In this 5-year period, 1245 cases were recorded in males (an estimated age-standardized incidence of 92.0 per 100,000) and 1003 in females (an age standardised rate (ASR) of 88.8 per 105). The overall percentage of cases with histological verification was just 41.8%, indicating that case-finding outside the laboratory had been quite successful; nevertheless the rather low rates suggest possible underdiagnosis of cancer, as well as cases missed. As in other reports from the region, the contemporary pattern is dominated by Kaposi's sarcoma (KS) (55.2% cancers in men, 28% in women), the effect of the evolving epidemic of AIDS. The incidence of cervix cancer in women is high (ASR 26.2 per 105), and there are moderately high rates of oesophageal cancer (ASR 15.4 per 105 in men, 9.3 per 105 in women). In childhood, the cancer profile is dominated by Burkitt's lymphoma, which accounts for 42.4% of cancers; KS is now the second most frequent cancer of childhood.
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Abstract
We describe the incidence of cancer in The Gambia over a 10-year period using data collected through the Gambian National Cancer Registry. Major problems involved with cancer registration in a developing country, specifically in Africa are discussed. The data accumulated show a low overall rate of cancer incidence compared to more developed parts of the world. The overall age standardized incidence rates (ASR) were 61.0 and 55.7 per 100 000 for males and females, respectively. In males, liver cancer was most frequent, comprising 58% of cases (ASR 35.7) followed by non-Hodgkin lymphoma, 5.4% (ASR 2.4), lung 4.0%, (ASR 2.8) and prostate 3.3% (ASR 2.5) cancers. The most frequent cancers in females were cervix uteri 34.0% (ASR 18.9), liver 19.4% (ASR 11.2), breast 9.2% (ASR 5.5) and ovary 3.2% (ASR 1.6). The data indicate that cancers of the liver and cervix are the most prevalent cancers, and are likely to be due to infectious agents. It is hoped that immunization of children under 1 year against hepatitis B will drastically reduce the incidence of liver cancer in The Gambia.
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Abstract
OBJECTIVE A high level of completeness of case-finding is essential if data from cancer registries are to be useful for comparative studies. A large case series, collected independently of the cancer registry case-finding mechanisms, as part of a study of the influence of HIV infection on cancer risk, was used to evaluate the completeness of the registry in Kampala, Uganda, for the years 1994-1996. RESULTS For adults aged 15 or more, the completeness of registration of diagnosed cancer cases was 89.6% (95% CI 87.0-91.7) overall. It varied with age (better ascertainment of younger cases, aged under 30) and cancer site (with Kaposi sarcoma cases significantly better identified), and cases with a histology report were more likely to be registered than those without (though the difference was not significant). Completeness declined with time, as in most registries, which continue to identify "late" cases some time after the initial diagnosis. CONCLUSION This is the first objective measurement of completeness of cancer registration in Africa, and it gives reassurance that published incidence rates are reasonablyaccurate (provided that there is not an insistence on the very latest results).
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Parkin DM, Moss SM. Lung cancer screening: improved survival but no reduction in deaths--the role of "overdiagnosis". Cancer 2001. [PMID: 11147614 DOI: 10.1002/1097-0142(20001201)89:] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Randomized controlled trials (RCTs) of lung cancer screening consistently show an excess number of cancer cases and longer survival in screened groups, but no difference in mortality between screened and control populations. METHODS The current study reviewed the various types of biases that confuse comparisons based on intermediate endpoints such as stage distribution and survival and the reasons for basing evaluations in RCTs of screening for early cancers on mortality from a specific cancer. RESULTS Four RCTs all showed improved stage of disease and survival in screened subjects, but there was no difference in mortality between screened and unscreened populations. The possible explanations for the higher incidence are chance (failed randomization) or "overdiagnosis" (detection of cases by screening that otherwise would never have surfaced). Analysis of the trial results confirmed that chance alone was a very unlikely explanation. Evidence suggests that some overdiagnosis of lung cancer is likely in screened subjects. This is a consistent observation in all other programs of screening for early cancers (breast, prostate, and neuroblastoma). CONCLUSIONS Overdiagnosis of cancer cases resulting from the screening process itself will give rise to excess cases of disease, and may, at least in part, explain the observations in the randomized trials.
