Time trends of esophageal cancer mortality in Linzhou city during the period 1988-2010 and a Bayesian approach projection for 2020

Familial Esophageal Cancer in Taihang Mountain, China: An Era of Personalized Medicine Based on Family and Population Perspective

In the Taihang Mountain areas, known as the “esophageal cancer zone” in China, the incidence of esophageal cancer (ESCA) ranks the first in the country and shows a familial and regional clustering trend. Taihang Mountain areas are located in a mountainous area, with inconvenient transportation, limited living conditions, unbalanced diet, and poor nutrition. Ninety percent of the pathological types of ESCA in Taihang Mountain areas are squamous cell carcinoma, among which the risk factors have not been well understood. These areas are usually remote villages and mountains with low population mobility, large family members, similar environmental factors, and a clear and stable genetic background. Therefore, according to the current situation, second-generation sequencing and multigroup analysis technology are used to analyze the familial ESCA patients; disease-related genetic variation are located; and then disease-related susceptibility genes associated with ESCA are screened and analyzed. Health education, tobacco control, endoscopic screening, and other health management projects for suspected and high-risk patients in areas with a high incidence of ESCA can be carried out for screening and early diagnosis, and the incidence of ESCA in Taihang Mountain areas can be reduced. A comprehensive continuous care pattern based on traditional medical nursing to track, monitor, evaluate, and intervene with patients diagnosed with ESCA to facilitate them with medications guidance, dietary guidance, and timely health problem-solving is established. Furthermore, statistical analysis of epidemiology, gene sequencing, and family genetics information can be performed on patients with ESCA in the Taihang Mountains areas to clarify the relationship between genetic phenotype and genotype during the occurrence of ESCA.

Trends in Incidence and Mortality of Esophageal Cancer in Huai'an District, a High-Risk Area in Northern Jiangsu Province, China

Purpose

This study aimed to provide a clear comparable figure of the trends in incidence and mortality rates of esophageal cancer (EC) in Huai’an District, Huai’an City, Jiangsu Province, China, a high-risk area for EC.

Methods

The data for age- and sex-specific incidence rates between 1998 and 2016, the mortality rates in 1990-2016 and the number of EC patients were obtained from Huai’an District Cancer Registry. Crude rates, Age-standardized rates (ASRs) by world standard population and truncated age-standardized rates of EC incidence and mortality were calculated. The joinpoint regression analysis was used to calculate the annual percent changes (APC), average annual percent changes (AAPC), and their 95% confidence intervals (CIs).

Results

Overall, 20,892 new EC cases and 20,806 EC deaths were registered in Huai’an District. ASR of EC incidence from 1998 to 2016 and mortality from 1990 to 2016 were 73.32/100,000 and 60.03/100,000, respectively. The ASR illustrated that the incidence of EC had significant downward trends in total, male and female (AAPC = −4.65, −4.90, and −5.51, respectively, p <.01). The age-specific incidence and mortality rates of EC increased dramatically in people over the age of 40, and peaked in people between the ages 70-74. In the subdivisions of Huai’an District, geographical diversities in the crude incidence and mortality rates of EC were found.

Conclusion

In summary, the incidence and mortality rates of EC showed downward trends in Huai’an District. However, the burden of EC still remained serious in this high-risk area. Cost-effective methods of intervention and health education should be enhanced for improving EC prevention.

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

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

Time Trends of Gastrointestinal Cancers Incidence and Mortality in Yangzhong From 1991 to 2015: An Updated Age-Period-Cohort Analysis

Background: Gastrointestinal (GI) cancers are the common cause of morbidity and mortality in China which seriously threaten people's health and lives. The aim of this study was to describe the temporal trend in the epidemiology of GI cancers from 1991 to 2015, with an emphasis on the effects of age, period and cohort in Yangzhong City, Jiangsu province, a high-risk area of GI cancers in China. Methods: Our study extracted cases of gastric cancer, esophageal cancer and colorectal cancer diagnosed from 1991 to 2015 from Yangzhong Cancer Registry. Age-standardized rates (ASRs) were calculated and joinpoint regression was used to compute the estimated annual percent changes. Age-period-cohort (APC) model was performed to investigate the independent effects of age, calendar period, and birth cohort. Results: Between 1991 and 2015, 18,006 new cases and 10,262 deaths were registered with GI cancers in Yangzhong. The age-standardized incidence rates (ASIRs) of gastric cancer decreased in both sexes during the study period. And the incidence rates of esophageal cancer stabilized at first then continued to decline, the turning point was in 2005 for men and 2001 for women. Changes in the mortality rates of gastric cancer and esophageal cancer showed significant declined trends around 2000-2010 in both genders. The incidence rates of colorectal cancer increased steadily during the entire study period, and the increase was more pronounced in the mortality rates of men. The results of APC analysis suggest that general decreases in incidence and mortality of esophageal cancer and gastric cancer might be caused by the downward trend of the period and cohort effects, while the increases in colorectal cancer might be caused by the uptrend of the period effects. Conclusions: The incidence and mortality rates of esophageal and gastric cancers showed a downward trend and colorectal cancer was on the rise as a whole in Yangzhong City. The different burden of gastrointestinal cancer indicating heterogeneous risk factors exist and may have contributed to these temporal variations.

