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.

Recent trends in incidence, mortality and survival after cancer of the female breast and reproductive organs. Umbria, Italy: 1978-2005

This study analyzed the incidence, mortality and survival after cancer of the female breast and reproductive organs in the Umbria region of Italy with the aim of generating hypotheses to explain trends. Mortality data were supplied by ISTAT (1978-1993) and ReNCaM (1994-2005) and incidence (1994-2005) and survival (at 12/31/2007) data by RTUP. Joinpoint regression was applied to evaluate temporal trends of the age-adjusted incidence and mortality rates. Mortality, incidence and relative survival rates were compared with national and international data. The incidence of breast cancer increased up to 2001 and afterwards significantly decreased; mortality rates significantly decreased after 1994. Uterine corpus incidence was practically stable, and decreased over the study period; mortality from all uterine subsites significantly decreased from 1978 onwards. Trends in ovarian cancer incidence and mortality (after 1985) were constant. Trends in occurrence of breast and cervical cancer were linked to population screening of Umbrian women, noting a low compliance by younger females with cervical cancer screening and emphasizing the opportunity of starting breast cancer screening at a younger age. Trends in the incidence of cancer of the uterus and ovary, though unsteady, were probably related to modifications in risk factor exposure. Survival was better for breast and cervical cancers than in the 1978-1982 period and might be due to early diagnosis and progress in therapy.

Incidence of multiple primary malignancies in women diagnosed with breast cancer

Using data from the Umbrian Population Cancer Registry (RTUP) we tested the hypothesis of relationships between several subsequent cancer sites in women who had had breast cancer. New patients (7,840) were collected from the RTUP between 01/01/1994 and 31/12/2006; 24 DCO cases were excluded; 332 successive multiple cancers in 320 patients were recorded. Including all second cancers, metachronous contralateral breast cancer, the observed/expected ratio (SIR) was non-significant. Excluding these cases, SIR was significantly lower whether with or without second skin carcinomas. SIR of all second metachronous contralateral cancers, excluding skin carcinomas, was non-significant. Significantly lower risk involved the colorectum, stomach, pancreas and metachronous breast with different histology. A significant excess was found of melanoma and total second breast cancers, including the contralateral. The excessive skin melanoma in breast cancer survivors was attributed to the relationship with BRCA2 and CDKN2A mutation-positive patients. The excess risk due to the CDKN2A mutation should also include pancreatic cancer which, in the present study, presented a significantly lower risk.

Urban-rural differences in gynaecological cancer occurrence in a central region of Italy: 1978-1982 and 1998-2002

Differences in gynaecological cancer incidence and mortality in the urban and rural areas of the Umbria region (central Italy) were investigated. All women with primary invasive breast cancers, uterine cervix and uterine corpus, and ovarian cancers diagnosed during the periods 1978-1982 and 1998-2002 were identified and analysed according to place of residence (either urban or rural). Mortality data were supplied by the National Institute of Statistics (ISTAT) for the period 1978 to 1982, whereas for the 1994-2002 period they were supplied by the Regional Nominative Causes of Death Registry (ReNCaM). Incident cases considered were taken from an ad hoc survey for the first period and from the Umbrian Population Cancer Registry database for the second one. For each site the age-adjusted incidence (AAIR) and mortality (AADR) rates were calculated. The expected number of rural cases was obtained from indirect standardisation with urban incidence and mortality rates of several sites. The significance of the observed expected ratios (SIRs for incidence and SMRs for mortality) and the corresponding 95% confidence intervals were based on the Poisson distribution. Urbanisation levels were established following the classification of the Italian Institute of Statistics. For all sites, excluding the ovary during the most recent period, the SIR relative to rural areas was below 1, but the rates were statistically significant only for breast cancer in both periods (SIR 0.81, 95% CI 0.74-0.88 and SIR 0.82, 95% CI 0.77-0.88, respectively) and for cervix uteri in the first period (SIR 0.77, 95% CI 0.59-0.94). The lower breast cancer incidence in the rural area could also be due to lesser compliance with screening procedures which, up until 2002, were not provided in the form of mass-screenings throughout the region by the Regional Health Department. These results underscore the need for continued efforts to provide preventive health services to medically underserved women throughout Umbria, including rural communities. Underutilisation of preventive healthcare services may result in failure to identify healthcare problems that might be successfully managed with medication or lifestyle changes, as well as missed opportunities to prevent potentially life-threatening diseases.

