Epidemiology and trends of gastrointestinal cancer in Iran (2004-2008)

Aim

Gastrointestinal (GI) cancer is among the most common cancers in Iran. The main purpose of this study was to evaluate changes in the time trends of stomach, colon and rectum, and esophageal cancer during the past decade in Iran.

Materials and Methods

In this cross-sectional study, the study population was all cases of GI cancers diagnosed in Iran between 2004 and 2008. Cancer incidence data for the years 2004-2008 were obtained from the cancer registry system of the Ministry of Health. All incidence rates were directly age standardized to the world standard population. Age-Satndardized incidence rate (ASR)per 10⁵ persons was calculated using direct standardization and the world standard population. The crude rate was calculated in this study. Data were analyzed using SPSS (version 17) and Microsoft Office Excel 2007.

Results

During the 2004-2008 period, the ASR and crude rates of GI cancers, including esophagus, stomach, colon and rectum, among males were 5.05, 15.02, and 8.29 and 4.01, 11.81, and 6.4, respectively, and among females were 6.52, 7.055, and 7.75 and 4.40, 4.85, and 5.49, respectively. The most common cancers in women were colon and rectum, and stomach cancer had the highest incidence in males. In this study, most cases of stomach cancer were adenocarcinoma adenocarcinoma (Nos) in both women and men. The most common type of colorectal cancer was adenocarcinoma, which was greater in men than women. The most common type of esophageal cancer was squamous cell carcinoma in both sexes. The north and northwestern regions of Iran have the highest risk of GI cancer.

Conclusion

According to this study, a significant increase was observed in the incidence of cancers in the north and western regions of Iran. Hence, screening and early detection programs are highly recommended in these high-risk areas.

Measuring the societal burden of cancer: a case of lost productivity in Nepal

OBJECTIVES

The global patterns of cancer incidences and mortality rates are slowly shifting towards low- and middle-income countries. Through our article, we highlight the societal cost associated with premature mortality and morbidity of cancer in Nepal. The monetary loss is indicative of the severity of the issue and it serves to motivate the policymakers realize the urgency in devising appropriate cancer control strategies.

STUDY DESIGN

The study design is a cross-sectional study using the GLOBOCAN 2012 data.

METHODS

Using the human capital approach, we measure the number of years of life lost (YLL) and the number of years of productive life lost (YPLL) due to cancer in Nepal.

RESULTS

We found that following diagnosis, a Nepali patient with cancer is likely to lose out on 19.64 years of their life; the average number of YLL is higher for females (22.2 years vs 16.8 years in males). After adjusting for labor force participation rate and predicted growth rate of the economy, we found that cancer led to a total productivity loss of $149 million (males) and $121 million (females) in 2012. The burden of the top five cancers accounted for almost half of the total productivity loss in both the genders. Cervical and lung cancer incur the maximum cost to society, respectively, for females and males.

CONCLUSIONS

The article highlighted the severity of the cancer issue and emphasized the urgency needed in devising cancer control policies in Nepal.

Burden of cancer in Poland analysed using potential years of life lost

Aim of the study

The aim was to assess the impact of the most frequent cancer-related causes of death in Poland by estimating the years of potential life lost (YPLL) and to compare different measures of the burden of cancer deaths on the population.

Material and methods

Mortality rate, YPLL and mean YPLL were calculated for the 11 most frequently recorded cancer-related causes of death in Poland. YPLL were measured applying the up-to-date reference life tables proposed by the Institute for Health Metrics and Evaluation and used in the Global Burden of Disease study (GBD 2015). Absolute numbers of cancer deaths by site, gender and five-year age groups were obtained from the Polish National Cancer Registry (2015).

Results

In 2015 the total YPLL amounted to 1,990,457, with 23.6% from lung and bronchial cancer. Mean YPLL was 19.79 years and varied considerably according to tumour site (26.12 [brain] – 14.3 [prostate]). Three tumour sites (brain, ovarian and kidney) are positioned higher according to mean YPLL than according to YPLL percentage and mortality percentage.

Conclusions

Our results draw attention to the impact of cancer on society and individual patients. Addressing research efforts to prevention and/or treatment of major YPLL causes could result in a substantial impact on general life expectancy.

