Global survival trends for brain tumors, by histology: analysis of individual records for 556,237 adults diagnosed in 59 countries during 2000-2014 (CONCORD-3)

BACKGROUND

Survival is a key metric of the effectiveness of a health system in managing cancer. We set out to provide a comprehensive examination of worldwide variation and trends in survival from brain tumors in adults, by histology.

METHODS

We analyzed individual data for adults (15-99 years) diagnosed with a brain tumor (ICD-O-3 topography code C71) during 2000-2014, regardless of tumor behavior. Data underwent a 3-phase quality control as part of CONCORD-3. We estimated net survival for 11 histology groups, using the unbiased nonparametric Pohar Perme estimator.

RESULTS

The study included 556,237 adults. In 2010-2014, the global range in age-standardized 5-year net survival for the most common sub-types was broad: in the range 20%-38% for diffuse and anaplastic astrocytoma, from 4% to 17% for glioblastoma, and between 32% and 69% for oligodendroglioma. For patients with glioblastoma, the largest gains in survival occurred between 2000-2004 and 2005-2009. These improvements were more noticeable among adults diagnosed aged 40-70 years than among younger adults.

CONCLUSIONS

To the best of our knowledge, this study provides the largest account to date of global trends in population-based survival for brain tumors by histology in adults. We have highlighted remarkable gains in 5-year survival from glioblastoma since 2005, providing large-scale empirical evidence on the uptake of chemoradiation at population level. Worldwide, survival improvements have been extensive, but some countries still lag behind. Our findings may help clinicians involved in national and international tumor pathway boards to promote initiatives aimed at more extensive implementation of clinical guidelines.

Funnel plots and choropleth maps in cancer risk communication: a Delphi study

BACKGROUND

In the last decades, the issues related to health risk communication to stakeholders and citizens involving health care practitioners and local political authorities have been increasingly debated. The study evaluated an alternative strategy to communicate cancer risk to local communities, involving an expert panel of public health operators in comparing two different graphic tools, Funnel Plot and Choropleth map.

STUDY DESIGN

A Delphi method process was implemented to achieve a unified consensus on an expert panel of public health operators with regard to weaknesses and strengths of the Funnel Plot and the Choropleth map as tools for cancer risk communication to local communities and other stakeholders.

METHODS

Participants were asked to score the efficacy of the two tools using a scale. Six properties were explored through two consecutive consensus rounds. Scales were used to calculate frequencies and the content validity ratio for each domain within the consensus rounds.

RESULTS

After the two consecutive rounds, participants expressed their preference in favour of the Choropleth map for its ability to define the spatial location of the risk and to locate any potential cluster, while reaching a consensus with regard to the Funnel Plot properties to identify hot spots, displaying the scope of the phenomenon under investigation, and to show the precision of estimates and communicating the significance of estimates.

CONCLUSIONS

The Delphi process allowed us to conclude that Funnel Plot could be used as a complement to the current and commonly used graphical and visual formats to effectively communicate cancer epidemiological data to communities and local authorities, representing a useful tool for empowering the general population.

Long-term survival, prevalence, and cure of cancer: a population-based estimation for 818 902 Italian patients and 26 cancer types

Original, population-based estimates of indicators of long-term survival and cure in cancer patients are provided. More than a quarter of cancer patients in Italy have reached death rates similar to those of the general population. Nearly three quarters of them will not die as a result of cancer. These estimates are potentially helpful to health-care planners, clinicians, and patients.

Background

Persons living after a cancer diagnosis represent 4% of the whole population in high-income countries. The aim of the study was to provide estimates of indicators of long-term survival and cure for 26 cancer types, presently lacking.

Patients and methods

Data on 818 902 Italian cancer patients diagnosed at age 15–74 years in 1985–2005 were included. Proportions of patients with the same death rates of the general population (cure fractions) and those of prevalent patients who were not at risk of dying as a result of cancer (cure prevalence) were calculated, using validated mixture cure models, by cancer type, sex, and age group. We also estimated complete prevalence, conditional relative survival (CRS), time to reach 5- and 10-year CRS >95%, and proportion of patients living longer than those thresholds.

Results

The cure fractions ranged from >90% for patients aged <45 years with thyroid and testis cancers to <10% for liver and pancreatic cancers of all ages. Five- or 10-year CRS >95% were both reached in <10 years by patients with cancers of the stomach, colon–rectum, pancreas, corpus and cervix uteri, brain, and Hodgkin lymphoma. For breast cancer patients, 5- and 10-year CRSs reached >95% after 19 and 25 years, respectively, and in 15 and 18 years for prostate cancer patients. Five-year CRS remained <95% for >25 years after cancer diagnosis in patients with liver and larynx cancers, non-Hodgkin lymphoma, myeloma, and leukaemia. Overall, the cure prevalence was 67% for men and 77% for women. Therefore, 21% of male and 31% of female patients had already reached 5-year CRS >95%, whereas 18% and 25% had reached 10-year CRS >95%.

