Lung and breast cancer mortality among women in France: Future trends

Age-Period-Cohort Study of Breast Cancer Mortality in Brazil in State Capitals and in Non-Capital Municipalities from 1980 to 2019

Breast cancer was identified as the cancer with the highest mortality rate among women in Brazil. This study analyzed the effects of age, period and birth cohort on the breast cancer mortality rate for Brazilian women, comparing state capitals and non-capital municipalities. Population and deaths data were extracted from the Brazilian Unified Health System database for women aged 30 years or older, for the years between 1980 and 2019. The effects were analyzed using the age-period-cohort model. Age effect on breast cancer mortality is observed in the model through higher mortality rates at older ages. Period effect is similar in all regions in the form of a marked increase in the rate ratio (RR) in non-capital municipalities by period than in state capitals. The RR of birth cohorts in the state capitals remained stable (north, northeast and central-west regions) or decreased followed by an increase in the most recent cohorts (Brazil as a whole and the southeast and south regions). The RR for the other municipalities, however, showed a progressive increase in the cohorts for all regions. Policies and actions focused on breast cancer in women should consider these differences among Brazilian regions, state capitals and other municipalities.

Approaches to the problem of nonidentifiability in the age-period-cohort models in the analysis of cancer mortality: a scoping review

Aiming to detect age, period and cohort effects in cancer mortality, age-period-cohort models (APC) can be applied to distinguish these effects. The main difficulty with adjusting an APC model involving age, period and cohort factors is the linear relationship between them, leading to a condition known as the 'nonidentifiability problem'. Many methods have been developed by statisticians to solve it, but there is not a consensus. All these existing methods, with their advantages and disadvantages, create confusion when choosing which one of them should be implemented. In this context, the present scoping review intends not to show all methods developed to avoid the nonidentifiability problem on APC models but to show which of them are, in fact, applied in the literature, especially in the cancer mortality studies. A search strategy was made to identify evidence on MEDLINE (PubMed), Scopus, EMBASE, Science Direct and Web of Science. A total of 46 papers were analyzed. The main methods found were: Holford's method (n = 14; 30%), ntrinsic estimator (n = 10; 22%), Osmond & Gardner method n = 8; 17%), Carstensen (n = 6;13%), Bayesian approach (n = 6;13%) and others (n = 2; 5%). Even with their limitations, all methods have beneficial applications. However, the decision to use one or another method seemed to be more related to an observed geographic pattern.

Gender and Regional Differences in Lung Cancer Mortality in Brazil

Background and Objective:

This was a population-based ecological with data of deaths from the Mortality Information System. The objective of this study was to analyze the temporal trends of mortality induced by bronchi and lung cancer in Brazil and its geographical regions between 2001 and 2015 and secondly to calculate predictions for 2016-2030.

Material and Methods:

The mortality trends were analyzed by the Joinpoint regression and calculation of predictions was used the Nordpred software.

Results:

There was a reduction trend in lung cancer mortality among Brazilian men living in South and Southeast regions of Brazil. However, there was an increasing trend in lung cancer mortality among Brazilian women living in Northeast, Southeast, and South regions of Brazil. When comparing the last observed period and the last foreseen period for males, it is expected an increase of 12.86% in the number of deaths, justified mainly by the change in population structure, with a reduction in the risk of death by the disease. For women, the expected increase is 26.22%, justified both by population structure, and the increased risk of deaths from the disease. The higher rates will be observed in the southern region of the country, for both sexes.

Conclusion:

The mortality induced by lung and bronchial cancer in Brazil was unevenly distributed. However lung cancer incidence had a reducing trend, the mortality caused following it was increased among men. For women, the rates are rising, and until 2030, the mortality load will continue to rise for both.

Statistical projection methods for lung cancer incidence and mortality: a systematic review

OBJECTIVES

To identify and summarise all studies using statistical methods to project lung cancer incidence or mortality rates more than 5 years into the future.

STUDY TYPE

Systematic review.

METHODS

We performed a systematic literature search in multiple electronic databases to identify studies published from 1 January 1988 to 14 August 2018, which used statistical methods to project lung cancer incidence and/or mortality rates. Reference lists of relevant articles were checked for additional potentially relevant articles. We developed an organisational framework to classify methods into groups according to the type of data and the statistical models used. Included studies were critically appraised using prespecified criteria.

RESULTS

One hundred and one studies met the inclusion criteria; six studies used more than one statistical method. The number of studies reporting statistical projections for lung cancer increased substantially over time. Eighty-eight studies used projection methods, which did not incorporate data on smoking in the population, and 16 studies used a method which did incorporate data on smoking. Age-period-cohort models (44 studies) were the most commonly used methods, followed by other generalised linear models (35 studies). The majority of models were developed using observed rates for more than 10 years and used data that were considered to be good quality. A quarter of studies provided comparisons of fitted and observed rates. While validation by withholding the most recent observed data from the model and then comparing the projected and observed rates for the most recent period provides important information on the model's performance, only 12 studies reported doing this.