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Fidaner C, Eser SY, Parkin DM. Incidence in Izmir in 1993-1994: first results from Izmir Cancer Registry. Eur J Cancer 2001; 37:83-92. [PMID: 11165134 DOI: 10.1016/s0959-8049(00)00355-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
A population-based cancer registry, covering the province of Izmir (population 2.7 million, 1993-1994) in Western Turkey was established in 1992. Results for 1993-1994 are presented. Overall cancer incidence was higher in males than in females (age-standardised rates 157.5 and 94.0 per 100000, respectively), as in previous non-population-based series. The principal cancers in males were tobacco-related - lung (age-standardised incidence rate (ASR) 61.6), bladder (ASR 11.0) and larynx (ASR 10.6), consistent with the high prevalence of smoking, and use of traditional high-tar tobaccos. Skin cancers were also relatively common (ASR 11.5 for cancers excluding melanoma). Gastrointestinal cancers were relatively rare. In women, breast cancer was by far the most common malignancy (ASR 24.4); cervical cancer was relatively rare (ASR 5.4). There is probably an underestimate of incidence, due to an inability to use data from certain sources (e.g. death certificates), resulting in a rather high proportion of histologically verified cases (93.7% overall). Nevertheless, the overall profile is an accurate reflection of incidence in this region of Turkey and provides much of the information required for planning strategies to control cancer.
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Parkin DM, Garcia-Giannoli H, Raphael M, Martin A, Katangole-Mbidde E, Wabinga H, Ziegler J. Non-Hodgkin lymphoma in Uganda: a case-control study. AIDS 2000; 14:2929-36. [PMID: 11153674 DOI: 10.1097/00002030-200012220-00015] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Lymphomas are a relatively common complication of AIDS in western countries, but little is known of the impact of the AIDS epidemic in Africa on the risk of these tumours. OBJECTIVE To investigate the types of non-Hodgkin lymphoma (NHL) occurring in Kampala, Uganda, their association with Epstein-Barr virus (EBV), and how their risk is modified by HIV and other variables. METHODS A case-control study comparing NHL cases with age/sex-matched controls. Lymphoma cases included 50 histologically diagnosed adults (31 with validation and phenotyping) and 132 histologically diagnosed children (61 with validation and phenotyping). Controls were adults with cancers unrelated to HIV and children with non-infectious diseases. RESULTS Most (90%) childhood lymphomas were EBV-positive Burkitt's lymphoma (BL), with no association with HIV. Adult lymphoma cases were mainly BL (mostly EBV positive) or diffuse B cell lymphomas (71%). Only a weak association was found with HIV infection; a more precise estimate was obtained with the total series (OR 2.2, 95% CI 0.9-5.1) than validated/phenotyped cases (OR 2.1, 95% CI 0.3-6.7). Higher socioeconomic status adults, who travelled away from home, or had a history of sexually transmitted diseases, appeared to have a moderately increased risk of lymphoma. CONCLUSION Childhood lymphomas were predominantly endemic BL, the risk of which was not modified by HIV. In adults, the risk associated with HIV was much lower in Uganda than in western countries, possibly because of the poor survival of immunosuppressed HIV-positive individuals. Future studies will require careful attention to subtyping of lymphomas, to investigate the possible differences between them.
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Abstract
BACKGROUND Randomized controlled trials (RCTs) of lung cancer screening consistently show an excess number of cancer cases and longer survival in screened groups, but no difference in mortality between screened and control populations. METHODS The current study reviewed the various types of biases that confuse comparisons based on intermediate endpoints such as stage distribution and survival and the reasons for basing evaluations in RCTs of screening for early cancers on mortality from a specific cancer. RESULTS Four RCTs all showed improved stage of disease and survival in screened subjects, but there was no difference in mortality between screened and unscreened populations. The possible explanations for the higher incidence are chance (failed randomization) or "overdiagnosis" (detection of cases by screening that otherwise would never have surfaced). Analysis of the trial results confirmed that chance alone was a very unlikely explanation. Evidence suggests that some overdiagnosis of lung cancer is likely in screened subjects. This is a consistent observation in all other programs of screening for early cancers (breast, prostate, and neuroblastoma). CONCLUSIONS Overdiagnosis of cancer cases resulting from the screening process itself will give rise to excess cases of disease, and may, at least in part, explain the observations in the randomized trials.
