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

Efficacy and safety of tacrolimus in older adults with ulcerative colitis: a retrospective study

BACKGROUND/AIMS

The prevalence of ulcerative colitis (UC) has been increasing, also in older adults. Here, we retrospectively compared the efficacy and safety of tacrolimus (TAC) in older and younger patients with UC.

METHODS

We included younger (age < 65 years; n = 116) and older patients (age ≥ 65 years; n = 21) with UC who received TAC from April 2009 through December 2022(mean follow-up, 1230 ± 175 days) and achieved remission. Evaluations included age at onset, laboratory values, estimated glomerular filtration rate (eGFR), use of 5-aminosalicylic acid (5-ASA), biological experience, colonoscopy scores, remission at 1 month after treatment initiation, and adverse events. Treatment duration and renal function were assessed in patients with follow-up data (younger patients, n = 110; older patients, n = 19).

RESULTS

Older patients had a higher age at onset and treatment initiation but less 5-ASA use and biological experience. Before treatment, hemoglobin, albumin, and eGFR were significantly lower in the older group and CRP was significantly higher. The remission rate was 80.1% in the younger group and 66.6% in the older group (P = 0.1862). Adverse events were similar in both groups. The older group had a shorter treatment duration and significantly less change in renal function at all time points.

DISCUSSION

Rates of TAC-induced remission and adverse events were similar in older and younger adults with UC.

CONCLUSION

TAC can be used safely in elderly patients with moderate to severe UC with careful monitoring.

Inflammatory Bowel Disease Treatment in Cancer Patients-A Comprehensive Review

Inflammatory bowel disease (IBD) is a chronic disease for which medical treatment with immunomodulating drugs is increasingly used earlier to prevent disability. Additionally, cancer occurrence in IBD patients is increased for several reasons, either IBD-related or therapy-associated. Doctors are therefore facing the challenge of managing patients with IBD and a past or current malignancy and the need to balance the risk of cancer recurrence associated with immunosuppressive drugs with the potential worsening of IBD activity if they are withdrawn. This review aims to explore the features of different subtypes of cancer occurring in IBD patients to present current evidence on malignancy recurrence risk associated with IBD medical therapy along with the effects of cancer treatment in IBD and finally to discuss current recommendations on the management of these patients. Due to sparse data, a case-by-case multidisciplinary discussion is advised, including inputs from the gastroenterologist, oncologist, and patient.

Outcomes of Older Patients with Resectable Colorectal Liver Metastases Cancer (CRLM): Single Center Experience

Surgery is the only potential curative option of CRLM if resectable. The curative approach in patients over 70 years old is challenging mainly because of comorbidities and other geriatric syndromes. Herein, we report outcomes of older patients with resectable CRLM in our center. We retrospectively analyzed characteristics and outcomes of older patients with CRLM operated at "Centre Hospitalier de l'Université de Montréal" (CHUM) between 2010 and 2019. We identified 210 patients aged ≥70 years with a median age of 76 (range: 70-85). CRLM were synchronous in 56% of patients. Median disease-free survival (DFS) was 41.3 months. Median overall survival (OS) was 62.2 months and estimated 5-year survival rate was 51.5% similar to those of younger counterparts. Patients with metachronous CRLM had a trend to a higher OS compared to those with synchronous disease (67.2 vs. 58.7 months; p = 0.42). Factors associated with lower survival in the multivariate analysis were right-sided tumors and increased Charlson Comorbidity index (CCI). Survival outcomes of patients aged ≥70 years were comparable to those of younger patients and those reported in the literature. Age should not be a limiting factor in the curative management of older patients with resectable CRLM.

Identification of the miRNA signature associated with survival in patients with ovarian cancer

Ovarian cancer is a major gynaecological malignant tumor associated with a high mortality rate. Identifying survival-related variants may improve treatment and survival in patients with ovarian cancer. In this work, we proposed a support vector regression (SVR)-based method called OV-SURV, which is incorporated with an inheritable bi-objective combinatorial genetic algorithm for feature selection to identify a miRNA signature associated with survival in patients with ovarian cancer. There were 209 patients with miRNA expression profiles and survival information of ovarian cancer retrieved from The Cancer Genome Atlas database. OV-SURV achieved a mean correlation coefficient of 0.77±0.01and a mean absolute error of 0.69±0.02 years using 10-fold cross-validation. Analysis of the top ranked miRNAs revealed that the miRNAs, hsa-let-7f, hsa-miR-1237, hsa-miR-98, hsa-miR-933, and hsa-miR-889, were significantly associated with the survival in patients with ovarian cancer. Kyoto Encyclopedia of Genes and Genomes pathway analysis revealed that four of these miRNAs, hsa-miR-182, hsa-miR-34a, hsa-miR-342, and hsa-miR-1304, were highly enriched in fatty acid biosynthesis, and the five miRNAs, hsa-let-7f, hsa-miR-34a, hsa-miR-342, hsa-miR-1304, and hsa-miR-24, were highly enriched in fatty acid metabolism. The prediction model with the identified miRNA signature consisting of prognostic biomarkers can benefit therapeutic decision making of ovarian cancer.