CONCLUSION

This systematic review provides an up-to-date summary of the statistical methods used in published lung cancer incidence or mortality projections. The assessment of the strengths of existing methods will help researchers to better apply and develop statistical methods for projecting lung cancer rates. Some of the common methods described in this review can be applied to the projection of rates for other cancer types or other non-infectious diseases.

Lung Cancer Mortality Trends in China from 1988 to 2013: New Challenges and Opportunities for the Government

Background: As lung cancer has shown a continuously increasing trend in many countries, it is essential to stay abreast of lung cancer mortality information and take informed actions with a theoretical basis derived from appropriate and practical statistical methods. Methods: Age-specific rates were collected by gender and region (urban/rural) and analysed with descriptive methods and age-period-cohort models to estimate the trends in lung cancer mortality in China from 1988 to 2013. Results: Descriptive analysis revealed that the age-specific mortality rates of lung cancer in rural residents increased markedly over the last three decades, and there was no obvious increase in urban residents. APC analysis showed that the lung cancer mortality rates significantly increased with age (20–84), rose slightly with the time period, and decreased with the cohort, except for the rural cohorts born during the early years (1909–1928). The trends in the patterns of the period and cohort effects showed marked disparities between the urban and rural residents. Conclusions: Lung cancer mortality remains serious and is likely to continue to rise in China. Some known measures are suggested to be decisive factors in mitigating lung cancer, such as environmental conservation, medical security, and tobacco control, which should be implemented more vigorously over the long term in China, especially in rural areas.

Inhibition of livin expression suppresses cell proliferation and enhances chemosensitivity to cisplatin in human lung adenocarcinoma cells

Livin is a novel member of the inhibitor of apoptosis protein family that has been reported to be overexpressed in various types of human malignancy. Although several studies have demonstrated that livin may be used as an effective target for tumor therapy, few studies have investigated its role in human lung adenocarcinoma. In the present study, two different methods were used in order to investigate the tumor‑suppressing effect of livin in human lung adenocarcinoma cells. Firstly, small interfering (si)RNA technology was used to down regulate livin expression; siRNA-mediated knockdown of livin was confirmed using reverse transcription quantitative polymerase chain reaction and western blot analysis, and cell proliferations was assessed using an MTT assay in vitro. Secondly, inhibition of livin expression was induced through the synergistic inhibitory effect between flavopiridol and tumor necrosis factor‑related apoptosis-inducing ligand (TRAIL). Experimental results revealed that, following transfection of the livin gene-silencing vector, the gene expression of livin was markedly decreased, SPC-A1 cell proliferation was significantly reduced and the therapeutic effect of the chemotherapy drug cisplatin was markedly improved. This growth inhibitory effect was also observed in the flavopiridol and TRAIL combination treatment group. In the flavopiridol and TRAIL combination treatment group, the protein expression of livin was significantly reduced and the survival rate of SPC‑A1 cells was significantly lower than the flavopiridol and TRAIL single operation group. In conclusion, the RNA silencing and the synergistic inhibitory effect between flavopiridol with TRAIL was able to effectively inhibit the expression of livin, significantly decrease SPC-A1 tumor cell proliferation and significantly enhance sensitivity to the chemotherapy drug cisplatin. These findings suggest that livin may be used as a novel target for tumor gene therapy.

Estrogen receptor beta and CXCR4/CXCL12 expression: differences by sex and hormonal status in lung adenocarcinoma

BACKGROUND AND AIMS

Studies have reported differences in lung cancer behavior between sex and hormonal status that suggest a role of estrogens and estrogen receptor beta (ERβ) in lung carcinogenesis. In some types of hormone-dependent cancer, estrogens may regulate CXCL12/CXCR4 expression through ERβ signaling. High expression of CXCL12/CXCR4 is associated with poor prognosis in lung cancer because it promotes tumor growth and metastasis. Therefore, in this study we investigated whether lung adenocarcinoma tissues from pre- and postmenopausal women and from men exhibit different ERβ, CXCR4/CXCL12 expression and whether this expression is associated with clinicopathological features.

METHODS

Sixty primary tumor samples of lung adenocarcinoma from pre- and postmenopausal women and from men were collected for this study. Thirty samples of healthy lung tissue adjacent to the tumor site were used as controls. ERβ and CXCL12/CXCR4 expression was analyzed by immunohistochemistry. Expression of these proteins was measured by digital image software and compared between sex and hormonal status.

RESULTS

Lung adenocarcinomas overexpressed ERβ, CXCR4 and CXCL12 compared to normal lung. Moreover, lung adenocarcinomas from premenopausal women exhibited higher signals for ERβ, CXCL12 and CXCR4 compared to postmenopausal women and to men, who showed lower signals for these proteins. A multivariate analysis revealed a strong association between the immunoreactivity level of ERβ, CXCL12/CXCR4 and both sex and hormonal status, but not with tumor stage and smoking.

CONCLUSION

These results demonstrated that ERβ and CXCL12/CXCR4 expression in lung adenocarcinoma depends on sex and hormonal status, which may partly explain the sex and hormonal differences in lung cancer behavior.