Mortality from major cancer sites in the European Union, 1955-1998

Pharmacoeconomic Comparison between Chronochemotherapy and Folfox Regimen in the Treatment of Patients with Metastatic Colorectal Cancer: A Cost-Minimization Study

Aims and background

The addition of oxaliplatin to the widely employed De Gramont schedule (FOLFOX regimen) in patients with metastatic colorectal cancer improved their outcome with a moderate toxicity pattern. The adaptation of the delivery rate of 5-fluorouracil, leucovorin and oxaliplatin to circadian rhythms (chronotherapy) resulted in a very high drug tolerability with clinical results at least comparable to those achieved with the FOLFOX regimen. However, chronomodulated infusion seemed to be more expensive, requiring dedicated electronic pumps and several disposable materials. The present study aimed to compare the direct costs of the two regimens and to determine whether chronotherapy was effectively more expensive than the FOLFOX regimen.

Study design

The direct costs of drug delivery devices derived from various publicly available sources and of toxicity management as extrapolated from two published studies considering comparable patient subsets were added and compared.

Results

Pump, central venous system and disposable materials for a single chronotherapy cycle were € 193 or € 212 according to whether the pumps were bought or rented, compared to € 58 for the FOLFOX regimen. Toxicity management costs were € 144 vs € 288 for the two schemes, respectively. Globally, a single course of chronotherapy cost € 337 or € 356, whereas a single FOLFOX cycle cost € 346.

Conclusions

Direct costs for a single chronotherapy cycle appeared to be comparable to a single course of the FOLFOX regimen. In fact, the major material cost of chronochemotherapy devices was balanced by a better tolerability profile. The overall improvement in quality of life with chronochemotherapy affecting indirect costs, such as reduction of work, and intangible costs is worthy of further pharmacoeconomic attention.

A Systematic Review of the Burden of Pancreatic Cancer in Europe: Real-World Impact on Survival, Quality of Life and Costs

PURPOSE

The purpose of this study was to assess the overall burden of pancreatic cancer in Europe, with a focus on survival time in a real-world setting, and the overall healthy life lost to the disease.

METHODS

Real-world data were retrieved from peer-reviewed, observational studies identified by an electronic search. We performed two de novo analyses: a proportional shortfall analysis to quantify the proportion of healthy life lost to pancreatic cancer and an estimation of the aggregate life-years lost annually in Europe.

RESULTS

Ninety-one studies were included. The median, age-standardised incidence of pancreatic cancer per 100,000 was 7.6 in men and 4.9 in women. Overall median survival from diagnosis was 4.6 months; median survival was 2.8-5.7 months in patients with metastatic disease. The proportional shortfall analysis showed that pancreatic cancer results in a 98 % loss of healthy life, with a life expectancy at diagnosis of 4.6 months compared to 15.1 years for an age-matched healthy population. Annually, 610,000-915,000 quality-adjusted life-years (QALYs) are lost to pancreatic cancer in Europe. Patients had significantly lower scores on validated health-related quality of life instruments versus population norms.

CONCLUSIONS

To the best of our knowledge, this is the first study to systematically review real-world overall survival and patient outcomes of pancreatic cancer patients in Europe outside the context of clinical trials. Our findings confirm the poor prognosis and short survival reported by national studies. Pancreatic cancer is a substantial burden in Europe, with nearly a million aggregate life-years lost annually and almost complete loss of healthy life in affected individuals.

The burden of premature mortality in Poland analysed with the use of standard expected years of life lost

Background

Despite positive changes in the health of the population of Poland, compared to the EU average, the average life expectancy in 2011 was 5 years shorter for males and 2.2 years shorter for females. The immediate cause is the great number of premature deaths, which results in years of life lost in the population. The aim of the study was to identify the major causes of years of life lost in Poland.

Methods

The analysis was based on a database of the Central Statistical Office of Poland, containing information gathered from 375,501 death certificates of inhabitants of Poland who died in 2011. The SEYLL_p (Standard Expected Years of Life Lost per living person) and the SEYLL_d (SEYLL per death) measures were calculated to determine years of life lost.

Results

In 2011, the total number of years of life lost by in Polish residents due to premature mortality was 2,249,213 (1,415,672 for males and 833,541 for females). The greatest number of years of life lost in males were due to ischemic heart disease (7.8 per 1,000), lung cancer (6.0), suicides (6.6), cerebrovascular disease (4.6) and road traffic accidents (5.4). In females, the factors contributing to the greatest number of deaths were cerebrovascular disease (3.8 per 1,000), ischemic heart disease (3.7), heart failure (2.7), lung cancer (2.5) and breast cancer (2.3). Regarding the individual scores per person in both males and females, the greatest death factors were road traffic accidents (20.2 years in males and 17.1 in females), suicides (17.4 years in males and 15.4 in females) and liver cirrhosis (12.1 years in males and 11.3 in females).

Conclusions

It would be most beneficial to further reduce the number of deaths due to cardiovascular diseases, because they contribute to the greatest number of years of life lost. Moreover, from the economic point of view, the most effective preventative activities are those which target causes which result in a large number of years of life lost at productive age for each death due to a particular reason, i.e. road traffic accidents, suicides and liver cirrhosis.