Risk of Cancer Recurrence Among Individuals Exposed to Antitumor Necrosis Factor Therapy: A Systematic Review and Meta-Analysis of Observational Studies

BACKGROUND

Patients with immune-mediated disorders such as ankylosing spondylitis, inflammatory bowel disease, psoriasis and rheumatoid arthritis are increasingly treated with tumor necrosis factor (TNF) inhibitors. The safety of anti-TNF therapy in patients with a history of cancer requires further evaluation. We conducted a systematic review and a meta-analysis of observational studies including patients with a history of cancer exposed to anti-TNF therapy assessing for a risk of new cancer or cancer recurrence.

MATERIALS AND METHODS

A computerized literature search of MEDLINE, Google scholar, and Cochrane Database of Systematic Reviews was performed through September 1, 2015. Study characteristics, quality, and risk of bias were assessed. Random-effects model meta-analyses were used to estimate the risk of new cancer development or cancer recurrence.

RESULTS

Nine English-language observational studies including patients with a history of cancer and exposed to anti-TNF therapy were idenitifed. The pooled incidence rate ratio of new or recurrent cancer among individuals with a history of cancer exposed to anti-TNF therapy was not significantly different compared with control therapies (incidence rate ratio, 0.90; 95% confidence interval, 0.59-1.37). Subgroup analyses were performed according to disease type, underlying cancer diagnosis, time to initiation of anti-TNF therapy and study quality. Heterogeneity of study populations, heterogeneity of the included cancer subtypes and utilization of observational studies limits the study quality.

CONCLUSIONS

The risk of new cancer or cancer recurrence among patients with a history of cancer and use of anti-TNF therapy is similar to the risk with nonbiological disease modifying therapies. These results support the use of anti-TNF medications in select populations despite prior diagnosis of cancer.

Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: reference and alternative scenarios for 2016-40 for 195 countries and territories

BACKGROUND

Understanding potential trajectories in health and drivers of health is crucial to guiding long-term investments and policy implementation. Past work on forecasting has provided an incomplete landscape of future health scenarios, highlighting a need for a more robust modelling platform from which policy options and potential health trajectories can be assessed. This study provides a novel approach to modelling life expectancy, all-cause mortality and cause of death forecasts -and alternative future scenarios-for 250 causes of death from 2016 to 2040 in 195 countries and territories.

METHODS

We modelled 250 causes and cause groups organised by the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) hierarchical cause structure, using GBD 2016 estimates from 1990-2016, to generate predictions for 2017-40. Our modelling framework used data from the GBD 2016 study to systematically account for the relationships between risk factors and health outcomes for 79 independent drivers of health. We developed a three-component model of cause-specific mortality: a component due to changes in risk factors and select interventions; the underlying mortality rate for each cause that is a function of income per capita, educational attainment, and total fertility rate under 25 years and time; and an autoregressive integrated moving average model for unexplained changes correlated with time. We assessed the performance by fitting models with data from 1990-2006 and using these to forecast for 2007-16. Our final model used for generating forecasts and alternative scenarios was fitted to data from 1990-2016. We used this model for 195 countries and territories to generate a reference scenario or forecast through 2040 for each measure by location. Additionally, we generated better health and worse health scenarios based on the 85th and 15th percentiles, respectively, of annualised rates of change across location-years for all the GBD risk factors, income per person, educational attainment, select intervention coverage, and total fertility rate under 25 years in the past. We used the model to generate all-cause age-sex specific mortality, life expectancy, and years of life lost (YLLs) for 250 causes. Scenarios for fertility were also generated and used in a cohort component model to generate population scenarios. For each reference forecast, better health, and worse health scenarios, we generated estimates of mortality and YLLs attributable to each risk factor in the future.