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Kubík AK, Parkin DM, Zatloukal P. Czech Study on Lung Cancer Screening: post-trial follow-up of lung cancer deaths up to year 15 since enrollment. Cancer 2000; 89:2363-8. [PMID: 11147613 DOI: 10.1002/1097-0142(20001201)89:11+<2363::aid-cncr9>3.3.co;2-n] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The study was launched in the mid-1970s to explore the capability of screening by chest X-ray and sputum cytology to be used as an effective component of the lung cancer control program in the Czech Republic, a Central European country with a high and increasing occurrence of lung cancer in men at that time. A complementary objective of this report is to ascertain whether the cumulative numbers of lung cancer deaths would equalize in the two randomized groups during a prolonged follow-up period. METHODS Six thousand three hundred sixty-four males who were heavy cigarette smokers, aged 40-64 years, were enrolled during a general health survey in 6 districts of the Czech Republic. At initial X-ray and sputum examination, 19 prevalent lung carcinoma cases were diagnosed. After stratified randomization, the remaining subjects entered a 3-year study: the intervention group (3171 participants) was subjected to semiannual chest X-rays and sputum investigation whereas the controls (3174 participants) had 1 examination only by chest X-rays and sputum investigation, 3 years after entry. During a further 3-year follow-up, a chest X-ray was taken at the end of Years 4, 5, and 6 for both the intervention and control groups. Subjects in both groups who were suspected to have lung carcinoma or other disease on the basis of screening results or symptoms were subjected to appropriate diagnostic studies and treatment. Data on all causes of death in Years 1-6 and on deaths from the lung cancer in Years 7-15 of participants in the intervention and control groups were compared. RESULTS The incidence rate of lung carcinoma from the intervention group was significantly higher than from the controls in the initial 3-year study period (P < 0.05), but not for the initial 6-year period (P = 0.06). Lung carcinoma cases detected by screening were identified at an earlier stage, were more often resectable, and had a significantly better survival than interval cases diagnosed mainly because of symptoms. There was no significant difference in the lung cancer mortality rate between the 2 groups in the initial 3-year study period or during follow-up prolonged up to Year 15 since enrollment. CONCLUSIONS The study gave no evidence that screening for lung cancer by chest X-ray is beneficial in terms of reducing mortality. Based on the results of this study, there is no justification to recommend semiannual screening as a component of a comprehensive lung cancer control program.
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Faulkner J, Dunlop AV, Winter GR, Parkin DM, Pimm M, Portnoy D, Keane B. Martha Dorothy Faulkner Geoffrey John Myers Margaret Ormiston Nicholas David Thomas Pimm John Sholem Portnoy. West J Med 2000. [DOI: 10.1136/bmj.321.7272.1353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hashibe M, Sankaranarayanan R, Thomas G, Kuruvilla B, Mathew B, Somanathan T, Parkin DM, Zhang ZF. Alcohol drinking, body mass index and the risk of oral leukoplakia in an Indian population. Int J Cancer 2000; 88:129-34. [PMID: 10962450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Although tobacco habits have been associated with the risk of oral leukoplakia, alcohol drinking and body mass index (BMI) as risk factors have not been well established. The purpose of this study is to evaluate the independent effects of drinking, BMI, tobacco chewing and smoking on the risk of oral leukoplakia. A case-control study was conducted, with data from an ongoing randomized oral cancer screening trial in Kerala, India. Trained health workers conducted interviews and performed oral visual inspections to identify oral premalignant lesions such as leukoplakia. The logistic regression model in SAS was used to estimate odds ratios (OR) and 95% confidence intervals (95% CI). A total of 927 leukoplakia cases and 47,773 controls were included in the analysis. Ever alcohol drinking was a significant risk factor for oral leukoplakia among nonsmokers (OR=2.1, 95%CI=1.3, 3.4) and non-chewers (OR=1.8, 95%CI=1. 3, 2.5) after adjusting for age, sex, education, BMI and tobacco habits. The association with alcohol drinking was stronger among women (OR=3.9, 95%CI=1.5, 10.4) than men (OR=1.5, 95%CI=1.3, 1.9). An inverse dose-response relationship was observed between BMI and the risk of oral leukoplakia (p for trend=0.0075). Tobacco chewing was a stronger risk factor for women (OR=37.7, 95%CI=24.2, 58.7) than for men (OR=3.4, 95%CI=2.8, 4.1). Smoking was a slightly stronger risk factor for men (OR=3.3, 95%CI=2.5, 4.3) than for women (OR=2.0, 95%CI=1.5, 2.9). In conclusion, alcohol drinking was found to be an independent risk factor while BMI might be inversely associated with the risk of oral leukoplakia in an Indian population.