Inequalities in esophageal cancer mortality in Brazil: Temporal trends and projections

The main objective of the study was to analyze the effect of age, period and birth cohort on esophageal cancer mortality in Brazil and its geographic regions, per sex. An ecological study is presented herein, which evaluated the deaths by esophageal cancer and the distribution, per geographic region. Poisson Regression was utilized to calculate the effects of age, period and birth cohort, and projections were made with the statistical software R, using the age-period-cohort model. Projection of data covered the period 2015–2029. Regarding the geographic regions of Brazil, a decrease was verified, throughout time, for the mortality rates of the South and Southeast regions, for men and women. For the North, Northeast and Midwest regions, an increase was evidenced in mortality rates, mainly for men, after the 2000's. Regarding the projections, a progressive increase of mortality rates was verified for the Northeast and North regions. Divergences evidenced for observed and projected esophageal cancer mortality rates revealed inequalities among the geographic regions of Brazil.

Trends of Esophageal Cancer Mortality in Rural China from 1989 to 2013: An Age-Period-Cohort Analysis

Background: Esophageal cancer is one of the most common cancers in rural China. The aim of this study was to describe the time trends of esophageal cancer mortality in rural China and to better elucidate the causes of these trends. Methods: The mortality data were obtained from the World Health Organization Mortality Database and the China Health Statistical Yearbook Database. The mortality data were analyzed with age-period-cohort (APC) analysis. Results: Our study indicates that the Age-Standardized Mortality Rates (ASMRs) in rural China generally decreased from 1989 to 2003, and thereafter increased until the year 2008 in both sexes. After 2008, the ASMRs decreased again. The results of APC analysis suggest that the general decrease in esophageal cancer mortality in rural China from 1989 to 2003 might be caused by the downtrend of the cohort effects and period effects, while the general increase in mortality from 2004 to 2008 might be caused by the uptrend of the period effects. The decrease in mortality after 2008 may be relevant to the Four Trillion RMB Investment Plan launched by the Chinese Government. Conclusions: The declining cohort effects were probably related to the improvement of socioeconomic status in childhood and the decreasing consumptions of alcohol drinking and smoking, while the trends of the period effects were relevant to the changes in the dietary pattern. Our findings may help predict future changes in esophageal cancer mortality.

Incidence, survival and prevalence of esophageal and gastric cancer in Linzhou city from 2003 to 2009

This study describes recent trends in incidence, survival and prevalence of subgroups of esophageal and gastric cancer in Linzhou city between 2003 and 2009. Data of esophageal and gastric cancer for the period of interest were extracted from the Linzhou Cancer Registry. Using information on tumor morphology or anatomical site, data were divided into six groups; esophageal squamous cell carcinoma, esophageal adenocarcinoma, other and unspecified types of esophageal cancer, and cardia, non-cardia, and unspecified anatomical site of stomach cancer. Incidence, survival and prevalence rates for each of the six cancer groups were calculated. The majority of esophageal cancers were squamous cell carcinomas (82%). Cardiac cancer was the major gastric cancer group (64%). The incidence of esophageal squamous cell carcinoma and gastric cardiac cancer increased between 2003 and 2009. Both esophageal and gastric cancer had a higher incidence in males compared with females. Overall survival was poor in all sub-groups with 1 year survival ranging from 45.9 to 65.6% and 5 year survival ranging from 14.7 to 30.5%. Prevalence of esophageal squamous cell carcinoma and gastric cardiac cancer was high (accounting for 80% overall). An increased focus on prevention and early diagnosis, especially in esophageal squamous cell carcinoma and gastric cardiac cancer, is required.

Model-based survival estimates of female breast cancer data

BACKGROUND

Statistical methods are very important to precisely measure breast cancer patient survival times for healthcare management. Previous studies considered basic statistics to measure survival times without incorporating statistical modeling strategies. The objective of this study was to develop a data-based statistical probability model from the female breast cancer patients' survival times by using the Bayesian approach to predict future inferences of survival times.

MATERIALS AND METHODS

A random sample of 500 female patients was selected from the Surveillance Epidemiology and End Results cancer registry database. For goodness of fit, the standard model building criteria were used. The Bayesian approach is used to obtain the predictive survival times from the data-based Exponentiated Exponential Model. Markov Chain Monte Carlo method was used to obtain the summary results for predictive inference.

RESULTS

The highest number of female breast cancer patients was found in California and the lowest in New Mexico. The majority of them were married. The mean (SD) age at diagnosis (in years) was 60.92 (14.92). The mean (SD) survival time (in months) for female patients was 90.33 (83.10). The Exponentiated Exponential Model found better fits for the female survival times compared to the Exponentiated Weibull Model. The Bayesian method is used to obtain predictive inference for future survival times.

CONCLUSIONS

The findings with the proposed modeling strategy will assist healthcare researchers and providers to precisely predict future survival estimates as the recent growing challenges of analyzing healthcare data have created new demand for model-based survival estimates. The application of Bayesian will produce precise estimates of future survival times.