FINDINGS

Globally, most independent drivers of health were forecast to improve by 2040, but 36 were forecast to worsen. As shown by the better health scenarios, greater progress might be possible, yet for some drivers such as high body-mass index (BMI), their toll will rise in the absence of intervention. We forecasted global life expectancy to increase by 4·4 years (95% UI 2·2 to 6·4) for men and 4·4 years (2·1 to 6·4) for women by 2040, but based on better and worse health scenarios, trajectories could range from a gain of 7·8 years (5·9 to 9·8) to a non-significant loss of 0·4 years (-2·8 to 2·2) for men, and an increase of 7·2 years (5·3 to 9·1) to essentially no change (0·1 years [-2·7 to 2·5]) for women. In 2040, Japan, Singapore, Spain, and Switzerland had a forecasted life expectancy exceeding 85 years for both sexes, and 59 countries including China were projected to surpass a life expectancy of 80 years by 2040. At the same time, Central African Republic, Lesotho, Somalia, and Zimbabwe had projected life expectancies below 65 years in 2040, indicating global disparities in survival are likely to persist if current trends hold. Forecasted YLLs showed a rising toll from several non-communicable diseases (NCDs), partly driven by population growth and ageing. Differences between the reference forecast and alternative scenarios were most striking for HIV/AIDS, for which a potential increase of 120·2% (95% UI 67·2-190·3) in YLLs (nearly 118 million) was projected globally from 2016-40 under the worse health scenario. Compared with 2016, NCDs were forecast to account for a greater proportion of YLLs in all GBD regions by 2040 (67·3% of YLLs [95% UI 61·9-72·3] globally); nonetheless, in many lower-income countries, communicable, maternal, neonatal, and nutritional (CMNN) diseases still accounted for a large share of YLLs in 2040 (eg, 53·5% of YLLs [95% UI 48·3-58·5] in Sub-Saharan Africa). There were large gaps for many health risks between the reference forecast and better health scenario for attributable YLLs. In most countries, metabolic risks amenable to health care (eg, high blood pressure and high plasma fasting glucose) and risks best targeted by population-level or intersectoral interventions (eg, tobacco, high BMI, and ambient particulate matter pollution) had some of the largest differences between reference and better health scenarios. The main exception was sub-Saharan Africa, where many risks associated with poverty and lower levels of development (eg, unsafe water and sanitation, household air pollution, and child malnutrition) were projected to still account for substantive disparities between reference and better health scenarios in 2040.

INTERPRETATION

With the present study, we provide a robust, flexible forecasting platform from which reference forecasts and alternative health scenarios can be explored in relation to a wide range of independent drivers of health. Our reference forecast points to overall improvements through 2040 in most countries, yet the range found across better and worse health scenarios renders a precarious vision of the future-a world with accelerating progress from technical innovation but with the potential for worsening health outcomes in the absence of deliberate policy action. For some causes of YLLs, large differences between the reference forecast and alternative scenarios reflect the opportunity to accelerate gains if countries move their trajectories toward better health scenarios-or alarming challenges if countries fall behind their reference forecasts. Generally, decision makers should plan for the likely continued shift toward NCDs and target resources toward the modifiable risks that drive substantial premature mortality. If such modifiable risks are prioritised today, there is opportunity to reduce avoidable mortality in the future. However, CMNN causes and related risks will remain the predominant health priority among lower-income countries. Based on our 2040 worse health scenario, there is a real risk of HIV mortality rebounding if countries lose momentum against the HIV epidemic, jeopardising decades of progress against the disease. Continued technical innovation and increased health spending, including development assistance for health targeted to the world's poorest people, are likely to remain vital components to charting a future where all populations can live full, healthy lives.

FUNDING

Bill & Melinda Gates Foundation.

Efficacy and safety of granulocyte adsorption apheresis in elderly patients with ulcerative colitis

BACKGROUND

Elderly ulcerative colitis (UC) is increasing. Elderly UC differ from younger UC with respect to the course of their disease. Granulocyte adsorption apheresis (CAP) is often used to treat elderly UC. We retrospectively analyzed the cases of elderly UC who underwent CAP for remission induction therapy in a comparison with younger UC.

METHODS

96 patients with UC underwent CAP. Patients who concurrently received tacrolimus, biological agents, or high-dose steroid therapy were excluded. The remaining 80 patients were evaluated. We divided them into an elderly group (aged ≥65 years) and a younger group, and then we compared the groups' (1) clinical characteristics, (2) the efficacy and adverse effects of CAP, and (3) the complications of PSL.

RESULTS

The remission rate was 70.8% in the elderly group and 87.5% in the younger group. There were significant differences between the two groups with respect to the age at the onset of UC, the estimated glomerular filtration rate on admission, underlying diseases, and complications of PSL therapy. Adverse effects of CAP included headache, complications of blood reinfusion, heparin allergy, hypotension, and failure of blood removal. There were significant differences between the two groups with respect to the complications of PSL therapy (all P < .05).

CONCLUSIONS

Although the elderly group had longer durations of UC, a higher prevalence of underlying diseases, and a higher frequency of adverse events due to PSL therapy. No serious adverse effects of CAP occurred in either group. Thus, CAP was safe and effective in both younger and elderly UC.

Bioassay-Guided Isolation and Evaluation of Antiproliferative Effects of (Z)-Ethylidene-4, 6-Dimethoxycoumaran-3-One from Pogostemon Quadrifolius (Benth.)