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Echimane AK, Ahnoux AA, Adoubi I, Hien S, M'Bra K, D'Horpock A, Diomande M, Anongba D, Mensah-Adoh I, Parkin DM. Cancer incidence in Abidjan, Ivory Coast: first results from the cancer registry, 1995-1997. Cancer 2000; 89:653-63. [PMID: 10931466 DOI: 10.1002/1097-0142(20000801)89:3<653::aid-cncr22>3.0.co;2-z] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND There are few data concerning cancer incidence rates in contemporary West Africa. The first data from the cancer registry of Abidjan, the capital of Ivory Coast, for the period 1995-1997 are reported in the current study. METHODS The cancer registry attempts to record data on all new cases of cancer diagnosed in the city of Abidjan, including cases without histologic confirmation of diagnosis. RESULTS Two thousand eight hundred fifteen new cancer cases were registered in 3 years, corresponding to age-standardized (world population) incidence rates of 83.7 per 100,000 in men and 98. 6 per 100,000 in women. As reported elsewhere in West Africa, the principal cancers in men were liver cancer (15%) and prostate cancer (15.8%), with modest rates of non-Hodgkin lymphoma (10.5%) and gastric cancer (4.5%). In women, breast cancer was the most frequent tumor (25.7%), followed by cervical cancer (24.0%) and non-Hodgkin lymphoma (7.3%). In contrast to other registry data from West Africa, Kaposi sarcoma occurs with moderate frequency (7.7% of cases reported in men and 2.1% in women). In the pediatric age group, relatively high incidence rates were found for Burkitt lymphoma. CONCLUSIONS Although there most likely is some underascertainment of cases, so that the actual incidence rates may be underestimated, the cancer profile should be a fair reflection of the true situation. In addition to tumors that are well known to be common in sub-Saharan Africa, such as cancers of the liver and cervix, this urban population shows some features of "Westernization" of cancer patterns, in particular the relatively high rates of breast cancer and prostate cancer. The effects of the acquired immunodeficiency syndrome epidemic are reflected in the moderate rates of Kaposi sarcoma reported.
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Abstract
BACKGROUND Head and neck cancers, among the 10 most frequent cancers in the world, are common in regions with a high prevalence of tobacco and alcohol habits. They account for one-fourth of male and one-tenth of female cancers in India. The authors report and discuss the survival from these cancers in Mumbai (Bombay), India. METHODS Follow-up information on 6311 head and neck cancer patients registered in the Bombay Population-Based Cancer Registry for the period 1987-1991 was obtained by a variety of methods, including matching with death certificates from the Bombay vital statistics registration system, postal/telephone enquiries, home visits, and scrutiny of medical records. The survival for each case was determined as the duration between the date of incidence and the date of death or date of loss to follow-up or the closing date of the study (December 31, 1996). Cumulative observed and relative survival were calculated by the Hakulinen method. For comparison of results with other populations, age-standardized relative survival (ASRS) was calculated by directly standardizing age specific relative survival to the specific age distributions of the estimated global incidence of major cancers in 1985. The log rank test was used in univariate analysis to identify the potentially important prognostic variables. The variables showing statistical significance in univariate analysis were introduced stepwise into a Cox regression model to identify the independent predictors of survival. RESULTS The 5-year relative survival rates were 74.5% for the lip, 42.7% for the anterior tongue, 25.5% for the posterior tongue, 45.1% for the mouth, 29.7% for the oropharynx, 38.7% for the nasopharynx, 29.1% for the hypopharynx, and 41.2% for the larynx. Age, marital status, religion, and site and clinical extent of disease emerged as independent predictors of survival. Age specific 5-year relative survival declined with advancing age. Single patients had a 20% excess risk of death compared with married patients. Those with cancers of the lip, mouth, nasopharynx, and larynx had a better prognosis than those with cancer at other sites. Those with regional spread of disease experienced a threefold increased risk of death, and those with distant metastasis experienced a sixfold excess risk. Less than one-fourth of cancers were localized in the organ of origin at diagnosis; 5-year survival for localized cancers ranged from 52.9% to 80.2% depending on the subsite. CONCLUSIONS There were significant variations in survival from cancer at individual sites within the head and neck region. Comparison with other populations revealed variations that seemed to be related to differences in detection and treatment. Tobacco and alcohol control measures and early detection linked with treatment are important measures to reduce mortality from head and neck cancer.