Years of life lost due to malignant neoplasms characterized by the highest mortality rate

INTRODUCTION

The analysis of premature deaths measured with years of life lost between the studied and referential populations helps to emphasize the social and economic aspect of a loss caused by deaths due to malignant neoplasms. The aim of the study was to analyze years of life lost by inhabitants of the Lodz province due to malignant neoplasms.

MATERIAL AND METHODS

The study material included a database which contained information gathered from 313,144 death certificates (including 66,899 people who died of malignant neoplasms) of inhabitants of the Lodz province who died between 1999 and 2008. The SEYLLp (Standard Expected Years of Life Lost per living person) method was used to determine years of life lost. Jointpoint models were used to analyze time trends.

RESULTS

In males the diseases which mostly contributed to death were tracheal, bronchial and lung malignant neoplasms (SEYLLp = 170.7) and cancer of the large intestine, rectum and anus (SEYLLp = 47.5). In females the principal diseases were tracheal, bronchial and lung malignant neoplasms (SEYLLp = 61.6), breast cancer (SEYLLp = 60.4) and cancer of the large intestine, rectum and anus (SEYLLp = 42.3). The years of life lost were growing in the period under study.

CONCLUSIONS

The number of years lost due to malignant neoplasms in the Lodz province between 1999 and 2008 was growing. The main reasons for deaths in females were tracheal, bronchial and lung malignant neoplasms as well as breast cancer and in males - cancer of the large intestine, rectum and anus as well as prostate cancer.

Trends in death attributed to myocardial infarction, heart failure and pulmonary embolism in Europe and Canada over the last decade

BACKGROUND

Worldwide, cardiovascular diseases and cancer account for ∼40% of deaths. Certain reports have shown a progressive decrease in mortality. Our main objective was to assess mortality trends related to myocardial infarction (MI), heart failure (HF) and pulmonary embolism (PE).

METHODS

MI, HF and PE were studied as cause of death based on the analysis of death certificates in Canada (C), England and Wales (E), France (F) and Sweden (S). We also used a multiple cause approach. Age-standardized death rates (SDR) were calculated.

RESULTS

The SDR for MI, HF or PE as the underlying cause of death, all decreased during the last decade. The decrease in SDR secondary to MI exceeded that for HF or PE. Concerning multiple cause of death, a greater decrease was also found for MI, compared with HF or PE.

CONCLUSIONS

We confirm the beneficial trends in SDR with MI, HF or PE both as underlying or multiple causes in the studied countries. For HF and PE, multiple cause approach seems more accurate to describe the burden of these two pathologies. Our study also suggests that more efforts should be dedicated to HF and PE in order to achieve similar trends than in MI.

Radiosensitization by a novel Bcl-2 and Bcl-XL inhibitor S44563 in small-cell lung cancer

Radiotherapy has a critical role in the treatment of small-cell lung cancer (SCLC). The effectiveness of radiation in SCLC remains limited as resistance results from defects in apoptosis. In the current study, we investigated whether using the Bcl-2/Bcl-XL inhibitor S44563 can enhance radiosensitivity of SCLC cells in vitro and in vivo. In vitro studies confirmed that S44563 caused SCLC cells to acquire hallmarks of apoptosis. S44563 markedly enhanced the sensitivity of SCLC cells to radiation, as determined by a clonogenic assay. The combination of S44563 and cisplatin-based chemo-radiation showed a significant tumor growth delay and increased overall survival in mouse xenograft models. This positive interaction was greater when S44563 was given after the completion of the radiation, which might be explained by the radiation-induced overexpression of anti-apoptotic proteins secondary to activation of the NF-κB pathway. These data underline the possibility of combining IR and Bcl-2/Bcl-XL inhibition in the treatment of SCLC as they underscore the importance of administering conventional and targeted therapies in an optimal sequence.

Current status of lung cancer screening

Low-dose CT (LDCT) is effective in the early detection of lung cancer, providing higher resectability and long-term survival rates. The National Lung Screening Trial shows a statistically significant mortality reduction in LDCT compared with chest radiography. The efficacy and safety of annual LDCT screening in heavy smokers must be explored, and the magnitude of benefit compared with the cost of large-scale screening. Trials in Europe have different study designs and an observational arm. Strategies to reduce lung cancer mortality should combine early detection with primary prevention and innovative biologic approaches.

Social sciences for food and health research

Healthier eating is a global challenge for chronic disease control. Food and Health Research in Europe (FAHRE) surveyed research structures and programmes in 32 countries, and reviewed research needs and gaps across nine themes. Food processing and safety research, nutrition and molecular research, and disease-based clinical research are strong; but research is weak on determinants of disease and healthier eating through policies and changing behaviours. Biomedical and commercial research for patents contrast with social research for the public interest. More funding and capacity support should go to social research in the food and health sector.

A massive lesion detection algorithm in mammography

A new algorithm for massive lesion detection in mammography is presented. The algorithm consists in three main steps: 1) reduction of the dimension of the image to be processed through the identification of regions of interest (roi) as candidates for massive lesions; 2) characterization of the RoI by means of suitable feature extraction; 3) pattern classification through supervised neural networks. Suspect regions are detected by searching for local maxima of the pixel grey level intensity. A ring of increasing radius, centered on a maximum, is considered until the mean intensity in the ring decreases to a defined fraction of the maximum. The ROIS thus obtained are described by average, variance, skewness and kurtosis of the intensity distributions at different fractions of the radius. A neural network approach is adopted to classify suspect pathological and healthy pattern. The software has been designed in the framework of the INFN (Istituto Nazionale Fisica Nucleare) research project GPCALMA (Grid Platform for Calma) which recruits physicists and radiologists from different Italian Research Institutions and hospitals to develop software for breast cancer detection.