The aim of the study was to isolate and identify the major cytotoxic principle from plant leaves of Pogostemon quadrifolius (Benth.) and evaluate its antiproliferative potential against human cancer cells. Plant leaves were extracted sequentially with a soxhlet apparatus, using petroleum ether, chloroform and methanol solvents. Petroleum ether and chloroform extracts exhibited antiproliferative properties against Caco-2, HeLa, THP-1, MCF-7 and Jurkat E6-1cancer cell lines tested, but methanol extracts failed to exhibit such activity. The major antiproliferative principle from petroleum ether and chloroform extracts was isolated with the help of bioassay guided column chromatography. This cytotoxic compound was further analysed by UV, TLC, HPLC, LC-MS, GC-MS and NMR analyses and was identified to be novel: (Z)-ethylidene-4,6-dimethoxycoumaran-3-one (Compound 1). The half-maximal inhibitory concentrations for proliferation (IC₅₀) exhibited by compound 1 were 19.4, 23.1, 22.1, 35.9 and 8.32 µM against Caco-2, HeLa, THP-1, MCF-7 and Jurkat E6-1 cancer cell lines, respectively. Further experiments revealed that compound 1 triggered the apoptosis mode of cell death in cancer cell lines. Thus, the present study allowed isolation and identification of a novel cytotoxic natural compound, (Z)-ethylidene-4,6-dimethoxycoumaran-3-one, from plant leaves of P. quadrifolius (Benth.). Our pre-clinical study also indicated that compound 1 is particularly active in the acute T cell leukemia cell line (Jurkat E6-1) with potential for application as a chemotherapeutic agent in the future.

Patterns of Cancer in Kurdistan - Results of Eight Years Cancer Registration in Sulaymaniyah Province-Kurdistan-Iraq

BACKGROUND

Cancer has become a major health problem associated with high mortality worldwide, especially in developing countries. The aim of our study was to evaluate the incidence rates of different types of cancer in Sulaymaniyah from January-2006 to January-2014. The data were compared with those reported for other middle east countries.

MATERIALS AND METHODS

This retrospective study depended on data collected from Hiwa hospital cancer registry unit, death records and histopathology reports in all Sulaymaniyah teaching hospitals, using international classification of diseases.

RESULTS

A total of 8,031 cases were registered during the eight year period, the annual incidence rate in all age groups rose from 38 to 61.7 cases/100,000 population/year, with averages over 50 in males and 50.7 in females. The male to female ratio in all age groups were 0.98, while in the pediatric age group it was 1.33. The hematological malignancies in all age groups accounted for 20% but in the pediatric group around half of all cancer cases. Pediatric cancers were occluding 7% of total cancers with rates of 10.3 in boys and 8.7 in girls. The commonest malignancies by primary site were leukemia, lymphoma, brain, kidney and bone. In males in all age groups they were lung, leukaemia, lymphoma, colorectal, prostate, bladder, brain, stomach, carcinoma of unknown primary (CUP) and skin, while in females they were breast, leukaemia, lymphoma, colorectal, ovary, lung, brain, CUP, and stomach. Most cancers were increased with increasing age except breast cancer where decrease was noted in older ages. High mortality rates were found with leukemia, lung, lymphoma, colorectal, breast and stomach cancers.

CONCLUSIONS

We here found an increase in annual cancer incidence rates across the period of study, because of increase of cancer with age and higher rates of hematological malignancies. Our study is valuable for Kurdistan and Iraq because it provides more accurate data about the exact patterns of cancer and mortality in our region.

Efficacy and safety of acupuncture for chemotherapy-induced leucopoenia: protocol for a systematic review

INTRODUCTION

Many cancer patients experience leucopoenia during chemotherapy. Granulocyte- colony-stimulating factor (G-CSF) is used to treat chemotherapy-induced leucopoenia (CIL) but has various limitations. Clinical trials have indicated that acupuncture may prevent bone marrow suppression and increase leucocyte counts after chemotherapy. The objective of this review is to assess the efficacy and safety of acupuncture for treating CIL.

METHODS AND ANALYSIS

This systematic review will electronically search the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Library, Medline, EMBASE, the China National Knowledge Infrastructure Database (CNKI), the Chinese Biomedical Literature Database (CBM), the Chinese Scientific Journal Database (VIP Database) and the Wanfang database from their inception to 1 January 2016. Other sources will also be searched including potential grey literature, conference proceedings and the reference lists of identified publications and existing systematic reviews. Two reviewers will independently search the databases, perform data extraction and assess the quality of studies. Data will be synthesised by either the fixed-effects or the random-effects model according to a heterogeneity test. White blood cell counts will be assessed as the primary outcome. Adverse effects, incidence of leucopoenia, quality of life and physical condition will be evaluated as secondary outcomes. RevMan V.5.3 will be employed for data analysis. The results will be expressed as risk ratios for dichotomous data and mean differences for continuous data.