Estimating Years of Life Lost Due to Cardiovascular Disease in Japan

BACKGROUND

In Japan, the burden associated with myocardial infarction (MI) and ischemic stroke as well as atherosclerotic cardiovascular disease (ASCVD) generally is high. One key element in measuring disease burden is years of life lost (YLL). The aim of this study was to understand the burden of these diseases by estimating YLL at an overall disease level and average person-YLL (PYLL), a measure of disease burden also used in prior studies. Methods and Results: Because calculation of YLL and PYLL involves inputs such as disease prevalence, disease-related mortality by age, and general population mortality by age and sex, we searched public databases of disease surveillance to identify comprehensive Japanese-specific inputs. For our reference analysis, disease-specific prevalence and mortality were taken from the Institute for Health Metrics and Evaluation Global Disease Burden study, and background mortality data were from the Japanese life tables published by the Ministry of Health, Labour and Welfare. The average age of patients with MI or stroke was 74 and 70 years, respectively. On average, men comprised 59% and 54% of the MI and stroke population, respectively. The disease-level burden of ASCVD (inclusive of MI, stroke, and peripheral artery disease) was 2,703,711 YLL in 2017. The patient-level burden was 11.99 PYLL for MI and 9.39 PYLL for stroke.

CONCLUSIONS

The burden of ASCVD, MI, and stroke in terms of premature mortality is substantial in Japan, both on a population disease level and an individual patient level.

The Burden of Premature Mortality Related to Suicide in West Azerbaijan From 2014 to 2016

Background: Examining the premature death rate represents the first step in estimating the overall burden of disease, reflecting a full picture of how different causes affect population health and providing a way of monitoring and evaluating population health. Aims: This study was conducted to assess the burden of premature mortality from suicides in West Azerbaijan Province, northwest of Iran from 2014 to 2016. Method: To calculate years of potential life lost (YPLL), we categorized all methods of suicide, then we subtracted actual age at death by suicide from the relevant age-based life table produced by the World Health Organization in 2015, after which we added the results for each type of suicide in a particular year. Results: We analyzed 638 suicides. Overall, during the 3-year study period for both sexes, the greatest sources of premature death among all methods of suicide were: hanging, strangulation, and suffocation (X70); smoke, fire, and flames (X76); and poisoning by narcotics and psychodysleptics (X62). Limitations: Limitations of the study include a lack of accurate, systematic recording and reporting of all cases of suicide, which might lead to measurement bias. Conclusion: This study identified and highlighted the most common methods of suicide in West Azerbaijan.

Sex and Racial/Ethnic Differences in Premature Mortality Due to HIV: Florida, 2000-2009

OBJECTIVE

This study aimed to characterize premature mortality among people diagnosed with HIV infection from 2000 to 2009 in Florida, by sex and race/ethnicity, to estimate differences in premature mortality that could be prevented by linkage to HIV care and treatment.

METHODS

Florida surveillance data for HIV diagnoses (excluding concurrent AIDS diagnoses) were linked with vital records data to ascertain deaths through 2011. Years of potential life lost (YPLL) were obtained from the expected number of remaining years of life at a given age from the U.S. sex-specific period life tables.

RESULTS

Among 41,565 people diagnosed with HIV infection during the study period, 5,249 died, and 2,563 (48.8%) deaths were due to HIV/AIDS. Age-standardized YPLL (aYPLL) due to HIV/AIDS per 1,000 person-years was significantly higher for females than males (372.6, 95% confidence interval [CI] 349.8, 396.2 vs. 295.2, 95% CI 278.4, 312.5); for non-Hispanic black (NHB) females than non-Hispanic white (NHW) and Hispanic females (388.2, 95% CI 360.7, 416.9; 294.3, 95% CI 239.8, 354.9; and 295.0, 95% CI 242.9, 352.5, respectively); and for NHB males compared with NHW and Hispanic males (378.7, 95% CI 353.7, 404.7; 210.6, 95% CI 174.3, 250.8; and 240.9, 95% CI 204.8, 280.2, respectively). In multilevel modeling controlling for individual factors, NHB race was associated with YPLL due to HIV/AIDS for women (p=0.04) and men (p<0.001).

CONCLUSION

Among people diagnosed with HIV infection, females and NHB people had a disproportionately high premature mortality from HIV/AIDS, suggesting the need for enhanced efforts to improve linkage to and retention in care and medication adherence for these groups.

Excess mortality in severe mental illness: 10-year population-based cohort study in rural Ethiopia

BACKGROUND

Evidence on mortality in severe mental illness (SMI) comes primarily from clinical samples in high-income countries.