Comparative analysis of the efficacy and safety of chemotherapy with oxaliplatin plus fluorouracil/leucovorin between elderly patients over 65 years and younger patients with advanced gastric cancer

BACKGROUND

A chemotherapy regimen with oxaliplatin, fluorouracil, and leucovorin is commonly used to treat advanced gastric cancer (AGC). This study was designed to compare the efficacy and the safety of oxaliplatin plus fluorouracil/leucovorin administered biweekly (mFOLFOX6) between elderly patients aged over 65 years and younger counterparts with AGC.

METHODS

This analysis included 82 AGC patients (≥65:31, <65:51). Patients with previously untreated chemo-naïve advanced adenocarcinoma of the stomach received oxaliplatin 85 mg/m(2), 5-FU bolus 400 mg/m(2) on day 1 and 5-FU 1,500 mg/m(2), leucovorin 75 mg/m(2) 22 h infusion on days 1 and 2 every 2 weeks. The aim of the study was to compare efficacy and safety, including response rate (RR), progression-free survival (PFS), overall survival, and grade ≥3 adverse events, between patients aged ≥65 years and patients aged <65 years.

RESULTS

Median progression-free survival (PFS) was not significantly different between both groups (≥65: 5.8 months, <65: 5.7 months, respectively, HR 0.77, 95% CI: 0.44-1.16, P = 0.18). Median overall survival was not significantly different between both groups (≥65: 10.3 months, <65: 9.5 months HR 0.83, 95% CI: 0.50-1.37, P = 0.46). The rate of grade 3 or 4 neutropenia did not differ with age group (≥65: 51.6%, <65: 43.1%); nor did the rates of neutropenic fever (≥65: 16.1%, <65: 5.9%), and infection without neutropenia (≥65: 3.2%, <65: 3.9%). Rates of grade ≥3 toxicities such as thrombocytopenia, nausea/vomiting, or peripheral neuropathy were not significantly different between the two groups.

CONCLUSIONS

mFOLFOX6 maintains its efficacy and safety in elderly patients aged over 65 years in comparison with AGC patients aged <65 years. Its judicious use should be considered regardless of age.

Lung cancer screening

Lung cancer is the primary cause of cancer mortality in developed countries. First diagnosis only when disease has already reached the metastatic phase is the main reason for failure in treatment. To this regard, although low-dose spiral computed tomography (CT) has proven to be effective in the early detection of lung cancer (providing both higher resectability and higher long-term survival rates), the capacity of annual CT screening to reduce lung cancer mortality in heavy smokers has yet to be demonstrated. Numerous ongoing large-scale randomised trials are under way in high-risk individuals with different study designs. The initial results should be available within the next 2 years.

MAGE-A antigens in lesions of the oral mucosa

Oral squamous cell carcinoma develops continuously out of predamaged oral mucosa. For the physician and pathologist, difficulties arise in distinguishing precancerous from cancerous lesions. MAGE-A antigens are tumor antigens that are found solely in malignant transformed cells. These antigens might be useful in distinguishing precancerous from cancerous lesions. The aim of this study was to verify this assumption by comparing MAGE-A expression in benign, precancerous, and cancerous lesions of the oral mucosa. Retrospectively, biopsies of different oral lesions were randomly selected. The lesions that were included are 64 benign oral lesions (25 traumatic lesions (oral ulcers), 13 dental follicles, and 26 epulis), 26 oral lichen planus, 123 epithelial precursor lesions (32 epithelial hyperplasia found in leukoplakias, 24 epithelial dysplasia found in leukoplakias, 26 erythroplasia with oral epithelial dysplasia, and 41 carcinomas in situ in erythroleukoplakias). The lesions were immunohistochemically stained with the poly-MAGE-A antibody 57B, and the results were compared. Biopsies of oral lichen planus, oral ulcers, dental follicles, epulis, and leukoplakia without dysplasia showed no positive staining for MAGE-A antigens. Leukoplakia with dysplasia, dysplasia, and carcinomata in situ displayed positive staining in 33%, 65%, and 56% of the cases, respectively. MAGE-A antigens were not detectable via immunohistochemistry in benign lesions of the oral mucosa. The staining rate of dysplastic precancerous lesions or malignant lesions ranged from 33% to 65%. The MAGE-A antigens might facilitate better differentiation between precancerous and cancerous lesions of the oral mucosa.

Factors predicting outcome for advanced gastroesophageal cancer in elderly patients receiving palliative chemotherapy

AIMS

Most patients with advanced gastroesophageal cancer are elderly, but current standard regimens have emerged from trials predominantly involving patients with a median age <65 years. The aim of this study was to assess the factors influencing survival outcome for an elderly gastroesophageal cancer non-trial population.

MATERIALS AND METHODS

We reviewed the case notes of all patients in our centre over the age of 65 years who received palliative chemotherapy for gastroesophageal cancer over a period of 3.5 years. Patients were classified as having received standard, non-standard combination or single-agent chemotherapy. After an initial univariate analysis, a multivariate analysis of the most significant prognostic factors was carried out.