ETHICS AND DISSEMINATION

The protocol does not need ethics approval because individuals cannot be identified. The review will be reported in a peer-reviewed publication or at a relevant conference.

TRIAL REGISTRATION NUMBER

CRD42015027594.

Insights into cancer surveillance in Central and Eastern Europe, Israel and Turkey

The current cancer landscape within transitional economies in central and Eastern Europe and the Mediterranean area is not particularly optimistic. Current perceptions are often based on extrapolations from other countries and regions; and hence the authors collaborated with the South Eastern Europe Oncology Group (SEEROG) to collect information on cancer registration in Central and Eastern Europe, Israel and Turkey. Healthcare authorities and specialist oncology centres in 21 countries in the region were contacted for information on cancer registries in their countries. Based on this information, the authors believe that the recording and reporting of data on cancer in the region is at an acceptable level. The authors discuss and compare institution- and population-based registries, and present opinions on elements of an 'ideal registry' based on the survey replies and comparisons with other registries. A comparison with the sources used for GLOBOCAN 2008 illustrates the need for consistent data to be communicated, published and utilised throughout the region and the oncology community. The authors conclude by considering the potential value of collaboration between health authorities across the region, as well as between the clinical and epidemiological communities, to ensure that cancer data are consistently collected, verified and made public.

Management of the elderly patients with inflammatory bowel disease: practical considerations

The aging U.S. population will approach 20% of the total population by 2030. The number of older patients with inflammatory bowel disease is anticipated to increase accordingly bringing the burden of multiple comorbidities, polypharmacy with drug interactions, the aging immune system, and extended social and financial issues to overall management of an already challenging management of these patients. Each of these concerns is measured by the metric of distinguishing the "fit versus frail" elderly and will be discussed in this review with an emphasis on a practical guide to therapy.

Nutrition deficiency increases the risk of stomach cancer mortality

BACKGROUND

The purpose of the study is to determine whether exposure to malnutrition during early life is associated with increased risk of stomach cancer in later life.

METHODS

The design protocol included analyzing the trend of gastric cancer mortality and nutrition and evaluating the association between nutrient deficiency in early life and the risk of gastric cancer by hierarchical age-period-birth cohort (APC) analysis using general log-linear Poisson models and to compare the difference between birth cohorts who were exposed to the 1959-1961 Chinese famine and those who were not exposed to the famine. Data on stomach cancer mortality from 1970 to 2009 and the dietary patterns from 1955 to 1985 which included the 1959-1961 Chinese famine period in the Zhaoyuan County population were obtained. The nutrition information was collected 15 years prior to the mortality data as based on the latest reference of disease incubation.

RESULTS

APC analysis revealed that severe nutrition deficiency during early life may increase the risk of stomach cancer. Compared with the 1960-1964 birth cohort, the risk for stomach cancer in all birth cohorts from 1900 to 1959 significantly increased; compared with the 1970-1974 cohort, the risk for stomach cancer in the 1975-1979 cohort significantly increased, whereas the others had a steadily decreased risk; compared with 85-89 age group in the 2005-2009 death survey, the ORs decreased with younger age and reached significant levels for the 50-54 age group after adjusting the confounding factors. The 1930 to 1964 group (exposed to famine) had a higher mortality rate than the 1965 to 1999 group (not exposed to famine). For males, the relative risk (RR) was 2.39 and the 95% confidence interval (CI) was 1.51 to 3.77. For females, RR was 1.64 and 95% CI was 1.02 to 2.62.

CONCLUSION

The results of the present study suggested that prolonged malnutrition during early life may increase the risk of stomach cancer mortality in later life.

High cancer mortality rates in the elderly in the UK

INTRODUCTION

Cancer is largely a disease of older individuals. We compared UK cancer mortality rates with those for other countries to assess progress.

METHODS

Death details were obtained from the WHO Mortality Database for the UK, the USA and 11 European countries. Mortality rates were calculated for the age groups 55-64, 65-74, 75-84 and ≥85 years. Trends between 1995-97 and 2003-05 were determined. The number of excess cancer deaths in the UK was calculated by applying the age-specific mortality rates observed in other regions to the UK.

RESULTS

For all cancers combined, UK rates for 2003-05 in those aged ≥75 years were 11-31% higher than in other regions. From 1995-97 to 2003-05, UK rates decreased by 16-17% in those aged <75 years, but increased by 2% in those ≥85 years compared with decreases of 4-16% for the other geographic areas. More than 14,000 cancer deaths in the UK in those aged ≥75 years would be avoided each year if UK mortality rates were identical to those in the USA.