Conclusions

A quarter of Italian cancer patients can be considered cured. This observation has a high potential impact on health planning, clinical practice, and patients' perspective.

A proposal for an evidence-based model of the screening for the colorectal carcinoma in an Italian setting

INTRODUCTION

The aim of this paper is to improve the feasibility perception of policymakers, health care workers and target population about the cost-effectiveness of the implementation of colorectal screening as Public Health strategy.

METHODS

Retrospective study by application of a three-step model designed for a local setting in Sicily (Palermo and its Province) in order to distribute Fecal Occult Blood Tests (FOBTs), offer colonoscopy and surgery, by district allocation of pharmacies, public digestive endoscopic centres and oncologic and general surgery units. Mean adherence to consolidated colorectal screening programs in Italy was applied in order to evaluate the feasibility of an operative model in our area.

RESULTS

Applying the model to the target population (269,368 individuals of both sexes), it can be expected a mean percentage of 79% delivered invitation and a mean participation rate of 46.3% accounting for a total of 213,070 invited individuals and 98,651 participating in the first round of the program. Furthermore, considering the national mean of 6% positive FOBT, 82% of colonscopy adhesion and 7% CRC detection rate, it can be scheduled a burden for health care structures involved in the program accounting for 49,325 FOBTs, 2,338 colonscopies and 141 surgeries for each year.

DISCUSSION

This work demonstrates the feasibility of a colorectal screening project in our area, showing a sustainable impact for local health care involved structures. Furthermore, this program may be spread as an applicative model to other areas, adapting the project to the needs of the local setting in which the colorectal screening will be organized.

Breast cancer registry in Palermo and its Province: incidence in 1999

The incidence of breast cancer in the city of Palermo and its Province was investigated. The cancer rate was higher in the city of Palermo (100.8/100,000/year), a great southern urban area, than in the 81 municipalities of the Province (79.2/100,000/year). Rates were also compared with those in other geographic areas of Italy, showing a smaller than expected negative north-south gradient in incidence, especially in the young age group, as shown by the cumulative risk observed in the 0-54-year-old group. These findings confirm the role of recent life style changes in the cancer risk distribution.

The Mediet Project

Preliminary evidence from a case control study of healthy postmenopausal women living in Palermo, Sicily, is presented to investigate the potential impact of a traditional Mediterranean diet on the risk of developing breast cancer. Of the 230 women who fulfilled specific eligibility criteria, 115 were enrolled in the study based on serum testosterone values equal to or greater than the median population value (0.14 microg/ml). Women were then individually randomized into a diet intervention (n = 58) and a control (n = 55) group. Women in the intervention group attended a weekly "cooking course" for 1 year, being trained by professional chefs in the correct use of the natural ingredients of the traditional Mediterranean diet, including whole cereals, legumes, seeds, fish, cruciferous vegetables, and many others. The intervention group was subsequently instructed to follow the learned diet at home, while the control group was only advised to increase the consumption of fruits and vegetables, as recommended by WHO. The following measures were taken at the beginning, middle, and end of the study: (a) fasting blood and 12-hour urine samples to assay defined hormonal endpoints; (b) height, weight, and circumference of the waist and hip; and (c) a food frequency and computerized 24-hour dietary recall questionnaire. After 1 year, both the control and the intervention groups showed satisfactory compliance rates (81 and 85%, respectively). In addition, preliminary results so far obtained reveal an unequivocal trend towards weight loss, a strong reduction in cholesterol levels, and a psychophysical feeling of well-being by women adopting the Mediterranean diet. The study is currently ongoing to verify the association of changes in serum and urine hormone levels and breast cancer risk in the intervention group.

Soluble and nuclear type I and II androgen-binding sites in benign hyperplasia and cancer of the human prostate

This paper presents an approach for the assessment of the androgen receptor (AR) status in benign prostatic hyperplasia (BPH) and prostate cancer (PCa) tissues. Evaluation of AR was carried out in both soluble and nuclear fractions by a standard competition method, using tritiated mibolerone as radioligand. Based on our experience with breast and endometrial cancer, this approach focused on both type I (high affinity, low capacity) and type II (reduced affinity, higher capacity) binding sites, aiming mainly at establishing a putative "functional" receptor mechanism, i.e., the presence of type I AR in both cytosol and nucleus. Ancillary studies were carried out to exclude a potential overestimation of the AR content by interference with other steroid receptors, namely, progesterone (PgR) or glucocorticoid (GcR) receptors. Results showed that the interaction by PgR or GcR upon AR measurement was not relevant. The distribution of AR, namely the percent of positivity either in a single or in both cell compartments, was not significantly different in BPH (N = 32) or PCa (N = 24) tissues. For type I binding, the percent of positivity in both soluble and nuclear fractions (i.e., the "functional" AR status) was very close to that observed for other endocrine-related tumors, like breast cancer. Concentrations of type I AR appeared significantly higher in PCa than in BPH tissues; this was true for both soluble and nuclear fractions. In contrast, no significant difference was found in type II AR concentrations in either cell fraction.(ABSTRACT TRUNCATED AT 250 WORDS)