AIMS

To describe mortality in people with SMI among a population cohort from a low-income country.

METHOD

We followed-up 919 adults (from 68 378 screened) with SMI over 10 years. Standardised mortality ratios (SMR) and years of life lost (YLL) as a result of premature mortality were calculated.

RESULTS

In total 121 patients (13.2%) died. The overall SMR was twice that of the general population; higher for men and people with schizophrenia. Patients died about three decades prematurely, mainly from infectious causes (49.6%). Suicide, accidents and homicide were also common causes of death.

CONCLUSIONS

Mortality is an important adverse outcome of SMI irrespective of setting. Addressing common natural and unnatural causes of mortality are urgent priorities. Premature death and mortality related to self-harm should be considered in the estimation of the global burden of disease for SMI.

Life expectancy and expected years of life lost to oral cancer in Taiwan: a nation-wide analysis of 22,024 cases followed for 10 years

OBJECTIVES

This analysis examined the life expectancies (LE) and expected years of life lost (EYLL) in relation to oral cancer in Taiwan.

MATERIALS AND METHODS

A semi-parametric extrapolation method was applied to estimate gender, age, histology, subsite, and stage stratified LE, EYLL of 22,024 pathologically verified oral cancer patients retrospectively recruited from the National Cancer Registry of Taiwan during 2002-2009, who were followed up to 2011.

RESULTS

The patients were predominantly male 20,101, (91.3%), and over 80% were less than 65years old. The mean age at diagnosis of males was younger than that of females (52.73years vs. 60.76years). The LE after diagnosis was longer among females than males (15.26years vs. 12.73years), with a smaller loss of the corresponding EYLL (8.88years vs. 14.05years), which prevails after stratification by age and stage. More than half of the oral cancer cases were diagnosed at a later stage, with 2921 cases (13.3%) of stage III and 8488 (38.5%) of stage IV. The five-year overall survival rate of oral cancer for stages I, II, III, and IV were 78.98%, 69.38%, 54.62%, and 36.17%, respectively. The earlier the diagnosis, the longer the life expectancy and the smaller the EYLL.

CONCLUSIONS

We concluded that early detection and early intervention of oral cancer can prolong life expectancy and reduce the years of life lost, indicating the importance of proactive screening and oral hygiene.

Age-specific cancer incidence rates increase through the oldest age groups

BACKGROUND

In the United States, from 2005 to 2009, nearly 8% of all cancers diagnosed and 15% of cancer deaths occurred in individuals aged 85 years and older (85+ age group). With the aging of the U.S. population, an analysis of incidence of cancer in the elderly population may provide information for clinical care and resource allocation.

MATERIALS AND METHODS

Previously reported data were retrieved from the Surveillance Epidemiology and End Results (SEER) 18 Registry for years 2000 to 2010 and Central Brain Tumor Registry of the United States (CBTRUS) for years 2004 to 2008. Cancers included invasive cases only, except for nonmalignant meningiomas, and rates were per 100,000.

RESULTS

The age-specific cancer incidence rate (IR) increases with age until a decrease in the 85+ age group. IR for all cancers combined for this age group was 2,317 per 100,000. Statistically, males had significantly higher IR compared with females (3,194 versus 1,911 [P≤0.0001]). Blacks had an IR similar to whites (2,255 versus 2,340 [P=0.12]). Despite a drop in the overall IR in this oldest age group, IR for certain cancers continued to increase. Among these cancers, gastrointestinal cancers like colorectal, pancreatic and stomach had the highest incidence and mortality rates.

CONCLUSIONS

This study contributes to measuring cancer burden in the oldest old population. In certain cancers, including meningiomas, the IR continues to rise with advancing age. Management of cancer in elderly is challenging and screening persons in the 85+ age group for frailty very thoroughly may help guide decisions of palliative versus aggressive therapies.

Years of life lost as a measure of cancer burden on a national level

Background:

The severity of cancers is often measured in number of deaths. However, number of years of life lost (YLL) may be a more appropriate indicator of impact on society. Here we have calculated the YLL of adult cancers in Norway for the year 2012, as well as for the previous 15-year period.

Methods:

Data on age composition, expected remaining years of life, total numbers of deaths and deaths due to cancer were retrieved from the National Census Agency Statistics Norway. YLL were calculated for both sexes aged 25–99 years based on each individual's age at death, and the expected remaining years of life at that age.