CONCLUSION

The UK is making poor progress in controlling cancer in older age groups. The gap in mortality rates between the UK and other countries and between old and young in the UK is widening.

Polonium and lung cancer

The alpha-radioactive polonium 210 (Po-210) is one of the most powerful carcinogenic agents of tobacco smoke and is responsible for the histotype shift of lung cancer from squamous cell type to adenocarcinoma. According to several studies, the principal source of Po-210 is the fertilizers used in tobacco plants, which are rich in polyphosphates containing radio (Ra-226) and its decay products, lead 210 (Pb-210) and Po-210. Tobacco leaves accumulate Pb-210 and Po-210 through their trichomes, and Pb-210 decays into Po-210 over time. With the combustion of the cigarette smoke becomes radioactive and Pb-210 and Po-210 reach the bronchopulmonary apparatus, especially in bifurcations of segmental bronchi. In this place, combined with other agents, it will manifest its carcinogenic activity, especially in patients with compromised mucous-ciliary clearance. Various studies have confirmed that the radiological risk from Po-210 in a smoker of 20 cigarettes per day for a year is equivalent to the one deriving from 300 chest X-rays, with an autonomous oncogenic capability of 4 lung cancers per 10000 smokers. Po-210 can also be found in passive smoke, since part of Po-210 spreads in the surrounding environment during tobacco combustion. Tobacco manufacturers have been aware of the alpha-radioactivity presence in tobacco smoke since the sixties.

Numerical solutions for a model of tissue invasion and migration of tumour cells

The goal of this paper is to construct a new algorithm for the numerical simulations of the evolution of tumour invasion and metastasis. By means of mathematical model equations and their numerical solutions we investigate how cancer cells can produce and secrete matrix degradative enzymes, degrade extracellular matrix, and invade due to diffusion and haptotactic migration. For the numerical simulations of the interactions between the tumour cells and the surrounding tissue, we apply numerical approximations, which are spectrally accurate and based on small amounts of grid-points. Our numerical experiments illustrate the metastatic ability of tumour cells.

The decline in stomach cancer mortality: exploration of future trends in seven European countries

Mortality from stomach cancer has fallen steadily during the past decades. The aim of this paper is to assess the implication of a possible continuation of the decline in stomach cancer mortality until the year 2030. Annual rates of decline in stomach cancer mortality from 1980 to 2005 were determined for the Netherlands, United Kingdom, France, and four Nordic countries on the basis of regression analysis. Mortality rates were extrapolated until 2030, assuming the same rate of decline as in the past, using three possible scenarios. The absolute numbers of deaths were projected taking into account data on the ageing of national populations. Stomach cancer mortality rates declined between 1980 and 2005 at about the same rate (3.6–4.9% per year) for both men and women in all countries. The rate of decline did not level off in recent years, and it was not smaller in countries with lower overall mortality rates in 1980. If this decline were to continue into the future, stomach cancer mortality rates would decline with about 66% between 2005 and 2030 in most populations, while the absolute number of stomach cancer deaths would diminish by about 50%. Thus, in view of the strong, stable and consistent mortality declines in recent decades, and despite population ageing, stomach cancer is likely to become far less important as a cause of death in Europe in the future.

Epidemiology of surgical treatment of nonmelanoma skin cancer of the head and neck in Greece

BACKGROUND

Nonmelanoma skin cancer (NMSC) constitutes the most common malignancy in Caucasians. Epidemiological data derive, mainly, from studies in the United States, Australia, and Northern Europe, whereas data from Mediterranean Europe are scarce.

OBJECTIVE

To provide information on the epidemiology of surgically treated NMSC of the head and neck in the region of Thrace, Northern Greece, and to evaluate the surgical treatment given.

METHODS

A retrospective review of patients surgically treated from 2004 to 2006 was conducted. Data on demographics, histology and skin cancer characteristics, and treatment efficacy and recurrence rate were extracted and analyzed.

RESULTS

One hundred seventy-nine NMSCs of the head and neck were excised and histopathologically confirmed in 160 patients, with the majority (58.7%) classified as Fitzpatrick skin type III. Histology included 125 basal cell carcinomas (BCCs) and 54 squamous cell carcinomas (SCCs). The mean age was 70.6 +/- 10.1 (range 38-97). Tumor size ranged between 2 and 50 mm. Excision with 5-mm margins was performed in every case, and the defects were closed mainly using local flaps. Incomplete excision was limited to 3.9% of cases, and the recurrence rate was 1.7%. The study revealed similar characteristics between BCC and SCC regarding age and sex but significant differences in terms of location and size.

CONCLUSIONS

Surgical resection achieves a satisfactory NMSC clearance rate in the head and neck.