RESULTS

In total, 120 patients were suitable for analysis. The median overall survival for patients receiving standard chemotherapy was 8.1 months, non-standard combination 8.3 months and single-agent fluoropyrimidines 3.9 months. Poor prognosis was predicted by two independent factors: poor performance status (hazard ratio 2.402; 95% confidence interval 1.53-3.77, P<0.001) and the presence of cancer symptoms (hazard ratio 2.235; 95% confidence interval 1.32-3.79, P=0.003).

CONCLUSIONS

An assessment of the performance status and the level of symptoms is vital in this vulnerable group of patients. Prospective randomised trials to assess the benefit of chemotherapy in elderly patients with gastroesophageal cancer are required.

Applicability of the Gail model for breast cancer risk assessment in Turkish female population and evaluation of breastfeeding as a risk factor

The Gail model is considered the best available means for estimating risk of breast cancer development, but it has not yet been applied systematically and validated in Turkish female population. This study was designed to evaluate the performance of the Gail model for Turkish female population. Additionally duration of breastfeeding was examined as a possible risk factor. Our analysis included 650 patients with invasive breast carcinoma (group 1) and 640 women with negative results who had undergone a screening mammography on visiting a mammary care unit (group 2). Two groups were compared with regard to individual risk factors included in the Gail model and also duration of breastfeeding. The Gail model was used to predict 5-year risk for each woman. Age and first live birth > or =30 years were associated with an increased relative risk for breast cancer development. Age at menarche, previous breast biopsy, atypical hyperplasia, and number of first degree relatives with breast cancer were found to be non-significant. The Gail model showed 13.3% sensitivity and 92% specificity in estimating the risk of breast cancer development in Turkish women. Positive predictive value was 63%, negative predictive value was 51.9%, and validity index was 53.1%. Duration of breastfeeding was significantly longer in group 1 than 2 (median 17 vs. 13 months). The proportion of parous women with no breastfed was higher in group 1 than 2. The currently used Gail model does not seem to be an appropriate breast cancer risk assessment tool for Turkish female population.

Analysis of oral cancer epidemiology in the US reveals state-specific trends: implications for oral cancer prevention

Background

Downward trends have been observed in oral cancer incidence and mortality in the US over the past 30 years; however, these declines are not uniform within this population. Several studies have now demonstrated an increase in the incidence and mortality from oral cancers among certain demographic groups, which may have resulted from increased risks or risk behaviors. This study examines the underlying data that comprise these trends, to identify specific populations that may be at greater risk for morbidity and mortality from oral cancers.

Methods

Oral cancer incidence and mortality data analyzed for this study were generated using the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) program.

Results

While oral cancer incidence and mortality rates have been declining over the past thirty years, these declines have reversed in the past five years among some demographic groups, including black females and white males. Sorting of these data by state revealed that eight states exhibited increasing rates of oral cancer deaths, Nevada, North Carolina, Iowa, Ohio, Maine, Idaho, North Dakota, and Wyoming, in stark contrast to the national downward trend. Furthermore, a detailed analysis of data from these states revealed increasing rates of oral cancer among older white males, also contrary to the overall trends observed at the national level.

Conclusion

These results signify that, despite the declining long-term trends in oral cancer incidence and mortality nationally, localized geographic areas exist where the incidence and mortality from oral cancers have been increasing. These areas represent sites where public health education and prevention efforts may be focused to target these specific populations in an effort to improve health outcomes and reduce disparities within these populations.

Risk factors for 30-day mortality after resection of lung cancer and prediction of their magnitude

BACKGROUND

There is considerable variability in reported postoperative mortality and risk factors for mortality after surgery for lung cancer. Population-based data provide unbiased estimates and may aid in treatment selection.

METHODS

All patients diagnosed with lung cancer in Norway from 1993 to the end of 2005 were reported to the Cancer Registry of Norway (n = 26 665). A total of 4395 patients underwent surgical resection and were included in the analysis. Data on demographics, tumour characteristics and treatment were registered. A subset of 1844 patients was scored according to the Charlson co-morbidity index. Potential factors influencing 30-day mortality were analysed by logistic regression.

RESULTS

The overall postoperative mortality rate was 4.4% within 30 days with a declining trend in the period. Male sex (OR 1.76), older age (OR 3.38 for age band 70-79 years), right-sided tumours (OR 1.73) and extensive procedures (OR 4.54 for pneumonectomy) were identified as risk factors for postoperative mortality in multivariate analysis. Postoperative mortality at high-volume hospitals (> or = 20 procedures/year) was lower (OR 0.76, p = 0.076). Adjusted ORs for postoperative mortality at individual hospitals ranged from 0.32 to 2.28. The Charlson co-morbidity index was identified as an independent risk factor for postoperative mortality (p = 0.017). A prediction model for postoperative mortality is presented.

CONCLUSIONS

Even though improvements in postoperative mortality have been observed in recent years, these findings indicate a further potential to optimise the surgical treatment of lung cancer. Hospital treatment results varied but a significant volume effect was not observed. Prognostic models may identify patients requiring intensive postoperative care.