Results:

Cancer deaths represented 25.8% of all adult deaths in 2012, with a lower fraction of females (28.7% in men and 23.1% in women), whereas cancer represented 35.2% of all YLL, with a higher fraction of females (32.8% in men and 37.8% in women). Females loose on average more life years to cancer than men (14.9 vs 12.7 years). Average YLL varied from 23.7 (cervical cancer) to 7.9 (prostate cancer). Lung cancer caused almost as many YLL alone (22.1% of cancer-caused YLL) as colon, prostate and breast cancer combined (23.1%). From 1997 to 2012, cancer-caused YLL as a fraction of all YLL increased from 32.5% to 35.2%, but with major differences among diagnoses.

Conclusions:

Cancer is a major and increasing cause of premature deaths, and YLL may be a more accurate measure than number of deaths. Public health efforts and research funding should be explicitly directed at preventing premature deaths.

Diseases attributable to asbestos exposure: years of potential life lost, United States, 1999-2010

BACKGROUND

Although asbestos use has been restricted in recent decades, asbestos-associated deaths continue to occur in the United States.

OBJECTIVES

We evaluated premature mortality and loss of potentially productive years of life attributable to asbestos-associated diseases.

METHODS

Using 1999-2010 National Center for Health Statistics mortality data, we identified decedents aged ≥25 years whose death certificate listed asbestosis and malignant mesothelioma as the underlying cause of death. We computed years of potential life lost to life expectancy (YPLL) and to age 65 (YPLL65 ).

RESULTS

During 1999-2010, a total of 427,005 YPLL and 55,184 YPLL65 were attributed to asbestosis (56,907 YPLL and 2,167 YPLL65 ), malignant mesothelioma (370,098 YPPL and 53,017 YPLL65 ). Overall and disease-specific asbestos-attributable total YPLL and YPLL65 and median YPLL and YPLL65 per decedent did not change significantly from 1999 to 2010.

CONCLUSIONS

The continuing occurrence of asbestos-associated diseases and their substantial premature mortality burden underscore the need for maintaining prevention efforts and for ongoing surveillance to monitor temporal trends in these diseases.

Expected years of life lost for six potentially preventable cancers in the United States

OBJECTIVE

This study aimed to quantify the reduced life expectancy for six types of potentially preventable cancer in the United States.

METHODS

A total of 1,579,310 patients diagnosed with cancers of the lung, colon and rectum, liver, breast, cervix, or prostate in 1992-2005 were identified from the Surveillance, Epidemiology, and End Results registries. The lifetime survival functions for the cancer cohort and age-/sex-matched reference population were generated using a semi-parametric extrapolation method with annual life tables. The average expected years of life lost (EYLL) for cancers were calculated by subtracting the estimated life expectancy of the cancer cohorts from that of the reference population.

RESULTS

Liver cancer and lung cancer had an average EYLL of over 13 years, while the EYLL for prostate cancer was below 2 years. When considering the annual incidence in 2012, lung cancer would cause the greatest subtotal of EYLL (3,116,000 years) followed by female breast cancer (1,420,000 years) and colorectal cancer (932,000 years).

CONCLUSION

The potential life years saved by successful prevention, in terms of EYLL since diagnosis, would be substantial for lung cancer, breast cancer, and colorectal cancer. This work will inform prioritization of strategies for cancer control to minimize the life expectancy loss.

Efficacy of bevacizumab with cisplatin and gemcitabine in Asian patients with advanced or recurrent non-squamous non-small cell lung cancer who have not received prior chemotherapy: a substudy of the Avastin in Lung trial

AIM

The phase III AVAiL study evaluated the efficacy and safety of the anti-vascular epidermal growth factor agent bevacizumab combined with platinum-based chemotherapy as first-line treatment in patients with advanced non-small-cell lung cancer (NSCLC). We report the results of a preplanned analysis of Asian patients enrolled in AVAiL.

METHODS

Patients with recurrent or advanced non-squamous NSCLC were randomized to receive bevacizumab 7.5 mg/kg, bevacizumab 15 mg/kg or placebo, plus cisplatin 80 mg/m(2) and gemcitabine 1250 mg/m(2) for up to six cycles, followed by bevacizumab or placebo until disease progression. An exploratory analysis was undertaken to assess efficacy and safety in an Asian subgroup.