[Quantitative determination of urine bacteria in the diagnosis of urinary tract infections in children]

Bacteria counts in fresh, unstained, uncentrifuged urine specimens, using a phase-contrast microscope, magnification X 400, and a hemocytometer chamber, proved to be a very useful method not only of excluding (specificity 0.92) but also identifying urinary tract infection (sensitivity 0.90) in children. The presence of greater than 5/0.1 ml bacteria in the urine was taken as the threshold value. The evaluation of leukocyturia alone did not alter the sensitivity of the method, even when it was associated with bacteriuria. When Proteus was isolated from urine cultures, the bacteria count proved negative in 60% of cases; otherwise when different bacteria were isolated in urine cultures, they were then identified during the bacteria count. The method is simple, inexpensive and rapid (it requires only a few minutes) and it may be used in a pediatric outpatient or hospital setting.

Risk factors of female cancers in Ragusa population (Sicily). 2. Breast cancer

A case-control study on breast, cervix and corpus uteri cancer cases registered in Ragusa between January 1, 1983 and June 30, 1985 has been conducted. Information on risk factors has been obtained by means of a structured questionnaire. Risk factors for breast cancer were: few pregnancies (1-2 vs greater than 4 OR 2.14, 95% CL 1.13-4.04), few children (for postmenopausal only, chi trend 4.84), previous breast disease (OR 1.97, 95% CL 1.20-3.23), family history (OR 3.57, 95% CL 1.92-6.63), alcohol (OR 1.68, 95% CL 1.12-2.53), high socioeconomical status (1 vs 4 OR 2.93, 95% CL 1.22-70.03). A protective role was evident for: early age at first birth (for premenopausal only, less than 20 vs greater than 20 OR 0.11, 95% CL 0.01-0.90), previous ovary disease (OR 0.26, 95% CL 0.08-0.88). Age at menarche, age at menopause, years of fertile life and breast feeding were not found to be related to breast cancer. A different distribution of risk factors among cases with and without family history has been suggested. A synoptic table shows the distribution of the most important risk factors of the three investigated female cancers in the Ragusa population, reported in the present and in an accompanying paper.

Risk factors of female cancers in Ragusa population (Sicily)--1. Endometrium and cervix uteri cancers

A case-control study on breast, cervix and endometrium cancer cases registered in Ragusa between January 1, 1983 and June 30, 1985 has been conducted. Information on risk factors has been obtained by means of a structured questionnaire. Risk factors for endometrium cancer were: few children (1-2 vs greater than 4 OR 15.18, 95%CL 1.96-117.64), oestrogenic treatment (OR 2.20, 95%CL 1.05-4.90), obesity (Quetelet index greater than 30 vs less than 22 OR 10.42, 95%CL 1.30-83.86), family history (OR 2.87, 95% CL 1.05-7.83). Risk factors for cervix uteri cancer were: multiple abortions (greater than 2 vs 0 OR 9.87, 95%CL 1.46-66.66), no contraception (OR 8.33, 95%CL 2.38-25.00), younger age of mother at birth (OR 6.89, 95%CL 1.71-27.70). Age at menarche, age at menopause and years of fertile life were not found to be related to either endometrium or cervix uteri cancer. The existence of influencing differences (ancestry, environment, lifestyle) has been postulated.

A case-control study on breast cancer risk factors in a southern European population

A case-control study has been carried out among women attending a screening service in Palermo (Sicily) from 1974 through 1983 to ascertain the distribution of the most frequently investigated risk factors for breast cancer in a southern European population. Information has been obtained from the archives of the screening service. The analysis was separately conducted for pre- and post-menopausal cases and non-cases. Risk factors for pre-menopausal women are: nulliparity (nulliparous versus parous: OR 2.17, 95% CI 1.41-3.32); age at first birth (25-29 versus less than 20: OR 2.16, 95% CI 1.17-4.00); interval between menarche and first birth (greater than 20 years versus less than 6: OR 5.34, 95% CI 2.08-13.66); number of births (greater than 4 versus 1-2: OR 1.98, 95% CI 1.10-3.50). Risk factors for post-menopausal women are: nulliparity (nulliparous versus parous: OR 2.18, 95% CI 1.59-2.99); age at first birth (greater than 29 versus less than 20: OR 1.84, 95% CI 1.13-2.99); interval between menarche and first birth (16-20 years versus less than 6: OR 2.15, 95% CI 1.20-3.85). Age at menarche, age at menopause, breast feeding and family history were not found to be risk factors for breast cancer in the investigated population. The existence of influencing differences between northern and southern populations has been postulated.