Cancer mortality trends in the Umbria region of Italy 1978-2004: a joinpoint regression analysis

BACKGROUND

The aim of the present paper was to analyse cancer mortality in the Umbria region, from 1978 to 2004. Mortality trends depend on a number of factors including exposures, health system interventions, and possibly artefact (e.g. classification change, variations of data completeness). Descriptive data on mortality only allow for generation of hypotheses to explain observed trends. Some clues on the respective role of possible mortality determinants may be found comparing mortality with incidence and survival data.

METHODS

Mortality data for the periods 1978-1993 and 1994-2004 were supplied by the National Institute of Statistics (ISTAT) and the Regional Causes of Death Registry (ReNCaM) respectively. Sex and site-specific mortality time trends were analysed by the "joinpoint regression" method.

RESULTS

For all sites combined, in both sexes, the standardised rate was first increasing before the end of the eighties and decreasing thereafter. Gastric cancer mortality showed a different trend by gender; that is the rate constantly decreased over the period among females while, for males, it was first increasing up to 1985 and decreasing thereafter. Liver cancer trend showed a pattern similar to gastric cancer. Large bowel cancer showed a gender specific trend, that is it was increasing among males and stable among females. Also lung cancer mortality varied by gender: it started to decline after 1989 among males but was steadily increasing over the study period among women. A decreasing trend for female breast cancer mortality began in 1994. Prostate cancer mortality trend is the only one showing two significant joinpoints: mortality decreased up to 1990, then it increased up to 1998 and, finally, was decreasing.

CONCLUSION

Overall cancer mortality was decreasing in both sexes in Umbria and this favourable trend will probably continue and further improve since population screening against breast, cervix, and large bowel cancers were recently introduced. Besides gastric cancer, tobacco-related cancers and prostate cancer mainly contributed to mortality reduction in males, whereas breast cancer mainly contributed to declining mortality in females.

Cancer mortality, recent trends and perspectives

Considering that a register for cancer was established in Federation of Bosnia and Herzegovina only recently, basic reliable source for the analysis of cancer mortality trends are the data on death cases caused by such diseases. Lack of census as well as standardized mortality rate data makes the study even more difficult to make. The aim of the study is the analysis of the malign diseases trend in the post-war period according to the available data. The study is the descriptive work on the analysis of the system using linear regression methods for expected trend for the total population and age group from 0 to 64 years. Registered rate of cancer mortality in Federation of Bosnia and Herzegovina in 2004 was 142 per 100000 inhabitants, and indicates input stream in the analyzed period. Total increase in mortality of males and females is 2.5% per year. It is expected that in 2020 around 5000 inhabitants of Federation of Bosnia and Herzegovina will die of some malign disease. Trend of mortality of malign diseases in males is higher than in females and more probable in older population. There is a tendency of mortality decrease in the group of 0-64 years of age. Mortality list of the most frequent locations of cancer has undergone changes. Liver cancer, colon cancer, sigma and rectum cancer as well as lung and breast cancer lead the list. Objective ageing of the population, technological drawbacks, insufficient primary and secondary prevention worsened by socio-economic life conditions will affect the increase in number of people with malign diseases in Bosnia and Herzegovina.

Gender aspects of treatment and drug related toxicity in medical oncology

The whole field of Oncology benefits from the huge amount of basic science "invested" and from the experience accumulated during several decades that enables more patients with malignant diseases to be cured or to survive for longer periods. Incidence and mortality rates from cancer have been decreasing by around 1 % per year since the mid-nineties of the past century in the European Union. However, the spectrum of malignant diseases and the outcome is not equally distributed between the two sexes. Startlingly, in advanced cancers, women receiving the same treatment schemes as men fare better. Until recently, however, the pharmacological knowledge of the pharmacokinetic and pharmacodynamic action of cytotoxic drugs was scarce for women, as like in other fields of medicine, studies recruited far more men than women and because results were often not reported separately for both sexes. These practices are slowly changing and gender specific outcome data are progressively accumulating. Such data on gender-specific differences or similarities are essential for building newer, more adequate tools for dosing drugs than the current form based on a "falsely accurate and individualzed" estimation of the body surface area. Nevertheless, the socioeconomical and sociocultural context of living remains genderspecifically different, influencing the coping of individuals with a life-threatening disease. On the other hand, as recently shown for chronic lymphocytic leukaemia, gender-specific analysis might open new insights in the biology of the disease and modify treatment strategies.

A comparison of the diagnostic performance of systematic versus ultrasound-guided biopsies of prostate cancer

Transrectal ultrasound (TRUS) is an important tool for urologists and radiologists in the detection of prostate cancer. Various TRUS-guided biopsy techniques are applied in clinical practice. Frequently, only the detection rates achieved with these methods are compared. Other diagnostic performance parameters, particularly the specificity and negative predictive value, are seldom compared. After extensive assessment of the available literature, this review describes the methods of TRUS-guided biopsy for prostate cancer detection. A distinction was made between systematic biopsies and biopsies that target a perceived (hypoechoic or Doppler-enhancing) lesion on imaging. Subsequently, the diagnostic performance (sensitivity, specificity, positive and negative predictive values, accuracies) was compared between these techniques. Imaging-guided biopsy showed better diagnostic performance than systematic biopsy with higher sensitivity. The combinations of sensitivity and specificity were highest for colour Doppler and contrast-enhanced targeted biopsy. Studies targeting hypoechoic lesions had relatively high sensitivity, but specificity was low. Presently however, with widespread prostate-specific antigen screening, fewer prostate cancers are hypoechoic, and the value of targeting hypoechoic lesions has diminished. Performing colour or contrast-enhanced Doppler biopsy or adding these techniques to systematic biopsies improves diagnostic performance, particularly by increasing sensitivity.