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Nguyen QM, Nguyen MQ, Nguyen HC, Nguyen CH, Kramárová E, Parkin DM. Incidence of childhood cancer in Ho Chi Minh City, Vietnam, 1995-97. Paediatr Perinat Epidemiol 2000; 14:240-7. [PMID: 10949216 DOI: 10.1046/j.1365-3016.2000.00272.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Incidence rates of childhood cancer for the city of Ho Chi Minh are presented for the first time. For the 3-year period 1995-97, a total of 302 cancer cases were registered in children under 15 years of age, with a male to female ratio of 1.1. The overall crude rate was 78.8 and the age-standardised incidence rate was 88.4 per million person-years, which was low in comparison with other countries in eastern Asia and with the predominantly white population of Australia. Leukaemia (principally acute lymphocytic), brain tumours and lymphomas were the most common childhood neoplasms, which is consistent with the pattern observed in other registries of the region. The rate of retinoblastoma was higher than in the other regional registries. On the other hand, no cases of hepatocellular carcinoma were registered.
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Hashibe M, Mathew B, Kuruvilla B, Thomas G, Sankaranarayanan R, Parkin DM, Zhang ZF. Chewing tobacco, alcohol, and the risk of erythroplakia. Cancer Epidemiol Biomarkers Prev 2000; 9:639-45. [PMID: 10919731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
Although chewing tobacco, smoking, and alcohol drinking have been suggested as risk factors for oral cancer, no study has examined the relationship between those factors and the risk of erythroplakia, an uncommon but severe oral premalignant lesion. In this study, we have analyzed the effects of chewing tobacco, smoking, alcohol drinking, body mass index, and vegetable, fruit, and vitamin/iron intake on the risk of erythroplakia and explored potential interactions between those factors in an Indian population. A case-control study including 100 erythroplakia cases and 47,773 controls was conducted, as part of an on-going randomized oral cancer screening trial in Kerala, India. The analysis was based on the data from the baseline screening for the intervention group, where the diagnostic information was available. The information on epidemiological risk factors was collected with interviews conducted by trained health workers. The erythroplakia cases were identified by health workers with oral visual inspections, and then confirmed by dentists and oncologists who made the final diagnosis. The odds ratios (OR) and their 95% confidence intervals (CIs) were calculated by the logistic regression model using SAS software. The adjusted OR for erythroplakia was 19.8 (95% CI, 9.8-40.0) for individuals who had ever chewed tobacco, after controlling for age, sex, education, body mass index, smoking, and drinking. The adjusted OR for ever-alcohol-drinkers was 3.0 (95% CI, 1.6-5.7) after controlling for age, sex, education, body mass index, chewing tobacco, and smoking. For ever-smokers, the adjusted OR was 1.6 (95% CI, 0.9-2.9). A more than additive interaction on the risk of erythroplakia was suggested between tobacco chewing and low vegetable intake, whereas a more than multiplicative interaction was indicated between alcohol drinking and low vegetable intake, and between drinking and low fruit intake. We concluded that tobacco chewing and alcohol drinking are strong risk factors for erythroplakia in the Indian population. Because the CIs of interaction terms were wide and overlapping with those of the main effects, only potential interactions are suggested.
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