RESULTS

Of the 1043 patients enrolled, 105 were Asian and were included in the subgroup analysis. Progression-free survival was 8.5 months (95% CI 7.3-10.8) in the bevacizumab 15-mg/kg group, 8.2 (95% CI 6.6-11.7) in the 7.5-mg/kg group and 6.1 (95% CI 5.1-8.0) in the placebo group. Median overall survival in the 7.5-mg/kg bevacizumab group was prolonged compared with placebo group (HR 0.46; 95% CI 0.22-0.97). Nausea was the most common adverse event, occurring at similar rates (ranging from 69-76%) in all study groups. Hypertension was the most common adverse event of special interest, seen in 29, 55 and 16% of patients in the 7.5-mg/kg and 15-mg/kg bevacizumab and placebo groups, respectively.

CONCLUSION

Study results strongly suggest that bevacizumab at a dose of 7.5 mg/kg improves the duration of overall survival when combined with cisplatin-gemcitabine in Asian patients. Bevacizumab was well tolerated in this patient group.

Premature mortality due to cancer in Japan, 1995 and 2005

To better understand premature mortality due to cancer, we estimated years of life lost (YLL) and average years of life lost (AYLL) due to cancer for the years 1995 and 2005, based on data from the Vital Statistic of Japan. In men, we identified a total of 159,623 cancer deaths in 1995 and 196,603 in 2005. Total YLL were 2,342,560.4 and 2,724,066.0 years, respectively. Averaged for all cancers, people died 14.7 years earlier than life expectancy in 1995 and 13.9 years in 2005. AYLL was longest for brain cancer deaths, at 26.3 years earlier than expected in 1995 and 22.8 years in 2005, followed by leukemia. In women, a total of 103,399 cancer deaths occurred in 1995 and 129,338 in 2005. Total YLL were 1,818,960.4 years in 1995 and 2,160,706.5 years in 2005, corresponding to AYLL for all cancer combined of 17.6 and 16.7 years. The AYLL of brain cancer deaths was also the longest, at 29.4 years in 1995 and 27.8 in 2005, followed by leukemia and female sex-related cancers. Results showed that cancer of the stomach, colorectum, liver and lung were the most frequent cancers in both sexes in both 1995 and 2005 and responsible for a remarkable number of YLL. Further, AYLL was greatest for brain cancer and leukemia in both sexes and for sex-related cancers in women, namely breast, cervix and ovarian cancer.

Serbia within the European context: An analysis of premature mortality

Background

Based on the global predictions majority of deaths will be collectively caused by cancer, cardiovascular diseases, and traffic accidents over the coming 25 years. In planning future national health policy actions, inter – regional assessments play an important role. The purpose of the study was to analyze similarities and differences in premature mortality between Serbia, EURO A, EURO B, and EURO C regions in 2000.

Methods

Mortality and premature mortality patterns were analysed according to cause of death, by gender and seven age intervals. The study results are presented in relative (%) and absolute terms (age-specific and age-standardized death rates per 100,000 population, and age-standardized rates of years of life lost – YLL per 1,000). Direct standardization of rates was undertaken using the standard population of Europe. The inter-regional comparison was based on a calculation of differences in YLL structures and with a ratio of age-standardized YLL rates per 1,000. A multivariate generalized linear model was used to explore mortality of Serbia and Europe sub-regions with ln age-specific death rates. The dissimilarity was achieved with a p ≤ 0.05.

Results

According to the mortality pattern, Serbia was similar to EURO B, but with a lower average YLL per death case. YLL patterns indicated similarities between Serbia and EURO A, while SRR YLL had similarities between Serbia and EURO B. Compared to all Europe sub-regions, Serbia had a major excess of premature mortality in neoplasms and diabetes mellitus. Serbia had lost more years of life than EURO A due to cardiovascular, genitourinary diseases, and intentional injuries. Yet, Serbia was not as burdened with communicable diseases and injuries as were EURO B and EURO C.

Conclusion

With a premature mortality pattern, Serbia is placed in the middle position of the Europe triangle. The main excess of YLL in Serbia was due to cardiovascular, malignant diseases, and diabetes mellitus. The results may be used for assessment of unacceptable social risks resulting from health inequalities. Within intentions to reduce an unfavourable premature mortality gap, it is necessary to reconsider certain local polices and practices as well as financial and human resources incorporated in the prevention of disease and injury burden.