Breast cancer risk assessment in the Czech female population--an adjustment of the original Gail model

BACKGROUND

Several mathematical models have been developed for predicting individual breast cancer risk. Such models can help clinicians to choose appropriate preventive and therapeutic interventions for each patient. Unfortunately, the validity of these models has not been tested outside the USA.

METHODS

The authors describe a case-control study in the Czech Republic with a similar design to that of the US Breast Cancer Detection and Demonstration Project (BCDDP). The main objective of the study was to evaluate the validity of the Gail model in the Czech female population, and to develop a local model using the same statistical approach as the Gail model. Between November 2000 and May 2004, 14,566 questionnaires containing case history data from both healthy women (control group) and women with breast cancer were collected. Case-control age-matched pairs (n = 4598) have subsequently been matched and analyzed.

RESULTS

Our results show that the original Gail model was not able to properly distinguish between controls and breast cancer cases in the Czech female population. Based on paired data, the mean 5-year and life-time breast cancer risk was 1.379 +/- 0.668 and 7.990 +/- 3.184 in the control group and 1.375 +/- 0.692 and 8.028 +/- 3.506 in the patients with breast cancer group. The original Gail model was also not able to properly describe age-specific baseline risk of breast cancer development in the Czech population. In response the authors developed two variants of modified/locally adjusted models.

CONCLUSION

The original Gail model is not an accurate breast cancer risk assessment tool for the Czech female population.

Trends in cancer mortality in the European Union and accession countries, 1980-2000

Cancer mortality rates and trends over the period 1980-2000 for accession countries to the European Union (EU) in May 2004, which include a total of 75 million inhabitants, were abstracted from the World Health Organization (WHO) database, together with, for comparative purposes, those of the current EU. Total cancer mortality for men was 166/100,000 in the EU, but ranged between 195 (Lithuania) and 269/100,000 (Hungary) in central and eastern European accession countries. This excess related to most cancer sites, including lung and other tobacco-related neoplasms, but also stomach, intestines and liver, and a few neoplasms amenable to treatment, such as testis, Hodgkin's disease and leukaemias. Overall cancer mortality for women was 95/100,000 in the EU, and ranged between 100 and 110/100,000 in several central and eastern European countries, and up to 120/100,000 in the Czech Republic and 138/100,000 in Hungary. The latter two countries had a substantial excess in female mortality for lung cancer, but also for several other sites. Furthermore, for stomach and especially (cervix) uteri, female rates were substantially higher in central and eastern European accession countries. Over the last two decades, trends in mortality were systematically less favourable in accession countries than in the EU. Most of the unfavourable patterns and trends in cancer mortality in accession countries are due to recognised, and hence potentially avoidable, causes of cancer, including tobacco, alcohol, dietary habits, pollution and hepatitis B, plus inadequate screening, diagnosis and treatment. Consequently, the application of available knowledge on cancer prevention, diagnosis and treatment may substantially reduce the disadvantage now registered in the cancer mortality of central and eastern European accession countries.

Trends in mortality from major cancers in the European Union, including acceding countries, in 2004

BACKGROUND

In May 2004, 10 additional countries joined the European Union (EU), including a total of 75 million inhabitants. Most of these were from central and eastern European countries with comparably high cancer mortality rates and with relatively unfavorable trends. Therefore, it is important to provide updated mortality data regarding major cancers in various countries and to analyze trends for the current population of the EU.

METHODS

The authors considered mortality rates (directly standardized to the world standard population) for all cancers and for 8 major cancer sites in the year 2000 in the 25 countries of the EU and analyzed corresponding trends since 1980 using data derived from the World Health Organization data base.

RESULTS

For men, overall cancer mortality in the year 2000 varied by a factor > 2 between the highest rate of 258.5 per 100,000 men in Hungary and the lowest rate of 122.0 per 100,000 men in Sweden. Central and Eastern European accession countries had the highest rates not only for lung and other tobacco-related cancers but also for gastrointestinal cancers and leukemias. The geographic pattern was different and the range of variation was smaller for women, i.e., between 136.7 per 100,000 women in Denmark and 76.4 per 100,000 women in Spain in the year 2000. In the EU as a whole, lung cancer mortality in men peaked at 55.4 per 100,000 men in 1988 and declined thereafter to 46.7 per 100,000 men in 2000. Gastric cancer steadily declined from 19.7 per 100,000 men in 1980 to 10.1 per 100,000 men in 2000. Other major sites showed moderately favorable trends over the last few years. In women, breast cancer peaked at 21.7 per 100,000 in 1989 and declined to 18.9 per 100,000 in 2000. Mortality from gastric, (cervix) uterus, and intestinal cancers demonstrated steady decreases, but lung cancer increased from 7.7 per 100,000 women in 1980 to 11.1 per 100,000 women in 2000. The increase in lung cancer mortality in women age < 55 years was 38% between 1990 and 2000 (from 2.16 per 100,000 women to 2.99 per 100,000 women), reflecting the spread of tobacco smoking among women in the EU over the last few decades.