Plantago ovata consumption and colorectal mortality in Spain, 1995-2000

BACKGROUND

Consumption of Plantago ovata may protect against colorectal cancer. To test this hypothesis, an ecological study was performed to determine mortality rates and distribution of colorectal cancer, and the consumption and distribution of P ovata, in different provinces in Spain. The putative association between P ovata consumption and mortality from colorectal cancer was then evaluated.

METHODS

We conducted a comparative ecological study of Spanish provinces, with colorectal cancer mortality as the dependent variable and per capita consumption of P ovata by province and year as the independent variable. Associations were analyzed by calculating Spearman's correlation coefficients and a Poisson multiple regression model.

RESULTS

Consumption of P ovata tended to be inversely correlated with mortality from colorectal cancer. In the Poisson regression analysis this tendency remained and reached statistical significance for the top quintile of P ovata consumption in the adjusted analysis (P = 0.042).

CONCLUSIONS

Our results show an inverse trend between the consumption of P ovata and colorectal cancer mortality. We recommend additional observational studies of individuals, in order to better control confounding factors.

Cancer mortality among men in Central Serbia: 1985-2006 survey study

AIM

To analyze cancer mortality trends in men in Central Serbia during 1985-2006 period.

METHODS

Mortality rates and trends for the most frequent cancers in men (lung, stomach, colorectal, pancreatic, and prostate cancer) were calculated. Mortality rates for all cancers were adjusted by direct standardization. Percentage changes of the rates were calculated as the percentage difference between the rates of two successive years and then as a mean of these changes for the entire observed period. Trend lines were estimated using linear regression.

RESULTS

Total cancer mortality in men increased, with mean percentage of annual changes being 1.53% (95% confidence interval [CI], -0.09-3.16). Lung, stomach, colorectal, pancreatic, and prostate cancers represented 58.1% and 61.6% of total cancer deaths in 1985 and 2006, respectively. Increasing trends were observed for all investigated cancers: mean annual percentage change for lung cancer was 2.31%(95% CI, 1.03-3.59), for colorectal cancer 2.23% (95% CI, -0.18-4.65), for prostate cancer 3.06% (95% CI, -2.07-8.18), and for pancreatic cancer 1.58% (95% CI, -2.17-5.32). Stomach cancer mortality significantly decreased in age groups 40-49 and 50-59 years.

CONCLUSION

The most frequent cancers in men in Central Serbia, i.e., lung, colorectal, prostate, and pancreatic cancer, showed an increasing trend. Only stomach cancer mortality decreased over time.

Cancer mortality in the European Union, 1970-2003, with a joinpoint analysis

BACKGROUND

Cancer mortality peaked in the European Union (EU) in the late 1980s and declined thereafter.

MATERIALS AND METHODS

We analyzed EU cancer mortality data provided by the World Health Organization in 1970-2003, using join point analysis.

RESULTS

Overall, cancer mortality levelled off in men since 1988 and declined in 1993-2003 (annual percent change, APC = -1.3%). In women, a steady decline has been observed since the early 1970s. The decline in male cancer mortality has been driven by lung cancer, which levelled off since the late 1980s and declined thereafter (APC = 2.7% in 1997-2003). Recent decreases were also observed for other tobacco-related cancers, as oral cavity/pharynx, esophagus, larynx and bladder, as well as for colorectal (APC = -0.9% in 1992-2003) and prostate cancers (APC = -1.0% in 1994-2003). In women, breast cancer mortality levelled off since the early 1990s and declined thereafter (APC = -1.0% in 1998-2003). Female mortality declined through the period 1970-2003 for colorectal and uterine cancer, while it increased over the last three decades for lung cancer (APC = 4.6% in 2001-2003). In both sexes, mortality declined in 1970-2003 for stomach cancer and for a few cancers amenable to treatment.

CONCLUSION

This update analysis of the mortality from cancer in the EU shows favorable patterns over recent years in both sexes.

Cancer mortality differences among urban and rural residents in Lithuania

Background

The aim of this study was to describe and to compare the cancer mortality rates in urban and rural residents in Lithuania.

Methods

Cancer mortality has been studied using the materials of the Lithuanian cancer registry. For the period 1993–2004 age-standardized urban and rural population mortality rates (World standard) were calculated for all malignant neoplasm's and for stomach, colorectal, lung, prostate, breast and cervical cancers. The annual percentage change (APC) was calculated using log-linear regression model, two-sided Mantel-Haenzel test was used to evaluate differences in cancer mortality among rural and urban populations.

Results

For males in rural population cancer mortality was higher than in urban (212.2 and 197.0 cases per 100000) and for females cancer mortality was higher in urban population (103.5 and 94.2 cases per 100000, p < 0.05). During the study period the age-standardized mortality rates decreased in both sexes in urban residents. The decreasing mortality trend in urban population was contributed by decline of the rates of lung and stomach cancer in male and breast, stomach and colorectal cancer in female. Mortality rates in both urban and rural population were increasing for prostate and cervical cancers.