Epidemiological overview on the effectiveness of mass screening for female cancer in Umbria, Italy

Using incidence, survival and mortality we tried to verify the effectiveness of mass-screening interventions for cervical uterine, breast, and colorectal cancer in females. Mortality data concern the period from 1978-2002. Incident cases derived from an ad hoc survey for 1978-1982 data and from the RTUP from 01/01/1994 to 31/12/2002. Relative survival rates were calculated for 1978-1982, 1994-1997 and 1998-2002 time intervals. All standardized mortality figures showed a steady trend. Incidence rates concerning cervical uterine cancer showed a decrease starting from the 1978-1982 period, whereas those for breast cancer had a constant increasing trend, and those for colorectal cancer increased up to 1997-1999 and later remained constant. For breast cancer the 5-year survival rate increased about 15% compared to the first period, for colon cancer there was less of an increase and the increase for cervical uterine cancer survival was only for the 1998-2002 period compared to the former ones. With constant incidence rates, improvement in survival from cervical uterine cancer may be due to a high number of cancer cases detected at an early stage. The effect of breast cancer screening on incidence is evident, though differences still did not influence mortality and survival. Colorectal cancer epidemiology can be considered as a prescreening pattern. Mortality, incidence and survival data allow a good overview for the effectiveness of screening procedures.

[Decrease of frequency of male lung cancer in Umbria region. 1978-1982 and 1994-1999]

In Umbria, region of Central Italy, lung cancer is the leading cause of death due to cancer in males. The aim of this work is to highlight decrease of mortality from lung cancer in males in Umbria, in the last 20 years and to describe relationship among incidence, mortality and survival of this cancer. The incidence data derived from an ad hoc survey carried out over the period 1978-1982 and for 1994-1999 from the Umbrian Population Cancer Registry (RTUP). The mortality data were derived from official publications of the Italian Central Institute for Statistics (ISTAT) and covered the entire period 1978-1999. Estimated annual percent change (EAPC) was calculated by joinpoint regression analysis. Decrease of mortality from male lung cancer in Umbria began in the 1990-ies due to reduced quantity of tar in cigarettes, decreasing consumption of tobacco and increasing of survival derived from the quality and the effectiveness of the oncological health care system.

[Survival of men with upper aerodigestive cancer in Umbria, Italy. 1978-82 and 1994-98]

The aim of this study is to analyze the upper aerodigestive cancer survival in Umbria, a central Italian region, in the periods 1978-82 and 1994-98. The cases' data diagnosed in the period 1978-82 were derived from an ad hoc survey carried out in Umbria and for the years 1994-98 from Umbria Population-based Registry (RTUP). In the period 1994-98 the relative survival has lightly improved compared with the previous one. Comparison among five year relative standardized survival for head and neck, oesophagus and larynx, in Umbria region and in the other Italian registries, shows a quite high survival that could be further improved with an early diagnosis and, consequently, less destroying treatments.

[Trends of colorectal cancer incidence, mortality and survival in the Umbria, region of Italy. 1978-82 and 1994-99]

The aim of the study is to show the colorectal cancer trend in Umbria, a central Italian region, from 1978 to 1999. Data concerning regional incidence, mortality and survival derived from an ad hoc survey carried out in Umbria in the period 1978-1982 and from Umbria Population-based Registry (RTUP) for the years 1994-1999. The incidence of colorectal cancer increases in both sexes, expecially for the age class > 75 years. Mortality rises slightly, without no difference between sexes. Survival of patients with colorectal cancer has improved in the two sexes from 45 to 74 years-age, while the lower survival has registered for age between 75 and 84 years. We concluded that the situation in Umbria is quiet good, but it is affected by aging of Umbrian population. Delaying in diagnosis or inefficacy in therapy can explain shorter survival in older patients.