CONCLUSIONS

The priority for further reduction of cancer mortality in the EU remains tobacco control together with more widespread availability of modern diagnostic and treatment procedures for neoplasms that are amenable to treatment.

Mediterranean diet and cancer risk

Various aspects of the Mediterranean diet are considered favourable with regard to cancer risk. These aspects were analysed using data from a series of case-control studies conducted in northern Italy between 1983 and 2001 on over 12,000 cases of 20 cancer sites and 10,000 controls. For most epithelial cancers, the risk decreased with increasing vegetable and fruit consumption, with odds ratios (OR) between 0.3 and 0.7 for the highest versus the lowest tertile. Subjects reporting frequent red meat intake showed ORs above unity for several common neoplasms. Conversely, fish (and consequently, n-3 fatty acids) tended to be another favourable dietary indicator. Wholegrain food intake was related to reduced risk of several types of cancer, particularly of the upper digestive tract, probably on account of its high fibre content. Fibres were in fact found to be protective with regard to colorectal and other selected cancers. In contrast to wholegrain, refined grain intake, and consequently glycaemic load, was associated with an increased risk of different types of cancer, including those of the upper digestive tract, colorectum, breast and endometrium. These results thus suggest that a low-risk diet for cancer entails increasing vegetables and fruit, reducing meat, but also refined carbohydrate consumption. Furthermore, olive oil and other unsaturated fats, which may be a unique common characteristic of the Mediterranean diet, should be preferred to animal and saturated fats. A score summarizing the major characteristics of the Mediterranean diet was inversely and consistently related to the risk of selected cancer sites. Regular consumption of pizza, one of the most typical Italian foods, showed a reduced risk of digestive tract cancers. Pizza could however simply be an indicator of a typical Italian diet.

Population-based incidence and mortality cancer trends (1986–1997) from the network of Italian cancer registries

The objective of this study was to analyse incidence and mortality cancer trends in the Italian Network of Cancer Registries (about 8,000,000 inhabitants) during the period 1986-1997. Included were 525,645 newly diagnosed cancers and 269,902 cancer deaths (subjects > 14 years). Joinpoints (points in time where trend significantly changes from linearity) were found and estimated annual percentage changes (EAPC) used to summarize tendencies. Overall cancer incidence increased in both sexes and cancer mortality significantly decreased (since 1991 among men). Lung cancer showed significantly decreasing incidence (EAPC = -1.4%) and mortality (EAPC = -1.6%) among men and increasing trends among women. In women, breast cancer incidence significantly increased (EAPC= +1.7%) and mortality decreased since 1989 (EAPC= -2.0%). Stomach cancer incidence and mortality decreased in both sexes. Prostate incidence sharply increased since 1991 and mortality decreased. Colon cancer incidence increased and rectum mortality decreased significantly in both sexes. Significant increases in incidence were also found for kidney (up to 1991 among men), urinary bladder, skin epithelioma, melanoma, liver (up to 1993 among men), pancreas, mesothelioma, Kaposi's sarcoma (up to 1995 among men), testis, thyroid, non-Hodgkin's lymphomas and multiple myeloma. Mortality significantly decreased for cancers of the oral cavity and pharynx, oesophagus, liver (women), larynx (men), bone, cervix (since 1990), central nervous system, urinary bladder, thyroid, Hodgkin's lymphomas and leukaemias (men). Non-Hodgkin's lymphoma mortality increased in both sexes. In conclusion, most of the changes seen can be explained as the effect of changes in smoking habits and of the extension of secondary prevention activities. The Italian health care system will also have to cope with growing cancer diagnostic and therapeutic needs due to population ageing.

Trends in oral cancer mortality in Europe

Mortality from oral cancer has been rising appreciably in most European countries up to the late 1980s, essentially for men. To update trends in oral cancer, death certification data from oral and pharyngeal cancer for 27 European countries were abstracted and analysed from the WHO mortality database over the period 1980-99. Oral cancer mortality in men has started to decline since the late 1980s in most western countries, although some persisting upward trends were registered for Belgium, Denmark, Greece, Portugal, or Scotland. Persisting rises were observed for most central and eastern Europe up to the mid 1990s, reaching exceedingly high rates in Hungary (20.2/100000 at all ages, 51.4 at age 35-64), Slovakia, Slovenia, and the Russian Federation. Some levelling of rates in some countries, such as Poland or the Czech Republic, was observed over more recent calendar years. Oral cancer was low, but moderately upwards in European women, mainly from central and eastern Europe. These trends should be essentially interpreted in terms of patterns and changes in exposure to alcohol and tobacco, and call for urgent control of these factors, as well as for improved diagnosis and management of oral cancer in central and eastern Europe.