Conclusion

This study shows that large rural and urban inequalities in cancer mortality exist in Lithuania. The contrast between the health of residents in urban and rural areas invites researchers for research projects to develop, implement, and enhance cancer prevention and early detection intervention strategies for rural populations.

Cytotoxic therapy for the elderly with metastatic breast cancer: A review on safety, pharmacokinetics and efficacy

As the incidence of invasive breast cancer, mainly developing at older age, is rising, the absolute number of elderly developing metastatic disease is also increasing. In view of improved life expectancy, sociocultural changes and better supportive measures for chemotherapy-induced toxicity, there is an increasing request for the administration of chemotherapy in elderly. At the moment, medical oncologists are still reluctant to use chemotherapy in elderly partly because of concern about increased toxicity and poor tolerability of this patient cohort, and the inability to appropriately select elderly that may benefit from chemotherapy. The question is whether this attitude remains justified. In this review, the current status of clinical research in the area of metastatic breast cancer regarding toxicity and activity of chemotherapy in older breast cancer patients is discussed. Further, data on pharmacokinetics are emphasised as age-related physiologic changes may affect these features with consequences for toxicity and decision-making. Moreover, data on assessment tools trying to characterise the 'functional age' are reviewed. In general, the literature data are scarce and hampered by major limitations, while pharmacokinetic data indicate that a different approach in older breast cancer patients does not always seem justified. To increase our knowledge aiming at optimisation of cancer treatment in elderly, there is a clear necessity for prospective, well-designed studies with emphasis on the particular requirements of older patients and incorporation of pharmacokinetic and -dynamic evaluation of cytotoxic agents used in this specific group. As in other research areas, maximal progress will be achieved by joined efforts of co-operative research groups.

Epidemiology of Prostate Cancer

Prostate cancer is one of the most important cancers in men. With a worldwide incidence of 25.3 per 100,000 it is the second most common cancer in men, with large differences between countries. Important clues on risk factors remain to be found. Age, genetic factors and environmental influences have been studied. Incidence has been increasing over the last few decades, largely due to early detection procedures. The mortality rate of 8.1 per 100,000 mainly affects men at older ages; increases in this rate over time and differences between countries are markedly smaller than for incidence. For the future, prostate cancer will remain an important and--through evolutions in incidence and demography--growing health problem.

Epidemiology of nonmelanoma skin cancer (NMSC) in Europe: accurate and comparable data are needed for effective public health monitoring and interventions

Nonmelanoma skin cancer (NMSC) is the most common malignancy occurring in white populations. It is currently becoming an important challenge in terms of public health management as the increasing incidence rates will probably have a tremendous impact on healthcare costs. Possible factors driving this rise in NMSC numbers are increases in both acute and prolonged UV exposure together with increasing numbers of older people in the population. A better understanding of NMSC epidemiology in Europe is essential if an evidence-based European-wide public health policy is to be developed. It is obvious this can only be achieved by recording and analysing comparative epidemiological data. Finally, by improving the skin examination training for physicians, developing guidelines and exchanging best practices, a high level of healthcare could be provided for NMSC.

[Proposed terms for endobronchial lesions in patients suspected of having a bronchial neoplasm]

Endoscopists describe lung cancer lesions using varying terminology. This study aimed to assess the probability of neoplastic disease in terms of endoscopic findings expressed in an original classification system. The endoscopic lesions were classified as infiltrations (superficial lesions without a clear border with normal mucosa) or masses (exophytic lesions easily distinguished from the bronchial wall). Each lesion was categorized according to 3 grades reflecting probability of malignancy. A grade I infiltration was a lesion presenting 1 of the following characteristics: loss of luster, increased thickness, or redness, with a smooth surface. A grade II infiltration presented 2 of the aforementioned characteristics, with a rough surface. A grade III infiltration presented 3 of those characteristics. A grade I mass was an exophytic lesion with a smooth surface, uniformly colored. A grade II mass presented a smooth surface of a distinct color, and a grade III mass had a rough surface and irregular coloring. We assessed 377 patients with suspicion of neoplasm. Twenty-three percent of the infiltrations were grade I carcinomas, 74% were grade II, and 95% were grade III. Twenty-three percent of masses were grade I, 77% were grade II, and 97% were grade III. The probability of malignancy increased significantly with grade (P< .001) for both types of lesion. In summary, there is a positive correlation between the terms used and the probability of carcinoma. Most grade III lesions were carcinomas, but apparently innocuous grade I lesions could be carcinomas in a significant number of cases.