Cancer mortality in Europe, 1995-1999, and an overview of trends since 1960

Mortality data, abstracted from the World Health Organization database, are presented in tabular form for 26 cancer sites or groups of sites, plus total cancer mortality, in 36 European countries during the period 1995-1999. Trends in mortality are also given in graphic form for 23 major countries plus the European Union as a whole over the period 1960-1999. In the European Union, total cancer mortality declined by 7% for both sexes over the last 5 years considered. The fall since the late 1980s was 10% in both sexes, corresponding to the avoidance of over 90000 deaths per year, as compared to the rates of the late 1980s. For the first time, over the last few years, some leveling of mortality was reported also in the Russian Federation, the Czech Republic, Poland, Hungary and other Eastern European countries, although cancer rates in those areas remain exceedingly high. The overall favorable pattern of cancer mortality over recent years is largely driven by the decline of tobacco-related cancer mortality in men. However, important components of the trends are also the persistence of substantial falls in gastric cancer, mainly in Russia and Eastern Europe, the recent decline in intestinal cancer in both sexes and of breast cancer in women, together with the long-term falls in uterine (cervical) cancer, leukemias, Hodgkin's disease and other neoplasms amenable to advancements in diagnosis and treatment. Female lung cancer mortality has been declining in the Russian Federation, but is still rising in other areas of the continent. Thus, urgent intervention is needed to bring under control the tobacco-related lung cancer epidemic in European women before it reaches the high level observed in North America. Supplementary material for this article can be found on the International Journal of Cancer website at http://www.interscience.wiley.com/jpages/0020-7136/suppmat/index.html

Regional variations in mortality rates of pancreatic cancer in China: Results from 1990-1992 national mortality survey

AIM: To examine the regional variations in mortality rates of pancreatic cancer in China.

METHODS: Aggregated mortality data of pancreatic cancer were extracted from the 1990-1992 national death of all causes and its mortality survey in China. Age specific and standardized mortality rates were calculated at both national and provincial levels with selected characteristics including sex and residence status.

RESULTS: Mortality of pancreatic cancer ranked the ninth and accounted for 1.38% of the total malignancy deaths. The crude and age standardized mortality rates of pancreatic cancer in China in the period of 1990-1992 were 1.48/100000 and 1.30/100000, respectively. Substantial regional variations in mortality rates across China were observed with adjusted mortality rates ranging from 0.43/100000 to 3.70/100000 with an extremal value of 8.7. Urban residents had significant higher pancreatic mortality than rural residents.

CONCLUSION: The findings of this study show different mortality rates of this disease and highlight the importance of further investigation on factors, which might contribute to the observed epidemiological patterns.

Early lung-cancer detection with spiral CT and positron emission tomography in heavy smokers: 2-year results

BACKGROUND

Low-dose spiral CT of the chest effectively detects early-stage lung cancer in high-risk individuals. The high rate of benign nodules and issues of making a differential diagnosis are critical factors that currently hamper introduction of large-scale screening programmes. We investigated the efficacy of repeated yearly spiral CT and selective use of positron emission tomography (PET) in a large cohort of high-risk volunteers.

METHODS

We enrolled 1035 individuals aged 50 years or older who had smoked for 20 pack-years or more. All patients underwent annual low-dose CT, with or without PET, for 5 years. Lesions up to 5 mm were deemed non-suspicious and low-dose CT was repeated after 12 months (year 2).

FINDINGS

By year 2, 22 cases of lung cancer had been diagnosed (11 at baseline, 11 at year 2). 440 lung lesions were identified in 298 (29%) participants, and 95 were recalled for high-resolution contrast CT. PET scans were positive in 18 of 20 of the identified cancer cases. Six patients underwent surgical biopsy for benign disease because of false-positive results (6% of recalls, 22% of invasive procedures). Complete resection was achieved in 21 (95%) lung cancers, 17 (77%) were pathological stage I (100% at year 2), and the mean tumour size was 18 mm. There were no interval lung cancers in the 2.5 years of follow-up (average time on study from randomisation to last contact), although 19 individuals were diagnosed with another form of cancer (two deaths and 17 non-fatal admissions).

INTERPRETATION

Combined use of low-dose spiral CT and selective PET effectively detects early lung cancer. Lesions up to 5 mm can be checked again at 12 months without major risks of progression.

Cancer mortality trends in the EU and acceding countries up to 2015

BACKGROUND

Examination of trends in cancer mortality in Europe over the past 30 years has shown that, after long-term rises, age-standardised mortality from most common cancer sites has fallen in the EU since the late 1980s. This study aimed to examine trends in the age-specific and age-standardised cancer mortality rates and numbers of cancer deaths up to 2020 for all cancers and various specific sites for all 15 EU countries, the 10 acceding countries, Bulgaria and Romania (currently applicant countries, along with Turkey), and Iceland, Norway and Switzerland of the four EEA countries.

PATIENTS AND METHODS

Mortality rates were modelled as a function of age, calendar period and birth cohort. Birth cohort was calculated as age subtracted from calendar period.

RESULTS

As a consequence of the generally decreasing trends in the age-standardised rates, the best estimate is that there will be approximately 1.25 million cancer deaths in 2015, which is almost 130,000 (11%) more deaths than in 2000, but 155,000 (11%) fewer deaths than the 1.4 million projected in 2015 on the basis of demographic changes alone. The increases in the forecast numbers of cancer deaths in 2015 are proportionally larger in males than in females (13% and 10%, respectively) and proportionally larger in the acceding countries than in the current EU member countries (14% and 11%, respectively).

CONCLUSIONS

Our forecasts are conservative best estimates of future cancer mortality. There is clearly scope for large improvements in survival, and hence reductions in cancer mortality, in some countries, through eliminating these differences using existing knowledge and treatment regimes.